Key Points

  • The Sixth Circuit, 2-1, reversed the dismissal of a Monell failure-to-train claim against Knox County, Tennessee, over the 2023 overdose death of pretrial detainee Ricky Lynn Lewis.
  • The majority inferred inadequate training at the pleading stage from specific written jail screening and monitoring policies that at least ten staff members allegedly failed to follow across about seventeen hours.
  • The majority held deliberate indifference plausibly pleaded under the single-incident theory, applying the en banc court's knowledge standard from Poynter v. Shirley, and held causation plausibly pleaded.
  • The panel unanimously affirmed dismissal of the failure-to-screen custom, overcrowding, and underfunding theories.
  • Judge Hermandorfer dissented in part, writing that Linden v. City of Southfield and Wright v. Louisville Metro Government require factual allegations about the training program itself.

A divided federal appeals court revived a lawsuit accusing Knox County, Tennessee, of failing to train its jail staff to handle drug overdoses. The court held that the complaint stated a claim because at least ten employees allegedly ignored the jail's own medical policies while a detainee deteriorated over roughly seventeen hours before his death.

The U.S. Court of Appeals for the Sixth Circuit ruled 2-1 on Oct. 8 for Jennifer Byrum, whose father, Ricky Lynn Lewis, died of an overdose after he was booked into the county's Roger D. Wilson Detention Facility in May 2023. Judge Bloomekatz wrote for the court, joined by Judge Stranch. Judge Hermandorfer dissented in part.

The decision allows a failure-to-train claim against a local government to proceed past a motion to dismiss even though the complaint describes nothing about the training the county actually provided. The majority inferred inadequate training from the jail's written screening and monitoring policies and from allegations, drawn from surveillance video, that every staff member who dealt with Lewis disregarded them. Judge Hermandorfer called that "first-of-its-kind reasoning."

Byrum sued under 42 U.S.C. § 1983, the federal civil rights statute. Under Monell v. Department of Social Services, a 1978 Supreme Court decision, a county is liable under that law only for its own policies or customs, not merely for employing someone who violated a person's rights. A failure to train can qualify, subject to what the court called "rigorous requirements of culpability and causation."

According to the complaint, police arrested Lewis on drug possession charges early on May 25, 2023, after he called 911 to report his car stolen and admitted using methamphetamine. He arrived at the jail around 5:02 a.m., unable to walk on his own, and staff did not medically screen him. About two hours later, staff used a sternum rub and smelling salts to rouse him but gave him no naloxone, the opioid-overdose drug, and one employee joked that Lewis must be "dying of bone cancer."

Staff then locked Lewis in a holding cell for about nine hours. State standards required hourly checks, and the jail's own policy required checks every 15 to 30 minutes for detainees with medical conditions. Judge Bloomekatz wrote that staff "left him virtually unmonitored and untreated—writhing in pain and lying barely conscious on the floor covered in his own feces." Around 10 p.m., staff found him not breathing but waited about 40 minutes to call 911. Lewis died the next morning of "acute methamphetamine, fentanyl, xylazine, and morphine intoxication," according to the autopsy report.

U.S. District Judge Thomas A. Varlan in Knoxville dismissed the claims against the county. Byrum's claims against individual employees had been dismissed after she failed to serve them properly, so her appeal concerned only the county.

The majority held that the scale of the failure supported an inference about training. "This is not a case where a single employee (or even a few) failed to follow protocol or best practices," Judge Bloomekatz wrote. She described the allegations as "a comprehensive failure to provide medical treatment and follow clear jail policies to screen and monitor detainees with medical needs by every single member of the jail staff."

The majority relied on its 2023 decision in Helphenstine v. Lewis County, which held that jailers' failure to respond to a medical emergency could let a jury find their training insufficient. The court distinguished Linden v. City of Southfield, which affirmed dismissal of a training claim against a city whose first responders declared a living woman dead. Those responders had specialized expertise, the majority wrote, while "one would not necessarily expect that jail staff would have the same education and expertise." In a second case, Wright v. Louisville Metro Government, the plaintiffs identified no specific policy at issue, the court said.

The majority declined to require a plaintiff to plead the contents of a county's training before discovery. If Byrum had to plead what the county's training manual contained, Judge Bloomekatz wrote, "it is hard to imagine how any such claim could survive."

The court also held that Byrum plausibly alleged deliberate indifference, the stringent fault standard for municipal liability, from this single incident. "Given the opioid epidemic and the prevalence of drug addiction, drug-related medical emergencies are not a hidden danger," the majority wrote. The court applied the stricter knowledge standard that the full Sixth Circuit adopted in September in Poynter v. Shirley and held that Byrum's claim survives it.

Judge Hermandorfer wrote that the complaint "says nothing about the County's training program beyond the conclusory assertion that the training was inadequate." She wrote that the majority's approach "risks converting allegations about individuals' bad acts or negligence into failsafe failure-to-train claims against municipalities." Citing Linden and Wright, she would have affirmed. "Plausible failure-to-train claims require factual allegations about training," she wrote.

The dissent also questioned where the majority's line falls. "Is inadequate action by two or three jail staff enough? Does the answer depend on how many total jail staff are employed?" Judge Hermandorfer asked. "But I fear courts will be left guessing about how to apply its failure-to-train formulation in cases to come." The majority responded that its reasoning "is rooted in the ordinary standards for assessing the sufficiency of a complaint on a Rule 12(b)(6) motion to dismiss."

All three judges agreed to affirm the dismissal of Byrum's other theories against the county. The panel held that she alleged no pattern of other detainees left to "sleep it off" without screening and did not tie jail overcrowding to Lewis's death. On her underfunding theory, the court wrote, "Absent allegations of an unlawful policy or practice, however, the merits of the County's policy choices are not ours to review."

Richard E. Collins of Collins Law argued for Byrum. Federico A. Flores of the Knox County Law Director's Office argued for the county.

The ruling reverses the dismissal of the failure-to-train claim, which the majority said "may proceed past the pleading stage." The majority noted that discovery into the county's training policies "could support or harm Byrum's claim."