The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF OKLAHOMA
ALICIA HARRIS, as Special )
Administrator of the Estate of Tory )
Ray Wiliams, Sr., deceased, )
)
Plaintiff, )
)
vs. ) Case No. 25-CV-539-JFJ
)
1. VIC REGALADO, in his official )
capacity as Tulsa County Sheriff, )
2. TURN KEY HEALTH CLINICS, )
LLC, an Oklahoma limited liability )
corporation, and )
3. MEGAN RASOR, APRN )
)
Defendants. )
OPINION AND ORDER
Before the Court are (1) Defendant Megan Rasor, APRN’s (“Nurse Rasor”) Motion to
Dismiss (ECF No. 39), (2) Defendant Turn Key Health Clinic’s (“Turn Key”) Motion to Dismiss
(ECF No. 29), and (3) Defendant Vic Regalado’s (“Sheriff Regalado”) Motion to Dismiss (ECF
No. 28). Each defendant seeks dismissal pursuant to Federal Rule of Civil Procedure 12(b)(6) for
failure to state a claim upon which relief can be granted. The parties have consented to a magistrate
judge presiding over the case. ECF No. 45. For the reasons set forth below, all three motions are
denied.
I. Allegations in Second Amended Complaint
Plaintiff Alicia Harris (“Plaintiff”), brings this action as Special Administrator of the Estate
of Tory Ray Williams, Sr. (“Williams”), deceased. Plaintiff alleges the following relevant facts in
the Second Amended Complaint (ECF No. 26). In December 2022 and January 2023, Williams
received treatment for pneumonia and congestive heart failure, including a left heart
catheterization on January 5, 2023. 2d Am. Compl. ¶¶ 8-18. On January 23, 2023, Williams was
arrested and transported to the Tulsa County Jail (“Jail”), where he received medical intake
screening. Id. ¶¶ 19-21. Williams reported breathing problems and congestive heart failure to the
intake nurse, and the nurse documented that Williams had hypertension and insulin-dependent
diabetes. Id. ¶¶ 21-22. Williams authorized Turn Key to obtain his mental health records from
Hillcrest and Walgreens, and the intake nurse scheduled Williams for a “chronic care evaluation”
with Nurse Rasor on February 7, 2023, due to his diabetes and congestive heart failure. Id. ¶¶ 23,
25. On January 23, 2023, Nurse Rasor ordered insulin for Williams. Id. ¶ 26.
On January 25, 2023, a medical emergency was called for Williams. Id. ¶ 28. Turn Key
medical staff responded to the call, and Williams informed the nurses that he felt as though he
could not breathe. Id. ¶ 29. After taking Williams’ vital signs and observing his breathing, Turn
Key nurses found no signs of respiratory distress. Id. ¶ 30. Upon determining Williams was not
in distress, the nurses instructed Williams to place a sick call if needed. Id. ¶ 32. On January 26,
2023, Nurse Rasor prescribed a dose of Lasix (a diuretic used to treat edema associated with
congestive heart failure) along with a dose of potassium chloride, and she ordered a chest x-ray.
Id. ¶ 36. On January 27, 2023, Williams underwent the x-ray, which showed “mild cardiomegaly
with possible mild interstitial edema.” Id. ¶ 37.
On January 29, 2023, a Turn Key nurse set an appointment for Williams to see Turn Key’s
Doctor of Nursing Practice (“DNP”) Andrew Skousen, with the note stating that Williams’ chest
x-ray had not yet been reviewed and asking whether Turn Key would continue Williams on any
medications, as he had received only a single dose of Lasix up to that date. Id. ¶ 40. In response
to the nursing note, DNP Skousen ordered 90 doses of Lasix for Williams but did not evaluate or
examine Williams. Id. ¶¶ 41-42. Williams received a second dose of Lasix on February 1, 2023.
Id. ¶ 43.
On February 4, 2023, Williams went to the Jail’s medical unit, complaining of shortness
of breath and increased edema. Id. ¶ 44. According to the Turn Key nurse, Willims had “3+ pitting
edema on his legs” (swelling that creates a dimple after pressing it); diminished breath sounds in
his lung bases, with wheezing noted in the upper lungs; and a “non-productive cough.” Id. ¶¶ 44.
The nurse informed Turn Key physician Kent King, M.D. of Williams’ symptoms, and Dr. King
ordered 4 doses of 40 mg Lasix. Id. ¶ 45. Williams received a dose of Lasix that night. Id. ¶ 46.
Williams also underwent an EKG on February 4, which showed “sinus tachycardia with occasional
premature ventricular complexes” (extra heartbeats); “Incomplete Right Bundle Branch Block”
(delay or blockage); “right Ventricular Hypertrophy” (increased muscle mass in response to
chronic pressure overload); and “Nonspecific T wave abnormality” (deviations in the T waves).
Id. ¶ 48. Several hours after taking the Lasix, Williams was feeling better and able to return to his
pod, with the nurse informing Williams to notify staff if he had increased edema and shortness of
breath in the future or no continued improvement from his medications. Id. ¶ 47.
On February 6, 2023, a Turn Key nurse noted that Williams had been experiencing a cough
for more than two weeks. Id. ¶ 51. On February 7, 2023, Nurse Rasor provided chronic care
evaluation as ordered at Williams’ medical intake. Id. ¶ 52. At the exam, Nurse Rasor charted
that Williams’ heart had no murmurs or clicks and had a regular rhythm; his respirations were
unlabored; and there were no edemas present on his extremities. Id. ¶ 53. Nurse Rasor scheduled
Williams for a chest x-ray and EKG for February 21, 2023. Id. ¶ 54. On February 21, Williams
underwent an EKG, which revealed a “possible left atrial enlargement.” Id. ¶ 55. Nurse Rasor
apparently reviewed the EKG the following day, but she did not take any action in response to the
new EKG findings. Id. ¶ 60.
On February 24, 2023, a medical emergency was called when Williams was found by his
cellmate lying on his bed, unresponsive, and covered in vomit. Id. ¶ 61. Plaintiff alleges Williams
was not closely monitored at the jail, with visual sight checks of Williams not being performed
every hour as required by the Oklahoma Jail Standards. Id. ¶ 62. When a deputy arrived two
minutes later and found Williams unconscious, he began doing chest compressions. Id. ¶¶ 63-64.
A Turn Key nurse arrived a minute later and observed Williams had a “pink frothy sputum coming
out of the corner of his mouth.” Id. ¶ 65. The medical staff administered a dose of Narcan, which
was ineffective. Id. ¶ 66. An ambulance was called a minute later, and EMSA arrived
approximately nine minutes later to transport Williams to Hillcrest Hospital. Id. ¶ 67. Upon arrival
at Hillcrest, Williams had no pulse or cardiac activity, and he was pronounced dead shortly after
arrival. Id. ¶¶ 68-69.
Plaintiff alleges Turn Key’s and the Tulsa County Sheriff’s Office’s (“TCSO”) deliberate
indifference to Williams’ serious medical needs were in furtherance of and consistent with their
policies, customs, and/or practices. Id. ¶ 71. Plaintiff alleges Tulsa County/Sheriff Regalado
retained Turn Key in December 2016 as the Jail’s medical contractor, pursuant to a contract that
made Turn Key responsible for the costs of pharmaceuticals, off-site medical services, and
hospitalizations up to $500,000 per year, with the County/TCSO responsible for any excess costs.
Id. ¶¶ 82, 88. Plaintiff alleges these contractual provisions incentivize under-prescribing and
under-administering medications and keeping inmates at the Jail to avoid off-site costs, despite
inmates’ serious medical needs. Id. ¶ 89. Plaintiff alleges Turn Key (1) has a policy of avoiding
off-site medical costs for inmates at the Jail as a cost-saving measure; (2) has an established policy,
practice, and/or custom of allowing undertrained and under-supervised LPNs to, de facto, run the
medical unit at the Jail; (3) has an established practice of failing to adequately assess inmates with
complex and serious medical and mental health needs, including a failure to regularly take vital
signs; and (4) has an established practice of failing to train medical and mental health staff on what
constitutes alarming vital signs and when to report alarming vital signs to a physician; and failing
to send inmates with complex and serious medical and mental health needs to an outside medical
facility for adequate assessment and treatment. Id. ¶¶ 90-98. Plaintiff alleges Turn Key’s policies
and customs were a moving force behind the constitutional violations and injuries to Williams and
others. Id. ¶ 99. Plaintiff provides details of nine other instances of Turn Key’s alleged deficient
medical care system leading to deaths or negative medical outcomes – four at the Jail and five at
other jail facilities where Turn Key was the contractual medical provider. Id. ¶¶ 101-148.
Further, as to Sheriff Regalado/Tulsa County, Plaintiff alleges that by the time of Williams’
incarceration in January 2023, the County/TCSO “knew, or should have known, that Turn Key’s
grossly deficient system and ‘plan’ posed excessive risks to the health and safety of inmates, like
Mr. Williams, who suffer from serious and complex medical conditions.” Id. ¶ 85. Plaintiff alleges
Sheriff Regalado/Tulsa County are aware or should be aware of Turn Key’s repeated failures to
provide constitutionally adequate medical care for inmates yet made the conscious decision to
retain Turn Key as the Jail’s medical provider. Id. ¶ 154. Plaintiff describes four other incidents
at the Jail since 2017, in which Turn Key’s allegedly deficient medical care resulted in death or
negative medical consequences for inmates or detainees. Id. ¶¶ 105-106 (Caleb Lee), ¶¶ 107-115
(Dunniven Phelps), ¶¶ 136-142 (Dean Stith), ¶¶ 143-148 (Montoya Holmes). Plaintiff further
alleges Sheriff Regalado/Tulsa County had a “well-established policy, custom, or procedure
whereby visual sight checks of inmates were not performed as required by the Oklahoma Jail
Standards,” and the failure to conduct sight checks of Williams was consistent with that policy,
custom, or practice. Id. ¶¶ 156-157.
Plaintiff asserts claims under 42 U.S.C. § 1983 against the Defendants for failure to provide
adequate medical care in violation of Williams’ Fourteenth Amendment rights, specifically (1)
individual liability against Nurse Rasor for failure to provide Williams with adequate or timely
medical treatment, proper monitoring and supervision, diagnostic testing, and reasonable access
to outside medical providers, in deliberate indifference to Williams’ serious medical needs, health,
and safety; (2) municipal liability against Turn Key for effectively denying Williams constitutional
conditions of confinement resulting from gross deficiencies in medical procedures, staffing,
facilities, and procedures; and (3) official capacity liability against Sheriff Regalado for
maintaining a healthcare delivery system at the Tulsa County Jail that has such gross deficiencies
in staffing, facilities, equipment, or procedures that Williams was effectively denied access to
adequate medical care.
II. Motion to Dismiss – Rule 12(b)(6) Standard
In considering a Rule 12(b)(6) motion, the court must accept all well-pleaded allegations
of the complaint as true and must construe them in the light most favorable to the nonmoving party.
See Anderson v. Merrill Lynch Pierce Fenner & Smith, Inc., 521 F.3d 1278, 1284 (10th Cir. 2008).
A court must then determine whether these accepted facts state a facially “plausible” claim for
relief. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).
A claim has facial plausibility when the plaintiff pleads factual content that allows
the court to draw the reasonable inference that the defendant is liable for the
misconduct alleged. The plausibility standard is not akin to a probability
requirement, but it asks for more than a sheer possibility that a defendant has acted
unlawfully. Where a complaint pleads facts that are merely consistent with a
defendant’s liability, it stops short of the line between possibility and plausibility
of entitlement to relief.
Id. (internal quotations omitted). “A pleading that offers labels and conclusions or a formulaic
recitation of the elements of a cause of action will not do. Nor does a complaint suffice if it tenders
naked assertions devoid of further factual enhancement.” Id. at 678 (citation modified).
III. Nurse Rasor
Nurse Rasor seeks dismissal of the claim against her pursuant to Federal Rule of Civil
Procedure 12(b)(6), arguing that Plaintiff’s allegations regarding the EKG reports establish that
Nurse Rasor was attentive to Williams’ medical needs and not deliberately indifferent. Nurse
Rasor argues the allegations show that there was no reason to believe Williams would suffer a
sudden, fatal medical event on February 24, 2023.
A. Deliberate Indifference
Under the Fourteenth Amendment, pre-trial detainees have a constitutional right to medical
care, which is violated when medical providers or prison officials are deliberately indifferent to a
detainee’s serious medical needs. Garcia v. Salt Lake County, 768 F.2d 303, 307 (10th Cir. 1985).1
“The deliberate indifference standard lies ‘somewhere between the poles of negligence at one end
and purpose or knowledge at the other.’” Johnson v. Sanders, 121 F.4th 80, 88 (10th Cir. 2024)
(quoting Farmer v. Brennan, 511 U.S. 825, 836 (1994)). The Tenth Circuit has equated deliberate
indifference to “recklessness, in which a person disregards a risk of harm of which he is aware.”
Paugh v. Uintah Cnty., 47 F.4th 1139, 1154 (10th Cir. 2022) (quotation omitted).
The Tenth Circuit recognizes two types of conduct amounting to deliberate indifference in
the context of detainee medical care. “First, a medical professional may fail to treat a serious
medical condition properly.” Sealock v. Colorado, 218 F.3d 1205, 1211 (10th Cir. 2000). When
this type of conduct is alleged, “the medical professional has available the defense that he was
merely negligent in diagnosing or treating the medical condition, rather than deliberately
indifferent.” Id. (citing Estelle v. Gamble, 429 U.S. 97, 105-06 (1976)). Second, prison officials
may “prevent an inmate from receiving treatment or deny him access to medical personnel capable
of evaluating the need for treatment.” Id. (citing Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir.
1980)). A prison medical professional who serves solely “as a gatekeeper for other medical
1 Courts apply a Fourteenth Amendment due process standard that protects pretrial detainees
against deliberate indifference to their serious medical needs, while the Eighth Amendment’s
prohibition of cruel and unusual punishment protects convicted inmates. Clark v. Colbert, 895
F.3d 1258, 1267 (10th Cir. 2018). The same analysis applies to both an Eighth Amendment and a
Fourteenth Amendment claim when a plaintiff brings a § 1983 claim for deliberate indifference.
See Olsen v. Layton Hills Mall, 312 F.3d 1304, 1315 (10th Cir. 2002).
personnel capable of treating the condition” may be liable under this standard if he or she “delays
or refuses to fulfill that gatekeeper role due to deliberate indifference.” Id.
Deliberate indifference “involves both an objective and a subjective component.” Olsen v.
Layton Hills Mall, 312 F.3d 1304, 1315 (10th Cir. 2002) (citing Sealock, 218 F.3d at 1209). “[T]he
focus of the objective component is the seriousness of the plaintiff’s alleged harm, while the focus
of the subjective component is the mental state of the defendant with respect to the risk of that
harm.” Prince v. Sheriff of Carter Cnty., 28 F.4th 1033, 1044 (10th Cir. 2022). To satisfy the
objective component, “the alleged deprivation must be ‘sufficiently serious’ to constitute a
deprivation of constitutional dimension.” Self v. Crum, 439 F.3d 1227, 1230 (10th Cir. 2006)
(quoting Farmer v. Brennan, 511 U.S. 825, 834 (1994)). “A medical need is sufficiently serious
‘if it is one that has been diagnosed by a physician as mandating treatment or one that is so obvious
that even a lay person would easily recognize the necessity for a doctor’s attention.’” Sealock, 218
F.3d at 1209 (quoting Hunt v. Uphoff, 199 F.3d 1220, 1224 (10th Cir. 1999)). The question raised
by the objective prong “is whether the alleged harm . . . is sufficiently serious . . . , rather than
whether the symptoms displayed to the prison employee are sufficiently serious.” Mata v. Saiz,
427 F.3d 745, 753 (10th Cir. 2005).
To satisfy the subjective component, there must be evidence that “the official ‘knows of
and disregards an excessive risk to inmate health or safety; the official must both be aware of facts
from which the inference could be drawn that a substantial risk of serious harm exists, and [s]he
must also draw the inference.’” Mata, 427 F.3d at 751 (quoting Farmer, 511 U.S. at 837). The
subjective component may be met if the jury can “infer that a prison official had actual knowledge
of the constitutionally infirm condition based solely on circumstantial evidence, such as the
obviousness of the condition.” Tafoya v. Salazar, 516 F.3d 912, 916 (10th Cir. 2008) (citing
Farmer, 511 U.S. at 842). Moreover, the subjective component may be satisfied if the defendant’s
“delay in providing medical treatment caused either unnecessary pain or a worsening of [his]
condition. Even a brief delay may be unconstitutional.” Mata, 427 F.3d at 755. However, the
“negligent failure to provide adequate medical care, even one constituting medical malpractice,
does not give rise to a constitutional violation.” Self, 439 F.3d at 1233 (quotation omitted).
B. Analysis
Plaintiff has plausibly alleged a claim under § 1983 based on Nurse Rasor’s deliberate
indifference to Williams’ serious medical needs. Plaintiff alleges Williams was in custody at the
Tulsa County Jail for 32 days, during which time his heart condition worsened. Specifically,
Plaintiff alleges a February 4, 2023, EKG revealed sinus tachycardia with occasional premature
ventricular complexes; incomplete right bundle branch block; right ventricular hypertrophy; and
nonspecific T wave abnormality. Plaintiff alleges Turn Key medical staff, including Nurse Rasor,
took no action in response to the EKG findings, with Nurse Rasor conducting only an evaluation
on February 7, 2023. On February 21, 2023, a second EKG revealed “possible left atrial
enlargement,” suggesting a new problem with the left side of Williams’ heart. Plaintiff alleges
this deterioration should have triggered an immediate evaluation from a physician or trip to the
hospital, but again, Turn Key staff and Nurse Rasor took no action. Three days later, Williams
was found unresponsive in his cell, and he died that day despite attempts to revive him.
These allegations, taken as true for purposes of this motion, state a claim for a constitutional
violation. As for the objective component, Plaintiff has plausibly alleged Williams suffered a
serious medical need in the form of a deteriorating heart condition as evidenced on the EKG
reports, which Nurse Rasor failed to escalate or respond with treatment. Only three days after his
second EKG, which revealed a new left heart condition, Williams died. Death is undoubtedly
sufficiently serious to meet the objective component. See Martinez v. Beggs, 563 F.3d 1082, 1088-
89 (10th Cir. 2009) (explaining that an inmate’s heart attack and death were “without doubt,
sufficiently serious to meet the objective component necessary to implicate the Fourteenth
Amendment”).
As for the subjective component, a reasonable inference can be drawn from Plaintiff’s
allegations that Nurse Rasor had actual knowledge of Williams’ serious medical conditions based
on her background knowledge of Williams’ heart problems, in combination with her review of
Williams’ second EKG. Plaintiff sufficiently alleges Nurse Rasor failed in her “gatekeeper” duty
to contact other medical personnel capable of treating Williams’ condition. See Lucas v. Turn Key
Health Clinics, LLC, 58 F.4th 1127, 1139 (10th Cir. 2023) (explaining that “doing nothing in the
face of serious medical needs is obviously sufficient to state a claim” under “gatekeeper” theory).
Nurse Rasor’s alleged delay or failure in addressing or escalating Williams’ known deteriorating
heart condition demonstrates deliberate indifference to Williams’ serious medical needs. See id.
(explaining that, “under the subjective component of the deliberate indifference analysis, a
licensed medical professional’s heightened knowledge and training can be highly relevant and may
tend to show awareness of and disregard of a substantial risk; especially so when the injuries, like
here, are internal and impossible for a layman to surmise”) (citation omitted). Williams’
symptoms, shown via the EKG readings on February 4 and 21, may plausibly indicate that Nurse
Rasor “knew the risk to the prisoner and chose (recklessly) to disregard it.” Martinez, 563 F.3d at
1089. See Self, 439 F.3d 1227 (explaining that subjective indifference may be shown if a medical
professional “responds to an obvious risk with treatment that is patently unreasonable”). Cf. Mata,
427 F.3d at 759 (concluding that prison nurses fulfilled gatekeeper role by reporting EKG findings
to higher-level providers).
In briefing, Nurse Rasor asks the Court to find that the EKG results on February 21 actually
indicated substantial improvement in Williams’ heart condition, compared to his earlier results on
February 4. Nurse Rasor argues it is improper to “stack” the two EKG results as cumulative.
Nurse Rasor further argues that a “possible left atrial enlargement,” even if present, does
not indicate an emergency situation, like a heart attack, but rather indicates another underlying
condition that may be chronic. Nurse Rasor likens the EKG findings to symptoms of a common
cold, which a layperson without specialized medical knowledge could find not emergent and not
requiring immediate hospital transport or an urgent call to a physician. She urges the Court to
make these findings based on its “common sense” and definitions from Internet sources. Nurse
Rasor urges the Court to take judicial notice of the meaning of “possible left atrial enlargement,”
according to an Internet medical source, as an abnormal increase in the left atrium size that may
remain asymptomatic but may indicate underlying cardiac pathology that warrants further
investigation. See ECF No. 39 at 5 n.3.
The Court rejects Nurse Rasor’s arguments. At the motion to dismiss stage, the Court must
take Plaintiff’s allegations as true and must not read additional facts into the record based on Nurse
Rasor’s own interpretation of the EKG findings. Plaintiff alleges Williams died three days after
the EKG, and the Court cannot conclude at this stage of proceedings that Nurse Rasor acted in an
objectively reasonable manner in response to the EKG findings. At this stage of the proceeding,
the Court also cannot decide, when such findings are considered based on “common sense” or the
Internet definition provided, that the second EKG findings were similar to mere cold symptoms.
This is particularly true when viewed in conjunction with the prior EKG findings and Williams’
reported history of congestive heart failure and other conditions. Plaintiff alleges that Nurse Rasor
was aware of all these facts, and it is at least plausible that she knew the risks to Williams and
chose not to elevate care with deliberate indifference to those risks.
Finally, the Court rejects Nurse Rasor’s attempt to analogize Plaintiff’s claims to those in
Mejia-Perez v. Centurion of Ariz. LLC, No. CV 22-00896-PHX-DWL (JFM), 2023 U.S. Dist.
LEXIS 205624 (D. Ariz. Nov. 16, 2023). In Mejia-Perez, an outside physician reviewed a prison
inmate’s EKG findings, which included “bilateral atrial enlargement.” Id. at *24. The outside
physician recommended a non-urgent follow-up appointment. Id. The plaintiff in that case did
not allege deliberate indifference occurred based on this recommendation, but rather based on the
prison doctor’s denial of an earlier EKG. Id. at 33-34. Therefore, Nurse Rasor’s argument that
“deliberate indifference was not found in this case,” is misleading, as the issues on summary
judgment in Mejia-Perez had nothing to do with that particular EKG finding or the resulting
recommendation by a physician.
Nurse Rasor’s motion to dismiss is denied.
IV. Turn Key
Plaintiff brings a § 1983 claim against Turn Key pursuant to a municipal liability theory.
Section 1983 liability can lie with an entity such as Turn Key, but only when a constitutional
violation is inflicted pursuant to a government policy or custom. Monell v. Dep’t of Soc. Servs. Of
City of New York, 436 U.S. 658, 694 (1978). “Respondeat superior or vicarious liability will not
attach under § 1983.” City of Canton v. Harris, 489 U.S. 378, 385 (1989) (citing Monell, 436 U.S.
at 694-95). See Bd. of Cnty. Comm’rs v. Brown, 520 U.S. 397, 403 (1997) (explaining that a
municipal entity “may not be held liable under § 1983 solely because it employs a tortfeasor”).
Monell liability “has been extended to ‘private entities acting under color of state law,’ such as
medical contractors.” Lucas, 58 F.4th at 1144 (quoting Dubbs v. Head Start, Inc., 336 F.3d 1194,
1216 (10th Cir. 2003)).
A. Constitutional Violation
To establish a medical contractor’s Monell liability, the plaintiff must first plausibly allege
that its employee or employees violated a plaintiff’s constitutional rights. See Est. of Beauford v.
Mesa Cnty., Colo., 35 F.4th 1248, 1275 (10th Cir. 2022). Alternatively, even if no single
individual employee is found liable, a municipal entity may still be liable for a “systemic failure
of medical policies and procedures” as a basis for unconstitutional conduct. Lucas, 58 F.4th at
1144 (citing Crowson v. Washington Cnty. Utah, 983 F.3d 1166, 1191-92 (10th Cir. 2020)). Here,
Plaintiff alleges both kinds of constitutional violations committed by Turn Key.
Plaintiff has adequately alleged a constitutional violation by Nurse Rasor, see supra Part
III, who Plaintiff alleges was Turn Key’s employee at the relevant times and acting within the
scope of her employment. See 2d Am. Compl. ¶ 4.2
The Court does not find Plaintiff sufficiently alleges a constitutional violation based on any
“systemic” failure of Turn Key’s medical policies and procedures. Although Plaintiff alleges
Williams was never evaluated or seen by a physician while incarcerated at the Jail (2d Am. Compl.
¶ 70), Plaintiff alleges only one failure by Nurse Rasor that may have led to his death. This singular
failure, attributed to a single Turn Key employee, is insufficient to establish a systemic failure by
Turn Key. Cf. Wimbley v. McCurtain Cnty. Jail Trust, No. CIV-25-78-RAW-GLJ, 2025 WL
3190646, at *5 (E.D. Okla. Aug. 29, 2026) (finding plaintiff adequately alleged constitutional
violation based on “systemic failure” at Turn Key to adequately staff physicians at jail, where
plaintiff exhibited multiple stroke symptoms but Turn Key staff refused plaintiff’s repeated
requests for medical help over the course of a month).
Plaintiff sufficiently pleaded a constitutional violation committed by Nurse Rasor, and the
Court proceeds to the other elements of Monell liability in relation to that constitutional violation.
B. Other Elements of Monell Liability
In addition to proving a constitutional violation, to hold a municipality liable, a plaintiff
must prove “(1) an official policy or custom (2) caused the plaintiff’s constitutional injury and (3)
2 In its motion, Turn Key raises the same arguments Nurse Rasor raised regarding the significance
and seriousness of the EKG findings on February 4 and 21. ECF No. 29 at 10-12. The Court
rejects those arguments for the same reasons explained above with regard to Nurse Rasor’s motion.
that the municipality enacted or maintained that policy with deliberate indifference to the risk of
that injury occurring.” George, on behalf of Bradshaw v. Beaver Cnty., by & through Beaver Cnty.
Bd. of Comm’rs, 32 F.4th 1246, 1253 (10th Cir. 2022).
For the first element of Monell liability, an official municipal policy or custom may take
several forms, including: (1) “an informal custom amounting to a widespread practice that,
although not authorized by written law or express municipal policy, is so permanent and well
settled as to constitute a custom or usage with the force of law,” or (2) “the failure to adequately
train or supervise employees, so long as that failure results from deliberate indifference to the
injuries that may be caused.” Bryson v. City of Okla. City, 627 F.3d 784, 788 (10th Cir. 2010)
(citation modified). These are the two types of municipal policies or customs alleged by Plaintiff
in this case. The Court addresses each below.
1. Plaintiff Has Not Adequately Alleged Municipal Liability Based on
Informal Custom
Plaintiff alleges three informal customs by Turn Key: (1) under-prescribing medication and
discouraging the sending of inmates offsite for medical care, to achieve profits under the cost-
saving terms of its agreement with the Tulsa County Sheriff’s Office; (2) permitting undertrained
and under-supervised LPNs to de facto, run the medical unit at the Jail, without direct supervision
by a physician or RN; and (3) failing to adequately assess inmates with complex and serious
medical needs, including failure to regularly take vital signs. Plaintiff fails to state a claim for any
of these alleged informal customs.3
3 Plaintiff’s allegations concerning the alleged deficiencies in medical care provided at the Jail by
other medical providers, such as Armor Correctional Health Services, Inc. (2d Am. Compl. ¶¶ 73-
81), are not relevant to Turn Key’s policies, customs, and practices. Therefore, the Court does not
consider those events for purposes of deciding Turn Key’s motion.
a) Cost-Saving Measures
Plaintiff first alleges generally that Turn Key implemented cost-saving measures of under-
prescribing medication and discouraging sending inmates to offsite care, pursuant to its cost-
sharing contract with Tulsa County. This theory fails for three reasons. First, the cost-sharing
agreement itself is not sufficient to establish a custom of improper cost-cutting, because it does
not “reveal an improper financial incentive to keep costs low as it simply describes the cost sharing
agreement between the County and Turn Key.” Lucas v. Turn Key Health Clinics, LLC, 58 F.4th
1127, 1145 (10th Cir. 2023) (emphasis added) (analyzing similar or identical contract to that
alleged in this case and explaining that, to the extent the contract reveals any financial incentive,
“it is no more troublesome than any institution’s general desire to maintain low costs”); Robinson,
2026 WL 788150, at *8 (explaining that, to withstand a motion to dismiss, plaintiff’s municipal
claim against Turn Key must rest on more than the “bald claim that Turn Key’s policies were
driven by cost-cutting measures”).
Second, assuming this policy of cost-cutting was adequately pled and supported by the
cost-sharing agreement, Plaintiff’s Second Amended Complaint does not allege that Nurse Rasor,
as the employee committing the constitutional violation, was motivated by reducing costs in her
failure to escalate Plaintiff’s care to a physician or an emergency facility. Instead, as explained
below, the facts alleged in the Second Amended Complaint indicate that Nurse Rasor knowingly
disregarded risks revealed by the EKG findings because she did not receive adequate training on
when to escalate care in the face of serious medical risks. See Lucas, 58 F.4th at 1145 (holding
that complaint did not sufficiently allege that medical staff were “motivated by cost” in their
actions or plead facts leading to a plausible inference that any cost-saving policies caused the
plaintiff’s injuries).
Third, to the extent Plaintiff relies on an alleged “systemic” failure at Turn Key that
connects to Turn Key’s cost-cutting measures, Plaintiff has not adequately alleged a constitutional
violation based on any such “systemic” failure. Plaintiff’s allegations based on this theory are
disconnected from the factual allegations regarding Williams’ medical care at the Jail. Plaintiff
identifies a single nurse and a specific failure of care, which do not plausibly amount to a
“systemic” failure by Turn Key. Consequently, Plaintiff does not adequately connect the factual
allegations to any cost-saving policy by Turn Key. Cf. Wimbley, 2025 WL 3190646, at *5 (finding
plaintiff sufficiently alleged a connection between Turn Key’s lack of funding for physicians to
his alleged injuries, where plaintiff repeatedly requested medical assistance for stroke symptoms
but Turn Key staff refused to send him to the hospital or have him assessed by a physician).
b) LPNs and Inadequate Assessment
The second and third alleged customs are not adequately tied to the facts of this case or
Williams’ injuries. Plaintiff does not allege that Williams’ care was supervised by any
“undertrained and under-supervised LPN.” To the contrary, Plaintiff alleges Nurse Rasor, who is
an APRN, provided the constitutionally deficient care to Williams. Plaintiff also does not allege
Williams’ vitals were not regularly taken or that he was inadequately “assessed” in any specific
way. Rather, Plaintiff’s allegations of constitutionally deficient care pertain to Nurse Rasor’s
failure to act on Williams’ concerning EKG findings, which the Court views as different in nature
than mere “assessment” of Williams’ condition. These two alleged customs cannot plausibly have
caused Williams’ injuries.
2. Plaintiff Has Adequately Alleged Municipal Liability Based on Failure
to Train
Plaintiff alleges one “failure to train” theory of municipal liability: that Turn Key had an
established practice of failing to train medical staff on what constitutes alarming vital signs and
when to report alarming vital signs to a physician, and failing to send inmates with complex and
serious medical needs for outside treatment.
Entity liability “is at its most tenuous where a claim turns on a failure to train.” Connick
v. Thompson, 563 U.S. 51, 61 (2011). “Only where a failure to train reflects a ‘deliberate’ or
‘conscious’ choice by a municipality . . . can a city be liable for such a failure under § 1983.”
Valdez v. Macdonald, 66 F.4th 796, 815 (10th Cir. 2023) (quoting City of Canton, Ohio v. Harris,
489 U.S. 378, 389 (1989)). Under this theory, a plaintiff must demonstrate that the “need for more
or different training was so obvious, and the inadequacy so likely to result” in the constitutional
violation, that the municipal policymakers “can reasonably be said to have been deliberately
indifferent to the need for additional training.” Porro v. Barnes, 624 F.3d 1322, 1328 (10th Cir.
2010) (citation modified). It is insufficient to show there were “general deficiencies” in the
training program. Id. (quotation omitted). Rather, the plaintiff must “identify a specific deficiency
that was obvious and closely related to his injury, so that it might fairly be said that the official
policy or custom was both deliberately indifferent to his constitutional rights and the moving force
behind his injury.” Id. (quotation omitted).
“A pattern of similar constitutional violations by untrained employees is ordinarily
necessary to demonstrate deliberate indifference for purposes of failure to train.” Connick, 563
U.S. at 62 (quotation omitted).4 A municipality’s “continued adherence to an approach that [it]
know[s] or should know has failed to prevent tortious conduct by employees may establish the
4 In a narrow range of circumstances, a failure to train theory of municipal liability may be based
on a single incident, where a violation of federal rights may be a “highly predictable consequence”
of the specific training failure. Valdez, 66 F.4th at 815 (quotation omitted). Such a theory, while
rarely applicable, would not require proof of a pre-existing pattern of violations. Id. at 816.
Because Plaintiff does not appear to rely on this theory of “single-incident” liability, the Court
does not address it in-depth.
conscious disregard for the consequences of [its] action – the ‘deliberate indifference’ – necessary
to trigger municipal liability.” Id. (quotation omitted). Without such notice of a particular training
deficiency, “decisionmakers can hardly be said to have deliberately chosen a training program that
will cause violations of constitutional rights.” Id.5
In addition to establishing a training deficiency and deliberate indifference to such
deficiency, a plaintiff must plead that there is a “direct causal link between the policy or custom
and the injury alleged.” Id. (quotation omitted). See Haines v. Fisher, 82 F.3d 1503, 1507 (10th
Cir. 1996) (explaining that the municipality’s official policy must be the “moving force for the
constitutional violation in order to establish the liability of a government body under § 1983”)
(citing Monell, 436 U.S. at 694). “Therefore, it is only when the execution of the government’s
policy or custom inflicts the injury that the municipality may be held liable under § 1983.”
Hollingsworth v. Hill, 110 F.3d 733, 744 (10th Cir. 1997) (citation modified).
The Court finds that Plaintiff’s alleged training deficiency in the form of failing to train
medical staff on when to report alarming vital signs to a physician, and failing to send inmates
with serious medical needs to an outside facility, is specifically and adequately pled. See Est. of
Angelo v. Bd. of Cnty. Comm’rs of Jefferson Cnty., No. 1:23-CV-01607-CNS-STV, 2024 WL
2274080, at *14 (D. Colo. May 20, 2024) (finding allegations that jail medical provider trained its
staff “not to escalate care” is a “specific deficiency” for municipal liability purposes on a motion
to dismiss). This alleged practice of failure to train directly links to Turn Key’s alleged deliberate
indifference to Williams’ medical needs via its employee Nurse Rasor, who allegedly was not
5 Due to the overlap in the failure-to-train context, the Court evaluates the “policy or custom” and
“deliberate indifference” elements of Monell liability together.
properly trained to elevate Williams’ concerning EKG findings on February 21, 2023, by
contacting a physician or having him taken to a hospital.6
Plaintiff also adequately alleges a pattern or practice of similar constitutional violations by
allegedly untrained Turn Key employees. Plaintiff cites eight other prior instances of allegedly
constitutionally inadequate care by Turn Key personnel at the Jail and other jail facilities involving
Turn Key personnel. Id. ¶¶ 105-142.7 Many of those instances involved inmates with serious
symptoms and vital signs, where Turn Key staff failed to report the symptoms to a physician or
transport the inmate to the hospital, which resulted in negative medical outcomes for the inmate,
including death. Most similar to Williams’ situation, Plaintiff alleges Dunnivan Phelps was
booked into the Jail in September 2019 and, despite symptoms of severe weakness on one side of
his body and a finding by a Turn Key nurse of high blood pressure, the Turn Key nurse did not
escalate Phelps’ case by reporting it to a physician, RN, or Nurse Practitioner. 2d Am. Compl. ¶¶
107-111. Not until later the following day did an APRN determine that Phelps had a three-day
history of stroke symptoms. Id. ¶ 115. As another similar example, Plaintiff alleges Dean Stith
was booked into the Jail in December 2021, and a Turn Key psychologist failed to call for an
ambulance or escalate Stith’s care to a physician despite concerning fluctuations of his vital signs.
Id. at ¶¶136-140. The following day, Stith was found unresponsive in his cell and was transported
to the hospital in cardiac arrest, dying shortly after arrival. Id. ¶ 142. These allegations support
an inference that Turn Key’s established practice of maintaining an inadequately trained medical
staff on elevation of care, exhibited by its past conduct, resulted in Turn Key’s alleged deliberate
6 The Court reads the term “vital signs” broadly to include EKG findings.
7 The August 2023 incident at the Jail involving Montoya Holmes occurred after Williams’ death
and therefore cannot form the basis for notice of a pre-existing pattern of deficient training. 2d
Am. Compl. ¶¶ 143-148.
indifference to Williams’ obvious need for medical care. There is no set numerical requirement,
and the Court finds the number alleged here to be sufficient. See Griego v. City of Albuquerque,
100 F. Supp. 3d 1192, 1213 (D.N.M. 2015) (explaining that, to establish the existence of an
informal policy, custom, or practice, a plaintiff may plead “a pattern of multiple similar instances
of misconduct,” with “no set number” required to “render the alleged policy plausible”).
Turn Key argues that the Court should not find a “custom” of failing to train or deliberate
indifference to such inadequate training, because many of the prior instances alleged in the Second
Amended Complaint either remain active cases, resulted in settlement, or resulted in a finding of
no liability for Turn Key. Turn Key essentially argues that, if a plaintiff alleges multiple instances
of constitutional violations, but Turn Key prolonged or settled the underlying prior legal cases,
Turn Key should prevail on a motion to dismiss a Monell claim. The Court is unpersuaded, at least
at this stage of the proceedings, that pending or settled cases should be excluded from the analysis
of whether it had a custom of failing to train and was acting with deliberate indifference to such
inadequate training. Based on the Court’s review of judicial records, none of the three prior cases
from the Jail held that there was no underlying constitutional violation by the relevant Turn Key
employee.8 Further, the incidents are identical to the type of § 1983 allegations in this case, and
they fall within six years of Williams’ incident in this case, meaning the prior incidents have a
clear nexus to Plaintiff’s allegations. Cf. Lopez v. City of Opa-Locka, No. 24-22076-CIV-
ALTONAGA/Reid, 2024 WL 4930610, at *3-4 (S.D. Fla. Dec. 2, 2024) (finding spreadsheet of
11 prior § 1983 cases against city unpersuasive to establish a policy or custom of relevant
8 The Court views this as a critical factor. If any court had held that there was no underlying
constitutional violation by any Turn Key employee, this argument by Turn Key may be more
persuasive.
constitutional violations, where cases varied widely in types of § 1983 claims and spanned over
two decades).
Finally, Plaintiff has adequately pleaded causation, because it is plausible that Turn Key’s
alleged widespread training deficiencies resulted in Williams’ death. Nurse Rasor’s alleged failure
to escalate Williams’ care following her review of the February 21 EKG was “consistent with the
chronic deficiencies” in medical care that amounted to a widespread policy of a failure to train
Turn Key staff on when to escalate alarming vital signs. Burke v. Regalado, 935 F.3d 960, 1000
(10th Cir. 2019). The “execution” of the custom – waiting to act on the EKG findings instead of
notifying a physician or taking Williams to the hospital – “inflicted” Williams’ injury by causing
his condition to worsen until he was found unresponsive in his cell on February 24. See
Hollingsworth, 110 F.3d at 744.
Plaintiff sufficiently pleaded Monell liability for Nurse Rasor’s alleged constitutional
violation based on a failure-to-train theory. Turn Key’s motion to dismiss is denied.
V. Sheriff Regalado
A. Consideration of Material Beyond Complaint
As an initial matter, Sheriff Regalado requests that the Court look beyond the Second
Amended Complaint and consider Williams’ complete medical record while at the Jail, attaching
the record as an exhibit to his motion. ECF No. 28-1 (medical record). Sheriff Regalado explains
that Plaintiff directly quotes from and references Williams’ Jail medical record throughout the
Second Amended Complaint. Sheriff Regalado argues that, as a document referenced in the
complaint and central to Plaintiff’s claims, Williams’ full Jail medical record, the authenticity of
which is not in dispute, should be considered as part of the motion to dismiss. Plaintiff opposes
the request.
In general, “a motion to dismiss should be converted to a summary judgment motion if a
party submits, and the district court considers, materials outside the pleadings.” Alvarado v. KOB-
TV, L.L.C., 493 F.3d 1210, 1215 (10th Cir. 2007) (quotation omitted). However, the court may
consider documents referred to in the complaint on a motion to dismiss “if the documents are
central to the plaintiff’s claim and the parties do not dispute the documents’ authenticity.” Id.
(quotation omitted). “Those documents, however, ‘may only be considered to show their contents,
not to prove the truth of matters asserted therein.’” Walbridge v. City of Oilton, Oklahoma, 785
F. Supp. 3d 978, 989 (N.D. Okla. 2025) (quoting Tal v. Hogan, 453 F.3d 1244, 1265 n.24 (10th
Cir. 2006)).
Here, the Court rejects Sheriff Regalado’s request for consideration of Williams’ full Jail
medical record and excludes it from the Rule 12(b)(6) analysis. In her response brief, Plaintiff
disputes whether the record submitted by Sheriff Regalado is “complete, accurate, or even
authentic.” ECF No. 36 at 15. Thus, Plaintiff directly disputes the accuracy and completeness of
the medical record. Further, medical records are not the type of documents that are typically
considered at the motion-to-dismiss stage, because they are prone to disputes as to meaning and
accuracy. See Crawford v. Turn Key Health Clinics, LLC, No. 24-CV-6-JDR-SH, 2025 WL
1885637, at *3 (N.D. Okla. July 8, 2025) (“Medical records are not akin to a contract or insurance
policy where there is no dispute as to the authenticity or accuracy of the document.”); Morris v.
City of Tulsa, No. 19-cv-0073-CVE-JFJ, 2019 WL 7373035, at *3 (N.D. Okla. Dec. 31, 2019).
Therefore, the Court declines to consider the submitted medical record evidence in ruling on
Sheriff Regalado’s motion to dismiss.
B. Municipal Liability
As with Turn Key, Plaintiff asserts a Monell claim against Sheriff Regalado in his official
capacity as Sheriff of Tulsa County. This claim is effectively a claim against Tulsa County. See
Burke v. Regalado, 935 F.3d 960, 998 (10th Cir. 2019). Therefore, Plaintiff must allege facts
showing that a policy or custom by Sheriff Regalado or TCSO, or deliberately indifferent training
or supervision, caused Williams’ constitutional deprivation. See id. at 998-99 (10th Cir. 2019).
Sheriff Regalado first argues that Plaintiff fails to plead a constitutional deprivation.
However, as discussed above with respect to Nurse Rasor, Plaintiff states a § 1983 claim against
Nurse Rasor for deliberate indifference to Williams’ serious medical needs in violation of
Williams’ rights under the Fourteenth Amendment. The Court rejects Sheriff Regalado’s
arguments that no such deprivation occurred for reasons explained above with respect to Nurse
Rasor’s motion. Plaintiff has alleged sufficient facts to show that Williams suffered a
constitutional deprivation at the Jail by an employee of TCSO’s contractual medical provider.
Sheriff Regalado next argues Plaintiff fails to show a custom or policy maintained by
Sheriff Regalado or TCSO that was the moving force behind deprivation of Williams’
constitutional rights. Courts in this district have found that a sheriff is the final policymaker for a
county jail who is responsible for enforcing the jail’s policies and procedures for providing
adequate medical care to inmates. See Robinson v. Turn Key Health Clinics, LLC, No. 24-CV-
0622-CVE-MTS, 2026 WL 788150, at *8 (N.D. Okla. Mar. 20, 2026); Crawford v. Turn Key
Health Clinics, LLC, No. 24-CV-6-JDR-SH, 2025 WL 1885637, at *7-8 (N.D. Okla. July 8, 2025);
Wirtz v. Regalado, No. 18-CV-599-GKF-FHM, 2020 WL 1016445, at *13 (N.D. Okla. Mar. 2,
2020). Therefore, to state an official-capacity claim against Sheriff Regalado, Plaintiff “must
allege facts to plausibly suggest that the constitutional violation, carried out by Turn Key
employees, represented an official policy or custom of Tulsa County or TCSO, establishing ‘a
causal link between the municipal action and the deprivation of federal rights.’” Robinson, 2026
WL 788150, at *8 (quoting Brown, 520 U.S. at 404).9
Plaintiff’s allegations satisfy this standard. Plaintiff alleges that Sheriff Regalado retained
Turn Key as the Jail’s medical provider despite Turn Key’s constitutionally deficient medical care
at the Jail, as demonstrated through Turn Key’s established practice of failing to train medical and
mental health staff on what constitutes alarming vital signs; when to report alarming vital signs to
a physician; and when to send inmates with complex and serious medical and mental health needs
to an outside medical facility for adequate assessment and treatment. ECF No. 36 at 21-22 (citing
2d Am. Compl. ¶ 98). Plaintiff alleges this policy of retaining Turn Key, despite its deficient
medical care, was the direct cause of the violation of Williams’ constitutional rights. Specifically,
the failure to train Turn Key staff, including Nurse Rasor, on when to escalate care for concerning
vital signs resulted in the failure of Nurse Rasor to escalate Williams’ concerning EKG results to
a physician or take Williams to the hospital, ultimately leading to Williams’ death. 2d Am. Compl.
¶¶ 99, 154-155.
Plaintiff further alleges that Turn Key’s established practice of deficient training was
widespread. Based on these prior incidents, Sheriff Regalado was or should have been aware that
9 The Court acknowledges Plaintiff’s argument that a public entity such as TCSO may be liable
under § 1983 pursuant to a doctrine of “non-delegable duty.” Under this doctrine, which has been
adopted by some district courts within the Tenth Circuit, “a public entity may be indirectly liable
under § 1983 for a third party’s policies when it contracts out its final policymaking authority to a
third party.” Est. of Angelo, 2024 WL 2274080, at *19. The question then “is not whether the
County itself promulgated an unconstitutional policy or had notice of problems caused by [Turn
Key]’s policy, but whether [Turn Key] had an unconstitutional policy and otherwise satisfies the
Monell requirements. If it does, the County can be liable because [Turn Key] stepped into the
County’s shoes with the County’s permission.” Est. of Walter by & through Klodnicki v. Corr.
Healthcare Companies, Inc., 323 F. Supp. 3d 1199, 1216 (D. Colo. 2018). See also Stewart v.
Dominicis, No. 24-3058-JWB, 2026 WL 1345859, at *6 (D. Kan. May 14, 2026). The Tenth
Circuit and Oklahoma district courts have not clearly adopted this approach, and the Court does
not rely on it here.
Turn Key was providing constitutionally inadequate medical care to inmates and yet retained Turn
Key as the Jail’s medical provider. Id. ¶¶ 154-155. Plaintiff alleges three similar prior incidents
at the Jail involving Turn Key staff occurred that would put Sheriff Regalado on notice of the need
for different or additional training of Turn Key medical staff. As discussed above with respect to
Turn Key’s liability, Plaintiff alleges that Dunniven Phelps and Dean Stith suffered negative
medical outcomes at the Jail in 2019 and 2021, respectively, after Turn Key providers failed to
escalate his serious symptoms to higher-level care. 2d Am. Compl. ¶¶ ¶¶ 107-115, 136-142.
Plaintiff also alleges another incident involving Turn Key’s failure to treat serious symptoms at
the Jail that resulted in those inmates’ deaths or other negative medical outcomes. Id. ¶¶ 105-106
(Caleb Lee). These three examples also suffice to plausibly allege deliberate indifference by
Sheriff Regalado in retaining Turn Key as the Jail’s medical provider. See 2d Am. Compl. ¶ 85
(“At least by the time of Mr. Williams’ incarceration, the County/TCSO knew, or should have
known, that Turn Key’s grossly deficient system and ‘plan’ posed excessive risks to the health and
safety of inmates, like Mr. Williams, who suffer from serious and complex medical conditions.”).10
Sheriff Regalado argues that these three examples are insufficient to support municipal
liability, because they are isolated and involve different medical issues. The Court rejects this
argument. Even if the “widespread practice” and “deliberate indifference” analyses are limited to
these three examples, they are sufficient to support an inference of Sheriff Regalado’s deliberate
indifference to Jail inmates’ serious medical needs by retaining Turn Key as the Jail’s medical
provider.11 See Griego, 100 F. Supp. 3d at 1213 (explaining that, to establish the existence of an
10 Plaintiff’s allegations concerning the alleged deficiencies in medical care provided at the Jail by
other medical providers, prior to Turn Key’s retention in December of 2016 (2d Am. Compl. ¶¶
73-81), are not relevant to Turn Key’s policies, customs, and practices at the Jail.
11 Because the Court finds Plaintiff has plausibly alleged municipal liability against Sheriff
Regalado based on knowledge of Turn Key’s widespread practices leading to Nurse Rasor’s
informal policy, custom, or practice, a plaintiff may plead “a pattern of multiple similar instances
of misconduct,” with “no set number” required to “render the alleged policy plausible”). Sheriff
Regalado further argues that none of these examples has resulted in a liability finding against the
Sheriff or Turn Key. However, as discussed above regarding Turn Key’s motion, the Court is not
persuaded that these active or settled cases should be excluded from consideration of whether a
practice was widespread at the motion-to-dismiss stage, particularly where the plaintiff in a prior
case had sufficiently alleged an underlying constitutional violation. See ECF No. 46 in Phelps v.
Turn Key, 4:21-cv-365-GKF-JFJ (N.D. Okla. Aug. 31, 2026) (finding that Dunniven Phelps had
“sufficiently alleged an underlying constitutional violation” for purposes of Monell claim against
Sheriff Regalado).
Plaintiff’s allegations are sufficient to withstand dismissal as to the deliberate indifference
claim against Sheriff Regalado, in his official capacity. Sheriff Regalado’s motion to dismiss the
Monell claim is denied.
C. Punitive Damages
Sherif Regalado seeks dismissal of Plaintiff’s request for punitive damages. It is well-
established that “a municipality is immune from punitive damages under 42 U.S.C. § 1983.” City
of Newport v. Fact Concerts, Inc., 453 U.S. 247, 271 (1981). However, a punitive damage claim
“is not an independent cause of action and is not properly at issue in a Rule 12(b)(6) motion.”
Crawford v. Turn Key Health Clinics, LLC, No. 24-CV-6-JDR-SH, 2025 WL 1885637, at *7–8
actions, the Court does not address Plaintiff’s alternative grounds for municipal liability, based on
a Jail policy of violating the Oklahoma Jail Standards in failing to perform regular visual sight
checks of detainees. See ECF No. 36 at 20-26. As explained above with regard to Turn Key, the
Court does not find a constitutional violation sufficiently alleged based on a systemic failure to
provide medical care at the Jail, nor does it find the alleged cost-sharing policy between TCSO
and Turn Key to be sufficiently linked to Williams’ injuries.
(N.D. Okla. July 8, 2025) (citing Mason v. Texaco, Inc., 948 F.2d 1546, 1554 (10th Cir. 1991).
Therefore, the Court denies Sheriff Regalado’s request to dismiss the punitive damages claim.
VI. Conclusion
For the reasons detailed above, Defendant Megan Rasor, APRN’s Motion to Dismiss (ECF
No. 39) is DENIED. Defendant Turn Key’s Motion to Dismiss (ECF No. 29) is DENIED.
Defendant Vic Regalado, in his official capacity as Sheriff of Tulsa County’s Motion to Dismiss
(ECF No. 28) is DENIED.
SO ORDERED this 11th day of August, 2026.
J F. JAY AGISA RATE JUDGE
UNITED STATES DISTRICT COURT
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