Cyr v. Schuylkill County

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

CATHERINE ANN CYR, : CIVIL ACTION NO. 3:22-CV-453

Administratrix of the Estate of :

VINCENT ALEXANDER DAVALOS, : (Judge Neary)

:

Plaintiff :

:

v. :

:

SCHUYLKILL COUNTY, :

PRIMECARE MEDICAL INC., :

OFFICER BETTINGER, OFFICER :

SABOL LIEUTENANT KEPPEL, :

OFFICER KLINGER, OFFICER FRYE, :

OFFICER BENDER, OFFICER :

RAINIS, NURSE GROSS, and :

NURSE HYSOCK, :

:

Defendants :

MEMORANDUM

When the government holds a person in custody, it is responsible for their

well-being, but it does not have to foresee all potential ailments. This is especially so

when the detainee is already receiving some treatment and does not fully explain

his condition. Plaintiff Catherine Ann Cyr, Administratrix of the Estate of Vincent

Alexander Davalos, initiated this action against defendants after Davalos, her son,

died while in Schuylkill County Prison (“SCP”). Defendants are Nurses Alyssa

Hysock and Carina Gross, PrimeCare Medical Inc. (“PrimeCare”), Officers Cody

Bettinger and Corey Sabol, Lieutenant Gary Keppel, and Schuylkill County.1 She

alleges the defendants failed to provide adequate medical care to Davalos as

required by the Fourteenth Amendment (through 42 U.S.C. § 1983) and, against

only the County, alleges violations of the Americans with Disabilities Act (“ADA”),

42 U.S.C. § 12101, et seq., and the Rehabilitation Act of 1973 (“RA”), 29 U.S.C. § 701,

et seq. All defendants moved for summary judgment, which shall be granted.

I. Factual Background & Procedural History2

On June 9, 2020, Frackville Borough Police responded to a domestic

disturbance call where the suspect, Davalos, was fleeing the scene in a U-Haul

truck. (Doc. 53 ¶¶ 13-16).3 He crashed and was taken into custody. (Id. ¶¶ 16-17).

1 Though her complaint additionally named Officers Frye and Bender in the

caption, no claims were levied against them. Additionally, Cyr did not oppose

granting summary judgment with respect to Officers William Klinger and David

Rainis. (Doc. 69 at 3 n.1). Therefore, summary judgment shall be granted in favor of

these officers.

2 Local Rule 56.1 requires that a motion for summary judgment pursuant to

Federal Rule of Civil Procedure 56 be supported “by a separate, short, and concise

statement of the material facts, in numbered paragraphs, as to which the moving

party contends there is no genuine issue to be tried.” M.D. PA. L.R. 56.1. A party

opposing a motion for summary judgment must file a separate statement of material

facts, responding to the numbered paragraphs set forth in the moving party’s

statement and identifying genuine issues to be tried. Id. Unless otherwise noted,

the factual background herein derives from the parties’ Rule 56.1 statements of

material facts. (See Docs. 53, 56, 66, 68). To the extent the parties’ statements are

undisputed or supported by uncontroverted record evidence, the court cites

directly to the statements of material facts.

3 Nurses Hysock and Gross, along with PrimeCare (“Medical Defendants”)

are jointly represented in this matter and Lt. Keppel, Officers Sabol and Bettinger,

along with the County (“County Defendants”) are jointly represented. Where facts

are shared and undisputed, the court cites to the Medical Defendants’ statement of

material facts for convenience.

While in the back of a police cruiser shortly after being arrested, Davalos was

evaluated by Shenandoah EMS. (See generally Doc. 70-3). During that evaluation,

he was asked “What are you so sweaty from?” to which Davalos replied he had done

a few lines of meth. (Id. at 0:56-1:09). While an EMS technician can be heard saying

Davalos felt “okay” and that he was not “complaining of anything,” (id. at 6:09-6:19),

Davalos asked to be taken to a hospital, (id. at 6:29-6:41). He then appears to clarify,

saying he “wants to work out a deal” which responding police and EMS took to

mean Davalos withdrew the hospital request. (Id. 6:59-7:07). Davalos was arraigned,

and then a state police officer transported Davalos to SCP. (Doc. 53 ¶¶ 21-23). SCP

contracts with PrimeCare to provide medical services to inmates incarcerated

there. (Id. 53 ¶ 2).

Upon arriving at SCP, Davalos underwent an initial screening. (Doc. 53 ¶¶ 24-

25). The purpose of the initial screening was to check Davalos for COVID symptoms

or any injuries requiring hospitalization. (Id. ¶¶ 24-26). If it was reported that the

detainee had recently been in an accident, it was PrimeCare’s policy for the

detainee to go to a hospital first for medical clearance. (Id. ¶ 27).

Nurse Hysock conducted Davalos’s initial screening, as Lt. Keppel watched

on. (Id. ¶¶ 28, 46). During his screening, Davalos reported having taken heroin

earlier that day and appeared intoxicated, as well as sweaty. (Id. ¶¶ 30-32).

Additionally, he reported he was having an asthma attack and needed his inhaler.

(Doc. 53 ¶¶ 36-37). According to Nurse Hysock’s incident report,4 Davalos had an

oxygen saturation level of 97%, a pulse of 92, and clear lungs. (Doc. 53-6). After

conferring with a provider on Davalos’s medical history, Nurse Hysock received an

order for him to be placed on medication tapers to treat the anticipated withdrawal

symptoms. (Doc. 53 ¶ 43). It is disputed whether Nurse Hysock was aware Davalos

had been in an accident. She claims she was unaware of the motor vehicle crash,

(Doc. 53 ¶ 40), but Lt. Keppel stated the transporting officer told them both about

the crash, (Doc. 70-35, Deposition of Gary Keppel (hereinafter “Keppel Dep.”),

13:13-14:3). After completing the screening, Davalos was accepted to SCP and, since

her shift was over, Nurse Hysock left the facility. (Doc. 53 ¶¶ 50, 52).

Officer Bettinger then came to perform the security intake for Davalos. (Id. ¶

53). He answered all of Officer Bettinger’s questions, though he may have nodded

off at times, and Officer Bettinger was able to complete a strip search without issue.

(Id. ¶¶ 55-56; Doc. 70-21 at 17:50-18:30). During intake, Davalos was allowed to call

his mother. (Doc. 56 ¶ 31). Cyr claims that during this call, Davalos told her “he

couldn’t breathe” as Officer Bettinger listened on. (Doc. 70-24 at 84:1-18). Davalos

also asked Officer Bettinger for his inhaler at some point during intake, but the

officer did not provide him with one or take any other action on Davalos’s request.

(Doc. 70-21 at 20:22-20:52). After the security screening, Davalos was taken to Echo

4 Nurse Hysock’s incident report was not created contemporaneously with

her examination of Davalos, but rather, at 9:45 p.m., after Davalos had been

pronounced deceased. (Doc. 53-6; Doc. 53 ¶ 85; Doc. 56 ¶ 40; Doc. 66 ¶ 84). SCP

requested Nurse Hysock complete the incident report after Davalos’s death, which

is typical in that type of situation. (Doc. 70-10 39:16-40:20).

Block, where correctional officers were to conduct hourly checks. (Doc. 53 ¶¶ 60-61).

It was corporate policy for PrimeCare to conduct a lengthy, detailed medical

screening within four hours of an inmate’s arrival to a facility. (Id. ¶¶ 62, 65).

Officer Sabol was the guard working at Echo Block the day Davalos was at

the jail. (Doc. 70-28, Deposition of Cory Sabol, 29:9-23). When Officer Sabol was

collecting dinner trays from the inmates, Davalos said he had trouble breathing and

needed his inhaler. (Id. at 31:12-14). At that point, Nurse Gross was called to Echo

Block to evaluate Davalos. (Doc. 53 ¶ 68). When she arrived, she found Davalos

having seizure-like activity with tremors in his arms. (Id. ¶¶ 69-70). Nurse Gross

then administered an ammonia inhalant. (Id. ¶ 71). After being given the inhalant,

she found Davalos able to follow commands, his pupils equal and reactive, and that

his vital signs were stable and within normal limits. (Id. ¶¶ 72-73). Davalos was

scheduled to receive his medications to treat withdrawal symptoms at around 9 p.m.

(Id. ¶ 78).

Davalos was then left undisturbed. Officer Sabol would conduct checks of the

inmates every so often. Video evidence shows Officer Sabol walking on Davalos’s

room’s level from 4:04 p.m. to 4:13 p.m., 5:29 p.m. to 5:32 p.m., various times

between 5:49 p.m. to 6:15 p.m., 7:38 p.m. to 7:39 p.m., and lastly at 7:42 p.m. (See

generally, Doc. 70-27). During that last check, Officer Sabol discovered Davalos

lying in his cell. (Doc. 66 ¶ 84). Lifesaving measures were undertaken, and Davalos

was transported a hospital and pronounced dead at 8:31 p.m. (Doc. 53 ¶ 85; Doc. 56 ¶

40; Doc. 66 ¶ 84). An autopsy report determined the cause of death to be acute

fentanyl and amphetamine/methamphetamine toxicity caused by the rupture of one

of three bags of fentanyl that Davalos had ingested. (Doc. 53 ¶¶ 86-87). At no point

did anyone ask Davalos if he had ingested any drugs, nor did Davalos ever

volunteer that information. (Doc. 53 ¶¶ 51, 58, 74; Doc. 66 ¶¶ 51, 58, 74).5 In other

words, it was not until the autopsy that anyone other than Davalos learned that he

had ingested three bags of fentanyl.

II. Legal Standard

Rule 56 of the Federal Rules of Civil Procedure provides that summary

judgment is appropriate if the moving party “shows that there is no genuine dispute

as to any material fact and the movant is entitled to judgment as a matter of law.”

FED. R. CIV. P. 56(a). A factual dispute is material if resolution of it “might affect the

outcome of the suit under the governing law” and genuine “if the evidence is such

that a reasonable jury could return a verdict for the nonmoving party.” Mall

Chevrolet, Inc. v. General Motors LLC, 99 F.4th 622, 631 (3d Cir. 2024) (quoting

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). When considering a

motion for summary judgment, a court must view the evidence in the light most

favorable to the non-moving party. Tolan v. Cotton, 572 U.S. 650, 657 (2014) (citing

Adickes v. S.H. Kress & Co., 398 U.S. 144, 157 (1970)). The court’s duty is not “to

5 Officer Bettinger claims to ask all inmates if they have any drugs “in or on

you” yet, there was never a specific finding made to Davalos. (Doc. 66 ¶ 57).

Additionally, there is no documentation to support Officer Bettinger having ever

asked about drug use. (Id.). Looking at the evidence in the light most favorable to

Cyr, the court assumes Officer Bettinger never asked whether Davalos had drugs in

him for the purposes of this opinion.

weigh the evidence and determine the truth of the matter but to determine whether

there is a genuine issue for trial.” Anderson, 477 U.S. at 242-43.

There are “two closely related methods for a movant to succeed at summary

judgment.” Mall Chevrolet, 99 F.4th at 630. “First, under the standard approach, the

moving party may produce material facts, established as genuinely undisputed, that

entitle it to judgment as a matter of law.” Id. (citing FED. R. CIV. P. 56(a)). “Second,

under the Celotex approach, a moving party may instead demonstrate that the

nonmoving party has not made ‘a showing sufficient to establish the existence of an

element essential to that party’s case on which that party will bear the burden of

proof at trial.’” Id. (quoting Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986)).

The nonmoving party can defeat a motion for summary judgment by

producing evidence to establish a genuine issue of material fact. Anderson, 477 U.S.

at 256. The nonmoving party “may not rest upon mere allegation or denials of his

pleading, but must set forth specific facts showing that there is a genuine issue for

trial.” Id. The party “must do more than simply show that there is some

metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co., Ltd. v.

Zenith Radio Corp., 475 U.S. 574, 586 (1986). “The mere existence of a scintilla of

evidence in support of the plaintiff’s position will be insufficient; there must be

evidence on which the jury could reasonably find for the plaintiff.” Anderson, 477

U.S. at 252. Moreover, if the nonmovant’s version of disputed facts is “blatantly

contradicted by the record, so that no reasonable jury could believe it, a court

should not adopt that version of the facts for purposes of ruling on a motion for

summary judgment.” Scott v. Harris, 550 U.S. 372, 380 (2007).

III. Discussion

As Cyr claims all defendants provided inadequate medical care to Davalos,

the court begins with that claim.

A. Applicable Law

To prevail on an inadequate medical care claim, “a plaintiff must make (1) a

subjective showing that ‘the defendants were deliberately indifferent to [his or her]

medical needs’ and (2) an objective showing that ‘those needs were serious.’”

Pearson v. Prison Health Serv., 850 F.3d 526, 534 (3d Cir. 2017) (quoting Rouse v.

Plantier, 182 F.3d 192, 197 (3d Cir. 1999)). There is no dispute in this case whether

Davalos’s medical needs were serious; they were. (Doc. 54 at 11; see generally Doc.

59).6 As such, the analysis now turns to whether the record can establish deliberate

indifference in this case.

1. Applicability of Kingsley

Before getting to the claims themselves, Cyr raises a jurisprudential issue.

Per the Third Circuit Court of Appeals, a claim of inadequate medical care for a

pre-trial detainee, brought under the Fourteenth Amendment, is currently

evaluated under the same standard as a convicted prisoner’s claim under the

Eighth Amendment. Hubbard v. Taylor, 399 F.3d 150, 166 n.22 (3d Cir. 2005). Cyr,

however, urges the court to adopt a standard of “objective unreasonableness” as

articulated in Kingsley v. Hendrickson, 576 U.S. 389, 396-97 (2015). (Doc. 67 at 4).

6 Though in the question presented, the County Defendants say Davalos’s

needs were not serious, (Doc. 59 at 4), in the body of the brief, they attack whether

anyone in the prison knew if his conditions were serious, (id. at 8-9).

Although Kingsley deals with a pre-trial detainee, the Court only analyzed an

excessive force claim, not a claim of inadequate medical care. Kingsley, 576 U.S. at

391-92. To date, our court of appeals has yet to comment on whether Kingsley

applies to areas outside of excessive force for pre-trial detainees. Moore v. Luffey,

767 F. App’x 335, 340 n.2 (3d Cir. 2019) (non-precedential).7 Instead, post-Kingsley,

the Third Circuit and other district courts within its ambit have applied the

deliberate indifference standard in non-excessive force contexts. See e.g., Thomas

v. City of Harrisburg, 88 F.4th 275, 281 & n. 23 (3d Cir. 2023); Andrews v. Harper,

576 F. Supp. 3d 305, 314 (W.D. Pa. 2021) (collecting cases).

Until our court of appeals rules otherwise, this court declines Cyr’s invitation

to depart from existing caselaw and continues to apply the established precedent

analyzing Fourteenth Amendment deliberate indifference claims under the Eighth

Amendment’s framework. Cf. United States v. Orocio, 645 F.3d 630, 648 (3d Cir.

2011) (Chagares, J., concurring) (cautioning against “extrapolating from [a Supreme

Court case’s] implications a holding on an issue that was not before that Court in

order to upend settled circuit precedent.”), abrogated by Chaidez v. United States,

568 U.S. 342 (2013).

7 This court notes there is a split among other circuits as to whether the

Kingsley analysis should be extended beyond the force context. See Brawner v.

Scott Cnty., Tennessee, 14 F.4th 585, 595-94, 596 (6th Cir. 2021) (identifying the

Second, Seventh, Ninth, and, later in that opinion, the Sixth Circuits expanding

Kingsley while the Fifth, Eighth, Tenth, and Eleventh Circuits not extending

Kingsley to non-excessive force claims).

2. Deliberate Indifference

When analyzing a deliberate indifference claim, our court of appeals has

clarified:

there are two very distinct subcomponents to the deliberate

indifference prong of an adequacy of care claim. The first is the

adequacy of the medical care—an objective inquiry where expert

testimony could be helpful to the jury. The second is the individual

defendant’s state of mind—a subjective inquiry that can be proven

circumstantially without expert testimony.

Pearson, 850 F.3d at 536. In this case, Cyr’s expert has opined that the care provided

to Davalos was inadequate. (Doc. 51-2 at 8). In viewing the record in the light most

favorable to Cyr, the court will assume that prong of deliberate indifference has

been met. Thus, to grant defendants’ motions, they must show there is no dispute

about the subjective state of mind of the individual defendants.

To prove deliberate indifference, a plaintiff must show “that prison officials

knew of and disregarded ‘an excessive risk to inmate health or safety,’ meaning a

‘substantial risk of serious harm.’” Durham v. Kelley, 82 F.4th 217, 229 (3d Cir. 2023)

(quoting Farmer v. Brennan, 511 U.S. 825, 837 (1994)). “Indifference to a substantial

risk of serious harm is manifested by an intentional refusal to provide care, delayed

medical treatment for non-medical reasons, denial of prescribed medical treatment,

or a denial of reasonable requests for treatment that leads to suffering or risk of

injury.” Id. at 230 (citing Durmer v. O’Carroll, 991 F.2d 64, 68 (3d Cir. 1993)).

B. The Medical Defendants

Cyr alleges Nurses Hysock and Gross denied Davalos adequate medical care,

and that their employer, PrimeCare, should be liable for failure to train them. The

Medical Defendants argue that the undisputed material facts concerning deliberate

indifference entitle them to summary judgment. They are correct, and summary

judgment will be granted in their favor.

1. Nurse Hysock

The strongest fact cited by Cyr in support of claims against Nurse Hysock is

that the transporting officer told her Davalos had been in a motor accident. (Doc. 66

¶ 27). However, while perhaps establishing negligence, such fact does not establish

Nurse Hysock was deliberately indifferent to Davalos’s condition. Nowhere in the

record is there anything establishing Davalos had any physical ailments related to

the motor accident. So, while she may have failed to follow PrimeCare policy, that

failure would be negligence at worst, not deliberate indifference.

Davalos presented with trouble breathing, potentially due to his asthma,

trouble walking, and appeared intoxicated. (Doc. 67 at 12). At the same time,

nothing in the record suggests he ever asked Nurse Hysock if he could be sent to a

hospital due to a life-threatening condition. Instead, to Nurse Hysock, Davalos

presented as someone who appeared to be under the influence. (Doc. 70-10,

Deposition of Alyssa Hysock (hereinafter, “Hysock Dep.”), 45:6-11). His pupils were

normal. (Hysock Dep. 46:19-21). After conferring about his state with a provider,

Nurse Hysock received an order to treat Davalos’s anticipated withdrawal

symptoms. (Doc. 53 ¶ 43). She rendered treatment based on her view of the

circumstances.

Even assuming she was wrong, and that the standard of care demanded her

to recognize Davalos’s symptoms as overdosing rather than withdrawal, Cyr cannot

establish Nurse Hysock was deliberately indifferent. In response to his complaints

about asthma, Nurse Hysock retrieved a pulse ox machine and found his oxygen

saturation to be acceptable. (Doc. 53 ¶ 44; Hysock Dep. 51:22-25).8 His withdrawal

medications had been ordered and were on their way.

Thus, Nurse Hysock did not refuse to provide medical care to Davalos; she

completed her intake assessment. Conferring with a provider, Davalos was to

receive medication to treat expected withdrawal symptoms, so no prescribed

medical treatment was denied. Finally, Davalos never made any requests for

treatment to Nurse Hysock that would have prevented his death. Therefore, Cyr

has failed to establish Nurse Hysock was deliberately indifferent in treating

Davalos.

2. Nurse Gross

Cyr’s attempts to establish deliberate indifference against Nurse Gross fair

no better. For one, Cyr is incorrect when she says, “Nurse Gross did not actually

treat Davalos.” (Doc. 67 at 15). When Nurse Gross responded to a call to check on

Davalos, she administered an ammonia inhalant. (Doc. 53 ¶ 71). After that, Davalos

was able to follow commands and his vital signs were stable and within normal

8 Cyr points out that Nurse Hysock did not document Davalos’ pulse and

oxygen saturation level until after his death. (Doc. 66 ¶ 44). However, she points to

nothing in the record disputing Davalos’ actual oxygen saturation level or Nurse

Hysock’s more general testimony that Davalos’ oxygen saturation was within

acceptable limits.

limits. (Id. ¶¶ 72-73).9 His pupils were equal and reactive. (Id. ¶ 72). Davalos was told

to increase his fluid consumption and that he would be getting medication to

withdrawal symptoms in a few hours. (Id. ¶¶ 76-77).

Cyr also argues Nurse Gross was deliberately indifferent by not offering

Davalos more care despite knowing the detailed medical screening would not occur

for several more hours. (Doc. 67 at 15-16). This delay was due to supposed staffing

shortages. (Id. at 16). But there is no support in the record that after Nurse Gross

treated Davalos with ammonia salts, he suffered any more noticeable symptoms.

Rather, the only evidence is that after Davalos was aroused, his vital signs were

normal and his pupils were reactive. From this, it is not clear there was an

immediate need for further medical treatment. Additionally, there has been no

suggestion Davalos asked Nurse Gross for a specific kind of medical treatment.

Thus, medical care was rendered and no care was denied. True, Davalos’s drug

tapers were to come later, but the record does not demonstrate Davalos was in need

of receiving the detoxification medicine earlier. So, whether there was a nursing

shortage at the prison is immaterial; Davalos did not receive an earlier screening

because Nurse Gross determined Davalos was stable. (Doc. 53 ¶¶ 72-73, 75).

Additionally, the cases cited by Cyr to establish Nurse Gross was deliberately

indifferent are not persuasive. First, Sandoval v. County of San Diego, 985 F.3d 657

(9th Cir. 2021), is factually distinguishable from this case. In Sandoval, one nurse

9 Cyr’s response is that only Nurse Gross’ chart notes report Mr. Davalos

following commands and that his vital signs were normal. (Doc. 66 ¶¶ 72-73). Once

again, she fails to point to anywhere else in the record disputing these facts.

initially evaluated the decedent, placed him in a prison cell used for medical

monitoring, and did not check on him for over six hours. Id. At 670. Additional

personnel were deliberately indifferent by failing to immediately call paramedics

when the decedent was found unresponsive. Id. at 670-71. In this case, by contrast,

Nurse Gross did not make any determinations to leave Davalos unattended; she

responded to a call for help, treated him, and judged him to be fit to continue to be

in his routinely monitored cell. (Doc. 53 ¶¶ 68-79). Additionally, once Davalos was

found unresponsive, lifesaving measures were immediately undertaken, and he was

sent to a hospital. (See Doc. 53 ¶ 85; Doc. 53-7).

Grote v. Kenton County, Kentucky, 85 F.4th 397 (6th Cir. 2023) is also

unavailing. In that case, when the nurse was dealing with the decedent, she was

originally unable to take the decedent’s blood pressure because “he was twitching

and unable to hold still.” Id. at 401. The decedent’s “oxygen level registered at 89

percent, and he was hyperventilating.” Id. The nurse in Grote never took any other

vital signs. Id. Conversely, when Nurse Gross arrived to treat Davalos, he became

easily aroused with an ammonia inhalant. (Doc. 53 ¶ 71). Additionally, she

documented that Davalos was able to follow commands, his pupils were equal and

reactive, and that his vital signs were stable and within normal limits. (Id. ¶¶ 72-73).

Unlike Grote, the record does not show Davalos “was in clear medical distress of a

magnitude requiring emergency medical attention.” Grote, 85 F.4th at 410.10

3. PrimeCare

Cyr also makes a claim that PrimeCare itself is liable for not providing

adequate medical care to Davalos. A plaintiff’s assertion of liability for

constitutional violations under Section 1983 against an entity can be sustained

based on the U.S. Supreme Court’s ruling in Monell v. New York City Department

of Social Services. Natale v. Camden Cnty. Corr. Facility, 318 F.3d 575, 583-84 (3d

Cir. 2003). In making this Monell claim, the entity is not liable through respondeat

superior or vicarious liability, rather, plaintiffs must show “there was a relevant [ ]

policy or custom, and that the policy caused the constitutional violation they

allege.” Id.

For Cyr, her Monell claim has three major charges: (1) insufficient staffing by

PrimeCare; (2) failure to provide adequate medical attention to inmates in need of

care; and (3) failure to properly train its employees on recognizing when emergency

medical care is needed and the difference between withdrawal and overdosing.

(Doc. 1 ¶¶ 113-14). None of these assertions passes muster.

Regarding the first, as already discussed, it is simply not the case that

insufficient staffing played a role in Davalos’s death. This is crucial because for any

Monell claim, there must be a “a causal link between the execution of the policy and

10 Further, in Grote, the 6th Circuit was conducting its deliberately indifferent

analysis under an objective framework, rather than the subjective standard this

court is continuing to use. See Grote, 85 F.4th at 405. This is yet another facet

making that case inapplicable to this one.

the injury suffered.” Kranson v. Valley Crest Nursing Home, 755 F.2d 46, 51 (3d Cir.

1985) (quoting Losch v. Borough of Parkesburg, 736 F.2d 903, 910 (3d Cir.1984)).

Davalos was seen by two nurses during his stay, one almost immediately upon his

arrival to the facility. (See Doc. 53 ¶¶ 28-29, 68; Doc. 66 ¶¶ 28-29, 68). Next, when a

guard noticed Davalos was in distress, the guard called for help and Nurse Gross

appeared shortly thereafter. (See Doc. 53 ¶ 68; Doc. 66 ¶ 68). Thus, Davalos clearly

had access to medical personnel. That he was only scheduled to receive his

detoxification medication as well as have a full medical evaluation later in the

evening is beside the point. Cyr has marshalled no evidence that the Constitution

requires an in-depth medical exam for all new admissions to a prison within a few

hours of arrival.11 To the extent Davalos suffered a “delay” in treatment, it was

caused by a misdiagnosis of his problem—not staffing levels. As such, this claim

fails.

Nor is there any evidence of a constitutional violation regarding adequate

medical care. While Cyr is correct a Monell claim can lie even when no individual is

liable, that is only true when there is still an underlying constitutional violation. See

Mervilus v. Union Cnty., 73 F.4th 185, 196-97 (3d Cir. 2023). Here, Cyr failed to show

anyone from PrimeCare was deliberately indifferent to Davalos’s conditions. Both

Nurse Hysock and Gross administered treatment to Davalos. Perhaps their

treatment was negligent, but their actions demonstrate they were not deliberately

11 Indeed, even Cyr’s own expert concedes such initial screens are done

“typically within 24 hours of admission.” (Doc. 70-13 at 3).

indifferent. Put another way, it cannot be proven that someone (or the entity) knew

of Davalos’s condition and ignored it.

Moving to the training claims, the Third Circuit has clarified that

“[o]rdinarily, ‘[a] pattern of similar constitutional violations by untrained

employees’ is necessary ‘to demonstrate deliberate indifference for purposes of

failure to train.’” Thomas v. Cumberland Cnty., 749 F.3d 217, 223 (3d Cir. 2014)

(quoting Connick v. Thompson, 563 U.S. 51, 62, (2011)). There are exceptions when

“the need for training ‘can be said to be “so obvious,” that failure to do so could

properly be characterized as “deliberate indifference” to constitutional rights.’” Id.

(quoting City of Canton, Ohio v. Harris, 489 U.S. 378, 390 n.10 109 (1989)).

With respect to PrimeCare, however, Cyr’s claims are not that there was a

failure to train, but that the training provided was inadequate. For example, she

acknowledges that PrimeCare had policies on giving immediate medical care to

inmates who need it; she just claims that policy was not followed in this case. (See

Doc. 67 at 19-20). Even her own expert concedes that Relias, the training service

used by PrimeCare, “presents the PrimeCare protocols in an educationally sound

format.” (Doc. 70-13 at 12). It is therefore undisputed that PrimeCare offered

relevant training to its employees, the question is whether it was enough or being

properly followed.

Because PrimeCare did see a need for training and did offer relevant training

Cyr’s Monell claim does not fit into the Canton exception and so the ordinary

prerequisite of a “pattern of violations” applies. See Thomas, 749 F.3d at 223. As the

Supreme Court has said, “[t]hat a particular officer may be unsatisfactorily trained

will not alone suffice [for Monell liability], for the officer’s shortcomings may have

resulted from factors other than a faulty training program.” City of Canton, Ohio v.

Harris, 489 U.S. 378, 390-91 (1989). Moreover, a Monell claim does not arise when

“an otherwise sound program has occasionally been negligently administered.” Id.

at 391. Cyr has not shown evidence of a pattern of violations, focusing only the harm

to Davalos. (See Doc 67 at 19-20). Because PrimeCare had relevant policies to

prevent overdose deaths, the burden for Cyr is to show that those policies were

repeatedly violated. She may have shown certain policies were not followed for

Davalos specifically, but she has failed to show this is a widespread problem.

C. The County Defendants

Cyr similarly alleges the County Defendants failed to provide Davalos with

adequate medical care, and that Schuylkill County is responsible for their failure.

The County Defendants argue in response that their personnel were not

deliberately indifferent and even if they were, qualified immunity shields them from

liability.

1. Lieutenant Keppel

Lt. Keppel was present only for Davalos’s initial booking, (Doc. 1 ¶¶ 27, 39),

while Nurse Hysock conducted the intake screening, (Doc. 56 ¶ 14). The strongest

piece of evidence against Lt. Keppel is that he reported being told Davalos was

involved in a motor vehicle accident. (Keppel Dep. 13:10-14:3). The policy of SCP

was to send any new admittee who had been in an accident to the hospital for

evaluation. (Hysock Dep. 21:4-8). Just as with Nurse Hysock, at most this is

negligence on the part of Lt. Keppel for failing to follow policy.12 There is nothing in

the record suggesting Davalos suffered any injuries from the motor vehicle accident

or that his condition upon entering the prison was in any way related to the car

crash. (Doc. 56 ¶ 39; Doc. 66 ¶ 47). Otherwise, Lt. Keppel observed Davalos being

evaluated by Nurse Hysock, (Doc. 56 ¶ 14), and he may rely on her medical

judgements, Spruill v. Gillis, 372 F.3d 218, 236 (3d Cir. 2004). And so, the court will

grant summary judgment in Lt. Keppel’s favor.

2. Officer Sabol

As to Officer Sabol, Cyr’s claims boil down to his failure to conduct his proper

routine checks of the inmates in Echo Block. (Doc. 12-13). Although correctional

officers are to perform hourly checks on inmates in Echo Block, (Doc. 53 ¶ 61), the

evidence is clear: Officer Sabol did not perform a check at 7:00 p.m., (Doc. 70-27 at

3:05:10-4:28:22).13 As elsewhere, this action is negligence and not deliberate

indifference. Officer Sabol was there when Nurse Gross was called to check on

Davalos who reported difficulty breathing. (Doc. 56 ¶¶ 35, 37). After treating him

with an ammonia inhalant (Doc. 53 ¶ 71), Nurse Gross cleared Davalos to stay in

incarceration. (Doc. 56 ¶ 37). Thus, as far as Officer Sabol knew, Davalos was fine.

12 “[P]olices do not determine constitutional law.” Smith v. Freland, 954 F.2d

343, 348 (6th Cir. 1992). See also Bornstein v. Monmouth Cnty. Sheriff's Off., 658 F.

App’x 663 (3d Cir. 2016) (non-precedential) (citing Smith, 954 F.2d at 347-48) (“But

the issue is not whether they violated internal prison policies but whether they

violated the Constitution.”).

13 County Defendants claim Officer Sabol conducted a check at 7:00 p.m. That

is plainly not true upon review of the video evidence. (Doc. 70-27 at 3:05:10-4:28:22).

Counsel is reminded of the duty of candor owed to this court.

He had been seen by a medical professional and the only evidence in the record

reports Davalos’s condition at the time to be stable. (Doc. 56 ¶ 37).

3. Officer Bettinger

The story is a bit complicated with respect to Officer Bettinger. There is a

dispute over whether Officer Bettinger overheard Davalos say to his mother that he

could not breathe. (See Doc. 70-24, at 84:1-18). While Officer Bettinger knew

Davalos had been “cleared by medical” before he saw him, (Doc. 70-21 at 9:16-9:19),

he also did not know the details of Nurse Hysock’s examination, (id. at 27:55-28:05).

Further, Officer Bettinger admitted that Davalos requested an inhaler, but he never

informed anyone else about that request, saying he “forgot.” (Id. at 20:22-20:52).

Still, Davalos was well-enough to answer all of Officer Bettinger’s questions. (Doc.

56 ¶ 26). Even if Officer Bettinger heard Davalos say he could not breathe, that

would be undercut by the fact that Bettinger clearly had conversations with

Davalos; he therefore could breathe well enough to talk. Finally, Officer Bettinger

was not told by medical staff to pay extra attention to Davalos or treat him any

different than a normal inmate. Deliberate indifference is a high bar to clear and,

reviewing these facts, the court finds no reasonable jury could find Officer Bettinger

knew of and disregarded an excessive amount of risk to Davalos. See Durham v.

Kelley, 82 F.4th at 229.

And even if he were deliberately indifferent, Officer Bettinger would be

protected by qualified immunity. “Qualified immunity shields federal and state

officials from money damages unless a plaintiff pleads facts showing (1) that the

official violated a statutory or constitutional right, and (2) that the right was clearly

established at the time of the challenged conduct.” Ashcroft v. al-Kidd, 563 U.S. 731,

735 (2011) (internal quotation marks omitted).

Cyr claims that the Supreme Court’s decision in Estelle v. Gamble had firmly

established the right to adequate medical care. (Doc. 69 at 17-18) (quoting Evans v.

Columbia Cnty., 711 F. Supp. 3d 256, 307-08 (M.D. Pa. 2024), dismissed, No. 24-1227,

2024 WL 3676934 (3d Cir. Apr. 16, 2024)). However, the Third Circuit recently

stressed that courts should not “analyze rights so abstractly. Instead, existing law

must clearly establish that what this officer did in these circumstances violated the

plaintiff's rights.” Urda v. Sokso, 146 F.4th 311, 314 (3d Cir. 2025). Estelle’s general

requirement to provide adequate medical care is therefore a too abstract framing of

Davalos’s rights in this case. Moreover, Estelle itself is unhelpful to Cyr because in

that case, the Court found no rights had been violated. 429 U.S. 97, 107-08 (1976).

Cyr’s attempts to lean on the 2023 Third Circuit decision in Thomas v. City of

Harrisburg, is also unavailing. (Doc. 69 at 18). For one, Thomas was issued about

two and half years after the events giving rise to this case. (Doc. 53 ¶¶ 13-16). To

overcome a qualified immunity analysis, the right must be clearly established at the

time of the conduct. See Urda, 146 F.4th at 313 (citation omitted). Even putting that

aside, the circumstances of Thomas are wholly different than what occurred here.

In Thomas, an officer observed the plaintiff with “pasty white” lips and saw

“cocaine rocks fall out of [his] shirt.” 88 F.4th at 278-79. That officer suspected the

plaintiff in Thomas had ingested a large amount of cocaine. Id. at 279.

Here, there were no physical signs of drugs on Davalos’s person. While

Officer Bettinger suspected Davalos had taken some sort drugs, (Doc. 70-21 at 7:14-

7:32), there is nothing to suggest Officer Bettinger had reason to believe this was a

significant amount. While he did not know the specific details, Officer Bettinger did

know Davalos had been evaluated by medical personnel in some capacity before he

conducted his screening. (Id. at 9:16-9:19). Cyr has not shown a case where, after

having been seen by medical staff, an officer violated a pre-trial detainee’s rights for

securing additional medical care when the detainee was still somewhat responsive.

Therefore, the court cannot say Officer Bettinger was “plainly incompetent” given

the circumstances of this case. al-Kidd, 563 U.S. at 743 (2011) (quoting Malley v.

Briggs, 475 U.S. 335, 341 (1986)). Qualified immunity would shield Officer Bettinger

in this case, even if he were deliberately indifferent.

4. Schuylkill County

Cyr levies the same arguments against Schuylkill County as she does against

PrimeCare. (Doc. 1 ¶¶ 111-21). In her brief, she mainly tries to tie PrimeCare’s

deficiencies to the County. (Doc. 69 at 13-15). Therefore, the analysis with

PrimeCare applies equally to the County. To briefly summarize, the alleged

deficient policies of the County are not responsible for Davalos’s death. To the

extent there were customs or practices of failing to abide by official policies, Cyr has

failed to provide evidence of a pattern of violations necessary to make a claim

against the County itself. Without repetitive violations, Cyr cannot demonstrate this

was anything other than “an otherwise sound program [that] has [been]

occasionally been negligently administered.” City of Canton, 489 U.S. at 391.

Accordingly, the County is entitled to summary judgement on the Monell claims as

well.

D. ADA/RA Claims

Cyr finally claims the County violated the ADA and RA14 by failing to

reasonably accommodate Davalos’s addiction disability by giving him adequate care

and access to other prison services. She argues the County should have

accommodated Davalos’s disability, his substance use disorder, by placing him on

medical watch or, in the alternative, having sent him to a hospital for treatment.

(Doc. 1 ¶¶ 139-40; Doc. 69 at 19). However, in making a failure to accommodate

claim, a plaintiff must show the defendant knew of “both the disability and desire

for an accommodation.” Taylor v. Phoenixville Sch. Dist., 184 F.3d 296, 313 (3d Cir.

1999) (emphasis added). Nowhere in the complaint does Cyr ever allege Davalos

requested an accommodation or what that accommodation must be. (See Doc. 1 ¶¶

131-46).

Scouring the record in the light most favorable to Cyr, only one piece of

evidence possibly could relate to a request for an accommodation regarding his

substance use disorder. When Davalos was first being arrested, he seems to say he

would rather go to a hospital. (Doc. 70-3 at 6:38-7:06). However, that request was

made to Frackville police officers and unidentified EMT workers. (See Doc. 56 ¶ 9;

Doc. 68 ¶ 9). No evidence has been provided linking either the Frackville police

officers or the EMTs to Schuylkill County. As such, there is nothing in the record

14 “With limited exceptions, the same legal principles govern ADA and RA

claims.” CG v. Pennsylvania Dep’t of Educ., 734 F.3d 229, 235 (3d Cir. 2013) (internal

footnote omitted). None of those exceptions are pertinent here and neither party

disputes the same legal standards applies in this matter. (See Doc. 59 at 18-19; Doc.

69 at 19).

establishing that Schuylkill County knew Davalos had requested any sort of

accommodation. Because there were no requests for accommodations, Cyr’s ADA

and RA claims must fail. See, e.g., Hanafy v. Hill Int’l, Inc., 669 F. Supp. 3d 419, 438-

39 (E.D. Pa. 2023); Drozdowski v. Northland Lincoln Mercury, 321 F. App’x 181, 184-

85 (3d Cir. 2009) (non-precedential).

IV. Conclusion

After reviewing the record in the light most favorable to her, Cyr failed to

show any individual defendant was deliberately indifferent in responding to her

son’s medical needs. She also failed to show a pattern of constitutional violations

necessary to establish Monell liability. Thus, defendants’ motions for summary

judgment shall be granted.15 An appropriate order shall issue.

/S/ KELI M. NEARY

Keli M. Neary

United States District Judge

Middle District of Pennsylvania

Dated: September 30th, 2025

15 Because the court is granting the Medical Defendants’ summary judgment

motion, their motion in limine will be denied as moot.