Burke

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF OKLAHOMA

TAYLOR BURKE, as Personal Representative )

for the Estate of Michael Reagan, Jr., deceased, )

)

Plaintiff, )

v. )

) Case No. 6:23-CV-113-JAR

ADEL MALATI, M.D., in his individual )

capacity, )

)

Defendant. )

OPINION AND ORDER

This is a civil rights action brought under 42 U.S.C. § 1983 by plaintiff Taylor

Burke, as Personal Representative for the Estate of Michael Reagan, Jr., based on

alleged violations of the United States Constitution by defendant Adel Malati, M.D.,

in his individual capacity, during Mr. Reagan's detention at Okmulgee County

Criminal Justice Authority ("OCCJA") in Okmulgee, Oklahoma. Before the Court is

Dr. Malati's motion for summary judgment. [Dkt. 84].1 Plaintiff submitted a timely

response [Dkt. 99], and Dr. Malati replied [Dkt. 104]. By consent of the parties [Dkt.

21], and pursuant to Fed. R. Civ. P. 73(a) and 28 U.S.C. § 636(c)(1), the undersigned

United States Magistrate Judge exercises complete jurisdiction over this action

through and including trial and entry of a final judgment.

I. UNDISPUTED MATERIAL FACTS 2

Mr. Reagan was booked into OCCJA on the morning of January 3, 2020. [Dkt.

1 For clarity and consistency herein, when the court cites to the record, it uses the pagination

and document numbers provided by CM/ECF.

2 Unless otherwise noted, the following facts are undisputed for summary judgment purposes.

99-12]. Upon intake, Nurse Janette Hansen received several prescription

medications, including gabapentin, prescribed for Mr. Reagan's seizure disorder.

[Dkt. 99-13 at 1 (noting all medications were "expired" upon their delivery)]. Later

that day, Nurse Hansen conducted a medical intake screening and documented Mr.

Reagan's seizure history. [Dkt. 99-14].

On January 9, 2020, OCCJA's medical doctor, Dr. Malati, prescribed four

medications for Mr. Reagan, including gabapentin. [Dkt. 99-2; Dkt. 99-3 at 5 (35:4-

9)]. Pursuant to his employment agreement and OCCJA policy, Dr. Malati was

responsible for making all final judgments concerning inmate health care, had

supervisory authority over all medical personnel, was to ensure that outside medical

resources and specialized treatment were available to provide a full range of health

care options, and was obligated to assist in training medical staff. [Dkt. 99-8, §§ 1.1,

3.4; Dkt. 99-22, § 15-1.5]. Dr. Malati admittedly never provided any training to jail

nurses. [Dkt. 99-3 at 7 (62:7-65:8), 10 (132:5-11)]. OCCJA policy further required that

inmates have "regular access to a medical staff member who is qualified to screen,

refer, and provide basic treatment for ongoing or emerging health care problems."

[Dkt. 99-17, § 15-5.4].

During the relevant period, Dr. Malati was physically present at the jail about

once per week and was otherwise on call at all times. [Dkt. 84 at 11, ¶¶ 26-27; Dkt.

99 at 10, ¶¶ 26-27]. Jail nurses had his cell phone number and were authorized to

contact him at any time regarding inmate health issues. [Dkt. 84-4, ¶ 5]. Although

Dr. Malati testified that jail nurses had complete discretion to decide when to call an

ambulance, [Dkt. 84-4, ¶ 6; Dkt. 99-3 at 10 (132:5-11)], Nurse Julie Bauer testified

that she was required to contact her nursing supervisor and then Dr. Malati before

calling EMS for an inmate, [Dkt. 104-1 at 3 (24:2-19)]. In any event, Dr. Malati was

never contacted about Mr. Reagan's condition or medication refusals and never

personally examined him. [Dkt. 84 at 8, ¶ 6; Dkt. 99 at 6, ¶ 6; Dkt. 84-4, ¶¶ 7-8].

During his ten-day detention, Mr. Reagan declined his prescribed medications

on all but one occasion. [Dkt. 99-13 at 3]. At approximately 4:20 a.m. on January 10,

2020, Nurse Margret Hillburn responded to Mr. Reagan's cell after he reported a

seizure and stated he "couldn't see." After assessing his vital signs, Nurse Hillburn

documented no apparent abnormalities and instructed Mr. Reagan's cellmate to

notify staff if further seizure activity occurred. [Dkt. 99-15 at 2]. Later that day,

around 7:00 p.m., detention officers found Mr. Reagan on the floor of his cell in a

"seizure-like state," escorted him to medical, and he reported not having slept since

arrival. [Dkt. 99-15 at 1; Dkt. 99-16]. Medical staff administered prescribed

medications and returned him to his cell. At approximately 10:45 p.m. that evening,

staff again responded to Mr. Reagan's cell for "possible seizure activity." Mr. Reagan

stated that he "was sick" and asked "to go to [a] hospital." [Dkt. 99-15 at 1]. Medical

staff advised that, while he could go to medical for evaluation, there was "as of yet …

no reason to be sent to the hospital." [Id. at 1, 3].

At approximately 7:20 a.m. the next day, Mr. Reagan pushed a nurse during

pill pass and was transferred to a segregation cell. [Dkt. 99-18]. In the early morning

hours of January 13, Captain Lane Wilson heard banging from the segregation unit

and directed Shift Supervisor Miguel Rivera ("Sgt. Rivera") and Detention Officer

Joseph Terry to investigate. [Dkt. 9-6 at 2-5]. They found Mr. Reagan on his back on

the cell floor with blood under his head and observed that he appeared to be having

a seizure. [Id. at 2]. Nurse Bauer responded at approximately 3:01 a.m. and, together

with Officer Terry and Sgt. River, transported Mr. Reagan to the nurses' station,

arriving around 3:05 a.m. [Id. at 5]. Nurse Bauer recorded that Mr. Reagan was "not

responsive to verbal stimuli" and had an elevated heart rate. [Id. at 1].

Mr. Reagan was then wheeled to cell H114, located near Nurse Bauer's office,

where he was placed on the floor. [Dkt. 9-4 at 10-11 (45:23-46:4); Dkt. 99-6 at 2-3].

Because she was the only nurse on duty, Nurse Bauer then left OCCJA to deliver

paperwork to another detention center. [Id. at 12-13 (48:21-49:7); Dkt. 99-6 at 3]. At

around 3:30 a.m., an inmate notified jail staff via intercom that Mr. Reagan "was

having a seizure" and "vomiting blood." [Dkt. 99-6 at 5, 7]. Sgt. Rivera and Officer

Terry responded within minutes and found Mr. Reagan unresponsive on the floor.

[Id. at 3; Dkt. 9-20]. Nurse Bauer was informed of further seizure-like activity and

requested that Mr. Reagan be transported to an emergency room by an OCCJA

transport officer. [Dkt. 99-6 at 1].

At approximately 3:40 a.m., Nurse Bauer entered cell H114 and observed

"what appeared to be more seizure activity." She checked for a pulse and respirations

but found none, and CPR was initiated. [Id.]. An ambulance arrived at 4:00 a.m. and

departed seven minutes later with Mr. Reagan, who was unresponsive, pulseless, and

apneic. [Dkt. 99-5 at 1, 3]. He was pronounced deceased at 5:11 a.m. [Dkt. 99-7 at 3].

II. PROCEDURAL HISTORY

In April 2021, plaintiff filed a §1983 action against OCCJA, several members

of jail staff, and Dr. Malati based on allegations arising from Mr. Reagan's death.

[Dkt. 84 at 9, ¶ 16; Dkt. 99 at 8, ¶ 16]. On March 31, 2022, plaintiff and Dr. Malati

stipulated to dismissal without prejudice. [Dkt. 84-1].

Plaintiff initiated this action on March 30, 2023, and amended his complaint

on March 13, 2024, asserting a § 1983 claim for deliberate indifference to serious

medical needs in violation of the Eighth and Fourteenth Amendments. [Dkt. 28].

Plaintiff alleges that Dr. Malati was responsible for developing and implementing jail

policies, ensuring the provision of adequate medical care, training medical staff, and

supervising OCCJA medical personnel, and that his failure in these respects caused

constitutionally inadequate care to Mr. Reagan [Id. at ¶¶ 7, 28, 55, 59-62, 70-81].

III. GOVERNING LEGAL STANDARDS

A. SUMMARY JUDGMENT

Summary judgment should be granted "if the movant 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 fact is material if it "might affect the outcome

of the suit under the governing law." Anderson v. Liberty Lobby, 477 U.S. 242, 248

(1986). A dispute is genuine if "the evidence is such that a reasonable jury could

return a verdict for the nonmoving party." Id. At the summary judgment stage, the

court's task "is not 'to weigh the evidence and determine the truth of the matter but

to determine whether there is a genuine issue for trial.'" Tolan v. Cotton, 572 U.S.

650, 656 (2014) (quoting Anderson, 477 U.S. at 249). In making that determination,

a court must view the evidence "in the light most favorable to the opposing party." Id.

However, "[w]here the record taken as a whole could not lead a rational trier of fact

to find for the nonmoving party, there is no genuine issue for trial." Matsushita Elec.

Insu. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) (citation omitted).

B. CLAIMS, THEORIES, AND DEFENSES UNDER § 1983

Section 1983 provides a cause of action for "the deprivation of any rights,

privileges, or immunities secured by the Constitution and laws" by any person acting

under color of state law. 42 U.S.C. § 1983. Thus, a successful § 1983 plaintiff must

show that (1) a right secured by the Constitution or laws of the United States was

violated, and (2) the alleged violation was committed by a person acting under color

of state law. West v. Atkins, 487 U.S. 42, 48 (1988).

1. Deliberate Indifference to Serious Medical Needs

Claims based on failure to provide adequate medical care are governed by the

"deliberate indifference to serious medical needs" standard articulated in Estelle v.

Gamble, 429 U.S. 97 (1976). The Eighth Amendment "embodies 'broad and idealistic

concepts of dignity, civilized standards, humanity, and decency' … against which we

must evaluate penal measures," including the government's obligation to provide

medical care to incarcerated persons who cannot provide it for themselves. Id. at 102-

03 (internal quotations omitted). Deliberate indifference to serious medical needs

constitutes the "unnecessary and wanton infliction of pain" proscribed by the Eighth

Amendment and is actionable whether manifested by medical staff or by guards who

deny or delay access to care or interfere with prescribed treatment. Id. at 104-05.

These principles apply to pretrial detainees through the due process clause of the

Fourteenth Amendment. Howard v. Dickerson, 34 F.3d 978, 980 (10th Cir. 1994).

Deliberate indifference has both objective and subjective components. Wilson

v. Seiter, 501 U.S. 294, 298-99 (1991). The objective component is satisfied where the

harm is "sufficiently serious," such as a condition that results in significant suffering

or death. Id.; Mata v. Saiz, 427 F.3d 745, 753 (10th Cir. 2005). The subjective

component requires proof that the defendant-official knew of and disregarded a

substantial risk to inmate health or safety; the official must be both aware of facts

from which the inference could be drawn that a substantial risk of serious harm exists

and must also draw that inference. Farmer v. Brennan, 511 U.S. 825, 837 (1994). This

standard is akin to criminal recklessness and may be established by circumstantial

evidence. Id. at 836, 843; Martinez v. Beggs, 563 F.3d 1082, 1089 (10th Cir. 2009).

Prison and jail officials violate the Constitution when they "prevent an inmate

from receiving treatment or deny him access to medical personnel capable of

evaluating the need for treatment." Sealock v. Colorado, 218 F.3d 1205, 1211 (10th

Cir. 2000). In applying these principles, the Tenth Circuit has required a showing

that a particular official actually appreciated the substantial risk of serious harm and

then disregarded it. See, e.g., Wise v. Caffey, 72 F.4th 1199, 1210-12 (10th Cir. 2023)

(analyzing deliberate indifference claims against jail officers and medical staff in light

of inmate's symptoms and their responses).

2. Supervisory Liability

Individual-capacity claims against supervisory officials are governed by the

"affirmative link" framework. Such officials may not be held liable on a theory of

respondeat superior; instead, a plaintiff must establish an affirmative link between

the supervisor's conduct and the alleged constitutional violation. Schneider v. City of

Grand Junction Police Dep’t, 717 F.3d 760, 767 (10th Cir. 2013). The affirmative-link

requirement has three elements: (1) the supervisor's personal involvement, (2) a

causal connection between the supervisor's actions and the constitutional violation,

and (3) a culpable state of mind. Id.

Personal involvement may be shown by evidence that the supervisor

personally participated in the violation, exercised control or direction over the

offending subordinates, failed to train or supervise them, or "promulgated, created,

implemented or possessed responsibility for the continued operation of a policy" that

caused the deprivation." Keith v. Koerner, 843 F.3d 833, 838 (10th Cir. 2016) (quoting

Dodds v. Richardson, 614 F.3d 1185, 1195 (10th Cir. 2010)). Causation requires that

the supervisor "set in motion a series of events that the defendant knew or reasonably

should have known would cause others to deprive the plaintiff of [his] constitutional

rights." Id. The culpable-state-of-mind element aligns with the subjective deliberate

indifference standard and asks whether the supervisor knew of and disregarded an

excessive risk that his policies, customs, staffing choices, training, or supervisory

practices would result in constitutionally inadequate medical care. See Schneider, 717

F.3d at 769-70; Burke v. Regalado, 935 F.3d 960, 997-1001 (10th Cir. 2019).

3. Qualified Immunity

"Individual defendants named in a § 1983 action may raise the defense of

qualified immunity," Cillo v. City of Greenwood Vill., 739 F.3d 451, 460 (10th Cir.

2013), which "shields public officials … from damages actions unless their conduct

was unreasonable in light of clearly established law," Gann v. Cline, 519 F.3d 1090,

1092 (10th Cir. 2008). When a defendant asserts qualified immunity, the plaintiff

bears the burden to show that (1) that the defendant's actions violated a federal

constitutional or statutory right, and, if so, (2) that the right was clearly established

at the time of the defendant's unlawful conduct. Cillo, 739 F.3d at 460; Pearson v.

Callahan, 555 U.S. 223, 232 (2009). Courts may address these prongs in either order.

Pearson, 555 U.S. at 236. A right is clearly established if it is "sufficiently clear that

every reasonable official" would have understood that what he was doing violated

that right, typically by reference to "on point" Supreme Court or Tenth Circuit

precedent. Doe v. Woodard, 912 F.3d 1278, 1289 (10th Cir. 2019). Although a case

directly on point is not required, existing precedent must place the constitutional

question "beyond debate." Mullenix v. Luna, 577 U.S. 7, 12 (2015).

IV. ANALYSIS

The Court first examines whether plaintiff has demonstrated a constitutional

violation attributable to Dr. Malati in his supervisory role, and then considers

whether that right was clearly established at the time of Mr. Reagan's death.

A. CONSTITUTIONAL VIOLATION

Dr. Malati's liability depends upon whether one or more of his subordinates

violated Mr. Reagan's constitutional rights. See Dodds, 614 F.3d at 1194-95.

1. Underlying Violation by Subordinates (Objective Prong)

The undisputed harm suffered by Mr. Reagan is sufficiently serious to satisfy

the objective component of deliberate indifference. See Martinez, 563 F.3d at 1088

(death "without doubt" satisfies the objective component).

2. Underlying Violation by Subordinates (Subjective Prong)

As to the subjective component, the record, viewed in the light most favorable

to plaintiff, would permit an inference that OCCJA nurses recognized Mr. Reagan

faced an ongoing medical crisis but failed to take reasonable steps to investigate and

respond. Nurse Hillburn documented that Mr. Reagan stated he "couldn't see"

following a seizure on January 10, yet she did not contact Dr. Malati. [Dkt. 99-15 at

2]. That evening, after additional seizure-like episodes, Mr. Reagan reported he had

not slept for seven days and requested to go to the hospital. Nurse Kilo administered

his prescribed medications, returned him to his cell, and advised there was "no reason

to be sent to the hospital," without seeking higher-level evaluation or summoning

EMS. [Id. at 1, 3; Dkt. 99-16]. In the early hours of January 13, after officers and

Nurse Bauer observed Mr. Reagan with seizure-like symptoms and decreased

responsiveness, he was left on the floor of a cell while Nurse Bauer left the facility,

and a substantial further delay occurred before EMS was summoned, despite an

intercom call reporting another seizure and vomiting of blood. [Dkt. 99-4 at 5 (14:1-

10), 13 (49:1-17); Dkt. 99-6; Dkt. 99-20].

On this record, a reasonable jury could find that at least Nurses Kilo and Bauer

(and potentially other OCCJA staff) subjectively appreciated a substantial risk that

Mr. Reagan—who experienced repeated seizures, reported vision changes and illness,

expressly requested hospital care, and ultimately became unresponsive—faced a

serious medical emergency yet failed to respond reasonably. See Sealock, 218 F.3d at

1211-12; Mata, 427 F.3d at 755-61.

B. SUPERVISORY LIABILITY

Because plaintiff has adduced sufficient evidence of an underlying

constitutional violation by OCCJA personnel, the Court next considers whether he

has established an affirmative link between that violation and Dr. Malati. See

Schneider, 717 F.3d at 768-69.

1. Personal Involvement

The personal-involvement element may be satisfied by showing that Dr. Malati

personally participated in the violation; exercised control or direction over the

offending subordinates; failed to train or supervise them; or "promulgated, created,

implemented or possessed responsibility for the continued operation of a policy" that

caused the underlying deprivation. Keith, 843 F.3d at 838 (quoting Dodds, 614 F.3d

at 1195). Plaintiff also may show that he was responsible for but failed to create and

enforce policies to protect inmates from having serious medical needs disregarded.

Perry v. Durborow, 892 F.3d 1116, 1122-23 (10th Cir. 2018). In jail-medical-care

cases, the Tenth Circuit examines whether the supervisor's policy choices created or

maintained a system in which constitutional violations were a plainly obvious

consequence. See e.g., Burke, 935 F.3d at 999-1001. Here, plaintiff proceeds on three

theories: failure to implement necessary policies, failure to train, failure to supervise.

a. Failure to Implement Necessary Policies

Plaintiff relies heavily on the employment agreement and jail policy, which

provide that Dr. Malati shall make all final judgments relating to inmate health care,

have supervisory authority over all medical personnel, approve and annually review

OCCJA health care policies, ensure access to outside resources including emergency

care, and assist in the training medical staff. He also points to the former OCCJA

director's testimony that although the director wrote jail policies, it was Dr. Malati's

responsibility to implement jail healthcare policies. [Dkt. 99-9 at 2 (130:1-21), 3

(135:10-13)]. Plaintiff contends that, despite this authority, Dr. Malati failed to

implement policies requiring or clearly directing LPNs to contact a physician or call

EMS when inmates with known seizure disorders experienced recurrent seizures,

reported vision changes, or requested hospital care.

The record permits a reasonable jury to find that Dr. Malati possessed

responsibility for the continued operation of the medical policy framework at OCCJA

and could have implemented more specific escalation policies for seizure-related

emergencies. See Dodds, 614 F.3d at 1199-1200. While Dr. Malati maintains that

nurses could independently contact EMS and points to the absence of any formal

restriction on emergency transport or consultation, Nurse Bauer's conflicting account

of escalation protocol renders such assertions materially disputed.

b. Failure to Train

A supervising official may be liable for failure to train where there is

"essentially a complete failure to train, or training that is so reckless or grossly

negligent that future misconduct is almost inevitable," but it is insufficient to allege

"general deficiencies" in training. Keith, 843 F.3d at 838 (quotations omitted). The

plaintiff must identify a specific deficiency closely related to his ultimate injury and

show that this deficiency actually caused the subordinates to act with deliberate

indifference. Id. Here, plaintiff identifies as the specific deficiency the absence of any

concrete training from Dr. Malati instructing LPNs on when to call an ambulance or

escalate to a higher-level provider for seizures and similar emergencies. [Dkt. 99 at

22-27]. He links this deficiency to the employment agreement's partial assignment of

training responsibility and to Dr. Malati's testimony that he provided no such specific

training and instead relied on LPN licensure and general orientation. [Dkt. 98-8, §

3.4; Dkt. 99-3 at 6 (46:4-48:22), 7 (62:7-65:3)].

Plaintiff has adequately demonstrated Dr. Malati's personal involvement

under a failure-to-train theory. The undisputed fact that Dr. Malati provided no

training or escalation guidance to medical staff is sufficient, on its own, to tie his

direct conduct to the alleged deficiency. His testimony confirming the absence of such

instruction establishes a specific omission traceable to his contractual duties.

Although the record does not indicate prior incidents or audits that would have

alerted him to these deficiencies, such notice concerns relate more appropriately to

issues of causation and state of mind. See Keith, 843 F.3d at 838.

c. Failure to Supervise

Failure-to-supervise claims are analyzed under the same basic framework as

failure-to-train claims, but focus on day-to-day oversight rather than formal

instruction. See Dodds, 614 F.3d at 1195-99; Burke, 935 F.3d at 999-1001. Plaintiff

again relies on the employment agreement's allocation of supervising responsibilities

to Dr Malati, and cites Dr. Malati's testimony that he spent about one hour per week

seeing inmates at OCCJA while also serving as medical director at multiple other

facilities. [Dkt. 99-3 at 2 (24:10-25:25)]. Plaintiff argues that this limited on-site

presence, combined with heavy reliance on LPNs who lacked concrete escalation

guidance, effectively left nurses unsupervised in making critical medical decisions for

inmates like Mr. Reagan.

The employment agreement, together with Dr. Malati's admittedly limited on-

site presence, reasonably supports the inference that he did not adequately discharge

his supervisory duties over OCCJA medical staff as they delivered frontline care to

inmates. Under Tenth Circuit precedent, a supervisor expressly charged with

overseeing medical personnel and implementing medical policies, yet alleged to have

left LPNs effectively unsupervised in managing serious medical conditions, may be

found personally involved in any ensuing violations. See e.g., Dodds, 614 F.3d at 1199-

1200; Burke, 935 F.3d at 999-1001. Plaintiff's failure-to-supervise theory therefore

satisfies the personal-involvement element.

2. Causation

To establish causation, plaintiff must show that Dr. Malati "set in motion a

series of events" that he "knew or reasonably should have known" would cause his

subordinates to deprive Mr. Reagan of his constitutional rights. Keith, 843 F.3d at

838. In supervisory-liability cases, the inquiry often focuses on whether policy,

training, or supervisory decisions made the violation a plainly obvious consequence.

See Burke, 935 F.3d at 999-1001; Prince v. Sheriff of Carter Cnty., 28 F.4th 1033,

1048-52 (10th Cir. 2022).

Plaintiff contends that Dr. Malati implemented and maintained a medical

system that relied almost entirely on LPNs, left them clinically unsupervised for most

of the week, and provided confusing or incomplete protocols while failing to train

them on seizure emergencies and hospital transfer criteria. Plaintiff argues that this

system, in combination with Dr. Malati's knowledge of Mr. Reagan's seizure disorder

from prescribing gabapentin, created a foreseeable risk that LPNs would delay

contacting a physician or EMS when Mr. Reagan experienced multiple seizures,

reported vision issues, requested hospital care, and grew increasingly unresponsive.

Dr. Malati responds that any failings by jail nurses on January 10-13 were isolated

misjudgments and not the foreseeable product of his system-level decisions, and

again emphasizes his materially disputed testimony that jail nurses could call EMS

without his permission.

Tenth Circuit precedent indicates that structural deficiencies, combined with

the certainty that staff will confront recurring medical emergencies, can create a jury

question where a system delegates emergent assessments to minimally trained staff

without guidance. See Burke, 935 F.3d at 999-1001; Prince, 28 F.4th at 1048-52.

Plaintiff's evidence concerning the absence of specific escalation training and Dr.

Malati's materially disputed belief that LPNs could escalate inmate medical issues

without his involvement is sufficient, at this stage, to create a triable issue on

whether his decisions "set in motion" the events leading to Mr. Reagan's death.

3. Deliberately Indifferent State of Mind

The remaining question is whether a reasonable jury could find that Dr. Malati

acted with deliberate indifference in that he knew of and disregarded an excessive

risk that his policies, customs, or supervisory practices would result in

constitutionally inadequate medical care. See Schneider, 717 F.3d at 769-70. Plaintiff

argues that a jail medical director in Dr. Malati's position would appreciate that

inmates routinely present with seizures and other serious conditions, that relying

primarily on LPNs without meaningful escalation guidance creates a substantial risk

of delayed emergency care, and that choosing to maintain such a system despite these

obvious risks amounts to deliberate indifference. He analogizes to Burke, where the

sheriff allowed well-documented systemic deficiencies to persist for years, and

contends that similar inferences may be drawn here from the structure of OCCJA's

medical operations and Dr. Malati's limited on-site involvement. [Dkt. 99 at 28-31].

Dr. Malati emphasizes that plaintiff has not presented evidence of prior

incidents, audits, or complaints putting him on notice of systemic failures comparable

to those in Burke. He further notes the absence of evidence that he was informed

about Mr. Reagan's medication refusals, seizure complaints, or emergency response

issues; that he had any reason to believe nurses did not understand they could call

EMS; or that OCCJA had a history of similar events involving seizure patients. [Dkt.

84 at 20-22; Dkt. 104 at 3-5]. On his view, plaintiff's evidence, at most, supports

negligence in designing or operating OCCJA's medical system, which is insufficient

to establish deliberate indifference.

The Court concludes, however, that the question of whether plaintiff has

offered sufficient evidence for a jury to find that Dr. Malati acted with deliberate

indifference is a closer one than with respect to the subordinate staff, and ultimately

turns on how the factfinder evaluates the obviousness of the risks posed by OCCJA's

staffing, training, and supervisory framework in light of Dr. Malati's acknowledged

role and limited direct involvement.

C. CLEARLY ESTABLISHED LAW

Plaintiff principally invokes Burke to contend that Dr. Malati's alleged conduct

violated clearly established law, arguing that this Tenth Circuit decision gave fair

warning that a jail official charged with implementing medical policies, supervising

jail nurses, and conducting trainings can be held liable for deliberate indifference

when systemic decisions create a substantial risk of serious harm. [Dkt. 99 at 29-30].

See Quinn v. Young, 780 F.3d 998, 1013 (10th Cir. 2015) (noting it is "well-settled"

that "[t]he plaintiff bears the burden of citing … what he thinks constitutes clearly

established law.").3 Elsewhere in his response, plaintiff relies on Prince, Crowson v.

Wash. Cnty., Utah, 983 F.3d 1166 (10th Cir. 2020), and Estate of Jensen by Jensen v.

Clyde, 989 F.3d 848 (10th Cir. 2021), to contend that jail policymakers may be held

3 "Constitutional rights are clearly established when Tenth Circuit or Supreme Court

precedent particularized to the case at issue exists." Shepherd v. Robbins, 55 F.4th 810, 815 (10th Cir.

2022) (emphasis added). "Materially similar facts can make the precedent sufficiently particularized."

Id. (emphasis added). Thus, a right is clearly established when operable precedent encompasses

"materially similar conduct" or applies "with obvious clarity" to the conduct at issue. Id.

liable when they design or maintain a medical system that renders constitutional

violations a plainly obvious consequence. [Dkt. 99 at 22-23]. Each of these authorities,

however, is materially distinguishable from the present case.

In Burke, the Tenth Circuit emphasized that the sheriff had been repeatedly

alerted—through audits, reports, and other notifications—to years-long, systemic

deficiencies in jail medical care, yet failed to implement corrective measures. See 935

F.3d at 999-1001. By contrast, plaintiff identifies no comparable pattern of audits,

reports, or complaints showing that Dr. Malati was ever informed of recurring

emergency-response failures or known training deficiencies at OCCJA prior to Mr.

Reagan's death, and thus Burke does not clearly establish liability for a part-time

medical director who lacked such notice.

Prince involved a sheriff who had "actual knowledge of numerous systemic

problems" with jail health care and faced evidence that he was responsible, in his

official capacity, for failing to medically train jail employees, inadequately staffing

the jail, and delaying inmate medical attention. See 28 F.4th at 1049-51. Here, in

contrast, there is no showing that Dr. Malati had direct, documented notice of

"numerous systemic problems" comparable to those in Prince, or that he personally

ignored repeated warnings about dangerous delays in care.

Crowson likewise does not provide clearly established guidance for this case.

There, the Tenth Circuit reversed the denial of qualified immunity to an infrequently

on-site jail physician where the alleged violation was premised on his diagnostic

choices, concluding it was not clearly established that "reaching a diagnosis without

blood test results violated the plaintiff's rights where the plaintiff's symptoms were

consistent with either withdrawal or encephalopathy." 983 F.3d at 1183-84. Crowson

thus confirms that, in materially similar circumstances involving an off-site jail

physical, the law was not clearly established as to the physician's clinical decisions,

and it does not address—much less clearly prohibit—the kind of higher-level

supervisory and structural choices at issue here.

In Estate of Jensen, the Tenth Circuit found a triable issue of deliberate

indifference as to an on-site "gatekeeper" nurse who personally observed a detainee's

severe, worsening withdrawal symptoms yet failed to call the part-time physician or

secure hospital care, but it declined to impose liability on the physician based solely

on higher-level policy or training theories in that posture. See 989 F.3d at 955-59.

Estate of Jensen therefore underscores the potential liability of frontline gatekeepers

who directly witness and disregard an inmate's obvious need for care, while

simultaneously signaling that the Tenth Circuit would not extend clearly established

law to a similarly situated part-time physician on a purely supervisory theory like

the one plaintiff advances here.

The Court therefore finds that Burke, Prince, Crowson, and Estate of Jensen

do not clearly establish a constitutional violation by Dr. Malati—a largely off-site, on-

call medical director/jail physician who was never contacted about the decedent's

seizure-related issues, never personally involved in his care, and not on notice of

recurring emergency-response failures or known training deficiencies—based on his

maintenance of a system that authorizes licensed nurses to call EMS without

providing detailed escalation guidance. Those decisions involve officials who had

direct, documented notice of recurring systemic problems, or frontline gatekeepers

who personally observed serious medical needs and responded unreasonably or not

at all, which is materially different from Dr. Malati's posture. Given that none of

plaintiff's cited precedents render his supervisory-liability theories "beyond debate,"

plaintiff has not met his burden to show that Dr. Malati's alleged conduct violated

clearly established law.

V. CONCLUSION

Because plaintiff has not shown that the alleged conduct violated clearly

established law, the Court concludes that Dr. Malati is entitled to qualified immunity.

IT IS THEREFORE ORDERED that Dr. Malati's motion for summary

judgment [Dkt. 84] is hereby GRANTED.

IT IS FURTHER ORDERED that the pretrial conference set for April 23, 2026

is hereby STRICKEN.

IT IS FURTHER ORDERED that the jury trial set to begin on May 4, 2026 is

hereby STRICKEN.

DATED this 16th day of April, 2026.

_______________________________________

JASON A. ROBERTSON

UNITED STATES MAGISTRATE JUDGE