Opinion
CIVIL 1:22-CV-00164
02-06-2023
ANITA ARGOTT, Plaintiff, v. LACKAWANNA COUNTY, et al., Defendants.
Mariani, Judge
REPORT AND RECOMMENDATION
Susan E. Schwab, United States Magistrate Judge
I. Introduction.
Plaintiff Anita Argott claims that while she was a pretrial detainee at the Lackawanna County Prison the defendants violated her Fourteenth Amendment rights by denying her adequate medical treatment and by punishing her for raising medical issues. Currently pending are two motions to dismiss the amended complaint: one filed by Lackawanna County and other County defendants, and the other filed by the third-party medical provider defendants. For the reasons set forth below, we recommend that the court grant in part and deny in part each motion. We further recommend that the court grant Argott one final opportunity to amend her complaint.
II. Background and Procedural History.
Argott, through counsel, begin this action by filing a complaint on February 1, 2022. See doc. 1. After some of the defendants named in the original complaint filed a motion to dismiss and a brief in support, see docs. 5, 17, we scheduled a case management conference, and we stayed further briefing on the motion to dismiss as well as the deadline for the other defendants to respond to the complaint pending the case management conference, see docs. 18, 21. At the case management conference, we discussed Argott filing an amended complaint in response to the motion to dismiss, and following the conference, we set a deadline for her to file an amended complaint. See doc. 24. On April 29, 2022, Argott filed an amended complaint. See doc. 25.
A. The Amended Complaint.
The amended complaint names the following defendants: (1) Lackawanna County (“the County”); (2) the Lackawanna County Prison Board (“the Board”); (3) Timothy Betti, the Warden of the Lackawanna County Prison (“LCP”); (4) John/Jane Does 1-20, unidentified LCP corrections officers (“the County Doe defendants”); (5) Correctional Care, Inc. and/or Correctional Care Management, P.C. (“CCI”); (6) Edward Zaloga, D.O., the owner and president of CCI; (7) John/Jane Does 11-20, unidentified CCI health care providers; and (8) John/Jane Doe employers A-Z, described as multiple fictitious employing entities. Argott is suing the individual defendants in both their individual and official capacities. Doc. 25 ¶¶ 4, 5, 7, 8, 17.
Argott alleges that these Doe defendants may include Officers B. Cherkas, Slack, M. Caolo, Terresia Williams, Kelly, Q. Staback, Aurmais, Taveres, K. Flynn, Pelucucci, R. Bracey, B. Gilgallon, Mackrell, M. Russo, Orue, Barrett, D. Pietmykos, Bolsvert, Chapman, and Rosado. Doc. 25 ¶ 5. It is not clear why if she knows their names, Argott refers to them as John/Jane Does 1-20.
She also purports to sue CCI in “its individual capacity, its supervisory capacity as an employer, and in all other official capacities.” Doc. 25 ¶ 6.
Argott presents federal and state-law claims. Asserting claims under 42 U.S.C. § 1983, she invokes federal-question jurisdiction under 28 U.S.C. § 1331. Id. ¶¶ 11-12. And asserting that there is complete diversity and that the amount in controversy exceeds $75,000, she invokes diversity jurisdiction under 28 U.S.C. § 1332. Id. ¶ 13. She also invokes supplemental jurisdiction under 28 U.S.C. § 1367. Id. ¶ 14. Argott alleges the following facts in her amended complaint.
Defendant Zaloga, who is a doctor of osteopathy, “owns, operates, controls, maintains, and is the President of” CCI, which is a business corporation registered under the laws of the Commonwealth of Pennsylvania. Id. ¶¶ 6-7. At all relevant times, CCI was under contract with the County to provide medical care to inmates and pretrial detainees at the LCP. Id. ¶ 6. Defendant Betti was the warden of the LCP during all relevant times. Id. ¶ 4.
1. Argott's detention and medical treatment while at the LCP.
During the relevant time period, Argott was a pretrial detainee at the LCP. Id. ¶ 1. She became a detainee at the LCP on or about November 14, 2020, after she was arrested for charges that were later dropped. Id. ¶ 19. On November 19, 2020, she began experiencing stomach distress, and after she complained about such, a nurse gave her Prilosec, a medication for heartburn. Id. ¶¶ 20-21.
On November 24, 2020, Argott became shaky, and she had body aches and dry heaves. Id. ¶ 22. She was seen by a nurse, who provided her with Tylenol, a medication for pain relief, and instructed her to increase her fluid intake. Id. ¶ 23.
On December 3, 2020, a nurse was called to Argott's unit, where Argott was lying on her bed guarding her stomach. Id. ¶ 24. Defendant Zaloga briefly saw Argott, and he prescribed Gas-X, a medication for gas relief. Id. ¶ 25. Later that same day, Argott was complaining of nausea, vomiting, and abdominal pains, and a nurse was again called to the unit. Id. ¶ 26. Argott reported that she had loose stools earlier that day and that the Gas-X had not provided her relief. Id. ¶ 27. Without performing a medical examination, defendant Zaloga prescribed Pepto-Bismal, a medication for indigestion. Id. ¶ 28.
The next day-December 4, 2020-a nurse was called to the unit again because Argott was lying in bed holding her abdomen in severe pain. Id. ¶ 29. Several hours later, Argott was found on the floor complaining of severe abdominal pain, and she had poor skin turgor. Id. ¶ 30. She was sent to the medical department for evaluation. Id. ¶ 31. There, she reported poor intake and output for the past few days. Id. But no treatment was provided, and Argott returned to her unit. Id. ¶ 32. Later that same day, a nurse was again called to the unit because Argott was again found on the floor. Id. ¶ 33. Defendant Zaloga was called, and he placed Argott on a 30-minute “behavior watch.” Id. ¶ 34.
The next day-December 5, 2020-Argott was assessed for complaints of nausea, almost daily vomiting, no bowel movement for three days, little urine production, and poor fluid intake. Id. ¶ 35.
The next day-December 6, 2020-a nurse was called to the unit because of Argott's severe vomiting. Id. ¶ 36. Argott was taken to the medical unit for evaluation. Id. After a urine-dip strip was interpreted as showing a urinary tract infection, Argott was prescribed Bactrim, an antibiotic, and encouraged to increase her hydration. Id. ¶ 37. Defendant Zaloga again ordered a 30-minute “behavior watch.” Id. ¶ 38. Later that day, Argott was found “with a severely altered level of consciousness, pale skin, with positive tenting, shortness of breath, and weak hand grips and pedal pulses.” Id. ¶ 39. She had not urinated since the previous night. Id. Defendant Zaloga was called and informed of Argott's status. Id.
At some point on December 6, 2020, Argott was taken by ambulance to the Geisinger Clinical Medical Center with life-threatening injuries. Id. ¶ 40. Upon arrival at Geisinger or soon thereafter, Argott was suffering from: “malnutrition; dehydration; significant septic shock; internal hernia; bowel perforation; multiple organ failure; acute kidney injury; acute hypoxemic respiratory failure; lung atelectasis; blood infection; bacterial pneumonia; [and] physical pain and suffering.” Id. ¶ 41.
2. The County and CCI's Contractual Relationship and Policies.
Years earlier-in 2004-the County entered into a Comprehensive Health Services Agreement (“agreement”) with CCI for the provision of all medical treatment and services for inmates and detainees at the LCP. Id. ¶ 43. According to Argott, under this agreement, the County “specifically delegated its legal responsibility to provide medical treatment to Defendant CCI and Defendant Zaloga”; it “paid the costs of care, administrative expenses, and compensation for Defendant CCI”; and it and defendant Betti “were responsible for screening CCI's employees who would be working in the Prison.” Id. ¶¶ 45, 48, 49. And, per Argott, under this agreement, “CCI voluntarily undertook to engage in a traditional government function in lieu of the government itself performing the function”; “CCI agreed to render services commensurate with then current levels of care being provided by Defendant County and to act in accordance with the customs and practices of Defendant County”; “CCI must evaluate, care [for], and treat all inmates, detainees, and prisoners” incarcerated at the LCP; “CCI is responsible for staffing the Prison with sufficient medical personnel”; and “CCI agreed to comply with all civil right law[s] in effect and agreed to comply with the Commonwealth of Pennsylvania's right-to-know laws.” Id. ¶¶ 44, 46, 47, 48, 50.
Argott alleges that the nature of the bidding process for the contract for medical care at the LCP “provides an incentive for Defendant CCI to deny services in order to keep costs low, which ensures that the Agreement will continue to get renewed.” Id. ¶ 51. Per Argott, it was CCI's policy or custom “to provide the absolute minimum of health care to inmates,” and “CCI structured itself and its policies and practices within the Prison such that the less health care it provided to inmates, the more profitable [it] would be.” Id. ¶ 53. According to Argott, CCI's policies, customs, or practices included: “institutional indifference such that outside medical referrals to hospitals should not be made, even in emergency situations”; “that a nurse practitioner without appropriate expertise and a single doctor, Defendant Zaloga, would examine, diagnose, and treat the entire array of ailments in a large prison population with diverse medical needs”; and that “sometimes Defendant Zaloga would supervise Defendant CCI employees and sometimes he would not be on premises supervising any care that other Defendant CCI employees were providing.” Id. ¶¶ 54, 57, 58.
Argott alleges that CCI's policies and customs “were such that medical complaints need not be promptly and appropriately evaluated.” Id. ¶ 55. And in her case, CCI did not promptly follow up on her “numerous complaints of severe abdominal pain, urinary and bowel complaints, and vomiting[,]” and “[e]ven when faced with a life-threatening situation, 24 hours before she was diagnosed with multiple organ failure, bowel perforation and sepsis among other injuries, [she] was only treated for a urinary tract infection, and not physically examined by Defendant Zaloga.” Id. She was sent to the hospital only after her “symptoms became seriously emergent and life threatening ....” Id. Argott asserts that her treatment was “within the policy norms of CCI.” Id. ¶ 56.
According to Argott, defendants the County and the Board regulate and implement customs, policies, and practices as well as direct, manage, and control the LCP and CCI and their customs, policies, and practices. Id. ¶¶ 2-3.
Defendant Zaloga is the highest ranking official of CCI, and he and CCI “treat themselves as if they are one and the same entity or person.” Id. ¶ 52. He had final policy-making authority with respect to CCI, and his “actions and inactions constituted the policies of Defendant CCI.” Id. ¶¶ 7, 52. According to Argott, defendant Zaloga acted “under the command and authority” of defendants the County, the Board, and Betti. Id. ¶ 7.
Argott alleges that “CCI regulates and implements customs, practices, and policies; directs, manages, and controls the [LCP] Medical Department and its customs, practices, and policies; and employees all medical staff at [the LCP], including all individually named medical defendants.” Id. ¶ 6. She also alleges that defendant CCI acted pursuant to the “customs, policies, contracts, and/or practices” of defendants the County, the Board, the LCP, and itself. Id. ¶ 7.
According to Argott, defendant Betti, as the Warden of the LCP, “was responsible for the hiring, screening, training, retention, supervision, discipline, counseling, and control of Prison employees and/or agents assigned to” the LCP, including defendant CCI and “some or all of Defendants John Does 1 through 20.” Id. ¶ 4. And, as per Argott, Betti was “responsible for the promulgation and implementation of the policies and procedures and allowance of the practices and customs pursuant to which the acts and omissions by Defendants alleged herein were committed.” Id. Argott further alleges that “the policies/customs related to the handling of medical complaints and/or punishments of prisoners experiencing medical symptoms created a known risk that Defendant Betti was aware of which led to the serious medical injury in this case.” Id.
Argott alleges that the John/Jane Doe Corrections Officers were employed at the LCP by and under the command of defendants Betti, the County, and the Board, and they were acting pursuant to customs, policies, and practices of the County and the Board. Id. ¶ 5. She alleges that John/Jane Doe Medical Providers 11-21 are CCI employees who were members of the medical staff at the LCP, and they were acting pursuant to the customs, policies, and practices of the County, the LCP, the Board, and CCI. Id. ¶ 8. And she alleges that “John/Jane Doe Employers A-Z (fictitious name for unknown employers) are citizens or corporations incorporated under the laws of a State of the United States that employed any of the parties that participated in any way in [her] care beginning on November 14, 2020.” Id. ¶ 9.
Argott alleges that the defendants “were acting under color of state law and color of their authorities as officials of Lackawanna County or in conspiracy with Lackawanna County.” Id. ¶ 16.
3. The Counts in the Amended Complaint.
The amended complaint contains four counts. Count I is a 42 U.S.C. § 1983 claim against all the defendants based on the Fourteenth Amendment. In this count, which mentions both procedural and substantive due process, the focus is on the medical care (or lack thereof) Argott received. Argott claims that she had serious medical needs, and the defendants were deliberately indifferent to those needs. Id. ¶ 61. In this regard, she asserts that the “[d]efendants developed, implemented, approved, and/or maintained a number of deficient customs, policies, and/or practices with deliberate indifference to the health and safety of Prison inmates and detainees, which proximately cause the deprivation of [her] rights to be free from cruel and unusual punishment.” Id. ¶ 60. She further contends that the defendants violated her Fourteenth Amendment rights in the following ways: failing to provide necessary medical treatment despite being informed of her needs and knowing that serious injury would result; failing to observe or document her condition as per the policy of the County and CCI, which knowingly caused severe injury and exacerbated her condition; providing minimal health care to inmates in order maximize profits for CCI and defendant Zaloga; failing to meet the basic needs of the prison population by understaffing the medical department; failing to employ medical personnel with appropriate expertise or to employ a sufficient number of medical personnel to provide necessary medical treatment to the prison population; failing to have proper policies and customs to handle medical complaints; and failing to have proper policies and customs related to the punishment of inmates with medical complaints. Id. ¶ 65(a), (d)-(i). And she contends that the individual corrections defendants violated her Fourteenth Amendment rights by failing to notify the medical defendants of her condition and failing to document her deteriorating condition, despite being informed of her needs and knowing that serious injury would result; and by (with the approval of the individual medical defendants), placing her in behavioral confinement as punishment for her medical complaints, which exacerbated her condition. Id. ¶ 65(b), (c). Argott concludes that “[a]ll Defendants have knowingly encouraged, tolerated, ratified, and have been deliberately indifferent to established patterns, practices, and customs in the Prison with regard to the medical care and treatment of inmates and have failed to implement more or different training, supervision, investigation, or discipline resulting in inadequately trained and supervised correctional officer and medical staff who therefore fail to safely supervise and treat the inmates.” Id. ¶ 66. And, as a result, she suffered substantial injury and damage. Id. ¶ 67.
Count II is also a 42 U.S.C. § 1983 claim against all the defendants based on the Fourteenth Amendment. Although Argott labels Count II as a conditions-of-confinement claim or claims, there appears to be significant overlap between Count I and Count II. Argott contends that with deliberate indifference, the defendants allowed her physical condition to deteriorate, and they “either intentionally subjected [her] to conditions amounting to punishment or allowed conditions unreasonably excessive in proportion to any legitimate governmental interest furthered by those conditions.” Id. ¶¶ 69, 71. And the list of conditions that she contends violated her rights is the exact same list that she sets forth in Count I. Compare doc. 25 ¶ 65(a)-(i) with doc. 25 ¶ 71(a)-(i). Argott concludes that the “[d]efendants knowingly encouraged, tolerated, ratified, and have been deliberately indifferent to the referenced conditions in the Prison with regard to medical care and treatment of inmates and failed to take reasonable action to remedy those conditions or in any way cause them not to be in violation of [her] Fourteenth Amendment right not to be subjected to conditions amounting to punishment without being charged with a crime.” Id. ¶ 72. And, as a result, she suffered substantial injury and damage. Id. ¶ 73.
Count III is styled as a state-law claim or claims of negligence/gross negligence/recklessness against defendants Zaloga, CCI, and the individual medical defendants. Argott claims that these defendants were negligent or reckless in many ways, and that their breach of their duties to her caused her substantial injury and damage. Id. ¶¶ 76-86.
Count IV is a claim of corporate negligence against CCI. Argott contends that CCI, which was responsible for arranging and coordinating inmate health care at the LCP, had the following duties: to select and retain only competent physicians and nurses; to oversee those who practice medicine at the LCP; and to formulate, adopt, and to enforce rules and policies to ensure the inmates receive quality care. Id. ¶¶ 88-91. CCI selected and retained defendant Zaloga and the individual medical defendants, who, according to Argott, were incompetent. Id. ¶ 92. She alleges that in addition to being liable for its own grossly negligent and deliberately indifferent policies, CCI is liable for placing defendant Zaloga in a supervisory position over CCI employees and for failing to properly oversee CCI employees. Id. ¶¶ 93-94. Argott claims that CCI's breach of its duties to her caused her substantial injury and damage. Id. ¶¶ 95-96.
As relief, Argott seeks compensatory damages, pre- and post-judgment interest, attorney's fees, and “[a]ny and all such further relief as the Court deems just.” Id. at 19 (Wherefore Clause).
Argott attaches as exhibits to her complaint certificates of merit as to CCI, defendant Zaloga, and John/Jane Does 11-20 (unidentified CCI health care providers), as well as a copy of the agreement between Lackawanna County and CCI. See doc. 25 at 21-40.
B. Pending Motions.
On May 9, 2022, defendants the County, the Board, Betti, and the County Doe defendants filed a motion to dismiss the amended complaint pursuant to Fed.R.Civ.P. 12(b)(6), and they later filed a brief in support of that motion. See docs. 28, 32. Argott then filed a brief in opposition to that motion. See doc. 34.
The original complaint named the LCP as a defendant. See doc. 1 at 1 (caption). The amended complaint does not name the LCP as a defendant. See doc. 25 at 1-2 (caption). Although the motion to dismiss the amended complaint is purportedly brought on behalf of the LCP, see doc. 28 at 2, we assume this was simply an oversight on the part of counsel. Similarly, the original complaint named as defendants John/Jane Does 1-10, unidentified LCP corrections officers. See doc. 1 at 1 (caption). The amended complaint names as defendants John/Jane Does 1-20, unidentified LCP corrections officers. See doc. 25 at 1 (caption). Although the motion to dismiss is purportedly brought on behalf of John/Jane Does 1-10, see doc. 28 at 2, we assume that the reference to John/Jane Does 1-10, instead of John/Jane Does 1-20, was simply an oversight on the part of counsel.
On May 13, 2022, defendants CCI and Zaloga filed a partial motion to dismiss the amended complaint pursuant to Fed.R.Civ.P. 12(b)(6), and they later filed a brief in support of that motion. See docs. 33, 36. They move to dismiss only Counts I and II of the amended complaint. Id. Argott filed a brief in opposition to that motion. See doc. 37.
No reply brief has been filed as to either motion to dismiss, and the motions are ripe for decision. For the reasons discussed below, we recommend that the court granted in part and deny in part the motions to dismiss. We also recommend that the court grant Argott leave to amend.
III. Pleading and Fed.R.Civ.P. 12(b)(6) Standards.
In accordance with Fed.R.Civ.P. 12(b)(6), the court may dismiss a complaint for “failure to state a claim upon which relief can be granted.” When reviewing a motion to dismiss under Rule 12(b)(6), “[w]e must accept all factual allegations in the complaint as true, construe the complaint in the light favorable to the plaintiff, and ultimately determine whether plaintiff may be entitled to relief under any reasonable reading of the complaint.” Mayer v. Belichick, 605 F.3d 223, 229 (3d Cir. 2010). In making that determination, we “consider only the complaint, exhibits attached to the complaint, matters of public record, as well as undisputedly authentic documents if the [plaintiff's] claims are based upon these documents.” Id. at 230.
“A Rule 12(b)(6) motion tests the sufficiency of the complaint against the pleading requirements of Rule 8(a).” I.H. ex rel. D.S. v. Cumberland Valley Sch. Dist., 842 F.Supp.2d 762, 769-70 (M.D. Pa. 2012). “Under Federal Rule of Civil Procedure 8(a)(2), a pleading must contain a ‘short and plain statement of the claim showing that the pleader is entitled to relief.'” Ashcroft v. Iqbal, 556 U.S. 662, 677-78 (2009) (quoting Fed.R.Civ.P. 8(a)(2)). The statement required by Rule 8(a)(2) must give the defendant fair notice of the nature of the plaintiff's claim and of the grounds upon which the claim rests. Erickson v. Pardus, 551 U.S. 89, 93 (2007). Detailed factual allegations are not required, but more is required than “labels,” “conclusions,” or “a formulaic recitation of the elements of a cause of action.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007). “In other words, a complaint must do more than allege the plaintiff's entitlement to relief.” Fowler v. UPMC Shadyside, 578 F.3d 203, 211 (3d Cir. 2009). “A complaint has to ‘show' such an entitlement with its facts.” Id.
In considering whether a complaint fails to state a claim upon which relief can be granted, the court “‘must accept all facts alleged in the complaint as true and construe the complaint in the light most favorable to the nonmoving party.'” Krieger v. Bank of Am., N.A., 890 F.3d 429, 437 (3d Cir. 2018) (quoting Flora v. Cnty. of Luzerne, 776 F.3d 169, 175 (3d Cir. 2015)). But a court “need not credit a complaint's bald assertions or legal conclusions when deciding a motion to dismiss.” Morse v. Lower Merion Sch. Dist., 132 F.3d 902, 906 (3d Cir. 1997). A court also need not “assume that a . . . plaintiff can prove facts that the . . . plaintiff has not alleged.” Associated Gen. Contractors of Cal. v. California State Council of Carpenters, 459 U.S. 519, 526 (1983).
Following Twombly and Iqbal, a well-pleaded complaint must contain more than mere legal labels and conclusions. Rather, it must recite factual allegations sufficient to raise the plaintiff's claimed right to relief beyond the level of mere speculation. In practice, consideration of the legal sufficiency of a complaint entails a three-step analysis:
First, the court must “tak[e] note of the elements a plaintiff must plead to state a claim.” Second, the court should identify allegations that, “because they are no more than conclusions, are not entitled to the assumption of truth.” Finally, “where there are well-pleaded factual allegations, a court should assume their veracity and then determine whether they plausibly give rise to an entitlement for relief.”Santiago v. Warminster Twp., 629 F.3d 121, 130 (3d Cir. 2010) (footnote and citations omitted) (quoting Iqbal, 556 U.S. at 675, 679).
IV. Discussion.
The two pending motions to dismiss address only Argott's federal claims, which she brings pursuant to 42 U.S.C. § 1983. “Section 1983 imposes civil liability upon any person who, acting under the color of state law, deprives another individual of any rights, privileges, or immunities secured by the Constitution or laws of the United States.” Shuman v. Penn Manor School Dist., 422 F.3d 141, 146 (3d Cir. 2005). Section 1983 “does not create any new substantive rights but instead provides a remedy for the violation of a federal constitutional or statutory right.” Id. To establish a claim under § 1983, the plaintiff must establish a deprivation of a federally protected right and that this deprivation was committed by a person acting under color of state law. Woloszyn v. County of Lawrence, 396 F.3d 314, 319 (3d Cir. 2005).
Argott alleges that the defendants were acting under color of state law, and the defendants do not dispute their status as state actors for purposes of 42 U.S.C. § 1983. Thus, the inquiry is whether Argott has plausibly alleged that the defendants engaged in conduct that violated her constitutional rights. Argott claims that the defendants violated her Fourteenth Amendment due process rights in connection with both the medical care they provided and the conditions of her confinement. Before addressing whether the amended complaint states a Fourteenth Amendment due process claim upon which relief can be granted against the defendants, we set forth the due process standards applicable to pretrial detainees, such as Argott.
A. Due Process Rights of Pretrial Detainees.
“Under the Due Process clause, ‘a detainee may not be punished prior to an adjudication of guilt.'” E. D. v. Sharkey, 928 F.3d 299, 307 (3d Cir. 2019) (quoting Bell v. Wolfish, 441 U.S. 520, 535 (1979)). “Not every disability imposed during pretrial detention amounts to ‘punishment' in the constitutional sense, however.” Bell, 441 U.S. at 537. Rather, “restrictions on pretrial detainees will constitute punishment prohibited by the Due Process Clause when: (1) there is a showing of express intent to punish on the part of those officials; (2) the restriction or condition is not rationally related to a legitimate non-punitive government purpose, i.e., if it is arbitrary or purposeless; or (3) the restriction is excessive in light of that purpose.” Steele v. Cicchi, 855 F.3d 494, 504 (3d Cir. 2017) (internal citations, corrections, and quotations omitted). Thus, “[a]bsent a showing of an expressed intent to punish on the part of detention facility officials, . . . if a particular condition or restriction of pretrial detention is reasonably related to a legitimate governmental objective, it does not, without more, amount to ‘punishment.'” Bell, 441 U.S. at 538-39 (footnote omitted).
Here, Argott presents her claims as both conditions-of-confinement claims and as medical-care claims. The above standard applies to her conditions-of-confinement claims. It also applies to her medical-care claims, but in the context of such medical-care claims how that standard translates in practice remains unclear.
“The Third Circuit's standard for evaluating a pretrial detainee's claim of inadequate medical treatment under the Due Process Clause is not entirely clear.” Dewald v. French, No. 1:22-CV-00317, 2022 WL 17669716, at *5 (M.D. Pa. Dec. 14, 2022) (Wilson, J.). The due process rights of pretrial detainees are “at least as great” as the Eighth Amendment protections available to convicted prisoners. City of Revere v. Massachusetts General Hospital, 463 U.S. 239, 244 (1983). In other words, the Eighth Amendment “established] a floor.” Hubbard v. Taylor, 399 F.3d 150, 165-66 (3d Cir. 2005). But, in the context of the provision of medical care, “[t]here is an open question of ‘how much more protection unconvicted prisoners should receive' under the Fourteenth Amendment” than convicted prisoners receive under the Eighth Amendment. Mattern v. City of Sea Isle, 657 Fed.Appx. 134, 138 n.5 (3d Cir. 2016) (quoting Kost v. Kozakiewicz, 1 F.3d 176, 188 n.10 (3d Cir. 1993)).
In the past, the Third Circuit has “found no reason to apply a different standard than that set forth in Estelle (pertaining to prisoners' claims of inadequate medical care under the Eighth Amendment) when evaluating whether a claim for inadequate medical care by a pre-trial detainee is sufficient under the Fourteenth Amendment.” Natale v. Camden Cnty. Corr. Facility, 318 F.3d 575, 581 (3d Cir. 2003) (citing Boring v. Kozakiewicz, 833 F.2d 468, 472 (3d Cir. 1987)). More recently, in other contexts, however, both the Supreme Court and the Third Circuit have held that the standard under the Cruel and Unusual Punishment Clause of the Eighth Amendment, which is applicable to convicted persons, is different from the standard under the Due Process Clause, which is applicable to pretrials detainees. See, e.g., Kingsley v. Hendrickson, 576 U.S. 389, 396-97, 400-01 (2015) (contrasting the rights of convicted prisoners under the Eighth Amendment not to be subject to cruel and unusual punishment with the rights of pretrial detainees under the Due Process Clause not to be punished at all, and holding that to establish an excessive-force claim, unlike a convicted prisoner, who must show that the defendant acted with the subjective intent to maliciously and sadistically cause harm, “a pretrial detainee must show only that the force purposely or knowingly used against him was objectively unreasonable”); Hubbard, 399 F.3d at 166-67 (noting that the Eighth Amendment prohibits cruel and unusual punishment, but pretrial detainees cannot be punished at all, and reversing and remanding in a case brought by pretrial detainees regarding conditions of confinement because the district court improperly analyzed their claim under the Eighth Amendment, rather than the Due Process Clause of the Fourteenth Amendment).
Recognizing that medical-care claims brought by pretrial detainees are due process claims, not Eighth Amendment claims, Judges in this district have nevertheless generally continued to apply Eighth Amendment standards to such claims. See, e.g., Hasara v. Buchannon, No. 1:22-CV-1149, 2023 WL 35326, at *2 (M.D. Pa. Jan. 4, 2023) (Rambo, J.) (applying Eighth Amendment standards to medical claim of a pretrial detainee); Brown v. Rivello, No. 4:22-CV-01155, 2022 WL 17978798, at *3 (M.D. Pa. Dec. 28, 2022) (Brann, C.J.) (same); Norton v. Primecare Med. Servs., No. 1:22-CV-418, 2022 WL 17834068, at *5 (M.D. Pa. Dec. 21, 2022) (Conner, J.) (stating that “[t]o assert a prima facie due process violation based on inadequate medical care, pretrial detainees must allege deliberate indifference to a serious medical need” [which is the Eighth Amendment standard]); Caiby v. Haidle, No. 3:18-CV-1120, 2022 WL 17741689, at *2 (M.D. Pa. Dec. 16, 2022) (Mariani, J.) (noting that it was not clear whether the plaintiff was a pretrial detainee or a convicted prisoner, but after observing that the Third Circuit has applied the Eighth Amendment framework to medical claims of pretrial detainees, analyzing the claim under the framework of the Eighth Amendment); Dewald, 2022 WL 17669716, at 5 (applying the Eighth Amendment standard to medical claim of a pretrial detainee after noting that although the Third Circuit has suggested that the standard is whether the treatment amounts to punishment, the Third Circuit has evaluated such claims under the Eighth Amendment standard); Rubino v. Lackawanna Cnty., No. 3:18-CV-1211, 2022 WL 3229945, at *5 (M.D. Pa. Aug. 10, 2022) (Mariani, J.) (stating that “the analysis of Plaintiff's medical care claim is not affected by whether she is classified as a pretrial detainee or a post-trial convicted inmate”); Giddings v. Sines, No. 1:21-CV-01841, 2022 WL 36235, at *4 (M.D. Pa. Jan. 4, 2022) (Kane, J.) (applying Eighth Amendment standards to medical claim of a pretrial detainee); Loughney v. Corr. Care, Inc., No. CV 3:19-1101, 2021 WL 4447635, at *2 n.5 (M.D. Pa. Sept. 28, 2021) (Mannion, J.) (noting that although the plaintiff was a pretrial detainee, the court was applying the Eighth Amendment standards).
Here, in their briefs, both Argott and the defendants refer to the deliberate-indifference standard of the Eighth Amendment. See doc. 34 at 8-13, 17; doc. 37 at 8-16, 21; doc. 36 at 8-11; doc. 32 at 13-18, 24-25. And although Argott also refers to punishment under the Due Process Clause, when discussing the medicalcare claims, she nevertheless links that discussion to deliberate indifference. See doc. 34 at 15-16. Given that, even though Argott was a pretrial detainee, at this juncture, we analyze her medical claims under the Eighth Amendment standard.
Argott does assert that she was punished for seeking medical help. Doc. 34 at 14. In this regard, she cites to Paragraph 65(c) of her amended complaint. That part of the amended complaint alleges that the defendants violated her rights by the “Individual Corrections Defendants, with the approval of Individual Medical Defendants, placing [her] into behavioral confinement for punishment by reason only of her medical complaint, which knowingly exacerbated her condition and illness.” Doc. 25 ¶ 65(c). We address Argott's claim in this regard as a conditions-of-confinement claim, rather than a medical-care claim. In her brief, Argott also points to the following as conditions of confinement: “CCI having a single doctor and understaffed nursing crew to serve the entire prison population's medical needs out of profit-interest (Amend Compl. ¶57); providing the absolute minimum in terms of care and treatment for profitmaximation (Id. ¶53); refusing to or unreasonably delaying transfer to specialists and hospitals even in emergency situations for similar monetary self-interest (Id. ¶ 54); and failing/refusing to take seriously the medical complaints of detainees until they become life-threatening (Id. ¶55).” Doc. 37 at 17-18. She seems to blur any distinction between her medical-care claims and what she calls conditions-of-confinement claims. Nevertheless, as these conditions relate to Argott's medical care, we consider them in connection with her medical-care claim.
As discussed later, we conclude that the amended complaint fails to state a claim upon which relief can be granted against the County Doe defendants because Argott has not alleged personal involvement on the part of those defendants. Except as to the County Doe defendants, we conclude that the amended complaint states medical claims upon which relief can be granted against the moving defendants under the Eighth Amendment standard. Thus, what, if any, additional protections the Due Process Clause provides to pretrial detainees in this context does not make a difference at this juncture of the proceedings.
“An inmate must rely on prison authorities to treat his [or her] medical needs; if the authorities fail to do so, those needs will not be met.” Estelle v. Gamble, 429 U.S. 97, 103 (1976). In order for a plaintiff to allege a viable Eighth Amendment medical claim, she must allege facts from which it can reasonably be inferred that the defendant acted with deliberate indifference to her serious medical needs. Id. at 104; see also Groman v. Township of Manalapan, 47 F.3d 628, 637 (3d Cir. 1995) (“Failure to provide medical care to a person in custody can rise to the level of a constitutional violation under § 1983 only if that failure rises to the level of deliberate indifference to that person's serious medical needs.”). This is a two-part inquiry: “a plaintiff must make (1) a subjective showing that ‘the defendants were deliberately indifferent to [his or her] medical needs' and (2) an objective showing that ‘those needs were serious.'” Pearson v. Prison Health Serv., 850 F.3d 526, 534 (3d Cir. 2017) (quoting Rouse v. Plantier, 182 F.3d 192, 197 (3d Cir. 1999)).
A medical need is serious if it “has been diagnosed by a physician as requiring treatment” or if it “is so obvious that a lay person would easily recognize the necessity for a doctor's attention.” Monmouth Cnty. Corr. Institutional Inmates v. Lanzaro, 834 F.2d 326, 347 (3d Cir. 1987) (quoting Pace v. Fauver, 479 F.Supp. 456, 458 (D.N.J. 1979), aff'd, 649 F.2d 860 (3d Cir. 1981) (table)). Additionally, “if ‘unnecessary and wanton infliction of pain' results as a consequence of denial or delay in the provision of adequate medical care, the medical need is of the serious nature contemplated by the eighth amendment.” Id. (quoting Estelle, 429 U.S. at 103). Further, “where denial or delay causes an inmate to suffer a life-long handicap or permanent loss, the medical need is considered serious.” Id.
Deliberate indifference is a subjective standard. Farmer v. Brennan, 511 U.S. 825, 840 (1994). “To act with deliberate indifference to serious medical needs is to recklessly disregard a substantial risk of serious harm.” Giles v. Kearney, 571 F.3d 318, 330 (3d Cir. 2009). To act with deliberate indifference, the prison official must have known of the substantial risk of serious harm and must have disregarded that risk by failing to take reasonable measures to abate it. Farmer, 511 U.S. at 837. “[T]he official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Id.
B. Defendants Zaloga and CCI's Motion to Dismiss.
Defendants Zaloga and CCI move to dismiss Counts I and II of the amended complaint. For the reasons set forth below, the amended complaint states a claim upon which relief can be granted against defendants Zaloga and CCI based on Argott's medical care, but it fails to state a claim upon which relief can be granted against defendants Zaloga and CCI based on Argott being placed on 30-minute behavior watches.
At the outset, we note that in their brief, defendants Zaloga and CCI make factual statements about the events at issue that are not found in Argott's amended complaint. See doc. 36 at 6, 10. “[A] court reviewing a motion to dismiss must examine the plausibility of ‘allegations in the complaint.'” Doe v. Princeton Univ., 30 F.4th 335, 344-45 (3d Cir. 2022) (quoting Twombly, 550 U.S. at 555). “Factual claims and assertions raised by a defendant are not part of that scrutiny.” Id. at 345. Thus, we will not consider the factual assertions raised by defendants Zaloga and CCI that are not found in the amended complaint.
1. The amended complaint states a claim upon which relief can be granted against defendant Zaloga based on Argott's medical care, but it fails to state a claim upon which relief can be granted based on defendant Zaloga placing Argott on 30-minute behavior watches.
The amended complaint states a Fourteenth Amendment medical-care claim upon which relief can be granted against defendant Zaloga, but it does not state a conditions-of-confinement claim upon which relief can be granted against defendant Zaloga based his twice ordering that Argott be placed on 30-minute behavior watches.
We first address Argott's medial claim, which as set forth above has two elements-the subjective element (deliberate indifference) and the objective element (a serious medical need).
As to objective element, defendant Zaloga does not make a convincing argument that Argott has not alleged a serious medical need. In fact, at one point, he (as well as CCI) asserts that he is not contesting that prong of Argott's medical claim. See doc. 36 at 8 (“Medical Defendants do not contend that Plaintiff's alleged conditions, assuming that are true for the purposes of this motion, do not constitute a serious medical need, therefore the only question is whether Medical Defendants [sic] actions constituted ‘deliberate indifference.'”). Yet at another point, he (as well as CCI) asserts that Argott “was not diagnosed with any serious medical condition while she was at the prison and none of her complaints could be said to be objectively serious to a lay person.” Id. at 10. And he (as well as CCI) criticizes the amended complaint for failing “to identify which alleged medical conditions [Argott] had upon arrival at the hospital and which developed ‘soon thereafter.'” Id. at 10-11.
Argott alleges a serious medical need. She alleges that over the course of 18 days she complained of increasing symptoms and that her condition deteriorated to the extent that she was found lying on the floor at the prison several times, including on December 6, 2020, when she found with, among other things, “a severely altered level of consciousness.” See doc. 25 at ¶¶20-39. And while her allegation regarding the conditions that “she was suffering from or soon thereafter developed” after her arrival at the hospital, see id. ¶ 41, leaves it unclear precisely which of those conditions she was suffering from while at the prison, it is clear from the amended complaint that she is alleging that her condition deteriorated while at the prison leading to those conditions. At this early stage of the proceedings, we do not need to pinpoint the exact time when Argott's condition became objectively serious. Construing the amended complaint in the light most favorable to Argott, she has sufficiently alleged that she was suffering from serious medical conditions while at the prison.
As to the subjective element, defendant Zaloga contends that Argott fails to allege facts from which it can reasonably be inferred that he was deliberately indifferent. In this regard, he asserts that every that time that she complained about her condition, she was evaluated and provided treatment. But that is not what Argott alleges. She alleges that on December 3, 2020, after the Gas X prescribed by defendant Zaloga did not help and she complained of nausea, vomiting, and abdominal pain, defendant Zaloga did not examine her. Doc. 25 ¶¶ 26-28. Rather, he prescribed Pepto-Bismal without examining her. Id. ¶ 28. And Argott alleges that on December 4, 2022, after she was found on the floor complaining of severe pain and with poor skin turgor, although she was sent to the medical department for evaluation, no treatment was provided. Id. ¶¶ 30-32. Later that day, after Argott was again found on the floor, Zaloga placed her on 30-minue “behavior watch.” Id. ¶ 34. Further, although Argott alleges that she was assessed on December 5, 2020 “for complaints of nausea, almost daily vomiting, no bowel movement for three days, little urine production, and poor fluid intake,” the amended complaint does not allege that any treatment was provided at that time. Id. ¶ 35. Given these allegations, defendant Zaloga's contention that every time Argott complained about her condition, she was evaluated and provided treatment is without merit.
Defendant Zaloga also contends that Argott fails to allege facts from which it can reasonably be inferred that he was deliberately indifferent because he exercised professional judgment in treating her, her allegations amount to nothing more than a disagreement with the treatment provided, and she alleges nothing more than negligence.
The mere misdiagnosis of a condition or medical need, or negligent treatment provided for a condition, is not actionable as a constitutional claim because medical malpractice is not a constitutional violation. See Farmer, 511 U.S. at 835 (holding that “deliberate indifference describes a state of mind more blameworthy than negligence”); Spruill v. Gillis, 372 F.3d 218, 235 (3d Cir. 2004) (“Allegations of medical malpractice are not sufficient to establish a Constitutional violation.”); Singletary v. Pa. Dep't of Corr., 266 F.3d 186, 192 n. 2 (3d Cir. 2002) (claims of medical malpractice, absent evidence of a culpable state of mind, do not constitute deliberate indifference under the Eighth Amendment). Instead, deliberate indifference represents a much higher standard, one that requires “obduracy and wantonness, which has been likened to conduct that includes recklessness or a conscious disregard of a serious risk.” Rouse, 182 F.3d at 197 (quoting Whitley v. Albers, 475 U.S. 312, 319 (1986)).
“Indeed, prison authorities are accorded considerable latitude in the diagnosis and treatment of prisoners.” Durmerv. O'Carroll, 991 F.2d 64, 67 (3d Cir. 1993) (citations omitted). And courts will “disavow any attempt to second guess the propriety or adequacy of a particular course of treatment . . . [which] remains a question of sound professional judgment.” Palakovic v. Wetzel, 854 F.3d 209, 228 (3d Cir. 2017) (quoting Inmates of Allegheny County Jail v. Pierce, 612 F.2d 754, 762 (3d Cir. 1979)). “Mere disagreement as to the proper medical treatment does not support an Eighth Amendment claim.” Caldwell v. Luzerne Cnty. Corr. Facility Mgmt. Employees, 732 F.Supp.2d 458, 472 (M.D. Pa. 2010).
The Third Circuit has found deliberate indifference where a prison official: “(1) knows of a prisoner's need for medical treatment but intentionally refuses to provide it; (2) delays necessary medical treatment based on a non-medical reason; or (3) prevents a prisoner from receiving needed or recommended medical treatment.” Rouse, 182 F.3d at 197. The Third Circuit has also held that “[n]eedless suffering resulting from the denial of simple medical care, which does not serve any penological purpose, . . . violates the Eighth Amendment.” Atkinson v. Taylor, 316 F.3d 257, 266 (3d Cir. 2003). “For instance, prison officials may not, with deliberate indifference to the serious medical needs of the inmate, opt for ‘an easier and less efficacious treatment' of the inmate's condition.” Palakovic, 854 F.3d at 228 (quoting West v. Keve, 571 F.2d 158, 162 (3d Cir. 1978). “Nor may ‘prison authorities deny reasonable requests for medical treatment . . . [when] such denial exposes the inmate to undue suffering or the threat of tangible residual injury.'” Id. (quoting Lanzaro, 834 F.2d at 346). Thus, “[a] ‘failure to provide adequate care . . . [that] was deliberate, and motivated by non-medical factors' is actionable under the Eighth Amendment, but ‘inadequate care [that] was a result of an error in medical judgment' is not.” Parkell v. Danberg, 833 F.3d 313, 337 (3d Cir. 2016) (quoting Durmer, 991 F.2d at 69).
“[T]here is a critical distinction ‘between cases where the complaint alleges a complete denial of medical care and those alleging inadequate medical treatment.'” Pearson, 850 F.3d at 535 (quoting United States ex. rel. Walker v. Fayette Cnty., 599 F.2d 573, 575 n.2 (3d Cir. 1979)). “Because ‘mere disagreement as to the proper medical treatment' does not ‘support a claim of an eighth amendment violation,' when medical care is provided, we presume that the treatment of a prisoner is proper absent evidence that it violates professional standards of care.” Id. (quoting Lanzaro, 834 F.2d at 346). And “there are two very distinct subcomponents to the deliberate indifference prong of an adequacy of care claim.” Id. at 536. “The first is the adequacy of the medical care-an objective inquiry where expert testimony could be helpful to the jury.” Id. “The second is the individual defendant's state of mind-a subjective inquiry that can be proven circumstantially without expert testimony.” Id. But a claim that medical care was delayed or denied completely “must be approached differently than an adequacy of care claim.” Id. at 537. “Unlike the deliberate indifference prong of an adequacy of care claim (which involves both an objective and subjective inquiry), the deliberate indifference prong of a delay or denial of medical treatment claim involves only one subjective inquiry-since there is no presumption that the defendant acted properly, it lacks the objective, propriety of medical treatment, prong of an adequacy of care claim.” Id. “All that is needed is for the surrounding circumstances to be sufficient to permit a reasonable jury to find that the delay or denial was motivated by non-medical factors.” Id.
Argott is asserting an adequacy-of-care claim; she alleges that some care was provided, but defendant Zaloga was nevertheless deliberately indifferent. As set forth above, “[w]here a prisoner has received some amount of medical treatment, it is difficult to establish deliberate indifference, because prison officials are afforded considerable latitude in the diagnosis and treatment of prisoners.” Palakovic, 854 F.3d at 227. “Nonetheless, there are circumstances in which some care is provided yet it is insufficient to satisfy constitutional requirements.” Id. Here, Argott has alleged facts from which it can reasonably be inferred that although defendant Zaloga provided some care, he was nevertheless deliberately indifferent to her serios medical needs. She suggests that the care provided, which in her brief she describes as “medicine-cabinet care,” see doc. 37 at 12, was woefully inadequate and that the lack of further care caused or failed to stem her deterioration. And she alleges that such inadequate care was provided pursuant to policies of CCI that were designed to save money for CCI. Construing the allegations in the amended complaint in the light most favorable to Argott, she has alleged more than negligence or a mere disagreement with the treatment provided. She has sufficiently alleged that the scant medical care that was provided was inadequate and was motivated by non-medical factors, i.e., to save CCI money. At the pleading stage this is sufficient to state a claim upon which relief can be granted. Whether Argott will be able to prove those allegations must wait for a later stage of the proceedings.
Although we conclude that Argott states a medical claim against defendant Zaloga upon which relief can be granted, we conclude that she fails to state a conditions-of-confinement claim against him based his twice placing her 30-minute behavior watches. Although Argott alleges that the watches were punishment for her complaining about her medical condition, her allegation of punishment is a legal conclusion that lacks a factual foundation. Argott does not describe what the 30-minute behavior watches entailed. Nor does she allege what any officer did in connection with defendant Zaloga's order for such watches. Given the lack of any factual allegations regarding the watches, Argott has not plausibly alleged that such watches violated her right to due process.
2. The amended complaint states a claim upon which relief can be granted against CCI based on Argott's medical care, but it fails to state a claim upon which relief can be granted against CCI based on defendant Zaloga placing Argott on 30-minute behavior watches.
CCI is a private corporation providing medical services to the LCP. “To state a claim against a private corporation providing medical services under contract with a . . . prison system, a plaintiff must allege a policy or custom that resulted in the alleged constitutional violations at issue.” Palakovic, 854 F.3d at 232. We apply the standard under Monell v. Department of Social Services, 436 U.S. 658 (1978), applicable to municipal entities, to private corporations, such as CCI. See Natale, 318 F.3d at 583-85 (applying Monell to a claim against Prison Health Services, a private company the provided health services to the correctional facility).
Despite the Monell standard applying to claims against it, CCI fails in its brief to mention that standard or tailor its arguments in light of that standard. Arguably, CCI has forfeited any argument that the amended complaint fails to state a claim against it under the Monell standard. See Barna v. Bd. of Sch. Directors of Panther Valley Sch. Dist., 877 F.3d 136, 147 (3d Cir. 2017) (explaining that “[f]orfeiture is the failure to make the timely assertion of a right, an example of which is an inadvertent failure to raise an argument” (citation and internal quotation marks omitted)). Nevertheless, we conclude that the amended complaint states a claim against CCI under the Monell standard based on Argott's medical care.
Under Monell, an entity cannot be held liable under 42 U.S.C. § 1983 for the unconstitutional acts of its employees on a theory of respondeat superior. Monell, 436 U.S. at 691. Rather, under Monell, an entity “is responsible only for ‘their own illegal acts.'” Connick v. Thompson, 563 U.S. 51, 60 (2011) (quoting Pembaur v. City of Cincinnati, 475 U.S. 469, 479 (1986) (emphasis in original)). A Monell claim may proceed in two ways. Forrest v. Parry, 930 F.3d 93, 105 (3d Cir. 2019). One way for a plaintiff to present such a claim is to allege “that an unconstitutional policy or custom of the [entity] led to his or her injuries.” Id. Another way for a plaintiff to present such a claim is to allege that his or her injuries “were caused by a failure or inadequacy by the [entity] that ‘reflects a deliberate or conscious choice.'” Id. (quoting Estate of Roman v. City of Newark, 914 F.3d 789, 798 (3d Cir. 2019)).
To plead a claim under the policy-or-custom strand of Monell liability, “a plaintiff must allege that ‘[an entity's] policy or custom . . . inflict[ed] the injury' in question.” Estate of Roman, 914 F.3d at 798 (quoting Monell, 436 U.S. at 694). ‘“Policy is made when a decisionmaker possess[ing] final authority to establish . . . policy with respect to the action issues an official proclamation, policy, or edict.'” Id. (quoting Andrews v. City of Philadelphia, 895 F.2d 1469, 1480 (3d Cir. 1990) (alteration in original) (internal quotation marks omitted)). ‘“Custom, on the other hand, can be proven by showing that a given course of conduct, although not specifically endorsed or authorized by law, is so well-settled and permanent as virtually to constitute law.'” Id. (quoting Bielevicz v. Dubinon, 915 F.2d 845, 850 (3d Cir. 1990)).
“To satisfy the pleading standard, [a plaintiff] must identify a custom or policy, and specify what exactly that custom or policy was.” McTernan v. City of York, 564 F.3d 636, 658 (3d Cir. 2009). “Although a policy or custom is necessary to plead a . . . claim, it is not sufficient to survive a motion to dismiss.” Estate of Roman, 914 F.3d at 798. “A plaintiff must also allege that the policy or custom was the ‘proximate cause' of his injuries.” Id.
Another way for a plaintiff to present a claim under Monell is to allege that his or her injuries “were caused by a failure or inadequacy by the [entity] that ‘reflects a deliberate or conscious choice.'” Forrest, 930 F.3d at 105 (quoting Estate of Roman, 914 F.3d at 798). “The latter avenue arose in the failure-to-train context, but applies to other failures and inadequacies by [entities], including those related to supervision and discipline of its . . . officers.” Id.
A plaintiff asserting a claim based on a failure or inadequacy of training, supervision, or discipline “need not allege an unconstitutional policy.” Estate of Roman, 914 F.3d at 798. Rather, he or she must show that the entity's failure to train, supervise, or discipline “its employees ‘reflects a deliberate or conscious choice.'” Id. (quoting Brown v. Muhlenberg Twp., 269 F.3d 205, 215 (3d Cir. 2001)). In this regard, the plaintiff must show “a failure or inadequacy amounting to deliberate indifference on the part of the [entity].” Forrest, 930 F.3d at 106. “This consists of a showing as to whether (1) . . . policymakers know that employees will confront a particular situation, (2) the situation involves a difficult choice or a history of employees mishandling, and (3) the wrong choice by an employee will frequently cause deprivation of constitutional rights.” Id. In addition to deliberate indifference, a plaintiff asserting a Monell claim based on a failure or inadequacy of training, supervision, or discipline must also allege causation. Elliott v. Pennsylvania Interscholastic Athletic Assoc., No. 3:19-CV-01934, 2022 WL 987887, at *5 (M.D. Pa. Mar. 31, 2022). “[T]he causation inquiry focuses on whether ‘the injury [could] have been avoided had the employee been trained under a program that was not deficient in the identified respect.” Thomas v. Cumberland Cnty., 749 F.3d 217, 226 (3d Cir. 2014) (quoting City of Canton, Ohio v. Harris, 489 U.S. 378, 391 (1989)).
Argott alleges that it was CCI's policy or custom “to provide the absolute minimum of health care to inmates,” and “CCI structured itself and its policies and practices within the Prison such that the less health care it provided to inmates, the more profitable [it] would be.” Doc. 25 ¶ 53. According to Argott, CCI's policies, customs, or practices included: “institutional indifference such that outside medical referrals to hospitals should not be made, even in emergency situations”; “that a nurse practitioner without appropriate expertise and a single doctor, Defendant Zaloga, would examine, diagnose, and treat the entire array of ailments in a large prison population with diverse medical needs”; and that “sometimes Defendant Zaloga would supervise Defendant CCI employees and sometimes he would not be on premises supervising any care that other Defendant CCI employees were providing.” Id. ¶¶ 54, 57, 58.
Argott also alleges that CCI's policies and customs “were such that medical complaints need not be promptly and appropriately evaluated.” Id. ¶ 55. And in her case, CCI did not promptly follow up on her “numerous complaints of severe abdominal pain, urinary and bowel complaints, and vomiting[,]” and “[e]ven when faced with a life-threatening situation, 24 hours before she was diagnosed with multiple organ failure, bowel perforation and sepsis among other injuries, [she] was only treated for a urinary tract infection, and not physically examined by Defendant Zaloga.” Id. Argott was sent to the hospital only after her “symptoms became seriously emergent and life threatening . . . .” Id. Argott asserts that her treatment was “within the policy norms of CCI.” Id. ¶ 56.
Given these allegations, we conclude that Argott has alleged facts from which it can reasonably be inferred that a policy or custom of CCI violated her rights with respect to her medical care. Moreover, one situation “where acts of a government employee may be deemed to be the result of a policy or custom of the governmental entity for whom the employee works, thereby rendering the entity liable under § 1983” is “where ‘no rule has been announced as policy but federal law has been violated by an act of the policymaker itself.'” Natale, 318 F.3d at 584 (quoting Bd. of Cnty. Comm'rs of Bryan Cnty. v. Brown, 520 U.S. 397, 417-18 (1997) (Souter, J., dissenting)). As discussed above, we conclude that the amended complaint states a claim upon which relief can be granted against defendant Zaloga based on Argott's medical treatment. Thus, given that defendant Zaloga is alleged to be a policymaker for CCI, CCI may be liable based on Zaloga's actions or inactions. See Whitehurst v. Lackawanna Cnty., No. 3:17-CV-00903, 2020 WL 6106616, at *17 (M.D. Pa. Mar. 5, 2020) (report and recommendation) (concluding that “to the extent Dr. Zaloga may be found liable for deliberate indifference to Whitehurst's serious medical needs-whether by his acts or omissions as Whitehurst's treating physician or his failure to adequately staff the prison with properly trained medical and mental health professionals to meet the basic medical and mental healthcare needs of its hundreds of inmates, many of whom suffer from serious mental illnesses-CCI and the County may be held liable as well under Monell” (footnote omitted)), report and recommendation adopted, 2020 WL 6083409, at *1 (M.D. Pa. Oct. 15, 2020).
Although we conclude that Argott states a medical claim against defendant CCI upon which relief can be granted, we conclude that she fails to state a conditions-of-confinement claim against CCI based on defendant Zaloga twice placing her 30-minute behavior watches. As discussed above, because Argott does not allege what such watches entail, she has not plausibly alleged that the watches violated her right to due process.
C. Defendants the County, the Board, Betti, and the County Doe Defendants' Motion to Dismiss.
Defendants the County, the Board, Betti, and the County Doe defendants move to dismiss Counts I and II of the amended complaint. For the reasons set forth below, the official capacity claims against Betti and the County Doe defendants should be dismissed as duplicative of the claims against the County. Also, as set forth below, the amended complaint states a claim upon which relief can be granted against defendants the County, the Board, and Betti based on Argott's medical care, but it fails to state a claim upon which relief can be granted against these defendants based on Argott being placed on 30-minute behavior watches. Also, the complaint fails to state any claims upon which relief can be granted against the County Doe defendants.
1. The claims against defendant Betti and the County Doe defendants in their official capacities should be dismissed.
Official-capacity suits are “only another way of pleading an action against an entity of which an officer is an agent.” Monell, 436 U.S. at 690, n. 55. In an official-capacity suit, the entity of which the officer is an agent is the real party in interest. Kentucky v. Graham, 473 U.S. 159, 166 (1985). “There is no longer a need to bring official-capacity actions against local government officials, for under Monell, supra, local government units can be sued directly for damages and injunctive or declaratory relief.” Id. at 167 n.14.
Official capacity claims against a municipal official or employee are duplicative of claims brought against the municipality of which he or she is an official or employee. Halchak v. Dorrance Twp. Bd. of Supervisors, No. 3:18-CV-1285, 2022 WL 17742270, at *12 n. 18 (M.D. Pa. Dec. 16, 2022) (Mariani, J.). “As a matter of law, official-capacity claims merge with those claims brought against the municipality that employs the official.” Loomis v. Montrose Borough Police Dep't, No. 3:20-CV-1610, 2021 WL 2865290, at *2 n.1 (M.D. Pa. July 8, 2021) (Conner, J.). As such, claims against municipal officials in their official capacities are frequently dismissed when the plaintiff also names the municipality as a defendant. See Taylor v. Derry Twp. Sch. Dist., No. 1:20-CV-1363, 2022 WL 80479, at *4 (M.D. Pa. Jan. 7, 2022) (Conner, J.) (citing cases).
Here, given that Argott names the County in her amended complaint, the claims against defendants Betti and the County Doe defendants in their official capacities are redundant of the claims against the County. Thus, we recommend that those claims be dismissed.
Although the defendants lump the Board in with Betti and the County Doe defendants with regard to their argument that the official capacity claims are redundant, they make no attempt to show that the Board is not a separate entity from the County. Because the parties have not briefed the issue of whether the Board is a separate entity from the County, we do not reach that issue at this time.
2. The amended complaint states a claim upon which relief can be granted against defendants the County and the Board based on Argott's medical care, but it fails to state a claim upon which relief can be granted against these defendants based on Argott being placed on 30-minute behavior watches.
The County and the Board contend that Argott has not alleged facts from which it can reasonably be inferred that they had a policy or custom that resulted in a violation of her rights. They contend that Argott's allegations in this regard are conclusory. We disagree.
Like CCI, municipal entities, such as the County and the Board, cannot be held liable under 42 U.S.C. § 1983 for the unconstitutional acts of its employees on a theory of respondeat superior. Monell, 436 U.S. at 691 (1978). Rather, as discussed above, “under § 1983, local governments are responsible only for ‘their own illegal acts.'” Connick 563 U.S. at 60 (quoting Pembaur, 475 U.S. at 479). And a plaintiff can state a claim against a municipality in two ways: (1) by showing that an unconstitutional policy or custom of the municipality led to her injuries; or (2) by showing that her injuries “were caused by a failure or inadequacy by the municipality that ‘reflects a deliberate or conscious choice.'” Forrest, 930 F.3d at 105 (quoting Estate of Roman, 914 F.3d at 798).
The County had a constitutional obligation to provide medical care to its prisoners and detainees. Ponzini v. Monroe Cnty., No. 3:11-CV-00413, 2015 WL 5123720, at *10 (M.D. Pa. Aug. 31, 2015) (Mariani, J.). It contracted with CCI to provide that medical care. But that contract does not absolve the County of its duty. Id. Rather, despite the contract, ‘“the county itself remains liable for any constitutional deprivations caused by the policies or customs of”' its contractmedical provider. Id. at 11 (quoting Ancata v. Prison Health Servs., Inc., 769 F.2d 700, 705 (11th Cir. 1985)). ‘“In that sense, the county's duty is non-delegable.”' Id. (quoting Ancata, 769 F.2d at 705).
Here, Argott alleges that the County regulates and implements customs, policies, and practices as well as directs, manages, and controls the LCP and CCI and their customs, policies, and practices. Doc. 25 ¶¶ 2-3. She further alleges that defendant Zaloga acted “under the command and authority” of the County, and that CCI as well as the John/Jane Doe medical providers acted pursuant to the “customs, policies, contracts, and/or practices” of the County. Id. ¶¶ 7-8. And, as set forth above, the amended complaint states a claim against CCI based on its policies and practices. “It follows, then, that [the County] also has potential liability stemming from its own, independent obligation to police its medical services contract with [CCI].” Id. (denying summary judgment to Monroe County based on its potential liability stemming from its obligation to police its contract for medical care with PrimeCare Medical, Inc.); see also Ravert v. Monroe Cnty., No. 4:20-CV-0889, 2021 WL 1017372, at *7 (M.D. Pa. Mar. 17, 2021) (Arbuckle, M.J.) (analogizing that case to Ponzini and denying motion to dismiss filed by Monroe County given that the plaintiff had alleged a Monell claim against PrimeCare Medical, Inc.); Whitehurst v. Lackawanna Cnty., No. CV 3:17-903, 2020 WL 6083409, at *4 (M.D. Pa. Oct. 15, 2020) (Mannion, J.) (agreeing with the reasoning of Ponzini and denying summary judgment to the County given that there were questions of fact about the County's vigilance in supervising its contract with CCI).
The County suggests that the amended complaint fails to state a claim against it upon which relief can be granted because neither negligence nor a mere disagreement as to the proper course of treatment amounts to deliberate indifference. But as discussed above, construing the allegations in the amended complaint in the light most favorable to Argott, she has alleged more than negligence or a mere disagreement with the treatment provided. She has alleged that the medical care that was provided was inadequate and was motivated by nonmedical factors, i.e., to save CCI money. And “[w]hile the Court recognizes that ‘prison officials cannot be required to second guess the medical judgment of the [staff] physician,' [the County's] contractual position vis-a-vis [CCI] is an altogether different type of relationship than that between an on-the-ground medical provider and a correctional officer working” at the prison. Ponzini, 2015 WL 5123720, at *11 (quoting Ellison v. Scheipe, 570 F.Supp. 1361, 1363 (E.D. Pa. 1983)). The County's “potential liability arises from its policy of contracting away of a nondelegable duty coupled with its [alleged] failure to ensure that the contract was properly carried out and the nondelegable duty met.” Id. at * 11 n.15.
In sum, we conclude that the amended complaint states a claim upon which relief can be granted against the County based on Argott's medical care. But we conclude that it fails to state a conditions-of-confinement claim against the County based on defendant Zaloga twice placing Argott on 30-minute behavior watches. As discussed above, because Argott does not allege what such watches entail, she has not plausibly alleged that such watches violated her right to due process.
Argott's allegations against the Board are substantially the same as her allegations against the County. The Board makes the same arguments as the County, and it does not argue that it is any different position than the County. Thus, for the reasons set forth above regarding the County, we conclude that the amended complaint states a claim upon which relief can be granted against the Board based on Argott's medical care. But we conclude that the amended complaint fails to state a conditions-of-confinement claim against the Board based on defendant Zaloga twice placing Argott on 30-minute behavior watches.
3. The amended complaint states a claim upon which relief can be granted against defendant Betti in his individual capacity based on Argott's medical care, but it fails to state a claim upon which relief can be granted against him in his individual capacity based on Argott being placed on 30-minute behavior watches.
Defendant Betti moves for dismissal of the claims against him. There are no allegations that defendant Betti personally participated in the events surrounding Argott's medical care. Rather, we construe Argott to be seeking to impose supervisory liability on defendant Betti.
Liability under Section 1983 “‘cannot be predicated solely on the operation of respondeat superior.'” Evancho v. Fisher, 423 F.3d 347, 353 (3d Cir. 2005) (quoting Rode v. Dellarciprete, 845 F.2d 1195, 1207 (3d Cir. 1998)). “Because vicarious liability is inapplicable to Bivens and § 1983 suits, a plaintiff must plead that each Government-official defendant, through the official's own individual actions, has violated the Constitution.” Iqbal, 556 U.S. at 676.
A constitutional deprivation cannot be premised merely on the fact that the defendant was a supervisor when the incidents set forth in the complaint occurred. See Alexander v. Forr, 297 Fed.Appx. 102, 104-05 (3d Cir. 2008). But there are two viable theories of supervisory liability. Santiago, 629 F.3d at 129 n.5. Under the first theory, a supervisor can be liable if he or she established and maintained a policy, practice, or custom that directly caused the constitutional harm. Id. Under the second theory, a supervisor can be liable if he or she participated in violating the plaintiff's rights, directed others to violate the plaintiff's rights, or as the person in charge had knowledge of and acquiesced in his or her subordinates' violations of the plaintiff's rights. Id.
Here, Argott alleges that defendant Betti, as the Warden of the LCP, “was responsible for the hiring, screening, training, retention, supervision, discipline, counseling, and control of Prison employees and/or agents assigned to” the LCP, including defendant CCI and “some or all of Defendants John Does 1 through 20.” Id. ¶ 4. Defendant Betti was also “responsible for screening CCI's employees who would be working in the Prison.” Id. ¶ 48. And, as per Argott, Betti was “responsible for the promulgation and implementation of the policies and procedures and allowance of the practices and customs pursuant to which the acts and omissions by Defendants alleged herein were committed.” Id. ¶ 4. Argott further alleges that “the policies/customs related to the handling of medical complaints and/or punishments of prisoners experiencing medical symptoms created a known risk that Defendant Betti was aware of which led to the serious medical injury in this case.” Id.
Given these allegations, Argott has alleged a supervisory liability claim upon which relief can be granted against defendant Betti in his individual capacity based on her medical care. But as with the other defendants, the amended complaint fails to state a conditions-of-confinement claim against the County based on defendant Zaloga twice placing Argott on 30-minute behavior watches given that Argott does not allege what such watches entail.
4. The amended complaint fails to state a claim upon which relief can be granted against the County Doe defendants in their individual capacities.
Although the County Doe defendants are listed as defendants, the amended complaint does not allege facts sufficient to show that these defendants were personally involved in the alleged violation of Argott's rights. In fact, the amended complaint does not include any allegations whatsoever regarding the County Doe defendants in the section of the amended complaint that sets forth what happened to Argott.
The amended complaint does allege in a conclusory fashion that the actions of the defendants that violated her rights include the failure of the individual corrections defendants to notify the medical defendants of Argott's “legitimate medical requests, complaints, and condition” and to document her “deteriorating condition, despite being informed by [her] of her needs and knows that serious injury would result.” Doc. 25 ¶ 65(b). But she does not allege any particular instances when the County Doe defendants allegedly failed to notify medical defendants about Argott's condition. To the contrary, in the section of the amended complaint that sets forth what happened to Argott, it is repeatedly alleged that a nurse was called to the unit in response to Argott's condition. See doc. 25 ¶¶ 24, 26, 29, 33, 36. Similarly, Argott does not allege any particular instances when the County Doe defendants allegedly failed to document her condition, or even, that it was the County Doe defendants' (as opposed to the medical defendants') responsibility to do so. The amended complaint also alleges in a conclusory fashion that the actions of the defendants that violated her rights include the failure of the individual corrections defendants placing Argott in behavior confinement as punishment for her medical complaint, which knowingly exacerbated her condition and illness. Id. ¶ 65(c). But Argott alleges no facts about what any of the County Doe defendants did in this regard.
Further, although Argott's allegations frequently include references to the defendants, without specifying which defendants, such vague pleading is not sufficient to show how the County Doe defendants were personally involved in the events at issue. “The Third Circuit has previously found persuasive the observation that ‘[v]ague references to a group of “defendants,” without specific allegations tying the individual defendants to the alleged unconstitutional conduct[,]' cannot show the necessary personal involvement or meet the notice pleading standards of Federal Rule of Civil Procedure 8(a).” Whitehurst, 2020 WL 6083409, at *9 (quoting Park v. Temple Univ., 757 Fed.Appx. 102, 109 (3d Cir. 2018)). Rather, the ‘“court must be able to discern “who is responsible for what” from the operative pleading.'” Id. (quoting Park, 757 Fed.Appx. at 109).
In sum, the general and conclusory allegations regarding the County Doe defendants are insufficient to state a claim upon which relief can be granted against them. To be clear, we are not saying that at the pleading stage, Argott must identify the County Doe defendants by name. But to state a claim upon which relief can be granted, she must show what the County Doe defendants did that allegedly violated her rights
V. Leave to Amend.
“[I]f a complaint is subject to a Rule 12(b)(6) dismissal, a district court must permit a curative amendment unless such an amendment would be inequitable or futile.” Phillips v. County of Allegheny, 515 F.3d 224, 245 (3d Cir. 2008). In a civil-rights action, the court “must provide the plaintiff with this opportunity even if the plaintiff does not seek leave to amend.” Id.
Here, Argott has already amended her complaint once, and her amended complaint still is deficient in the respects discussed above. Nevertheless, given the liberal-amendment standard and given that Argott has requested leave to amend if the court grants any part of the defendants' motions to dismiss, and in an abundance of caution, we will recommend that the court provide Argott one final opportunity to amend.
VI. Recommendations.
For the foregoing reasons, we recommend that the court grant in part and deny in part the County defendants' motion (doc. 28) to dismiss the amended complaint. More specifically, we recommend that the court dismiss the claims against defendant Betti and the County Doe defendants in their official capacities. We also recommend that the court dismiss the claims against the County, the Board, and Betti (in his individual capacity) based on Argott being placed on behavior watches. We further recommend that the court dismiss all the claims against the County Doe defendants in their individual capacities. We recommend that the court otherwise deny the County defendants' motion.
We also recommend that the court grant in part and deny in part the motion (doc. 33) to dismiss the amended complaint filed by defendants Zaloga and CCI. More specifically, we recommend that the court dismiss the claims against defendants Zaloga and CCI based on Argott being placed on behavior watches. We recommend that the court otherwise deny defendants Zaloga and CCI's motion.
We further recommend that the court grant Argott one final opportunity to amend her complaint. Finally, we recommend that the case be remanded to the undersigned for further proceedings.
The Parties are further placed on notice that pursuant to Local Rule 72.3:
Any party may object to a magistrate judge's proposed findings, recommendations or report addressing a motion or matter described in 28 U.S.C. § 636 (b)(1)(B) or making a recommendation for the disposition of a prisoner case or a habeas corpus petition within fourteen (14) days after being served with a copy thereof. Such party shall file with the clerk of court, and serve on the magistrate judge and all parties, written objections which shall specifically identify the portions of the proposed findings, recommendations or report to which objection is made and the basis for such objections. The briefing requirements set forth in Local Rule 72.2 shall apply. A judge shall make a de novo determination of those portions of the report or specified proposed findings or recommendations to which 54 objection is made and may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge. The judge, however, need conduct a new hearing only in his or her discretion or where required by law, and may consider the record developed before the magistrate judge, making his or her own determination on the basis of that record. The judge may also receive further evidence, recall witnesses or recommit the matter to the magistrate judge with instructions.