Failure-to-Train Monell Liability Requires a Predicate Constitutional Violation; Systemic Theories Must Be Preserved on Appeal

I. Introduction

This appeal arises from the death of Lorri Gayle Tedder, a pretrial detainee at the Rogers County Jail in Claremore, Oklahoma. During booking-area restraint events and subsequent monitoring, Ms. Tedder suffered a sudden cardiac episode and later died at a hospital. Her estate representatives sued under 42 U.S.C. § 1983, alleging violations of Ms. Tedder’s Fourteenth Amendment right to adequate medical care in pretrial detention.

Two defendants remained at issue on appeal: (1) Nurse Kylee Foster, the jail medical provider who assessed Ms. Tedder during the critical minutes before CPR began, and (2) Turn Key Health Clinics, LLC, the private contractor providing jail medical staffing. The district court granted summary judgment to both. The Tenth Circuit affirmed, holding the record (including video) did not permit a reasonable jury to find Nurse Foster acted with deliberate indifference, and that Turn Key’s Monell liability theories failed—principally because the Estate tethered those theories to an individual constitutional violation it could not establish and waived any systemic alternative.

II. Summary of the Opinion

• Nurse Foster: The court held there was no genuine dispute that Nurse Foster subjectively believed Ms. Tedder had a pulse and was breathing at the first pulse check (~6:27 p.m.). The Estate’s reliance on Foster’s later handwritten report did not create a triable issue because the “not able to find a pulse” statement referred to a later assessment (~6:30 p.m.) after Foster returned to the cell. Given the objective record (including video), no reasonable jury could find Foster knew of and disregarded an excessive risk.
• Turn Key: The court affirmed summary judgment on Monell theories. The Estate conceded on appeal that Turn Key’s liability “hinges on the existence of an underlying constitutional violation,” and that “no violation by Nurse Foster, so no liability for her employer.” Having also abandoned any argument tied to another nurse (Amy Moore) and disclaimed systemic theories, the Estate’s Monell claims could not survive.

III. Analysis

A. Precedents Cited (and How They Drive the Result)

1. Summary judgment standards; video evidence as an “objective” constraint

• Est. of Beauford v. Mesa County and Fed. R. Civ. P. 56(a): Frames de novo review and the “no genuine dispute” standard, emphasizing that courts draw reasonable inferences for the nonmovant but need not accept accounts contradicted by objective evidence.
• Thomas v. Int'l Bus. Machs. (quoting Anderson v. Liberty Lobby, Inc.): Supplies the canonical definitions of “material” and “genuine” disputes.
• Pelt v. Utah and Thom v. Bristol-Myers Squibb Co.: Clarify burden-shifting—movants may negate an essential element or show insufficient evidence; nonmovants must present specific admissible facts beyond pleadings.
• Scott v. Harris (as applied via Est. of Beauford v. Mesa County): Authorizes courts to reject nonmovant versions when video “blatantly contradicts” them. Here, video of the timing and Nurse Foster’s demeanor anchored the court’s reading of the record and narrowed what inferences were “reasonable.”

2. Deliberate indifference in pretrial detention medical-care claims

• Est. of Beauford v. Mesa County: Reiterates that pretrial detainees receive the same deliberate-indifference standard applied under the Eighth Amendment.
• Farmer v. Brennan: Supplies the subjective component: the official must both (i) be aware of facts from which an inference of substantial risk could be drawn and (ii) actually draw that inference, then disregard it.
• Self v. Crum: Limits constitutional liability where a medical provider exercises considered judgment or provides care consistent with symptoms; negligence and even malpractice are not deliberate indifference.
• Sealock v. Colorado: Supports the objective “serious medical need” concept (here undisputed on appeal).
• Berry v. City of Muskogee and City of Canton v. Harris: Reinforce that § 1983 deliberate indifference requires conduct exceeding even gross negligence.

3. Monell liability (including private contractors) and the “systemic” exception

• Monell v. Department of Social Services of the City of New York: The foundation for entity liability based on policy/custom (not respondeat superior).
• Est. of Burgaz v. Bd. of Cnty. Comm'rs for Jefferson Cnty.: Sets elements (policy/custom, causation, deliberate indifference) and distinguishes “driving force” theories (requiring a predicate individual violation) from “systemic” theories that may proceed without identifying a single unconstitutional actor.
• Dubbs v. Head Start, Inc.: Supports extending Monell doctrine to private § 1983 defendants acting under color of state law—critical because Turn Key is private.
• Lucas v. Turn Key Health Clinics, LLC and Buchanan v. Turn Key Health Clinics, LLC: Noted to show Turn Key’s Monell-susceptibility is commonly assumed when not disputed.
• Crowson v. Washington County: Provides the key distinction between (i) Monell “driving force” claims (e.g., failure-to-train) dependent on an underlying individual constitutional violation and (ii) the narrow “systemic” exception where combined actions/omissions under a policy/custom can violate rights.
• Thao v. Grady Cnty. Crim. Just. Auth.: Reiterates the “twenty hands rather than two” formulation (quoting Crowson v. Washington County), underscoring why systemic theories exist but must be properly developed.
• Trigalet v. City of Tulsa and Hinton v. City of Elwood: Reinforce the general rule that absent an underlying constitutional violation, entity claims typically fail—particularly for training/supervision theories.
• A.J.T. ex rel. A.T. v. Osseo Area Schs., Indep. Sch. Dist. No. 279: Used rhetorically to mark “radical agreement” where both sides accept the same controlling proposition.

4. Preservation, waiver, and abandonment on appeal

• Bronson v. Swensen and In re Bryan: Support treating unbriefed or abandoned issues as forfeited/abandoned on appeal.
• United States v. Olano and United States v. Carrasco-Salazar: Support the court’s treatment of express abandonment as waiver.
• United States v. Moore and McDonald v. Kinder-Morgan, Inc.: Confirm that affirmative disclaimers in appellate briefing foreclose arguments and can make it unnecessary to reach alternative theories addressed below.
• Adler v. Wal-Mart Stores, Inc. and McKibben v. Chubb: Reinforce nonmovant obligations at summary judgment to produce specific admissible facts once the movant carries its initial burden.

B. Legal Reasoning

1. Nurse Foster: why the subjective prong failed as a matter of law

The opinion treats the objective prong as conceded and centers the dispute on the subjective prong: whether Nurse Foster (i) knew of and (ii) disregarded an excessive risk. The Estate attempted to manufacture a triable issue by reading Nurse Foster’s handwritten incident report (the “Foster Report”) as an admission that she could not find a pulse during the first pulse check (~6:27 p.m.), yet left the cell anyway.

The court’s reasoning is largely temporal and evidentiary:

• Temporal parsing of the Foster Report: The report describes events at “1829” and “1830.” The panel agreed with the district court that “not able to find a pulse” plainly refers to the later assessment (~6:30 p.m.) after Foster was called back—not the earlier 6:27 pedal-pulse check, which the report does not mention.
• Video-based inference about subjective belief: The panel relied on video showing a marked change in Foster’s demeanor upon returning (including “Oh, Jesus!”). That reaction supported the inference she did not subjectively believe Ms. Tedder was pulseless when she briefly left to gather supplies.
• Care consistent with perceived symptoms: Because Foster testified she saw breathing and “felt a pulse” before leaving, her decision to retrieve supplies and vital-sign equipment while officers remained and EMS had been called was treated as a medical response “consistent with the symptoms presented,” aligning with Self v. Crum and Est. of Beauford v. Mesa County.

In short, the panel held the record did not permit a reasonable jury to find the crucial knowledge element: actual awareness and inference-drawing as required by Farmer v. Brennan. Without that, deliberate indifference fails at the threshold.

2. Turn Key: Monell theories failed due to the Estate’s chosen theory and appellate waiver

The court’s treatment of Turn Key is as much about doctrine as about litigation choices.

• Driving-force theories require a predicate violation: The Estate’s failure-to-train/supervise theory, as framed on appeal, depended on Nurse Foster committing a constitutional violation. Because Foster did not, Turn Key could not be liable on that theory. The panel also clarified (in footnote 8) that the district court wrongly assumed a failure-to-train claim can proceed “systemically”; under Crowson v. Washington County, it cannot in this circuit.
• Systemic liability was available in principle but waived in fact: The panel acknowledged the “systemic” exception recognized in Est. of Burgaz v. Bd. of Cnty. Comm'rs for Jefferson Cnty. and Crowson v. Washington County—i.e., that a policy/custom plus combined omissions may violate rights without a single identified unconstitutional actor. But the Estate expressly disclaimed systemic theories on appeal and conceded “no violation by Nurse Foster, so no liability for her employer.” That waiver made it unnecessary to evaluate whether systemic proof existed.
• Abandonment of alternative predicate actors: The panel noted the district court had assumed, without deciding, a theory involving another nurse (Amy Moore), but the Estate did not pursue it on appeal, so it was abandoned.

C. Impact

1. Practical impact on detainee medical-care litigation

• Video will often decide the “subjective” prong: The opinion illustrates how time-stamped video can constrain inferences about what a medical provider subjectively believed at a given moment—particularly when plaintiffs rely on post-incident reports or impeachment theories.
• Incident reports must be read chronologically: The court’s refusal to treat an arguably ambiguous line (“not able to find a pulse”) as referring to an earlier event signals that plaintiffs must tie report statements to a coherent timeline; otherwise, courts may treat the reading as unreasonable given objective evidence.

2. Impact on Monell claims against private jail-health contractors

• Reaffirmation of the predicate-violation requirement for training claims: Even where a private contractor is treated as a Monell defendant (per Dubbs v. Head Start, Inc.), failure-to-train/supervise theories remain tethered to an underlying constitutional violation by an individual employee under Crowson v. Washington County.
• Systemic theory is narrow and must be preserved: The “twenty hands rather than two” systemic pathway (discussed via Thao v. Grady Cnty. Crim. Just. Auth.) is not self-executing. Parties must actually argue it and support it with evidence and causal theory. The court’s waiver holding is a cautionary tale: systemic Monell liability can be lost by appellate framing.

IV. Complex Concepts Simplified

1. “Deliberate indifference” (objective vs. subjective)

• Objective component: Was the medical need serious? (Here, effectively yes—cardiac arrest risk is plainly serious.)
• Subjective component: Did the defendant actually realize there was a substantial risk and then disregard it? Under Farmer v. Brennan, it is not enough that the risk was obvious in hindsight; the defendant must have actually drawn the inference at the time.

2. “Monell” liability and why it is not respondeat superior

• No automatic employer liability: Under Monell v. Department of Social Services of the City of New York, an entity is liable only if a policy/custom caused the constitutional injury, not merely because it employed the actor.
• Two pathways:
  • Driving-force (typical): A policy failure (like inadequate training) drives an employee’s constitutional violation—requires that employee violation.
  • Systemic (limited exception): A policy/custom plus combined omissions can itself produce a constitutional violation even if no single employee’s conduct is independently unconstitutional—recognized as narrow in Crowson v. Washington County and Est. of Burgaz v. Bd. of Cnty. Comm'rs for Jefferson Cnty.

3. “Waiver” vs. “forfeiture/abandonment” on appeal

• Abandonment: Not briefing an issue (e.g., the Amy Moore theory) generally means the appellate court will not consider it.
• Waiver: Expressly disclaiming a theory (here, systemic Monell liability) is stronger than silence; it affirmatively removes the issue from appellate review.

V. Conclusion

The Tenth Circuit affirmed summary judgment by applying a rigorously time-specific, video-informed view of the record to the subjective deliberate-indifference inquiry. The decision underscores that, in medical-care § 1983 claims, plaintiffs must produce evidence that the defendant actually perceived and disregarded a substantial risk—not merely that the outcome was tragic or that alternative care might have been better.

On Monell liability, the opinion is a pointed reminder that theory selection and issue preservation matter as much as doctrine: failure-to-train claims remain dependent on a predicate constitutional violation in this circuit, and even potentially viable “systemic” theories can be lost through appellate waiver or inadequate briefing.