by Douglas Ankney

The U.S. Court of Appeals for the Eighth Circuit revived a 42 U.S.C. § 1983 complaint (“Complaint”) that alleged claims of, inter alia, deliberate indifference to serious medical needs and a failure to train, on behalf of Jovon Mitchell who died from a stroke while being detained at the St. Louis County Jail (“Jail”).

According to the Complaint, on December 23, 2019, Mitchell began vomiting, experiencing a terrible headache and feeling nauseous. A Jail nurse reported his symptoms to physician assistant Todd Parker, who, in turn, prescribed some medication and instructed nursing staff to potentially take Mitchell to the hospital if he continued vomiting.

At 4:00 a.m. on December 25, Mitchell or his cellmate pressed an emergency call button and told unit control Mitchell had “the worst headache of his life,” that he was dizzy and that he was unable to walk. Jail medical staff had a standing order from Dr. Emily Doucette to contact a doctor immediately if any patient complained of “the worst headache of their life.” At 4:15 a.m., Jail nurse Connie Heitman arrived at Mitchell’s cell. Heitman recorded Mitchell’s symptoms as “a bad headache, a throbbing forehead, nausea, vomiting, difficulty standing, and complaints of an inability to eat.”

While Heitman observed that Mitchell’s gait was unsteady, she did not inform Parker of this. Nor did Heitman record Mitchell’s blood pressure as required by standing orders and jail policy. A guard present during Heitman’s visit stated that, during the visit, Mitchell had slurred speech and pleaded to be transferred to the infirmary—but Heitman refused to transfer him there.

Approximately an hour later, Mitchell or his cellmate again pressed the emergency call button to complain that Mitchell’s symptoms were worsening. Heitman was notified and she responded that Mitchell “would need to wait for when the morning nurse was available.” Fifty minutes later, other Jail detainees assisted the now non-ambulatory Mitchell to visit the morning Jail Nurse Vicki Reynolds. Mitchell, while waiting to see Reynolds, attempted to remain upright against a wall, but his efforts weakened and he slid to the floor. He lay on the floor for close to ten minutes until compassionate detainees carried him to see Reynolds.

Reynolds observed Mitchell’s symptoms and noted them as: “a serious headache, vomiting, and a dry mouth, and that he felt he was going to pass out.” After contacting Parker, Reynolds directed that Mitchell be returned to his cell. Reynolds later confessed that she “delayed providing further treatment or sending [Mitchell] to the infirmary to ensure that he was not malingering.”

However, Mitchell had no history of malingering and had been a cooperative and compliant detainee. Approximately three hours later, during a medication round, Reynolds noted that Mitchell had an “unsteady gait.” Reynolds further noted that after consulting Parker, it was determined that Mitchell was to be sent to the infirmary. After yet another two hours elapsed, at 12:40 p.m., video recorded that Mitchell staggered out of the cell block and was transported via wheelchair to the infirmary.

Jail Nurse Shyla Howard was an infirmary nurse that day, and she noted Mitchell’s symptoms to be: “throbbing headache, vomiting, slurred speech, a dry mouth, and dehydration.” Howard failed to take Mitchell’s vitals during the visit. But she did report her observations to Parker, “who ordered blood pressure tests and suggested Howard provide [Mitchell] with intravenous fluids if he was unable to drink enough or hold it in.” In response, Howard gave Mitchell a cup of water. She also ordered a series of blood pressure tests over the span of the next hour that were completed at around 2:15 p.m. Then Mitchell was returned to an infirmary cell where he was kept alone for approximately three hours.

At 5:15 p.m., Jail Nurse Katie Cora discovered an unconscious Mitchell lying on his cell floor and not breathing. Cora attempted to resuscitate him using Jail medical equipment, but the medical equipment malfunctioned. Additional nurses responded with functional equipment, but it was too late as they could not resuscitate Mitchell.

Mitchell was transported to a hospital, but again it was too late. On December 27, 2019, Mitchell was pronounced brain dead. His cause of death was a stroke. [May the Readers pause and hold a moment of silence and acknowledge that Mitchell’s life and manner of death had, and has, meaning to all of us caught up in this beast known as Incarceration Decimation.]

Paul Banasco, Director of Justice Services for St. Louis County (“County”), supervised the Jail’s guards. Banasco was aware that other detainees had suffered symptoms similar to Mitchell’s and their condition also ended in death because of County employee’s failure to conduct security tours and to require that detainees stand up for health checks.

Mitchell’s brother, Juan Mitchell (“Plaintiff “), sued on Mitchell’s behalf. Against the County, Plaintiff alleged Mitchell’s federal constitutional rights were violated due to a failure of the County to train its subordinates which resulted in Mitchell’s death. Against Heitman, Reynolds and Howard, Plaintiff alleged a violation of Mitchell’s Eighth and Fourteenth Amendment rights through deliberate indifference to his serious medical needs. Plaintiff also alleged various claims under Missouri state law.

Collectively, the Defendants moved to dismiss under Federal Rule of Civil Procedure 12(b)(6). The district court granted the motion to dismiss the federal claims and then declined to exercise supplemental jurisdiction over Mitchell’s state law claims. Mitchell timely appealed.

The Court observed “[i]t is well established that the Eighth Amendment prohibition on cruel and unusual punishment extends to protect prisoners from deliberate indifference to serious medical needs.” See: Gregoire v. Class, 236 F.3d 413 (8th Cir. 2000). The Court employs “a two-part inquiry to determine whether a defendant was deliberately indifferent.” See: Jackson v. Buckman, 756 F.3d 1060 (8th Cir. 2014). Under Jackson, Plaintiff must first allege that Mitchell suffered “from an objectively serious medical need, meaning a medical need that was ‘diagnosed by a physician as requiring treatment’ or that was ‘so obvious that even a layperson would easily recognize the necessity for a doctor’s attention.”

“Second,” the Court wrote, “[Plaintiff] must allege that each particular defendant ‘actually knew of but deliberately disregarded [this] serious medical need.’” In the instant case, no physician had diagnosed Mitchell with a serious condition. However, “[a] defendant’s actual knowledge may be inferred ‘from the very fact that the risk was obvious.’” See: Jones v. Minn. Dep’t of Corr., 512 F.3d 478 (8th Cir. 2008).

The Court added, “Deliberate indifference may be demonstrated ‘by prison doctors who fail to respond to [a] prisoner’s serious medical needs.’” See: Dulany v. Carnahan, 132 F.3d 1234 (8th Cir. 1997). Deliberate indifference may also be shown by “[g]rossly incompetent or inadequate care” where “the treatment is so inappropriate as to evidence intentional maltreatment or a refusal to provide essential care. … Mere negligence or medical malpractice, however, are insufficient to rise to a constitutional violation.”

The Court determined that Plaintiff had: (1) established Mitchell’s objectively serious medical need and (2) that each defendant knew of but disregarded this need. With regard to prong (1), Mitchell reported he was experiencing the “worst headache of his life,” along with his symptoms of “nausea, vomiting, dizziness, difficulty standing, an inability to walk, an inability to eat, and slurred speech.”

These symptoms demonstrated a serious medical need that “was so obvious that even a layperson would have easily recognized the necessity for a doctor’s attention.” In Troupe v. Young, the Court had already determined that similar symptoms of “frequent vomiting, hearing loss, dizziness, a decreased level of physical activity, difficulty walking, need for a wheelchair, extreme weakness rendering [the detainee] nearly bedridden, headaches, and visible weight loss” demonstrated a serious medical need. See: Troupe v. Young, 143 F.4th 955 (8th Cir. 2025).

As to prong (2), Plaintiff had plausibly alleged, as recounted above, that Heitman, Reynolds and Howard were each aware of Mitchell’s symptoms and serious medical need. A jury could conclude Heitman deliberately disregarded Mitchell’s medical need because she provided him only Tylenol, i.e., “[a] jury could find that this treatment was so inappropriate as to evidence a refusal to provide essential care.”

Reynolds demonstrated deliberate indifference when she disregarded Mitchell’s medical need and sent him back to his cell. And while Howard provided “some care” (blood pressure tests and a cup of water), “[a] jury could find that this treatment was so inappropriate as to evidence a refusal to provide essential care.” Turning to Plaintiff’s failure-to-train claim against the County, the Court observed “[a] municipality can be liable under 42 U.S.C. § 1983 for a failure to train or supervise its employees where: (1) the municipality’s training practices are inadequate; (2) the municipality was deliberately indifferent to the rights of others in adopting those policies such that the failure to train reflects a deliberate or conscious choice by the municipality; and (3) an alleged deficiency in the municipality’s training practices actually caused the plaintiff’s constitutional deprivation.” See: Ulrich v. Pope Cnty., 715 F.3d 1054 (8th Cir. 2013) The municipality must be on “notice that its procedures were inadequate and likely to result in a constitutional violation.” See: Andrews v. Fowler, 98 F.3d 1069 (8th Cir. 1996).

In the instant case, Plaintiff’s Complaint demonstrated the County’s training practices were inadequate, “including its failures to correct nurses’ erroneous diagnosis of malingering”; its failure “to ensure nurses adhered to standing orders”; and its failure to ensure guards “required detainees stand up for health checks.” The County had notice by the fact of its knowledge of prior detainee deaths.

And Plaintiff’s Complaint plausibly alleged that the County’s inadequate training practices caused the Jail staff to be deliberately indifferent to Mitchell’s medical need which caused his death. Accordingly, the Court reversed the district court’s dismissal with regard to these claims, and because Plaintiff had plausibly alleged federal claims, the Court also ordered the district court to exercise supplemental jurisdiction over Plaintiff’s state law claims. See: Mitchell v. Saint Louis Cnty., 160 F.4th 950 (8th Cir. 2025).  

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