Deference to Jail Medical Staff and the “Highly Probable Risk” Standard in Pretrial Detainee Medical-Care Claims: Commentary on Hehrer v. County of Clinton

I. Introduction

The Sixth Circuit’s published decision in Rhonda Hehrer v. County of Clinton, Michigan, No. 24‑2016 (6th Cir. Dec. 12, 2025), addresses a tragic death and refines important doctrines at the intersection of jail medical care, pretrial detainees’ constitutional rights, and municipal liability. The court confronts how far non‑medical correctional officers must go in responding to a detainee’s worsening illness when medical professionals are involved, and what it means—after Brawner v. Scott County—for officers to act “recklessly” under the Fourteenth Amendment.

Joseph Hehrer, a 26‑year‑old pretrial detainee in the Clinton County Jail, died from undiagnosed diabetes after several days of vomiting, weight loss, and apparent decline. His estate sued the county, several individual jail officers, the private medical contractor (Advanced Correctional Healthcare, Inc., “ACH”), and individual medical providers. The federal claims targeted the county and officers; the state‑law claims focused on ACH and its clinicians.

The central issues on appeal were:

Whether the individual corrections officers were deliberately indifferent to Hehrer’s serious medical needs under the Fourteenth Amendment;
Whether Clinton County was liable under Monell on a failure‑to‑train theory for allegedly inadequate training on medical observation when medical staff were not physically present; and
Whether the district court abused its discretion by declining supplemental jurisdiction over the remaining state‑law claims against the medical defendants after granting summary judgment on all federal claims.

The Sixth Circuit affirmed summary judgment in favor of all county defendants and upheld the dismissal of the state‑law claims without prejudice.

Doctrinally, the opinion is significant for three main reasons:

It clarifies, in a published opinion, how “recklessness” under the post‑Brawner Fourteenth Amendment standard maps onto classic tort concepts—requiring a “highly probable” risk of serious harm.
It strongly reinforces the principle that non‑medical jail officers may generally reasonably defer to on‑site and on‑call medical professionals, and that liability arises only when specific “red flag” exceptions are present.
It tightens the scope of “single‑incident” failure‑to‑train liability in jail‑medical contexts, aligning this case with Winkler and distinguishing Helphenstine.

II. Factual and Procedural Background

A. The Underlying Events

On January 18, 2019, Joseph Hehrer was involved in a car accident in Clinton County, Michigan, and was charged with driving under the influence of heroin and with violating probation from an earlier conviction. Unable to post bond, he was held in the county jail. During intake, a screening officer took a medical history: the form recorded that Hehrer denied any chronic conditions, specifically including diabetes, and appeared healthy.

Clinton County had contracted with Advanced Correctional Healthcare (ACH) to provide jail medical services. Under that contract, ACH agreed:

To staff a nurse on site for 56 hours per week;
To have a physician or mid‑level provider visit the jail once per week; and
To keep a physician on call at all times.

In early February, ACH nurse Wendy Freed evaluated Hehrer. He again denied medical issues, except for a concussion from the accident, and weighed 128 pounds. His family saw him weekly and noticed no problems through February.

In early March, things changed. On March 2, his mother learned by phone that he was not feeling well. Over the next days he began to deteriorate. The opinion focuses on the critical window from March 5 to March 9, 2019.

1. March 5–6: First Sick‑Call and Initial Medical Response

March 5: Hehrer submitted his first sick‑call slip, reporting fever, queasiness, headaches, heartburn, and that he had “puked a couple times.” Sergeant Sarah Faggion, working the overnight shift, ordered him moved out of the general dorm into a receiving cell in the booking area for medical observation. That area is staffed 24/7, but the jail lacked a formal infirmary.
March 6, early morning: Around 12:35 a.m., an officer moved him to a receiving cell near the booking “cage,” allowing easy visual monitoring by staff.
March 6, morning: Sergeant Chad Bashore came on at 6:00 a.m. A few hours later, Nurse Freed evaluated Hehrer. Her note states that he had been unable to “hold things down” since March 2 but had not vomited since 11 p.m. the previous night. He reported a good appetite, no pain with urination, felt “not that sick,” and mainly wanted to sleep. He asked to return to the dorm. Freed consulted ACH physician Dr. Daryl Parker, who instructed that Hehrer remain under observation, prescribed Zofran (an anti‑nausea medication), and planned to examine him on the next clinic day.
March 6, evening: Sergeant Richard Stout started the night shift. Two hours later, Dr. Parker came to the jail and examined Hehrer. According to Parker, Hehrer felt better and was keeping meals down. Parker saw “[n]o apparent disease,” thought he “looked good,” but noted a 14‑pound weight loss since February. He ordered continued weight monitoring but cleared Hehrer to return to the dorm.

2. March 7: Worsening Symptoms and Return to Observation

On March 7, while back in general population, inmates perceived that Hehrer looked sick. He slept most of the day, rose for meals, and ate little. Around 6:30 p.m., an inmate flagged down an officer and gestured toward Hehrer with apparent concern. Jail records suggest Hehrer reported that he had been vomiting but did not want to go “up front” (to booking/observation). He returned to his bunk.
Less than two hours later, surveillance shows him picking up a trash can, likely to vomit, and going to speak with an officer at the control center. He complained that his kidneys hurt, it hurt to urinate, he had stabbing pains, and could not keep food or water down. He was then escorted back to a receiving cell in the booking area. Staff took his vital signs.
Sergeant Stout, still on night shift, “did not know of any ‘protocol’” for this scenario. He called the on‑call ACH provider, relayed Hehrer’s symptoms and vitals, and followed the provider’s directions: give more Zofran, encourage water intake, and monitor.

3. March 8: Continued Illness, Additional Nursing Contact, and Alleged Vomiting of Blood

On the morning of March 8, video shows Hehrer taking a breakfast tray and then apparently crawling to vomit in his cell.
Around 9:30 a.m., Nurse Freed evaluated him again. His heart rate was high, but his blood pressure and temperature were normal. He told her he had been “throwing up blood,” claiming blood was “in the drain,” but she saw no blood and did not witness vomiting during the exam. She contacted Dr. Parker, who prescribed additional Zofran and Prilosec (for stomach acid) and ordered lab tests.
Throughout the day, Hehrer was intermittently up for meals and showering, but video indicates ongoing vomiting. Freed and officers checked on him periodically. Around 2:00 p.m., Freed documented that he refused breakfast and lunch because he did not like the food, said he was “ok,” and wanted to return to the dorm; she again told him Parker wanted him to remain in observation.
Later on March 8, a cellmate was placed with Hehrer. The cellmate reports seeing him vomit blood and alerting officers, who, the cellmate says, ignored his pleas. An expert retained by the estate opined that between the evening of March 7 and 6:00 p.m. on March 8, video showed “less than 10 minutes” of nursing contact.

4. March 9: Sudden Collapse and Hospitalization

Overnight into March 9, video suggests that Hehrer continued to vomit, but he received no further medical attention during those hours.
At 6:00 a.m. on March 9, Sergeant James Burdick and Officer Corey Becker started their shift. Burdick spoke with Hehrer “multiple times” that morning and thought he looked unhealthy and “very skinny.” When he got a breakfast tray, Burdick encouraged him to eat; Hehrer later testified that he “nibbled” some toast and drank a little milk. Burdick relayed these observations to ACH nurse Dawn Thelen.
Around 8:50 a.m., Thelen brought medication to Hehrer and examined him. She thought he looked ill and could not take medication by himself; she helped him ingest his meds, then attempted to weigh him, but he was too weak to stand. She told Burdick he needed to go to the hospital, and Burdick began the process for off‑site transport.
Initially, Thelen believed he was “stable,” but his condition “quickly changed.” He vomited up his medications and what looked like blood. His skin became cool and took on a yellowish tint. Concluding that he needed immediate emergency care, Thelen notified Burdick, who instructed Becker to call 911 immediately—bypassing the jail administrator step usually required for non‑emergic transfers.
Paramedics found Hehrer semiconscious and critically ill, suffering from cardiogenic shock, hypovolemic shock, low blood pressure, high blood sugar, and multi‑organ dysfunction. He now weighed 110 pounds—18 pounds less than in February. Despite aggressive treatment, he died four days later. His death certificate listed multisystem organ dysfunction secondary to diabetic ketoacidosis (DKA).

B. The Lawsuit and District Court Rulings

Hehrer’s mother, as personal representative of the estate (“the Estate”), brought:

Federal § 1983 claims against the “County Defendants”: Clinton County; Sheriff Lawrence Jerue; Jail Administrator Thomas Wirth; Sergeants Faggion, Burdick, Bashore, and Stout; and Officer Becker. The Estate alleged:
- That the individual officers (collectively, “the Officers”) were deliberately indifferent to His serious medical needs in violation of his Fourteenth Amendment due‑process rights; and
- That Clinton County (and Jerue and Wirth in their official capacities) were liable under Monell for failure to train officers on medical observation when no medical staff were physically present.
State‑law claims (negligence/medical malpractice) against ACH, Dr. Parker, and nurses Freed and Thelen.

The County Defendants moved for summary judgment. A magistrate judge recommended granting the motion, holding:

The officers had forfeited the “clearly established” prong of qualified immunity by inadequate briefing, but
The Estate had not created a jury question on the constitutional violation itself for deliberate indifference, and
The Monell failure‑to‑train claim also failed.

The district court adopted the recommendations, granted summary judgment on the federal claims, and declined supplemental jurisdiction over the state‑law claims, dismissing them without prejudice.

The Estate appealed.

III. Summary of the Sixth Circuit’s Opinion

The Sixth Circuit (Judge Murphy, joined by Chief Judge Sutton and Judge Bloomekatz) affirmed in all respects.

Deliberate Indifference (Individual Officers)
The court:
- Treated Hehrer as a pretrial detainee (protected under the Fourteenth Amendment) rather than a convicted prisoner.
- Applied the post‑Brawner Fourteenth Amendment standard: officers are liable if they “recklessly disregarded a risk so obvious that they either knew or should have known of it,” a standard “more than negligence” but short of Farmer’s subjective requirement.
- Clarified that “recklessness” requires a “highly probable” risk of serious harm—“substantially greater” than the risk needed for negligence, drawing explicitly on the Restatement (Second) of Torts § 500 and Prosser & Keeton.
- Held that, even under this more plaintiff‑friendly standard, the Estate failed on the subjective/recklessness element, because the Officers reasonably deferred to medical professionals, sought medical input when new symptoms arose, and followed medical instructions.
- Analyzed each officer individually and found insufficient evidence that any one of them faced and ignored a “highly probable” risk of serious harm or acted unreasonably in light of ongoing medical involvement.
Monell Failure‑to‑Train (Clinton County)
The Estate argued that the County failed to train officers on how to handle sick inmates when medical staff were absent, amounting to deliberate indifference. The court:
- Reiterated that failure‑to‑train liability requires:
  - (1) Deliberate indifference by policymakers to a known or obvious risk of constitutional violation, usually shown by a pattern of prior similar violations; and
  - (2) Causation between the training deficiency and the alleged violation.
- Found no pattern of similar incidents and rejected the Estate’s attempt to rely on a single‑incident theory, emphasizing that such claims succeed only in “rare” and “patently obvious” circumstances.
- Held that Clinton County was not deliberately indifferent because its ACH contract ensured 56 hours/week of on‑site nursing, weekly physician visits, and 24/7 on‑call coverage—bringing the case within Winkler, not Helphenstine.
Supplemental Jurisdiction (State‑Law Claims)
After disposing of all federal claims at summary judgment, the district court declined supplemental jurisdiction over the remaining state‑law claims. The Sixth Circuit:
- Reaffirmed the presumption that federal courts should decline supplemental jurisdiction when all federal claims are dismissed before trial.
- Found no exceptional circumstances justifying retention of the state‑law claims.
- Thus held that the district court did not abuse its discretion in dismissing those claims without prejudice.

IV. Analysis

A. Precedents Cited and How They Shaped the Decision

1. Qualified Immunity Framework: Wesby and Lawler

The court situates the analysis within the familiar qualified‑immunity framework of District of Columbia v. Wesby, 583 U.S. 48 (2018): plaintiffs must show (1) a constitutional violation and (2) that the right was clearly established at the time. Here, a procedural twist—forfeiture—shapes the analysis. The magistrate judge found the officers’ briefing insufficient on the “clearly established” prong, effectively removing step two from the appeal. The Sixth Circuit therefore addressed only whether a constitutional violation occurred (step one).

Crucially, relying on Lawler ex rel. Lawler v. Hardeman County, 93 F.4th 919 (6th Cir. 2024), and Gibson v. Abate (6th Cir. 2025), the panel holds that, at step one, courts apply current constitutional standards, not the law as it existed at the time of the alleged conduct. Step two—“clearly established law”—is where temporal concerns belong. Because step two was forfeited, the court applied the post‑Brawner pretrial‑detainee standard even though the events occurred in 2019, before Brawner (2021).

2. Eighth vs. Fourteenth Amendment: Farmer, Brawner, and Helphenstine

Historically, both convicted prisoners and pretrial detainees alleging inadequate medical care had to meet the two‑part deliberate‑indifference test of Farmer v. Brennan, 511 U.S. 825 (1994):

Objective: A serious medical need; and
Subjective: The defendant actually knew of and disregarded a substantial risk of serious harm.

Brawner v. Scott County, 14 F.4th 585 (6th Cir. 2021), changed that for pretrial detainees under the Fourteenth Amendment. Building on Kingsley v. Hendrickson (which applied an objective standard to pretrial detainee excessive‑force claims), Brawner held that a pretrial detainee can establish the second prong by showing that an officer “recklessly disregarded” a risk so obvious that the officer either knew or should have known of it—an arguably more objective and plaintiff‑friendly test.

Helphenstine v. Lewis County, 60 F.4th 305 (6th Cir. 2023), applied Brawner, holding that officers who ignored obvious symptoms of drug withdrawal and failed to secure needed medical care could be found deliberately indifferent under this modified standard.

In Hehrer, the panel explicitly adopts this Brawner/Helphenstine formulation and rejects the officers’ attempt to revert to the older Farmer standard for conduct occurring before 2021. Because qualified immunity’s “clearly established” prong was forfeited, there was no barrier to using the updated constitutional test.

3. Serious Medical Need: Blackmore and Grote

On the objective prong, the court leans on Blackmore v. Kalamazoo County, 390 F.3d 890 (6th Cir. 2004), and Grote v. Kenton County, 85 F.4th 397 (6th Cir. 2023). Those cases hold that a serious medical need exists when a layperson would easily perceive the necessity for a doctor’s attention, as with persistent vomiting and severe abdominal pain over several days.

The panel assumes, without definitively deciding, that the Estate likely met this element: repeated vomiting, nausea, pain, and eventual vomiting of blood are classic serious‑need indicators under Blackmore and Grote.

4. Defining “Recklessness”: Restatement § 500, Safeco, and Prosser & Keeton

The opinion’s most important doctrinal contribution is its reliance on tort authorities to give content to “recklessness” in the Fourteenth Amendment context. Citing:

Restatement (Second) of Torts § 500 and Comment g (1965);
Safeco Ins. Co. of America v. Burr, 551 U.S. 47, 68‑69 (2007); and
W. Page Keeton, Prosser and Keeton on the Law of Torts § 34 (5th ed. 1984),

the court emphasizes:

Recklessness is not just a slightly more serious negligence; it involves a substantially greater risk of harm.
This risk must be “so marked as to amount substantially to a difference in kind” rather than degree, compared with ordinary negligence.
The risk of harm must be “highly probable” to materialize and cause injury.

This explicit importation of tort‑law recklessness into constitutional deliberate‑indifference analysis tightens the standard and gives lower courts a more structured way to distinguish negligence (insufficient) from constitutional recklessness (sufficient).

5. Deference to Medical Professionals: Mercer, Grote, Shaver, McGaw, Smith, and Graham

A core theme of the opinion is that non‑medical jail staff are generally entitled to rely on medical professionals. The court weaves together a line of cases:

Mercer v. Athens County, 72 F.4th 152 (6th Cir. 2023)
Grote, 85 F.4th 397
Shaver v. Brimfield Township, 628 F. App’x 378 (6th Cir. 2015)
McGaw v. Sevier County, 715 F. App’x 495 (6th Cir. 2017)
Smith v. County of Lenawee, 505 F. App’x 526 (6th Cir. 2012)
Graham v. County of Washtenaw, 358 F.3d 377 (6th Cir. 2004)

From these, the court draws several principles:

Non‑medical officers act reasonably by referring medical concerns to qualified professionals.
Once a detainee is under a medical provider’s care, officers generally act reasonably when they follow the provider’s diagnosis and treatment plan (Grote, McGaw).
Requiring lay officers to “veto” or second‑guess medical decisions would be not only doctrinally unsound but potentially unsafe (McGaw).

However, this deference has limits. Citing Stojcevski v. Macomb County, 827 F. App’x 515 (6th Cir. 2020), and Barberick v. Hilmer, 727 F. App’x 160 (6th Cir. 2018), the court recognizes that officers may be liable if:

They fail to seek medical help when an inmate experiences new and alarming symptoms after a prior medical evaluation;
They knowingly rely on an unethical medical provider who mistreats inmates (Smith); or
They fail to implement medical instructions, including required monitoring (Howell v. NaphCare, Inc., 67 F.4th 302 (6th Cir. 2023)).

The Sixth Circuit then situates Hehrer within this framework: the officers here, in the court’s view, consistently sought medical input, followed medical instructions, and did not ignore new alarming symptoms without further medical contact.

6. Comparisons: Greene, Helphenstine, Howell, and Smith

The Estate leaned on several recent, plaintiff‑friendly decisions; the court carefully distinguishes them:

Greene v. Crawford County, 22 F.4th 593 (6th Cir. 2022): There, an inmate suffered delirium tremens from alcohol withdrawal, and officers never secured medical care, routing him instead only to mental‑health staff. He died after roughly four days without any proper medical attention. Greene held a jury could find deliberate indifference because officers “failed to seek any basic medical assistance.” In Hehrer, by contrast, the detainee received nurse and physician care repeatedly, including on‑call consultations.
Helphenstine: Similarly involved officers ignoring unmistakable signs of drug withdrawal with inadequate medical backup. The Hehrer court notes that unlike in Helphenstine, Clinton County's arrangement included robust on‑call and on‑site medical coverage.
Howell: In that case, an inmate in sickle‑cell crisis died after medical staff directed that he remain at the jail in a restraint chair. Officers argued they merely deferred to medical judgment. The Sixth Circuit nevertheless denied qualified immunity where an officer failed to follow medical and policy directives for frequent checks and for reporting “anything unusual.” In Hehrer, by contrast, the officers followed medical directions and did not disregard monitoring obligations.
Smith: There, the court granted immunity to officers who reasonably relied on a doctor’s opinion, but denied it to two officers who failed to monitor a deteriorating inmate. The Hehrer panel analogizes its case to the former category, emphasizing that Nurse Thelen took charge of medical decision‑making on March 9 and that Officer Burdick spoke repeatedly with Hehrer and promptly called 911 when told to do so.

7. Monell and Failure‑to‑Train: Monell, Gambrel, Connick, Bryan County, Winkler, and Helphenstine

On the municipal‑liability front, the opinion is anchored in:

Monell v. Department of Social Services, 436 U.S. 658 (1978)
Connick v. Thompson, 563 U.S. 51 (2011)
Board of County Commissioners v. Brown, 520 U.S. 397 (1997)
Gambrel v. Knox County, 25 F.4th 391 (6th Cir. 2022)
Winkler v. Madison County, 893 F.3d 877 (6th Cir. 2018)
Helphenstine (again)

Key points:

Municipalities are not vicariously liable under § 1983; plaintiffs must link injuries to a policy or custom.
Failure‑to‑train claims require:
- (1) A training deficiency amounting to deliberate indifference—a “stringent standard of fault” requiring proof that policymakers disregarded a known or obvious risk; and
- (2) Proof that the deficiency actually caused the constitutional violation.
Usually, plaintiffs must show a pattern of similar constitutional violations. Single‑incident liability exists only in “rare” cases where the need for training is “patently obvious” (e.g., arming police officers with firearms but providing no training on constitutional use of force).

In Helphenstine, the Sixth Circuit allowed a failure‑to‑train claim to proceed where:

The jail doctor visited only weekly and lacked experience treating withdrawal;
There was little meaningful medical backup; and
Untrained officers were effectively left to decide what constituted a “medical emergency.”

Hehrer distinguishes that scenario and aligns with Winkler, holding that when a jail has:

Regular on‑site medical staff,
24/7 on‑call coverage, and
A practice of referring cases to those professionals,

a plaintiff cannot readily show that it was “patently obvious” that officers would violate inmates’ rights due to lack of training, especially absent any pattern of prior incidents.

8. Supplemental Jurisdiction: Cotterman, Kowall, and Bishop

Finally, the court invokes Sixth Circuit precedent such as Cotterman v. City of Cincinnati, 2023 WL 7132017 (6th Cir. 2023), Kowall v. Benson, 18 F.4th 542 (6th Cir. 2021), and Bishop v. Children’s Center for Developmental Enrichment, 618 F.3d 533 (6th Cir. 2010) to emphasize:

There is a presumption against retaining supplemental jurisdiction once all federal claims are resolved before trial.
Dismissal of state‑law claims in that posture is usually not an abuse of discretion absent special factors (e.g., extreme duplication of effort, imminent trial, or strong state interest in a federal forum).

Because the Estate’s only argument for retaining jurisdiction was that the district court supposedly erred on the federal claims (a contention rejected on the merits), there was no basis to disturb the district court’s discretionary decision.

B. The Court’s Legal Reasoning

1. Applying the Fourteenth Amendment Recklessness Standard

The court first clarifies that it will apply the Fourteenth Amendment standard for pretrial detainees, not the Eighth Amendment standard for convicted prisoners. Although Hehrer was serving time on a probation violation, he was also detained pretrial on new drug‑driving charges, and no party pressed for application of the Eighth Amendment. The court therefore treats him purely as a pretrial detainee.

Under Brawner/Helphenstine, the subjective element asks whether the officers acted “recklessly in the face of an unjustifiably high risk of harm that is either known or so obvious that it should be known” (internal quotations and citations omitted). Critically, the panel:

Affirms that recklessness is more than negligence;
Defines it as requiring a risk of serious harm that is “highly probable” to materialize; and
Requires that officers’ responses be assessed for reasonableness once they know or should know of the risk (citing Campbell v. Riahi, 109 F.4th 854 (6th Cir. 2024)).

The court then bifurcates the analysis:

Did each officer face a risk of serious harm to Hehrer that was “highly probable” given the information available at the time?
If so, did that officer respond unreasonably?

2. Individualized Analysis of Each Officer

A key structural feature of the opinion is that the court scrupulously evaluates each named officer separately, consistent with cases like Greene and Jane Doe v. Jackson Local School District, 954 F.3d 925 (6th Cir. 2020): there is no collective liability merely for being on duty.

a. Sergeant Bashore

March 6: During his first shift, nurse Freed’s assessment and Dr. Parker’s instructions indicated that:
- Hehrer felt only “not that sick”;
- He wanted to return to the dorm; and
- Parker ordered continued observation and Zofran, not emergent care.
March 7: During his second shift, Parker had just cleared Hehrer to return to general population the previous night and ordered only weight monitoring. No evidence suggested that during Bashore’s on‑duty hours, inmates or staff alerted him to alarming new symptoms beyond what Parker had already considered.

Given these facts, the court concludes that no reasonable jury could find that Bashore faced a “highly probable” risk of serious harm that required him to override medical judgment. His reliance on Freed and Parker was, in the court’s view, objectively reasonable.

b. Sergeant Stout

March 6 night: Stout’s shift began shortly before Dr. Parker personally examined Hehrer and found “no apparent disease,” clearing him to return to the dorm. There is no evidence of worsening symptoms requiring attention during Stout’s remaining shift that night.
March 7 night: When serious new complaints arose (kidney pain, pain urinating, inability to keep food or water down):
- Stout moved Hehrer back to medical observation,
- Ensured vital signs were taken, and
- Called the on‑call medical provider, relayed the symptoms, and followed the instructions to give more Zofran, encourage water intake, and monitor.

The panel finds this conduct squarely within the class of “reasonable deference” to medical expertise. Stout did not ignore new alarming symptoms; he escalated them appropriately to medical staff and followed their directives.

C. Sergeant Faggion

March 5–6 night: After receiving the sick‑call form that described fever, queasiness, headaches, heartburn, and a few episodes of vomiting (but no history of chronic disease), she:
- Had Hehrer moved from the dorm into medical observation.
- Did not call a nurse during the night, relying on the fact that a nurse would address the request in the morning.
March 8–9 night: Video suggests ongoing vomiting, but no new symptoms beyond what Nurse Freed and Dr. Parker already knew (including alleged vomiting of blood). They had not ordered emergent care or expressed alarm.

The court reasons that:

On March 5–6, given the intake statement denying chronic illness and the fairly common constellation of flu‑like symptoms, the risk of serious harm appearing “highly probable” was not evident.
On March 8–9, the continued vomiting did not constitute a “new and alarming” development compared to earlier reports known to medical staff; and Freed and Parker had not treated it as emergent.

Accordingly, the panel holds that Faggion’s decision to move him to observation, then await the nurse in the morning, did not amount to constitutional recklessness.

d. Sergeant Burdick and Officer Becker

March 8: Burdick and Becker worked day shifts. Nurse Freed evaluated and monitored Hehrer that morning and afternoon. Becker was not assigned to the booking area and did not bear direct observation duties.
March 9 morning:
- Burdick repeatedly checked on Hehrer, observed his frailty and poor appetite, and relayed this to Nurse Thelen.
- Becker did not observe acute distress or vomiting that would suggest immediate danger.
- Once Thelen concluded that hospital care was required, Burdick initiated transport without delay and then, when the situation rapidly escalated, bypassed normal procedures to have Becker call 911 immediately.

In the court’s view:

Burdick did exactly what is expected: kept in contact, involved the nurse, and when instructed, obtained emergency help.
Becker followed orders and had no independent reason to suspect that it was that serious harm would occur absent more aggressive action.

Because Nurse Thelen herself initially thought he was “stable” and then quickly changed her view as his condition worsened, the court finds no basis to say these officers should have anticipated sooner that his life was in imminent danger.

3. The Crux: Reasonable Deference vs. Constitutional Abdication

Reading the opinion as a whole, the court’s central conclusion is that this is a case of medical misdiagnosis or inadequate medical treatment, not of corrections‑officer deliberate indifference.

The officers:

Promptly moved him to observation when he first reported illness;
Ensured that he was evaluated multiple times by nurses and at least once in‑person by the doctor;
Called the on‑call provider when his condition worsened;
Followed medical instructions; and
Acted swiftly once a nurse concluded that emergency hospitalization was necessary.

The court emphasizes that to hold these officers liable would be to impose on them a duty to overrule medical judgment, something the Sixth Circuit has repeatedly rejected as both legally unnecessary and practically dangerous.

C. Impact and Future Implications

1. Refinement of the Fourteenth Amendment “Recklessness” Standard

By explicitly tying constitutional recklessness to the Restatement and Prosser & Keeton, the panel:

Clarifies that mere medical negligence—even gross negligence—is insufficient for a Fourteenth Amendment claim against non‑medical officers.
Requires plaintiffs to show an objectively high probability of serious harm, not just a possibility or a risk that, in hindsight, proved catastrophic.
Arms defense counsel and district courts with a concrete metric—“highly probable” and “substantially greater” risk—to evaluate summary‑judgment motions.

This doctrinal sharpening will likely make it more difficult for pretrial detainees to survive summary judgment on deliberate‑indifference claims against non‑medical officers in cases where medical staff are actively involved.

2. Strengthened “Safe Harbor” for Officers Who Defer to Medical Staff

Hehrer reinforces a strong presumption of reasonableness when:

Medical staff regularly see the detainee;
Officers timely convey new symptoms to those professionals; and
Officers carry out the resulting medical orders.

Future plaintiffs will need to focus on situations that fall into the recognized exceptions:

No meaningful medical involvement (Greene‑type cases);
Medical staff giving manifestly unethical or grossly inadequate care known to officers (Smith‑type scenarios of known mistreatment); or
Officers failing to follow explicit medical instructions or monitoring schedules (Howell‑type failures).

This may shift litigation emphasis toward:

Claims against medical providers (under state law or, where available, under § 1983); and
Arguments that medical involvement was so perfunctory or incompetent as to be constitutionally deficient in itself.

3. Tightening Monell Failure‑to‑Train Liability in Jail Medical Contexts

On the municipal side, Hehrer underscores that:

Simply alleging that officers were not trained “enough” about medical emergencies is rarely sufficient;
Some pattern of prior similar medical failures is ordinarily required to show deliberate indifference; and
Courts will treat robust contracts with medical providers (on‑site hours and 24/7 on‑call coverage) as strong evidence against a finding that policymakers disregarded obvious risks.

The opinion significantly narrows the reach of Helphenstine in failure‑to‑train claims by stressing its factual distinctiveness:

In Helphenstine, the doctor was on‑site only once weekly and lacked experience in the relevant condition; untrained officers often made emergency decisions alone.
In Hehrer, the ACH contract provided regular on‑site nursing and constant on‑call medical coverage, and officers demonstrably used it (e.g., Stout’s call on March 7).

Municipalities can take from this case a template for reducing Monell exposure in jail‑medical contexts:

Maintain clear contractual arrangements for regular on‑site nursing and 24/7 on‑call coverage;
Document officers’ routine practice of consulting medical personnel; and
Ensure that basic, common‑sense training instructs officers to refer medical questions to professionals rather than to diagnose or treat on their own.

4. Procedural Lessons: Forfeiture of the Clearly‑Established Prong

The magistrate judge’s finding of forfeiture on the “clearly established” prong is a procedural caution:

Defendants asserting qualified immunity must squarely brief both prongs and explain why the law was not clearly established at the relevant time.
Failure to do so can expose them to application of current, more plaintiff‑friendly substantive standards at step one without the protection of step two.

Here, the officers prevailed even under the updated standard, but in a closer case, forfeiture of step two could be outcome‑determinative.

5. Supplemental Jurisdiction: Reinforcing the Presumption to Decline

By applying the default rule that federal courts ordinarily dismiss state‑law claims once all federal claims are resolved pre‑trial, Hehrer continues a line of cases encouraging:

State courts to handle purely state‑law medical‑malpractice claims; and
Federal courts to conserve resources and docket space for genuine federal controversies.

Practically, this means that plaintiffs who join state‑law medical claims with federal constitutional claims should be prepared to refile in state court if they lose the federal piece early.

V. Complex Concepts Simplified

1. Deliberate Indifference

“Deliberate indifference” is the constitutional line between:

Ordinary mistakes or negligence (not a constitutional violation), and
Conscious or reckless disregard of a serious risk to a detainee’s health or safety (a constitutional violation).

In pretrial detainee medical‑care cases, it means:

The detainee has a serious medical need (something that obviously requires a doctor); and
The official either knew or should have realized that there was a highly probable risk of serious harm and then responded unreasonably to that risk.

2. Recklessness vs. Negligence

Negligence is failing to use reasonable care—e.g., a doctor misreading a lab test or a nurse forgetting a routine check.
Recklessness involves:
- Knowing (or being charged with knowing) that serious harm is very likely if you do nothing; and
- Proceeding anyway in disregard of that likely harm.

The Hehrer court uses tort law to say that recklessness requires a risk substantially greater than what would make conduct merely negligent—a difference in kind, not just in degree. In constitutional cases, this is the threshold plaintiffs must cross.

3. Qualified Immunity

Qualified immunity protects government officials from being sued for money damages unless both:

They violated the Constitution; and

The violated right was “clearly established” at the time (meaning that, in light of existing precedent, any reasonable officer would have known the conduct was unlawful).

In Hehrer, the officers lost the benefit of step two (clearly established) because they didn’t adequately argue it—but they ultimately won because the court decided there was no constitutional violation at all.

4. Monell and Failure‑to‑Train

Under Monell, a city or county can be liable for constitutional violations only if the violation stems from:

An official policy;
A widespread, well‑settled custom; or
A deliberate decision by policymakers not to train employees in an area where the need for training is obvious (“failure‑to‑train”).

For failure‑to‑train, plaintiffs generally must show:

A pattern of similar constitutional violations in the past (warning the city of a problem); and
The city’s failure to fix the training anyway—a sign of deliberate indifference.

Only in unusual, “patently obvious” cases can a single incident suffice (for example, giving armed officers no training about when they can shoot).

5. Supplemental Jurisdiction

Federal courts can hear state‑law claims that are related to federal claims in the same case. This is called “supplemental jurisdiction.” But if the federal claims disappear early (e.g., at summary judgment), courts almost always dismiss the state‑law claims so that state courts can decide them. That is what happened in Hehrer: once the § 1983 claims failed, the medical‑malpractice claims against ACH and its staff were left for the state courts.

VI. Conclusion

Hehrer v. County of Clinton is a sobering case: a 26‑year‑old detainee died from an undiagnosed, treatable condition. Yet the Sixth Circuit’s opinion illustrates the distinction between tragic outcomes and constitutional violations.

Doctrinally, the case:

Clarifies that, under the Fourteenth Amendment as interpreted in Brawner, “recklessness” requires a highly probable risk of serious harm, borrowing analytical tools from tort law to differentiate negligence from constitutional fault.
Reaffirms a strong rule that non‑medical jail officers may generally rely on the judgment of medical professionals, subject to defined exceptions (new and alarming symptoms unreported, known unethical medical providers, or failure to follow explicit medical directives).
Consolidates the limits of Monell failure‑to‑train liability in jail‑medical settings, emphasizing the importance of documented medical‑service contracts and on‑call coverage, and confining Helphenstine to its facts.
Reaffirms the presumption that federal courts decline supplemental jurisdiction over state‑law claims once federal claims are dismissed before trial.

For plaintiffs, Hehrer signals that successful Fourteenth Amendment medical‑care claims against non‑medical correctional staff will increasingly require:

Clear evidence that officers ignored glaring, emergent symptoms without involving medical professionals; or
Strong proof that officers knew medical staff were giving patently inadequate care and yet did nothing.

For correctional institutions and local governments, the opinion underscores:

The value of robust, 24/7 medical coverage (on‑site and on‑call);
The legal protection offered when officers consistently defer to, and follow, medical directives; and
The importance of at least basic training that the role of line officers is to facilitate—not supplant—medical judgment.

In the broader landscape of detainee‑rights jurisprudence, Hehrer both solidifies and sharpens the post‑Brawner framework. It makes clear that while the Fourteenth Amendment provides significant protection for pretrial detainees, those protections are carefully calibrated to distinguish constitutional wrongs from even grievous medical misjudgments for which state‑law remedies, not federal constitutional law, remain the primary vehicle for redress.