Julie Helphenstine v. Lewis County

RECOMMENDED FOR PUBLICATION

Pursuant to Sixth Circuit I.O.P. 32.1(b)

File Name: 23a0024p.06

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

┐

JULIE HELPHENSTINE, Administratrix of the Estate of

│

Christopher Dale Helphenstine and Guardian of

│

B.D.H., the minor son of Christopher Dale

│

Helphenstine,

│ No. 22-5407

Plaintiff-Appellant, >

│

│

v. │

│

LEWIS COUNTY, KENTUCKY; JEFF LYKINS, ANTHONY │

RUARK, ANDY LUCAS, BEN CARVER, AMANDA │

MCGINNIS, SANDY BLOOMFIELD, MARK RILEY, │

MELINDA MONROE, JEFFERY THOROUGHMAN, TOMMY │

VON LUHRTE, D.O., JOHNNY BIVENS, and JOHN │

BYARD, individually, │

Defendants-Appellees. │

┘

Appeal from the United States District Court for the Eastern District of Kentucky at Ashland.

No. 0:18-cv-00093—Henry R. Wilhoit, Jr., District Judge.

Argued: December 7, 2022

Decided and Filed: February 9, 2023

Before: SUTTON, Chief Judge, COLE and GRIFFIN, Circuit Judges.

_________________

COUNSEL

ARGUED: Gregory A. Belzley, BELZLEY, BATHURST & BENTLEY, Prospect, Kentucky,

for Appellant. Jeffrey C. Mando, ADAMS, STEPNER, WOLTERMANN & DUSING, PLLC,

Covington, Kentucky, for Lewis County Appellees. Clayton L. Robinson, ROBINSON &

HAVENS, PSC, Lexington, Kentucky, for Appellee Tommy von Luhrte, D.O. ON BRIEF:

Gregory A. Belzley, BELZLEY, BATHURST & BENTLEY, Prospect, Kentucky, James L.

Thomerson, ROSE GRASCH CAMENISCH MAINS PLLC, Lexington, Kentucky, for

Appellant. Jeffrey C. Mando, ADAMS, STEPNER, WOLTERMANN & DUSING, PLLC,

Covington, Kentucky, for Lewis County Appellees. Clayton L. Robinson, Courtney L. Soltis,

ROBINSON & HAVENS, PSC, Lexington, Kentucky, for Appellee Tommy von Luhrte, D.O.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 2

_________________

OPINION

_________________

GRIFFIN, Circuit Judge.

Christopher Helphenstine was arrested and charged with drug crimes in Lewis County,

Kentucky. While detained, he began to withdraw from alcohol or drugs. Despite severe

vomiting and diarrhea, the only medical care he received was two doses of antiemetics,

prescribed via fax machine by a doctor who never saw him. He died five days after his arrest.

His estate sued several jail employees, the doctor contracted to provide medical care at the jail,

and Lewis County for deliberate indifference to his serious medical needs in violation of the

Fourteenth Amendment, and for negligence in violation of state law. The district court ruled that

no defendant violated Helphenstine’s constitutional rights, declined to exercise jurisdiction over

the state-law negligence claim, and granted summary judgment in favor of all defendants.

We affirm in part, reverse in part, and remand for further proceedings.

I.

Christopher Helphenstine was arrested and charged with drug offenses on April 14, 2017

and taken to the Lewis County Detention Center (the “jail”). He was detained there until he died

en route to the hospital on April 19.

April 16, 2017. Around 8:30 p.m. on Sunday, April 16, Helphenstine “vomit[ed] all over

the floor” in general population, so defendant Deputy Jailer Mark Riley moved him to a single-

man “detox” cell. Helphenstine told Riley that he was “dope sick” and “wanted to be by hisself

[sic] so he can get over it.” Riley testified that he asked Helphenstine if he wanted to see a

doctor or go to the hospital, but Helphenstine responded that he did not.

At the time of Helphenstine’s detention, no jail employee had medical training beyond

first aid and CPR. Instead, the jail contracted with local doctor Tommy von Luhrte, D.O., to

provide medical care to inmates. Dr. von Luhrte was contractually obligated to visit the jail at

least once a week, but he did not always do so if the jail did not report that any inmates were

No. 22-5407 Helphenstine v. Lewis County, et al. Page 3

sick. When he visited, he came on Tuesday nights. So when Helphenstine began feeling ill on

Sunday evening, the jailers knew he would not receive any medical care for at least two days

unless someone reached out to Dr. von Luhrte.

Beginning at 9:20 p.m., the jailers took turns checking on Helphenstine about every

twenty minutes by opening a flap in the door to the isolation cell, looking into the cell, and

occasionally talking to him. They recorded their observations on a log sheet that hung on the

door of the cell. Helphenstine vomited again at 10:34 p.m.

April 17, 2017. According to the log sheet, Helphenstine was observed vomiting at

12:17 a.m. and 2:44 a.m. by defendant Deputy Jailer Anthony Ruark, and again at 5:42 a.m. by

defendant Deputy Jailer Melinda Monroe.1 He was “sitting up” for a brief period between

10:23 a.m. and 11:30 a.m., “talking” at 9:23 p.m., and “moving” at 11:12 p.m., but the log sheet

otherwise notes him as “laying down” all day.

By midnight, Helphenstine’s condition had deteriorated. Defendant Deputy Jailer

Amanda McGinnis prepared a non-emergency but “urgent” medical request for Helphenstine,

stating that he was in withdrawal (though she did not know from what), vomiting and soiling

himself, refusing to eat or drink, and had not gotten out of bed for twenty-four hours. McGinnis

faxed this request to Dr. von Luhrte’s office, even though she knew the office was closed due to

the late hour.

April 18, 2017. Between 6:00 a.m. and 7:00 a.m., Helphenstine was sweaty and smelled

of vomit and feces, so he showered for almost an hour while jail staff cleaned his cell.

Helphenstine was scheduled to be arraigned that morning, so at about 9:15 a.m.,

defendant Deputy Sheriff John Byard escorted Helphenstine on the short walk from the jail to the

courthouse. Byard noticed that Helphenstine was lethargic and drooling. Before the arraignment

began, Byard approached the bench and told the judge that Helphenstine was “acting like he’s

just clear out of it,” had “[s]tuff coming out of his mouth,” and was “really not coherent.”

1

Apparently, Monroe has not been located, and thus not deposed.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 4

The judge postponed the arraignment after speaking with deputies about his condition. Byard

walked Helphenstine back to the jail, apparently without incident.

McGinnis’s overnight fax was brought to Dr. von Luhrte’s attention by mid-morning.

Dr. von Luhrte testified that he called the jail and directed that Helphenstine be taken to a

hospital to receive IV fluids, but he was told that Helphenstine refused to go to the hospital.

Dr. von Luhrte could not remember with whom he spoke, and he did not document the call.

There is no record of this call at the jail, and no defendant recalls taking a call from Dr. von

Luhrte. Further, no jailer recalls Helphenstine ever refusing treatment (with the exception of

Riley’s question on April 16, after Helphenstine first vomited).

Regardless, Dr. von Luhrte testified that, because he believed Helphenstine had refused

to go to the hospital, he faxed a prescription to the jail for Reglan (an antiemetic), and he

encouraged Helphenstine to rest, sip liquids, and eat bland food. Dr. von Luhrte was concerned

Helphenstine “might be getting dehydrated,” but he did not instruct the jailers to monitor

Helphenstine’s food or fluid intake.

Around 3:00 p.m., Helphenstine received a dose of Reglan. Dr. von Luhrte testified that

he received a call around that time from someone who identified themself only as “the jailer,”

whom Dr. von Luhrte thought might be defendant Jailer Jeff Lykins. Dr. von Luhrte testified

that he again informed the jailer that Helphenstine needed to go to the hospital, but was told that

Helphenstine refused again. Dr. von Luhrte told the jailer to try again, but Helphenstine

purportedly refused a third time. As with the first call from Dr. von Luhrte, there is no record of

this call taking place, and Lykins specifically denies ever speaking with Dr. von Luhrte.

Dr. von Luhrte then prescribed Zofran, a stronger antiemetic, for Helphenstine.

Although April 18 was a Tuesday (his normal night to visit the jail) and although he

knew of Helphenstine’s condition, Dr. von Luhrte did not visit the jail that evening. There is a

dispute over whether the jail sent a “Sick Call List” to Dr. von Luhrte’s office. The doctor

claims he did not receive one. But the jail produced a Sick Call List dated April 17, 2017, listing

three inmates that needed medical attention. Nonetheless, Dr. von Luhrte failed to go to the jail

to treat Helphenstine.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 5

At 9:00 p.m., Helphenstine received doses of both Reglan and Zofran. About that time,

defendant Deputy Jailer Andy Lucas checked on Helphenstine, who told Lucas “that he was not

going to drink any more whiskey again.” Lucas testified that Helphenstine was standing and

alert at that time. Around 11:00 p.m., Helphenstine asked for something cold to drink, so Lucas

brought him a Mountain Dew. Helphenstine drank some of the soda and then said, “I’m feeling

all right now.”

April 19, 2017. At about midnight, Helphenstine laid face-down on his mat. For the next

few hours, he remained there, largely motionless. Video shows him occasionally twitching and

raising or shaking his feet.

At 2:42 a.m., a deputy entered Helphenstine’s cell to check on him. McGinnis testified

that this was Ruark, but Ruark was unsure whether he did this. The jailer twice offered

Helphenstine a drink, but he refused. At 2:50 a.m., McGinnis also entered Helphenstine’s cell.

While the first deputy lifted Helphenstine’s head, McGinnis put a straw to his mouth and

encouraged him to drink. At about 2:56 a.m., McGinnis helped Helphenstine drink a small

amount again. And at 3:13 a.m., McGinnis observed Helphenstine through the window and

noted that he had consumed some liquid. Defendant Deputy Jailer Sandy Bloomfield, the shift

supervisor, watched this entire interaction on video from the control room.

Around 3:30 a.m., Ruark looked through the window into Helphenstine’s cell, where it

“appeared to [him] that something may be wrong[.]” Helphenstine did not respond to his name,

so Ruark asked another jailer to get Bloomfield from the control room and see if she could get

Helphenstine to respond. McGinnis also came to help; she could not locate Helphenstine’s

pulse. They observed Helphenstine as cold, blue, and unresponsive, and began CPR while

Bloomfield called 911. EMTs described Helphenstine as “warm and drenched in sweat” when

they arrived. They took over CPR and transported Helphenstine to the hospital. He was

pronounced dead en route.

Plaintiff’s experts testified that Helphenstine died either from withdrawal or from severe

dehydration caused by withdrawal. But Helphenstine’s death certificate lists his cause of death

as “acute (fentanyl) and chronic drug abuse,” with the interval between onset and death listed as

No. 22-5407 Helphenstine v. Lewis County, et al. Page 6

minutes. The medical examiner who performed the autopsy, Dr. Meredith Frame, testified that

fentanyl was present in Helphenstine’s blood at a level of 1.8 ng/ml. This was within her

understanding of the therapeutic levels of fentanyl (1 to 3 ng/ml). However, there is no evidence

that Helphenstine took fentanyl at any time while at the jail.

Plaintiff Julie Helphenstine, the decedent’s wife and administratrix of his estate,2 sued,

bringing a deliberate indifference claim under 42 U.S.C. § 1983 against all defendants and a

negligence claim under Kentucky law against the individual defendants. In addressing

defendants’ motion for summary judgment, the district court analyzed plaintiff’s § 1983 claim

against each defendant individually, concluded that none were deliberately indifferent, and

declined to exercise jurisdiction over the state-law negligence claim. Accordingly, the court

granted summary judgment in favor of all defendants. Plaintiff timely appealed.3

II.

We review the district court’s summary judgment rulings de novo. Wilmington Tr. Co. v.

AEP Generating Co., 859 F.3d 365, 370 (6th Cir. 2017). “Summary judgment is proper when,

viewing the evidence in the light most favorable to the nonmoving party, there is no genuine

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

Id. (citation omitted). “Credibility determinations, the weighing of the evidence, and the

drawing of legitimate inferences from the facts are jury functions, not those of a judge,” when

ruling on a motion for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255

(1986).

The parties quibble regarding our standard of review. Plaintiff argues that we must view

defendants’ “self-serving testimony” with “a heightened degree of skepticism.” The Lewis

County defendants respond that we need not do so because plaintiff forfeited this argument and

because she relies on nonbinding out-of-circuit precedent for this proposition.

2

Because the couple shares a surname, we refer to decedent Chris Helphenstine as Helphenstine, and Julie

Helphenstine as plaintiff.

3

Plaintiff has not appealed the district court’s grant of summary judgment in favor of defendant Johnny

Bivens, and on appeal, she has waived any opposition to the grant of summary judgment in favor of defendants Ben

Carver and Jeffrey Thoroughman.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 7

While plaintiff did not characterize the Lewis County defendants’ testimony as “self-

serving” before the district court, the thrust of her argument was the same: because all

reasonable inferences must be drawn in her favor, we need not accept defendants’ statements or

arguments as true if there is conflicting evidence to the contrary. Thus, she has not forfeited this

argument. But the Lewis County defendants are correct when they note that, in our circuit, we

do not “disregard evidence merely because it serves the interests of the party introducing it.”

Harris v. J.B. Robinson Jewelers, 627 F.3d 235, 239 (6th Cir. 2010). True, we may disregard

self-serving statements when they are “blatantly contradicted by the record.” Scott v. Harris,

550 U.S. 372, 380 (2007). But we need not apply any special scrutiny to defendants’ statements

simply because they are self-serving. See, e.g., Bledsoe v. Tenn. Valley Auth. Bd. of Dirs.,

42 F.4th 568, 589 (6th Cir. 2022). Of course, the general rules—that we must take all reasonable

inferences in plaintiff’s favor and may not make any credibility determinations—still apply.

Liberty Lobby, 477 U.S. at 255.

A.

Plaintiff claims that defendants were deliberately indifferent to a serious risk of harm to

Helphenstine, in violation of his constitutional rights.

1.

Until recently, we analyzed both pretrial detainees’ and prisoners’ claims of deliberate

indifference “under the same rubric.” Brawner v. Scott Cnty., 14 F.4th 585, 591 (6th Cir. 2021)

(citation omitted). A prisoner’s deliberate indifference claim arises from the Eighth Amendment

and has objective and subjective components. See, e.g., Farmer v. Brennan, 511 U.S. 825, 834

(1994). The “objective component” addresses the conditions leading to the alleged violation: it

“requires a plaintiff to prove that the alleged deprivation of medical care was serious enough to

violate the Constitution.” Griffith v. Franklin Cnty., 975 F.3d 554, 567 (6th Cir. 2020) (citation

and brackets omitted). The “subjective” component, meanwhile, addresses the officials’ state of

mind and requires a plaintiff to show that a defendant “kn[ew] of and disregard[ed] an excessive

risk to inmate health or safety; the official must both be aware of facts from which the inference

No. 22-5407 Helphenstine v. Lewis County, et al. Page 8

could be drawn that a substantial risk of serious harm exists, and he must also draw the

inference.” Farmer, 550 U.S. at 837.

But in Brawner, we considered whether the Supreme Court’s decision in Kingsley v.

Hendrickson, 576 U.S. 389 (2015), required “modification of the subjective prong of the

deliberate-indifference test for pretrial detainees,” like Helphenstine. 14 F.4th at 596. In

Kingsley, the Court addressed the standard for excessive force claims brought by both pretrial

detainees and convicted prisoners. 576 U.S. at 400–02. The Court concluded that a pretrial

detainee need demonstrate “only that the force purposely or knowingly used against him was

objectively unreasonable,” rather than both objectively and subjectively unreasonable, like a

prisoner must. Id. at 396–97, 400–02. It based its decision largely on the difference between the

Due Process Clause of the Fourteenth Amendment (from which a pretrial detainee’s claim arises)

and the Cruel and Unusual Punishments Clause of the Eighth Amendment (from which a

prisoner’s claim arises). Id. at 398–402. The Court did not, however, address whether an

objective-only standard applies to other pretrial-detainee claims, such as deliberate indifference.

See Brawner, 14 F.4th at 592.

Brawner answered the question left open by Kingsley, holding that Kingsley required

modification of the subjective component of a pretrial detainee’s deliberate indifference claim:

“Given Kingsley’s clear delineation between claims brought by convicted prisoners under the

Eighth Amendment and claims brought by pretrial detainees under the Fourteenth Amendment,

applying the same analysis to these constitutionally distinct groups is no longer tenable.” Id. at

596. We modified the subjective prong as follows: “A pretrial detainee must prove more than

negligence but less than subjective intent—something akin to reckless disregard.” Id. (internal

quotation marks omitted). In other words, a plaintiff must prove that a defendant “acted

deliberately (not accidentally), [and] also recklessly ‘in the face of an unjustifiably high risk of

harm that is either known or so obvious that it should be known.’” Id. (quoting Farmer, 511 U.S.

at 836).

Recently, however, a panel of this court called this reading of Brawner into question.

See Trozzi v. Lake Cnty., 29 F.4th 745 (6th Cir. 2022). In Trozzi, the panel agreed that Brawner

modified the subjective element. Id. at 753–54. But based on the Brawner opinion itself,

No. 22-5407 Helphenstine v. Lewis County, et al. Page 9

“post-Brawner decisions, and background principles,” id. at 754, it concluded that the subjective

inquiry “still requires consideration of an official’s actual knowledge of the relevant

circumstances.” Id. at 755. It then framed the test this way: “Reading Farmer, Kingsley,

Brawner, and Greene [v. Crawford Cnty., 22 F.4th 593 (6th Cir. 2022)] together, a plaintiff must

satisfy three elements for an inadequate-medical-care claim under the Fourteenth Amendment:

(1) the plaintiff had an objectively serious medical need; (2) a reasonable officer at the scene

(knowing what the particular jail official knew at the time of the incident) would have

understood that the detainee’s medical needs subjected the detainee to an excessive risk of harm;

and (3) the prison official knew that his failure to respond would pose a serious risk to the pretrial

detainee and ignored that risk.” Id. at 757–58 (emphasis added).

We hold that this framing of the elements is irreconcilable with Brawner. We appreciate

that our sister circuits are all over the map on this issue. As an initial matter, four circuits have

rejected the extension of Kingsley to deliberate indifference claims. See Cope v. Cogdill, 3 F.4th

198, 207 n.7 (5th Cir. 2021); Whitney v. City of St. Louis, 887 F.3d 857, 860 n.4 (8th Cir. 2018);

Strain v. Regalado, 977 F.3d 984, 989–93 (10th Cir. 2020); Dang by & through Dang v. Sheriff,

Seminole Cnty., 871 F.3d 1272, 1279 n.2 (11th Cir. 2017). Three more circuits continue applying

the pre-Kingsley framework, though without ruling out a future switch. See Miranda-Rivera v.

Toledo-Davila, 813 F.3d 64, 74 (1st Cir. 2016); Moore v. Luffley, 767 F. App’x 335, 340 n.2 (3d

Cir. 2019); Mays v. Sprinkle, 992 F.3d 295, 300–01 (4th Cir. 2021). As to the circuits that extend

Kingsley’s objective inquiry to deliberate indifference, they disagree on the question to ask. One

circuit asks what “a reasonable official in the [defendant’s] circumstances would have

appreciated” about the risks facing a detainee. Gordon v. Cnty. of Orange, 888 F.3d 1118, 1125

(9th Cir. 2018). One circuit asks what the defendant himself knew or should have known about

the risks. Darnell v. Pinerio, 849 F.3d 17, 34–35 (2d Cir. 2017). And a third circuit asks if the

defendant displayed “purposeful, knowing, or reckless disregard of the consequences.” Miranda

v. Cnty. of Lake, 900 F.3d 335, 354 (7th Cir. 2018); Pittman by & through Hamilton v. Cnty. of

Madison, 970 F.3d 823, 827 (7th Cir. 2020) (same).

Whatever the merits of these approaches to Kingsley, we do not think that Brawner leaves

the question open. Simply put, Brawner held that Kingsley required us to lower the subjective

No. 22-5407 Helphenstine v. Lewis County, et al. Page 10

component from actual knowledge to recklessness. Indeed, several panels of our court have

interpreted Brawner in this way. See Greene, 22 F.4th at 610 (“A jury could find that Greene’s

need for immediate medical attention was ‘known or so obvious that it should [have been] known

to [defendant.]’” (first alteration in original)); Britt v. Hamilton Cnty., No. 21-3424, 2022

WL 405847, at *2 (6th Cir. Feb. 10, 2022) (“The key question in this case goes to deliberate

indifference: Did the officers act ‘recklessly in the face of an unjustifiably high risk’ that is

either ‘known or so obvious that it should be known’?” (quoting Brawner, 14 F.4th at 596–97)).

Because Brawner was decided before Trozzi, Brawner controls. Stewart v. Trierweiler,

867 F.3d 633, 638 (6th Cir. 2017); Salmi v. Sec’y of Health & Hum. Servs., 774 F.2d 685, 689

(6th Cir. 1985). Accordingly, plaintiff must show (1) that Helphenstine had a sufficiently serious

medical need and (2) that each defendant “acted deliberately (not accidentally), [and] also

recklessly ‘in the face of an unjustifiably high risk of harm that is either known or so obvious that

it should be known.’” Brawner, 14 F.4th at 596 (quoting Farmer, 511 U.S. at 836).

2.

Defendants do not challenge the district court’s finding that Helphenstine suffered an

objectively serious medical need. Thus, our focus rests exclusively on the subjective prong.

Greene v. Crawford County is instructive for the subjective analysis. There, Dwayne

Greene was booked into the county jail. 22 F.4th at 601. He was drunk, and the booking staff

suspected he would experience alcohol withdrawal. Id. But by the time Greene was booked, the

jail nurse had left and would not return to the jail for four days. Id. Greene was detained without

incident for a few days until jailers observed him hallucinating. Id. at 601–02. A jailer requested

a mental health evaluation for Greene, so a mental health counselor evaluated Greene and

determined he was experiencing delirium tremens (a severe form of alcohol withdrawal). Id. at

602–03. The counselor did not encourage jail staff to seek medical treatment. Id. at 603. By the

end of that day, “Greene had been in the jail for three days and had not received any basic

medical care. He had not seen a medical professional, had not received any medication, had not

had his blood pressure, temperature, or any vitals checked, had not received an IV, and had not

No. 22-5407 Helphenstine v. Lewis County, et al. Page 11

been offered any fluids beyond water.” Id. Greene was found unresponsive in his cell at 7:38

a.m. the next morning and taken to the hospital, where he later died. Id. at 603–04.

Greene’s estate brought deliberate indifference claims against several jailers. Id. at 604.

The district court granted summary judgment in favor of some and denied as to others. Id. at

607–08. On appeal, we held that “a jury could find that Greene was in ‘obvious’ need of some

medical attention in the hours following [the] evaluation.” Id. at 608–09 (quoting Brawner,

14 F.4th at 597). Despite Greene’s hallucinations and the fact that he “had not slept in over

24 hours prior to his incapacitation[,]” the “County Defendants nonetheless failed to seek any

basic medical assistance.” Id. at 609. “At a certain point, [that] bare minimum observation

ceases to be constitutionally adequate.” Id. We left the question of when that point occurred “for

the jury to determine.” Id. We then applied these principles to each defendant and held that a

jury could find that several defendants recklessly failed to act reasonably by not seeking medical

assistance for Greene. Id. at 609–13.

3.

With this framing in mind, we review each defendant’s actions individually. Id. at 607.

Mark Riley. Riley moved Helphenstine from general population to the detox cell on

April 16, knew that Helphenstine was “dope sick,” and knew that he vomited at least once. Riley

admitted that “somebody needed to call Dr. [v]on Luhrte” at that time. Because he neither

placed that call nor asked another defendant to call Dr. von Luhrte on April 16, a reasonable jury

could find that Riley acted with deliberate indifference.

Riley resists, arguing that during his shift, no reasonable officer would understand that

Helphenstine was experiencing an objectively serious medical need. “A sufficiently serious

medical need 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.”

Griffith, 975 F.3d at 567 (internal quotation marks removed). Vomiting is “a clear manifestation

of internal physical disorder.” Blackmore v. Kalamazoo Cnty., 390 F.3d 890, 899 (6th Cir.

2004). Further, that jailers “deem[] [a detainee]’s condition sufficiently serious to place him in

an observation cell” tends to show a sufficiently serious medical need. Id.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 12

When Helphenstine began to fall ill on April 16, Riley knew he needed medical attention:

Riley knew he had vomited, moved him to an observation cell, and testified that someone needed

to call a doctor. Thus, a reasonable jury could conclude that Helphenstine’s medical need was, at

this point, so obvious that a lay person like Riley should—and did—recognize the need for

medical attention. See id.

Because Riley, a lay person, recognized that Helphenstine’s condition was serious

enough that he needed medical attention, a jury could also reasonably conclude that Riley

recklessly disregarded that known risk to Helphenstine’s health via his inaction. Accordingly,

we reverse the district court’s grant of summary judgment in favor of Riley.

Amanda McGinnis. Defendant McGinnis had, comparatively, a large amount of contact

with Helphenstine. Late in the evening on April 17, she knew he was going through withdrawal,

and she sent the initial fax to Dr. von Luhrte early on April 18, noting that Helphenstine was

vomiting and soiling himself, refusing to eat or drink, and had not gotten out of bed for 24 hours.

She knew that other deputies cleaned Helphenstine’s cell of vomit and feces while he showered

that morning and that he was not feeling well at that point. In the early morning hours of April

19, another jailer had to help McGinnis hold Helphenstine’s head up for him to drink. McGinnis

even admitted that she consciously treated Helphenstine’s medical needs differently on account

of his being detained:

Q: If—and I understand that you were constrained by your employment and the

things—the way things worked at the jail but if you’d come home one night and

seen a family member or a loved one in Mr. Helphenstine’s condition that you

saw the night of the 17th when you sent the medical request form to Dr. [von

Luhrte], would you have taken them to the hospital?

A: Yes.

A reasonable jury could find that McGinnis acted with deliberate indifference.

Despite McGinnis’s admission that she would have taken “a family member or a loved

one” in Helphenstine’s condition to the hospital, she took no action to help him beyond faxing

Dr. von Luhrte—which she knew would not result in a response for at least several hours. The

district court concluded that McGinnis had done enough, relying on the general principle that it

is often sufficient for a jailer to contact a medical professional when they perceive a medical

No. 22-5407 Helphenstine v. Lewis County, et al. Page 13

issue with an inmate or detainee. See Winkler v. Madison Cnty., 893 F.3d 877, 903 (6th Cir.

2018). But that general rule applies when a jailer contemporaneously contacts a medical

professional who can provide near-immediate treatment. Indeed, we have found that as little as a

one-hour delay in treatment could be enough for a jury to conclude that a jailer was indifferent to

an inmate’s medical needs. See Terrance v. Northville Reg’l Psychiatric Hosp., 286 F.3d 834,

845 (6th Cir. 2002) (holding that “although she knew about the decedent’s serious medical

condition, [the defendant] chose to wait [almost an hour] for Dr. Said instead of immediately

contacting another physician or the emergency team,” from which a jury could impose liability).

The same is true here: A jury could conclude that McGinnis’s choice to send a fax in the middle

of the night, when no one would be present at Dr. von Luhrte’s office and no one would respond

for several hours, was deliberately indifferent to Helphenstine’s medical needs.

Moreover, McGinnis was with Helphenstine shortly before his death and observed that he

was effectively unresponsive. Around 3 a.m. on April 19, Helphenstine could not even lift his

head to drink. McGinnis knew that Helphenstine had not received any medical attention or care

beyond two doses of antiemetics. Despite this personal observation and knowledge, she did not

seek medical attention for him.

We have held that similar facts were enough to establish a constitutional violation under

the pre-Brawner standard, so they are certainly enough to defeat summary judgment now. See

Smith v. Cnty. of Lenawee, 505 F. App’x 526 (6th Cir. 2012). In Smith, a defendant shift

commander was only present at the jail for a detainee’s final hours of life before the detainee

died of delirium tremens. Id. at 534–35. The commander knew that the detainee was medicated,

and that she was “resting more quietly . . . than she had during the previous day.” Id. at 535.

However, when he went into the detainee’s cell, he did not check the detainee’s vitals, and she

was largely unresponsive. Id. at 534–35. We found that the commander “was on notice that [the

detainee] was very ill and yet did nothing to make sure that [the detainee] had not taken a turn

for the worse.” Id. at 535.

We cited Smith approvingly in Greene: “[A defendant] did not observe Greene in a near-

lifeless state like [the] officer in Smith observed. However, worse than the officer in Smith, [that

defendant] knew on December 8 that Greene had not received any medication—or any basic

No. 22-5407 Helphenstine v. Lewis County, et al. Page 14

medical assistance—in four days.” 22 F.4th at 611. Given this information, which the defendant

actually knew, a jury could infer that the defendant was on notice of Greene’s serious illness and

yet did nothing—enough to satisfy Brawner and defeat summary judgment. Id.

The same is true here: McGinnis observed Helphenstine in a near-lifeless state, knowing

that Helphenstine had not received even basic medical observation or assistance. A jury could

reasonably conclude that she recklessly failed to act reasonably by not seeking medical

assistance for Helphenstine. The district court erred in concluding otherwise.

Anthony Ruark and Sandy Bloomfield. The Smith/Greene analysis is equally applicable

to Ruark and Bloomfield, and a reasonable jury could conclude that they acted with deliberate

indifference.

Ruark knew that Helphenstine was in withdrawal and observed him vomiting at least

twice in the early morning hours of April 17. Ruark testified that he could not recall if

Helphenstine could “hold[] anything down” at the time. And a jury could conclude that around

3 a.m. on April 19, Ruark saw Helphenstine lying face down, barely moving, and had to

physically lift his head for McGinnis to help him to drink. But Ruark did not seek medical

attention for Helphenstine.

Similarly, Bloomfield knew Helphenstine was in the observation cell because he was

“dope sick,” and she knew he was going through withdrawal. Bloomfield was aware that he had

diarrhea and had been vomiting and sweating. She saw Helphenstine lie face-down on his mat

via the jail cameras on the morning of April 19. And she watched McGinnis and the other

officer try to get Helphenstine to drink some liquid, but instead observed him lying down without

moving. Yet Bloomfield did not seek medical attention for Helphenstine.

As in Smith and Greene, these defendants observed Helphenstine in a near-lifeless state

after days of illness. A jury could reasonably conclude that they recklessly failed to act

reasonably by not seeking medical assistance for Helphenstine.

To avoid this conclusion, Bloomfield argues that she believed Helphenstine was, at

various times, “coherent,” responsive, and improving. Thus, she argues, she did not know of any

No. 22-5407 Helphenstine v. Lewis County, et al. Page 15

risk, so she could not disregard that risk and she is not liable. But these observations are of no

moment when we apply Brawner. Although Bloomfield observed Helphenstine’s condition

fluctuate, the record demonstrates that she should have known that he was urgently in need of

medical care—at the very least, when she observed Helphenstine unmoving and unable to lift his

own head to drink, she should have recognized a serious need for medical care. Reckless

inaction in the face of that obvious need is enough to proceed to a jury under Brawner. The

district court erred in concluding otherwise.

Jeff Lykins. Lykins is Lewis County’s elected Jailer. Plaintiff brings a deliberate

indifference claim against Lykins both in his individual and supervisory capacities, which we

address in turn.

Lykins first learned of Helphenstine’s condition on April 17, when he reviewed Riley’s

report (dated April 16) that Helphenstine had vomited and was moved to an observation cell. He

interacted with Helphenstine on April 18 around the time of the scheduled arraignment, when he

thought Helphenstine “looked okay.” And Lykins agreed that at that time, there was no one at

the jail “who could determine whether Mr. Helphenstine’s condition was a medical emergency,

other than Dr. [v]on Luhrte.”

Further, Dr. von Luhrte testified that he called the jail on the afternoon of April 18 and

spoke with someone who identified himself only as “the jailer,” whom Dr. von Luhrte believed

to be Lykins. The doctor testified that he instructed the jailer to take Helphenstine to the hospital

twice, which Helphenstine refused. But Lykins testified that he did not speak to Dr. von Luhrte

that day (as did all other Lewis County defendants). And no defendant ever heard Helphenstine

refuse treatment. This leaves a material dispute of fact, from which a jury could conclude that

Dr. von Luhrte told Lykins to take Helphenstine to the hospital, but Lykins did not act on that

advice. If the jury believed Dr. von Luhrte, it could also reasonably conclude that Lykins knew

Helphenstine’s condition needed hospital care. Under such circumstances, a trier of fact could

reasonably conclude that Lykins acted at least recklessly by disregarding that advice.4

4

True, Lykins would have been entitled to rely on Dr. von Luhrte’s medical advice. See Winkler, 893 F.3d

at 895. However, he is not entitled to ignore or reject Dr. von Luhrte’s advice.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 16

Accordingly, the district court erred when it granted summary judgment in favor of Lykins in his

individual capacity.

However, for plaintiff’s supervisory-liability claim to succeed, she must show that Lykins

was actively involved in offensive conduct, and that his conduct caused Helphenstine’s injuries.

Crawford v. Tilley, 15 F.4th 752, 761–62 (6th Cir. 2021). She has not done so.

We begin and end with active involvement. “To succeed on a supervisory liability claim,

a plaintiff must show that a supervisory official at least implicitly authorized, approved or

knowingly acquiesced in the unconstitutional conduct of the offending subordinate.” Id. at 761

(brackets and quotation marks omitted). This requires active unconstitutional conduct by the

supervisor because supervisory liability will not attach for a failure to act. Id. But plaintiff’s

claim rests entirely on Lykins’s purported failure to act: she argues that Lykins “failed to effect

[Dr. v]on Luhrte’s order that Helphenstine be taken to the hospital”; “did not check on

Helphenstine”; and “conducted no investigation at all into what had happened to Helphenstine,

or the performance of his staff or [Dr. v]on Luhrte.” There is no evidence that he directed any

subordinate to act in a way that violated Helphenstine’s rights, nor is there evidence that he

authorized or acquiesced in any unconstitutional conduct. Thus, the district court properly

granted summary judgment in Lykins’s favor on the supervisory-liability claim against him.

John Byard and Andy Lucas. The two remaining individual Lewis County defendants

had no reason to know that Helphenstine was suffering a serious medical need. Accordingly, the

district court properly granted summary judgment in their favor.

Byard merely walked Helphenstine from the jail to the courthouse on April 18; informed

the judge that Helphenstine was “acting like he’s just clear out of it,” had “[s]tuff coming out of

his mouth,” and was “really not coherent”; and walked Helphenstine back to the jail.

Lucas had only two brief contacts with Helphenstine. Around 9:00 p.m. on April 18, he

saw Helphenstine in the isolation cell, when Helphenstine told Lucas he “was not going to drink

anymore whiskey again.” Around 11:30 p.m., he brought Helphenstine a Mountain Dew to

drink. There is no evidence that Lucas was aware of Helphenstine’s medical condition over the

No. 22-5407 Helphenstine v. Lewis County, et al. Page 17

previous days, particularly since Lucas spent most of his shift physically separated from the part

of the jail where Helphenstine was housed.

Neither Byard nor Lucas observed vomiting, diarrhea, shaking, sweating, or any other

manifestation of illness. Neither had any “reason to appreciate the seriousness of [Helpenstine’s]

condition.” Speers v. Cnty. of Berrien, 196 F. App’x 390, 396 (6th Cir. 2006). Although both

Byard and Lucas knew that Helphenstine was going through withdrawal, that knowledge alone

did not require either of them to seek medical care for Helphenstine, particularly since

withdrawal “typically may be managed in a prison setting and indeed frequently is managed

there.” Id. at 395. While it may have been prudent for Byard and Lucas to seek some medical

care for Helphenstine, no reasonable jury could conclude that they were aware of a serious

medical need, nor that they recklessly disregarded a known or obvious risk to Helphenstine’s

health.

In response, plaintiff highlights Lucas’s admission that if he knew the jail’s policy that

classified withdrawal as a medical emergency, he would have called an ambulance for

Helphenstine on April 18. Unlike McGinnis’s similar admission, though, this question was not

premised on Lucas’s personal knowledge of Helphenstine’s condition. It was based only on the

jail’s policy, which Lucas failed to follow. Alone, the failure to follow an internal policy does

not give rise to a deliberate indifference claim. Griffith, 975 F.3d at 578.

For these reasons, we affirm the district court’s grant of summary judgment in favor of

Byard and Lucas.

Dr. von Luhrte. Because Dr. von Luhrte is a physician, the subjective component of

plaintiff’s claim against him is slightly different than that of the other defendants. Generally, “a

patient’s disagreement with his physicians over the proper course of treatment alleges, at most, a

medical-malpractice claim, which is not cognizable under § 1983.” Darrah v. Krisher, 865 F.3d

361, 372 (6th Cir. 2017). But “a doctor’s provision of ‘grossly inadequate medical care’ to an

involuntary detainee may amount to deliberate indifference.” Miller v. Calhoun Cnty., 408 F.3d

803, 819 (6th Cir. 2005) (quoting Terrance, 286 F.3d at 844). “Grossly inadequate medical care

is medical care that is ‘so grossly incompetent, inadequate, or excessive as to shock the

No. 22-5407 Helphenstine v. Lewis County, et al. Page 18

conscience or to be intolerable to fundamental fairness.’” Id. (quoting Terrance, 286 F.3d at

844). And when the medical need is obvious, “medical care which is so cursory as to amount to

no treatment at all may amount to deliberate indifference.” Terrance, 286 F.3d at 843 (citation

omitted).

Dr. von Luhrte was never physically present at the jail, but he received a fax explaining

that Helphenstine was in withdrawal, “soiling himself and vomiting [and] refusing to eat and

drink due to upset stomach.” This led him to believe that Helphenstine “might be getting

dehydrated.” But in response, Dr. von Luhrte merely faxed two prescriptions to the jail and

encouraged Helphenstine to rest, sip liquids, and eat bland food. He testified that by the

afternoon of April 18, Helphenstine’s condition may have been a medical emergency and he

required treatment that only a hospital could provide. Nonetheless, Dr. von Luhrte neither

visited the jail, nor provided medical care or direction for Helphenstine’s treatment.

To be sure, Dr. von Luhrte maintains that he called the jail twice and advised that

Helphenstine must be taken to the hospital immediately. However, the jail does not have record

of either telephone call and no Lewis County defendant recalls ever speaking to Dr. von Luhrte.

Thus, there is a genuine issue of material fact as to whether the phone calls occurred.

On this record, a reasonable jury could conclude that Dr. von Luhrte acted with deliberate

indifference. Dr. von Luhrte knew that Helphenstine was in distress and knew that he needed

treatment that only a hospital could provide. With this knowledge, a reasonable jury could

conclude that he did not direct the jail staff to transport Helphenstine to the hospital, and thus

find that this inaction in the face of Helphenstine’s serious medical need was deliberately

indifferent. See Gibson v. Muskowitz, 523 F.3d 657, 662–63 (6th Cir. 2008).

Moreover, a jury could conclude that the treatment Dr. von Luhrte did provide was “so

cursory as to amount to no treatment at all[.]” Terrance, 286 F.3d at 843 (citation omitted).

Despite acknowledging that Helphenstine needed IV fluid replacement and hospital-grade care,

he only prescribed antiemetics and advised the jailers to help Helphenstine orally rehydrate.

A reasonable jury could conclude that Dr. von Luhrte knew that treatment plan would be

inadequate. See id.; cf. Rouster v. Cnty. of Saginaw, 749 F.3d 437, 448 (6th Cir. 2014)

No. 22-5407 Helphenstine v. Lewis County, et al. Page 19

(“Had [the defendant] been subjectively aware of the seriousness of [the inmate’s] medical

condition, her decision to treat him only with over-the-counter medication might have been so

cursory as to amount to a conscious disregard of his needs.”). Thus, the question of “whether

that course of treatment constituted deliberate indifference is a question best suited for a jury.”

Darrah, 865 F.3d at 370. The district court erred when it granted summary judgment in Dr. von

Luhrte’s favor.

Lewis County. Plaintiff also seeks to impose municipal liability on Lewis County.

“A municipality is a ‘person’ under 42 U.S.C. § 1983, and so can be held liable for constitutional

injuries for which it is responsible.” Morgan v. Fairfield Cnty., 903 F.3d 553, 565 (6th Cir. 2018)

(citing Monell v. Dep’t of Soc. Servs. of City of New York, 436 U.S. 658, 690 (1978)).

A municipality cannot be liable under a theory of respondeat superior; it can only be held liable

for “its own wrongdoing.” Id. This requires plaintiff to demonstrate that the alleged federal

violation occurred because of a municipal “policy or custom.” Monell, 436 U.S. at 694.

A municipality may be held liable under one of four recognized theories: “(1) the existence of

an illegal official policy or legislative enactment; (2) that an official with final decision making

authority ratified illegal actions; (3) the existence of a policy of inadequate training or

supervision; or (4) the existence of a custom of tolerance or acquiescence of federal rights

violations.” Burgess v. Fischer, 735 F.3d 462, 478 (6th Cir. 2013). Plaintiff argues that Lewis

County failed to adequately train and supervise its jailers regarding medical emergencies.

We agree.

“A municipality’s culpability for a deprivation of rights is at its most tenuous where a

claim turns on a failure to train.” Connick v. Thompson, 563 U.S. 51, 61 (2011). There are two

ways to support a claim that a failure to train or supervise is the result of a municipality’s

deliberate indifference. Plaintiff may prove (1) a “pattern of similar constitutional violations by

untrained employees” or (2) “a single violation of federal rights, accompanied by a showing that

[the municipality] has failed to train its employees to handle recurring situations presenting an

obvious potential for a constitutional violation.” Shadrick v. Hopkins Cnty., 805 F.3d 724, 738–

39 (6th Cir. 2015) (internal quotation marks omitted). Plaintiff has not identified any other

constitutional violations, so she must demonstrate that the single violation (Helphenstine’s death)

No. 22-5407 Helphenstine v. Lewis County, et al. Page 20

was accompanied by Lewis County’s failure to train the jailers to handle this potentially

recurring situation. This sort of claim is available only “in a narrow range of circumstances,”

where a federal rights violation “may be a highly predictable consequence of a failure to equip

[employees] with specific tools to handle recurring situations.” Board of Cnty. Comm’rs of

Bryan Cnty. v. Brown, 520 U.S. 397, 409 (1997).

The question here is whether the County’s failure to train its employees amounted to

deliberate indifference, on behalf of the County, to the rights of detainees. See City of Canton v.

Harris, 489 U.S. 378, 388 (1989). Such a claim has three elements. Plaintiff must show (1) that

the County’s “training or supervision was inadequate for the tasks performed; (2) the inadequacy

was the result of the municipality’s deliberate indifference; and (3) the inadequacy was closely

related to or actually caused the injury.” Winkler, 893 F.3d at 902 (citation omitted). Here, a

reasonable jury could conclude that she has met her burden.

First, the adequacy of the training program. Drug and alcohol withdrawal was common

among people housed at the jail. The jail’s written policies stated that “[d]rug or alcohol

withdrawal” constituted an emergency. But the written policies contained no instructions or

guidelines for how staff should care for an inmate in withdrawal beyond contacting the “Jail

Medical Coordinator and the Facility Physician[.]”5

The record is mixed on whether the jailers ever received any training or instruction

regarding withdrawal or medical emergencies. McGinnis testified that she had received training

on what constituted an alcohol-withdrawal-related medical emergency, identifying

uncontrollable vomiting, diarrhea, or unresponsiveness. Most jailers agreed that an inmate

experiencing a medical emergency should be sent to the hospital, but the deputy jailers also

testified that they had not received any training regarding withdrawal or how to identify medical

emergencies. Indeed, Lykins agreed that no one at the jail had specific “training to determine

whether someone going through alcohol or drug withdrawal was experiencing signs or symptoms

that indicated that their withdrawal was about to be fatal.” And several Lewis County defendants

5

The medical coordinator is not a medically trained position. Rather, the medical coordinator is

responsible for corresponding with Dr. von Luhrte, making appointments, and medical billing.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 21

professed ignorance when asked if they knew that a jail policy identified drug or alcohol

withdrawal as a medical emergency—some had never even seen the policy.

The Lewis County defendants argue (and the district court held) that they received

sufficient training because some defendants testified that they knew what to look for to identify a

medical emergency. We find this argument unpersuasive for two reasons. First, defendants

testified that they did not receive training on how to identify a withdrawal-related medical

emergency. The fact that they could identify some symptoms of medical emergencies likely

came from some other source (perhaps experience or common sense). It did not come, on this

record, from a training provided by the jail. And second, even if they were able to identify signs

of a medical emergency in the abstract, they were unable to do so when one presented itself. For

example, McGinnis and Ruark testified that severe vomiting could be an emergency. But these

defendants observed Helphenstine vomiting—Ruark even testified that he was not sure that

Helphenstine could hold anything down—and did not seek medical intervention. Given this, a

reasonable jury could conclude that their training, to the extent they were trained, was

insufficient.

Finally, the district court held that the fact that the jailers received only CPR and first aid

training cannot create a question of fact on a failure-to-train claim in this circuit. That statement

of the law is inaccurate. True, we have held that jailers trained in CPR and first aid received

adequate training to respond to medical emergencies. See Winkler, 893 F.3d at 903; Berry v.

Delaware Cnty. Sheriff’s Off., 796 F. App’x 857, 864 (6th Cir. 2019). But in Winkler, the jail

had trained medical staff on site forty hours per week, and medical staff was “available to jail

personnel, either in person or by phone, for consultation about an inmate 24 hours a day, 7 days a

week.” 893 F.3d at 885, 903. And in Berry, the jail had “nursing coverage 24 hours a day, seven

days a week,” so the jailers’ training was sufficient. 796 F. App’x at 864. Those jailers could

immediately contact medically trained staff, so first aid and CPR training was sufficient to bridge

the short gap between contacting a medical professional and medical treatment. Not so here,

where a detainee was almost wholly reliant on the jailers for medical care.

No. 22-5407 Helphenstine v. Lewis County, et al. Page 22

At bottom, it appears that defendants were not trained on how to identify or address a

medical emergency. A jury could easily conclude that this training program, to the extent that it

existed, was insufficient.

Second, Lewis County’s deliberate indifference. “Deliberate indifference is a stringent

standard of fault, requiring proof that a municipal actor disregarded a known or obvious

consequence of his action.” Connick, 563 U.S. at 61 (brackets and quotation marks omitted). If

the “unconstitutional consequences of failing to train” employees are “patently obvious,” the

county “could be liable under § 1983 without proof of a pre-existing pattern of violations.” Id. at

64. Asking employees to use professional judgment that lies outside their area of expertise may

demonstrate deliberate indifference. See Canton, 489 U.S. at 390 & n.10. For example, absent

specific training on the use of deadly force, armed police officers would not be “equipped with

the tools” necessary to make the relevant legal determination. Connick, 563 U.S. at 70.

The inadequacy of the training and supervision at the jail demonstrates that it results from

the County’s deliberate indifference to the rights of its inmates because the possible

unconstitutional consequences are patently obvious. This is particularly palpable when viewing

Lewis County’s woeful training policy against the backdrop of Dr. von Luhrte’s performance

and the County’s lack of supervision.

Begin with the written policies: The County hired Dr. von Luhrte to provide medical

care to inmates, but required him to visit the jail only once a week. This violates Kentucky’s

administrative regulations, which mandate that a jail conduct at least two sick calls per week.

501 Ky. Admin. Regs. 3:090(10)(a), 3:170. And the County had a policy that the elected jailer,

Lykins, was to publish a quarterly report on the jail’s medical services. But Lykins did not do

so. Indeed, Lykins had never actually seen Dr. von Luhrte visit the jail, and explicitly testified

that the County did not supervise Dr. von Luhrte’s performance in any way.

Further, Dr. von Luhrte was unaware of the policies and regulations that did exist,

including the ones regarding the standard of care he owed to the inmates. He agreed that he had

no knowledge of the specific “medical services that are supposed to be provided to inmates in

Kentucky jails.” Dr. von Luhrte testified that he often treated minor ailments over the phone

No. 22-5407 Helphenstine v. Lewis County, et al. Page 23

without examining the patient. And he admitted that he did not have the experience to treat an

inmate in withdrawal.

The jail doctor was unable to deal with common medical conditions at the jail, and he

was rarely present at the jail. The deputy jailers did not have any medical training or medical

knowledge, so often, no one at the jail could recognize or treat a medical emergency. But with

no medical professionals on site, the County effectively asked the jailers to make determinations

about what constituted a medical emergency—a requirement well outside their area of expertise.

And the County did not supervise the jailers or Dr. von Luhrte at all. A reasonable jury could

easily conclude that these policies were the result of the County’s deliberate indifference to

inmate health and safety. See Shadrick, 805 F.3d at 742 (“Because it is so highly predictable that

a poorly trained [County employee] working in the jail setting ‘utterly lacks an ability to cope

with constitutional situations,’ a jury reasonably could find that [the County]’s failure to train

reflects ‘deliberate indifference to the highly predictable consequence, namely, violations of

constitutional rights.’” (quoting Connick, 563 U.S. at 64, 67 (brackets omitted))).

Third, relation to Helphenstine’s death. There is a dispute of material fact as to

Helphenstine’s cause of death. It is not clear whether he died from fentanyl intoxication (as set

forth on the death certificate), alcohol withdrawal (as asserted by one of plaintiff’s experts), or

severe dehydration due to alcohol withdrawal (as identified by another of plaintiff’s experts). On

this record, a jury could conclude that he died from withdrawal (or related complications), which

was mismanaged and ignored by defendants.

In sum, a jury could conclude that Helphenstine’s death was the result of the County’s

deliberate indifference. Helphenstine fell ill on April 16 and received no medical attention or

care until his death three days later. No Lewis County defendant tried to effect Dr. von Luhrte’s

advice that Helphenstine be provided with rehydrating food or drink. County employees gave

him two doses of antiemetics, but no County employee ever checked his vitals; provided him

with rehydration beyond sips of Mountain Dew, water, Ensure, or juice; or sought hospital-level

care. The County offered little more to Helphenstine than observation, and “[a]t a certain point,

bare minimum observation ceases to be constitutionally adequate.” Greene, 22 F.4th at 609.

Plaintiff has demonstrated that a reasonable jury could conclude that the County’s training and

No. 22-5407 Helphenstine v. Lewis County, et al. Page 24

supervision was inadequate, that the inadequacy was caused by Lewis County’s indifference, and

that the inadequacy caused Helphenstine’s death. The district court improperly granted summary

judgment in favor of Lewis County.

B.

The Lewis County Defendants also argue that they are entitled to qualified immunity on

plaintiff’s claims. Qualified immunity shields public officials from personal liability under

§ 1983 unless they “violate clearly established statutory or constitutional rights of which a

reasonable person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). To

determine whether defendants are entitled to qualified immunity, we must ask two questions:

(1) “whether the facts that a plaintiff has . . . shown . . . make out a violation of a constitutional

right,” and (2) “whether the right at issue was ‘clearly established’ at the time of [the]

defendant’s alleged misconduct.” Pearson v. Callahan, 555 U.S. 223, 232 (2009) (citation

omitted).

The inquiry is simple for defendants Byard and Lucas. Having concluded above that

their conduct did not rise to the level of deliberate indifference, they are entitled to qualified

immunity because they did not violate Helphenstine’s constitutional rights. But for the

remaining defendants, who may have violated a constitutional right, we must consider whether

the right they allegedly violated was clearly established. See, e.g., Burwell v. City of Lansing,

7 F.4th 456, 476 (6th Cir. 2021).

“For a right to be clearly established, the contours of the right must be sufficiently clear

that a reasonable official would understand that what he is doing violates that right.” Id.

(brackets and internal quotation marks omitted). “The unlawfulness must be apparent in the light

of pre-existing law, but we need not find a case in which the very action in question has

previously been held unlawful.” Id. at 476–77 (brackets, ellipses, and citation omitted). In this

case, we look to see how clearly the right to be free from deliberate indifference was established

at the time Helphenstine died in 2017. See Brosseau v. Haugen, 543 U.S. 194, 198 (2004) (per

curiam).

No. 22-5407 Helphenstine v. Lewis County, et al. Page 25

It has been true since 1972 that “where the circumstances are clearly sufficient to indicate

the need of medical attention for injury or illness, the denial of such aid constitutes the

deprivation of constitutional due process.” Greene, 22 F.4th at 615 (citation omitted); see also

Fitzke v. Shappell, 468 F.2d 1072, 1076 (6th Cir. 1972). “Furthermore, we reiterated in 2013

that it is clearly established that a prisoner has a right not to have his known, serious medical

needs disregarded by a medical provider or an officer.” Greene, 22 F.4th at 615 (brackets,

ellipses, and citation omitted). For example, over a decade ago, we “denied qualified immunity

to an officer who failed to seek medical assistance for an individual suffering from [severe

alcohol withdrawal] in a situation of obvious illness even when the officer knew that the detainee

was on withdrawal medication and being observed.” Id. (citing Smith, 505 F. App’x at 535).

Just like in Greene, Helphenstine experienced a dangerous medical condition for at least

a day before his death. The Lewis County defendants did not provide any medical assistance

during that time beyond two doses of antiemetics. Helphenstine’s right not to have his serious

medical needs disregarded by the Lewis County defendants was clearly established in this

scenario. Id. Accordingly, none of the remaining Lewis County defendants are entitled to

qualified immunity.

C.

The district court declined to exercise supplemental jurisdiction over plaintiff’s state-law

negligence claim once it granted summary judgment in favor of defendants on plaintiff’s § 1983

claim. Because we reverse the district court’s grant of summary judgment as to the § 1983 claim

in part, we also reverse the district court’s dismissal of the state-law claim in part: on remand,

the district court should reconsider whether it should now exercise supplemental jurisdiction over

the negligence claim against the remaining defendants. See, e.g., Bishop v. Children’s Ctr. for

Developmental Enrichment, 618 F.3d 533, 538–39 (6th Cir. 2010).

No. 22-5407 Helphenstine v. Lewis County, et al. Page 26

III.

For these reasons, we reverse the district court’s grant of summary judgment in favor of

Riley, McGinnis, Ruark, Bloomfield, Lykins (in his individual capacity), Dr. von Luhrte, and

Lewis County. We affirm the district court’s judgment as to Byard, Lucas, and Lykins (in his

supervisory capacity), and remand for further proceedings consistent with this opinion.