Unpublished Sixth Circuit: Stroke Misdiagnosis, “More Than Negligence,” and Reasonable Deference to Jail Medical Staff Defeat Fourteenth Amendment Deliberate-Indifference Claims

1. Introduction

In Nicholas Plug v. Van Buren County, Michigan; Daniel Abbott; Dillon Kelly; Roslynn Hickmott, the Sixth Circuit reviewed a pretrial detainee’s suit under 42 U.S.C. § 1983 after he suffered a stroke while detained at the Van Buren County Jail. Nicholas Plug alleged that jail nurse Roslynn Hickmott and booking/line deputy Dillon Kelly were deliberately indifferent to his serious medical needs in violation of the Fourteenth Amendment. He also asserted municipal and supervisory liability claims against Van Buren County and Sheriff Daniel Abbott under Monell v. Dep't of Soc. Servs., 436 U.S. 658 (1978), alleging failures to train/supervise and an unconstitutional policy of denying adequate care to detainees with drug withdrawal symptoms.

The key issues on appeal were whether the evidence could support (i) a constitutional deliberate-indifference violation by the nurse or deputy under the Sixth Circuit’s post-Brawner Fourteenth Amendment standard, and (ii) any Monell liability in the absence of an underlying constitutional violation. The court affirmed summary judgment for all defendants.

2. Summary of the Opinion

The Sixth Circuit affirmed the district court’s grant of summary judgment, holding that even assuming Plug had an objectively serious medical need, he failed to create a triable issue that either Nurse Hickmott or Deputy Kelly acted “deliberately and also recklessly” in the face of an unjustifiably high risk of harm. The court characterized Plug’s evidence—particularly his expert’s report—as, at most, supporting medical negligence, which is insufficient for a constitutional deliberate-indifference claim. Because Plug could not establish an underlying constitutional violation, his Monell claims against the County and Sheriff Abbott necessarily failed.

3. Analysis

A. Precedents Cited

  • Boyd v. N. Biomedical Rsch., Inc., 165 F.4th 424 (6th Cir. 2026): Provided the appellate standard of review—de novo review of summary judgment.
  • Knick v. Township of Scott, 588 U.S. 180 (2019): Used for the general proposition that § 1983 ensures a federal forum for unconstitutional treatment by state officials.
  • Troutman v. Louisville Metro Dep't of Corr., 979 F.3d 472 (6th Cir. 2020): Restated the two core § 1983 elements: a constitutional right and deprivation by a person acting under color of state law.
  • Heeter v. Bowers, 99 F.4th 900 (6th Cir. 2024): Supplied the qualified-immunity framing at summary judgment—no liability if no violation of clearly established rights.
  • Howell v. NaphCare, Inc., 67 F.4th 302 (6th Cir. 2023): (i) Stated the governing Fourteenth Amendment deliberate-indifference standard for pretrial detainees; (ii) emphasized the “reckless” component; and (iii) supported the idea that a non-medically trained officer may reasonably defer to medical staff.
  • Greene v. Crawford County, 22 F.4th 593 (6th Cir. 2022): Defined “objectively serious” medical need and underscored individualized assessment of each defendant’s knowledge and conduct (no imputed knowledge among defendants). Also reinforced deference by nonmedical officers to medical professionals.
  • Brawner v. Scott County, 14 F.4th 585 (6th Cir. 2021): Anchored the mens rea standard for pretrial detainees in the Sixth Circuit: “more than negligence but less than subjective intent— something akin to reckless disregard.” The opinion relied on Brawner to reject the case where the proof sounded in negligence/misdiagnosis rather than recklessness.
  • Mercer v. Athens County, 72 F.4th 152 (6th Cir. 2023), Grote v. Kenton County, 85 F.4th 397 (6th Cir. 2023), and Howell v. NaphCare, Inc., 67 F.4th 302 (6th Cir. 2023): These were Plug’s primary comparators. The court distinguished them as involving far more obvious emergency indicators (seizures, head trauma and loss of consciousness in Mercer; alleged lethal meth dose with shaking/hyperventilation in Grote; obvious pain in the context of known sickle cell disease in Howell).
  • Chambers v. Sanders, 63 F.4th 1092 (6th Cir. 2023) (and also Grote v. Kenton County, 85 F.4th 397 (6th Cir. 2023)): Stated the rule that Monell liability generally requires an underlying constitutional violation; absent that, municipal/supervisory claims fail.
  • Monell v. Dep't of Soc. Servs., 436 U.S. 658 (1978): Framed municipal liability, which the court rejected for lack of an underlying constitutional violation.

B. Legal Reasoning

1) The Sixth Circuit’s deliberate-indifference framework (pretrial detainees)

The court applied the Sixth Circuit’s two-part test for Fourteenth Amendment medical-care claims: (1) an objectively serious medical need; and (2) deliberate and reckless action/inaction in the face of an unjustifiably high risk that is known or so obvious it should be known. The panel “assume[d] without deciding” the first prong, and resolved the case on prong two.

2) Nurse Hickmott: misdiagnosis evidence did not rise above negligence

The court focused on what Hickmott observed and documented: improved COVID-like symptoms, lack of pain, alertness and command-following, intact motor function, stable though elevated blood pressure, and only partial speech changes (mumbling/reluctance to speak but with some clear and correct words). It held that, on this record, no reasonable jury could find it reckless for Hickmott not to conclude that Plug was suffering from an obvious stroke requiring emergency intervention.

Critically, the court treated Plug’s expert report as supporting at most that Hickmott “should have” considered stroke and that her failure amounted to “medical negligence.” Under Brawner v. Scott County, negligence—even gross negligence—is not enough; the constitutional claim requires a reckless disregard-type showing. The court thus drew a bright evidentiary line: proof of “should have diagnosed” does not automatically become proof of “recklessly disregarded.”

The panel also distinguished Plug’s cited cases (Mercer v. Athens County, Grote v. Kenton County, Howell v. NaphCare, Inc.) as involving more unmistakable emergency presentations than the more ambiguous cluster of symptoms here.

3) Deputy Kelly: reasonable deference plus affirmative action when symptoms escalated

For Kelly, a nonmedical officer, the court emphasized (i) proper intake documentation and transmission of information to medical staff, and (ii) lack of evidence that he observed obvious stroke symptoms before October 16 that medical staff failed to address. The court relied on the principle (drawn from Howell v. NaphCare, Inc. and Greene v. Crawford County) that nonmedical officers do not act with deliberate indifference when they reasonably defer to medical professionals.

On October 16—when Plug said he felt ill—Kelly removed him from the cell, assessed that there was a medical issue, contacted medical personnel, and recommended hospital transport. The court found no plausible theory that this response was reckless, and noted that Plug did not identify what more Kelly constitutionally had to do in that moment.

4) Monell claims: no underlying violation, no municipal/supervisory liability

Applying Chambers v. Sanders (and echoing Grote v. Kenton County), the court held that without an underlying constitutional violation by an individual defendant, Plug could not proceed on Monell theories against the County or Sheriff Abbott. The opinion thus treated the individual-liability failure as dispositive of policy/failure-to-train claims in this posture.

C. Impact

  • Reinforces the negligence–recklessness divide in jail medical-care litigation. The opinion underscores that expert testimony framed as “should have diagnosed” and “medical negligence” may be insufficient to reach a jury under the Sixth Circuit’s Fourteenth Amendment standard without additional evidence of conscious or obvious-risk disregard.
  • Signals a high bar for “obviousness” in stroke-presenting symptoms in carceral settings. The court treated sleepiness, reduced appetite, stable elevated blood pressure, and intermittent mumbling/reluctance to speak—without pain or motor deficits—as not obviously requiring emergency stroke intervention, at least on this record.
  • Strengthens “reasonable deference” protection for nonmedical officers. Documenting intake information, routing it to medical staff, and acting promptly when symptoms escalate was deemed constitutionally adequate. Future claims against deputies will likely need proof of either blatant medical crisis signs or defiance of medical direction.
  • Confirms Monell dependence on an underlying violation in this procedural posture. Plaintiffs bringing policy/failure-to-train claims should anticipate that if individual deliberate-indifference claims fail at summary judgment, Monell claims may collapse as well absent a viable theory recognized in the circuit.

4. Complex Concepts Simplified

  • Deliberate indifference (Fourteenth Amendment medical care): Not every bad medical outcome is unconstitutional. The plaintiff must show an objectively serious medical need and that the defendant responded with a reckless disregard of a high risk (more than a mistake).
  • “Objectively serious medical need”: A condition diagnosed as requiring treatment, or one so obvious that even a lay person would recognize the need for a doctor.
  • Recklessness vs. negligence: Negligence is a failure to use reasonable care (a medical misdiagnosis can be negligence). Recklessness is a more blameworthy mental state—ignoring a risk that is known or so obvious it should be known.
  • Qualified immunity: A doctrine that can protect officials from damages if they did not violate clearly established constitutional rights. Here, the court effectively found no constitutional violation on the record.
  • Monell liability: A county/sheriff’s office can be liable under § 1983 only for its own unconstitutional policy/custom (or certain training/supervision failures), not simply because it employs a wrongdoer. In this decision, the absence of an individual constitutional violation ended the Monell inquiry.

5. Conclusion

The Sixth Circuit’s decision affirms that, for pretrial detainees, proving a serious medical event occurred (even a stroke with permanent injury) does not itself establish a constitutional claim. The plaintiff must present evidence that each defendant’s response was recklessly indifferent to an unjustifiably high and apparent risk—not merely negligent. The court also reiterated that nonmedical deputies may constitutionally rely on medical staff when that reliance is reasonable, and that Monell claims typically fail without an underlying constitutional violation. In practical terms, the opinion tightens the evidentiary demands for turning “missed diagnosis” facts into Fourteenth Amendment liability in the Sixth Circuit.