Eleventh Circuit Holds Alabama County May Be Liable for Policy of Providing Inadequate Jail Medical Care
by Matt Clarke
On November 20, 2025, the United States Court of Appeals for the Eleventh Circuit held that an Alabama law making sheriffs responsible for jail prisoners’ health care did not excuse a county from liability for having a policy resulting in inadequate prisoner health care. The summary dismissal of a claim against the county in a lawsuit over the death of a jail prisoner was reversed and the case was remanded.
Mitchell Wayne Smothers, Jr. was convicted of fourth-degree possession of a forged instrument. He was booked into Alabama’s Walker County Jail in February 2019. At that time, he had several serious health issues, including liver cirrhosis secondary to hepatitis C, alcoholism, chronic obstructive pulmonary disease, recurrent cellulitis, and nonhealing pressure wounds. Just one month earlier, he was discharged from a hospital after being treated for antibiotic-resistant infections in large, open, nonhealing wounds on his leg.
The County contracted for prisoner health care with Preemptive Forensic Health Solutions (“Preemptive”) which is owned and operated by Roger Childers, a registered nurse with a Ph.D. in Business Administration. He referred to himself and signed communications as “Dr. Childers.” Court documents show the healthcare company was aware of Smothers’s medical condition but nurses changed his bandages twice shortly after booking and then, apparently, discontinued any wound care and Smothers was never seen by a physician.
Prior to being booked into the jail, Smothers was taking antibiotics for the wound infections and several other medications. While he was at the jail, he received no medication other than ibuprofen. Not surprisingly, his health deteriorated. By August 2, 2019, the “swollen” condition of his legs and “difficulty breathing” were so bad that jailers transferred him to a hospital, bypassing Preemptive. He was diagnosed with metabolic encephalopathy, septic shock secondary to cellulitis, a urinary-tract infection, and hepatorenal syndrome. He died of septic shock at the hospital ten days later.
Aided by Jasper, Alabama attorneys Seth L. Diamond and Charles C. Tatum, the estate of Smothers filed a federal civil rights lawsuit against Childers, Preemptive, and Walker County. Childers and Preemptive settled but the County filed a successful motion for summary judgment, claiming it could not be held liable because Alabama law placed responsibility for administering health care at the jail on the sheriff, pursuant to Ala. Code § 14-6-19. The estate appealed.
The Eleventh Circuit noted that inadequate health care at the jail had been an issue long before Smothers died. There had been eleven prisoner deaths at the jail, several allegedly due to inadequate medical treatment, since the first contract with Preemptive was signed in 2009. That contract charged the County one-sixth of its previous costs for jail health care.
In September 2009, before the Preemptive contract, 33 detainees were sent to outside medical providers. By contrast, during its first six years under contract, Preemptive sent less than a dozen detainees to outside medical providers.
Nick Smith challenged the jail’s inadequate health care during his successful 2018 campaign for sheriff. However, the County Commissioners refused to allow Sheriff Smith to cancel the Preemptive contract and even renewed it over his objections.
The Court held that a reasonable jury could find the County “reserved for itself the authority to change its policy of providing inadequate medical care to inmates.” Thus, just as in Ancata v. Prison Health Services, 769 F.2d 700 (11th Cir. 1985), it made itself liable for the inadequate care regardless of state law, as a county is liable when it establishes a policy that violates detainees’ constitutional rights per Monell v. Department of Social Services, 436 U.S. 658 (1978). See: Smothers v. Childers, 159 F.4th 922 (11th Cir. 2025)
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Related legal cases
Smothers v. Childers
| Year | 2025 |
|---|---|
| Cite | 159 F.4th 922 (11th Cir. 2025) |
| Level | Court of Appeals |
Ancata v. Prison Health Services, Inc.
| Year | 1985 |
|---|---|
| Cite | 769 F.2d 700 (11th Cir. 1985). |
| Level | Court of Appeals |
| Attorney Fees | 0 |
| Damages | 0 |
| Injunction Status | N/A |
[1] U.S. Court of Appeals, Eleventh Circuit
[2] No. 84-5923
[3] 769 F.2d 700, 1985
[4] August 26, 1985
[5] CAROL ANCATA, INDIVIDUALLY, AS NATURAL GUARDIAN OF TARA ANCATA, AND AS PERSONAL REPRESENTATIVE OF ANTHONY ANCATA, DECEASED, PLAINTIFF-APPELLANT,
v.
PRISON HEALTH SERVICES, INC., A DELAWARE CORP., SUSAN COLLIGAN, KAREN SUTTON, R. HARGROVE, HENRY BLADY, ROBERT BUTTERWORTH, AND GEORGE BRESCHER, IN HIS CAPACITY AS SHERIFF OF BROWARD COUNTY, DEFENDANTS-APPELLEES
[6] Appeal from the United States District Court for the Southern District of Florida.
[7] Peter M. Siegel; Randall C. Berg, Jr., Miami, Florida, for Appellant.
[8] Bruce W. Jolly, Ft. Lauderdale, Floridas.
[9] Deborah Mann; Robert Klein, West Palm Beach, Florida.
[10] Edward R. Nicklaus, Miami, Florida.
[11] Alexander Cocalis, Ft. Lauderdale, Florida.
[12] Christopher R. Fertig; Lawrence J. Marraffino, Fertig & Gamble, Ft. Lauuderdale, Florida, for Appellee.
[13] Henderson and Clark, Circuit Judges and Tuttle, Senior Circuit Judge. Henderson, Circuit Judge, concurring in part and dissenting in part.
[14] Author: Clark
[15] CLARK, Circuit Judge:
[16] I. FACTS
[17] A. Procedural History
[18] This is an appeal from an order of the district court dismissing all counts of plaintiff's first amended complaint based upon 42 U.S.C. §1983.
[19] Plaintiff is the personal representative of the deceased's, Anthony Ancata's, estate and the guardian of his minor child Tara Ancata. Defendant Prison Health Services is and was the entity responsible for providing medical care to those housed at the Broward County Jail. Defendants Colligan, Sutton, Hargrove and Blady were all medical personnel employed by Prison Health Services, Inc. Robert Butterworth was sued in his official capacity as the sheriff of Broward County at the time of the incidents forming the basis of this lawsuit. Sheriff Brescher was sued in his official capacity as the current sheriff of Broward County. Broward County was sued for its alleged failure to provide adequate funding to address the medical needs of individuals incarcerated there.
[20] Plaintiff's original complaint was filed in August of 1984. Each defendant, other that Prison Health Services, filed a motion to dismiss.*fn1 Before the court ruled on the motions to dismiss, the defendants consented to the filing of an amended complaint. This took place in October of 1984. Counts 1 and 2 of the complaint alleged that all the defendants violated plaintiff's decedent's right to be free from cruel and unusual punishment by the deliberate indifference to his serious medical needs. The remaining counts raised pendent state law claims. After the amended complaint was filed, defendant Broward County and defendant Blady filed motions to dismiss. The district court entered an order on November 19, 1984 dismissing all counts of the complaint against all defendants.*fn2 The district court determined that counts 1 and 2 of the complaint as amended, alleging the constitutional violations, alleged at most, only medical malpractice. Thus, the court determined that dismissal as to all medical defendants was proper. With respect to the non-medical defendants, the district court found that the allegations against them were grounded on notions of respondeat superior and therefore were subject to dismissal. The district court dismissed the pendent state law claims as it had found no valid federal claim.
[21] B. The Facts as Alleged in Plaintiff's Complaint
[22] The facts, as alleged in the plaintiff's complaint, indicate the following. Anthony Ancata was arrested and placed in pre-trial detention at the Broward County Jail on August 20, 1982. On August 29, 1982, he began to suffer from a variety of medical symptoms including swelling of the ankle, inability to sleep, chills, lower back pain, tingling and numbness of his hands, hyperventilation, severe pain in his back and right leg, double vision, and other serious problems. Despite his complaints, Prison Health Services and its employees, defendants Blady, Colligan, Sutton and Hargrove did little or nothing to evaluate the medical needs of Mr. Ancata.*fn3
[23] The defendants did administer such non-prescription drugs as Ben Gay and Tylenol II and suggested an orthopedic or psychiatric evaluation. However, they took no steps to have Ancata examined by either an orthopedic specialist or a psychiatrist. Rather, they informed Ancata and his family that he would not be referred to a non-staff specialist without a court order. Furthermore, they refused to acquiesce in the entry of a court order unless plaintiff agreed to bear the costs of the recommended diagnostic evaluation. Mr. Ancata, however, had already been declared indigent.
[24] Ancata's appointed public defender successfully obtained a court order compelling an evaluation by an orthopedic specialist. The orthopedist recommended a neurological evaluation. However, Prison Health Services would again not agree to a medical evaluation by a neurologist without a court order. The second court order was again obtained by the public defender representing Mr. Ancata. After the neurological examination was conducted, Anthony Ancata was hospitalized. He was soon diagnosed as having leukemia. He died in the hospital on December 30, 1982 from respiratory failure.*fn4
[25] The appellant raises the following issues on appeal: (1) whether the complaint sufficiently alleged a case of deliberate indifference to serious medical needs thus rendering dismissal improper; (2) whether the federal claims asserted against the sheriff of Broward County and Broward County itself were premised solely on notions of respondeat superior; and (3) whether the dismissal of the pendent state law claims, if the federal claims are found to state a cause of action, was premature.
[26] II. THE LEGAL ISSUES IN CONTEXT
[27] When reviewing an order granting a motion to dismiss for failure to state a claim, this court must accept the facts as pleaded to be true and resolve them in the light most favorable to the plaintiff. The motion to dismiss should not be granted unless it appears to a certainty, "that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Milburn v. United States,734 F.2d 762, 765 (11th Cir.1984). The threshold of sufficiency that a complaint must meet to survive a motion to dismiss for failure to state a claim is, as we have stated previously, "exceedingly low." Quality Foods de Centro America, S.A. v. Latin American Agribusiness Devel.,711 F.2d 989, 995 (11th Cir.1983).
[28] It should also be noted at the outset in this case that the defendants fall into several different groups. Prison Health Services, as was noted previously, is the entity responsible, pursuant to an agreement between it and the county, for providing medical care to those housed at the Broward County Jail. Defendants Colligan, Sutton, Hargrove and Blady were all medical personnel employed by Prison Health Services. The issue to be resolved as to Prison Health Services and its employees, i.e. the medical defendants, is whether plaintiff's allegations sufficiently stated a constitutional tort of deliberate indifference to serious medical needs.
[29] The county and the current sheriff are sued as public bodies ultimately responsible for providing medical care to those incarcerated in Broward County. Mr. Butterworth was the sheriff at the time of Ancata's death. The issue to be resolved as to these defendants, i.e., the non-medical defendants, is whether the district court properly dismissed the claims against them when it determined that any liability they may be exposed to was based solely upon notions of respondeat superior.
[30] A. Medical Defendants and the Deliberate Indifference to Serious Medical Needs Claim
[31] The question before us is whether the allegations of plaintiff's complaint are sufficient to permit a jury to find that the medical defendants' conduct amounted to a deliberate indifference to serious medical needs. See Estelle v. Gamble, 429 U.S. 97, 97 S. Ct. 285, 50 L. Ed. 2d 251 (1976).*fn5
[32] The medical defendants do not contest, and there can be no serious dispute, that if their actions resulted in a deprivation of Ancata's constitutional rights, they would be subject to liability pursuant to 42 U.S.C. §1983. Although Prison Health Services and its employees are not strictly speaking public employees, state action is clearly present. Where a function which is traditionally the exclusive prerogative of the state (or here, county) is performed by a private entity, state action is present. Jackson v. Metropolitan Edison Co., 419 U.S. 345, 95 S. Ct. 449, 42 L. Ed. 2d 477 (1974); see also Lawyer v. Kernodle, 721 F.2d 632 (8th Cir.1983) (private physician hired by county to perform autopsies was acting under color of state law); Morrison v. Washington County, Alabama,700 F.2d 678 (11th Cir.1983) (refusing to dismiss physician employed by county from § 1983 action); Perez v. Sugarman, 499 F.2d 761 (2d Cir.1974) (holding that state action was present for private institution's acts where the City of New York removed a child from the mother's custody and placed the child in a private child care institution).
[33] If the complaint is sufficient, then dismissal for failure to state a claim is improper. Accepting plaintiff's allegations as true, and giving the plaintiff the benefit of all legitimate inferences from the complaint as we must, we conclude that the complaint sufficiently alleges a claim of deliberate indifference to serious medical needs.
[34] There are at least three separate although somewhat overlapping aspects to plaintiff's claim of deliberate indifference. The first is plaintiff's allegation that the defendants failed to provide even that level of diagnostic care that they themselves believed necessary. The knowledge of the need for medical care and intentional refusal to provide that care has consistently been held to surpass negligence and constitute deliberate indifference. See Robinson v. Moreland,655 F.2d 887 (8th Cir.1981). In Ramos v. Lamm, 639 F.2d 559, 575 (10th Cir.1980), cert. denied, 450 U.S. 1041, 101 S. Ct. 1759, 68 L. Ed. 2d 239 (1981) the court said:
[35] Deliberate indifference to serious medical needs is shown when prison officials have prevented an inmate from receiving recommended treatment or when an inmate is denied access to medical personnel capable of evaluating the need for treatment.
[36] In this case the plaintiff alleged that the defendants knew that medical care was necessary but simply refused to provide it. The complaint maintains that the defendants concluded that Ancata required a psychiatric or orthopedic evaluation and refused to take the steps to see that he was properly evaluated. Instead, they placed the burden on decedent to obtain a court order for the very examination they believed necessary. Intentional failure to provide service acknowledged to be necessary is the deliberate indifference proscribed by the Constitution. See Woodall v. Foti,648 F.2d 268, 272-73 (5th Cir.1981).
[37] Second, plaintiff alleges that the defendants failed to secure medical care for Ancata because he would not pay. Delay in medical treatment cannot be justified as a means to coerce payment. See City of Revere v. Massachusetts General Hospital, supra. Furthermore, if necessary medical treatment has been delayed for non-medical reasons, a case of deliberate indifference has been made out. See Archer v. Dutcher,733 F.2d 14, 17 (2d Cir.1984). Plaintiff alleged that Ancata was indigent and that the defendants put the financial interest of Prison Health Services ahead of the serious medical needs of Ancata.
Monell v. Department. of Social Services
| Year | 1978 |
|---|---|
| Cite | 436 U.S. 658 (1978) |
| Level | Supreme Court |
| Conclusion | Bench Verdict |
| Injunction Status | N/A |