Keele v. Glynn County (938 F. Supp. 2d 1270, 2013)

ORDER

LISA GODBEY WOOD, Chief Judge.

Presently before the Court is Defendants’ Motion for Summary Judgment. See Dkt. No. 44. Upon due consideration, Defendants’ motion is GRANTED IN PART and DENIED IN PART.

I. PROCEDURAL BACKGROUND

This action is predicated on the tragic death of Plaintiffs daughter, Kara Thompson (“Thompson”). See Dkt. No. 1. Specifically, Thompson succumbed to necrotizing tracheobroncitis and pneumonia while detained in the Glynn County Detention Center (“GCDC”) in May 2009. See id.

Plaintiffs general theory of liability is that, while detained, Thompson’s access to necessary medical care was delayed or deficient and that the delay or deficiency led to Thompson’s death. Plaintiffs Complaint has eight (8) counts. See id. In Counts 1, 4, 7, and 8, Plaintiff asserts federal law claims. Specifically, Count 1 asserts claims of constitutional violations against Defendant Glynn County and the remaining Defendants in their official capacities. Count 7 asserts claims of constitutional violations against four (4) individual Defendants in their individual capacities. Count 4 seeks attorney’s fees pursuant to 42 U.S.C. § 1988. Count 8 seeks punitive damages for the individual Defendants’ constitutional violations.

In Counts 2, 3, 5, and 6, Plaintiff asserts state law claims. Specifically, Count 2 asserts violations of state statutes pertaining to detainee supervision and care by Defendant Glynn County and Defendant Bennett. Counts 3 and 6 assert tort claims against Defendants Bennett and Orr. Count 5 asserts tort claims against Defendant Gunderson.

Defendant Gunderson moved for summary judgment on all claims against him. Dkt. No. 40. Plaintiff consented to Defendant Gunderson’s motion. Dkt. No. 52. The Court approved the parties’ agreement. See Dkt. No. 76. Accordingly, references to “Defendants” in the remainder of this Order refer to the remaining Defendants.

Defendants moved for summary judgment on all of Plaintiffs claims. See Dkt. No. 44. This motion is fully briefed. See Dkt. Nos. 53, 75. The Court heard oral argument regarding the motion on December 18, 2012.

II. FACTUAL BACKGROUND

The relevant facts are taken principally from the parties’ Statements of Material Facts and responses thereto. Dkt. Nos. 44-1, 57, 57-1. Pursuant to Federal Rule of Civil Procedure 56(e) and Local Rule 56.1, all material facts not specifically controverted by specific citation to the record are deemed admitted, unless otherwise inappropriate.

Where the parties offer conflicting accounts of the events in question, this Court draws all inferences and presents all evidence in the light most favorable to Plaintiff. See Hamilton v. Southland Christian Sch., Inc., 680 F.3d 1316, 1318 (11th Cir.2012) (citation omitted).

A. GCDC

1. C-Pod

The GCDC consists of six (6) housing units or “pods.” Dkt. No. 57-1 ¶ 1. Female inmates at the GCDC were detained in C-Pod. Id. In May 2009, C-Pod housed approximately eighty-eight (88) inmates, approximately twenty-four (24) inmates above design capacity. Id. ¶ 102.

2. Detention Officers

GCDC detention officers worked twelve (12) hour shifts. Id. ¶ 3. The day shift was from 6:00 a.m. to 6:00 p.m. Id. The night shift was from 6:00 p.m. to 6:00 a.m. Id.

One officer worked in the C-Pod control station during each shift. Id. ¶ 1. That officer was relieved from her duty station to perform hourly rounds (or for any other reason) by a floater, supervisor, booking officer, or other available personnel. Id. ¶ 5.

3. GCDC Medical Personnel

In 2009, the GCDC’s only doctor was Doctor Jeffrey Gunderson. Id. ¶ 20. Dr. Gunderson was an independent contractor. Dkt. No. 55-18, at 14-15. Dr. Gunderson hired and paid one (1) physician assistant. Id. at 15, 34-35. Neither Dr. Gunderson nor his assistant was a GCDC employee. Dkt. No. 57-1 ¶ 20-21. All other GCDC medical personnel were county and sheriffs office employees. Id. ¶ 21. Neither the county nor the sheriffs department consulted Dr. Gunderson regarding GCDC policy or staffing needs. Id. ¶¶21, 105.

Dr. Gunderson worked twenty (20) hours per week and was on call twenty-four (24) hours per day, every day. Dkt. No. 55-18, at 14-15. In general, his assistant performed initial evaluations and handled sick call on Thursday and Friday mornings. Id. at 15. In general, Dr. Gunderson handled such tasks Saturday through Wednesday. Dkt. No. 57-1 ¶ 20.

Two. (2) licensed practical nurses (“LPNs”) worked during most, if not all, day shifts. Id. ¶7. Frequently, an LPN worked during night shifts. Id. Sometimes the LPN was also the GCDC “floater” during the night shift. Id. Dr. Gunderson instructed Nurse John Orr,' an LPN, to notify Dr. Gunderson if Nurse Orr learned that an inmate was withdrawing from drugs. Dkt. No. 55-18, at 63.

B. Thompson’s Detention

In May 2009, Thompson was seventeen (17) years old. She lived with Plaintiff. Dkt. No. 1, at 4;

While visiting Plaintiff and Thompson, Thompson’s grandmother discovered that approximately $250 was missing from her purse and car. Id. She assumed that Thompson took the money. Id. To teach Thompson a lesson, Thompson’s grandmother took a warrant out, alleging that Thompson took the missing money. Id.

1. Day 1: Friday, May 8, 2009

-On Friday, May 8, Thompson was arrested. Id. She was booked at the GCDC. Id. During the intake process, Thompson reported that she had previously been treated for drug addiction. Dkt. Nos. 44-1 ¶ 7; 57 ¶ 7. Thompson also stated that she may have a broken rib for which she had already been treated. Dkt. Nos. 44-1 ¶ 8; 57 ¶ 8. Starting Friday, Thompson ate and drank very little, if anything, other than water. Dkt. No. 57-1 ¶ 65. From Friday, May 8, until Sunday, May 10, she often gave her food to other inmates. Dkt. No. .55-5, at 45. Moreover, Thompson regurgitated much, if not all, of the food that she did consume. Dkt. No. 57-1 ¶ 65. Thompson’s minimal food consumption and vomiting continued throughout, the week. Id. ¶¶ 65, 66.

Sometime Friday, Inmate Amber Lambert filled out and submitted a sick call sheet for Thompson. Dkt. No. 55-1, at 20. The sick call sheet requested pain medication for Thompson’s sore ribs. Id.

2. Day 2: Saturday, May 9, 2009

On Saturday, May 9, Thompson told Detention Officer Helen Brown that her rib hurt. Dkt. Nos. 44-1 ¶ 9; 57 ¶ 9. Officer Brown notified the on-duty nurse. Dkt. Nos. 44-1 ¶ 10; 57 ¶ 10. The nurse gave Thompson Ibuprofen and an ice. pack to ease the discomfort. Dkt. Nos. 44-1 ¶ 10; 57 ¶ 10.'

Also on May 9, Plaintiff delivered two (2) medications to the GCDC. Dkt. Nos. 44-1 ¶ 11; 57¶11. Thompson was prescribed these medications prior to her dA tention. Dkt. Nos.' 44-1 ¶ 11; 57 ¶ 11. They were prescribed because of Thompson’s rib injury. Dkt. Nos. 44-1 ¶ 11; 57 ¶ 11. During her detention, Thompson received these medications as prescribed. Dkt. Nos. 44-1 ¶ 12; 57 ¶ 12.

Officer Brown brought Thompson’s lunch to her in her cell. Dkt. No. 55-5, at 27.

Sometime during the weekend, Thompson had “the shakes.” Dkt. Ño. 55-10, at 11. Thompson lay around and slept for much of the weekend. Dkt. No. 55-5, at 11-13.

3. Day 3: Sunday, May 10, 2009

Every morning at 6:30 a.m., GCDC officers inspected the inmates’ cells for cleanliness. Id. at 15, Beginning Sunday, May 10, inmates made ; Thompson’s bed and cleaned her cell because Thompson could not or would not do so. Dkt. No. 55-8, at 39. This continued throughout the week. Id.

Officer Brown brought Thompson’s lunch to her in her cell. Dkt. No. 55-5, at 27.

4. Day 4: Monday, May 11, 2009 ,

■ Sometime Monday morning, Dr. Gunderson performed Thompson’s initial medical screening. Dkt. Nos. 44-1 ¶ 13; 57 ¶ 13. Dr. Gunderson questioned Thompson about her medical history. Dkt. Nos. 44-1 ¶ 13; 57 ¶ 13. He did not perform a physical evaluation. Dkt. Nos. 44-1 ¶ 13; 57 ¶ 13. Because Thompson reported that she had not taken illicit drugs, Dr. Gunderson did not place Thompson on a drug detox protocol. Dkt. Nos. 44-1 ¶ 14; 57 ¶ 14. ’

At approximately 10:30 p.m. on Monday, May 11, Thompson told Detention Officer Jessica Carnette that she had rashes over her body. Dkt. Nos. 44-1 ¶ 15; 57 ¶ 15. Officer Carnette notified Nurse Orr. Dkt. Nos. 44-1 ¶ 16; ¶ ¶ 16. Nurse Orr examined Thompson. Dkt. Nos. 44-1 ¶ 16; 57 ¶ 16. He noted that Thompson had a rash and had vomited one (1) time. Dkt. Nos. 44-1 ¶ 16; 55-11, at 167; 57 ¶ 16. He also noted that Thompson complained of nausea and of her throat and chest “tightening up.” Dkt. Nos. 44-1 ¶ 16; 57 ¶ 16.

Nurse Orr called Dr. Gunderson and informed him of Thompson’s condition. Dkt. Nos. 44-1 ¶ 17; 57 ¶ 17. Dr. Gunderson prescribed multiple drugs, including Benadryl, Prednisone, and Cimetidine. Dkt. No. 55-11, at 168-69. Dr. Gunderson had Nurse Orr place Thompson on the sick call list so that Thompson would be seen by Dr. Gunderson the following day. Dkt. Nos. 44-1 ¶ 19; 57 ¶ 19.

Sometime Monday, Inmate Dinah Smith began telling officers that she believed that Thompson was withdrawing from drugs. Dkt. No. 55-5, at 39. Inmate Smith relayed this concern to Officer Carnette and Nurse Orr at 6:00 p.m. See id.; Dkt. No. 56-60. During the week, Inmate Smith also relayed this concern to Officer Harris, Officer Brown, and Master Sergeant James Jones. Dkt. No. 55-5, at 39.

Starting Monday, Thompson did not want to get out of bed. Dkt. No. 55-1, at 23. She spent most of her time lying down. Dkt. No. 55-6, at 12.

5. Day 5: Tuesday, May 12, 2009

At 9:30 a.m. on Tuesday, May 12, Dr. Gunderson evaluated Thompson to followup on the prior night’s phone-based medical orders. Dkt. Nos. 44-1 ¶ 20; 55-18, at 81; 57 ¶ 20. Dr. Gunderson noted that Thompson had a rash and complained of nausea. Dkt. Nos. 44-1 ¶ 21; 57 ¶ 21. Dr. Gunderson adjusted the prescribed medications. Dkt. No. 57 ¶ 20, 22. He also prescribed a medication for Thompson’s nausea. Dkt. Nos. 44-1 ¶ 22; 57 ¶ 22. Dr. Gunderson noted that Thompson was happy, laughing, and in no distress. Dkt. No. 55-18, at 81.

Sometime Tuesday, Officer Daphine Parker told Thompson that Thompson was not taking care of herself, showering, or cleaning her area. Dkt. Nos. 55-5, at 24; 55-6, at 13-14. Officer Parker told Thompson that she was “nasty”'for not doing so. Dkt. Nos. 55-5, at 24; 55-6, at 13-14.

6. Day 6: Wednesday, May 13, 2009

At 6:00 a.m. on Wednesday, May 13, Thompson complained about her rashes. Dkt. No. 56-57, at 25. At approximately 6:30 a.m., GCDC medical personnel provided Thompson with medications for the rash. Id. Medical personnel also prescribed a cotton blanket, rather than the standard-issue wool blanket. Id.

At 7:00 a.m., Thompson refused, breakfast. Id.

Sometime Wednesday, Thompson had chills. Dkt. No. 55-8, at 22. Sometime Wednesday, Thompson urinated on herself. Dkt. No. 55-5, at 24-25; see also Dkt. No. 55-10, at . 13-14 (referencing a weekday before Friday, May 15). Noticing this, some inmates bathed Thompson. Dkt. No. 55-10, at 13-14.

Sometime Wednesday, Thompson began' hallucinating. Dkt. No. 55-8, at 22. Thompson’s hallucinations continued throughout the week.

Sometime Wednesday, several inmates informed an officer in the C-Pod control station that Thompson was very sick and needed medical help. Id. at 23-24.

7. Day 7: Thursday, May 14, 2009

On Thursday, May 14, Thompson refused breakfast. Dkt. No. 56-57, at 25. Sometime Thursday, Thompson had chills. Dkt. No. 55-8, at 22. Inmate Smith observed that Thompson felt clammy, warm, and sweaty. Dkt. No. 55-5, at 29. Inmate Smith also observed that Thompson was pale and had visible blisters on the inside of her mouth. Id.

Sometime Thursday, Inmate Lambert filled out and submitted a sick call sheet for Thompson. Dkt. No. 55-1, at 21. The sick call sheet stated that Thompson had diarrhea, was vomiting and wheezing, and needed medical assistance. Id. at 22.

During the day on Thursday, Inmate Lambert pushed the call button in Thompson’s cell and summoned the C-Pod officer. Id. at 26. Inmate Lambert told the responding officer that Thompson had not eaten or drunk anything, that she only lay around, that she needed medical assistance, and that nothing had been done for her. Id. at 26-27. In response, Officer Highsmith and a male nurse came to Thompson’s cell. Id. at 27. They stayed for at least ten (10) minutes. Id. at 50. Officer Highsmith told Thompson that she “needed to get up and try to do something with [her]self.” Id. at 28-29. Thompson said, “I feel like I’m dying.” Id. at 29. Officer Highsmith asked Thompson when she last ate and whether should could get up and drink some water. Id. at 30. Inmate Lambert stated that Thompson could not “hold [anything down” and needed help. Id. at 30.

At 6:00 p.m. Inmate Smith told Officer Brown that she believed that Thompson was withdrawing from drugs. See Dkt. Nos. 55-5, at 39; 56-60.

At approximately 8:00 p.m., Detention Officer Brown observed Thompson wearing only a shirt and underwear. Dkt. Nos. 44-1 ¶ 23; 55-17, at 30-31; 57 ¶23. Officer Brown told Thompson to cover herself. Dkt. Nos. 44-1 ¶ 24; 57 ¶ 24. Thompson said that she was hot and asked for a fan. Dkt. Nos. 44-1 ¶ 24; 57 ¶24. Officer Brown stated that Thompson could not have a fan. Dkt. Nos. 44-1 ¶ 25; 57 ¶ 25. Officer Brown also told Thompson that she at least needed to cover herself with a sheet. Dkt. Nos. 44-1 ¶ 25; 57 ¶ 25.

At approximately 9:00 p.m., Officer Brown observed that Thompson had not covered herself. Dkt. No. 44-1 ¶ 26. When asked, Thompson stated that she was uncovered because she was hot. Dkt. No. 55-17, at 31-32. More specifically, Thompson stated that she felt like she was having a heat stroke. Dkt. No. 56-27. Officer Brown also observed feces stains on Thompson’s underwear. Id. Because Thompson remained uncovered, Officer Brown placed Thompson on twenty-four (24) hour cell restriction for insubordination. Dkt. No. 44-1 ¶ 27.

During each hourly check from 6:00 p.m. Thursday until 6:00 a.m. Friday, Officer Brown found Thompson lying in her bed. Dkt. No. 55-17, at 43.

Starting Thursday, Thompson did not leave her cell (other than in the instances described below). Dkt. No. 55-1, at 39. She spent most of her time lying down. Dkt. No. 55-6, at 12.

8. Day 8: Friday, May 15, 2009

a. Night Shift

At approximately 6:00 a.m. on Friday, May 15, Officer Brown conducted her hourly rounds. After reaching Thompson’s cell, Officer Brown noticed that Thompson had soiled herself. Dkt. No. 55-5, at 16. Officer Brown backed away. Id. She then ridiculed Thompson for not showering or cleaning herself. Id. at lb-17. Officer Brown stated, “Just because you women come to jail doesn’t mean you have to stop being women; you can still take care of yourself.” Id.

b. Day Shift

Officer Parker was the C-Pod officer from 6:00 a.m. until 6:00 p.m. on Friday, May 15. During the shift change, Officer Brown relayed to Officer Parker that Thompson was on cell restriction for insubordination related to being unclothed. Dkt. No. 55-4, at 13-14.

During her first hourly round, Officer Parker spoke with Thompson. Specifically, she discussed Thompson’s earlier insubordination with regards to being unclothed. Id. at 20-21. She also asked Thompson if she was “okay.” Id. Thompson acknowledged that she was okay. Id. Officer Parker noted that it was early in the morning and Thompson was sleepy and groggy. Id. at 21.

On her second hourly round, Officer Parker aroused Thompson from sleep to ensure that she was , conscious and alert. Id. at 26. Officer Parker asked Thompson if she felt better and let Thompson know that she was there if Thompson needed anything. Id. Thompson stated that she did not feel better. Id. at 26-27. Officer Parker checked on Thompson during each subsequent hourly round. Id. at 25. Each time, Thompson was in her bed, and Officer Parker had similar interactions with Thompson. Id. at 25, 27. At som’e point, Officer Parker observed Thompson walking around: Id. at 19.

Someone ate half of Thompson’s lunch. Id. at 27. It is unknown whether Thompson or her roommate, Inmate Patricia Dixon, consumed the meal. Id. at 27-28.

Around lunchtime, Thompson smelled very bad. Dkt. No. 55-10, at 18-19. She vomited on her sheets. Id. at 19. Her skin was yellow. Id. She was hallucinating. Id.

Sometime Friday, Thompson complained to Inmate Chandler Lloyd that her rib hurt. Id. at 16.

Multiple times throughout the day, Thompson and her roommate, Inmate Dixon, notified Officer Parker that Thompson did not feel well. Dkt. No. -57-1 ¶ 48. Officer Parker checked on Thompson after each request. Dkt. Nos. 5.5-4, at 24-25; 57-1 ¶ 48. Officer Parker also called GCDC medical staff multiple times during the day to report that Thompson did not feel well, was not eating, and was lying down. Dkt. No. 55-4, at 35; 57-1 ¶48. Thompson saw medical personnel at least two (2) times during Officer Parker’s shift. Dkt. No. 55-4, at 42.

Before dinner, at approximately 5:00 or 6:00 p.m., Inmate Morgan Medlin found Thompson in her cell covered in feces, urine, and vomit. Dkt. No. 55-6, at 16-17. Thompson walked to the bathroom, where some inmates undressed and bathed her. Dkt. Nos. 55-5, at 18; 55-6, at 16, 25. Other inmates cleaned Thompson’s room. Dkt. No. 55-6, at 25.

Before dinner, Officer Parker noted that Thompson appeared “more alert.” Dkt. No. 55^4, at 29. Consequently, Officer Parker made Thompson come out of her room to get her dinner tray. Id. Thompson sat down in the open area to eat. Id. Officer Parker saw Thompson take bites of her meal; however, Inmate Smith observed that Thompson ate almost nothing. Id. at 29-30; Dkt. No. 55-5, at 26. Inmate Smith notified an unknown officer that Thompson had not eaten all week. Dkt. No. 55-5, at 26.

c. Night Shift

While Thompson had dinner, Officer Parker’s shift ended. Dkt. No. 55-4, at 29-30. At 6:00 p.m., Officer Carnette, Master Sergeant Jones, and Nurse Orr’s shifts began. Dkt. Nos. 55-3, at 9; 55-4, at 29-30; 55-12, at 182.

After Officér Carnette’s shift began, inmates told her that Thompson needed medical attention' because she had been soiling herself. Dkt. No. 55-5, at 48. Officer Carnette notified medical personnel. Id. Officer Carnette stated that all that she could do was notify medical personnel. Id. at 48 — 19.

At approximately 6:30 p.m., Thompson was vomiting and dry heaving. Dkt. No. 55-8, at 27-28.

At approximately 6:30 p.m., Nurse Orr was delivering medications in the C-Pod. Id. at 27. Several inmates told Nurse Orr that Thompson was hallucinating, breaking out in hives, vomiting, pale, and in need of medical care. Id. at 48-49. Nurse Orr yelled, “[Thompson’s] putting on the greatest show[] for y’all in the world. She’s one of the best actors. Nothing is wrong with this girl.” Id. at 26.

At 7:00 p.m., Thompson walked to Nurse Orr’s medication cart and received her medication. Dkt. No. 56-18. Nurse Orr noted in Thompson’s medical record that Thompson walked to the medication cart unassisted and without difficulty. Dkt. No. 56-68, at 3. Nurse Orr also noted that Thompson was awake and alert. Id.

At approximately 7:00 p.m., Inmate Smith told Nurse Orr that Thompson needed “help” because she had not eaten all week, was not drinking, and was not getting up or doing any activity. Dkt. No. 55-5, at 31-32. 'Inmate Smith also told Nurse Orr that she had showered Thompson that night. Id. at 32. Nurse Orr told Inmate Smith that she was not a doctor and that she should let him do his job. Id.

Sometime Friday evening, an inmate told Officer Carnette that Thompson vomited. Dkt. No. 55-16, at 71. Officer Carnette notified Nurse Orr. Id. at 72. Officer Carnette • told the inmate that if Thompson threw up again, Officer Carnette needed to see it. Id.

Inmates continued to tell Officer Carnette that Thompson needed medical attention. Dkt. No. 55-3, at 9-10. Around 7:00 p.m., Officer Carnette told Master Sergeant Jones about the inmates’ complaints. Id. Master Sergeant Jones came to C-Pod. Id. at 10. He observed Thompson sitting at a table in C-Pod watching television. Id. at 13-14. He called Nurse Orr to report the inmates’ request that Thompson receive medical care. Id. at 11. Some inmates pushed on the officer station glass where Officer Carnette and Master Sergeant Jones were stationed until Master Sergeant Jones assured them that medical staff was on its way to see. Thompson. Id. Officer Carnette stated that all that she could do was call the, medical staff, and that it was out of her hands after that. Dkt. No. 55-5, at 22. Master Sergeant Jones left C-Pod when Nurse Orr arrived. Dkt. No. 55-3, at 13.

Sometime Friday night, Inmate Smith told Master Sergeant Jones that Thompson needed help because she had not eaten all week, was hallucinating, was weak, and could not get up and shower. Dkt. No. 55- 5, at 18, '21. Inmate Smith also told Master Sergeant Jones that she assumed that Thompson was withdrawing from drugs. Id. at 21. Master Sergeant Jones commented generally that inmates broke laws, were addicts, and needed to learn how to deal with the consequences of their actions. Id. at 18, 20. He specifically told Inmate Smith that she was an inmate and addict, that she was not a doctor, and that she needed to mind her own business. Id. at 20.

At approximately 7:30 p.m., Thompson urinated on herself. -Dkt. Nos. 55-5, at 46; 56- 18, at 1 (referencing Thompson and Inmate Lloyd walking to showers).

Between 7:30 and 11:00 p.m., Thompson’s condition deteriorated. Dkt. No. 55-5, at 19. She had hot and cold sweats. Id. She “hollered” when inmates touched her. Id.

At approximately 8:30 p.m., Officer Carnette notified Nurse Orr that Thompson was vomiting and complained of feeling bad. Dkt. Nos. 55-12, at 184; 57 ¶ 28. At 8:45 p.m., Nurse Orr and Officer Carnette entered Thompson’s cell.’ Dkt. No. 56-18, at 3. Nurse Orr and Officer Carnette exited the cell a few minutes later. Id. They returned to the cell at 9:10 p.m. Id. During one of these visits, Nurse Orr assessed Thompson. Nurse Orr did not recall if Thompson remained supine during his assessment. See Dkt. No. 55-11, at 187-88. Nurse Orr questioned Thompson about her complaints. Thompson said that she was nauseous, vomited, felt bad, and was withdrawing from Oxycontin. Dkt. Nos. 55-12, at 184; 56-68, at 3. Nurse Orr checked Thompson’s blood pressure and pulse. Dkt. No. 56-68, at 3. These vital signs were within the normal range. Dkt. No. 55-12, .at 189. Nurse Orr noted in Thompson’s medical chart that he saw no signs or symptoms of distress and that Thompson was awake and alert. Id. at 187-89; Dkt. No. 56-68, at 3. Nurse Orr also noted in the chart that. Thompson should follow-up with the doctor the following morning. Dkt. Nos. 55-12, at 192-93; 56-68, at 3.

Just prior to lockdown at 11:00 p.m., Officer Carnette noted that Thompson was in her cell speaking with several inmates. Dkt. No. 57-1 ¶ 57. The inmates left Thompson’s room at lockdown. •

After lockdown, Inmate Medlin heard Thompson crying, asking for help, and asking for her boyfriend. Dkt. No. 55-6, at 24. Inmate Lloyd heard Thompson making mumbling sounds and apologizing to her grandmother and mother. Dkt. No. 55-10, at 27.

9. Day 9: Saturday, May 16, 2009

a. Events Leading up to Thompson’s Death

At approximately 1:30 a.m. on Saturday, May 16, Officer Carnette conducted her hourly rounds. Dkt. No. 57-1 ¶ 58. She saw Thompson lying in bed. Dkt. No. 55-16, at 83.

Shortly after 2:00 a.m., Thompson moved from her bed and lay next to Inmate Dixon on Inmate Dixon’s mattress. Inmate Dixon banged on the cell door to get the officers’ attention. Dkt. No. 57-1 ¶ 59.

After being relieved at her station, Officer Carnette responded to Inmate Dixon’s call. See Dkt. No. 56-18, at 4. Officer Carnette instructed Thompson to return to her bed. Dkt. No. 57-1 ¶ 59. Thompson responded that she could not move. Id. Officer Carnette asked Inmate Dixon’ if Thompson fell. Id. Inmate Dixon stated that Thompson had not fallen. Id. Officer Carnette again instructed Thompson to return to her bed. Id. Thompson again responded that she could • not move. Id.

Inmate Dixon told Officer Carnette that Thompson was hallucinating. Dkt. No. 55-4, at 73. Officer Carnette observed that Thompson did not appear to be in distress, that her speech was not slurred, and that she spoke normally. Id. at 68, 70. Officer Carnette also noted that Thompson made “cooing” noises. Id. at 74.

Officer Carnette summoned Sergeant Gary Hollingsworth. Dkt. No. 57-1 ¶ 59. As he entered C-Pod, Sergeant Hollingsworth said to C-pod in general, “What kind of show is [Thompson] putting on for you guys tonight?” Dkt. No. 55-10, at 28.

Officer Carnette told Sergeant Hollingsworth that she was concerned about how to handle Thompson crawling into Inmate Dixon’s bed. Dkt. No. 57-1 ¶¶ 59, 61. Officer Carnette and Sergeant Hollingsworth went to Thompson’s cell. Id. ¶ 59. Thompson remained on Inmate Dixon’s mattress on the floor with her forehead under the lower bunk. Id. Sergeant Hollingsworth tried to talk to Thompson three (3) times. Thompson did not respond. Id. ¶ 61. She appeared to be sleeping. Dkt. No. 55-2, at 51. In an attempt to goad Thompson into responding, Sergeant Hollingsworth talked about Thompson to Officer Carnette. Dkt. No. 57-1 ¶ 61. Thompson did not respond. Id.

Sergeant Hollingsworth touched Thompson between her face and neck, thought that he felt a pulse, and noted that she did not feel cold. ■ Id. Sergeant Hollingsworth heard Thompson breathing. Dkt. No. 55-2, at 53. He described it as “nice and smooth.” Id. He-also noted that Thompson snored. Id. at 52-53.

During Officer Carnette and Sergeant Hollingsworth’s visit to Thompson’s cell, Inmate Dixon asked to be moved. Dkt. No. 57-1 ¶ 59. To prevent a fight, the officers removed Inmate Dixon from the cell. Dkt. Nos. 55 — 4, at 85-86; 57-1 ¶ 62.

Inmate Medlin asked Sergeant Hollingsworth if Inmate Medlin should sleep with Thompson so that Thompson was not left alone. Dkt. No. 55-6, at 20. Sergeant Hollingsworth said that there was “nothing wrong with [Thompson]” and that “she was putting on a good show.” Id. at 20-21.

At approximately 2:20 a.m., the officers closed Thompson’s cell door. Dkt. Nos. 55-2, at 52, 54; 56-18, at 4. Sergeant Hollingsworth heard a louder response from Thompson as the door closed. Dkt. No. 55-2, at 52, 54. Inmate Lloyd heard a guzzle-like sound when the door closed. Dkt. No. 55-10, at 30. That was the last sound that Inmate Lloyd heard from Thompson. Id. Officer Carnette and Sergeant Hollingsworth notified Nurse Orr about Thompson’s condition, including her hallucinations, assertions that she could not move, and her cooing noises. Dkt. No. 55-16, at 77-78. Sergeant Hollingsworth instructed Officer Carnette to check on Thompson in a “few minutes.” Dkt. No. 55-2, at 52.

Inmate Medlin last heard a sound from Thompson approximately thirty (30) minutes after Inmate Dixon was removed from Thompson’s room. Dkt. No. 55-6, at 24.

At approximately 2:45 a.m., Officer Carnette conducted her hourly rounds. Dkt. No. 56-18, at 4. She looked through Thompson’s cell door window and noticed that Thompson remained on the mattress on the floor. Dkt. No. 55-16, at 85. Officer Carnette opened the door and called out Thompson’s name. Dkt. No. 57-1 ¶ 63. Thompson did not reply. Id. Officer Carnette banged her keys on the desk in Thompson’s room. Id. Thompson did not-respond. Id. Officer Carnette left the cell. Id. She summoned Sergeant Hollingsworth and Nurse Orr. Id.

At approximately 2:50 a.m., Officer Carnette and Sergeant Hollingsworth returned to Thompson’s cell. Dkt. No. 55-16, at 88. Sergeant Hollingsworth did not find a pulse in Thompson’s neck. Dkt. No. 55-2, at 56. He noticed that she was cold and pale. Id. Thompson was not breathing. Id.

Nurse Orr entered Thompson’s cell shortly after Officer Carnette and Sergeant Hollingsworth. Dkt. No. 56-18. Thompson was nonresponsive and unconscious. Dkt. No. 57-1 ¶ 64. Nurse Orr and Officer Carnette said, “This isn’t funny.” Dkt. No. 55-6, at 21.

Nurse Orr attempted to' arouse Thompson by placing an ammonia strip under Thompson’s nose. Dkt. No. 57-1 ¶ 64. Thompson did not respond. Id. Nurse Orr found no pulse. Id. The officers moved Thompson to the hallway — where there was -more- room — and commenced CPR. Id.; Dkt. No. 55-16, at 91.

The officers told GCDC personnel to summon EMS. Dkt. No. 56-68, at 4. EMTs arrived and continued administering CPR. Dkt. No. 56-18, at 4. Thompson exhibited no signs of life. Dkt. No. 57-1 ¶ 64.

b. Events After Thompson’s Death

At approximately 7:30 a.m., Undersheriff Ron Corbitt, Captain Alston, and other officers entered and exited Thompson’s cell. Dkt. No. 55-5, at 36. A few minutes later, officers entered Thompson’s cell with látex gloves, paper towels, spray bottles, and trash bags. Id. at 37. They cleaned Thompson’s cell in approximately ten (10) minutes. Id.

A couple of hours after Thompson’s cell was cleaned, Georgia Bureau of Investigation (“GBI”) agents arrived and investigated Thompson’s death.. Id.

10. Inmates’ Observations

Many inmates noted that Thompson’s condition progressively worsened throughout her detention. Dkt. No. 57-1 ¶ 65. From their perspective, Thompson was obviously ill. Id.

C. Autopsy

An autopsy showed that Thompson died from necrotizing tracheobroncitis (i.e., a dying and inflamed airway). Dkt. No. 55-24, at 13-14, 28. She had pneumonia in both lungs, was septic due to staphylococcus and E. Coli infections, and had a small pocket of pus in her heart muscle. Id. at 14-15, 23. Thompson’s toxicology report indicated a positive result for hydrocodone at a subtherapeutic level. Id. at 25. Toxicology results also revealed the presence of Benadryl and Promethazine (at a sub-therapeutic level), both of which Thompson was still taking on May 15. Dkt. Nos. 55-II, at 220;, 55-24, at 25-26. There were no signs of external trauma. Dkt. No. 55-24, at 14.

Dr. Gunderson’s opined that Thompson’s condition took several days to develop. Dkt. No. 55-18, at 81; see also Dkt. No. 55-24, at 17 (opining that the infection took more than a, few hours but less than a week to develop).

III. LEGAL STANDARD

Summary judgment is appropriate “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). A fact is “material” if it “might affect the outcome of the suit under the governing law.” FindWhat Investor Grp. v. FindWhat.com, 658 F.3d 1282, 1307 (11th Cir.2011) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986)). A dispute over such a fact is “genuine” if the “evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id. In making this determination, the court is to view all of the evidence in the light most favorable to the nonmoving party and draw all reasonable inferences in that party’s favor. Johnson v. Booker T. Washington Broad. Serv., Inc., 234 F.3d 501, 507 (11th Cir.2000).

The party seeking summary judgment bears the initial burden of demonstrating the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). To satisfy this burden, the movant must show the court that there is an absence of evidence to support the nonmoving party’s case. Id. at 325, 106 S.Ct. 2548. If the moving party discharges this burden, the burden shifts to the nonmovant to go beyond the pleadings and present affirmative evidence to show that a genuine issue of fact does exist. Anderson, 477 U.S. at 257, 106 S.Ct. 2505.

IV. FEDERAL LAW CLAIMS

A. Count 1: Claims Against Defendant Glynn County

In Count 1, Plaintiff brings claims against Defendant Glynn County pursuant to 42 U.S.C. § 1983. Specifically, Plaintiff asserts that Defendant Glynn County had a policy, practice, or custom of deliberate indifference to detainees’ serious medical needs that led to the violation of Thompson’s Fourteenth Amendment rights. See Dkt. No. 1 ¶¶ 37-49.

Defendants moved for summary judgment on Count 1. -Defendants argue that there is no municipal liability under § 1983 because (1) Plaintiff failed to identify a custom, practice, policy, or act of a final policymaker that caused Plaintiffs injury and (2) there is no evidence that any alleged policy or custom was the moving force behind the events at issue in this case. See Dkt. No. 44-2, at 26-27. For the reasons stated below, summary judgment as to Count 1 is GRANTED.

1. Legal Standard

“A municipality may not be held liable under section 1983 on a theory of respondeat superior.” Snow ex rel. Snow v. City of Citronelle, Ala., 420 F.3d 1262, 1270-71 (11th Cir.2005) (citing City of Canton v. Harris, 489 U.S. 378, 109 S.Ct. 1197, 103 L.Ed.2d 412 (1989)): Therefore, even if the individual defendants violated Thompson’s constitutional rights, the County is not necessarily liable. To impose § 1983 liability on a municipal entity, a plaintiff must show: “(1) that [her] constitutional rights were violated; (2) that the municipality had a custom or policy that constituted deliberate indifference to that constitutional right; and (3) that the policy or custom caused the violation.” Bankshot Billiards, Inc. v. City of Ocala, 634 F.3d 1340, 1349 (11th Cir.2011) (quoting McDowell v. Brown, 392 F.3d 1283, 1289 (11th Cir.2004)).

A policy is a “decision that is officially adopted by the municipality, or created by an official of such rank that he or she could be said to be acting on behalf of the municipality.” Cooper v. Dillon, 403 F.3d 1208, 1221 (11th Cir.2005) (citing Sewell v. Town of Lake Hamilton, 117 F.3d 488, 489 (11th Cir.1997)). Because a municipality is unlikely to maintain an official policy that endorses a constitutional violation on its face, a plaintiff typically must show that (1) the municipality had a custom or practice permitting a constitutional violation and (2) the custom or practice was the moving force behind the constitutional violation. Craig v. Floyd Cnty., Ga., 643 F.3d 1306, 1310 (11th Cir.2011) (citing Grech v. Clayton Cnty., Ga., 335 F.3d 1326, 1329 (11th Cir.2003)).

A custom “is a practice that is so settled and permanent that it takes on the force of law.” Cooper, 403 F.3d at 1221 (citing Sewell, 117 F.3d at 489). It .must be so “longstanding and widespread ... that it is deemed authorized by the policy-making officials because they must have known about it but failed to stop it.” Craig, 643 F.3d at 1310- (citation and alterations omitted). This requirement “prevents the imposition of liability based upon an isolated incident” and “ensures that a municipality is held liable only for those deprivations resulting from the decisions of its duly constituted legislative body or of those officials whose acts may fairly be said to be those of the municipality.” Id. (internal citations and punctuation omitted). An act performed pursuant to a custom “may fairly subject a municipality to liability on the theory that the relevant practice is so widespread as to have the force of law.” Id. (quoting Bd. of Cnty. Comm’rs v. Brown, 520 U.S. 397, 404, 117 S.Ct. 1382, 137 L.Ed.2d 626 (1997)) (internal citation omitted).

A plaintiff cannot rely only on her individual treatment to establish a policy or custom, even if she is treated on multiple days by different defendants. See Goebert v. Lee Cnty., Fla., 510 F.3d 1312, 1332 (11th Cir.2007); Craig, 643 F.3d at 1311-12 (summarizing McDowell, 392 F.3d 1283). Moreover, a “single incident of a constitutional violation is insufficient to prove a policy or custom even when the incident involves several employees of the municipality.” Craig, 643 F.3d at 1311.

2. Application

In Count 1, Plaintiff asserts that Glynn County had policies and/or customs of deliberate indifference to pretrial detainee’s serious medical needs in contravention of their rights under the Fourteenth Amendment. See Dkt. No. 1 at ¶¶ 37-49. Specifically, Plaintiff avers that Glynn County’s policies were to “deny basic medical care to inmates or detainees in the-hope that the inmate[s] or detainee[s] could survive with untreated medical conditions until they were released from the [GCDC];” “to disregard an excessive risk to [a detainee’s] health despite” knowledge of the risk; to utilize LPNs and “prison officials with very little, if any, medical training and no ability to evaluate [or treat a detainee’s] condition; to provide medical care that was so “cursory” that it amounted to “no care at all;” to delay medical care; to not take detainees to the hospital despite knowledge of illness to avoid paying for medical care; and to under-staff the GCDC. Dkt. No. 1 ¶¶ 41-47.

In her response to Defendants’ motion for summary judgment, Plaintiff asserts that Sheriff Bennett’s — and, thus, the County’s — policies were to consider detainees’ complaints to be lies “unless there was physical evidence of their illness;” to allow detention officer to assess a detainee’s medical complaint and exercise discretion as to how to act; to afford detention officers discretion as to whether a detainee’s refusal to eat was cause for concern and action; to allow' detention officers to place detainees on twenty-four (24) hour cell restriction without getting supervisor or disciplinary committee approval; and to budget such that the GCDC could not afford more doctors or registered nurses. Dkt. No. 53, at 66-68.

a. Policy

The evidence does not reveal an official County or GCDC policy that facially endorsed the violation of a detainee’s constitutional rights. Plaintiff concedes that the County’s written policies were facially constitutional. See id. at 66 (stating only that the written policies were not followed).

Plaintiff asserts that Sheriff Bennett set official county policies that were not contained in the GCDC’s written materials; however, Plaintiff provided no evidence that the purported deficiencies in Thompson’s case resulted from policies enacted or adopted by the County or Sheriff Bénnett. Because Plaintiff provided no evidence that unconstitutional “policies” regarding detainees’ medical care at the GCDC were officially adopted by the County or an official capable of acting on behalf of the County, the Court cannot conclude that the County had a policy that facially endorsed the violation of a detainee’s constitutional rights.

b. Custom or Practice

Plaintiff has not provided evidence of another occasion when the GCDC’s alleged customs or practices contributed to or exacerbated a detainee’s medical condition. . Thompson’s isolated, albeit tragic, incident does not provide evidence of the County or GCDC’s “persistent” or “widespread” custom or practice. See Craig, 643 F.3d at 1311 (quoting McDowell, 392 F.3d at 1290-91). Plaintiffs proof of a custom or practice rests entirely on a “single incident of unconstitutional activity.” See id. (quoting City of Oklahoma City v. Tuttle, 471 U.S. 808, 823-24, 105 S.Ct. 2427, 85 L.Ed.2d 791 (1985)). This is “not sufficient to impose liability” against the County. See id.

Plaintiff failed to present evidence that the alleged constitutional violation was done pursuant to an official policy or an unofficial custom or practice of Glynn County. Perry v. Greene Cnty., Ga., 392 Fed.Appx. 761, 765 (11th Cir.2010). Consequently, Defendants’ request for summary judgment on Count 1 is GRANTED.

B. Count 7: Claims Against Defendants Orr, Brown, Camette, and Hollingsworth in their Individual Capacities

In Count 7, Plaintiff brings- claims against Defendants Orr, Brown, Carnette, and Hollingsworth pursuant to 42 U.S.C. § 1983. Specifically, Plaintiff asserts that these defendants were deliberately, indifferent to Thompson’s serious medical needs in violation of the Fourteenth Amendment. See Dkt. No. 1 at ¶¶ 77-82.

Defendants moved for summary judgment for two (2) reasons. First, Defendants contend that they did not violate Plaintiffs Fourteenth Amendment rights. Second, Defendants contend that they are entitled to qualified immunity. For the reasons stated below, summary judgment as to Count 7 is GRANTED IN PART and DENIED IN PART.

1. Substantive Constitutional Violation

a. Legal Standard

Deliberate indifference to a pretrial detainee’s serious medical needs is a violation of the detainee’s Fourteenth Amendment rights. See Goebert v. Lee Cnty., 510 F.3d 1312, 1326 (11th Cir.2007) (referring to prisoner and Eighth Amendment). To prove deliberate indifference, a plaintiff must show three (3) things. First, she must show that the detainee had a serious medical need. Id. (citing Bozeman v. Orum, 422 F.3d 1265, 1272 (11th Cir. 2005) (per curiam)). This is an objective inquiry. Id. Second, she must show that the defendant acted with deliberate indifference to the detainee’s serious medical need. Id. (citing Bozeman, 422 F.3d at 1272). This is a subjective inquiry. Id. Third, the plaintiff must show that the defendant’s wrongful conduct caused the detainee’s injury. Id. (citing Hale v. Tallapoosa Cnty., 50 F.3d 1579, 1582 (11th Cir.1995)).

i. Objectively Serious Medical Need

First, a plaintiff must show that the detainee had an objectively serious medical need. “A medical need that is serious enough to satisfy the objective component ‘is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.’ ” Id. (quoting Hill v. Dekalb Reg'l Youth Det. Ctr., 40 F.3d 1176, 1187 (11th Cir.1994), overruled in part on other grounds by Hope v. Pelzer, 536 U.S. 730, 739 n. 9, 122 S.Ct. 2508, 153 L.Ed.2d 666 (2002)).

ii. Acted with Deliberate Indifference

Second, a plaintiff must show that each defendant acted with deliberate indifference to the detainee’s medical need. This requires proof of three things: “(1) subjective knowledge of a risk of serious harm; (2) disregard of that risk; (3) by conduct that is more than [gross] negligence.” Id. at 1327 (citation omitted) (alteration in original).

Subjective knowledge of the risk requires that the defendant be “aware of facts from which the inference could be drawn that a substantial risk of serious harm exists.” Farmer v. Brennan, 511 U.S. 825, 837, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). It also requires the defendant to “draw the inference.” Id. “Whether a particular defendant has subjective knowledge of the risk of serious harm is a question of fact ‘subject to demonstration in the usual ways, including inference from circumstantial evidence.’ ” Goebert, 510 F.3d at 1327 (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970). Moreover, “a factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious.” Id. (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970). Crucially, the inquiry does not focus on serious medical needs “that [a defendant] should have perceived but did not.” Presley v. City of Blackshear, 650 F.Supp.2d 1307, 1315 (S.D.Ga.2008), aff'd, 340 Fed.Appx. 567 (11th Cir.2009) (citing Burnette v. Taylor, 533 F.3d 1325 (11th Cir.2008)) (emphasis added). Rather, the official must have actually perceived the medical need. See id. Finally, “imputed or collective knowledge cannot serve as the basis for a claim of deliberate indifference. Each individual Defendant must be judged separately and on the basis of what that person kn[ew].” Id. (quoting Burnette, 533 F.3d at 1331).

After showing the defendant’s subjective awareness of the substantial risk of harm, the plaintiff must show that the defendant “disregarded] that risk by failing to take reasonable measures to abate it.” Farmer, 511 U.S. -at 847, 114 S.Ct. 1970. Thus, even if a defendant “actually knew of a substantial risk to [detainee] health or safety[, she] may be found free from liability if [she] responded reasonably to the risk, even if the harm ultimately was not averted.” Id. at 844, 114 S.Ct. 1970. “Disregard of the risk is .... a question of fact that can be shown by standard methods.” Goebert, 510 F.3d at 1327 (citation omitted).

Finally, the plaintiff must show that the defendant’s conduct constituted more than gross negligence. “The meaning of ‘more than gross negligence’ is not self-evident.” Id. However, case law provides some guidance. Id. Notably, “[e]ven where medical care is ultimately provided, a prison official may nonetheless act with deliberate indifference by delaying the treatment of serious medical needs.” Pourmoghani-Esfahani v. Gee, 625 F.3d 1313, 1317 (11th Cir.2010) (citing McElligott v. Foley, 182 F.3d 1248, 1255 (11th Cir.1999)). Where a plaintiff is harmed by a delay in the provision of medical care, courts consider: “(1) the seriousness of the medical need; (2) whether the delay worsened the medical condition; and (3) the reason for the delay.” Goebert, 510 F.3d at 1327 (citing Hill, 40 F.3d at 1189). However, “accidental inadequacy, negligence in diagnosis or treatment, [and] medical malpractice” are insufficient to sustain a claim of deliberate indifference. Nimmons v. Aviles, 409 FedAppx. 295, 297 (11th Cir.2011) (per curiam) (quoting Taylor v. Adams, 221 F.3d 1254, 1258 (11th Cir.2000)).

Hi. Causation

Finally, a plaintiff must show that “the constitutional violation caused the injury.” Cottone v. Jenne, 326 F.3d 1352, 1358 (11th Cir.2003); Goebert, 510 F.3d at 1327. Causation “can be shown by personal participation in the constitutional violation.” Goebert, 510 F.3d at 1327 (citing Zatler v. Wainwright, 802 F.2d 397, 401 (11th Cir.1986) (per curiam)).

b. Application

Plaintiff alleges that four (4) defendants violated Thompson’s Fourteenth Amendment rights through deliberate indifference to Thompson’s medical needs. See Dkt. No. 1 ¶¶ 77-82.

i. Objectively Serious Medical Need

Construing the facts in Plaintiffs favor, Thompson entered the GCDC with bruised or fractured ribs. While at the GCDC, Thompson developed a rash. These conditions were diagnosed and treated by medical personnel. Consequently, these conditions were objectively serious medical needs. Goebert, 510 F.3d at 1326 (stating that a medical need satisfies the objective component if it “has been diagnosed by a physician as mandating treatment”).

Also while detained, Thompson developed necrotizing tracheobroncitis (i.e., a dying and inflamed airway), pneumonia, and a small pocket of pus in her heart muscle. Thompson also became septic. Prior to Thompson’s autopsy, there was no clinical diagnosis related to these conditions. Therefore, Plaintiff had a serious medical need with regards to these conditions only if the need was “so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.’ ” Id. (citation omitted).

Plaintiff does not contend that Thompson’s medical needs were serious on the day that she was detained. Specifically, Plaintiff does not question Thompson’s care prior to her last visit with Dr. Gunderson on Tuesday, May 12 at 9:30 a.m. At some time during her detention, however, Thompson lost control of her bowels, began to hallucinate, and vomited repeatedly. Thompson also became pale and developed blisters inside her mouth. These facts— taken collectively — would undoubtedly alert a lay person to the necessity of medical attention. See, e.g., Aldridge v. Montgomery, 753 F.2d 970, 972 (11th Cir.1985) (finding serious need where one-and-a-half-inch cut over detainee’s eye was allowed to bleed for two and one-half hours before sutured). Consequently, Thompson had an objectively serious medical need when these symptoms manifested.

ii. Deliberate Indifference to the Medical Need

Whether a particular defendant was subjectively deliberately indifferent is a unique inquiry as to each individual. See Presley, 650 F.Supp.2d at 1315 (recognizing that imputed or collective knowledge is insufficient for a claim of deliberate indifference) (quoting Burnette, 533 F.3d at 1331). Each defendant encountered Thompson under different circumstances. Consequently, the Court now carefully and separately analyzes whether Defendants Orr, Brown, Carnette, ’ and Hollingsworth were deliberately indifferent to Thompson’s medical needs. See Burnette, 533 F.3d at 1331 (“Each individual Defendant must be judged separately and on the basis of what that person [knew].”).

A. Nurse Orr

Nurse Orr worked night shifts (from 6:00 p.m. until 6:00 a.m.) on Monday, Tuesday, and Friday. Dkt. No. 56-60. Viewing the facts in the light most favorable to Plaintiff, Nurse Orr’s knowledge and actions were as follows:

On Monday at 6:00 p.m., Nurse Orr knew that Inmate Smith suspected that Thompson was withdrawing from drugs. See Dkt. Nos. 55-5, at 39; 56-60; see also supra note 10. By Monday night, Nurse Orr knew that Thompson had rashes on her body, vomited one time, and complained of nausea and of her throat and chest “tightening up.” ■ Dkt. Nos. 44-1 ¶ 16; 55-11, at 167; 57 ¶ 16. Nurse Orr also knew that Dr. Gunderson prescribed medication for Thompson’s condition and would personally evaluate Thompson Tuesday morning. Dkt. Nos. 44-1 ¶¶ 17,19; 57 ¶¶ 17,19.

Because Nurse Orr handed out medications during his evening shifts, Nurse Orr knew that Thompson took multiple medications related to her injured rib and skin rashes.

On Friday at approximately 6:30 p.m., Nurse Orr knew that Thompson was hallucinating, breaking out in hives, vomiting, pale, and in need of medical care. Dkt. No. 55-8, at 48-49. On Friday at 7:00 p.m., Nurse Orr observed Thompson walk unassisted to the medication cart to receive her medications. Dkt. Nos. 56-18; 56-68, at 3. Nurse Orr noted that Thompson was awake and alert. Dkt. No. 56-68, at 3. Also at approximately 7:00 p.m., Nurse Orr knew that Thompson had not eaten all week, was.not drinking, and was not getting up or doing any activity. Dkt. No. 55-5, at 31-32. Nurse Orr also knew that Inmate Smith had showered Thompson on Friday. Id. at 32.

Sometime Friday evening, Officer Carnette told Nurse Orr that an inmate reported seeing Thompson vomit. Dkt. No. 55-16, at 71-72. Also on Friday evening, Master Sergeant Jones relayed inmates’ concerns about Thompson’s need for medical attention to Nurse Orr. Dkt. No. 55-3, at 11. On Friday at approximately 8:30 p.m., Nurse Orr knew that Thompson was vomiting and complained of feeling bad. Dkt. Nos. 55-12, at 184; 57 ¶ 28.

On Friday at 8:45 p.m. or 9:10 p.m., Nurse Orr assessed Thompson. Nurse Orr learned that Thompson was nauseous, vomited, felt bad, and was withdrawing from Oxycontin. Dkt. Nos. 55-12, at 184; 56-68, at 3. Nurse Orr checked Thompson’s blood pressure and pulse and found them to be within the normal range. Dkt. No. 56-68, at 3; 55-12, at 189. Nurse Orr saw no signs or symptoms of distress. He found Thompson to be awake and alert. Dkt; Nos. 55-12, at 187-89; 56-68, at 3. Nurse Orr wrote in Thompson’s medical chart that Thompson should follow-up with the doctor the following morning. Dkt. Nos. 55-12, at 192-93; 56-68, at 3.

On Saturday at approximately 2:20 a.m., Nurse Orr knew about Thompson’s lying on Inmate Dixon’s mattress. Dkt. No. 55-16, at 77-78. He also knew of her hallucinations, assertions that she could not move, and her cooing noises. Id. On Saturday at approximately 2:50 a.m., Nurse Orr knew that Thompson was unconscious and unresponsive.

For the purposes of evaluating Defendants’ Motion, the Court divides Thompson’s medical conditions and Nurse Orr’s related and relevant knowledge of those conditions into three (3) segments. The Court evaluates each segment separately.

1. Friday Morning to Wednesday Morning.

The first time period spans from the time of Thompson’s detention until after Nurse Orr left work at 6:00 a.m. on Wednesday morning. Thompson did not have an untreated, objectively serious medical need until she developed rashes on Monday night. See supra Part IV.B.l.b.i. Nurse Orr knew of this medical need and responded appropriately to it. Specifically, he assessed Thompson^ condition, called Dr. Gunderson, and complied with Dr. Gunderson’s orders. Consequently, Plaintiff does not suggest that Nurse Orr was indifferent to Thompson’s medical needs at this time.

Nurse Orr’s only other interactions with Thompson during either of his shifts on Monday and Tuesday nights were when he delivered medications to Thompson as part of his routine delivery schedule. Plaintiff does not suggest that Nurse Orr improperly interacted with Thompson on these occasions. Moreover, Plaintiff did not develop any other manifestations of a serious medical need, such as hallucinations and uncontrolled urination and defecation, until sometimes Wednesday.

In summary, Thompson had an objectively serious medical need — rashes—during this first time period. Nurse Orr responded appropriately to this need. Consequently, Nurse Orr is entitled to summary judgment on the deliberate indifference claims that are based on conduct that occurred during this time period.

2. Friday Evening.

The second time period spans from the time that Nurse Orr’s shift began at 6:00 p.m. Friday evening until after he last assessed Thompson at approximately 9:10 p.m. on Friday.

From approximately 6:30 p.m. to 8:45 p.m., Nurse Orr learned the following facts: Thompson had not eaten all week, was not drinking, was not getting up or doing any activity, was hallucinating, broke out in hives, was vomiting, was pale,'complained of feeling bad, had been showered by another inmate, and needed medical care. During his delivery of medications at approximately 6:30 p.m. to 7:00 p.m., Nurse Orr yelled, “[Thompson’s] putting on the greatest show[] for y’ all in the world. She’s one of the best actors. Nothing is wrong with this girl.” Dkt. No. 55-8, at 26. Nurse Orr told an inmate who requested medical care for Thompson that the inmate was not a doctor and that she should let him do his job. Dkt. No. 55- 5, at 32.

At 8:45 p.m. and 9:10 p.m., Nurse Orr visited Thompson in her cell. Dkt. No. 56- 18, at 3. During one of these visits, Nurse. Orr assessed and questioned Thompson. Thompson said that she was nauseous, vomited, felt bad, and was withdrawing from Oxycontin. Dkt. Nos. 55-12, at 184; 56-68, at 3. Nurse Orr cheeked Thompson’s blood pressure and pulse. Dkt. No. 56-68, at 3. These vital signs were within the normal range. Dkt. No. 55-12, at 189. Nurse Orr found no signs or symptoms of distress. Dkt. No. 56-68, at 3. He found Thompson to be awake and alert. Dkt. Nos. 55-12, at 187-89; 56-68, at 3. Nurse Orr noted in Thompson’s medical chart that she should follow-up with the doctor the following morning. Dkt. Nos. 55-12, at 192-93; 56-68,.at 3.

Viewing the facts in the light most favorable to Plaintiff, Nurse Orr was subjectively aware that Thompson faced a substantial risk of serious medical harm. First, Nurse Orr knew of Thompson’s serious medical needs. Specifically, Nurse Orr knew that Thompson was hallucinating, withdrawing from Oxycontin, pale, vomiting, had hives, complained of feeling bad, had been showered by another inmate, and needed medical care. He also knew that Thompson was not eating, drinking, or getting up to do any activity. Second, the facts drawn in Plaintiffs favor show that Nurse Orr “dr[ew] the inference” that Thompson faced a substantial risk of serious harm. Fanner, 511 U.S. at 837, 114 S.Gt. 1970. Viewing the facts in Plaintiffs favor, Thompson’s medical needs were serious and obvious. Among other things, she was vomiting, hallucinating, withdrawing from Oxycontin, had hives, and had not eaten all week. Because the seriousness of Thompson’s medical needs was obvious, the Court must conclude — for the purposes of this Order — that Nurse Orr subjectively knew that Thompson faced a substantial risk of serious harm. See Goebert, 510 F.3d at 1327 (“[A] factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious.” (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970)).

Because the Court must draw all inferences in Plaintiffs favor, the Court’s finding is not altered by Nurse Orr’s observations that, at approximately 6:30 p.m., Thompson was awake and alert and walked unassisted to the medication cart to receive her medications. See Dkt. Nos. 56-18; 56-68, at 3. Nor is the Court’s finding altered by the fact that Nurse Orr found no signs and symptoms of distress after questioning Thompson and taking her vital signs at approximately 9:00 p.m. See Dkt. Nos: 55-12, at 184, 189; 56-68, at 3, 56-68, at 3. These facts do not erase Nurse Orr’s knowledge of Thompson’s serious medical needs. Specifically, notwithstanding whether Thompson could walk or answer-Nurse Orr’s questions, Nurse Orr knew that Thompson faced serious harm because he knew that she was hallucinating, vomiting, and withdrawing from Oxycontin. Because a factfinder can conclude from these facts that the risks to Thompson were obvious and, thus, Nurse Orr was subjectively aware of them, this Court must do so. See Goebert, 510 F.3d at 1327.

Nurse Orr also disregarded Thompson’s serious medical needs. First, he outwardly expressed disregard for Thompson’s obvious medical needs when he said, “[Thompson’s] putting on the greatest show[ ] for y’all in the world. She’s one of the best actors. Nothing is wrong with this girl.” Dkt. No. 55-8, at 26. Second, he provided a cursory assessment that allegedly failed to meet the level of care expected from him. See Dkt. No. 55-18, at 43-48, 66-70. Third, he postponed Thompson’s access to medical treatment by failing to call Dr. Gunderson or emergency medical personnel. Dkt. Nos. 55-12, at 192-93; 56-68, at 3. Viewing the evidence in Plaintiffs favor, Nurse Orr failed to take reasonable measures to abate the serious and obvious risks that Thompson faced. Consequently, he disregarded her serious medical needs. See Fanner, 511 U.S. at 847, 114 S.Ct. 1970 (noting that the plaintiff must show that the defendant “disregarded] th[e] risk [of substantial harm] by failing to take reasonable measures to abate it”).

Nurse Orr was more than grossly negligent. See Goebert, 510 F.3d at 1327 (listing the following factors in evaluating the defendant’s actions or omissions: “(1) the seriousness of the medical need; (2) whether the delay worsened the medical condition; and (3) the reason for the delay”). First, Thompson’s medical needs were serious. Second, delay in treatment worsened her condition. See Dkt. No. 57-1 ¶ 97 (providing Dr. Gunderson’s opinion that Thompson’s survival and full recovery were “99%” certain if Dr. Gunderson had been made aware of Thompson’s symptoms on Friday evening). Third, no reason other than Nurse Orr’s disregard for Thompson’s medical treatment caused the delay in Thompson’s medical care. These facts indicate that Nurse Orr was more than grossly negligent.

Finally, Plaintiffs facts show that Nurse Orr’s deliberate indifference to Thompson’s medical needs caused her death. Specifically, Dr. Gunderson stated that he was “99% sure that [Thompson] would have survived and recovered fully” if Dr. Gunderson was made aware of Thompson’s symptoms on Friday, May 15, at 8:30 p.m. See id

Viewing the evidence in Plaintiffs favor, (1) Nurse Orr was subjectively aware that Thompson faced a substantial risk of serious harm; (2) Nurse Orr was more than grossly negligent in disregarding that risk of harm; and (3) Nurse Orr’s actions caused Thompson’s injuries. Consequently, Nurse Orr is not entitled to summary judgment on the deliberate indifference claims that are based on conduct that occurred Friday evening.

S. Saturday Morning.

The third time period spans the brief period from Nurse Orr’s notification that Thompson was lying on her cellmate’s mattress until EMTs arrived at the GCDC.

At approximately 2:20 a.m. on Saturday, Nurse Orr knew that Thompson was lying on Inmate Dixon’s mattress, hallucinating, asserted that she could not move, and made cooing noises. Dkt. No. 55-16, at 77-78. At approximately 2:50 a.m. on Saturday, Nurse Orr was summoned to Thompson’s cell where he found her unconscious and unresponsive. Dkt. No. 55-2, at 56. He admi