Ralston v. Cantrell

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IN THE UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF ARKANSAS
FAYETTEVILLE DIVISION
JONATHAN WAYNE RALSTON 	PLAINTIFF
v. 	Civil No. 5:24-cv-05076-TLB-CDC
SHERIFF JAY CANTRELL, Washington
County, Arkansas; DR. ROBERT KARAS,
Karas Correctional Health (KCH); DUSTIN
SANDERS, KCH; JOHN OR JANE DOE STAFF
MEMBERS, KCH; JORDAN PREVERAS, KCH;
JACOB SMOTHERS, KCH; and NURSE KELLY
HINELY, KCH 	DEFENDANTS
REPORT AND RECOMMENDATION OF THE MAGISTRATE JUDGE
Plaintiff, Jonathan W. Ralston (“Ralston”), filed this civil rights action under 42 U.S.C. §
1983. 	Ralston proceeds pro se and in forma pauperis (“IFP”). 	Ralston is incarcerated in the
Ouachita River Correctional Unit of the Arkansas Division of Correction. 	The claims at issue in
this case arose while Ralston was incarcerated in the Washington County Detention Center
(“WCDC”). 	While housed at the WCDC, Ralston maintains his constitutional rights were
violated when he fell on two separate occasions due to water leaking from toilets. 	He further
contends he was denied adequate medical care for his injuries.
Pursuant to the provisions of 28 U.S.C. §§ 636(b)(1) and (3), the Honorable Timothy L.
Brooks, United States District Judge, referred this case to the undersigned for the purpose of
making this Report and Recommendation on the Motion to Dismiss filed by Separate Defendants
Karas, Sanders, Preveras, Smothers, Hinely, and John or Jane Doe Staff Members (collectively
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“the Medical Defendants”). (ECF No. 33). Ralston has responded, (ECF No. 46) and the Motion
is ready for decision.
I. 	BACKGROUND
By Order entered on October 4, 2024, Ralston was given permission to substitute Dr.
Robert Karas in place of John Karas. 	(ECF No. 29). 	At that time, Ralston was given explicit
instructions on what an Amended Complaint must contain: 	He was told he must write short, plain
statements telling the Court (1) the constitutional right Plaintiff believes was violated; (2) the name
of the Defendant who violated the right; (3) exactly what the Defendant did or failed to do; (4)
how the action or inaction of that Defendant is connected to the violation of Plaintiff=s
constitutional rights; and (5) what specific injury Plaintiff suffered because of that Defendant=s
conduct. 	Id. 	He was advised he must repeat this process for each person he has named as a
Defendant. 	Id. 	Ralston was also cautioned that he must affirmatively link the conduct of each
named Defendant with the specific injury he suffered, and warned that if he failed to so, allegations
against that Defendant would be dismissed for failure to state a claim. 	Id. 	The Court advised
Ralston that the First Amended Complaint supersedes, or takes the place of, the original
Complaint. 	Id.
Ralston filed his Amended Complaint on October 31, 2024. 	(ECF No. 30). 	In addition
to substituting Robert Karas in place of John Karas, Ralston omitted Karas Correctional Health as
a Defendant, and added Defendants Preveras, Smothers, and Hinely. 	Id.
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Claim One of Plaintiff’s Amended Complaint is against Defendant Cantrell. 	(ECF No.
30, at 6).0F
1 	Ralston alleges that on April 5, 2023, he fell and injured his right hand. 	Ralston
attributes the fall to the toilets leaking water onto the floor. 	Id. 	Prior to his fall, Ralston
maintains he had submitted several requests for the jail to investigate this problem and get it fixed.
Id. 	Ralston asserts he is “put at risk everyday of getting sick or hurt [due] to the over population
or [due] to the toilets leaking water onto the floor.” 	Id. 	Ralston states his hand is still hurting
him as of October 31, 2024, when he filed the Amended Complaint. 	Id. at 7.
Ralston further alleges that on March 6, 2024, he fell again due to toilets leaking in the
pod. 	(ECF No. 30 at 7). 	Ralston complains of over population, having to sleep on the floor on
a 3-inch-thick mat, leaking toilets, mold, the leaking walls, the ventilation system needing
cleaning, not getting outside exercise, and of the sanitary conditions. 	Id. 	Ralston also indicated
that inside the lock-down cells there is no way to get help in an emergency other than kicking the
door which could cause injury to his foot. 	Id. 	Ralston sued Defendant Cantrell in both his
individual and official capacities. 	Id. at 6.
In Claim Two, Ralston alleges a denial of medical care claim against the Medical
Defendants. 	(ECF No. 30 at 8). 	The claim concerns the medical care he received following both
falls. 	Id. at 9. 	Additionally, Ralston asserts he is not receiving proper mental health treatment
for his bi-polar disorder or for Post Traumatic Stress Disorder (PTSD). 	Id. at 10.
1 	The Amended Complaint became the operative pleading. 	See e.g., In re Atlas Van
Lines, Inc., 209 F.3d 1064, 1067 (8th Cir. 2000) (amended complaint ordinarily supersedes original
complaint and renders it without legal effect).
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Ralston alleges Defendant Karas is responsible for the medical neglect of his staff, for not
properly doing his job as a doctor to ensure Ralston is receiving appropriate medical care, for
neglecting his responsibilities to Ralston, and for failing to ensure the proper tests were done on
Ralston. 	(ECF No. 30 at 8). 	Ralston indicates he has asked to be seen by another doctor but was
told no. 	Id.
Next, Ralston alleges the entire medical staff is responsible for his medical care. 	(ECF
No. 30 at 9). 	When he fell and hurt his hand on April 5, 2023, Ralston says it took them days
before they x-rayed it and then he was told it was not broken. 	Id. 	Ralston asked for additional
x-rays and another doctor’s opinion because his hand is still causing him problems. 	Id. 	Ralston
says he has broken his hands before and saw the x-rays on them and knew when his hand was
broken. 	Id. 	Ralston asserts that “[a]ll staff keep putting me off” regarding his hand. 	Id.
On March 6, 2024, Ralston indicates he fell again and hurt the back side of his left hip.
(ECF No. 30 at 9). 	Ralston put in a sick call slip and “when the staff of Karas Correctional Health
(“KCH”) came to see me they said it was a sciatica nerve even though I told them my hip hurt and
it was pop[p]ing ever[y] time I walk.” 	Id. 	Ralston says it took twenty-days to get an x-ray and
then only a front shot of his hip was taken despite his having told “them” that he fell on the backside
of his hip. 	Id. 	As of the writing of the Amended Complaint, Ralston says his hip pops and hurts
when he sleeps, walks, or tries to exercise it. 	Id. 	He indicates “they” gave him exercises to do
but they make his hip hurt worse. 	Id. at 9-10. 	Every time he puts in a medical request “they tell
me its (sic) sent to provider for review or I’m told that I’m on sick call and they would come see
me or just put me off.” 	Id. at 10. 	At times, Ralston says he has “they” have put him on
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medication that does not help his medical problem and when he complains, he is simply taken off
it and no effort made to try something else. 	Id. 	Right now, Ralston says “they have me on pain
killers for my hip” but don’t try to determine what is really going on with his hip. 	Id.
Ralston indicates he has informed them of medication he needs for his bi-polar and PTSD
but “they will not get me the medication I need to be on for this.” 	(ECF No. 30 at 10). 	He asserts
that KCH staff has not shown any indication that they would do anything he has requested of them
or help him medically. 	Id. 	Ralston has sued the Medical Defendants in both their individual and
official capacities. 	Id. at 11.
As relief, Ralston seeks compensatory and punitive damages. 	(ECF No. 30 at 13). 	He
asks that the Defendants be required to pay for his future medical problems caused by his injuries.
Id. 	Ralston asks that Defendants be fired because of their putting his health and safety at risk, for
their neglect, for their inhumane treatment of him, and for their misconduct. 	Id. 	Finally, he asks
for another doctor to look at his hand and hip. 	Id.
II. 	LEGAL STANDARD
To survive a motion to dismiss pursuant to Rule 12(b)(6) for failure to state a claim, “a
complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is
plausible on its face.’” 	Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 570 (2007)); Fed. R. Civ. P. 12(b)(6); see also Fed. R. Civ. P. 8(a)
(requiring a “short and plain statement of the claim showing that the pleader is entitled to relief.”).
A claim is facially plausible “where the plaintiff pleads factual content that allows the court to
draw the reasonable inference that the defendant is liable for the misconduct alleged.” 	Blomker
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v. Jewell, 831 F.3d 1051, 1055 (8th Cir. 2016) (quotation omitted). 	“Threadbare recitals of the
elements of a cause of action, supported by mere conclusory statements, do not suffice.” 	Iqbal,
556 U.S. at 678.
The Court accepts as true all the factual allegations, “even if doubtful.” 	Twombly, 550
U.S. at 555. 	Thus, “a well-pleaded complaint may proceed even if it strikes a savvy judge that
actual proof of those facts is improbable, and ‘that a recovery is very remote and unlikely.’”
Twombly, 550 U.S. at 555 (quoting Scheuer v. Rhodes, 416 U.S. 232, 236 (1974)).
II. 	DISCUSSION
The Medical Defendants have moved to dismiss the claims against them. 	First, they assert
the Amended Complaint did not comply with the Court’s Order. 	Second, they argue the Amended
Complaint fails to allege plausible claims against each of them in their individual capacities as is
required by Rule 12(b)(6) and § 1983. 	Finally, they maintain no plausible official capacity claims
have been stated. 	Understandably, Ralston opposes the Motion arguing the medical staff has
exhibited deliberate indifference to his serious medical needs regarding his hand, hip, and mental
health. 	Ralston’s objections recite many of the facts regarding his injuries on April 5, 2023, and
March 6, 2024.
A. 	Compliance with the Court’s Order
The Court agrees Ralston failed to follow the explicit directions contained in the Order
granting him permission to file the Amended Complaint. 	(ECF No. 29). 	Ralston failed to allege
how each separate Medical Defendant personally violated his federal constitutional rights.
Ralston has also failed to allege a causal link between the actions of each separate Medical
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Defendant with the violation of his constitutional rights. 	However, Ralston’s failure to comply
with the Order does not necessitate dismissal.1F
2 	Rather, the Court must view the Amended
Complaint through the lens of Rule 12(b)(6) to determine the plausibility of his claims.
B. 	Individual Capacity Claims
Because “[l]iability under § 1983 requires a causal link to, and direct responsibility for, the
deprivation of rights,” Madewell v. Roberts, 909 F.3d 1203, 1208 (8th Cir. 1990) (citing Rizzo v.
Goode, 423 U.S. 362, 370-71 (1976)), and each official is “personally liable only for this own
misconduct,” S.M. v. Krigbaum, 808 F.3d 335, 340 (8th Cir. 2015) (citations omitted), the Court
must examine the conduct of each of the Medical Defendants separately to determine whether
plausible denial of medical care claims have been stated against them.
To state a plausible denial of medical care claim against any individual Medical Defendant,
Ralston must allege facts that, if taken as true, support a reasonable inference that (1) he had an
objectively serious medical need, and (2) that each individual Medical Defendant actually knew
of, but deliberately disregarded, that serious medical need.2F
3 	Ivey v. Audrain Cty., 968 F.3d 845,
848 (8th Cir. 2020). “A serious medical need is one that has been diagnosed by a physician as
requiring treatment, or one that is so obvious that even a layperson would easily recognize the
necessity for a doctor’s attention.” 	Coleman v. Rahija, 114 F.3d 778, 784 (8th Cir. 1997) (internal
quotations omitted). 	“To demonstrate that a defendant actually knew of, but deliberately
2 No motion to strike the Amended Complaint was filed.
3 Ralston was in convicted status. 	(ECF No. 30 at 2).
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disregarded, a serious medical need, the plaintiff must establish a mental state akin to criminal
recklessness: 	disregarding a known risk to the [detainee’s] health.” 	Barton v. Taber, 908 F.3d
1119, 1124 (8th Cir. 2018) (internal quotation marks and citations omitted). 	The Eighth Circuit
has stated that this “onerous standard requires a showing more than negligence, more than even
gross negligence, but less that purposefully causing or knowingly bringing about a substantial risk
of serious harm to the inmate.” 	Thompson v. King, 730 F.3d 742, 747 (8th Cir. 2013) (internal
quotations and citations omitted).
In his Amended Complaint, Ralston has failed to set forth factual allegations regarding the
actions of each individual Medical Defendant. 	Instead, he refers to the Medical Defendants only
as a unit using terms like they, them, and the staff. 	The only individual Medical Defendant
Ralston refers to by name in the statement of his claims is Defendant Karas. 	Even then, Ralston
uses broad terminology and alleges Defendant Karas is liable for the conduct of his staff. 	Ralston
mentions no specific conduct on the part of Defendant Karas. 	While it is clear Ralston disagrees
with the course of treatment he received, prisoners “have no right to receive a particular or
requested course of treatment.” 	Barr v. Pearson, 909 F.3d 919, 921 (8th Cir. 2018).
In short, the Court agrees with the Medical Defendants that the Amended Complaint fails
to allege what any individual Medical Defendant did or failed to do that violated Ralston’s
constitutional claims. 	No plausible individual liability claims are stated. 	Further, to the extent
Ralston seeks to hold Defendant Karas liable for the conduct of his staff, vicarious liability is
inapplicable to § 1983 cases. 	Iqbal, 556 U.S. at 677. 	The Medical Defendant are entitled to
dismissal of the individual capacity claims for failure to state plausible claims.
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C. 	Official Capacity Claims
“A suit against a government official in his or her official capacity is another way of
pleading an action against an entity of which the officer is an agent.” 	Baker v. Chisom, 501 F.3d
920, 925 (8th Cir. 2007) (citing Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 690 n.55 (1978)).
The principles set forth in Monell apply to medical care contractors. 	See e.g., Johnson v.
Hamilton, 453 F.3d 967, 973 (8th Cir. 2006). 	An official capacity claim against the Medical
Defendants is one against KCH.
The Medical Defendants argue that because there are no plausible individual liability
claims asserted, there can be no official capacity liability. 	However, the Eighth Circuit “has long
held that a municipality may be held liable for its unconstitutional policy or custom even when no
official has been found personally liable for his conduct under the policy or custom.” 	Webb v.
City of Maplewood, 889 F.3d 483, 486 (8th Cir. 2018). 	With this principle in mind, the Court
turns to an evaluation of whether there are any plausible official capacity claims asserted.
“Section 1983 liability for a constitutional violation may attach to a municipality [or to a
medical care contractor] if the violation resulted from (1) an ‘official municipal [or corporate]
policy,’ (2) an unofficial ‘custom,’ or (3) a deliberately indifferent failure to train or supervise.”
Corwin v. City of Indep., Mo., 829 F.3d 695, 699 (8th Cir. 2016) (citations omitted).
A policy is an official policy, a deliberate choice of a guiding principle or procedure made
by the municipal official who has final authority regarding such matters.” 	Mettler v. Whitledge,
165 F.3d 1197, 1204 (8th Cir. 1999). 	The next method of establishing municipal liability is
through the existence of an unofficial custom.
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[A] plaintiff may establish municipal liability through an unofficial custom of the
municipality by demonstrating (1) the existence of a continuing, widespread,
persistent pattern of unconstitutional misconduct by the governmental entity’s
employees; (2) deliberate indifference to or tacit authorization of such conduct by
the governmental entity’s policymaking officials after notice to the officials of that
misconduct; and (3) that plaintiff was injured by acts pursuant to the governmental
entity’s custom, i.e., that the custom was a moving force behind the constitutional
violation.
Corwin, 829 F.3d at 700 (citation and internal quotation marks omitted).
KCH may be subject to liability for the inadequate training of its employees where: “(1)
[KCH’s] . . . training practices [were] inadequate; (2) [KCH] was deliberately indifferent to the
rights of others in adopting them, such that the failure to train reflects a deliberate or conscious
choice by [KCH]; and (3) an alleged deficiency in the . . . training procedures actually caused the
plaintiff’s injury.” 	Parrish v. Ball, 594 F.3d 993, 997 (8th Cir. 2010) (citation and internal
quotation marks omitted). 	The final theory of liability is failure to supervise. 	Failure to
supervise claims “ultimately require the same analysis” as failure to train claims. 	Liebe v. Norton,
157 F.3d 574, 579 (8th Cir. 1998). 	“[A] failure to supervise claim ‘may be maintained only if a
defendant demonstrated deliberate indifference or tacit authorization of the offensive acts.’” 	Id.
(quoting White v. Holmes, 21 F.3d 277, 280 (8th Cir. 1994) (internal quotation marks omitted)).
Thus, the question is whether “the need for more or different [supervision was] so obvious and the
inadequacy so likely to result in the violation of constitutional rights that [KCH] . . . can reasonably
be said to have been deliberately indifferent.” 	City of Canton, Ohio v. Harris, 489 U.S. 378, 390
(1989).
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In the Amended Complaint where Ralston was asked to describe the custom, policy, or
widespread practice that he believes has violated his federal constitutional rights, Ralston
responded: “In violation of my constitutional rights as a pat[i]ent and right to be properly cared for
medic[al]ly. 	My rights are being violated because of medical neglect.” 	(ECF No. 30 at 11).
These allegations fall short of asserting any basis on which to hold KCH liable. 	Ralston
has pointed to no official policy or identified any continuing, widespread, persistent pattern of
unconstitutional conduct. 	He has not alleged a pattern of similar constitutional violations as is
ordinarily required to establish deliberate indifference for failure to train or supervise. 	The
Medical Defendants are entitled to dismissal of the official capacity liability claims.
III. 	CONCLUSON
For these reasons, it is recommended that the Motion to Dismiss (ECF No. 33) filed by
Separate Defendants Karas, Sanders, Preveras, Smothers, Hinely, and the John or Jane Doe Staff
Members be GRANTED, and each of them terminated as Defendants.
The parties have fourteen days from receipt of the Report and Recommendation in
which to file written objections pursuant to 28 U.S.C. § 636(b)(1). 	The failure to file timely
objections may result in waiver of the right to appeal questions of fact. 	The parties are
reminded that objections must be both timely and specific to trigger de novo review by the
district court.
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Status of Referral: 	The referral terminates upon the filing of this Report and
Recommendation.
RECOMMENDED this 19th day of March 2025.
___________________________________
CHRISTY COMSTOCK
UNITED STATES MAGISTRATE JUDGE
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