Carolyn Graham, as Personal Representative of the Estate of Terance Anthony Graham v. Count Yof Washtenaw

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RECOMMENDED FOR FULL-TEXT PUBLICATION
Pursuant to Sixth Circuit Rule 206
ELECTRONIC CITATION: 2004 FED App. 0043P (6th Cir.)
File Name: 04a0043p.06
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
_________________
CAROLYN GRAHAM, as
Personal Representative of the
Estate of Terance Anthony
Graham,
Plaintiff-Appellant,
v.
COUNT Y OF WASHTENAW,
Defendant-Appellee.
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No. 02-1614
Appeal from the United States District Court
for the Eastern District of Michigan at Detroit.
No. 00-72195—Anna Diggs Taylor, District Judge.
Argued: October 23, 2003
Decided and Filed: February 10, 2004
Before: KEITH, MARTIN, and SUTTON, Circuit Judges.
_________________
COUNSEL
ARGUED: Hugh M. Davis, Jr., CONSTITUTIONAL
LITIGATION ASSOCIATES, Detroit, Michigan, for
Appellant. Cynthia L. Reach, REACH, RANNEY &
2 Graham v. County of Washtenaw No. 02-1614
1There is some discrepancy in the record and briefs as to the correct
spelling of M r. Graham’s first name. According to the Notice of Ap peal,
however, it is spelled “T erance.”
CARPENTER, Ann Arbor, Michigan, for Appellee.
ON BRIEF: Hugh M. Davis, Jr., CONSTITUTIONAL
LITIGATION ASSOCIATES, Detroit, Michigan, for
Appellant. Cynthia L. Reach, REACH, RANNEY &
CARPENTER, Ann Arbor, Michigan, for Appellee.
_________________
OPINION
_________________
BOYCE F. MARTIN, JR., Circuit Judge. This case arises
from the tragic death of Terance Anthony Graham.1 Mr.
Graham died in police custody shortly after secretly ingesting
large quantities of cocaine upon being arrested for an
unrelated marijuana offense. Carolyn Graham, the personal
representative of Mr. Graham’s estate, sued Washtenaw
County pursuant to 42 U.S.C. § 1983, claiming that the
County’s policy regarding the provision of medical care to
prisoners in the County jail contributed to Mr. Graham’s
death. The district court granted the County’s motion for
summary judgment. For the following reasons, we affirm.
I. BACKGROUND
The facts giving rise to this case are, for the most part,
undisputed. On May 6, 2000, at approximately 8:39 in the
evening, Deputy Sinks arrested Mr. Graham for possession of
marijuana. A few minutes after the arrest, the deputy
permitted Mr. Graham to go behind a tree, allegedly to relieve
himself. It was later determined that while behind the tree
Mr. Graham had swallowed approximately an ounce of
cocaine, which is a felony under Michigan law. Mr. Graham
was escorted into the County jail at approximately 8:55.
Most of the events occurring inside the jail were captured on

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No. 02-1614 Graham v. County of Washtenaw 3
2In a written report, Deputy Sinks claimed that at this point Nurse
Lakatos told Mr. Graham that his heart was racing at around two hundred
beats per minute and asked him why his heart rate was so high. The
County denies that Nurse Lakatos observed or rep orted that M r. Graham’s
heart rate was two hundred beats per m inute and claim s that the deputy’s
report is inadmissible hearsay. This disagreement does not, however,
constitute a genuine dispute of material fact that would preclude summary
judgment.
videotape. Shortly after his arrival, jail personnel observed
Mr. Graham walking and acting erratically. At one point, he
pulled down his pants in full view of everyone in the booking
area. Jail personnel asked him several times, “What did you
take?” Instead of revealing that he had ingested cocaine, Mr.
Graham stated that he had smoked marijuana and drank
alcohol. After witnessing Mr. Graham’s erratic behavior, a
deputy requested that he be medically examined.
At approximately 9:00, Tracy Lakatos, a licensed practical
nurse, responded and examined Mr. Graham. Nurse Lakatos
was an employee of SecureCare, Inc., a company that the
County had hired to provide medical care to prisoners in the
County jail. Mr. Graham told her that he had been drinking
and using marijuana that evening and that he had asthma.
Nurse Lakatos gave him two doses of albuterol, a medication
used to treat asthma that has a known side effect of causing an
accelerated heart rate. At 9:06, Nurse Lakatos and Deputy
Sinks took Mr. Graham to an interview room.2 After a blood
alcohol test indicated that Mr. Graham was not intoxicated,
Nurse Lakatos said that Deputy Sinks could interview Mr.
Graham and she left the room at 9:11.
After providing a statement about his marijuana purchase
– the event prompting his arrest – Mr. Graham was turned
over to another deputy and was scheduled to be booked and
then released. At this point, jail personnel observed him
sweating profusely and using his shirt, which he had removed
from his body, to wipe off the sweat. Jail personnel
determined that he was not well enough to go through the
4 Graham v. County of Washtenaw No. 02-1614
booking process, so they placed him in a general population
cell at 9:23.
While inside the cell, Mr. Graham admitted to a cellmate
that he had ingested cocaine, but insisted that he did not want
the jail personnel to find out. Statements from his cellmates
indicate that while in the cell Mr. Graham “could barely talk,”
“was staggering,” “looked sick,” and “was holding his
stomach and rubbing his throat.” At approximately 10:00, a
cellmate pounded on the plexiglass window and yelled “He’s
hurt!” Witnesses reported that Mr. Graham appeared to be
having a seizure and that he had “a blank look on his face and
his eyes were real glassy.”
Nurse Lakatos responded and asked what was wrong.
Again, instead of telling Nurse Lakatos the truth, Mr. Graham
only said that he had swallowed some pills. Nurse Lakatos
used a pulse oximeter to determine his heart rate. One
cellmate observed that the pulse oximeter indicated a high
heart rate, which Nurse Lakatos apparently explained was due
to the marijuana. Satisfied that Mr. Graham needed no
additional medical care, Nurse Lakatos left the cell at
approximately 10:05.
At 10:16, Nurse Lakatos responded to another cry from a
cellmate that Mr. Graham had “passed out.” At this point, he
was taken to the medical room in the jail building, requiring
assistance from jail personnel to stay on his feet. At
approximately 10:40, he began to have multiple seizures, at
which point an ambulance was summoned. He was
transported to a hospital emergency room a few minutes later
and was pronounced dead at 11:31.
On May 12, 2000, Carolyn Graham, the personal
representative of Mr. Graham’s estate, filed a complaint
against the County, its Sheriff and certain officers. She filed
an amended complaint four days later. The claims against the
Sheriff and officers were subsequently dismissed, leaving a
section 1983 municipal liability claim against the County,

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No. 02-1614 Graham v. County of Washtenaw 5
which is the only claim at issue in this appeal. The essence of
the municipal liability claim is that the County’s contract with
SecureCare constituted a municipal “policy” that led to a
deprivation of Mr. Graham’s constitutional right to adequate
medical care while in police custody. Specifically, the
complaint alleges that: (1) the contract impermissibly creates
a policy of “automatic deference” by jail personnel to the
decisions of SecureCare staff concerning the medical
treatment of prisoners; and (2) the contract improperly
permits licensed practical nurses – like Nurse Lakatos – to
perform duties that exceed their competence under Michigan
law.
On August 3, 2001, the County filed a motion for summary
judgment, which was supplemented on August 28. On
October 1, the district court denied the motion without
prejudice and allowed Graham additional time to conduct
further discovery and to amend her complaint. She made no
attempt to file an amended complaint during the allotted time.
On February 4, 2002, the County renewed its motion for
summary judgment and, on February 11, filed a motion for
sanctions pursuant to Federal Rule of Civil Procedure 11
based upon Graham’s failure to withdraw the case in light of
this Court’s decision in Watkins v. Battle Creek, 273 F.3d 682
(6th Cir. 2001). In Watkins, we affirmed an award of
summary judgment to individual and municipal defendants in
a section 1983 case arising out of the death of an individual
who, like Mr. Graham, died in police custody after secretly
ingesting cocaine upon his arrest. Id.
On February 19, without requesting leave of the district
court, Graham attempted to file an amended complaint that
purportedly “clarified” her claim against the County and
asserted additional section 1983 claims, as well as a “medical
negligence” claim against various new defendants, including
SecureCare. The district court sua sponte rejected the
attempted filing. On February 25, Graham filed a motion for
leave to file the newly amended complaint.
6 Graham v. County of Washtenaw No. 02-1614
On March 11, the district court held a hearing during which
the following ruling was made from the bench:
It appears to the Court that at this time it must grant the
defendant’s motion for summary judgment because there
is no showing of any unconstitutional custom or policy
on the part of the Washtenaw County Jail which required
the deliberate indifference which could have led to the
plaintiff’s death. Indeed any other ruling here would be
extremely detrimental to prisoners who are incarcerated
in Michigan jails because the presence of medical
personnel is essential to their safety and their health.
Unfortunately the plaintiff here, as Watkins, in his case,
was the only person who knew what he had ingested, and
he was asked on several occasions by the medical
personnel and others, apparently, at this jail what was
wrong, and he did not disclose what his medical need
was. So I have to grant the motion for summary
judgment in this case.
After granting the County’s motion for summary judgment,
the district court denied Graham’s motion to file the amended
complaint. Graham later filed a motion for reconsideration,
which was denied on April 12. She also filed a medical
malpractice action against SecureCare and other defendants
in Michigan state court, which apparently is still pending.
After the completion of appellate briefing in this case, this
Court decided Weaver v. Shadoan, 340 F.3d 398 (6th Cir.
2003), another case involving the death of an individual in
police custody after secretly ingesting cocaine. In Weaver,
we relied upon our recent decision in Watkins to reverse the
district court’s denial of summary judgment to individual
defendants on the plaintiff’s section 1983 claims. Id.
On appeal, Graham argues that the district court erred in
granting summary judgment in favor of the County, in
denying her motion to file an amended complaint and in

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No. 02-1614 Graham v. County of Washtenaw 7
3The parties agree that M r. Graham had a constitutional right to
adequate medical care while in the custody of the County. Farmer v.
Brennan, 511 U .S. 825, 832 (199 4); Estelle v. Ga mb le, 429 U.S. 97, 104
(1976). It is well established that “deliberate indifference to the serious
medical needs of prisoners” constitutes cruel and unusua l punishment in
violation of the E ighth Amendment. Estelle, 429 U.S. at 104. W hile the
Eighth Amendment does not apply to pretrial detainees such as Graham,
the Fourteenth Amendment affords pretrial detainees a due process right
to adeq uate medical treatment that is analogous to the Eighth Amendment
rights of priso ners. City of Revere v. Mass. Gen. Hosp., 463 U.S. 239,
244 (1983).
denying her motion for reconsideration. We find these
arguments to be without merit.
II. ANALYSIS
We review de novo the district court’s grant of summary
judgment in favor of the County. Dotson v. Wilkinson, 329
F.3d 463, 466 (6th Cir. 2003). Summary judgment should be
granted when “the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a
judgment as a matter of law.” FED. R. CIV. P. 56(c). In
determining whether a genuine issue of material fact exists,
we must draw all reasonable inferences in favor of Graham,
as the nonmoving party. Bonds v. Cox, 20 F.3d 697, 701 (6th
Cir. 1994).
A. Section 1983 Claim
The essence of the section 1983 claim is that Mr. Graham
suffered a violation of his right to adequate medical care
while in custody and that the County’s policy regarding the
provision of medical care to its prisoners – as embodied in its
contract with SecureCare – led to that constitutional
violation.3 This claim implicates the familiar principles set
forth in Monell v. Department of Social Services, 436 U.S.
658, 694 (1978). In Monell, the Supreme Court explained
8 Graham v. County of Washtenaw No. 02-1614
4Our decisions in Watkins and Weaver centered upon whether
individual defend ants committed a constitutional violation by virtue of
their deliberate indifference to the serious medical needs of the respective
decedents. W hile one municipal liab ility claim was asserted in Watkins,
we did not discuss in much detail the merits of that claim, explaining
simply that “[i]f no constitutional violation by the individual defendants
is established, the municipal defendants cannot be held liable under
§ 19 83.” Watkins, 273 F.3d at 687 (citing City of Los Angeles v. Heller,
475 U .S. 796, 799 (198 6)). Thus, in light of our conclusion that none of
the individual defendants had committed a constitutional violation, we
held that summary judgment was properly granted on the municipal
liability claim as a matter of course. Id. This case is different fro m bo th
Watkins and Weaver in that there are no claims asserted against individual
defendants; the focus is solely upon the County’s liability. Therefore,
desp ite the factual similarities between this case and Watkins and Weaver,
our opinions in tho se case s do not auto matically compel the outcome here.
that municipal liability under section 1983 may only attach
where the “execution of a government’s policy or custom,
whether made by its lawmakers or by those whose edicts or
acts may fairly be said to represent official policy, inflicts the
injury” complained of. Thus, Graham must prove two basic
elements: (1) that a constitutional violation occurred; and
(2) that the County “is responsible for that violation.” Doe v.
Claiborne Cty., 103 F.3d 495, 505-06 (6th Cir. 1996). Our
decisions in Watkins and Weaver, discussed above, would be
relevant to the first element – i.e., whether Mr. Graham
suffered a deprivation of his constitutional right to adequate
medical care.4 We need not decide that issue, however,
because we find that even assuming that a constitutional
violation occurred, the County cannot be held liable for it.
A plaintiff asserting a section 1983 claim on the basis of a
municipal custom or policy must “identify the policy, connect
the policy to the [County] itself and show that the particular
injury was incurred because of the execution of that policy.”
Garner v. Memphis Police Dep’t, 8 F.3d 358, 364 (6th Cir.),
cert. denied, 510 U.S. 826 (1994). Graham’s claim is based
upon the County’s contract with SecureCare, which gives
SecureCare responsibility over the provision of medical care

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No. 02-1614 Graham v. County of Washtenaw 9
to prisoners in the County jail. The County concedes that this
contract constitutes a municipal “policy” within the meaning
of Monell.
The primary issue is whether Graham has alleged sufficient
facts to establish that the alleged constitutional violation
happened “because of the execution of [the County’s] policy.”
Id. (emphasis added). There must be “a direct causal link”
between the policy and the alleged constitutional violation
such that the County’s “deliberate conduct” can be deemed
the “moving force” behind the violation. Waters v. City of
Morristown, 242 F.3d 353, 362 (6th Cir. 2001) (citing Bd. of
Cty. Comm’rs v. Brown, 520 U.S. 397, 404 (1997)) (quotation
marks omitted); see also Searcy v. City of Dayton, 38 F.3d
282, 286 (6th Cir. 1994). These stringent standards are
“necessary to avoid de facto respondeat superior liability
explicitly prohibited by Monell.” Doe, 103 F.3d at 508.
Applying these standards, we conclude that Graham has failed
to establish the requisite causal link between the County’s
policy and the alleged constitutional violation.
As noted, Graham believes that two particular aspects of
the contract are most problematic. First, she argues that the
contract impermissibly creates a policy of “automatic
deference” by jail personnel to SecureCare medical staff with
respect to decisions concerning prisoners’ medical treatment.
According to Graham, that so-called automatic deference
policy is reflected in a provision stating that SecureCare “will
have the responsibility of determining whether emergency
services and/or hospitalization are necessary.” Additionally,
she relies upon a “Medical Autonomy” standard appearing in
the “SecureCare, Inc. Washtenaw County Sheriff Department
Policies and Procedures Manual,” which reads: “PURPOSE:
To insure that members of the medical, dental and mental
health staff have autonomy relative to professional judgement
in their respective profession.”
Graham also challenges the contract on the ground that it
permits licensed practical nurses, like Nurse Lakatos, to make
10 Graham v. County of Washtenaw No. 02-1614
5The County claim s that Bailey’s affidavit, as well as the affidavits
of two other individuals, were deemed inadmissible by the district court
and, accordingly, should not be considered part of the record on ap peal.
The record contains no written district court order declaring the affidavits
inadmissible, nor do the transcripts reveal a ruling from the bench to that
effect. The only pronouncement by the district court on this subject is a
passing statement during an o ral argument in which the judge stated :
That’s all right. The C ourt is not going to co nsider those
affidavits and I don’t think they’re helpful at any rate at this
stage of events. I’m going to deny this motion without prejudice
for summary judgment and give the plaintiff 60 days to attempt
to rectify the things that have not been done in this case.
However, while that statement indicates the co urt’s unwillingness to
consider the affidavits at that particular time, it does not represent a
definitive ruling as to the admissibility of the affidavits. Thus, it appears
that the affidavits are properly part of the record on app eal.
some medical decisions that are beyond their competence
under Michigan law. This assertion is based primarily upon
an affidavit of a licensed practical nurse named Cynthia
Bailey,5 but no legal authority is cited.
Thus, the crux of Graham’s argument is that the County’s
policy was responsible for the alleged constitutional violation
in this case because “the booking deputies deferred to Nurse
Lakatos” – who was unqualified under Michigan law to make
certain decisions concerning Mr. Graham’s treatment that the
contract permitted her to make – “and retained [Mr. Graham]
in a general population cell without referring him for
emergency medical treatment/evaluation because of the
County’s policy of deference . . . .”
Contrary to Graham’s assertions, we find nothing in the
County’s policy that is actionable under section 1983.
Graham concedes that it is not unconstitutional for
municipalities to hire independent medical professionals to
provide on-site health care to prisoners in their jails. Nor is
it unconstitutional for municipalities and their employees “to
rely on medical judgments made by medical professionals

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No. 02-1614 Graham v. County of Washtenaw 11
6In fact, as this and other recent cases such as Watkins and Weaver
have confirm ed, it is not unusual for individuals to ingest narcotics
surrep titiously in an attempt to hide them from the police, and then to
conceal that illegal ac tivity while in custody – even w hen they become
dangerously ill – out of fear of prosecution. This dangerous practice
prese nts a significant problem for the law enforcement comm unity. It
appears that, in general, more should be done in order to ensure that
arresting officers prevent, to the best of their ability, individuals from
ingesting narco tics in the first place, as well as to ensure that individuals
who show symptoms of a drug overdose while in custody obtain the
med ical care that they so urgently need, despite their po ssible reluctance
to reveal the true nature of their condition.
responsible for prisoner care.” Ronayne v. Ficano, No. 98-
1135, 1998 WL 183479, at *3 (6th Cir. Mar. 15, 1999)
(unpublished opinion). In fact, most would find such a policy
laudable in many respects. Not only does such a policy – like
the one at issue in this case – allow prisoners to receive
prompt health care from on-site doctors or nurses, it also
ensures that an independent party, rather than a corrections
officer, makes the critical decisions about whether and at
what point a prisoner’s medical needs are sufficiently severe
that ambulatory care or hospitalization is warranted.
Graham’s argument is essentially that the County’s policy
did not, in this particular case, adequately address Mr.
Graham’s specific medical needs. That may be so.6
However, “[t]he fact that alternative procedures might have
better addressed [a prisoner’s] particular needs does not show
that the [County was] deliberately indifferent to his medical
needs.” Id. Even if, as Graham contends, the policy required
jail personnel to defer to the medical decisions of SecureCare
employees, and even if it permitted licensed practical nurses
to make medical decisions that Michigan law does not permit
them to make, those alleged defects are insufficient to hold
the County liable for the alleged constitutional violation in
this case. It is possible that Mr. Graham received medical
care that fell below the applicable standard of care under
Michigan law. It is even possible that the medical care that he
received was so woefully inadequate as to rise to the level of
12 Graham v. County of Washtenaw No. 02-1614
a constitutional violation. But even assuming that Graham
did suffer a constitutional violation, that violation “resulted
from factors other than a faulty [County policy].” City of
Canton v. Harris, 489 U.S. 378, 390-91 (1989) (citations
omitted).
There can be no municipal liability where “an otherwise
sound program has occasionally been negligently
administered.” Id. at 391. The fact that individual actors may
“occasionally make mistakes . . . says little about the . . . legal
basis for holding the [County] liable.” Id. Yet that is
precisely the essence of Graham’s claim in this case. The
allegations in her complaint focus primarily upon the
inadequacy of the medical treatment that was provided to Mr.
Graham by SecureCare and its staff. However, “[w]here a
prisoner has received some medical attention and the dispute
is over the adequacy of the treatment, federal courts are
generally reluctant to second guess medical judgments and to
constitutionalize claims that sound in state tort law.”
Westlake v. Lucas, 537 F.2d 857, 860, n.5 (6th Cir. 1976).
Perhaps in recognition of the fact that her complaint is more
properly remediable under state law, Graham has filed a
medical malpractice lawsuit in Michigan state court against
SecureCare and others arising from the same events that
underlie this lawsuit.
In sum, the County instituted its policy regarding the
provision of medical care to prisoners undoubtedly in an
effort to improve the quality of their medical care. Even if
Mr. Graham received constitutionally inadequate medical
care, there is simply no evidence that the policy was the
“moving force” behind that constitutional violation. Waters,
242 F.3d at 362. Under the circumstances presented in this
case, the section 1983 claim against the County was properly
dismissed.

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No. 02-1614 Graham v. County of Washtenaw 13
7Presumably, after the district court denied her motion for leave to
file the amended complaint, Graham could have simply filed a separate
lawsuit alleging the new claims (other than, of course, the section 1983
claim against the Co unty, which was d ismissed with prejudice). It is
unclea r why she chose not to pursue that option.
B. Amended Complaint
Graham also challenges the district court’s denial of her
motion for leave to file a proposed amended complaint, which
purportedly “clarified” her municipal liability claim against
the County and asserted new claims against SecureCare and
Nurse Lakatos, along with Jeannette Figurel (a SecureCare
medical assistant) and corrections officers Dwight Settles and
Jay Klimowicz. Because her original complaint had already
been properly dismissed, however, there was no complaint
pending for Graham to amend. Under these circumstances,
we find that the district court did not abuse its discretion in
refusing to permit an amended complaint to be filed at that
point.7
C. Motion for Reconsideration
Finally, Graham appeals the district court’s denial of her
motion for reconsideration. In its written order denying the
motion, the district court explained that under Eastern District
of Michigan Local Rule 7.1(g)(1)-(3), “[g]enerally, and
without restricting the court’s discretion, the court will not
grant motions for rehearing or reconsideration that merely
present the same issues ruled upon by the court, either
expressly or by reasonable implication. The movant must not
only demonstrate a palpable defect by which the court and the
parties have been misled but also show that correcting the
defect will result in a different disposition of the case.” In the
district court’s view, Graham’s motion for reconsideration
merely raised arguments that were already ruled upon; it
failed to show either a reason justifying relief from the
judgment or a palpable defect by which the court was misled.
14 Graham v. County of Washtenaw No. 02-1614
We agree with the district court’s characterization of the
motion and, thus, find no abuse of discretion.
III. CONCLUSION
For the reasons discussed above, the district court’s
judgment is AFFIRMED.

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