Miles v. Rogers County Board of Commissioners

IN THE UNITED STATES DISTRICT COURT FOR THE

NORTHERN DISTRICT OF OKLAHOMA

MELISHA MILES, as Guardian of

FRANCIS PATTON, an incapacitated

Person,

Plaintiff, Case No. 24-CV-417-GAG-MTS

v.

ROGERS COUNTY BOARD OF

COMMISSIONERS, et al.,

Defendants.

OPINION AND ORDER

GUSTAVO A. GELPÍ, Circuit Judge.1

Before the court is Defendant Turn Key Health Clinics, LLC's ("Turn Key") Motion to

Dismiss (Dkt. No. 16) pursuant to Federal Rule of Civil Procedure 12(b)(6) ("Rule 12(b)(6)"). For

the reasons stated below, the motion to dismiss is GRANTED IN PART and DENIED IN PART.

I. BACKGROUND

Plaintiff Melisha Miles ("Plaintiff"), as guardian of Francis Patton ("Patton"), alleges the

following facts in the Complaint. On January 10, 2023, police officers conducted a well-being

check on Patton. (Dkt. No. 2-2.) After he failed the Standard Field Sobriety test, the officers took

him into custody under the suspicion that he was driving under the influence. (Id. at 6.) The

officers did not obtain medical clearance for Patton before booking him into jail. (Id.) While

Patton was in his jail cell, employees of the jail witnessed him behaving "erratically," including

pacing, stripping naked, and "[u]sing his underwear to clean things." (Id. at 7.) Patton remained

1 The Honorable Gustavo A. Gelpí, Circuit Judge, United States Court of Appeals for the First

Circuit, sitting by designation.

untreated in the jail cell for approximately two days. (Id. at 8.)

After those two days, Patton was transported to a mental health center and, later, to an

emergency room. (Id.) At the emergency room, he was diagnosed with severe sepsis, acute kidney

failure, rhabdomyolysis, a non-ST elevated myocardial infarction ("NSTEMI"), tachycardia, and

fever. (Id.) He, ultimately, was admitted into an intensive care unit and remained hospitalized for

over 60 days. (Id.) He was later diagnosed with HSV encephalitis which, with early detection and

treatment, are "fully resolved with prescription medication." (Id.) Due to his HSV encephalitis,

Patton is now "significantly debilitated," physically and mentally, and requires full-time care. (Id.

at 9.) He has been declared incompetent and placed under guardianship. (Id.)

On June 27, 2024, Plaintiff filed the Complaint alleging these facts against seven

defendants. (Id.) Those defendants included: the Rogers County Board of Commissioners; Scott

Walton (the Rogers County Sheriff); Zachary Starkey (the Jail Administrator of Rogers County);

Brandon Masingale (the Assistant Jail Administrator of Rogers County); Turn Key (an

independent contractor who provided medical services at the Amos G. Ward Detention Center (the

"Detention Center")); and two John Does (defined, respectively, as all officers at the Detention

Center and all medical personnel at the Detention Center). (Id. at 2-3.) Plaintiff sued under 42

U.S.C. § 1983, alleging violations of the Eighth and Fourteenth Amendments. (Id. at 13-81; Dkt.

No. 16 at 6.) Plaintiff asserts that Defendants' two-day delay in seeking medical care for Patton

resulted in his permanent incapacitation. (Dkt. No. 2-2 at 13.)

As it relates to Turn Key, Plaintiff's Complaint stated that Turn Key has a business model

that generates revenue through government contracts. (Id. at 11.) The Complaint further explained

that, through those contracts, Turn Key "assumes responsibility for the government's obligation to

provide healthcare services to people who are not free to seek out healthcare for themselves." (Id.)

At the direction of Turn Key, the highest trained medical provider at each jail is generally a

Licensed Practical Nurse ("LPN"). (Id. at 12.) Turn Key also "has a Nurse Practitioner or M.D."

on call, who is available if a LPN believes that the advice or opinion of a qualified medical provider

is needed. (Id.) LPNs cannot, themselves, assess or diagnose a medical condition. (Id.)

Plaintiff asserts that Turn Key does not provide training to LPNs on the "symptoms which

warrant contacting" a qualified medical provider. (Id.) Plaintiff also states that Turn Key is aware

that this lack of training "creates a scenario whereby serious conditions of detainees go unassessed,

undiagnosed, and untreated" because the LPNs do not know when to contact on-call medical

providers. (Id.) Plaintiff insists that this deficiency results in a denial of necessary medical care

and that Turn Key deliberately overlooks this truth, in favor of "turning profits for its

shareholders." (Id.) Plaintiff complains that Patton's scenario occurred due to Turn Key's policy

of "placing delusional, nonresponsive inmates into confinement without any form of medical

attention or evaluation." (Id. at 12-13.) Turn Key moves to dismiss all claims against it for failure

to state a claim pursuant to Rule 12(b)(6).

II. DISCUSSION

"The court's function on a Rule 12(b)(6) motion is not to weigh potential evidence that the

parties might present at trial, but to assess whether the plaintiff's . . . complaint alone is legally

sufficient to state a claim for which relief may be granted." Brokers’ Choice of Am., Inc. v. NBC

Universal, Inc., 757 F.3d 1125, 1135 (10th Cir. 2014) (quoting Peterson v. Grisham, 594 F.3d 723,

727 (10th Cir. 2010)). A complaint is legally sufficient only if it contains factual allegations such

that it states a claim to relief that "is plausible on its face." Bell Atl. Corp. v. Twombly, 550 U.S.

544, 570 (2007). "While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need

detailed factual allegations, a plaintiff's obligation to provide the 'grounds' of his 'entitle[ment] to

relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a

cause of action will not do." Id. at 555 (internal citations omitted) (alteration original). Instead,

"[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." Ashcroft v.

Iqbal, 556 U.S. 662, 678 (2009) (citing Twombly, 550 U.S. at 556). For the purpose of making the

dismissal determination, a court "must accept all the well-pleaded allegations of the complaint as

true and must construe them in the light most favorable to the plaintiff." Alvarado v. KOB–TV,

L.L.C., 493 F.3d 1210, 1215 (10th Cir. 2007) (quoting David v. City & Cnty. of Denver, 101 F.3d

1344, 1352 (10th Cir. 1996)).

In its motion to dismiss, Turn Key presses three main arguments: (1) Plaintiff did not set

forth an actionable section 1983 deliberate indifference claim against Turn Key; (2) Plaintiff has

failed to allege facts sufficient to support a section 1983 claim against Turn Key pursuant to the

municipal theory of liability; and (3) Plaintiff's state law claims fail under the Oklahoma

Governmental Tort Claims Act ("GTCA").

A. Plaintiff pleaded facts sufficient to sustain the section 1983 deliberate indifference claim

against Turn Key.

"A prison official's deliberate indifference to an inmate's serious medical needs violates the

Eighth Amendment." Sealock v. Colorado, 218 F.3d 1205, 1209 (10th Cir. 2000) (citing Estelle

v. Gamble, 429 U.S. 97, 102 (1976)). The deliberate indifference standard applies to pretrial

detainees through the Fourteenth Amendment. See Paugh v. Uintah Cnty., 47 F.4th 1139, 1153-54

(10th Cir. 2022) (citing Burke v. Regalado, 935 F.3d 960, 992 (10th Cir. 2019)). The Tenth Circuit

applies "the two-part Eighth Amendment inquiry when a pretrial detainee alleges deliberate

indifference to serious medical needs." Quintana v. Santa Fe Cnty. Bd. of Comm'rs, 973 F.3d

1022, 1028 (10th Cir. 2020). "This exercise requires both an objective and a subjective inquiry."

Id. (citing Martinez v. Beggs, 563 F.3d 1082, 1088 (10th Cir. 2009)). "The objective component

is met if the deprivation is 'sufficiently serious' . . . . The subjective component is met if a prison

official 'knows of and disregards an excessive risk to inmate health or safety.'" Sealock, 218 F.3d

at 1209 (quoting Farmer v. Brennan, 511 U.S. 825, 834, 837 (1994)).

There are "two types of conduct constituting deliberate indifference. First, a medical

professional may fail to treat a serious medical condition properly." Id. at 1211. Second, a prison

official may "prevent an inmate from receiving treatment or deny him access to medical personnel

capable of evaluating the need for treatment." Id. If "the medical professional knows that his

role . . . is solely to serve as a gatekeeper for other medical personnel capable of treating the

condition, and if he delays or refuses to fulfill the gatekeeper role due to deliberate

indifference, . . . he also may be liable for deliberate indifference from denying access to medical

care." Id. Plaintiff alleges that the medical professionals failed to meet their duties under both

types of conduct.2 (Dkt No. 2-2 at 21.)

Turn Key concedes that Patton's alleged permanent incapacitation is "sufficiently serious

to satisfy the objective component." (Dkt. No. 16 at 9-10.) It argues, however, that Plaintiff has

not pleaded "facts sufficient to satisfy the subjective component." (Id. at 10.) Turn Key appears

to make two arguments on that score: (1) that Plaintiff has not alleged facts to show it was "obvious

that [Patton] was suffering from HSV encephalitis or any other serious medical condition" (Id.)

and (2) that Plaintiff has not alleged that a "Turn Key medical provider knew of and disregarded a

significant risk of harm facing [Patton] of being permanently incapacitated from HSV

encephalitis" (Id. at 12). The court addresses each argument in turn.

1. Obvious risk

"When a risk is obvious, it is circumstantial evidence of an official's awareness of serious

2 Turn Key's argument that "there is no constitutional right to an evaluation by “someone with

more training" (Dkt. No. 16 at 10) is, thus, inapposite. Plaintiff has plausibly alleged that the Turn

Key professionals knew that their role was to serve as "gatekeepers" and that their actions were

not sufficient to discharge that gatekeeping obligation. See Mata v. Saiz, 427 F.3d 745, 758–60

(10th Cir. 2005); (Dkt No. 2-2 at 21).

medical need." Lucas v. Turn Key Health Clinics, LLC, 58 F.4th 1127, 1139 (10th Cir. 2023)

(citing Self v. Crum, 439 F.3d 1227, 1231-32 (10th Cir. 2006)). Turn Key emphasizes that

"Plaintiff [did] not properly allege that HSV encephalitis has an obvious presentation or tell-tale

signs and symptoms." (Dkt. No. 16 at 11.) It also states that "there is no basis whatsoever to find

that [Patton's] alleged serious medical condition would have been obvious to a layperson." (Id. at

13.) Turn Key does not point to any case law that would demand either of these requirements.

Nor could it, as the Tenth Circuit has plainly stated that "a medical condition is not required to be

obvious to a layman to state a claim." Lucas, 58 F.4th at 1139.3 Rather, obviousness to a layperson

is:

merely one of several contexts in which deliberate indifference can be shown.

Circumstantial evidence of obviousness in a missed diagnosis or delayed referral

appears in contexts including (1) recognition of inability to treat and still declining

or unnecessarily delaying referral; (2) condition is so obvious a layman would

recognize it; or (3) complete denial of care in the face of a medical emergency.

Id. (citing Self, 439 F.3d at 1232).

As Turn Key notes, the Tenth Circuit has held that "characteristics . . . common to many

intoxicated individuals" may not always present an "obvious" risk. See Martinez, 563 F.3d at

1091. But, taking the Complaint's allegations as true, the court finds that a reasonable jury could

conclude that the seriousness of the medical risks associated with the whole of Patton's symptoms

would be obvious to a reasonable observer. See Mata, 427 F.3d at 752 (citing Garrett v. Stratman,

254 F.3d 946, 950 (10th Cir. 2001)). In particular, Plaintiff's allegations that Patton's symptoms

worsened over time could support a jury's finding that it was "obvious" Patton needed medical

assistance. See Paugh, 47 F.4th at 1158 ("[A] reasonable jury could find that it would have been

'obvious' to any reasonable jail official that [pretrial detainee] needed medical assistance if the

3 This is especially true where, as here, a licensed medical professional is involved, whose

"heightened knowledge and training can be highly relevant." See id.

Individual Defendants saw [pretrial detainee's] condition worsening." (citing Gibson v. Cnty. of

Washoe, 290 F.3d 1175, 1188 (9th Cir. 2002), overruled on other grounds by Castro v. Cnty. of

Los Angeles, 833 F.3d 1060, 1076 (9th Cir. 2016))).

2. Knowledge of the specific risk of harm

The subjective component of a deliberate indifference claim "requires the prison official to

disregard the risk of harm claimed by the prisoner." Martinez, 563 F.3d at 1089. Turn Key asserts

that the Complaint "does not plead any facts that would support a theory that a Turn Key medical

provider knew that Mr. Patton's alleged symptoms were as a result of his HSV encephalitis and

that they did nothing." (Dkt. No. 16 at 11.) It also states that "[t]o be actionable, Plaintiff must

properly allege that a Turn Key medical provider knew of and disregarded a significant risk of

harm facing Mr. Patton of being permanently incapacitated from HSV encephalitis." (Id. at 12.)

Turn Key cites only Crocker v. Glanz, 752 F. App'x. 564 (10th Cir. 2018), in support of its

argument on this point. (Dkt. No. 16 at 12.) But, as Plaintiff notes, the weight of authority shows

that the Complaint need only allege that Turn Key was aware that Patton faced a substantial risk

of harm to his health and safety. See Lucas, 58 F.4th at 1141 (citing Farmer, 511 U.S. at 842).

Contrary to Turn Key's argument, the Complaint need not show that Turn Key was "consciously

aware [Patton] had a specific ailment." See id. ("[T]he complaint need not show [defendant] was

consciously aware [plaintiff] had a specific ailment -- cervical cancer -- but rather that [defendant]

was aware [plaintiff] faced a substantial risk of harm to [plaintiff's] health and safety."). Plaintiff

plausibly alleges that the Turn Key medical professionals were faced with symptoms of a serious

medical condition, whether or not they knew at the time what that specific condition was. In short,

this court cannot say that post-discovery, Plaintiff will not be able to "provide evidence supporting

an inference that defendant[] knew about and disregarded a substantial risk of harm to [Patton's]

health and safety." See Mata, 427 F.3d at 752 (citing Hunt v. Uphoff, 199 F.3d 1220, 1224 (10th

Cir. 1999)).

B. Plaintiff pleaded facts sufficient to sustain the Section 1983 claim against Turn Key

pursuant to a municipal theory of liability.

Turn Key next argues that Plaintiff has failed to "properly plead what is required to subject

Turn Key to liability pursuant to the municipal theory of liability." (Dkt. No. 16 at 13.)

"Under Monell, a plaintiff may sue local governing bodies directly for constitutional

violations pursuant to the body's policies." Lucas, 58 F.4th at 1144 (quoting Monell v. Dep't of

Soc. Servs., 436 U.S. 658, 690 (1978)). "Monell has been extended to 'private entities acting under

color of state law,' such as medical contractors." Id. (quoting Dubbs v. Head Start, Inc., 336 F.3d

1194, 1216 (10th Cir. 2003)). To establish Monell liability, the plaintiff must allege an "(1) official

policy or custom[,] (2) causation, and (3) state of mind." Hinkle v. Beckham Cnty. Bd. of Cnty.

Comm’rs, 962 F.3d 1204, 1239 (10th Cir. 2020) (alteration in original) (internal quotation marks

omitted) (quoting Burke v. Regalado, 935 F.3d 960, 998 (10th Cir. 2019)). Policies or customs

meeting the standard may arise from "a formal regulation or policy statement, an informal custom

that amounts to a widespread practice, . . . and the deliberately indifferent failure to adequately

train or supervise employees." Id. at 1239-40 (quoting Pyle v. Woods, 874 F.3d 1257, 1266 (10th

Cir. 2017)).

Turn Key presses that Plaintiff "must demonstrate a direct causal link between the

municipal action and the deprivation of federal rights to establish deliberate indifference under the

Monell theory of municipal liability." (Dkt. No. 16 at 14.) It further contends that Plaintiff "must

properly plead Mr. Patton’s incapacitation from HSV encephalitis was directly caused by one of

the alleged identified official policies or customs of Turn Key or that one of the alleged identified

policies or customs of Turn Key was a moving force behind Mr. Patton’s incapacitation." (Id. at

15.) Turn Key believes that Plaintiff has not alleged a sufficient nexus between Turn Key's policies

and Patton's alleged condition. (Id. at 16.)

Plaintiff alleges that Turn Key is responsible for "provid[ing] healthcare services in return

for payment." (Dkt. No. 2-2 at 11.) She further alleges that Turn Key makes "policy choices to

pursue profits at the direct detriment of medical care provided to inmates." (Id. at 12.) Her

Complaint lists "lack of training" of certain Turn Key employees and the non-completion of

medical intake screenings as part and parcel of these policy choices. (Id.) It also alleges that these

policy choices caused Patton's "deprivation of medical care," "delay in evaluation and treatment,"

and "incapacitation." (Id. at 13.) This court cannot say with certainty whether Plaintiff will be

able to prove causation, but at the pleading stage, the Complaint's allegations are sufficient to state

a Monell claim. See Quintana, 973 F.3d at 1033-34 ("[W]e cannot determine from the face of the

proposed [amended complaint] whether the plaintiffs will be able to substantiate their Monell

claim.").

C. Plaintiff's state law claims are dismissed pursuant to the GTCA.

Turn Key requests that this court decline to exercise supplemental judication over

Plaintiff’s state cause(s) of action, should this court grant its motion to dismiss with respect to the

federal claims. (Dkt. No. 16 at 19.) This court exercises its discretion to address the state law

claims. See United Int'l Holdings v. Wharf (Holdings), 210 F.3d 1207, 1220 (10th Cir. 2000)

("Once federal question jurisdiction exists, it is within the trial court's discretion to exercise

supplemental jurisdiction over those state law claims that derive from a common nucleus of facts."

(citing Thatcher Enters. v. Cache Cnty. Corp., 902 F.2d 1472, 1477 (10th Cir. 1990))).

Plaintiff has filed a negligence claim and a negligent hiring retention, training, and

supervision claim against Turn Key. (Dkt. No. 2-2 at 13-14.) Turn Key seeks dismissal of the

state law claims, arguing (1) that it is immune from liability under the GTCA, Okla. Stat. tit. 51,

§ 152.1, and (2) that the claim is barred by the statute of limitations. (Dkt. No. 16 at 19.)

1. Plaintiff's state law claims are not barred by the statute of limitations.

Turn Key and Plaintiff spar over the applicable statute of limitations. (Id. at 20; Dkt. No.

20 at 19.) Turn Key argues that Okla. Stat. tit. 12, § 95(A)(11) bars Plaintiff's state law claims.

(Dkt. No. 16 at 20.) That statute provides: "All actions filed by an inmate or by a person based

upon facts that occurred while the person was an inmate in the custody of . . . a contractor of the

State of Oklahoma," including "claims for injury to the rights of another, shall be commenced

within one (1) year after the cause of action shall have accrued." 12 Okla. Stat. § 95(A)(11).

"However, where a prisoner, former prisoner, or, as in this case, prisoner's next friend

brings a tort action against a private correctional facility, 'the GTCA is controlling.'" Stewart v.

Turn Key Health Clinics, LLC, 2024 WL 4543201, at *4 (W.D. Okla. Oct. 22, 2024) (collecting

cases). "The relevant notice provisions of the GTCA require a person to 'present a claim to the

state or political subdivision for any appropriate relief . . . . within one (1) year of the date the loss

occurs.'" Id. (quoting 51 Okla. Stat. § 156(A)-(B)). "'A person may not initiate a suit against the

state or a political subdivision unless the claim has been denied in whole or in part' by the state or

political subdivision." Id. "'Because under GTCA's § 157(A) the right to sue does not attach until

the claim has been denied or is deemed denied,' the Oklahoma Supreme Court has held 'that causes

of action brought under the GTCA do not accrue until that point.'" Id. (quoting Brown v. Creek

Cnty. ex rel. Creek Cnty. Bd. of Cnty. Comm'rs, 164 P.3d 1073, 1075 (Okla. 2007)).

Turn Key argues that 12 Okla. Stat. § 95(A)(11) bars Plaintiff's state law claims (Dkt. No.

16 at 20), but the GTCA supersedes Oklahoma state law. See Stewart, 2024 WL 4543201, at *4.

Turn Key also makes no argument as to the statute of limitations under the GTCA. Turn Key's

argument to dismiss based on the statute of limitations thus fails.

2. Turn Key's argument on immunity in tort pursuant to the GTCA warrants dismissal of

the state law claims.

The parties also dispute whether Turn Key is entitled to immunity under the GTCA. (Dkt

No. 16 at 16; Dkt. No. 20 at 20.) The GTCA provides that "[t]he state, its political subdivisions,

and all of their employees acting within the scope of their employment . . . shall be immune from

liability for torts." Okla. Stat. tit. 51, § 152.1(A). "Beginning in 2007 section 152 of the GTCA

stated an 'employee' includes licensed medical professionals under contract with city, county, or

state entities and providing medical care to inmates or detainees in the custody or control of law

enforcement agencies." Sanders v. Turn Key Health Clinics, 566 P.3d 591, 604 (Okla. 2025).

In making its argument for immunity, Turn Key relies on a 2018 Oklahoma Supreme Court

case, Barrios v. Haskell Cnty. Pub. Facilities Auth., 432 P.3d 233, 241 (Okla. 2018). Citing the

GTCA immunity provisions, Turn Key argues that "state actors are exempt as a matter of law from

liability for certain tort claims, such as those arising out of '[p]rovision, equipping, operation or

maintenance of any prison, jail or correctional facility.'" (Dkt. No. 16 at 22.) It says "there is no

question that Turn Key and its employees are insulated from liability in tort pursuant to the

GTCA." (Id.) In response, Plaintiff presses that the statute "specifically applies to licensed

medical professionals, not healthcare corporations such as Turn Key." (Dkt. No. 20 at 21.) It also

points the court to Lucas, 58 F.4th 1127, which held that immunity of this type is premature at the

motion to dismiss stage. Id.; Lucas, 58 F.4th at 1148.

The Tenth Circuit stated that determination of whether Turn Key was "entitled to immunity

based on Barrios’s non-binding legal assumption, which was decidedly not an express statement

of law[,]" is inappropriate at the pleading stage. See Lucas, 58 F.4th at 1148. However, the Lucas

opinion was based on "no Oklahoma court" having developed footnote five (the relevant text from

Barrios) at the time the Lucas decision was issued. Id. at 1147. Since then, the Oklahoma Supreme

Court has made clear that the GTCA:

[M]akes licensed medical professionals to be "employees" of this state, regardless

of the place in this state where duties as employees are performed, when the

licensed medical professionals are under contract, including when under contract

as an independent contractor, with city, county, or state entities and providing

medical care to inmates or detainees in the custody or control of law enforcement

agencies.

Sanders, 566 P.3d at 610. In Sanders, similar claims were brought against Turn Key as the ones

Plaintiff alleges here. See id. at 595. There, plaintiff Sanders filed a petition alleging that Turn

Key "caused the wrongful death of Sanders's wife as a result of her confinement" in an Oklahoma

jail. Id. After four weeks in custody, she was transported to a hospital where she was diagnosed

with, among other things, severe sepsis, acute kidney injury, and anemia. Id. The trial court in

that case granted Turn Key's motion to dismiss pursuant to 12 O.S. § 2012(B)(6), finding Turn

Key to be "immune from liability" under the GTCA. Id. Reviewing the trial court's grant of the

motion to dismiss, the Oklahoma Supreme Court held that under the GTCA, "the status of an

'employee' occurs when the nature of the act is a (1) licensed medical professional, (2) under

contract with a city county or state entity, (3) providing medical care, (4) to inmates or detainees

in the custody or [control of] law enforcement agencies." Id. at 606. It further found that Sanders's

petition alleged that "employees" of Turn Key were "contracted to provide medical care to

inmates." Id. at 609.

Plaintiff's complaint here is materially similar to the Sanders's complaint, in that it is "based

upon Turn Key's status as an independent contractor employing (or contracting with) licensed

medical professionals for the jail." See id. at 610. Thus, in accordance with Sanders, this court

grants Turn Key's motion to dismiss as to the state law negligence claims.4

4 Turn Key also argues that any claims brought by Melisha Miles individually should be dismissed.

(Dkt. No. 16 at 18.) Plaintiff acknowledges that her claims are brought solely in her capacity as

Patton's guardian. (Dkt. No. 20 at 23.)

III. CONCLUSION

For the reasons stated, Defendant Turn Key's motion to dismiss (Dkt. No. 16) is

GRANTED IN PART and DENIED IN PART.

DATED: May 16, 2025

s/ Gustavo A. Gelpí

GUSTAVO A. GELPÍ

United States Circuit Judge, Sitting by Designation