# Tressler v. Centre County

> District Court, M.D. Pennsylvania · December 5, 2024

URL: https://www.frixlaw.com/law-library/cases/10755589

## Case

- **Court:** District Court, M.D. Pennsylvania
- **Decided:** December 5, 2024
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
JESSICA TRESSLER, : CIVIL NO: 1:24-CV-00456
:
Plaintiff :
: (Magistrate Judge Schwab)
v. :
:
CENTRE COUNTY, et al., :
:
Defendants :

MEMORANDUM OPINION

I. Introduction.
The plaintiff, Jessica Tressler, contends that because she did not receive
appropriate care for her serious medical needs while detained at a county prison,
she was injured and needed heart-valve replacement surgery. She has sued
numerous individuals and entities. Currently before the court is a motion to
dismiss the complaint filed by some of the defendants. For the reasons set forth
below, we will grant in part and deny in part that motion to dismiss. We will also
give Tressler leave to file an amended complaint.

II. Background and Procedural History.
Tressler began this action by filing a complaint on March 15, 2024. See Doc.
1. There are three groups of defendants—the named County defendants, the
named PrimeCare defendants, and the John Doe defendants. The named County
defendants are Centre County, the Centre County Correctional Facility (“CCCF”),

and the following officers and officials of the CCCF: Supervisor Glenn Irwin,
Supervisor Christopher Schell, Counselor Henry Napolean, Corrections Officer
Medford, Corrections Officer Vangorder, Corrections Officer Rupert, and

Corrections Officer Quigley. The named PrimeCare defendants are PrimeCare
Medical, Inc. (“PrimeCare”) and the following medical providers and employees
of PrimeCare: Crystal Reams, Brenda Peters, Cassandra Nichols, Alesha Weaver,
Desiree Sheran, Deanna Brisco, Kelsey Schmidt, Nathan Figart, Stephanie Struble,

Jade Lose, and Rita Camacho. The John Doe defendants are listed as John Doe
Corrections Officers, John Doe Medical Director, and John Doe Medical Provider.
The John Doe defendants have not yet been identified and served. The

named PrimeCare defendants have filed an answer to the complaint. See doc. 12.
And the named County defendants have filed a motion to dismiss the complaint.
See doc. 13.1 Because the motion to dismiss filed by the named County defendants
is what is currently before the court, we summarize the allegations in the complaint

with respect to the named County defendants.

1 All the named parties have consented to proceed before a magistrate judge
pursuant to 28 U.S.C. § 636(c). See doc. 11.
From April 1, 2022, to April 18, 2022, Tressler was an inmate at the CCCF,
where she was held for a violation of probation. Doc. 1 ¶ 15. While at the CCCF,

Tressler was not properly treated for opiate withdrawal and a urinary tract
infection. Id. ¶ 16. The individual defendants labeled her a drug-seeking faker, and
she was denied medical care and refused medication because she could not

ambulate. Id. ¶ 19. Tressler suffered a gastrointestinal bleed, sepsis, and an
electrolyte disturbance complicated by dehydration. Id. ¶ 16. Ultimately, she had
to have heart-valve-replacement surgery. Id. If Tressler had received proper
antibiotic treatment for bacteremic sepsis, she would have avoided valve damage.

Id.
More specifically, Tressler alleges that on April 1, 2022, a PrimeCare
defendant responded to her complaint of severe back pain. Id. ¶ 20a.2 This medical

provider noted that Tressler’s blood pressure was severely elevated and that
Tressler had pain in her left flank area, but she did not provide Tressler with any
medical care. Id. Later that same day, another medical provider came to Tressler’s
cell. Id. ¶ 20b. Tressler begged for help, but this medical provider labeled her (in

2 Tressler provides the name of this medical provider as well as the names of
numerous other medical providers allegedly involved in the events. But we are
currently concerned only with the claims against the named County defendants, not
the named PrimeCare defendants. Thus, although Tressler names the medical
providers, to avoid confusion from so many different names and to highlight when
a County defendant is involved, for present purposes we refer to the medical
providers simply as medical providers rather than by their names.
her chart) as a drug-seeking faker, ignored her complaints, and denied her medical
care. Id. Later still on April 1, 2022, Tressler complained of pain at or near her

kidneys, said she believed she had a kidney infection, and asked for treatment. Id.
¶ 20c. But the medical provider believed Tressler was drug seeking and feigning
pain, and so, she denied Tressler medical care. Id. Two other medical providers

prescribed testing for Tressler, but they did not follow up and did not give Tressler
medical treatment. Id. ¶ 20d.
On April 2, 2022, another medical provider and Corrections Officer
Medford appeared at Tressler’s cell. Id. ¶ 20e. Tressler complained of flank pain,

and the medical provider and Officer Medford observed her urinate and checked
her prescriptions. Id. Tressler was not provided any additional medical care. Id.
Later that day, one of the medical providers from the previous day returned to

Tressler’s cell, discussed Tressler’s pain level, belittled Tessler, and told her that
she would not get any additional medication for pain. Id. ¶ 20f.
On April 3, 2022, Tressler was denied all medical care. Id. ¶ 20g.
On April 4, 2022, a medical provider acknowledged that Tressler had a

urinary tract infection, but she did nothing to follow up and did not provide
Tressler with any additional medical care or monitoring. Id. ¶ 20h.
On April 5, 2022, a medical provider examined Tressler and performed a

physical, but he did not give Tressler any medical care. Id. ¶20i. He also observed
blood in Tressler’s urine and noted her kidney pain, but he did not give her
additional medical treatment. Id. Also on April 5, 2022, another medical provider

approved an order to give Tressler anti-inflammatory medicine, but she did not
personally examine Tressler. Id. ¶20j.
The next day, although a medical provider came to Tressler’s cell, she
refused to provide medical treatment. Id. ¶20k.3

On April 7, 2022, Tressler was again not provided with any medical care and
was not examined even though a medical provider reviewed her chart, which
revealed that she had a urinary tract infection. Id. ¶ 20l.

On April 8, 2022, when a medical provider came to Tressler’s cell, Tressler
begged for medical care due to kidney pain. Id. ¶ 20m. The provider gave her a
Gatorade. Id.

On April 9, 2002, a medical provider examined Tressler, but she did give her
any medical treatment or care other than ordering Tylenol for her. Id. ¶¶ 20n, 20o.
On April 10, 2022, a medical provider reviewed Tressler’s chart and
indicated that her detox was complete, but she did not provide Tressler with any

medical care. Id. ¶ 20p. Also on April 10, 2022, a medical provider and
Corrections Officers Vangorder and Rupert came to Tressler’s cell, and Tressler,

3 The complaint merely alleges that she “refused to provide Plaintiff
medical.” Doc. 1 ¶ 20k. We assume this means that the medical provider refused
to provide Tressler with medical treatment.
who was lying face down on her bed and was unable to ambulate, told them that
she could not feel her legs. Id. ¶ 20q. The only care provided was that the medical

provider offered Tressler a “muscle rub” and increased the dosage of Tylenol. Id.
Later that same day, another medical provider and Officer Vangorder entered
Tressler’s cell, where they found her unconscious and used smelling salts to revive

her. Id. ¶ 20r. They provided limited to no medical care. Id.
The next day, a medical provider entered Tressler’s cell, and still believing
that she was faking, provided no care. Id. ¶ 20s. And the medical provider scolded
Tressler regarding Tressler’s inability to ambulate. Id.

On April 12, 2022, Tressler did not receive any medial care. Id. ¶ 20t.
On April 13, 2022, a medical provider reviewed Tressler’s chart and test
results. Id. ¶ 20u. Although she acknowledged Tressler’s abnormal results on

Tressler’s chart, she did not provide any follow-up care. Id.
On April 14, 2022, a medical provider and Corrections Officer Quigley
entered Tressler’s cell, where Tressler was lying naked and was mumbling
incoherently. Id. ¶ 20v. Although Tressler begged to go to the hospital, the

medical provider told her that she needed to ambulate and that she would feel
better. Id. She was not given any medical care. Id. Later that same day, the
medical provider returned to Tressler’s cell. Id. ¶ 20w. Tressler could not

ambulate, and the medical provider denied her medication because she could not
retrieve the medicine from the front of the cell. Id. Tressler again asked to go to
the hospital, but that request was denied because the medical provider believed that

she was drug seeking and faking her pain. Id.
On April 15, 2022, a medical provider arrived at Tressler’s cell and found
her unclothed, listless, and mumbling. Id. ¶ 20x. Tressler again asked to go to the

hospital, but the medical provider told her that she was drug seeking and that she
needed to be completely detoxed. Id. After Tressler urinated on herself, she was
placed in a restraint chair, moved to the public shower, and hosed off. Id. She was
given a Gatorade, but otherwise was denied medical care. Id.

On April 16, 2022, Tressler was denied all medical care. Id. ¶ 20y.
On April 17, 2022, Tressler was unable to get out of bed, and she asked for
help getting cleaned up after she defecated on herself. Id. ¶ 24. She was left sitting

in her own feces for approximately five hours after which corrections officers and
medical staff entered the cell to help her get cleaned up. Id. Three medical
providers found Tressler lying in her own urine and feces in her cell. Id. ¶ 20z.
They obtained an order to send her to Mount Nittany Medical Center for medical

care. Id.
On April 18, 2022, Tressler was transported from the CCCF to the Mount
Nittany Medical Center. Id. ¶¶ 17, 20aa, 25.4 There, Tressler was diagnosed with

internal bleeding, septic shock, a blood infection, pneumonia, and endocarditis of
two heart valves. Id. ¶ 25. She was placed on a ventilator. Id. Because the doctors
at the Mount Nittany Medical Center could not properly treat Tressler, she was

life-flighted to Geisinger Hospital, where she underwent lifesaving medical
procedures, including heart surgery. Id. ¶¶ 18, 26. Tressler had open heart surgery
to replace two valves in her heart. Id. ¶ 27. And she had a second heart surgery
due to an infection in her heart valve. Id. Tressler remained at Geisinger Hospital

for approximately four months. Id. ¶ 26.
Tressler characterizes the conditions of her confinement at the CCCF as
abhorrent and the actions of the defendants as shameful. Id. ¶ 20. She alleges that

at the beginning of her incarceration, corrections officers and medical staff brought
medication to her cell, but after several days, they stopped bringing the medication
to her cell, and although she was not able to ambulate, they told her to walk to get
her medication. Id. ¶ 21. Tressler told corrections officers and medical staff that

4 Tressler alleges that after medical staff entered her cell, she was rushed to
the Mount Nittany Medical Center. Doc. 1 ¶25. And she alleges that medical staff
entered her cell on April 17, 2022. Id. Although this suggests that she was
transported to the Mount Nittany Medical Center on April 17, 2022, Tressler
specifically alleges elsewhere that she was transported to the Mount Nittany
Medical Center on April 18, 2022. See id. ¶ 17.
she could not get out of bed and needed help, but her requests for medical care
were generally ignored. Id. Further, because she could not get out of bed to eat

meals, she missed approximately 30 meals during the time she was at the CCCF.
Id. ¶ 22. She experienced chronic diarrhea and she routinely defecated and
urinated on herself. Id. ¶ 23. And when she began to lose consciousness,

corrections officers and medical staff used smelling salts to bring her back to
consciousness. Id. Throughout her incarceration at the CCCF, Tressler told
correctional and medical staff that she was not feeling well and had trouble moving
around. Id. ¶ 28. She was labeled a faker and drug seeker. Id. She avers that one

particular medical provider and Corrections Officer Quigley continued to deny her
care, chide her, and refused to help her in any way. Id. ¶ 29. She also alleges that
defendant Napoleon, who was her counselor, was aware that she needed medical

care, and he knew that PrimeCare short-staffed the area where she was housed. Id.
¶ 30. But he did not object to the lack of care that she was receiving from the
corrections officer defendants and medical providers, and he did nothing to get her
appropriate care. Id.

In April 2022, Centre County contracted with PrimeCare for PrimeCare to
provide medical care to all prisoners and pretrial detainees at the CCCF. Id. ¶ 32.
Centre County and PrimeCare were responsible for creating, implementing, and

enforcing policies, practices, and procedure to ensure that prisoners and pretrial
detainees were provided with proper medical care while in custody. Id. ¶ 33. But
they failed to create, implement, and enforce practices and procedures to ensure

that Tressler was provided proper care. Id. ¶ 35. And as a result of the defendants’
actions and inactions, Tressler suffered physical injury, and the delay in her care
caused her to have an invasive surgical procedure. Id. ¶ 34. Centre County and

PrimeCare failed to ensure that medical personnel properly examined inmates with
health complaints, failed to ensure that PrimeCare referrals were properly referred
to outside medical professionals to provide care for inmates; and failed to provide
medical personnel and staff to treat inmates with physical complaints and medical

conditions at the CCCF. Id. ¶¶ 36–38.
According to Tressler, Centre County and PrimeCare have a long history of
denying medical treatment to inmates. Id. ¶ 31. And in support of that assertion,

she cites four cases in this court in which such was claimed. Id. (citing Bush v.
PrimeCare Med., Inc., 1:11-cv-01738 (M.D. Pa.); Gwilymjr v. Centre County
Correctional Facility, 3:12-cv-02605 (M.D. Pa.); Fite v. Prime Care Medical Co.,
Inc., 4:14-cv-00781 (M.D. Pa.); and Rossman v. PrimeCare Medical, Inc., 4:21-cv-

00703 (M.D. Pa.)).
The complaint contains five counts. Count I contains 42 U.S.C. § 1983
claims against all the defendants based on the Fourteenth Amendment for failure to

protect and denial of medical care. Id. ¶¶ 39–52. Count II contains 42 U.S.C.
§ 1983 claims against defendants Irwin, Schell, and the Doe Supervisors based on
the Fourteenth Amendment for supervisor liability. Id. ¶¶ 53–66. Count III

contains 42 U.S.C. § 1983 claims against Centre County and PrimeCare for
municipal liability. Id. ¶¶ 67–83. Count IV is a claim against PrimeCare under
Pennsylvania law for vicarious liability. Id. ¶¶ 84–89. Count V contains claims
against some of the PrimeCare defendants5 under Pennsylvania law for medical

negligence. Id. ¶¶ 90–96.6
As mentioned above, the named County defendants filed a motion to dismiss
the complaint. See doc. 13. That motion has been fully briefed. See docs. 14, 17,

18,7 23. For the reasons discussed below, we will grant in part and deny in part
that motion to dismiss.

5 Count V is brought against defendants PrimeCare, Camacho, Peters,
“Desiree” (which we assume to be a reference to defendant Desiree Sheran),
Nichols, Struble, Weaver, Lose, Briscoe, and Figart. See Doc. 1 at 19 (Count V
heading); Doc. 1 ¶ 91. There is no mention in this count of defendant Reams or
defendant Schmidt, who are also PrimeCare defendants.
6 Tressler attached a certificate of merit as to defendants PrimeCare,
Camacho, Peters, “Desiree” (which we assume to be a reference to defendant
Desiree Sheran), Nichols, Struble, Weaver, Lose, Briscoe, and Figart. Doc. 1 at 23.
7 The named County defendants make numerous assertions in footnotes in
their reply brief. To the extent those assertions are meant to be arguments, we note
that we do not address arguments raised only in a footnote. See United States v.
Yung, No. 19-1640, 2022 WL 2112794, at *7 (3d Cir. June 13, 2022) (concluding
that appellant forfeited argument that “he “tuck[ed] it into a single footnote,
without supporting authority or analysis”); John Wyeth & Brother Ltd. v. CIGNA
Int’l Corp., 119 F.3d 1070, 1076 n.6 (3d Cir. 1997) (“arguments raised in passing
III. Pleading and Fed. R. Civ. P. 12(B)(6) Standards.
In accordance with Fed. R. Civ. P. 12(b)(6), the court may dismiss a

complaint for “failure to state a claim upon which relief can be granted.” When
reviewing a motion to dismiss under Rule 12(b)(6), “[w]e must accept all factual
allegations in the complaint as true, construe the complaint in the light favorable to

the plaintiff, and ultimately determine whether plaintiff may be entitled to relief
under any reasonable reading of the complaint.” Mayer v. Belichick, 605 F.3d 223,
229 (3d Cir. 2010). In making that determination, we “consider only the
complaint, exhibits attached to the complaint, matters of public record, as well as

undisputedly authentic documents if the [plaintiff’s] claims are based upon these
documents.” Id. at 230.
“A Rule 12(b)(6) motion tests the sufficiency of the complaint against the

pleading requirements of Rule 8(a).” I.H. ex rel. D.S. v. Cumberland Valley Sch.
Dist., 842 F. Supp. 2d 762, 769–70 (M.D. Pa. 2012). “Under Federal Rule of Civil
Procedure 8(a)(2), a pleading must contain a ‘short and plain statement of the
claim showing that the pleader is entitled to relief.’” Ashcroft v. Iqbal, 556 U.S.

(such as, in a footnote), but not squarely argued, are considered waived.”); Schmalz
v. Sovereign Bancorp, Inc., 868 F. Supp. 2d 438, 457 n.14 (E.D. Pa. 2012) (“An
argument made only in a footnote is not worthy of credence (other than to be
rejected by footnote).”).
662, 677–78 (2009) (quoting Fed. R. Civ. P. 8(a)(2)). The statement required by
Rule 8(a)(2) must give the defendant fair notice of the nature of the plaintiff’s

claim and of the grounds upon which the claim rests. Erickson v. Pardus, 551 U.S.
89, 93 (2007). Detailed factual allegations are not required, but more is required
than “labels,” “conclusions,” or “a formulaic recitation of the elements of a cause

of action.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007). “In other
words, a complaint must do more than allege the plaintiff’s entitlement to relief.”
Fowler v. UPMC Shadyside, 578 F.3d 203, 211 (3d Cir. 2009). “A complaint has
to ‘show’ such an entitlement with its facts.” Id.

In considering whether a complaint fails to state a claim upon which relief
can be granted, the court “‘must accept all facts alleged in the complaint as true
and construe the complaint in the light most favorable to the nonmoving party.’”

Krieger v. Bank of Am., N.A., 890 F.3d 429, 437 (3d Cir. 2018) (quoting Flora v.
Cty. of Luzerne, 776 F.3d 169, 175 (3d Cir. 2015)). But a court “need not credit a
complaint’s bald assertions or legal conclusions when deciding a motion to
dismiss.” Morse v. Lower Merion Sch. Dist., 132 F.3d 902, 906 (3d Cir. 1997). A

court also need not “assume that a . . . plaintiff can prove facts that the . . . plaintiff
has not alleged.” Associated Gen. Contractors of Cal. v. California State Council
of Carpenters, 459 U.S. 519, 526 (1983).
Following Twombly and Iqbal, a well-pleaded complaint must contain more
than mere legal labels and conclusions. Rather, it must recite factual allegations

sufficient to raise the plaintiff’s claimed right to relief beyond the level of mere
speculation. In practice, consideration of the legal sufficiency of a complaint
entails a three-step analysis:

First, the court must “tak[e] note of the elements a
plaintiff must plead to state a claim.” Second, the court should
identify allegations that, “because they are no more than
conclusions, are not entitled to the assumption of truth.”
Finally, “where there are well-pleaded factual allegations, a
court should assume their veracity and then determine whether
they plausibly give rise to an entitlement for relief.”
Santiago v. Warminster Tp., 629 F.3d 121, 130 (3d Cir. 2010) (footnote and
citations omitted) (quoting Iqbal, 556 U.S. at 675, 679).
In sum, although “[w]e accept as true all factual matters [the plaintiff]
alleges, . . . his complaint cannot survive unless the facts it recites are enough to
state plausible grounds for relief.” Beasley v. Howard, 14 F.4th 226, 231 (3d Cir.
2021) (citing Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)). “A claim has facial
plausibility when the plaintiff pleads factual content that allows the court to draw
the reasonable inference that the defendant is liable for the misconduct alleged.”
Iqbal, 556 U.S. at 678. But “[a] claim that relies just on ‘conclusory statements,’
or on ‘threadbare recitals of the elements of a cause of action’ without supporting
factual allegations, does not establish plausible grounds for relief.” Id. (quoting
Fischbein v. Olson Rsch. Grp., Inc., 959 F.3d 559, 561 (3d Cir. 2020)).

IV. Discussion.
The pending motion to dismiss addresses only the claims against the named
County defendants. Those claims are federal claims brought under 42 U.S.C.
§ 1983. “Section 1983 imposes civil liability upon any person who, acting under

the color of state law, deprives another individual of any rights, privileges, or
immunities secured by the Constitution or laws of the United States.” Shuman v.
Penn Manor School Dist., 422 F.3d 141, 146 (3d Cir. 2005). Section 1983 “does

not create any new substantive rights but instead provides a remedy for the
violation of a federal constitutional or statutory right.” Id. To establish a claim
under § 1983, the plaintiff must establish a deprivation of a federally protected

right and that this deprivation was committed by a person acting under color of
state law. Woloszyn v. County of Lawrence, 396 F.3d 314, 319 (3d Cir. 2005).
The named County defendants concede that they were acting under color of
state law. See doc. 14 at 12. Thus, the question is whether Tressler has plausibly

alleged that they deprived her of a federally protected right.
Tressler claims that the named County defendants violated her rights under
the Fourteenth Amendment. Before we address the merits of the claims that are in
dispute, we note that Tressler agrees with the named County defendants that
certain claims should be dismissed. She agrees that the claims against defendants

CCCF, Irwin, and Schell should be dismissed. See doc. 17 at 13, 20. Thus, we will
dismiss those claims. Tressler also has not objected to the named County
defendants’ request to strike from the complaint her demand for $5,000,000. Thus,

we will strike that demand.
We now turn to the claims that are in dispute, which are the claims against
defendants Medford, Vangorder, Rupert, Quigley, and Napolean (“Individual
County Defendants”) and the claims against Centre County.

A. The Individual County Defendants.
The Individual County Defendants contend that the complaint fails to state a
claim upon which relief can be granted against them and that they are entitled to
qualified immunity. In the complaint, Tressler frames her claims against the

Individual County Defendants as both Fourteenth Amendment failure-to-protect
claims and Fourteenth Amendment denial-of-medical-care claims. See doc. 1 at 13
(title to Count I). We begin with the failure-to-protect claims, and we conclude
that the Individual County Defendants are entitled to qualified immunity as to

those claims. Then, we turn to the denial-of-medical-care claims, and conclude
that the complaint fails to state a claim upon which relief can be granted against
defendant Medford, but that it states a claim upon which relief can be granted
against defendants Vangorder, Rupert, Quigley, and Napoleon, and that at this
stage of the proceedings, defendants Vangorder, Rupert, Quigley, and Napoleon

are not entitled to qualified immunity from the denial-of-medical care claims.

1. Failure-to-Protect Claims.
For the reasons stated below, we conclude that the Individual County
Defendants are entitled to qualified immunity from Tressler’s Fourteenth
Amendment failure-to-protect claims.

Despite their participation in constitutionally impermissible conduct,
government officials “may nevertheless be shielded from liability for civil
damages if their actions did not violate ‘clearly established statutory or

constitutional rights of which a reasonable person would have known.’” Hope v.
Pelzer, 536 U.S. 730, 739 (2002) (quoting Harlow v. Fitzgerald, 457 U.S. 800, 818
(1982)). Qualified immunity ensures that before officers are subjected to suit, they
have notice that their conduct is unlawful. Id. “Qualified immunity balances two

important interests—the need to hold public officials accountable when they
exercise power irresponsibly and the need to shield officials from harassment,
distraction, and liability when they perform their duties reasonably.” Pearson v.

Callahan, 555 U.S. 223, 231 (2009). “If the law was clearly established, the
immunity defense ordinarily should fail, since a reasonably competent public
official should know the law governing his conduct.” Harlow, 457 U.S. at 818–19.
The qualified immunity analysis has two prongs. Pearson, 555 U.S. at 232.
One prong of the analysis is whether the facts that the plaintiff has alleged or

shown make out a violation of a constitutional right. Id. The other prong of the
analysis is whether the right was clearly established. Saucier v. Katz, 533 U.S. 194,
201 (2001).

“To determine whether a right was ‘clearly established,’ we conduct a two-
part inquiry.” Peroza-Benitez v. Smith, 994 F.3d 157, 165 (3d Cir. 2021). “First,
we must ‘define the right allegedly violated at the appropriate level of specificity.’”
Id. (quoting Sharp v. Johnson, 669 F.3d 144, 159 (3d Cir. 2012)). “This requires

us to frame the right ‘in light of the specific context of the case, not as a broad
general proposition.’” Id. (quoting Saucier, 533 U.S. at 201). “Second, we must
ask whether that right was ‘clearly established’ at the time of its alleged violation,

i.e., whether the right was ‘sufficiently clear that a reasonable official would
understand that what he is doing violates that right.’” Id. (quoting Saucier, 533
U.S. at 202). “This is an ‘objective (albeit fact-specific) question,’ where ‘[an
officer]’s subjective beliefs . . . are irrelevant.’” Id. (quoting Anderson v.

Creighton, 483 U.S. 635, 641 (1987)).
“To be clearly established, a legal principle must have a sufficiently clear
foundation in then-existing precedent.” D.C. v. Wesby, 583 U.S. 48, 63 (2018). In

other words, “[t]he rule must be ‘settled law,’ which means it is dictated by
‘controlling authority’ or ‘a robust ‘consensus of cases of persuasive authority.’”
Id. (internal citations omitted). “It is not enough that the rule is suggested by then-

existing precedent.” Id. Rather, “[t]he precedent must be clear enough that every
reasonable official would interpret it to establish the particular rule the plaintiff
seeks to apply.” Id.

If the law did not put the defendant on notice that his conduct would be
clearly unlawful, qualified immunity is appropriate. Bayer v. Monroe County
Children & Youth Services, 577 F.3d 186, 193 (3d Cir. 2009). “In other words,
‘existing precedent must have placed the statutory or constitutional question

beyond debate.’” Reichle v. Howards, 566 U.S. 658, 664 (2012) (quoting Ashcroft
v. al-Kidd, 563 U.S. 731, 741 (2011)). “This exacting standard ‘gives government
officials breathing room to make reasonable but mistaken judgments’ by

‘protect[ing] all but the plainly incompetent or those who knowingly violate the
law.’” City & Cnty. of San Francisco v. Sheehan, 575 U.S. 600, 611 (2015)
(quoting al-Kidd, 563 U.S. at 743).
“Defendants bear the burden of establishing qualified immunity.” White v.

Dauphin Cnty., No. 1:22-CV-1241, 2023 WL 6392735, at *4 (M.D. Pa. Sept. 29,
2023). “Officials demonstrate they are entitled to qualified immunity only if they
can show that a reasonable person in their position at the relevant time could have
believed, in light of clearly established law, that their conduct comported with
recognized legal standards.” E. D. v. Sharkey, 928 F.3d 299, 306 (3d Cir. 2019).

Here, the Individual County Defendants are entitled to qualified immunity
from Tressler’s failure-to-protect claims. The United States Court of Appeals has
“recognized a right to have a government actor intervene when the underlying

constitutional violation involves excessive force or sexual assault of a person in
custody or detention,” but it has held that its “precedent does not establish, let
alone clearly establish, a right to intervention in other contexts.” Thomas v. City of
Harrisburg, 88 F.4th 275, 285 (3d Cir. 2023), cert. denied, 2024 WL 4426554, at

*1 (U.S. Oct. 7, 2024), and 2024 WL 4426555, at *1 (U.S. Oct. 7, 2024)). The
medical context is one the contexts in which the Third Circuit has held that there is
no clearly established right to intervention. Id. at 285–86 (holding that “[b]ecause

there is not a clearly established right to intervention to prevent a violation of the
right to medical care, the Officers are entitled to qualified immunity as to [the
plaintiff’s] failure to intervene claim”).
Because a Fourteenth Amendment failure-to-protect claim in the medical

context is not clearly established, the Individual County Defendants are entitled to
qualified immunity as to that claim.
2. Denial-of-Medical-Care Claims.

Turning to the denial-of-medical-care claims, we first address whether the
complaint states a Fourteenth Amendment due process claim against the Individual
County Defendants. Then, having determined that the complaint states a claim
against four of the five Individual County Defendants, we address whether those

defendants are entitled to qualified immunity, and we conclude that they are not.

a. Failure to State a Claim.
Before addressing whether the allegations in the complaint state a
Fourteenth Amendment denial-of-medical-care claim, we need to specify the

standards for such a claim. For the reasons explained below, we conclude that
although Tressler’s claim is a Fourteenth Amendment due process claim, the same
standards that apply to Eighth Amendment medical claims apply here. We then set

forth those standards. And finally, we conclude that the complaint fails to state a
claim upon which relief can be granted against defendant Medford, but that it
states a claim upon which relief can be granted against defendants Vangorder,
Rupert, Quigley, and Napoleon.
i. Eighth Amendment standards apply to the denial-of-
medical-care claim.
“The Third Circuit’s standard for evaluating a pretrial detainee’s claim of
inadequate medical treatment under the Due Process Clause is not entirely clear.”
Beauchamps v. Bechtold, No. 1:22-CV-01279, 2023 WL 5017208, at *3 (M.D. Pa.

Aug. 7, 2023) (Wilson, J.). The due process rights of pretrial detainees are “at
least as great” as the Eighth Amendment protections available to convicted
prisoners. City of Revere v. Massachusetts General Hospital, 463 U.S. 239, 244

(1983). In other words, the Eighth Amendment “establishe[s] a floor.” Hubbard,
399 F.3d at 165–66. But, in the context of the provision of medical care, “[t]here
is an open question of ‘how much more protection unconvicted prisoners should
receive’ under the Fourteenth Amendment” than convicted prisoners receive under

the Eighth Amendment. Mattern v. City of Sea Isle, 657 F. App’x 134, 138 n.5 (3d
Cir. 2016) (quoting Kost v. Kozakiewicz, 1 F.3d 176, 188 n.10 (3d Cir. 1993)).
In Estelle v. Gamble, the Supreme Court held that “deliberate indifference to

serious medical needs of prisoners” violates the Eighth Amendment. 429 U.S. 97,
104 (1976). The Third Circuit has previously “found no reason to apply a different
standard than that set forth in Estelle (pertaining to prisoners’ claims of inadequate
medical care under the Eighth Amendment) when evaluating whether a claim for

inadequate medical care by a pre-trial detainee is sufficient under the Fourteenth
Amendment.” Natale v. Camden Cnty. Corr. Facility, 318 F.3d 575, 581 (3d Cir.
2003) (citing Boring v. Kozakiewicz, 833 F.2d 468, 472 (3d Cir. 1987)). More
recently, in other contexts, however, both the Supreme Court and the Third Circuit

have held that the standard under the Cruel and Unusual Punishment Clause of the
Eighth Amendment, which is applicable to convicted persons, is different from the
standard under the Due Process Clause, which is applicable to pretrials detainees.

See, e.g., Kingsley v. Hendrickson, 576 U.S. 389, 396–97, 400–01 (2015)
(contrasting the rights of convicted prisoners under the Eighth Amendment not to
be subject to cruel and unusual punishment with the rights of pretrial detainees
under the Due Process Clause not to be punished at all, and holding that to

establish an excessive force claim, unlike a convicted prisoner, who must show
that the defendant acted with the subjective intent to maliciously and sadistically
cause harm, “a pretrial detainee must show only that the force purposely or

knowingly used against him was objectively unreasonable”); Hubbard, 399 F.3d at
166–67 (noting that the Eighth Amendment prohibits cruel and unusual
punishment, but pretrial detainees cannot be punished at all, and reversing and
remanding in a case brought by pretrial detainees regarding conditions of

confinement because the district court improperly analyzed their claim under the
Eighth Amendment, rather than the Due Process Clause of the Fourteenth
Amendment).
Recognizing that medical claims brought by pretrial detainees are
substantive due process claims, not Eighth Amendment claims, judges in this

district have nevertheless generally continued to apply Eighth Amendment
standards to such claims. See, e.g., Ealy v. Schell, No. 3:24-CV-0126, 2024 WL
4291498, at *4 (M.D. Pa. Sept. 25, 2024) (Munley, J.) (applying Eighth

Amendment standards to medical claim of a; Brown v. Rivello, No. 4:22-CV-
01155, 2024 WL 4009640, at *3 (M.D. Pa. Aug. 30, 2024) (Brann, C.J.) (same);
White v. Dauphin Cnty., No. 1:22-CV-1241, 2024 WL 3046718, at *9 (M.D. Pa.
June 18, 2024) (Conner, J.) (same); Balliet v. Luzerne Cnty., No. 3:22-CV-02032,

2024 WL 2275252, at *4 (M.D. Pa. May 20, 2024) (Mehalchick, J.) (same);
Richardson v. Clark, No. 1:22-CV-00029, 2024 WL 1258653, at *7 (M.D. Pa.
Mar. 25, 2024) (Wilson, J.); Babner v. Cumberland Cnty., No. 3:20-CV-02465,

2023 WL 6276673, at *1 (M.D. Pa. Sept. 26, 2023) (Saporito, [then] M.J.) (same);
Giddings v. Rogers, No. 1:22-CV-00097, 2023 WL 2395470, at *4 (M.D. Pa. Mar.
6, 2023) (Kane, J.) (same); Peters v. Prime Care Med. Inc., No. 3:22-CV-1542,
2023 WL 3396926, at *3 (M.D. Pa. May 11, 2023) (Mariani, J.) (same); Loughney

v. Corr. Care, Inc., No. CV 3:19-1101, 2021 WL 4447635, at *2 n.5 (M.D. Pa.
Sept. 28, 2021) (Mannion, J.) (same).
Similarly, the Third Circuit has continued to rely on Eighth Amendment

standards when addressing medical claims of pretrial detainees. See e.g. Thomas,
88 F.4th at 281 n.23 (“Because the Fourteenth Amendment affords pretrial
detainees protections at least as great as those available to inmates under the Eighth

Amendment, we will review Sherelle Thomas’s claims for failure to render
medical care under the Fourteenth Amendment by applying the same standard used
to evaluate claims brought under the Eighth Amendment.”); Palakovic v. Wetzel,

854 F.3d 209, 223, 227–233 (3d Cir. 2017) (concluding that “when a plaintiff
seeks to hold a prison official liable for failing to prevent a detainee’s suicide, a
pre-trial detainee may bring a claim under the Due Process Clause of the
Fourteenth Amendment that is essentially equivalent to the claim that a prisoner

may bring under the Eighth Amendment” and addressing that claim as well as a
more general claim of deliberate indifference to a serious need for mental
healthcare under Eighth Amendment standards).

Considering the above and given that both Tressler and the Individual
County Defendants rely on Eighth Amendment standards, we will apply the Eighth
Amendment standards to Tressler’s denial-of-medical-care claims against the
Individual County Defendants.

ii. General Eighth Amendment Standards.
“The Eighth Amendment, through its prohibition on cruel and unusual
punishment, prohibits the imposition of ‘unnecessary and wanton infliction of pain
contrary to contemporary standards of decency.’” Pearson v. Prison Health Serv.,
850 F.3d 526, 534 (3d Cir. 2017) (quoting Helling v. McKinney, 509 U.S. 25, 32

(1993)). “An inmate must rely on prison authorities to treat his medical needs; if
the authorities fail to do so, those needs will not be met.” Estelle, 429 U.S. at 103.
To establish an Eighth Amendment medical claim, a plaintiff must show that “(1)

he had a serious medical need, (2) the defendants were deliberately indifferent to
that need; and (3) the deliberate indifference caused harm to the plaintiff.” Durham
v. Kelley, 82 F.4th 217, 229 (3d Cir. 2023).
A medical need is serious if it “has been diagnosed by a physician as

requiring treatment” or if it “is so obvious that a lay person would easily recognize
the necessity for a doctor’s attention.” Monmouth Cnty. Corr. Institutional Inmates
v. Lanzaro, 834 F.2d 326, 347 (3d Cir. 1987) (quoting Pace v. Fauver, 479 F.

Supp. 456, 458 (D.N.J. 1979), aff’d, 649 F.2d 860 (3d Cir. 1981) (table)).
Additionally, “if ‘unnecessary and wanton infliction of pain’ results as a
consequence of denial or delay in the provision of adequate medical care, the
medical need is of the serious nature contemplated by the eighth amendment.” Id.

(quoting Estelle, 429 U.S. at 103). Further, “where denial or delay causes an
inmate to suffer a life-long handicap or permanent loss, the medical need is
considered serious.” Id.
Deliberate indifference under the Eighth Amendment is a subjective
standard. Farmer v. Brennan, 511 U.S. 825, 840 (1994). “To act with deliberate

indifference to serious medical needs is to recklessly disregard a substantial risk of
serious harm.” Giles v. Kearney, 571 F.3d 318, 330 (3d Cir. 2009). To act with
deliberate indifference, the prison official must have known of the substantial risk

of serious harm and must have disregarded that risk by failing to take reasonable
measures to abate it. Farmer, 511 U.S. at 837. “[T]he official must both be aware
of facts from which the inference could be drawn that a substantial risk of serious
harm exists, and he must also draw the inference.” Id.

The mere misdiagnosis of a condition or medical need, or negligent
treatment provided for a condition, is not actionable as a constitutional claim
because medical malpractice is not a constitutional violation. See id, at 835

(holding that “deliberate indifference describes a state of mind more blameworthy
than negligence”); Spruill v. Gillis, 372 F.3d 218, 235 (3d Cir. 2004) (“Allegations
of medical malpractice are not sufficient to establish a Constitutional violation.”);
Singletary v. Pa. Dep’t of Corr., 266 F.3d 186, 192 n. 2 (3d Cir. 2002) (claims of

medical malpractice, absent evidence of a culpable state of mind, do not constitute
deliberate indifference under the Eighth Amendment). Instead, deliberate
indifference represents a higher standard, one that requires “obduracy and

wantonness, which has been likened to conduct that includes recklessness or a
conscious disregard of a serious risk.” Rouse v. Plantier, 182 F.3d 192, 197 (3d
Cir. 1999) (quoting Whitley v. Albers, 475 U.S. 312, 319 (1986)).

“Indeed, prison authorities are accorded considerable latitude in the
diagnosis and treatment of prisoners.” Durmer v. O’Carroll, 991 F.2d 64, 67 (3d
Cir. 1993) (citations omitted). And courts will “disavow any attempt to second

guess the propriety or adequacy of a particular course of treatment . . . [which]
remains a question of sound professional judgment.” Palakovic, 854 F.3d at 228
(quoting Inmates of Allegheny County Jail v. Pierce, 612 F.2d 754, 762 (3d Cir.
1979)). “Mere disagreement as to the proper medical treatment does not support

an Eighth Amendment claim.” Caldwell v. Luzerne Cnty. Corr. Facility Mgmt.
Employees, 732 F. Supp. 2d 458, 472 (M.D. Pa. 2010).
Thus,”[w]here a prisoner has received some amount of medical treatment, it

is difficult to establish deliberate indifference, because prison officials are afforded
considerable latitude in the diagnosis and treatment of prisoners.” Palakovic, 854
F.3d at 227. “Nonetheless, there are circumstances in which some care is provided
yet it is insufficient to satisfy constitutional requirements.” Id.

The Third Circuit has found deliberate indifference where a prison official:
“(1) knows of a prisoner’s need for medical treatment but intentionally refuses to
provide it; (2) delays necessary medical treatment based on a non-medical reason;

or (3) prevents a prisoner from receiving needed or recommended medical
treatment.” Rouse, 182 F.3d at 197. The Third Circuit has also held that
“[n]eedless suffering resulting from the denial of simple medical care, which does

not serve any penological purpose, . . . violates the Eighth Amendment.” Atkinson
v. Taylor, 316 F.3d 257, 266 (3d Cir. 2003). “For instance, prison officials may
not, with deliberate indifference to the serious medical needs of the inmate, opt for

‘an easier and less efficacious treatment’ of the inmate’s condition.” Palakovic,
854 F.3d at 228 (quoting West v. Keve, 571 F.2d 158, 162 (3d Cir. 1978). “Nor
may ‘prison authorities deny reasonable requests for medical treatment . . . [when]
such denial exposes the inmate to undue suffering or the threat of tangible residual

injury.’” Id. (quoting Monmouth Cty. Corr. Inst., 834 F.2d at 346). Thus, “[a]
‘failure to provide adequate care . . . [that] was deliberate, and motivated by non-
medical factors’ is actionable under the Eighth Amendment, but ‘inadequate care

[that] was a result of an error in medical judgment’ is not.” Parkell v. Danberg,
833 F.3d 313, 337 (3d Cir. 2016) (quoting Durmer, 991 F.2d at 69).
“[T]here is a critical distinction ‘between cases where the complaint alleges
a complete denial of medical care and those alleging inadequate medical

treatment.’” Pearson, 850 F.3d at 535 (quoting United States ex. rel. Walker v.
Fayette Cty., 599 F.2d 573, 575 n.2 (3d Cir. 1979)). “Because ‘mere disagreement
as to the proper medical treatment’ does not ‘support a claim of an eighth

amendment violation,’ when medical care is provided, we presume that the
treatment of a prisoner is proper absent evidence that it violates professional
standards of care.” Id. (quoting Monmouth Cty. Corr. Inst., 834 F.2d at 346). And

“there are two very distinct subcomponents to the deliberate indifference prong of
an adequacy of care claim.” Id. at 536. “The first is the adequacy of the medical
care—an objective inquiry where expert testimony could be helpful to the jury.”

Id. “The second is the individual defendant’s state of mind—a subjective inquiry
that can be proven circumstantially without expert testimony.” Id. But a claim that
medical care was delayed or denied completely “must be approached differently
than an adequacy of care claim.” Id. at 537. “Unlike the deliberate indifference

prong of an adequacy of care claim (which involves both an objective and
subjective inquiry), the deliberate indifference prong of a delay or denial of
medical treatment claim involves only one subjective inquiry—since there is no

presumption that the defendant acted properly, it lacks the objective, propriety of
medical treatment, prong of an adequacy of care claim.” Id. “All that is needed is
for the surrounding circumstances to be sufficient to permit a reasonable jury to
find that the delay or denial was motivated by non-medical factors.” Id.

iii. The complaint fails to state claim against defendant
Medford, but it states claims against defendants Vangorder,
Rupert, Quigley, and Napoleon.
The Individual County Defendants contend that the complaint fails to state a
claim against them upon which relief can be granted because Tressler has not
alleged facts from which it can plausibly be inferred that they were deliberately
indifferent.8 In this regard, they contend that Tressler was being seen and treated

by medical personnel,9 the medical personnel were not deliberately indifferent, and
they justifiably relied on the medical personnel.
A nonmedical prison official is not deliberately indifferent simply because

he or she failed to respond to a prisoner’s medical complaints when the prisoner
was already being treated by a prison doctor. Durmer, 991 F.2d at 69. “Absent a
reason to believe (or actual knowledge) that prison doctors or their assistants are
mistreating (or not treating) a prisoner, a non-medical prison official . . . will not be

chargeable with the Eighth Amendment scienter requirement of deliberate
indifference.” Spruill, 372 F.3d at 236;10 see also Pearson, 850 F.3d at 540 n.4.

8 Tressler asserts that the defendants claim that she did not have a serious
medical need. See doc. 17 at 16–17. The defendants have not, however, argued
that Tressler did not have a serious medical need. Rather, their arguments are
focused on the deliberate-indifference prong of a denial-of-medical-care claim.

9 Although the Individual County Defendants contend that Tressler was
receiving medical treatment and care everyday of her incarceration, see doc. 14 at
15, that is simply not what Tressler alleges. Rather, as set forth above, she alleges
that there were some days when she was denied all medical care.

10 In their reply brief, the Individual County Defendants suggest that Thomas
changed the analysis in Spruill. See doc. 18 at 8–9 (referring to the “Thomas
exclusion”). As discussed above in connection with the failure-to-protect claims,
in Thomas, the United States Court of Appeals held that there is no clearly
established right to intervention to prevent a violation of the right to medical care.
Thomas, 88 F.4th at 285. But while the Third Circuit held that the officers in that
case were entitled to qualified immunity as to the failure-to-protect claims, it also
(“[T]he same division of labor concerns that underlie that rule apply when a nurse
knows that a prisoner is under a physician’s care and has no reason to believe that

the doctor is mistreating the prisoner.” “Given that it is the physician with the
ultimate authority to diagnose and prescribe treatment for the prisoner, a nurse who
knows that the prisoner is under a physician’s care is certainly ‘justified in

believing that the prisoner is in capable hands,’ id. so long as the nurse has no
discernable basis to question the physician’s medical judgment.” Id. (quoting
Spruill, 372 F.3d at 236).
As to Officer Medford, all Tressler alleges is that on April 2, 2022, Officer

Medford and a medical provider appeared at Tressler’s cell, Tressler complained of
flank pain, the medical provider and Officer Medford observed her urinate and
checked her prescriptions, but Tressler was not provided any additional medical

care. Doc. 1 ¶ 20e. This is not sufficient to plausibly allege that Officer Medford
knew that although Tressler she was seen by a medical provider, he knew or had

held that those same officers were not entitled to qualified immunity at the denial-
of-medical-care claims in that case. Id. at 285–86. It also noted that “on the facts
here, a claim for failure to intervene would be almost identical to the underlying
claim of failure to render medical care: It would have been virtually impossible for
any of the Officers to have had knowledge of an ongoing violation of a right to
medical care without themselves participating in that violation.” Id. at 285 n.55.
We do not read Thomas’s holding that a failure-to-protect claim is not clearly
established in the medical context as changing the standards, including Spruill, for
a denial-of-medical-care claim.
reason to believe that the medical provider was not treating her. Accordingly,
Tressler has not plausibly alleged that Officer Medford was deliberately indifferent

to Tressler’s serious medical needs.
We reach a different conclusion, however, as to Officers Vangorder, Rupert,
and Quigley. As to these officers, Tressler allege that on April 10, 2022, a medical

provider and Corrections Officers Vangorder and Rupert came to her cell, and
Tressler, who was lying face down on her bed and was unable to ambulate, told
them that she could not feel her legs. Doc. 1 ¶ 20q. The only care provided was
that the medical provider offered Tressler a “muscle rub” and increased the dosage

of Tylenol. Id. Later that same day, another medical provider and Officer
Vangorder entered Tressler’s cell, where they found her unconscious and used
smelling salts to revive her. Id. ¶ 20r. They provided limited to no medical care.

Id. On April 14, 2022, a medical provider and Corrections Officer Quigley entered
Tressler’s cell, where Tressler was lying naked and was mumbling incoherently.
Id. ¶ 20v. Although Tressler begged to go to the hospital, the medical provider
told her that she needed to ambulate and that she would feel better. Id. She was not

given any medical care. Id. Tressler also avers that one particular medical provider
and Corrections Officer Quigley chided her and refused to help her in any way. Id.
¶ 29. A reasonable inference from these alleged facts is that Officers Vangorder,

Rupert, and Quigley relied on the medical providers’ medical judgment in not
providing care to Tressler. But that is not the only reasonable inference that can be
drawn from the facts alleged. Rather, given Tressler’s allegations that she could

not ambulate, but the medical providers did not provide anything more than
cursory care to her, she has plausibly alleged facts from which it could be inferred
that the Officers knew or had reason to know that she was not receiving

appropriate medical care. Thus, at this early stage of the proceedings, we will not
dismiss the denial-of-medical-care claims against Officers Vangorder, Rupert, and
Quigley.
Similarly, although it is close question, Tressler has plausibly alleged facts

from which it could be inferred that defendant Napoleon knew that she was not
receiving appropriate care. Tressler alleges that defendant Napoleon, who was her
counselor, was aware that she needed medical care, and he knew that PrimeCare

short-staffed the area where she was housed. Doc. 1 ¶ 30. But he did not object to
the lack of care that she was receiving from the corrections officer defendants and
medical providers, and he did nothing to get her appropriate care. Id. Given these
allegations, at this early stage of the proceedings, we will not dismiss the denial-of-

medical-care claim against defendant Napoleon.
b. Qualified Immunity.
The Individual County Defendants also contend that they are entitled to

qualified immunity. We have already determined that the complaint fails to state a
denial-of-medical-care claim upon which relief can be granted as to Officer
Medford, and we will dismiss that claim against him on that basis. Thus, we need

not address qualified immunity as to Officer Medford. Rather, we address
qualified immunity only as to defendants Vangorder, Rupert, Quigley, and
Napoleon. For the reasons explained below, we conclude that these defendants are
not entitled to qualified immunity from the denial-of-medical-care claims at this

stage of the proceedings.
As set forth more fully above, “[t]he qualified immunity inquiry contains
two prongs: (1) whether the facts alleged by the plaintiff show the violation of a

constitutional right, and (2) whether the law was clearly established at the time of
the violation.” Jefferson v. Lias, 21 F.4th 74, 80 (3d Cir. 2021). Defendants
Vangorder, Rupert, Quigley, and Napoleon focus their arguments on the first
prong.

Defendants Vangorder, Rupert, Quigley, and Napoleon contend that they are
entitled to qualified immunity because the facts alleged by Tressler fail to establish
the possibility of a constitutional violation by them. In this regard, they assert that

their actions were discretionary, that Tressler’s allegations suggest—at most—that
they were negligent or mistaken for relying on medical staff, and Tressler has not
alleged facts to establish that they were on notice that the medical care that she was

receiving was not proper. But as discussed above, we have already concluded that
the complaint sufficiently pleads facts from which it can reasonably be inferred
that they were deliberately indifferent to Tressler’s serious medical needs. Thus, at

this stage of the proceedings, defendants Vangorder, Rupert, Quigley, and
Napoleon are not entitled to qualified immunity under the first prong of the
qualified-immunity analysis.
Defendants Vangorder, Rupert, Quigley, and Napoleon do not specifically

address the second prong of the qualified-immunity analysis, i.e., whether the right
to medical care was clearly established. But we note the following. “For more
than forty years under Estelle, it has been clear that a prison official violates the

constitutional rights of an inmate by showing deliberate indifference to the
inmate’s existing serious medical need.” Adami v. Cnty. of Bucks, No. CV 19-
2187, 2022 WL 1073072, at *6–7 (E.D. Pa. Apr. 8, 2022). And the Third Circuit
has long applied that standard to pretrial detainees. See e.g. Natale v. Camden

Cnty. Corr. Facility, 318 F.3d 575, 582 (3d Cir. 2003). “Put simply, a detainee’s
right to adequate medical care is clearly established.” Rossman v. PrimeCare Med.
Inc., No. 4:21-CV-00703, 2022 WL 1019991, at *5 (M.D. Pa. Apr. 5, 2022).
B. Centre County.

Centre County contends that the claims against it should be dismissed. For
the reasons discussed below, we disagree, and we conclude that Tressler has stated
a claim upon which relief can be granted against Centre County.

A municipality, such as Centre County, cannot be held liable under 42
U.S.C. § 1983 for the unconstitutional acts of its employees on a theory of
respondeat superior. Monell v. Department of Social Services, 436 U.S. 658, 691
(1978). Rather, “under § 1983, local governments are responsible only for ‘their

own illegal acts.’” Connick v. Thompson, 563 U.S. 51, 60 (2011) (quoting
Pembaur v. City of Cincinnati, 475 U.S. 469, 479 (1986) (emphasis in original)).
“[A] § 1983 claim against a municipality may proceed in two ways.” Forrest v.

Parry, 930 F.3d 93, 105 (3d Cir. 2019). One way for a plaintiff to present a claim
against a municipality is to allege “that an unconstitutional policy or custom of the
municipality led to his or her injuries.” Id. Another way for a plaintiff to present a
claim against a municipality is to allege that his injuries “were caused by a failure

or inadequacy by the municipality that ‘reflects a deliberate or conscious choice.’”
Id. (quoting Estate of Roman v. City of Newark, 914 F.3d 789, 798 (3d Cir. 2019)).
To plead a claim against a municipality under the policy-or-custom strand of

municipal liability, “a plaintiff must allege that ‘a [local] government’s policy or
custom . . . inflict[ed] the injury’ in question.” Estate of Roman, 914 F.3d at 798
(quoting Monell, 436 U.S. at 694). ‘“Policy is made when a decisionmaker

possess[ing] final authority to establish municipal policy with respect to the action
issues an official proclamation, policy, or edict.’” Id. (quoting Andrews v. City of
Philadelphia, 895 F.2d 1469, 1480 (3d Cir. 1990) (alteration in original) (internal

quotation marks omitted)). ‘“Custom, on the other hand, can be proven by
showing that a given course of conduct, although not specifically endorsed or
authorized by law, is so well-settled and permanent as virtually to constitute law.’”
Id. (quoting Bielevicz v. Dubinon, 915 F.2d 845, 850 (3d Cir. 1990)).

“To satisfy the pleading standard, [a plaintiff] must identify a custom or
policy, and specify what exactly that custom or policy was.” McTernan v. City of
York, 564 F.3d 636, 658 (3d Cir. 2009). “Although a policy or custom is necessary

to plead a municipal claim, it is not sufficient to survive a motion to dismiss.”
Estate of Roman, 914 F.3d at 798. “A plaintiff must also allege that the policy or
custom was the ‘proximate cause’ of his injuries.” Id.
Another way for a plaintiff to present a claim against a municipality is to

allege that his or her injuries “were caused by a failure or inadequacy by the
municipality that ‘reflects a deliberate or conscious choice.’” Forrest, 930 F.3d at
105 (quoting Estate of Roman, 914 F.3d at 798). “The latter avenue arose in the

failure-to-train context, but applies to other failures and inadequacies by
municipalities, including those related to supervision and discipline of its . . .
officers.” Id.

A plaintiff asserting a municipal liability claim based on a failure or
inadequacy of training, supervision, or discipline “need not allege an
unconstitutional policy.” Estate of Roman, 914 F.3d at 798. Rather, she must show

that the municipality’s failure to train, supervise, or discipline “its employees
‘reflects a deliberate or conscious choice.’” Id. (quoting Brown v. Muhlenberg
Twp., 269 F.3d 205, 215 (3d Cir. 2001)). In this regard, the plaintiff must show “a
failure or inadequacy amounting to deliberate indifference on the part of the

municipality.” Forrest, 930 F.3d at 106. “This consists of a showing as to whether
(1) municipal policymakers know that employees will confront a particular
situation, (2) the situation involves a difficult choice or a history of employees

mishandling, and (3) the wrong choice by an employee will frequently cause
deprivation of constitutional rights.” Id. In addition to deliberate indifference, a
plaintiff asserting a municipal liability claim based on a failure or inadequacy of
training, supervision, or discipline must also allege causation. Elliott v.

Pennsylvania Interscholastic Athletic Assoc., No. 3:19-CV-01934, 2022 WL
987887, at *5 (M.D. Pa. Mar. 31, 2022). “[T]he causation inquiry focuses on
whether ‘the injury [could] have been avoided had the employee been trained

under a program that was not deficient in the identified respect.” Thomas v.
Cumberland Cty., 749 F.3d 217, 226 (3d Cir. 2014) (quoting City of Canton, Ohio
v. Harris, 489 U.S. 378, 391 (1989)).

Tressler alleges that Centre County and PrimeCare promulgated and
maintained policies and customs that caused her rights to be violated. Doc. 1 ¶ 68.
According to Tressler, Centre County and PrimeCare failed to adhere to protocol in

detecting and safeguarding inmates who made medical complaints. Id. ¶ 69. More
specifically, she alleges that Centre County and PrimeCare maintained a policy of
not staffing the mental-health ward with proper doctors and medical staff to treat
the non-psychiatric medical needs of inmates. Id. ¶ 70. And they had a policy of

allowing staff to conduct rounds from the front of the cell without entering the cell
to properly examine and evaluate inmates. Id. ¶ 71. They also maintained a policy
of not having a medical provider to properly evaluate inmates complaining of pain.

Id. ¶ 72. Further, they maintained a policy of not properly ensuring that referrals
for radiographic film studies were speedy, and they failed to follow up on such
referrals. Id. ¶ 73. And there was a custom among behavioral-health providers to
not properly investigate the cause of inmate complaints or the condition of inmates

in the mental-health ward and to treat inmates complaining of physical ailments as
somatic or psychosomatic. Id. ¶ 74.
According to Tressler, these policies and practices were implemented before,

during, and after her detention at the CCCF Id. ¶ 75. And Tressler alleges that
Centre County and PrimeCare knew of the danger posed by these polices and
customs. Id. ¶ 76. More specifically, they were aware prior to Tressler’s

incarceration at the CCCF of the serious and extreme danger posed by not properly
providing medical care to inmates in the mental health ward, but they took no steps
to enact proper policies. Id. ¶¶ 77, 78. And if they had enacted appropriate

protocols or adequately trained and/or supervised the individual defendants,
Tressler would have received appropriate care and supervision. Id. ¶ 79.
According to Tressler, Centre County and PrimeCare were deliberately indifferent
to her constitutional rights, their polices and customs were a direct and proximate

cause of her injuries and damages, and she suffered immense physical pain,
humiliation, fear, and physical injures as a result of their policies and customs. Id.
¶¶ 80, 81, 82.

Tressler also alleges that during all relevant times, defendants Irwin and
Schell were supervisors at CCCF, and they were personally involved in and
directly responsible for decision-making, practice, procedures, policy, training, and
customs at the CCCF. Id. ¶ 5. She also alleges that defendant John Doe Medical

Director was at all relevant times, a policy maker with respect to customs,
practices, policies, and procedures at the CCCF, and he as was personally involved
in Tressler’s medical treatment. Id. ¶ 6. According to Tressler, Irwin, Schell, and

John Doe Medical Director were deliberately indifferent to the needs of inmates at
the CCCF, including her. Id. ¶¶ 54, 60. They were aware that certain policies and
customs posed a grave danger to inmates, including Tressler. Id. ¶ 55. Further,

they maintained a policy of staffing the CCCF with inadequate medical providers,
and they did not properly refer Tressler to the proper physician to treat her
complaints of pain. Id. ¶¶ 56, 57.

In its brief in support, Centre County makes only a cursory argument that the
complaint fails to state a claim upon which relief can be granted against it. After
setting forth some standards applicable to Monell claims, Centre County argues:
Tressler must state with specificity the subject policy or
custom and then explain how that policy or custom caused the
alleged constitutional violation. There is no single standalone
or separate Centre policy or custom identified that directly or
caused an injury to Tressler. As such, there cannot be any
“direct causal link” by Centre’s policy/custom and Tressler’s
harm. The medical treatment was being handled by professions
[sic], specifically the PrimeCare employees on a daily basis.
The non-medical employees of Centre as well as any policies
regarding medical, were not the “moving force” behind any
civil rights violation.
In sum, Tressler has not and cannot validly set forth a
Monell claim under the facts and circumstances of her
Complaint. Thus, the Centre County should be dismissed with
prejudice and no further opportunities be given to her to amend.
Doc. 14 at 19 (emphasis in original). Similarly, in it reply brief, Centre County
argues:
Tressler must state with specificity the subject policy or
custom and then explain how that policy or custom caused the
alleged constitutional violation. The medical treatment was
being addressed by medical professionals, specifically the
PrimeCare employees. Based upon Tressler’s own facts, she
was seen on a daily basis. The non-medical employees of
Centre as well as any policies regarding medical care, were not
the “moving force” behind any civil rights violation.
Doc. 18 at 10 (emphasis in original).
To the extent that Centre County is suggesting that Tressler failed to identify
the policies or customs that allegedly violated her rights, we disagree. As we set
forth above, Tressler has set for the policies and customs at issue.
We also reject Centre County’s contention that Tressler has not plausibly

alleged that the policies and customs at issue caused a violation of her rights.
Tressler alleges that Centre County and PrimeCare promulgated and maintained
policies and customs that caused her rights to be violated. Doc. 1 ¶ 68. And, she
alleges, if they had enacted appropriate protocols or adequately trained and/or

supervised the individual defendants, she would have received appropriate care and
supervision. Id. ¶ 79. According to Tressler, Centre County and PrimeCare were
deliberately indifferent to her constitutional rights, their polices and customs were

a direct and proximate cause of her injuries and damages, and she suffered
immense physical pain, humiliation, fear, and physical injures as a result of their
policies and customs. Id. ¶¶ 80, 81, 82. Construing these allegations and
Tressler’s other factual allegations regarding the care that she received in the light

most favorable to her, as we must when deciding a motion to dismiss, Tressler has
plausibly alleged the Centre County’s policies and customs caused a violation of
her right to medical care.

Centre County may also be suggesting that because it contracted with
PrimeCare to provide medical care, it cannot be liable. If that is what it is
suggesting, it is wrong.

Centre County had a constitutional obligation to provide medical care to its
prisoners and detainees. Ponzini v. Monroe Cnty., No. 3:11-CV-00413, 2015 WL
5123720, at *10 (M.D. Pa. Aug. 31, 2015) (Mariani, J.). The fact that it contracted
with PrimeCare to provide that medical care does not absolve the County of its

duty. Id. at 11. Rather, despite the contract, ‘“the county itself remains liable for
any constitutional deprivations caused by the policies or customs of”’ its contract-
medical provider. Id. (quoting Ancata v. Prison Health Servs., Inc., 769 F.2d 700,

705 (11th Cir. 1985)). ‘“In that sense, the county’s duty is non-delegable.”’ Id.
(quoting Ancata, 769 F.2d at 705).
Thus, Centre County “has potential liability stemming from its own,
independent obligation to police its medical services contract with PrimeCare

Medical, Inc.” Id. (denying summary judgment to Monroe County based on its
potential liability stemming from its obligation to police its contract for medical
care with PrimeCare Medical, Inc.); see also Ravert v. Monroe Cnty., No. 4:20-

CV-0889, 2021 WL 1017372, at *7 (M.D. Pa. Mar. 17, 2021) (Arbuckle, M.J.)
(analogizing that case to Ponzini and denying motion to dismiss filed by Monroe
County given that the plaintiff had alleged a Monell claim against PrimeCare

Medical, Inc.); Whitehurst v. Lackawanna Cnty., No. CV 3:17-903, 2020 WL
6083409, at *4 (M.D. Pa. Oct. 15, 2020) (Mannion, J.) (agreeing with the
reasoning of Ponzini and denying summary judgment to the County given that

there were questions of fact about the County’s vigilance in supervising its contract
with the contract medical provider). And “[w]hile the Court recognizes that
‘prison officials cannot be required to second guess the medical judgment of the
[staff] physician,’ [the County’s] contractual position vis-à-vis PrimeCare Medical,

Inc. is an altogether different type of relationship than that between an on-the-
ground medical provider and a correctional officer working” at the prison. Ponzini,
2015 WL 5123720, at *11 (quoting Ellison v. Scheipe, 570 F. Supp. 1361, 1363

(E.D. Pa. 1983)). The County’s “potential liability arises from its policy of
contracting away of a nondelegable duty coupled with its [alleged] failure to
ensure that the contract was properly carried out and the nondelegable duty met.”
Id. at * 11 n.15.

Based on the foregoing, to the extent that Centre County is suggesting that it
cannot be liable because PrimeCare was providing contract medical care to its
prisoners and detainees, we reject that suggestion.
In sum, the complaint states a denial-of-medical-care claim upon which
relief can be granted against Centre County.

V. Leave to Amend.
“[I]f a complaint is subject to a Rule 12(b)(6) dismissal, a district court must
permit a curative amendment unless such an amendment would be inequitable or
futile.” Phillips v. County of Allegheny, 515 F.3d 224, 245 (3d Cir. 2008). In a

civil-rights action, the court “must provide the plaintiff with this opportunity even
if the plaintiff does not seek leave to amend.” Id.
It would be futile to allow Tressler to amend her complaint as to the failure-

to-protect claims against the Individual County Defendants given that they are
entitled to qualified immunity. But given the liberal-amendment standard, and in
an abundance of caution, we will provide Tressler an opportunity to amend her

complaint to attempt to state a denial-of-medical-care claim upon which relief can
be granted against defendant Medford.

VI. Conclusion.
For the reasons set forth above, the County defendants’ motion to dismiss
will be granted in part and denied in part. The motion will be granted to the extent

that all claims against defendants CCCF, Irwin, and Schell will be dismissed. The
motion will also be granted to the extent that the failure-to-protect claims against
defendants Medford, Vangorder, Rupert, Quigley, and Napoleon will be dismissed,

and the denial-of-medical-care claim against defendant Medford will be dismissed.
The motion will further be granted to the extent that the Tressler’s demand for a
specific monetary amount will be stricken. The motion will otherwise be denied.

We will grant Tressler leave to amend as set forth above. An appropriate order
follows.

S/Susan E. Schwab
Susan E. Schwab
United States Magistrate Judge

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10755589. Public record. Not legal advice.