A.m., by and through his next friend and mother, J.M.K. v. Luzerne County Juvenile Detention Center, a department of Luzerne County, Pennsylvania

PRECEDENTIAL
UNITED STATES COURT OF
APPEALS FOR THE THIRD CIRCUIT
No. 03-3075
A.M., by and through his next friend and
mother, J.M.K.,
Appellant
v.
LUZERNE COUNTY JUVENILE
DETENTION CENTER,
a department of Luzerne County,
Pennsylvania;
*SANDRA M. BRULO, individually
and in her official capacity
as chief administrator of the Luzerne
County Juvenile Detention Center;
LOUIS P. KWARCINSKI, individually
and in his official capacity
as deputy chief probation officer in
charge of the Luzerne County
Juvenile Detention Center;
JEROM E PRAWDZIK, in his
individual capacity;
CHRISTOPHER TRAVER, in his
individual capacity;
CHRISTOPHER PARKER, in his
individual capacity;
MICHAEL CONSIDINE, in his
individual capacity;
MARK PUFFENBERGER, M .D.,
in his official capacity;
ELAINE YOZVIAK, R.N., in her
individual capacity
*(Amended per Clerk's Order dated
8/14/03)
Appeal from the United States
District Court
for the Middle District of Pennsylvania
(D.C. Civil No. 01-cv-01276)
District Judge:
Honorable A. Richard Caputo
Argued April 16, 2004
Before: RENDELL, STAPLETON and
LAY*, Circuit Judges.
(Filed June 10, 2004)
Marsha L. Levick
Lourdes M. Rosado [ARGUED]
Juvenile Law Center of Philadelphia
1315 Walnut Street, 4th Floor
The Philadelphia Building
Philadelphia, PA 19107
Counsel for Appellant
Sean P. McDonough [ARGUED]
Dougherty, Leventhal & Price
75 Glenmaura National Blvd.
Moosic, PA 18507
Counsel for Appellees Luzerne
County Juvenile Detention Center,
Sandra Brulo, Louis P. Kwarcinski,
Elaine Yoziak, Christopher Traver,
Christopher Parker, Michael
Considine, and Jerome Prawdzik
*Honorable Donald P. Lay, Senior Circuit
Judge for the Eighth Circuit, sitting by
designation.

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2
James A. Doherty, Jr. [ARGUED]
Scanlon, Howley, Scanlon & Doherty
321 Spruce Street
1000 Bank Towers
Scranton, PA 18503
Counsel for Appellee
Mark Puffenberger, M.D.
OPINION OF THE COURT
LAY, Circuit Judge.
A.M ., by and through his next
friend and mother, J.M.K., filed suit under
42 U.S.C. § 1983 and state tort law against
the Luzerne County Juvenile Detention
Center (the “Center”) and several of its
administrators and staff, alleging they
violated his substantive due process rights
by failing to protect him from harm while
he was detained at the Center. The District
Court granted summary judgment in favor
of all Defendants and declined to exercise
supplemental jurisdiction over the
remaining state law claims. A.M. appeals.
For the reasons that follow, the District
Court’s order granting summary judgment
will be reversed in part and affirmed in
part.
I. BACKGROUND
On July 12, 1999, A.M. was
arrested in Lake Township, Pennsylvania,
for indecent conduct. He was taken to the
Center, a secure detention facility for
children alleged to be delinquent or
adjudicated delinquent and awaiting final
disposition and placement, and remained
there until August 19, 1999.1
While at the Center, A.M. was
physically assaulted by other juvenile
residents2 on numerous occasions. On July
26, 1999, A.M. reported that other
residents had, among other things, spit on
him, punched him in the arm, put his head
in a garbage can, and thrown urine on his
bed. An incident report completed by one
of the Center’s child-care workers, dated
August 1, 1999, states that A.M . was hit
on the back of the head with a ping-pong
paddle thrown by another resident.
Another incident report, dated August 2,
1999, relates that A.M. sustained a wound
to his chest. The wound would not stop
bleeding, and A.M. was taken to the
hospital for treatment. Other incident
reports were completed by the Center’s
child-care workers on an almost daily basis
between August 2 and August 16, 1999.
These reports reveal that other residents
punched A.M. in the face, hit him, choked
him, “whipped” him in the eye with a
towel, and threatened him with physical
harm. The assaults left A.M. with multiple
bruises over his body, puncture wounds,
black eyes, and swollen lips. The assaults
1At the time of his detention, A.M . was
thirteen years old, 4'11" tall, and about 92
pounds.
2The parties consistently refer to the
youths detained at the Center as
“residents.” For ease of reference, we will
use the same designation.

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3
also caused A.M . to suffer humiliation,
fear, and emotional distress.
Prior to his detention, A.M. had
eleven prior psychiatric inpatient
hospitalizations for behavior problems,
was seeing a psychiatrist in the
community, and had been taking
medication to treat his Attention Deficit
Hyperactivity Disorder (“ADHD”). A.M.
suffered from several other mental and
behavioral disabilities, including anxiety
disorder, depressive disorder, atypical
bipolar disorder, and intermittent explosive
disorder. The Center’s administrators and
supervisors were made aware of these
facts upon A.M.’s admission to the Center
or shortly thereafter. A.M.’s mental and
behavioral problems were reflected in his
behavior at the Center, which included
teasing and provoking other residents.
After A.M.’s admission to the Center, he
initially did not receive any medication for
his ADHD because the Center could not
obtain the necessary authorization to refill
his prescription.
On July 23, 1999, a psychiatric
evaluation was performed on A.M. by Dr.
Paul Gitlin for the purpose of assessing
A.M.’s current mental health treatment
needs. During the evaluation, A.M .
complained to Dr. Gitlin about the
treatment he was subjected to by other
residents, and Dr. Gitlin observed that
A.M. had a bruise on his arm. Dr. Gitlin
noted that A.M. had a long history of
mental health and behavioral problems and
that A.M . was having difficulty at the
Center because of his untreated ADHD.
Dr. Gitlin’s diagnosis of A.M. included a
Global Assessment Functioning scale of
20-30 out of a possible 100, indicating
behavior that is “considerably influenced
by delusions or hallucinations or serious
impairment in communication or judgment
. . . or inability to function in almost all
areas.” Diagnostic and Statistical Manual
of Mental Disorders 32 (4th ed. 2000). Dr.
Gitlin stated that it was medically
necessary for A.M. to have a highly
planned day, 7 days a week, 365 days a
year, and for A.M. to receive medication
on a continual basis in order to reduce his
impulsiveness and motor restlessness. Dr.
Gitlin entered an order for A.M. to receive
the medication dexedrine, and A.M. began
receiving the medication on July 24, 1999.
After Dr. Gitlin’s evaluation of A.M., and
during the remainder of his detention, no
mental health professional was called in to
see A.M. or consult with the Center’s staff
about A.M.’s behavior, despite the
ongoing difficulty child-care workers were
having with him.
During A.M.’s detention, the
Center’s administrators directed that A.M.
should be placed on the girls’ side of the
Center for a majority of the day. However,
child-care workers periodically failed to
abide by this directive, which resulted in
A.M. being placed with boys who had
previously assaulted him. On one
occasion, A.M. was sent from the girls’
side to the boys’ side because he was
“getting on the nerves” of a child-care
worker on the girls’ side.

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On August 19, 1999, A.M.
appeared in the Luzerne County Court of
Common Pleas, Juvenile Division, for a
disposition hearing. At the conclusion of
the hearing, the court committed A.M. to
Northwestern Intermediate Treatment
F a c i l i t y ( “ N o r t h w e s t e r n ” ) i n
Northumberland County, Pennsylvania, for
an indeterminate period of time.
On the day of his admission to
Northwestern, John DeAngelo, a counselor
at Northwestern, saw that A.M. was
bleeding from a puncture wound on his
chest. When DeAngelo asked A.M. about
the wound, A.M. told him that he had been
stabbed with an unknown object while at
the Center. A.M. went on to describe to
DeAngelo other physical assaults visited
upon him by residents of the Center.
DeAngelo proceeded to complete an
incident report concerning the alleged
physical assaults. DeAngelo reported that
A.M. told him staff at the Center knew
about the assaults but did not do anything
to stop them. In addition to the incident
report, DeAngelo completed a Report of
Suspected Child Abuse, dated August 26,
1999, in which he recounted A.M.’s
allegations of abuse while at the Center
and inaction by the Center’s staff. The
Report states that A.M. feared this type of
abuse would continue at each of his future
placements. DeAngelo and another
member of the Northwestern staff
observed that A.M.’s eyes were black and
blue when he arrived at Northwestern and
that A.M. appeared to be very scared.
Northwestern staff indicated that A.M.
expressed fear that he would be hurt by
other children at Northwestern.
In July of 2001, A.M., by and
through his next friend and mother,
commenced a § 1983 and state tort action
against the Center and the following
administrators and staff: Sandra Brulo, the
Center’s chief juvenile probation officer,
who acted as the Center’s chief
administrator; Louis Kwarcinski, the
Center’s deputy chief of juvenile
probation; Jerome Prawdzik, the detention
supervisor at the Center; Chris Traver,
Michael Considine, and Chris Parker,
former child-care workers at the Center;
Elaine Yozviak, a former registered nurse
at the Center; and Mark Puffenberger,
M.D., a physician who provided contract
services to the Center. The suit alleged
that the Defendants violated A.M.’s
substantive due process rights under the
Fourteenth Amendment to be free from
harm and to receive appropriate medical
treatment while in their custody.
II. DISTRICT COURT OPINION
After discovery, the Defendants
moved for summary judgment. The
District Court granted the Defendants’
motion on June 30, 2003. In its
Memorandum accompanying the order
granting summary judgment, the District
Court addressed each of A.M.’s claims
against the Defendants.
Count One. Count One of A.M.’s
complaint alleged that the Center and
Brulo and Kwarcinski, in their official

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capacities, were liable for failing to protect
A.M. from harm and failing to treat him,
and that Dr. Puffenberger was liable in his
official capacity for failing to treat A.M .
A.M. alleged several deficiencies
on the part of the Center, Brulo, and
Kwarcinski as the basis for liability on
Count One. The first allegation concerned
deficient hiring and staffing practices. The
District Court granted summary judgment
in favor of Brulo and Kwarcinski on this
allegation, after concluding that A.M.
failed to show a direct causal link between
A.M.’s injuries and the alleged hiring of
e m ployees without the requisite
educational degree or the alleged
understaffing of the Center. The second
allegation concerned inadequate training
of the Center’s staff. The District Court
granted summary judgment on this
allegation because A.M. failed to present
evidence f r o m w h i c h d e l ib e rate
indifference could be inferred. The third
allegation concerned the lack of a written
policy or protocol to ensure youth safety.
The District Court granted summary
judgment to Brulo and Kwarcinski on this
allegation because there was no direct
causal link between the lack of a policy
and A.M.’s alleged injuries. The final
allegation concerned the lack of policies
and procedures to address the mental and
physical health needs of residents. On this
allegation, the District Court held that
there was no evidence to suggest that the
Defendants’ actions were deliberately
indifferent.
The District Court granted summary
judgment in favor of Dr. Puffenberger on
A.M.’s claims that Dr. Puffenberger failed
to develop adequate medical policies for
the Center. The District Court assumed,
for purposes of summary judgment, that
Dr. Puffenberger was responsible for
developing such policies. However, the
District Court held that summary judgment
was appropriate because there was no
direct causal connection between A.M.’s
injuries and the allegedly deficient medical
policies.
Count Two. Count Two alleged
that Brulo, Kwarcinski, and Prawdzik were
liable in their individual capacities for
failing to protect A.M. from harm and
failing to treat him. The claims against
Brulo, Kwarcinski, and Prawdzik in Count
Two were based on their failure to develop
policies and their failure to adequately
supervise the Center’s child-care workers.
Because the District Court found that no
child-care workers under the supervision
of these Defendants violated A.M.’s
constitutional rights, it granted summary
judgment in favor of Brulo, Kwarcinski,
and Prawdzik in their individual
capacities.
Count Three. Count Three alleged
that Prawdzik, Traver, Parker, and
Considine were liable, in their individual
capacities, for failing to protect A.M. from
harm. A.M.’s claims against Prawdzik,
Considine, Traver, and Parker were based
on allegations that the child-care staff
failed to intervene soon enough when
violence between A.M. and other residents

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6
began to develop and failed to take A.M .
for medical care.
Regarding A.M.’s claims that the
child-care staff did not intervene soon
enough, the District Court compared the
situation to a prison disturbance and
considered whether the staff acted
“maliciously and sadistically to cause
harm.” See Fuentes v. Wagner, 206 F.3d
335, 345 (3d Cir. 2000). In the District
Court’s view, there was no evidence that
the staff acted maliciously or sadistically.
With regard to the alleged failure of the
staff to take A.M. to the nurse on certain
occasions, the District Court held that the
evidence did not support a conclusion that
this was done with deliberate indifference
to a serious medical need of A.M ., since he
sustained mostly bruises from the
altercations.
Count Four. Count Four alleged
that Dr. Puffenberger and Yozviak were
liable in their individual capacities for
failing to treat A.M. The District Court
granted summary judgment in favor of Dr.
Puffenberger and Yozviak, concluding that
any omissions by Yozviak did not amount
to a wanton infliction of pain and the
evidence against Dr. Puffenberger
suggested, at most, negligence.
III. DISCUSSION
A. Standard of Review
We review the District Court’s
grant of summary judgment de novo,
viewing “the underlying facts and all
reasonable inferences therefrom in the
light most favorable to the party opposing
the motion.” Pa. Coal Ass’n v. Babbitt, 63
F.3d 231, 236 (3d Cir. 1995). Summary
judgment is appropriately granted where
there is no genuine issue as to any material
fact and the moving party is entitled to
judgment as a matter of law. Fed. R. Civ.
P. 56(c). However, summary judgment
should not be granted where there is a
“genuine” dispute about a material fact,
“that is, if the evidence is such that a
reasonable jury could return a verdict for
the nonmoving party.” Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 248
(1986).
B. Substantive Due Process
In order to maintain a § 1983 claim,
“a plaintiff must show that the defendant
deprived him of a right or privilege
secured by the Constitution or laws of the
United States while acting under color of
state law.” Williams v. Borough of West
Chester, Pa., 891 F.2d 458, 464 (3d Cir.
1989). Analysis of a § 1983 claim begins
by identifying the “exact contours of the
underlying right said to have been
violated” and then determining “whether
the plaintiff has alleged a deprivation of a
constitutional right at all.” Nicini v.
Morra, 212 F.3d 798, 806 (3d Cir. 2000);
County of Sacramento v. Lewis, 523 U.S.
833, 841 n.5 (1998).
There appears to be no dispute
between the parties that A.M. has a liberty
interest in his personal security and well-

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being, which is protected by the
Fourteenth Amendment. See Youngberg
v. Romeo, 457 U.S. 307, 315-19 (1982).
The question thus becomes whether A.M.
has adduced sufficient facts from which a
reasonable jury could conclude that the
Defendan ts’ conduct constituted a
violation of his constitutional rights. To
answer this question, we must “determine
what level of conduct is egregious enough
to amount to a constitutional violation and
. . . whether there is sufficient evidence
that [the Defendants’] conduct rose to that
level.” Nicini, 212 F.3d at 809.
When executive action is at issue, a
violation of the Fourteenth Amendment
right to substantive due process may be
shown by conduct that “shocks the
conscience.” Lewis, 523 U.S. at 846-47.
Negligent conduct is never egregious
enough to shock the conscience, but
conduct intended to injure most likely will
rise to the level of conscience-shocking.
See id. at 849. In between these two
extremes is a middle range of conduct
known as deliberate indifference, which
may rise to the level of conscience-
shocking in certain circumstances. Id. at
849-50. The question of whether conduct
amounting to deliberate indifference is
sufficient to “shock the conscience”
requires an “exact analysis of [the]
circumstances” in a given case. Id. at 850.
The deliberate indifference standard
“is sensibly employed only when actual
deliberation is practical.” Id. at 851. As in
a prison setting, we believe the custodial
setting of a juvenile detention center
presents a situation where “forethought
about [a resident’s] welfare is not only
feasible but obligatory.” Id. We therefore
conclude that this case is properly
analyzed using the deliberate indifference
standard. The circumstances of this case
present a situation where the persons
responsible for A.M. during his detention
at the Center had time to deliberate
concerning his welfare. See Leamer v.
Fauver, 288 F.3d 532, 547 (3d Cir. 2002).
We now turn to the claims against each of
the Defendants.
1. Claims Against Yozviak
and Dr. Puffenberger
As to the claims in Count One and
Count Four against Dr. Puffenberger and
Yozviak, we sustain the District Court’s
grant of summary judgment in their favor.
We find no error in the District Court’s
grant of summary judgment in favor of
Yozviak on A.M.’s claim that she is liable
for failing to treat him. Like the District
Court, we find no evidence in the record to
support A.M.’s claims that Yozviak acted
with deliberate indifference in her alleged
failure to disseminate information to the
Center’s staff about A.M.’s mental health
history or take other steps in response to
the information.
Likewise, we find no error in the
District Court’s grant of summary
judgment in favor of Dr. Puffenberger.
The evidence reveals that Dr. Puffenberger
is a general physician who was under
contract with the Center to perform a
medical evaluation of each resident,

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including a physical examination, within
forty-eight hours of admission. Dr.
Puffenberger saw A.M. on only one
occasion when he conducted the physical
examination, and the record does not
include any evidence that Dr. Puffenberger
was asked, or required, to conduct a
psychiatric evaluation of A.M. Even if we
assume for the purposes of summary
judgment that Dr. Puffenberger had some
responsibility for formulating policies for
the Center, our review of the record leads
us to the conclusion that A.M. failed to
present sufficient facts that any failure of
Dr. Puffenberger with respect to his duties
rose to the level of deliberate indifference.
2. Claims Against the Center and
Brulo and Kwarcinski in
Their Official Capacities
A.M. asserts claims against Brulo
and Kwarcinski in their official capacities,
based on their status as policymakers for
the Center, and the Center itself. A suit
against a governmental official in his or
her official capacity is treated as a suit
against the governmental entity itself. See
Hafer v. Melo, 502 U.S. 21, 25 (1991). A
governmental entity, like the Center,
cannot be liable under a theory of
respondeat superior or vicarious liability.
See Monell v. New York Dep’t of Social
Servs., 436 U.S. 658, 691-92 (1978).
Rather, in order for a governmental entity
( g e n e r i c a l l y r e f e r re d t o a s a
“municipality”) to be liable for the
violation of a constitutional right under
§ 1983, the plaintiff must identify a policy
or custom of the entity that caused the
constitutional violation. Bd. of County
Comm’rs of Bryan County, Okla. v.
Brown, 520 U.S. 397, 403 (1997). A
plaintiff can establish causation by
“demonstrat[ing] that the municipal action
was taken with ‘deliberate indifference’ as
to its known or obvious consequences.”
Id. at 407.
A.M. has identified the following
policies or customs of the Center as
providing a basis for liability: (1) deficient
hiring and staffing policies and practices;
(2) lack of an adequate training program
for the Center’s child-care workers in
critical areas such as de-escalating
conflicts between youths and managing
youth behavior generally; (3) lack of
established protocols to ensure youth
safety, including the management of
problematic youth behavior, de-escalation
of conflicts, and identification and
protection of children at risk of
victimization; and (4) lack of established
policies to address the mental and physical
health needs of youth residents.
The District Court did not focus on
whether A.M. had produced evidence of
the existence of the alleged policies or
customs. Instead, the District Court
directed its analysis to whether there was a
direct causal link between the alleged
policies or customs and the harms suffered
by A.M . See Kneipp v. Tedder, 95 F.3d
1199, 1213 (3d Cir. 1996) (stating a
§ 1983 plaintiff must “establish that the
government policy or custom was the
prox imate cause of the inju ries
sustained”). In the District Court’s view,

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evidence of a causal connection was
lacking. Our review of the record leads us
to hold there exist sufficient facts to
prevent the grant of summary judgment
such that a jury should make the ultimate
determination as to the violation of the
alleged policies or customs, as we discuss
more fully below. Once evidentiary proof
is adduced, the issue of proximate cause is
best left to the determination of a trier of
fact. See id.
Deficient Hiring and Staffing
A.M. presented evidence that a
number of the Center’s child-care workers
did not meet state standards for
educational training. Under state law, the
Center’s child-care workers had to
possess, at a minimum, either an Associate
Degree in one of the social sciences or
exceptional ability in lieu of the academic
credentials. 55 Pa. Code § 3760.55(b).
Employment applications produced for
certain child-care workers reveal that these
workers did not possess the requisite
educational degree and there is no
evidence that they had the credentials that
would render them otherwise qualified for
the job.
More significantly, A.M. presented
evidence from which it may be inferred
that the Center failed to ensure that there
were enough child-care workers on duty to
appropriately supervise youth at all times.
Although Brulo testified in her deposition
that the Center complied with staffing
ratios, other evidence suggests that the
number of child-care workers supervising
the residents was inadequate. Christopher
Traver testified that he had to supervise as
many as ten residents at one time, and he
submitted a resignation letter in which he
complained that only one child-care
worker would be left with the residents
while he would be directed to complete
tasks unrelated to supervising the
residents, such as cleaning and other
janitorial-type duties.
There is also evidence in the record
that the Center was having problems with
the supervision of residents by child-care
workers at or around the time A.M. was a
resident. For example, there are letters of
r e p r i m a n d f r o m t h e C e n t e r ’ s
administrators to individual child-care
workers, rebuking those workers for
failing to adequately supervise the
residents and failing to follow certain
security measures.
The above evidence is at least
sufficient to create a fact issue as to
whether the Center had a policy or custom
of deficient hiring and staffing. In
addition to this evidence, A.M. submitted
the unrebutted testimony of a corrections
expert, Paul DeMuro, who opined that the
problems with inadequate supervision of
residents directly contributed to the
abusive treatment A.M. endured at the
Center. The District Court did not discuss
this evidence, but we believe the evidence
provides a causal link between the hiring
and staffing policies and A.M .’s injuries.
As long as the causal link between the
alleged policy or custom and the
constitutional injury is “not too tenuous,

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the question whether the municipal policy
or custom proximately caused the
constitutional infringement should be left
to the jury.” Bielevicz v. Dubinon, 915
F.2d 845, 851 (3d Cir. 1990). Based on
this standard, we conclude the evidence of
the causal connection between these
policies and A.M.’s injuries presented a
jury question.
Inadequate Training
Analysis of substantive due process
claims requires full consideration of all the
circumstances of a given case. See Lewis,
523 U.S. at 850. Therefore, the evidence
of deficient hiring and staffing policies
must be considered in context with the
evidence A.M. submitted concerning the
lack of an adequate training program for
the Center’s child-care workers. A.M.
contends the Center failed to train its
child-care workers with respect to de-
escalating conflicts between youth,
managing youth behavior generally,
dealing with sex offenders, and identifying
and protecting youth in the population who
would be easily victimized.
A municipality may be liable for
failing to train its employees if that failure
amounts to deliberate indifference. See
City of Canton v. Harris, 489 U.S. 378,
389-90 (1989) (explaining that failure to
train may amount to a policy or custom
that is actionable under § 1983 when “in
light of the duties assigned to specific
officers or employees[,] the need for more
or different training is so obvious, and the
inadequacy so likely to result in the
violation of constitutional rights, that the
policymakers of the city can reasonably be
said to have been deliberately indifferent
to the need.”). The deficiency of a
municipality’s training program must be
closely related to the plaintiff’s ultimate
injuries. Id. at 391.
The record discloses the following
with respect to the training of the Center’s
child-care workers. Child-care workers
received a three-day orientation after they
were hired, which essentially involved on-
the-job training with respect to such issues
as the Center’s physical plant and fire
safety. Brulo testified that the orientation
included training on dealing with
behavioral issues, but she did not identify
any specific training in this area. Brulo
also spoke generally about training in the
areas of mental health and dealing with
children, but she failed to describe with
any specificity the training program for
child-care workers.
Kwarcinski testified that the entire
staff of the Center received training on
dealing with physical threats to their own
safety and threats from bombs or weapons.
Although Kwarcinski testified that staff
received training on defensive tactics in
dealing with conflicts between residents,
he stated that there was no training on how
to de-escalate conflicts between youths or
identify children that could be easily
victimized by other residents in the Center.
Other testimony indicates that child-care
workers received training in CPR and first
aid but did not receive training in de-
escalating youth conflicts or identifying

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and protecting youths that could be easily
victimized.
Against this evidence, A.M.
presented the unrebutted testimony of his
corrections expert, DeMuro. DeMuro
opined that the Center did not have an
adequate training program for its staff and
did not meet nationally recognized
standards for training, which included
having forty hours of pre-service training.
In DeMuro’s opinion, the Center’s failure
to train its staff and follow other
recognized standards for the operation of
juvenile detention facilities directly
contributed to the inappropriate treatment
of A.M. while he was detained.
The Center suggests that the
numerous incident reports filed by child-
care workers demonstrate that A.M.’s
failure-to-train claim cannot be sustained.
However, we fail to see the logic in this
argument. Rather than support the
Center’s position, we see how a jury could
view the incident reports as additional
evidence of the lack of training for the
child-care workers. Several of the incident
reports indicate that child-care workers
watched conflicts between A.M. and other
residents escalate without intervening,
resulting in physical injury to A.M.
Viewing the incident reports in the light
most favorable to A.M., they demonstrate
the need for more or different training of
child-care workers to deal with residents
like A.M., who have significant behavioral
and mental health problems. The incident
reports also support an inference that
recurrent harm to A.M. at the hands of
other residents was predictable. See Bryan
County, 520 U.S. at 409-10 (“[A] high
degree of predictability may also support
an inference of causation -- that the
municipality’s indifference led directly to
the very consequence that was so
predictable.”).
In our view, the evidence supports
an inference that the potential for conflict
between residents of the Center was high.
Taken as a whole, we believe the evidence
concerning the Center’s failure to train its
child-care workers in areas that would
reduce the risk of a resident being deprived
of his constitutional right to security and
well-being was sufficient to prevent the
grant of summary judgment. In other
words, we cannot hold that the Center
“was not deliberately indifferent to the risk
as a matter of law.” Berg v. County of
Allegheny, 219 F.3d 261, 277 (3d Cir.
2000). Viewing the record in the light
most favorable to A.M., we conclude the
evidence concerning the Center’s training
program presents a genuine issue of
material fact as to the sufficiency of that
program and whether the inadequacies in
the program bear a causal relationship to
A.M.’s injuries.
Lack of Policies to Ensure Youth Safety
On appeal, A.M. argues he
presented sufficient evidence from which
a reasonable jury could infer that the
Center’s lack of established policies and
procedures to ensure youth safety may
have caused his injuries “at least in part.”
Bielevicz, 915 F.2d at 851. In this regard,
A.M. focuses primarily on the Center’s

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lack of a written policy or procedure for
reviewing and following up on incident
reports.
There is contradictory testimony in
the record regarding who was responsible
for reviewing incident reports and deciding
what course of action should be taken in
response. Brulo and Kwarcinski believed
Jerome Prawdzik was responsible for
reviewing all incident reports in the first
instance, investigating them, and giving
feedback to the child-care workers.
However, Prawdzik testified that incident
reports would first go to Kwarcinski, who
would decide which reports should go to
Prawdzik. Prawdzik indicated that either
Brulo or Kwarcinski had responsibility for
deciding what course of action should be
taken in response to the incident reports.
DeM uro testified that the Center
had diffuse accountability and poor
communication in key areas such as
reviewing and following up on incident
reports. In his opinion, deficiencies like
these illustrated that the Center had
seriously flawed policies and procedures
that contributed to A.M.’s injuries and
abusive treatment. In addition to relying
on this testimony, A.M. asserts that a
written policy clarifying the roles and
r e s p o n si b i li t ie s of th e C e n t e r ’ s
administrators and staff with respect to the
incident reports would have at least
minimized the chance that A.M. would be
inappropriately placed with youth who had
previously assaulted him.
Although this issue presents a close
question on whether the Center’s failure to
establish a written policy and procedure
for reviewing and following up on incident
reports amounts to deliberate indifference,
we conclude that a reasonable jury could
conclude from the evidence that by failing
to establish such a policy the Center
disregarded an obvious consequence of its
action, namely, that residents of the Center
could be at risk if information gleaned
from the incident reports was not reviewed
and acted upon. Similarly, a reasonable
jury could infer that the failure to establish
the policy was causally related to the
constitutional violations of which A.M .
complains. See Natale v. Camden County
Corr. Facility, 318 F.3d 575, 585 (3d Cir.
2003) (holding that a reasonable jury could
conclude that a governmental entity’s
failure to establish a policy to address the
immediate medication needs of inmates
was deliberately indifferent).
Lack of Policies Regarding Residents’
Physical and Mental Health Needs
The District Court granted summary
judgment in favor of the Center, Brulo,
and Kwarcinski on A.M.’s claim that the
lack of policies or procedures to address
the physical and mental health needs of
residents led to a violation of his
constitutional rights. The District Court
concluded that there was insufficient
evidence that the Center was deliberately
indifferent to A.M.’s medical needs, and
insufficient evidence that any policy or
custom of not providing mental health care
worsened A.M.’s condition or otherwise
caused him constitutional injury.

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We first address the District Court’s
c o n c l u s io n t h a t A .M . p r e s e n te d
insufficient evidence to suggest that the
Center was deliberately indifferent to his
serious medical needs. In this regard, the
District Court applied the deliberate
indifference standard for Eighth
Amendment claims brought by prisoners
against prison officials for failure-to-treat.
A.M. takes issue with the application of
this standard, noting that he was not a
convicted prisoner but merely a juvenile
detainee. Given his status as a detainee,
A.M. maintains his claims must be
a s s e s s e d u n d e r t h e F o u r te e n t h
Amendment.
We do not dispute that A.M.’s
claims are appropriately analyzed under
the Fourteenth Amendment since he was a
detainee and not a convicted prisoner.
However, the contours of a state’s due
process obligations to detainees with
respect to medical care have not been
defined by the Supreme Court. See City of
Revere v. Mass. Gen. Hosp., 463 U.S. 239,
244 (1983). Yet, it is clear that detainees
are entitled to no less protection than a
convicted prisoner is entitled to under the
Eighth Amendment. See id.; see also
Fuentes, 206 F.3d at 344. In Estelle v.
Gamble, 429 U.S. 97 (1976), the Supreme
Court held that a prisoner may state a
cause of action under § 1983 upon
showing that a prison official was
deliberately indifferent to his serious
illness or injury. Id. at 104-05. It is under
this standard that we assess whether A.M.
has presented sufficient evidence to show
that the Center was deliberately indifferent
to his serious mental health needs.
A.M. presented evidence that the
Center’s administrators were aware, upon
his admission, that he had serious mental
health and behavioral problems, which
required medication and psychiatric care.
There is conflicting evidence in the record
regarding whether the Center ever
contacted A.M.’s treating psychiatrist to
discuss his medication and treatment
needs. A.M. also presented evidence that
after Dr. Gitlin’s evaluation of him on July
23, 1999, no other mental health
professionals were consulted or asked to
treat A.M., despite the ongoing difficulties
the Center was having in managing his
behavior. Rather than attending to the
underl y in g m e n t a l h e a lth issues
contributing to the difficulties in managing
A.M ., the Center viewed him as merely a
behavior problem.
A.M. presented the unrebutted
testimony of his psychiatric expert, Dr.
Annie Steinberg, who stated that the
Center did not provide appropriate
treatment for A.M.’s pre-existing mental
health condition while he was a resident.
According to Dr. Steinberg, the Center did
not “mon itor, or recogn ize th e
exacerbation of [A.M.’s] psychiatric
symptoms, warning signs and the need for
modifications to the intervention, or
demonstrate the fundamental principles
relevant to the care of juveniles.” (J.A. at
108a.)
We conclude the evidence A.M.

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presented was sufficient to survive
summary judgment on whether the Center
was deliberately indifferent to A.M.’s
mental health needs. A reasonable jury
could conclude from the evidence that the
Center knew about A.M.’s significant
mental health issues but was unprepared to
take the steps necessary to address those
issues. We believe a genuine issue of
material fact exists as to whether the
Center’s failure to establish policies to
address the mental health needs of
residents like A.M. amounted to deliberate
indifference.
We next turn to A.M.’s argument
that he presented ample evidence that the
Center’s lack of policies to address the
physical and mental health needs of
residents caused him harm. A.M.
presented the unrebutted testimony of
DeMuro that the Center had a seriously
flawed intake and assessment system,
which failed to provide for the sharing and
dissemination of critical information about
his mental health history. DeMuro opined
that poor staff communication, particularly
concerning the medical and mental health
needs of residents, contributed to A.M.’s
ongoing abuse by other residents. In
addition to DeMuro’s testimony, A.M.
presented evidence that the Center never
contacted his treating psychiatrist after his
admission and had no protocols to address
when a resident’s treating psychiatrist was
to be contacted, what follow-up was to be
done once a resident received a mental
health evaluation, and who was
r e s p o n s i b l e f o r c o m m u n i c a t i n g
information about a resident’s mental
health concerns to the staff. There were
also the specific recommendations made
by Dr. Gitlin for managing A.M.’s mental
health problems and behavior, which do
not appear to have been read by the
Center’s administrators, shared with the
child-care workers, or incorporated into a
plan for A.M .’s safety or treatment.
Finally, Dr. Steinberg opined that the
Center’s failure to provide appropriate
treatment for A.M.’s pre-existing mental
health illnesses and protect A.M. from
harm worsened A.M.’s mental health
condition. A.M. argues this testimony
demonstrates that the combination of his
mental health con ditions and the
circumstances surrounding his detention
created the direct harm that led to his
injuries.
We believe the evidence A.M.
adduced on the issue of whether the lack
of policies to address the mental and
physical health needs of residents caused
his injuries is “not too tenuous.”
Bielevicz, 915 F.2d at 851. We therefore
conclude that the issue of causation should
have been left to a jury. Id.
In summary, based on the foregoing
reasons, we hold that the District Court
erred in granting summary judgment in
favor of the Center and Brulo and
Kwarcinski in their official capacities.3
3As stated earlier, the parties do not
appear to dispute that A.M. has a protected
liberty interest in his personal security and
well-being. Implicit in this opinion is the

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3. Claims Against Brulo, Kwarcinski,
and Prawdzik in Their Individual
Capacities
A.M.’s claims against Brulo,
Kwarcinski, and Prawdzik in their
individual capacities allege that they are
liable for developing inadequate policies
and customs and failing to adequately
supervise their subordinates. The District
Court disposed of the claims against these
Defendants, concluding there was no
evidence to suggest that any person under
their supervision violated A.M .’s
constitutional rights. Because A.M.’s
claims implicate these Defendants in their
roles as supervisors, we address the claims
in terms of supervisory liability.
There are two theories of
supervisory liability that are applicable to
this case. The first involves Brulo and
Kwarcinski in their roles as policymakers
for the Center. Individual defendants who
are policymakers may be liable under
§ 1983 if it is shown that such defendants,
“with deliberate indifference to the
consequences, established and maintained
a policy, practice or custom which directly
caused [the] constitutional harm.”
Stoneking v. Bradford Area Sch. Dist., 882
F.2d 720, 725 (3d Cir. 1989). Evidence in
the record show s that Brulo and
Kw arcinski had responsibility for
developing policies and procedures for the
Center. Given our conclusion that A.M .
presented sufficient evidence to present a
jury question on whether the Center’s
policies and procedures caused his
injuries, we conclude summary judgment
in favor of Brulo and Kwarcinski in their
individual capacities was inappropriate.
The second theory of liability
provides that a supervisor may be
personally liable under § 1983 if he or she
participated in violating the plaintiff’s
rights, directed others to violate them, or,
as the person in charge, had knowledge of
and acquiesced in his subordinates’
violations. See Baker v. Monroe
Township, 50 F.3d 1186, 1190-91 (3d Cir.
1995). Again, given our conclusion, as
discussed below, that A.M. presented
sufficient evidence to prevent the grant of
summary judgment on whether the child-
care workers were deliberately indifferent
to A.M.’s constitutional rights, we believe
summary judgment in favor of their
supervisors was inappropriate. The
incident reports prepared by the child-care
work ers provided notice to their
view that, given this protected interest, a
state-run juvenile detention center at least
has a duty to protect detainees from harm
(whether self-inflicted or inflicted by
others) and provide, or arrange for,
treatment of mental and physical illnesses,
injuries, and disabilities. A juvenile
detention center is comparable to a prison,
which, in general, does not have as its
primary aim the treatment of mental or
physical illnesses, injuries, or disabilities,
but nonetheless has a duty to care for and
protect its inmates. On remand, the district
court should more precisely define the
duties the Center owes to its residents and
consider the scope of those duties.

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supervisors that A.M. was being assaulted
by other residents and had severe behavior
problems. While there is some evidence
that Brulo, Kwarcinski, and Prawdzik took
some disciplinary action with respect to
certain child-care workers, A .M.’s
evidence that they took little or no action
to protect him is sufficient to present a
genuine issue of material fact as to their
knowledge of and acquiescence in the
conduct of the child-care workers.
Based on the foregoing, we hold
that the District Court erred in granting
summary judgment in favor of Brulo,
Kwarcinski, and Prawdzik in their
individual capacities.
4. Claims Against Prawdzik, Considine,
Traver, and Parker
The District Court granted summary
judgment in favor of these former child-
care workers and their immediate
supervisor on A.M.’s claim that they
repeatedly failed to protect him from harm.
On appeal, A.M. argues the District Court
applied the incorrect standard for assessing
their liability. As noted above, the District
Court relied on the standard for assessing
claims of excessive use of force by prison
officials in the prison disturbance context.
See Fuentes, 206 F.3d at 345 (holding that
excessive force claims in the context of a
prison disturbance require a subjective
inquiry into whether the force was applied
in a good-faith effort to restore or maintain
discipline, or maliciously and sadistically
to cause harm).
A.M. contends the Fuentes standard
is inapplicable in this case because it
applies to the use of force by prison
officials in a single instance of prisoner
unrest where there is a need to act quickly.
In contrast to a single instance of prisoner
unrest, A.M. points out that he was
assaulted by other residents on numerous
occasions over a five-week period of
detention, many times in the presence of
child-care workers. A.M. argues that it is
inappropriate to apply the deferential
malicious and sadistic standard in a case
such as his where there were almost daily
physical altercations between A.M. and
other residents. A.M. urges that his case is
more appropriately judged by the
deliberate indifference standard. We
agree.
This case does not appear to us as
one in which the child-care workers were
required to make split-second decisions to
maintain or restore order through the use
of excessive physical force. Cf. Hudson v.
McMillian, 503 U.S. 1, 6-7 (1992)
(holding that the core judicial inquiry in
cases where prison officials are accused of
using excessive force in the prison
disturbance context is “whether force was
applied in a good-faith effort to maintain
or restore discipline, or maliciously and
sadistically to cause harm”). Instead, the
evidence in this case presents a situation in
which child-care workers and their
immediate supervisor had the opportunity
over a five-week period to see a pattern of
physical assaults against A.M. emerging,
consult amongst each other concerning the
appropriate response to this pattern, and

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develop a plan to protect A.M. from
assaults by other residents.
Other courts have applied the
deliberate indifference standard in cases
where prison officials failed to protect an
inmate from attack by another inmate.
See, e.g., Jeffers v. Gomez, 267 F.3d 895,
913 (9th Cir. 2001) (applying the
deliberate indifference standard to claim
that prison officials failed to act on rumors
that Hispanic inmates were planning to
attack Black inmates); Williams v.
Mueller, 13 F.3d 1214, 1216 (8th Cir.
1994) (explaining application of the
deliberate indifference standard to a prison
official’s obligation to protect inmates
from harm by other inmates); Walker v.
Norris, 917 F.2d 1449, 1453 (6th Cir.
1990) (applying the deliberate indifference
standard to claim that prison officials
failed to prevent one inmate from stabbing
and killing another inmate).
While this circuit has not spoken
directly on this issue, we have held that a
corrections officer who witnesses but fails
to intervene in the beating of an inmate by
other officers is culpable if the officer had
a “reasonable opportunity” to intervene but
refused to do so. Smith v. Mensinger, 293
F.3d 641, 650 (3d Cir. 2002). Although
Mensinger is not directly on point, it
nonetheless provides support for our
conclusion that the District Court erred in
applying the malicious and sadistic
standard of Fuentes to A.M.’s claims
against the child-care workers and their
immediate supervisor.
We conclude that the District Court
should have analyzed A.M.’s claims
against the child-care workers and their
immediate supervisor using the deliberate
indifference standard. The deliberate
indifference standard in this context
requires evidence that the Defendants were
deliberately indifferent to a substantial risk
of harm to A.M. and did nothing to
prevent it. See Farmer v. Brennan, 511
U.S. 834 (1994).4 Applying this standard,
we believe the evidence, viewed in the
light most favorable to A.M., is sufficient
to present a jury question on whether the
child-care workers and their immediate
supervisor were deliberately indifferent to
A.M.’s right to security and well-being.
See Nicini, 212 F.3d at 816 (Rendell, J.,
dissenting) (“whether or not a defendant’s
conduct amounts to deliberate indifference
has been described as a ‘classic issue for
the fact finder’ and ‘a factual mainstay of
actions under [§] 1983’”) (quoting
Armstrong v. Squadrito, 152 F.3d 564, 577
(7th Cir. 1998)).
The evidence, in particular the
4We note that the claim in Farmer was
based on the Eighth Amendment, not the
Fourteenth Amendment. However, as we
previously discussed, the contours of a
state’s due process obligations to detainees
have not been defined. See Doe v.
Washington County, 150 F.3d 920, 922
(8th Cir. 1998). We reiterate that
detainees are entitled to no less protection
than a convicted prisoner. See id.;
Fuentes, 206 F.3d at 344.

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numerous incident reports, supports
A.M.’s contention that the child-care
workers failed to intervene when
altercations between A.M. and other
residents began. More troubling is
evidence that suggests child-care workers
would allow A.M. to get beaten up
because they were sick of him and he
deserved it. In our view, this evidence is
sufficient to prevent the grant of summary
judgment. Accordingly, we hold that the
District Court’s grant of summary
judgment in favor of Prawdzik, Considine,
Traver, and Parker must be reversed.
IV. CONCLUSION
For the reasons set forth in this
opinion, we will AFFIRM the District
Court’s grant of summary judgment in
favor of Elaine Yozviak, in her individual
capacity, and Dr. Mark Puffenberger, in
his individual and official capacities.
However, we will REVERSE the District
Court’s grant of summary judgment in
favor of the Center, Sandra Brulo and
Louis Kwarcinski, in their official and
individual cap acitie s, and Jerome
Prawdzik, Chris Traver, Chris Parker, and
Michael Considine, in their individual
capacities, and REMAND the case for
further proceedings.

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