Simms v. Board of County Commissioners for Oklahoma County et al

1
UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF OKLAHOMA
KIZZIE SIMS, individually and as
Special Administrator of the Estate of
Gregory Neil Davis,
)
)
)
)
Plaintiff, 	)
v.
)
)
)
Case No. CIV-23-780-R
BOARD OF COUNTY
COMMISSIONERS FOR OKLAHOMA
COUNTY, et al.,
Defendants.
)
)
)
)
)
ORDER
Gregory Neil Davis died from a perforated duodenal ulcer while in pretrial custody
at the Oklahoma County Detention Center. The administrator of Mr. Davis’s estate brought
this action under 42 U.S.C. § 1983 alleging that numerous medical and jail defendants were
deliberately indifferent to Mr. Davis’s serious medical needs in violation of the Fourteenth
Amendment and acted negligently under state law. Defendants have each moved for
summary judgment1 and the motions are fully briefed and at issue [Doc. Nos. 111, 113,
115, 117, 118, 119, 121, 122, 124, 126, 127, 128, 129, 150, 151, 152, 153, 154, 155, 159,
160, 161, 162, 163, 164, 165, 166, 167, 168].2
1 A Clerk’s Entry of Default [Doc. No. 77] pursuant to Fed. R. Civ. P. 55(a) was entered
as to Defendant Morris, a Stipulation of Dismissal [Doc. No. 88] was entered as to
Defendant Gage, and a Stipulation of Dismissal [Doc. No. 142] was entered as to
Defendants Carter, Mulanax, Harvey, Anderson-Depee, and Dean.
2 By separate order, the Court resolved the parties’ Daubert motions and granted Plaintiff’s
Motion for Sanctions as to Defendant Oklahoma County Criminal Justice Authority and
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 1 of 50

2
I. 	Background
A. Factual Background3
Mr. Davis was arrested by the Oklahoma City Police Department for Indecent
Exposure and Public Indecency after he was found walking in the street completely naked.
See Doc. No. 121-11, OCDC Booking Information; Doc. No. 119-13, Probable Cause
Affidavit. He was booked into the Oklahoma County Detention Center on August 3, 2021
at approximately 11:00 pm. Around that time, a Pre-Booking Screening was completed.
See 	Doc. 	No. 	121-13, 	Pre-Booking 	Screening. 	The 	Pre-Booking 	Screening 	form
documented that that Mr. Davis had an elevated heart rate and denied any immediate health
needs or problems. Id.
Jail Administrator in his official capacity. The curative measures described in the order
granting Plaintiff’s request for sanctions are not imputed to any other defendant.
3 Plaintiff’s response to Defendants’ statement of undisputed facts is needlessly prolix and
does not concisely admit or deny the facts as required by LCvR56.1. A particularly
egregious example is Plaintiff’s response to Fact No. 31 in Defendant Turn Key’s
Statement of Uncontroverted Facts. In Fact No. 31, Turn Key straightforwardly asserts that
an autopsy confirmed that Plaintiff died from a perforated duodenal ulcer. Rather than
admit this fact, which is confirmed by the autopsy report and death certificate, Plaintiff
objects that the statement is misleading and lacks context, but then admits the statement in
part. She then launches into a paragraph long explanation that injects additional facts,
argues for inferences to be drawn in her favor, and cites to other factual statements and a
string of exhibits in support. It should go without saying that “opposing almost every
paragraph with a narrative statement” followed by string citations is “not helpful to the
Court.” Neill v. State Farm Fire & Cas. Co., No. CIV-13-627-D, 2016 WL 4384793, at *2
(W.D. Okla. Aug. 16, 2016). The jail defendants have likewise needlessly complicated the
factual 	record 	by 	including 	immaterial 	facts, 	failing 	to 	support 	certain 	facts 	with
evidentiary citations, or providing evidentiary citations that are inaccurate. See, e.g., Doc.
No. 119, Fact 4-5, Fact 11(C).
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 2 of 50

3
The next morning, Misty Williams,4 a Licensed Practical Nurse employed by Turn
Key Health Clinics, attempted to perform an intake medical assessment, also called a
screening, on Mr. Davis. Nurse Williams could not complete the screening because Mr.
Davis was repeatedly chanting “OU, OU, OU,” displaying bizarre behavior, and not
answering questions. There is no genuine dispute that Mr. Davis was displaying obvious
mental health symptoms, the cause of which was unknown, at the time of the attempted
screening.
After multiple failed attempts to complete the screening, Nurse Williams placed Mr.
Davis on the Mental Health Observation floor of the jail, made a referral for him to be seen
by the mental health team, and noted that he needed to receive a full medical screening.
See Doc. No. 121-13, Pre-Booking Screening; Doc. No. 150-5, M. Williams Depo, 64:1-
66:11; Doc. No. 121-14, Turn Key Medical Records; Doc. No. 150-21, Medical Summary;
Doc. No. 121-12, OCDC Inmate Moved Form. Nurse Williams testified that inmates
needing medical screenings are tracked in Turn Key’s electronic medical records system
and that medical staff member was assigned to perform follow-up screenings. Doc. No.
121-3, M. Williams Depo, 39:8-20. On the Mental Health Observation floor, inmates are
supposed to be observed every thirty minutes by detention staff. Doc. No. 121-26,
Anderson Depo., 106:4-7.
Mr. Davis was housed on Mental Health Observation floor of the jail from August
4, 2021 until his death on August 12, 2021. He did not receive any medical assessment or
4 She has since married and changed her last name. To maintain consistency with the
medical records, the Court refers to her as Nurse Williams.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 3 of 50

4
treatment while at the jail. On August 5, 2021, Mr. Davis’s cellmate was moved after
having an altercation with Mr. Davis. Ex. 121-17, SIU Report. Mr. Davis did not have a
cellmate for the remainder of his incarceration.
On August 6, 2021,5 Sanaria Okongor, a Licensed Professional Counselor employed
by Turn Key Health, conducted a mental health assessment on Mr. Davis. Counselor
Okongor’s chart notation indicates that she overheard Mr. Davis chanting “OU, OU, OU”
and observed that he was naked, his speech and thought process was delusional, and he had
overt signs of psychosis. She further noted that he maintained eye contact for extended
periods and engaged upon verbal prompting. Ex. 121-14, Turn Key Health Medical
Records. Three days later, on August 9, 2021, Counselor Okongor conducted a second
assessment. Id. Her chart notation states that Ms. Davis was cooperative, had clear speech,
and maintained eye contact but continued to display signs of psychosis in speech and
thought process. Id. Apart from his mental health issues, she did not observe any immediate
concern for his welfare. Doc. No. 150-6, Okongor Depo, 45:3-46:7; 87:2-5. Also on August
9, 2021, a Turn Key nurse, who has not been identified, submitted a referral stating that
Mr. Davis “needs to be mentally evaluated by MH team.” Ex. 121-14, Turn Key Health
Medical Records. However, the next visit was another assessment, three days later, with a
counselor as part of routine rounds. See Doc. No. 121-5 Oparaku Depo, 69:14-25; Doc.
No. 121-14.
5 Dr. Irvin’s motion asserts that the assessment was initially scheduled for August 5, 2021,
but was rescheduled to August 6, 201 by Dr. Irvin. See Doc. No. 126 at p. 24. Neither party
references specific evidence in support of this factual assertion.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 4 of 50

5
At her deposition, Ms. Okongor testified that it was not uncommon to see inmates
like Mr. Davis and that “[m]ore information would need to be derived” about his history,
diagnosis, and medications. Ms. Okongor stated that she did not follow up with obtaining
that information because there were other people, including a psychiatrist and nurse
practitioner, who were responsible for meeting with everyone on the mental health unit.
Ms. Okongor typically reviews the notes from other providers before meeting with a
patient, including the intake screening. If the intake screening is not in existence, she tries
to figure out why it was not completed, including by asking the intake coordinator. She
further testified that the intake screening is important because it provides information about
the inmate’s history and “what’s going on with them mentally.” If the intake screening is
not completed, “it’s up to [her]” to try to obtain additional information or to learn more
about the inmate.” Doc. No. 150-6, Okongor Depo, 45:3-46:23; 53:11-56:3.
Mr. Davis attempted nearly 900 phone calls from his cell during his detention. None
of the calls were completed because Mr. Davis’s housing classification was improperly
recorded at the jail. However, the improper housing classification would not have
prevented him from using the phone to contact the emergency line.6 Doc. No. 121-17, SIU
Report; Doc. No. 121-39, Whittington Depo. 76:19-77:25.
Another inmate at the jail testified that Mr. Davis started complaining about three
to four days after arriving at the jail, he was screaming in pain, and he was beating on the
6 Although Plaintiff has introduced some deposition testimony suggesting that the phone
system at the jail experienced chronic failures, there is no evidence that Mr. Davis’s phone
could not contact the jail’s emergency services.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 5 of 50

6
door. Doc. No. 150-19, Schlicker Depo, 19:10-20:17, 48:18-49:23. The inmate further
testified that he reported Mr. Davis’s distress to jail staff but they did not check on him and
that Mr. Davis stopped screaming around 4:00 p.m. on August 11, 2021. Id. at 22:8-22,
48:7-17.
On August 12, 2021 at 6:45 a.m., the day of Mr. Davis’s death, Sgt. Ronald
Anderson and Lt. Birdie Morris conducted a sight check on Mr. Davis. Doc. No. 150-12,
Anderson Depo, 32:1-21. They asked for his name and whether he was alright and he
responded by stating his name. Id. Detention Officer Anderson testified that he thought Mr.
Davis “might need medical attention” because he was naked and would not keep his clothes
on. Doc. No. 121-26, Anderson Depo, 128:8-25, 130:3-15-131:25. Officer Anderson, who
was the only officer assigned to the 12th floor on that day, did not tell anyone that he
believed Mr. Davis might need medical attention. Id.; Doc. No. 150-22, SIU Report, p. 2.
The next sight check occurred approximately ninety minutes later, around 8:11 a.m.
Doc. No. 150-17, Kallas Depo, 28:13-29:25, 52:13-53:13. The Detention Services Team,
which included Cpt. Daniel Kallos, was making rounds to change out items for laundering.
Detention Officer Kallos looked through the cell door’s food port and window, knocked a
few times, and asked Mr. Davis if he wanted his blanket washed. Id. The cell was dark and
Mr. Davis was fully covered by his blanket. Mr. Davis did not respond to Officer Kallos’s
question but saw breathing so they moved on to the next cell. Id. He did not open the door
to check on Mr. Davis because they had two floors to do that day. Id.
At 9:03 a.m. that day, a Turn Key mental health provider, escorted by a detention
officer, went to Mr. Davis’s cell as part of their routine rounds. Doc. No. 121-5 Oparaku
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 6 of 50

7
Depo, 69:14-25; Doc. No. 121-14. They found Mr. Davis unresponsive and called for
assistance. Detention officers removed Mr. Davis from his cell and a nurse started CPR.
Doc. No. 121-14, Turn Key Health Medical Records; Doc. No. 22, jail surveillance video.
Mr. Davis was transported by ambulance to the hospital, where he was pronounced dead.
Plaintiff’s medical expert testified that an unperforated duodenal ulcer is not
typically a medical emergency, it can be symptomatic or asymptomatic, and symptoms can
include abdominal discomfort, nausea, and decreased appetite. Doc. No. 150-8, Borislow
Depo, 46:9-47:13, 58:5-21; 65:13-66:8. However, a perforated duodenal ulcer is a medical
emergency and it causes severe pain that even a lay person would recognize as requiring
prompt attention. Id. at 61:25-62:4, 120:14-121:6. Plaintiff’s medical expert further opined
that Mr. Davis likely had symptoms – specifically dehydration or decreased oral intake –
three to eight days prior to his death, and the ulcer most likely perforated two days prior to
his death (i.e. August 10 th ), or somewhere “in that vicinity.” Id. at 46:14-48:9, 56:2-23,
72:7-25. Individuals suffering from psychosis are able to indicate when they are in pain,
however, there is also evidence that Mr. Davis’s ability to communicate about himself was
limited by his mental state. Id. at 58:22-59:25; Doc. No. 150-6, Okongor Depo, 80:7-12.
Plaintiff’s expert on correctional nursing standards and operations was critical of the fact
that no medical professional attempted to complete the intake screening and that, if the
intake screening could not be completed due to Mr. Davis’s mental state, no medical
provider ever evaluated his condition to determine the cause of his psychosis. Doc. No.
150-7, Roscoe Depo, 48:13-51:12.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 7 of 50

8
Turn Key’s written policy required that a receiving screening take place for all
inmates “as soon as possible” upon acceptance into custody. Doc. No. 121-24. The
screening is intended to “ensure that emergent and urgent health needs are met.” Id. The
policy states that if an inmate was “unscreenable” due to mental health or other conditions,
the inmate would be held at intake housing or placed on medical observation until the
screening could be completed. Id. Turn Key’s written policy further provides that inmates
with chronic health conditions may receive an initial health assessment no later than
fourteen days, which is consistent with national correctional care guidelines, and that
complex or acutely ill patients can be referred to a provider prior to the fourteen-day
deadline. Doc. No. 156.
Dr. William Cooper is Turn Key’s Chief Medical Officer and is responsible for
supervising the nursing and mental health staff and writing policies. Doc. No. 121-4,
Cooper Depo, 9:17-23, 90:24-91:7. He conducts annual performance reviews and chart
reviews to ensure that staff are performing their duties and proving “good care.” Id. at 10:5-
20. Dr. Cooper testified that he trains his staff to place inmates on mental health observation
if an inmate is unable to complete the intake screening, but that it is also up to the clinical
judgment of the intake employee as to where the inmate is placed. Doc. No. 150-3, Cooper
Depo, 66:13-67:24; 77:14-20. He conceded that Turn Key staff could not determine the
cause of Mr. Davis’s behavior during the intake process, his behavior could indicate a very
serious condition, he was placed on mental health observation so he could be monitored,
and the risk of a medical or mental health emergency was present. Id. at 77:14-20, 81:3-8.
He also testified that one of the duties of the mental health staff at Turn Key is to look for
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 8 of 50

9
and relay information about the medical and mental health needs of the inmates. Doc. No.
121-4 at 9:17-23, 26:22-25. Dr. Cooper further indicated that Turn Key relies, in part, on
detention officers to timely and accurately relay information about the medical needs of
inmates and that a failure to relay that information can result in serious problems. Doc. No.
150-3 at 27:11-29:17. Prior to this incident, he was aware that the jail experienced staffing
shortages that prevented medical staff from having access to patients and that Turn Key
had threatened to terminate its contract with the jail because of insufficient staffing levels.
Id. at 32:17-33:4, 50:1-21, 54:21-55:5. However, he was told by Turn Key employees that
the staffing problems had been remedied. Id. at 50:17-22, 80:10-18, 102:6-11.
Dr. Alicia Irvin is the Director of Psychological Services for Turn Key. Doc. No.
150-2, Irvin Depo, 10:13-19. She testified that there is communication between the medical
and mental health personnel at Turn Key, that the medical personnel are responsible for the
intake screening process, and that mental health counselors could alert the medical
personnel that a medical screening is needed if they were aware that a screening had not
been completed. Doc. No. 121-6, Irvin Depo, 72:25-72:25. Neither Dr. Cooper nor Dr.
Irvin personally treated or evaluated Mr. Davis.
The Oklahoma County Detention Center is operated by the Oklahoma County
Criminal Justice Authority, a public trust. Oklahoma County, acting through the Board of
County Commissioners, is the sole beneficiary of the trust. Gregory Williams was the Jail
Administrator during the events at issue. Jail policy provides that each inmate should
receive a health care screening upon arrival at the facility, inmates that are unable to
adequately answer questions should be observed until the screening can be completed, and
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 9 of 50

10
inmates that appear to need immediate medical care should not be accepted at the facility.
Doc. No 150-31, OCDC Policy 701. Prior to this incident, the Oklahoma State Department
of Health cited the Oklahoma County Detention Center for certain deficiencies, including
inadequate staffing, missed sight checks, and no staff presence on floors on a regular basis.
Doc. No. 150-30, OSDH Inspection Report, p. 4-7, 16-19. The OSDH report also identified
one instance where an inmate did not receive a medical or mental health screening. Id. at
p. 1-2.7 Detention staff would sometimes falsify the record books that documented sight
checks. Doc. No. 150-4, Williams Depo, 22:9-23, 44:2-12, 138:24-139:3.
Administrator Williams was aware of the staffing shortages, missed sight checks,
and forged record books and acknowledged that those issues create a major concern for
inmate safety. Id.; 150:4-25. He further acknowledged that inmates on the mental health
observation floor are at risk of not being able to communicate their own needs, the facility
relies on the jail staff to monitor them for problems, and failing to properly monitor can
result in missing medical issues. Id. at 70:4-24; 83:19-84:18. He attempted to address the
staffing shortages by offering pay raises and making more efforts to recruit staff, but at
least some detention staff reported that they did not observe any changes in staffing. Doc.
7 Plaintiff contends that “the claim that OSDH found only one screening infraction is false.”
See Doc. No. 145 at ECF p. 23. As evidentiary support for this assertion, she cites to the
single screening infraction noted above. She also appears to rely on an OSDH report from
November 9, 2021 that found deficient screening practices at the jail during an October 22,
2021 visit. See Doc. No. 150-28. Because the November 9, 2021 report post-dates this
incident, it could not have provided notice of the deficiences. See Waller v. City & Cnty. of
Denver, 932 F.3d 1277, 1289 (10th Cir. 2019) (concluding that plaintiff did not state a
plausible municipal liability claim based on findings from a report issued after the
constitutional violation).
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 10 of 50

11
No. 119-22, Williams Depo, 189:4-190:3; Doc. No. 150-16, Lazar Depo, 32:5-12; Doc.
No. 150-11, Stewart Depo, 30:18-34:20; Doc. No. 150-9, Depee Depo, 34:9-35:18.
B. Procedural Background
Plaintiff contends that the failure to provide Mr. Davis with psychiatric and medical
care despite the severity of his psychosis and his ongoing complaints of worsening physical
pain violated his Fourteenth Amendment right to receive adequate medical attention while
incarcerated as a pretrial detainee. She asserts individual capacity claims pursuant to 42
U.S.C. § 1983 for deliberate indifference to serious medical needs against Detention
Officer Kallos, Detention Officer Anderson, Administrator Williams, Nurse Williams,
Counselor Okongor, Dr. Cooper, and Dr. Irvin. She also asserts a claim for municipal
liability pursuant to § 1983 against the Board of County Commissioners, the OCCJA, the
Jail Administrator in his official capacity, and Turn Key, alleging that their deliberately
indifferent policies, customs, training, and/or supervision was the moving force behind the
violation of Mr. Davis’s constitutional rights. Last, she asserts a claim for negligence under
state law against Turn Key, alleging that its medical personnel negligently and recklessly
failed to provide adequate medical care.
All defendants have moved for summary judgment, contending that the undisputed
material facts show that they did not violate Mr. Davis’s constitutional rights. Turn Key
additionally moves for summary judgment on the negligence claim, contending that it is
immune from liability pursuant to the Oklahoma Governmental Tort Claims Act.
To resolve these motions, the Court will first set out the standard on summary
judgment 	and 	the 	law 	governing 	claims 	of 	deliberately 	indifferent 	medical 	care,
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 11 of 50

12
supervisory liability, municipal liability, and qualified immunity. The Court will then
separately address the arguments asserted by the medical defendants and the county
defendants.
II. 	Standard of Decision
Federal Rule of Civil Procedure 56(a) provides that the “court shall grant summary
judgment if the movant shows that there is no genuine dispute as to any material fact and
the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). “An issue is
‘genuine’ if there is sufficient evidence on each side so that a rational trier of fact could
resolve the issue either way.... An issue of fact is ‘material’ if under the substantive law it
is essential to the proper disposition of the claim.” Adler v. Wal-Mart Stores, Inc., 144 F.3d
664, 670 (10th Cir. 1998) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248
(1986)). “The movant bears the initial burden of making a prima facie demonstration of
the absence of a genuine issue of material fact and entitlement to judgment as a matter of
law.” Id. at 670–71 (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)). “If the
movant carries this initial burden, the nonmovant that would bear the burden of persuasion
at trial may not simply rest upon its pleadings; the burden shifts to the nonmovant to go
beyond the pleadings and ‘set forth specific facts’ that would be admissible in evidence in
the event of trial from which a rational trier of fact could find for the nonmovant.” Id. at
671 (citing Fed. R. Civ. P. 56(e)).
Importantly, at this stage, the court’s role is not “to weigh the evidence and
determine the truth of the matter,” but to determine “whether the evidence presents a
sufficient disagreement to require submission to a jury or whether it is so one-sided that
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 12 of 50

13
one party must prevail as a matter of law.” Anderson, 477 U.S. at 249–52. “The evidence
of the non-movant is to be believed, and all justifiable inferences are to be drawn in his
favor.” Id. at 255.
III. 	Legal Framework
A. Deliberate Indifference to Serious Medical Needs
To recover under § 1983, a plaintiff must establish that a person acting under color
of state law “violated his constitutional or statutory rights.” Dodds v. Richardson, 614 F.3d
1185, 1194 (10th Cir. 2010). Plaintiff claims that Defendants violated Mr. Davis’s
constitutional rights by acting with deliberate indifference to his serious medical needs.
“[A] prison official’s deliberate indifference to a convicted prisoner’s serious medical
needs constitutes cruel and unusual punishment in violation of the Eighth Amendment.”
Prince v. Sheriff of Carter Cnty., 28 F.4th 1033, 1043 (10th Cir. 2022). A pretrial detainee,
such as Mr. Davis, is “entitled to the same standard of medical care under the Due Process
Clause of the Fourteenth Amendment.” Id.
The deliberate indifference standard “contains both an objective and subjective
component.” Lucas v. Turn Key Health Clinics, LLC, 58 F.4 th 1127, 1136 (10th Cir. 2023).
“The objective component examines whether the medical condition or harm claimed by
the inmate was ‘sufficiently serious[.]’” Prince, 28 F.4 th at 1044 (quoting Martinez v.
Beggs, 563 F.3d 1082, 1088 (10th Cir. 2009)). “[A] medical need is considered sufficiently
serious if the condition has been diagnosed by a physician as mandating treatment or is so
obvious that even a lay person would easily recognize the necessity for a doctor’s
attention.” Oxendine v. Kaplan, 241 F.3d 1272, 1276 (10 th Cir. 2001) (internal quotation
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 13 of 50

14
marks and ellipses omitted). “Deliberate indifference toward an inmate’s risk of death
certainly satisfies this standard[,]” although “a life-threatening condition” is not required.
Prince, 28 F.4 th at 1044-45 (quotation marks omitted). Further, “[w]here a prisoner claims
that harm was caused by a delay in medical treatment, he must show that the delay resulted
in 	substantial 	harm[,]” 	which 	may 	include 	“lifelong 	handicap, 	permanent 	loss, 	or
considerable pain.” Al-Turki v. Robinson, 762 F.3d 1188, 1193 (10th Cir. 2014) (internal
quotation marks omitted).
The subjective component of deliberate indifference standard is satisfied if
the official knows of and disregards an excessive risk to inmate health or
safety. The official must be aware of the facts from which the inference of a
substantial risk of serious harm could be drawn and also draw that inference.
A plaintiff need not show that a prison official acted or failed to act believing
that harm actually would befall an inmate, but rather that the official merely
refused to verify underlying facts that he strongly suspected to be true, or
declined to confirm inferences of risk that he strongly suspected to exist.
Whether a prison official had the requisite knowledge of a substantial risk is
a question of fact subject to demonstration in the usual ways, including
inference from circumstantial evidence such as whether the risk was obvious.
An official disregards risk when he fails to take reasonable measures to abate
the risk.
Lucas, 58 F.4th at 1137 (quotation marks and citations omitted).
Medical professionals operating in a prison may also be liable for deliberately
indifferent conduct, which can include the failure to treat a serious medical condition
properly or a failure to fulfill their role as a gatekeeper for other medical personnel. Sealock
v. Colorado, 218 F.3d 1205, 1211 (10th Cir. 2000). However, the “negligent failure to
provide adequate medical care, even one constituting medical malpractice, does not give
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 14 of 50

15
rise to a constitutional violation.” Self v. Crum, 439 F.3d 1227, 1233 (10 th Cir. 2006)
(internal quotation marks omitted).
B. Individual and Supervisory Liability Under § 1983
“A § 1983 defendant sued in an individual capacity may be subject to personal
liability and/or supervisory liability.” Brown v. Montoya, 662 F.3d 1152, 1163 (10 th Cir.
2011). “Supervisory liability” generally encompasses claims against defendant-supervisors
based on their deficient promulgation/implementation of a policy or supervision of
subordinates. Supervisory liability should not, however, “be misunderstood as implying
vicarious liability” for the actions of subordinates. Schneider v. City of Grand Junction
Police Dep't, 717 F.3d 760, 767 (10th Cir. 2013). “Instead, just as with any individual
§ 1983 defendant,” a plaintiff seeking to impose liability on a supervisor “must establish a
deliberate, intentional act by the supervisor to violate constitutional rights.” Jenkins v.
Wood, 81 F.3d 988, 994–95 (10th Cir. 1996) (quotation omitted). “[I]t is not enough for a
plaintiff merely to show a defendant was in charge of other state actors who actually
committed the violation[,]” id., nor is it sufficient to show a “supervisor’s mere knowledge
of his subordinate’s conduct.” Schneider, 717 F.3d at 767 (quotation omitted).
Rather, to hold a defendant liable under § 1983 based on his supervisory
responsibilities, a plaintiff must establish three elements: personal involvement, causation,
and state of mind. Burke v. Regalado, 935 F.3d 960, 997 (10th Cir. 2019). A supervisor’s
personal involvement may be shown “by establishing the supervisor promulgated, created,
implemented, or possessed responsibility for the continued operation of a policy, or the
establishment or utilization of an unconstitutional policy or custom, provided the policy or
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 15 of 50

16
custom resulted in a violation of the plaintiff’s constitutional rights.” Id. (internal quotation
marks, brackets, and citations omitted).
“The second element requires the plaintiff to show that the defendant’s alleged
action(s) caused the constitutional violation by setting in motion a series of events that the
defendant knew or reasonably should have known would cause others to deprive the
plaintiff of her constitutional rights.” Id. (quoting Est. of Booker v. Gomez, 745 F.3d 405,
435 (10th Cir. 2014)). The final element requires the plaintiff to show that the supervisor
acted with a culpable state of mind, which in this case is deliberate indifference. Id. at 997.
In this context, deliberate indifference requires “proof that a municipal actor disregarded a
known or obvious consequence of his action.” Id. (quoting Bd. of Cty. Comm'rs v. Brown,
520 U.S. 397, 410 (1997).
C. Municipal Liability
To succeed on a claim under § 1983 against local government entity,8 the plaintiff
must, in addition to establishing an underlying constitutional violation, prove that (1) a
government’s official policy or custom (2) caused a constitutional injury and (3) the policy
was enacted or maintained with the requisite state of mind. Schneider, 717 F.3d at 769. An
official policy or custom may take one of the following forms:
(1) a formal regulation or policy statement; (2) an informal custom
amounting to a widespread practice that, although not authorized by
written law or express municipal policy, is so permanent and well settled
as to constitute a custom or usage with the force of law; (3) the decisions
of employees with final policymaking authority; (4) the ratification by
such final policymakers of the decisions – and the basis for them – of
8 Municipal liability “has been extended to private entities acting under color of state law,
such as medical contractors.” Lucas v, 58 F.4th at 1144 (quotation omitted).
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 16 of 50

17
subordinates 	to 	whom 	authority 	was 	delegated 	subject 	to 	these
policymakers’ review and approval; or (5) the failure to adequately train
or supervise employees, so long as that failure results from deliberate
indifference to the injuries that may be caused.
Bryson v. City of Oklahoma City, 627 F.3d 784, 788 (10th Cir. 2010) (quotation and
alteration marks omitted).
“To establish the causation element, the challenged policy or practice must be
closely related to the violation of the plaintiff’s federally protected right.” Schneider, 717
F.3d at 770 (quotation omitted). Put another way, “[t]he policy or custom must be ‘the
moving force behind the injury alleged.’” Buchanan v. Turn Key Health Clinics, LLC, No.
22-7029, 2023 WL 6997404, at *8 (10 th Cir. Oct. 24, 2023) (quoting Schneider, 717 F.3d
at 770) (unpublished).
Last, the requisite state of mind is deliberate indifference. “In the municipal liability
context, deliberate indifference is an objective standard.” Barney v. Pulsipher, 143 F.3d
1299, 1307 n. 5 (10th Cir. 1998). The standard “may be satisfied when the municipality
has actual or constructive notice that its action or failure to act is substantially certain to
result in a constitutional violation, and it consciously or deliberately chooses to disregard
the risk of harm.” Id. at 1307. Typically, notice is “established by proving the existence of
a pattern of tortious conduct.” Id. However, deliberate indifference may also “be found
absent a pattern of unconstitutional behavior if a violation of federal rights is a highly
predictable or plainly obvious consequence of a municipality’s action or inaction.” Id.
(quotation marks and citation omitted).
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 17 of 50

18
Additionally, and pertinent to the claims in this case, “municipal liability may exist
without individual liability” where there has been a “systemic failure” of policies and
procedures that causes a “systemic violation carried out by multiple actors.” Lucas, 58
F.4th at 1144. Such claims are unusual and “ordinarily there will be a municipal violation
only 	where 	an 	individual 	officer 	commits 	a 	constitutional 	violation.” 	Crowson 	v.
Washington Cnty., 983 F.3d 1166, 1191 (10th Cir. 2020). But “[w]here the sum of multiple
officers’ actions taken pursuant to municipal policy results in a constitutional violation, the
municipality may be directly liable.” Id.
D. Qualified Immunity
“The doctrine of qualified immunity protects government officials from liability for
civil damages insofar as their conduct does not violate clearly established statutory or
constitutional rights of which a reasonable person would have known.” Pearson v.
Callahan, 555 U.S. 223, 231 (2009) (internal quotation marks omitted). “A defendant's
motion for summary judgment based on qualified immunity imposes on the plaintiff “the
burden of showing both (1) a violation of a constitutional right; and (2) that the
constitutional right was clearly established at the time of the violation.” Burke, 935 F.3d at
1002 (internal quotation marks omitted). “The plaintiff must satisfy both prongs to
overcome a qualified immunity defense.” Est. of Taylor v. Salt Lake City, 16 F. 4th 744,
757–58 (10th Cir. 2021) (internal quotation marks omitted).
“For the law to be clearly established, there must be a Supreme Court or Tenth
Circuit decision on point, or the clearly established weight of authority from other courts
must have found the law to be as the plaintiff maintains.” Crowson, 983 F.3d at 1178 (10th
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 18 of 50

19
Cir. 2020) (internal quotation marks and brackets omitted). This inquiry requires careful
attention to the specific facts of the case:
The Supreme Court has warned against defining a clearly established right at
a high level of generality. Instead, the clearly established law must be
particularized to the facts of the case. This is not to say that there must be a
case directly on point for a right to be clearly established. But the existing
precedent must have placed the statutory or constitutional question beyond
debate. A clearly established right is one that is sufficiently clear that every
reasonable official would have understood that what he is doing violates that
right.
Est. of Ceballos v. Husk, 919 F.3d 1204, 1214-15 (10th Cir. 2019) (internal quotation marks
and citations omitted).
IV. 	Discussion
A. Medical Defendants
1. 	Objectively Serious Harm
Turn Key and the individual medical Defendants argue that they are entitled to
summary judgment because Mr. Davis’s death from a perforated ulcer does not satisfy the
objective component of the deliberate indifferent standard. Turn Key interprets Plaintiff’s
claim, and the controlling law, far too narrowly. In a deliberate indifference case, “the
prisoner selects the harm” and, once they have done so, the sole focus of the objective
component is “whether that harm is sufficiently serious.” Mata v. Saiz, 427 F.3d 745, 753
(10 th Cir. 2005).
Here, Plaintiff has selected two possible harms that she argues are sufficiently
serious to satisfy the objective component: (1) failing to medically screen, treat, or refer
Mr. Davis for additional evaluation despite his acute psychosis and (2) Mr. Davis’s severe
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 19 of 50

20
abdominal pain and deteriorating physical condition. See Am. Pet. [Doc. No. 1-7] ¶¶ 333-
336 (asserting that the “total failure” to provide “psychiatric and medical care given the
clear severity of his psychosis and ongoing complaints of worsening several abdominal
pain” violated Mr. Davis’s constitutional rights). See also Pl.’s Br. [Doc. No. 145] at p 24-
25 (arguing that the perforated ulcer and “pronounced behavioral and psychological”
symptoms satisfy the objective prong); Pl.’s Br. [Doc. No 148] at p. 27 (arguing that Mr.
Davis’s presentation as an “acutely psychotic, unscreenable detainee whose condition was
‘unknown’” and his “days of audible, excruciating pain culminating in collapse” satisfy the
objective component); Pl.’s Br. [Doc. No. 149] at p. 24 (arguing that Mr. Davis’s ongoing
psychosis without any medical evaluation satisfies the objective standard); Pl.’s Br. [Doc.
No. 147] at p. 28 (arguing that Mr. Davis’s excruciating pain and death from a perforated
ulcer satisfy the objective component); Pl.’s Br. [Doc. No. 154] at p. 26-28 (arguing that
the objective component is satisfied “twice over: first, with his acute, florid psychosis upon
arrival, and second, with the agonizing symptoms of a fatal perforated ulcer that developed
while in custody”). Having selected the harm, the analysis turns to whether there are facts
from which a reasonable juror could conclude that the harm was sufficiently serious to
satisfy the objective component
As to the first harm, the undisputed material facts establish that, throughout his
detention, Mr. Davis was experiencing a serious mental health problem that was so obvious
even a lay person would easily recognize the need for further medical attention. Indeed, at
least some detention staff recognized exactly that. See Doc. No. 121-26, Depo. of
Anderson, 128:8-25, 131:8-25 (testifying that he thought Mr. Davis “might need medical
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 20 of 50

21
attention” because he was naked and would not keep his clothes on). Further, the Tenth
Circuit has found a triable issue of fact sufficient to preclude summary judgment on the
objective component of the deliberate indifference standard where a pretrial detainee
presented with mental health symptoms that were far less serious than the obvious
psychosis Mr. Davis was experiencing. See Olsen v. Layton Hills Mall, 312 F.3d 1304,
1316 (10 th Cir. 2002) (finding that a jury could conclude that pretrial detainee’s “OCD-
induced panic attack during the ride to jail was ‘sufficiently serious’”); see also Foelker v.
Outagamie Cnty., 394 F.3d 510, 513 (7th Cir. 2005) (finding that prisoner experiencing
hallucinations and defecating on himself presented evidence of a serious medical need even
though he was not in “pain or extreme distress”) (cited with approval in Prince, 28 F.4th at
1045).
Turn Key and the medical defendants do not genuinely dispute that Mr. Davis was
experiencing a serious mental health issue but nevertheless argue that the objective
component is not satisfied because there is no connection between Mr. Davis’s psychosis
and his ultimate cause of death from a perforated ulcer. But Plaintiff’s claimed harm is not
limited solely to Mr. Davis’s death. Rather, Plaintiff argues that the failure to secure timely
access to medical care, despite Mr. Davis’s obvious psychosis, resulted in substantial harm.
As explained by the Tenth Circuit,
[w]hen the prisoner’s Eighth Amendment claim is premised on an alleged
delay in medical care, the prisoner must show that the delay resulted in
substantial harm. That substantial harm can be the ultimate physical injury
caused by the prisoner’s illness, so long as the prisoner can show that the
more timely receipt of medical treatment would have minimized or prevented
the harm. The substantial harm can also be an intermediate injury, such as
the pain experienced while waiting for treatment and analgesics. Although
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 21 of 50

22
not every twinge of pain suffered as a result of delay in medical care is
actionable, when the pain experienced during the delay is substantial, the
prisoner sufficiently establishes the objective element of the deliberate
indifference test.
Kikumura v. Osagie, 461 F.3d 1269, 1292 (10th Cir. 2006) (internal quotation marks and
citations omitted) (overruled on other grounds).
Plaintiff has submitted sufficient evidence to create a triable issue of fact as to
whether Mr. Davis suffered a substantial intermediate harm from the delay in providing
medical care. The evidence, construed in Plaintiff’s favor, indicates that Mr. Davis was in
a state of obvious psychosis, the etiology of which was unknown, throughout his detention.
Expert medical testimony indicates that he was severely dehydrated for several days prior
to his death and more likely than not had symptoms of abdominal pain and nausea in the
days preceding the perforation of his ulcer. Although the parties agree that psychotic
individuals are able to express pain, there is evidence that Mr. Davis’s mental state limited
his ability to report his other medical symptoms. This evidence is sufficient to survive
summary judgment. A reasonable juror, viewing the evidence in Plaintiff’s favor, could
conclude that Mr. Davis suffered a substantial intermediate harm, in the form of prolonged
pain and suffering, that was caused by Defendants delay in medically screening or treating
his psychosis. See Prince, 28 F.4 th at 1044 (finding that inmate’s psychosis, fecal
incontinence, and catatonia were sufficiently serious harms, even if it was not obvious that
they would lead to his death); Sealock, 218 F.3d at 1210 n.5 (10th Cir. 2000) (rejecting
“causation-based argument” that Defendant did not cause inmate’s heart attack because
there was “factual evidence from which a jury could conclude that the delay occasioned by
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 22 of 50

23
his inaction unnecessarily prolonged appellant’s pain and suffering”); Encinias v. New
Mexico Corr. Dep't, 659 F. Supp. 3d 1227, 1240 (D.N.M. 2023) (finding that prisoner’s
“mental health diagnosis and attendant suffering (e.g., hallucinations, self-harm, anxiety,
depression) were also sufficiently serious because they were diagnosable (and diagnosed)
medical conditions requiring treatment and likely recognizable by even a lay person”);
Dominguez v. Colfax Cnty., No. CV 14-875 MV/KRS, 2018 WL 3621018, at *11 (D.N.M.
July 30, 2018) (concluding that pretrial detainee, who was disruptive during the booking
process and repeatedly found nude in his cell, suffered substantial harm from four-day
delay in psychiatric treatment that “prolonged his mental disturbance and attendant
suffering”).
Plaintiff’s second claimed harm is that Mr. Davis’s perforated ulcer caused severe
pain and ultimately death. In support, Plaintiff points to testimony from another inmate that
Mr. Davis was screaming in pain for several days and expert testimony testified that the
pain from a perforated ulcer would be severe and obvious. Evidence of “several hours of
untreated severe pain” is “sufficient to satisfy the objective prong of the deliberate
indifference test.” Al-Turki, 762 F.3d at 1194; see also Rife v. Oklahoma Dep't of Pub.
Safety, 854 F.3d 637, 653–54 (10 th Cir. 2017) (rejecting defendant’s argument that delay
in medical care did not cause substantial harm because there was evidence that that inmate
experienced “substantial pain while he waited for medical attention”). Moreover, the
failure to timely treat the perforated ulcer is causally connected to Mr. Davis’s death, a
harm which is obviously “sufficiently serious for purposes of the objective component of
deliberate indifference.” Prince, 28 F.4th at 1045.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 23 of 50

24
Thus, viewing the evidence in Plaintiff’s favor, Defendants have not established that
they are entitled to judgment as a matter of law as to the objective component of the
deliberate indifference standard.
2. 	Nurse Williams
Plaintiff’s claim against Nurse Williams is premised on her alleged failure to refer
Mr. Davis for psychiatric care, failure to complete a medical intake assessment, and/or
failure to refer him to a medical professional for an evaluation. See Am. Pet. [Doc. No. 1-
7] ¶¶ 394-398. Nurse Williams contends that she is entitled to summary judgment because
Plaintiff lacks sufficient evidence to establish either the objective or the subjective
component of the deliberate indifference standard.
As explained above, Nurse Williams’ argument as to the objective component is not
well-taken. However, as to the subjective component, Nurse Williams’s argument fairs
better. In considering this element, it is worth emphasizing that the subjective component
“presents a high evidentiary hurdle” and requires showing that the defendant knew about
and disregarded “a substantial risk of serious harm.” Self, 439 F.3d at 1232. “Arguments
that more could have been done, that one or more personnel were negligent, or that medical
malpractice allegedly occurred do not by themselves rise to the level of the deliberate
indifference standard required for a violation of the Constitution.” Johnson v. Davis Cnty.,
No. 1:18-CV-00080-DBB, 2021 WL 615325, at *9 (D. Utah Feb. 17, 2021), aff'd, No. 21-
4030, 2022 WL 830202 (10 th Cir. Mar. 21, 2022).
Here, the facts concerning Nurse Williams’ knowledge of Mr. Davis’s condition
and her response to those conditions are not genuinely in dispute. Nurse Williams was the
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 24 of 50

25
intake nurse at the jail the morning after Mr. Davis was booked. She made multiple
attempts to complete a medical intake screening with Mr. Davis and noted his bizarre and
uncooperative behavior. She referred him for an urgent mental health evaluation and noted
that he still needed to have a full medical intake assessment. Following the failed attempts
to complete the intake screening, Mr. Davis was placed on the mental health observation
floor, where he was supposed to be monitored by jail staff every thirty minutes.
These undisputed facts do not permit the inference that Nurse Williams acted with
deliberate indifference to Mr. Davis’s serious medical needs, either with respect to his
psychosis or his subsequent abdominal pain and eventual death. In response to Mr. Davis’s
obvious mental health needs and inability to complete the medical screening, Nurse
Williams’s exercised her clinical judgment to place Mr. Davis on the mental health
observation floor, issued an urgent referral for a mental health evaluation, and noted that
Mr. Davis was still in need of a full medical screening. She testified that inmates in need
of follow up screenings were tracked by the electronic medical records system and assigned
to a nurse for completion. These actions do not reflect a conscious disregard of Mr. Davis’s
mental health needs or a failure to fulfill her gatekeeping role to refer Mr. Davis’s serious
mental health symptoms for further evaluation by an appropriate provider. See Est. of
Beauford v. Mesa Cnty., Colorado, 35 F.4th 1248, 1272 (10 th Cir. 2022) (finding that the
mental health supervisor’s “decision about [inmate’s] housing placement was an exercise
of professional medical judgment and thus does not satisfy the subjective component of
the deliberate indifference test”); Crowson, 983 F.3d at 1180 (nurse that referred inmate to
a physician’s assistant for a psychological examination, rather than a physiological one,
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 25 of 50

26
based on belief he was suffering from psychological issues did not act with deliberate
indifference). Further, apart from Mr. Davis’s mental health symptoms, there is no
evidence indicating that Nurse Williams was subjectively aware that Mr. Davis was
experiencing pain or had any other medical needs that presented a serious risk to his health.
In addition to her constitutional claim, Plaintiff asserts that Nurse Williams acted
negligently under state law. On this claim, Nurse Williams asserts that she is immune from
liability pursuant to the Oklahoma Governmental Tort Claims Act, Okla. Stat. tit. § 152.1,
which provides that state employees are generally immune for torts committed with the
scope of their employment. This immunity extends to “licensed medical professionals” that
“are under contract, including when under contract as an independent contractor, with city,
county, or state entities and providing medical care to inmates or detainees in the custody
or control of law enforcement agencies.” Sanders v. Turn Key Health Clinics, 566 P.3d
591, 610 (Okla. 2025); see also Neal v. Oklahoma Cnty. Crim. Just. Auth., No. CIV-24-
00575-JD, 2025 WL 928825, at *1 (W.D. Okla. Mar. 27, 2025) (finding that the holding
of Sanders applies to Turn Key and it is entitled to immunity under the OGTCA).
Here, Plaintiff argues that there are fact questions as to whether Nurse Williams was
acting within the scope of her employment that preclude summary judgment.9 “Scope of
employment” is defined by the OGTCA as “performance by an employee acting in good
faith within the duties of the employee’s office or employment.” Okla. Stat. tit. 51, §
9 Plaintiff also argues, repeatedly, that the immunities available under the OGTCA do not
supply a defense to a claim asserted pursuant to § 1983. This argument is totally misplaced
as the medical defendants never suggested that their state law immunity should apply to
anything other than Plaintiff’s state law claims.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 26 of 50

27
152(13). Thus, “[a]n act of the employee is not in the scope of employment if the employee
acted maliciously or in bad faith.” Pellegrino v. State ex rel. Cameron Univ., 63 P.3d 535,
537 (Okla. 2003). Although Plaintiff contends that Nurse Williams could have and should
have done more for Mr. Davis, the record is devoid of any evidence from which a
reasonable juror could conclude that Nurse Williams acted maliciously or in bad faith. She
is therefore immune under the OGCTA with respect to the negligence claim.
Nurse Williams’ is therefore entitled to summary judgment in her favor.
3. 	Counselor Okongor
Plaintiff’s claim against Counselor Okongor is premised on her failure to refer Mr.
Davis for psychiatric care or “outside hospital care” despite her knowledge that he was
suffering from ongoing psychosis and had not been medically screened. See Am. Pet. [Doc.
No. 1-7] ¶¶ 387-388. Counselor Okongor argues that summary judgment is warranted
because Mr. Davis’s psychosis did not prevent him from communicating that he was in
severe pain and there is no evidence that she was aware of and disregarded symptoms of
physical distress. However, construing the 	evidence in Plaintiff’s favor, the Court
concludes that there are factual disputes as to whether Counselor Okongor fulfilled her
gatekeeping role and whether that failure caused substantial harm.
“A prison medical professional who serves ‘solely ... as a gatekeeper for other
medical personnel capable of treating the condition’ may be held liable under the deliberate
indifference standard if she ‘delays or refuses to fulfill that gatekeeper role.’” Mata, 427
F.3d at 751 (quoting Sealock, 218 F.3d at 1211). The critical inquiry “is not whether the
prison official provided some care but rather whether they fulfilled their sole obligation to
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 27 of 50

28
refer or otherwise afford access to medical personnel capable of evaluating a patient’s
treatment needs when such an obligation arises.” Lucas, 58 F.4 th at 1139. Because “the
subjective component is not satisfied, absent an extraordinary degree of neglect, where a
doctor merely exercises his considered medical judgment[,]” a claim is “actionable only in
cases where the need for additional treatment or referral to a medical specialist is obvious.”
Self, 439 F.3d at 1232. Importantly, to establish the subjective component, a plaintiff does
“not need to show [the clinician] was consciously aware that [the plaintiff] suffered from
a specific ailment, but ‘rather that he was aware [that the plaintiff] face a substantial risk
of harm to his health and safety.’” Buchanan, 2023 WL 6997404, at *6 (unpublished)
(quoting Lucas, 8 F.4 th at 1141).
Here, Ms. Okongor’s chart notes and deposition indicate that she was aware that
Mr. Davis was in a prolonged state of psychosis and his ability to communicate his own
needs was limited by his mental state. Although she testified that she did not observe any
immediate concern for his welfare, the evidence, viewed in Plaintiff’s favor, permits the
inference that she was aware Mr. Davis had not been medically screened, did not have a
diagnosis for his mental health status, and had not been evaluated by a medical practitioner
capable of diagnosing or treating his condition. Despite being aware of his ongoing
psychosis and the absence of any diagnosis or treatment, she made no effort to refer him
for further evaluation. Further, although Ms. Okongor may have assumed someone else
would provide the evaluation, a reasonable juror could conclude that, at least by the time
she completed her second evaluation, which was several days into his incarceration, such
an assumption was not reasonable.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 28 of 50

29
Under the deliberate indifference standard, a plaintiff “need not show that a prison
official acted or failed to act believing that harm actually would befall an inmate; it is
enough that the official acted or failed to act despite his knowledge of a substantial risk of
serious harm.” Farmer v. Brennan, 511 U.S. 825, 842 (1994). Although Counselor
Okongor may not have expressly intended harm, there is sufficient evidence to suggest that
Mr. Davis’s need for psychiatric or medical treatment was obvious and she failed to fulfill
her gatekeeper role by not referring him to medical personnel capable of providing
evaluation or treatment. Additionally, as previously explained, there is sufficient evidence
to create a triable issue as to whether the delay in treating Mr. Davis’s psychiatric needs
resulted in substantial harm by causing pain and suffering from his prolonged psychosis
and the emergent symptoms of his ulcer. See Blackmon, 734 F.3d at 1244 (denying
summary judgment to mental health counselor on qualified-immunity grounds because
there were facts suggesting he failed to fulfill his gatekeeper role by delaying or denying
“access to mental health care by qualified professionals” despite prisoner’s “grave mental
health problems”).
Apart from the constitutional claim, Counselor Okongor argues that she is entitled
to summary judgment on the negligence claim because, like Nurse Williams, she is immune
under the Oklahoma Governmental Tort Claims Act. Plaintiff counters that the immunity
for state employees acting within the scope of their employment extends to “licensed
medical professionals,” which does not include a licensed professional counselor like Ms.
Okongor.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 29 of 50

30
In Barrios v. Haskell Cnty. Pub. Facilities Auth., 432 P.3d 233, 236 n.5 (Okla.
2018), the Oklahoma Supreme Court stated that “[g]enerally speaking, the staff of a
healthcare contractor at a jail are employees who are entitled to tort immunity under the
GTCA by virtue of sections 152(7)(b), 153(A), and 155(25).” Subsequently, in Sanders,
566 P.3d at 608-09, which involved a claim against Turn Key based on its failure “to
provide access to medical and mental health personnel”, the Oklahoma Supreme Court
affirmed the trial court’s finding that Turn Key was immune from liability under the
OGTCA. More specifically, the Sanders court concluded that the immunity for “licensed
medical 	professionals” 	under 	contract 	with 	the 	city, 	county, 	or 	state 	codified 	in
§152(7)(b)(7) includes those who are under contract as an independent contractor.
Here, Turn Key contracted to provide medical and psychiatric services at the
Oklahoma County Detention Center. To fulfill that contractual obligation, Turn Key relied,
in part, on licensed professional counselors like Counselor Okongor. Given that “the staff
of a healthcare contractor at a jail” are “employees who are entitled to tort immunity under
the GTCA,” and Counselor Okongor was working as a licensed mental health staff member
for a healthcare contractor at a jail, the Court concludes that she falls within the scope of
§152(7)(b)(7) and is entitled to immunity as to the state law claims. Additionally, to the
extent Plaintiff argues that she was acting outside the scope of her employment, the Court
is not persuaded that the evidence would support a finding that she acted maliciously or in
bad faith.
Accordingly, Ms. Okongor is not entitled to summary judgment as to the § 1983
claim but is immune as to the negligence claim.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 30 of 50

31
4. 	Dr. Irvin
Plaintiff’s claim against Dr. Irvin is premised on her allegedly deficient supervision
of the mental health staff at the jail and her personal failure to refer Mr. Davis for a proper
evaluation. Am. Pet. ¶ 364. Dr. Irvin argues that summary judgment is warranted because
she did not personally evaluate Mr. Davis and there is insufficient evidence to show that
she was deliberately indifferent in performing her supervisory responsibilities.
Plaintiff has failed to meet her burden of coming forward with sufficient evidence
from which a reasonable juror could conclude that Dr. Irvin took actions in a deliberately
indifferent manner that caused a violation of Mr. Davis’s constitutional rights. Her direct
involvement with his care was limited to moving his initial mental health appointment by
one day. Plaintiff has not argued or identified evidence showing that delaying Mr. Davis’s
initial mental health evaluation by one day caused substantial harm. Further, even assuming
Dr. Irvin was aware at the time she moved the appointment that Mr. Davis was having a
mental health issue and had not yet been medically screened, there is no evidence indicating
that she had reason to believe the medical screening would not be performed by the medical
staff or that the mental health counselors she supervised would not appropriately refer
inmates for further evaluation and treatment. To the extent such a failure occurred in this
case, Plaintiff has not identified evidence showing that Dr. Irvin promulgated a policy
preventing or discouraging her subordinates to make referrals or was aware of prior, similar
failures and did not appropriately respond. Plaintiff has not identified any deliberate act or
failure to act by Dr. Irvin that “set in motion a series of events that the defendant knew or
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 31 of 50

32
reasonably 	should 	have 	known 	would 	cause 	others 	to 	deprive” 	Mr. 	Davis 	of 	his
constitutional rights. Dodds, 614 F.3d at 1195–96 (internal quotation marks omitted).
As for the negligence claim asserted against Dr. Irvin, Plaintiff does not develop
any argument in response to Dr. Irvin’s assertion that she is immune under the Oklahoma
Governmental Tort Claims Act. Plaintiff has therefore confessed this argument. But
regardless, the Court concludes that Dr. Irvin is entitled to immunity under the OGTCA
with respect to the negligence claim.
Accordingly, Dr. Irvin is entitled to summary judgment.
5. 	Dr. Cooper and Turn Key
Plaintiff’s claim against Dr. Cooper, the medical director for Turn Key, is premised
on Dr. Cooper’s personal participation in the failure to provide adequate medical care to
Mr. Davis and in his role as supervisor of the Turn Key medical staff. Am. Pet. ¶¶ 338. She
alleges that Dr. Cooper had knowledge of Mr. Davis’s condition and his subordinates’
failure to refer Mr. Davis for a medical evaluation or appropriately monitor his condition.
Id. ¶¶ 345-351. She further alleges that Dr. Cooper, as the final policymaker for Turn Key,
was deliberately indifferent to several longstanding deficiencies that are causally related to
the violation of Mr. Davis’s right to adequate medical care, including understaffing of
medical personnel, failing to provide treatment to inmates with mental health needs, failing
to perform medical screening, failing to assesses and treat life-threatening conditions
requiring emergency care, and failing to train medical staff. Id. at ¶ 609. Dr. Cooper argues
that summary judgment is warranted because he had no personal knowledge of Mr. Davis’s
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 32 of 50

33
condition or treatment and there is insufficient evidence to show that he was deliberately
indifferent in performing his supervisory responsibilities.
Initially, there is no evidence that Dr. Cooper was personally involved in Mr.
Davis’s care, personally aware of his condition, or personally aware of the medical staff’s
actions in connection with Mr. Davis. Plaintiff’s response brief concedes as much and
instead argues that Dr. Cooper’s personal involvement is established by his adoption and
maintenance of polices and customs that caused the failures alleged in this case. See Pl’s
Br. [Doc. No. 147] at p. 25. Because the claims against Dr. Cooper are premised on his
maintenance of policies and customs, as opposed to his personal participation in the
underlying constitutional violation, the elements of the claim largely overlap with the
municipal liability claim asserted against Turn Key. See Burke, 935 F.3d at 998-99. For
both claims, Plaintiff must identify evidence from which a reasonable could find “(1) a
causal relationship between the policy or custom and the underlying violation and (2)
deliberate indifference.” Id. at 999.
For her claim against Turn Key, Plaintiff alleges widespread failures to provide
necessary 	medical 	treatment, 	perform 	medical 	screenings, 	or 	adequately 	train 	its
employees. Am. Pet. ¶¶ 543-546; 555. Turn Key, like Dr. Cooper, argues that summary
judgment is warranted because there is no evidence that any policy or custom of Turn Key
was the moving force behind Mr. Davis’s claimed constitutional violation or that any
policy or custom was enacted with deliberate indifference.10
10 Turn Key also argues that Plaintiff’s claim fails because none of Turn Key’s employees
committed a constitutional violation. However, as previously explained, there is a genuine
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 33 of 50

34
Plaintiff first contends that Turn Key, and Dr. Cooper, maintained a practice of
failing to ensure that unscreenable detainees received a medical evaluation. The evidence,
even construed in Plaintiff’s favor, does not support this contention. Turn Key’s written
policies require a screening to be completed as soon as possible, Nurse Williams testified
that Turn Key tracks inmates in need of a medical screening and has a medical provider
monitor the list,11 and Dr. Cooper testified that medical and mental health staff are trained
to relay concerns about the needs of inmates. To be sure, there is evidence that this system
did not function properly in this case as Mr. Davis never received a medical screening or
any medical treatment. But a reasonable factfinder could not infer that Turn Key maintains
a widespread practice of failing to medically screen inmates or that Dr. Cooper’s
supervision was deficient based solely on the alleged failures in this case. See Burke, 935
F.3d at 997 (“Section 1983 does not authorize respondeat superior liability for a supervisor
based solely on the actions of his subordinates.”). And apart from Mr. Davis, Plaintiff has
only identified one prior instance where an inmate did not receive a timely medical or
mental health screening. Evidence of “only one similar incident …fall[s] far short of
plausibly alleging a ‘widespread practice’” or of raising the inference that the defendant
was deliberately indifferent to a pattern of constitutionally deficient conduct. Waller, 932
F.3d at 1287, 1290. See also Johnson v. Davis Cnty., No. 21-4030, 2022 WL 830202, at *4
dispute of material facts as to whether Counselor Okongor performed her gatekeeping role
in a deliberately indifferent manner.
11 Plaintiff’s nurse expert criticizes Dr. Cooper for failing to describe this system. However,
Plaintiff has not identified deposition testimony or other evidence showing that Dr. Cooper
was asked about the system and was either unable to describe it or provided an explanation
that was inconsistent with Nurse Williams’s testimony.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 34 of 50

35
(10th Cir. Mar. 21, 2022) (unpublished) (rejecting municipal liability claim where there
were “no prior similar constitutional violations that would have put defendants on notice
that their screening practices were deficient”). Additionally, although Plaintiff suggests
that medical staff must have observed Mr. Davis during their routine rounds, she did not
identify evidence showing that Turn Key personnel were present when Mr. Davis was
purportedly screaming out in pain from his impending or perforated ulcer. See Lance v.
Morris, 985 F.3d 787, 795 (10 th Cir. 2021) (“[A] claim of deliberate indifference cannot be
based on speculation about what [the defendant] might have seen or heard.”).
Plaintiff next faults Turn Key and Dr. Cooper for promulgating or relying on “a
custody-gated, passive-notification access model that depended on officers to open doors,
escort clinicians, and carry messages to medical” despite knowing that the jail frequently
experienced staff shortages and missed sight checks. Pl.’s Br. [Doc. No. 147] at p. 33; see
also Pl.’s Br. [Doc. No. 145] at p. 29. There is evidence that Dr. Cooper and Turn Key
were aware, prior to this incident, that the jail experienced detention staff shortages and
missed sight checks.12 But this case does not involve a denial of adequate medical care
because detention officers were not available to escort medical personnel or open a cell
door for treatment. To the extent Plaintiff faults the medical personnel for placing Mr.
Davis on the mental health observation floor without a medical screening, despite
12 Dr. Cooper (in his individual capacity and not as a corporate representative for Turn
Key) testified that the only defect he knew of was that periodically there were not enough
detention officers to provide medical personnel with access to patients. He further testified
that he believed that problem was remedied and that he was not aware of problems where
inmates were suffering from long-term medical issues that went undetected.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 35 of 50

36
knowledge that his ability to self-advocate was limited and the detention staff were not
appropriately performing their sight checks, there is insufficient evidence to permit the
inference that Dr. Cooper or Turn Key were aware that medical staff was customarily
failing to provide appropriate screenings, monitoring, or treatment to patients on the mental
health observation floor.
Plaintiff’s operative pleading alleges several additional deficient policies and
customs and Turn Key moves for summary judgment on each. Plaintiff does not develop a
specific argument in a response and has therefore waived further reliance on those theories.
Alternatively, looking at the issue on the merits, Turn Key’s arguments are persuasive.
Plaintiff alleges that Turn Key, and Dr. Cooper in his individual supervisory capacity, do
not provide adequate medical staff at the jail, fail to provide appropriate medical treatment
for inmates with psychiatric needs, fail to adequately assess and treat life-threatening
conditions, fail to ensure its policies align with the jail facilities, utilize unqualified medical
staff or permit staff to operate outside their scope of practice, and fail to adequately train
its staff. There is insufficient evidence to show these alleged deficiencies were the policies,
customs, or widespread practices of Turn Key. Further, Plaintiff has failed to explain how
some of the alleged deficient practices, such as the failure to review jail policies and
medical understaffing, have a causal connection to the injuries in this particular case. The
problem was not a lack of medical personnel, but that the medical personnel, rightly or
wrongly, did not provide a medical screening or treatment for Mr. Davis. See Buchanan v,
2023 WL 6997404, at *10. As to the failure to train claim, Turn Key has identified evidence
indicating that its employees receive training and that Dr. Cooper conducts employee
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 36 of 50

37
reviews. Plaintiff has not identified more than a scintilla of evidence in opposition and has
therefore failed to create a triable issue of fact as to this claim.
Last, Turn Key and Dr. Cooper argue that they are immune from negligence liability
under the Oklahoma Governmental Tort Claims Act. Plaintiff has not developed an
argument in opposition and the Court concludes that Turn and Dr. Cooper are entitled to
immunity pursuant to § 152(7)(b)(7) of the OGTCA.
Accordingly, Turn Key and Dr. Cooper are entitled to summary judgment in their
favor.
B. County Defendants
1. 	Constitutional Right to Medical Care
The individual County Defendants (Detention Officer Anderson, Detention Officer
Kallos, and Administrator Williams) first argue that a pretrial detainee does not have a
constitutional right to medical care. The Supreme Court and the Tenth Circuit have “long
held that a prison official’s deliberate indifference to a convicted prisoner’s serious medical
needs constitutes cruel and unusual punishment in violation of the Eighth Amendment”
and that pretrial detainees “are entitled to the same standard of medical care under the Due
Process Clause of the Fourteenth Amendment.” Prince, 28 F.4 th at 1043. “[T]his Court’s
role is to apply Tenth Circuit precedent, not to reconsider it[,]” United States v. Hay, 601
F. Supp. 3d 943, 952 (D. Kan. 2022), and this argument is therefore rejected.
The Board of County Commissioners and the OCCJA also argue that Plaintiff’s
claim asserting that Mr. Davis’s constitutional rights were violated as the result of systemic
failures impermissibly seeks the implementation of a federal constitutional tort regime and
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 37 of 50

38
runs afoul of the Tenth Amendment. The Tenth Circuit has recognized that “while unusual,
municipal liability may exist without individual liability: for example, for a systemic failure
of medical policies and procedures.” Lucas, 58 F.4th at 1144. The Court will apply
controlling Tenth Circuit precedent to Plaintiff’s systematic failure claim and rejects
Defendants’ argument that the claim violates the Tenth Amendment.
2. 	Objectively Serious Harm
Like the medical defendants, the county defendants all argue that Plaintiff cannot
satisfy the objective component of the deliberate standard because Mr. Davis did not suffer
from a sufficiently serious medical need. In making this argument, the county defendants
contend that Plaintiff is merely speculating that Mr. Davis displayed observable symptoms
of an ulcer and that there is a lack of evidence indicating that detention or medical staff
ever suspected that Mr. Davis was suffering from a more serious condition other than
psychosis. This is a mischaracterization of the record evidence.
Plaintiff has introduced expert testimony indicating that Mr. Davis’s ulcer most
likely perforated around August 10 th and that he would have experienced severe and
obvious pain. Dr. Cooper agreed that a perforated ulcer would cause extreme pain over the
course of hours or days. Doc. No. 150-3, Cooper Depo, 84:4-86:9. Plaintiff has also
introduced testimony from another inmate indicating that Mr. Davis was screaming in pain
and beating on the door. There is evidence that Mr. Davis attempted nearly 900 phone calls
during his brief incarceration. This is more than mere speculation and is sufficient evidence
to create a triable issue of fact as to whether Mr. Davis had a serious medical need that was
so obvious that even a lay person would easily recognize the necessity for a doctor’s
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 38 of 50

39
attention. See Rife, 854 F.3d at 652 (concluding that there affidavit from another inmate
stating that the plaintiff was repeatedly moaning in pain was sufficient to create a triable
issue of fact as to whether there was an obvious need for medical attention)
Summary judgment is therefore not warranted with respect to the objective
component.
3. 	Detention Officer Anderson
Plaintiff asserts that Detention Officer Anderson observed Mr. Davis’s distress –
including his psychosis and worsening physical condition – but failed to take any action in
response. Am. Pet. ¶¶ 337-345. Officer Anderson contends there is no evidence that he
acted in a deliberately indifferent manner.
The undisputed facts indicate that Officer Anderson, along with another detention
officer, conducted a sight check on Mr. Davis. During the sight check, Mr. Davis provided
his name in response to the officer’s inquiry.13 At that time, Officer Anderson thought Mr.
Davis “might need medical attention” because he was naked and would not keep his clothes
on. Officer Anderson did not report his concerns to anyone, left the floor to perform other
duties, and missed several subsequent sight checks.
Although Plaintiff makes much of Officer Anderson’s observation that Mr. Davis
might need medical attention, the only reasonable inference to be drawn from Officer
Anderson’s statement and deposition testimony is that he believed Mr. Davis needed to be
13 Officer Anderson also responded to the emergency call after Mr. Davis was found
unresponsive. But Plaintiff does not argue that his actions at this point were deliberately
indifferent.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 39 of 50

40
seen by a provider because he was continuing to take his clothes off. There is no evidence
indicating that he subjectively inferred that Mr. Davis’s condition presented an excessive
or urgent risk to his health. The evidence is also insufficient to support an inference that
Officer Anderson was present during the time period that Mr. Davis was allegedly
screaming in pain or showing signs of physical distress. Officer Anderson testified that he
did not observe any concerning physical symptoms and Plaintiff has not offered any
evidence that might permit a reasonable inference to the contrary. The evidence does not
support the finding that Officer Anderson was consciously aware of an excessive risk to
Mr. Davis’s health and disregarded it. See Martinez v. Beggs, 563 F.3d 1082, 1090 (10th
Cir. 2009) (granting summary judgment to detention officers who failed to complete
multiple sight checks of inmate that was intoxicated, had not been medically screened, and
was alone in cell because they did not subjectively know that he faced a risk of imminent
heart attack); Heidel v. Mazzola, 851 F. App'x 837, 840–41 (10th Cir. 2021) (“Especially
when considering the lack of evidence regarding the officers’ subjective awareness, the
alleged deviations from timely cell checks and proper booking do not amount to deliberate
indifference in these circumstances.”).
Accordingly, Officer Anderson is entitled to summary judgment in his favor.
4. 	Detention Officer Kallos
Plaintiff asserts that Detention Officer Kallos had knowledge of an obvious risk of
serious harm when he failed to conduct a proper sight check and acted with deliberate
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 40 of 50

41
indifference by not verifying Mr. Davis’s condition. Officer Kallos contends there is no
evidence that he acted in a deliberately indifferent manner.14
The undisputed facts indicate that on August 12, 2021 at 8:11 a.m., approximately
ninety minutes after Officer Anderson completed his sight check, the Detention Services
Team made rounds on Mr. Davis’s section of the jail to change out the laundry. Officer
Kallos was part of the Detention Services Team.15 Officer Kallos testified that he looked
through the cell door’s food port and window, knocked a few times, and asked Mr. Davis
if he wanted his blanket washed. Mr. Davis was fully covered by his blanket and did not
respond. Officer Kallos testified that he saw Mr. Davis breathing, assumed he was sleeping,
and moved on to the next cell.
Plaintiff faults Officer Kallos for assuming Mr. Davis was asleep and not verifying
his responsiveness, particularly given that the cell was dark, he did not have a flash light,
and he only looked in for a few seconds.16 Crediting these facts and drawing inferences in
14 Officers Anderson and Kallos also raise the defense of qualified immunity. Because the
evidence is insufficient to find that Officer Anderson or Kallos violated Mr. Davis’s
constitutional rights, there is no need to addresses whether the alleged violation violated
the clearly established law.
15 The evidence also shows that Officer Kallos performed a sight check or clothing change
out at Mr. Davis’s cell on August 5. This interaction does not form the basis of Plaintiff’s
claim against Officer Kallos. See Pl.’s Br. [Doc. No. 156] at p. 12 (“[T]the August 5
encounter is irrelevant to the constitutional violation at issue.”)
16 Plaintiff specifically criticizes Officer Kallos for not verifying “flesh and movement” as
required by jail policy. This language appears to be derived from the jail’s policy on
performing an inmate count at least three times per day for the purpose of ensuring all
inmates are accounted for. See Doc. No. 150-37. The policy on performing “safety checks”
does not include the language about verifying “flesh and movement” and instead provides
that the checks shall be “sufficient to determine whether the inmate is experiencing any
stress or trauma.” See Doc. No. 150-48. The policy on performing “sight checks” states
that staff should “pay close attention to any sign of unusual behavior or distress displayed
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 41 of 50

42
Plaintiff’s favor, the Court is not persuaded that a reasonable juror could conclude that
Officer Kallos was aware of a serious risk to Mr. Davis and consciously disregard it. There
is no evidence indicating that Officer Kallos was aware that Mr. Davis had previously been
screaming in pain or showing distressing physical symptoms. There is no evidence that
Officer Kallos knew that Mr. Davis was in a prolonged state of untreated psychosis or that
earlier that morning detention officers had concluded that Mr. Davis needed medical
attention for his erratic behavior. There is no evidence that Officer Kallos saw any signs of
distress at the time he performed the sight check. What the evidence does show is that
Officer Kallos saw Mr. Davis breathing, assumed he was sleeping, and moved on.
Although his failure to conduct a more thorough sight check might suggest he was
negligent in performing his duties, the evidence here does not rise to the level of deliberate
indifference. See Est. of Beauford, 35 F.4th at 1264 (detention officer’s failure to perform
required sight check after previously observing inmate “under his blanket and grunting”
did not amount to deliberate indifference because detention officer did not have actual
knowledge that inmate was experiencing seizure).
Obviously, with the benefit of hindsight, it is easy to say that more could have or
should have been done for Mr. Davis by the detention officers named in this case. But that
is not the relevant inquiry. Rather, to survive summary judgment, there must be evidence
from which a reasonable juror could conclude that the individual defendants knew of and
by the inmate and take proper action in accordance with provided training.” See Doc. No.
150-35. In any event, a policy violation does not necessarily equate with a constitutional
violation.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 42 of 50

43
disregarded an excessive risk to Mr. Davis’s health. The evidence, construed in Plaintiff’s
favor, does not support such a finding with respect to these individual defendants. The
Court recognizes that there is evidence from which a reasonable juror could conclude that
Mr. Davis was in severe and obvious pain for an extended period of time during his
incarceration and did not receive any medical treatment. This is troubling, to say the least.
But Plaintiff has not shown that the jail or medical staff named in this action were present
during this time period.
Accordingly, Officer Kallos is entitled to summary judgment in his favor.
5. 	Administrator Williams and the OCCJA
For her claim against Administrator Williams in his individual capacity, Plaintiff
contends that he maintained and tolerated practices that were the moving force behind Mr.
Davis’s death, including placing unscreened inmates into housing, missing sight checks,
and ignoring a recognized need for medical care.17 Plaintiff’s claim against the OCCJA
(and Administrator Williams in his official capacity) is essentially the same and relies on
deficient screening practices and a widespread failure to complete required sight checks.
Administrator Williams and the OCCJA argue that Plaintiff has failed to present evidence
showing an underlying constitutional violation and, additionally, failed to create a triable
17 Plaintiff’s brief in response to Administrator Williams’s motion references alleged
statements or opinions by “defense expert Adler.” Doc. No. 155 at p. 37. However, Plaintiff
has not attached the expert report or deposition testimony of Adler in her response brief.
Although these supporting documents might appear elsewhere in the record, it is not the
responsibility of the Court to search the record in support of the underlying exhibits.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 43 of 50

44
issue of fact as to whether a municipal policy or custom was the moving force behind the
constitutional violation.
As to Plaintiff’s claim that the jail maintained a policy or custom of failing to
provide medical screenings to inmates, there is insufficient evidence to support a finding
that the jail maintained such a policy in a deliberately indifferent manner. Similar to the
claim against Turn Key, the jail’s written policies require medical screening and, apart
from one prior instance, Plaintiff has not identified evidence showing that the jail was
routinely neglecting to complete medical screenings prior to this incident.
Plaintiff’s claim that the jail maintained a widespread practice of understaffing the
jail and failing to monitor inmates presents a closer question. Generally, supervisory or
municipal liability claims require individual liability by a subordinate employee. See
Burke, 935 F.3d at 998; Strain, 984 F.2d at 997. However, in limited circumstances,
municipal liability may exist absent the individual liability of a specific employee.
“[W]here ‘the acts or omissions of no one employee may violate an individual’s
constitutional rights, the combined acts or omissions of several employees acting under a
governmental 	policy 	or 	custom 	may 	violate 	an 	individual’s 	constitutional 	rights.’”
Quintana v. Santa Fe Cnty. Bd. of Commissioners, 973 F.3d 1022, 1033 (10 th Cir. 2020)
(quoting Garcia v. Salt Lake Cty., 768 F.2d 303, 310 (10 th Cir. 1985)). “Deliberate
indifference to serious medical needs may be shown by proving there are such gross
deficiencies in staffing, facilities, equipment, or procedures that the inmate is effectively
denied access to adequate medical care.” Id. at 308; see also Crowson, 983 F.3d at 1185-
86.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 44 of 50

45
Although Plaintiff has not identified sufficient evidence to create a triable issue of
fact that Detention Officers Anderson and Kallos were deliberately indifferent to Mr.
Davis’s serious medical needs, there is sufficient evidence to create a genuine issue of fact
as to whether gross deficiencies in staffing and procedure were the moving force behind a
violation of Mr. Davis’s constitutional rights. Viewing the evidence in the light most
favorable to Plaintiff, a reasonable juror could conclude that the jail had chronic,
widespread, and grossly deficient practices regarding the monitoring of inmates. In
addition to deficiency notices from the state health department, there is deposition
testimony from detention officers that sight checks were routinely missed as a result of
insufficient staffing levels. Administrator Williams was aware of these deficiencies and
candidly acknowledged that failing to monitor inmates presents a risk to inmate safety,
particularly for inmates on mental health observation. Although Administrator Williams
testified that he attempted to remedy the staffing shortages by offering pay increases and
engaging in recruitment efforts, a jury could discount the reasonableness of these efforts
given the longstanding nature of the problem. Further, there is a genuine factual dispute as
to whether these deficient practices were the moving force behind a violation of Mr.
Davis’s constitutional rights, i.e. that the failure to monitor caused a delay in medical care
that resulted in substantial harm to Mr. Davis. There is evidence that Mr. Davis experienced
severe pain over the course of multiple days and the symptoms would have been obvious
to a lay person, but detention officers did not report his pain to medical personnel. There
is also evidence that in the hours prior to Mr. Davis being found unresponsive, detention
officer missed numerous sight checks due, at least in part, to a lack of adequate staff. In
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 45 of 50

46
short, Plaintiff’s have presented evidence sufficient to raise a genuine factual dispute as to
whether Administrator Williams, and the OCCJA, were deliberately indifferent to the risk
that inadequate monitoring and staffing would result in a constitutional violation like the
one Mr. Davis experienced. See Winton v. Bd. of Comm'rs of Tulsa Cnty., 88 F. Supp. 2d
1247, 1269 (N.D. Okla. 2000) (“A jury could, therefore, find an affirmative link between
the Sheriff’s maintenance or acquiescence in an inadequate watch tour policy and the delay
in discovering Mr. Winton’s injuries.”).
Administrator Williams contends that summary judgment is nevertheless warranted
because he is entitled to qualified immunity. As previously noted, “[a] defendant’s motion
for summary judgment based on qualified immunity imposes on the plaintiff the burden of
showing both (1) a violation of a constitutional right; and (2) that the constitutional right
was clearly established at the time of the violation.” Burke v, 935 F.3d at 1002 (internal
quotation marks omitted). As to the first prong, for the reasons explained above, there is a
genuine 	factual 	dispute 	concerning 	whether 	jail 	employees 	violated 	Mr. 	Davis’s
constitutional right to adequate medical care by failing to report his obvious pain or
summon medical attention and whether Administrator Williams tolerated a widespread
practice that was the moving force behind that violation. As to the second prong,
Administrator Williams contends only that there is no constitutional right to medical care,
an argument that contravenes binding Supreme Court and Tenth Circuit precedent.
Moreover, the Tenth Circuit has previously recognized that a jail administrator can be
liable under § 1983 for a violation of a pretrial detainee’s right to adequate medical care
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 46 of 50

47
based on widespread and chronic understaffing, inadequate training, and failure to timely
address medical issues. See Burke, 935 F.3d at 997-1000.
Summary judgment is therefore denied for Administrator Williams in his individual
capacity and the OCCJA.
6. 	Board of County Commissioners
Plaintiff’s claim against the Board of County Commissioners is premised on its
authority over the contracting for medical services at the jail and its alleged prioritization
of cost-cutting measures over sufficient medical care. Am Pet. ¶¶ 518-531. The BOCC
argues that it is entitled to summary judgment because, as a matter of law, it has no
authority over the jail. Additionally, the BOCC argues that Plaintiff has no evidence to
support her theory that a lack of funding caused a constitutional violation.
The BOCC’s contention that it is “legally impossible” for it to be held liable for a
constitutional violation at the jail likely overstates its case. See, e.g., Miller v. Oklahoma
Cnty. Crim. Just. Auth., No. CIV-22-00665-JD, 2025 WL 2325184, at *10 (W.D. Okla.
Aug. 12, 2025). But the Court nevertheless concludes that summary judgment is warranted
because Plaintiff has not identified sufficient evidence to support its theory that the
BOCC’s funding decisions were the moving force behind the alleged constitutional
violation. Although Plaintiff complains of understaffing and other operational deficiencies
at the jail, she has not adequately connected those deficiencies to a policy or custom of the
BOCC. In these circumstances, the BOCC is entitled to summary judgment in its favor.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 47 of 50

48
C. Defendants Eastman, Hallock, Horn, and Merriott
Defendants Eastman, Hallock, Horn, and Merriott are Turn Key nurses that either
responded to the request for emergency medical assistance or completed documentation
after Mr. Davis was found unresponsive. Plaintiff has not identified any evidence
indicating that these defendants were directly involved with Mr. Davis’s care, had
awareness of his medical conditions or symptoms, or were deficient in the way they
responded to the request for medical assistance after he was found unresponsive. Based on
this lack of evidence, the nurses move for summary judgment on Plaintiff’s claim.
In response, Plaintiff requests that she be permitted to dismiss her claims against
these defendants with prejudice pursuant Fed. R. Civ. P. 41(a)(2). The nurses object and
contend they are entitled to judgment in their favor such that they may pursue recoverable
attorney fees and costs as prevailing parties.
“Rule 41(a)(2) controls voluntary dismissals after an opposing party answers or files
a motion for summary judgment.” Phillips USA, Inc. v. Allflex USA, Inc., 77 F.3d 354, 357
(10 th Cir. 1996). The rule permits a voluntary dismissal “only by court order, on terms that
the court considers proper.” Fed.R.Civ.P. 41(a)(2). “The rule is designed primarily to
prevent voluntary dismissals which unfairly affect the other side, and to permit the
imposition of curative conditions.” Phillips USA, 77 F.3d 354, 357 (10th Cir. 1996)
(quotation omitted). “Absent legal prejudice to the defendant, the district court normally
should grant such a dismissal.” Ohlander v. Larson, 114 F.3d 1531, 1537 (10 th Cir. 1997).
Several factors may bear on whether the defendant will suffer legal prejudice, including
“the opposing party’s effort and expense in preparing for trial; excessive delay and lack of
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 48 of 50

49
diligence on the part of the movant; insufficient explanation of the need for a dismissal;
and the present stage of litigation.” Id. However, “[t]hese factors are neither exhaustive nor
conclusive.” Brown v. Baeke, 413 F.3d 1121, 1124 (10 th Cir. 2005).
The Court notes that some of these factors weigh against dismissal. Defendants
spent considerable time preparing for and filing their dispositive motion, which raises a
substantive challenge to Plaintiff’s claims, and the case is an advanced procedural posture.
Further, Plaintiff made no effort to respond to the motion and has not adequately explained
why she rejected the nurses’ post-discovery but pre-dispositive motion request for
dismissal.
However, unlike the majority of Rule 41 dismissals, Plaintiff is requesting a
dismissal of the claims with prejudice. When that is the case, “the normal analysis will
result in the district court granting the plaintiff’s motion to dismiss with prejudice.” Cnty.
of Santa Fe, N.M. v. Pub. Serv. Co. of New Mexico, 311 F.3d 1031, 1049 (10 th Cir. 2002).
Additionally, although counsel for the nurses appears to have expended considerable time
and effort litigating this case, much of that work overlapped with the work performed for
the other medical defendants. Given that position, and the fact that Plaintiff is requesting a
dismissal with prejudice, the Court concludes that her request for dismissal under Rule
41(a)(2) should be granted and the nurses’ motion for summary judgment denied as moot.
The Court further declines to award the nurses’ attorneys’ fees as a condition of the
dismissal. See AeroTech, Inc. v. Estes, 110 F.3d 1523, 1528 (10th Cir. 1997) (“In contrast,
when a plaintiff dismisses an action with prejudice, attorneys’ fees are usually not a proper
condition of dismissal because the defendant cannot be made to defend again.”).
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 49 of 50

50
Accordingly, Defendants Eastman, Hallock, Horn, and Merriott are dismissed with
prejudice pursuant to Rule 41(a)(2) and their Motion for Summary Judgement is denied as
moot.
V. 	Conclusion
As set out above, the motions for summary judgment filed by Defendants Williams
[Doc. No. 119]; OCCJA [Doc. No. 111], and Okongor [Doc. No. 129] are denied. The
motions for summary judgment filed by Defendants BOCC [Doc. No. 118], Kallos [Doc.
No. 115], Anderson [Doc. No. 113], Turn Key [Doc. No. 122], Cooper [Doc. No. 127],
Irvin [Doc. No. 126], and Misty Williams [Doc. No. 128] are granted.
The motion for summary judgment filed by Defendants Eastman, Hallock, Horn,
and Merriott [Doc. No. 124] is denied as moot and these defendants are dismissed with
prejudice pursuant to Rule 41(a)(2).
Last, in accordance with the Stipulation of Dismissal [Doc. No. 142] dismissing the
claims against Defendants Carter, Mulanax, Harvey, Anderson-Depee, and Dean without
prejudice, the motion for summary judgment [Doc. No. 117] filed by these defendants is
denied as moot.
IT IS SO ORDERED this 3rd day of February, 2026.
Case 5:23-cv-00780-R Document 179 Filed 02/03/26 Page 50 of 50