At 7:23 p.m. on July 10, 2018, a man called 911 to report a disturbance outside his house in Scott County, Mississippi. Sheriff’s Deputy Zack Holland arrived at 7:38 p.m. and found Miranda Musgrove and Sheila Matthews screaming at one another. Musgrove was holding her four-year-old daughter, A.A. Deputy Holland separated the women, called for backup, and talked with each woman individually to figure out what was going on. But as Musgrove tried to describe the situation to Deputy Holland, her story jumped among topics, and her movements were erratic. The same behavior continued throughout the encounter.
Deputy Holland asked Musgrove if she needed medical attention. Musgrove responded, “No.” But after Musgrove’s erratic behavior continued and Deputy Holland noticed that Musgrove had “white foam” coming from both sides of her mouth, Deputy Holland called an ambulance at 7:45 p.m. for “a female subject out here under the influence of something.” A minute later, Deputy Holland radioed for an ambulance a second time, and Musgrove yelled, “I don’t need an ambulance!” Around that time, A.A. began to cry and reach for Deputy Holland. Afraid for the child’s safety, Deputy Holland asked Musgrove if he could hold A.A. while they talked. Musgrove agreed.
While Deputy Holland waited for the ambulance and backup to arrive, he tried again to piece together the situation. But Musgrove oscillated among talking about several disjointed topics, angrily threatening to hurt various onlookers in the neighborhood, and asking Deputy Holland for help. For example, she talked about getting in a fight with someone named Charlie and breaking his meth pipe; she said multiple times that she hadn’t taken any of her anxiety medicine; and she continued to repeat various other cryptic things like “I need to get away from here,” “He did this to me,” “I took something to drink and started feeling this way,” and “Charlie set me up.” The encounter largely continued in the same way—“Musgrove talking about Charlie, at times asking for help in serious tones, moving suddenly and unpredictably, and making threats.”
Roughly 20 minutes after the encounter began, Sheriff’s Deputy Cody May (the requested backup) arrived at the scene. The paramedics arrived soon after. The paramedics asked, “Have you had any drugs or alcohol today?” Musgrove said “no.” The paramedics explained again that they were there to help and that Musgrove needed to be honest with them about whether she had consumed any drugs or alcohol. Again, she denied consuming any substances. Nevertheless, the paramedics asked Musgrove multiple times if she wanted to go to the hospital and tried to convince her to go with them. Musgrove declined.
After Musgrove became even more aggressive and accusatory, the Deputies placed her under arrest for public intoxication, disorderly conduct, and child endangerment. The Deputies then repeatedly asked Musgrove whether a family member could pick up A.A. to avoid calling the Mississippi Department of Human Services (DHS). Musgrove refused, so Deputy May called for a DHS worker. While they waited for DHS to dispatch someone, Deputy May continued to ask Musgrove to provide a family member’s phone number. Eventually—after many minutes of Musgrove screaming at and accusing everyone at the scene—she calmed down and gave Deputy May a phone number for Judy Evans, A.A.’s great-grandmother.
Evans agreed to take custody of A.A. Deputy Holland transported A.A. and Musgrove together to meet Evans as well as Musgrove’s mother, Kelley Danos. Musgrove was unruly throughout the trip. She screamed, cursed, and even tried to kick the windows out of the patrol car. After the Deputies told her many times to calm down, she eventually laid down across the back seat and continued to mutter to herself. While Deputy Holland transitioned A.A. to Evans’s car, Deputy May and Danos checked on Musgrove who “appeared to be asleep and still breathing normally.” May informed Danos that the paramedics had already been called to check on Musgrove and that he would have the nurse assess her at the police station.
The Deputies then drove Musgrove to the Scott County Detention Center. Musgrove talked intermittently during the 15-mile ride and sat back up at one point before laying down again. When they arrived at the Detention Center at 10:13 p.m., Musgrove was found breathing but unresponsive in the backseat. The Deputies took her from the car, removed her handcuffs, sat her up in a chair, and called another ambulance. Musgrove ultimately died at the hospital from drug-induced cardiac arrest.
Musgrove’s heirs filed suit, alleging violations of Musgrove’s Fourteenth Amendment rights under 42 U.S.C. § 1983. The heirs also brought various claims under state law. Scott County and Deputies Holland and May moved for summary judgment. The district court granted Defendants’ summary judgment motions. The court held that the Deputies were entitled to qualified immunity because the undisputed facts did not support a prima facie case of deliberate indifference, the Monell claims against the County could not proceed without an underlying constitutional violation and the state law claims were barred by the Mississippi Tort Claims Act. The 5th affirmed.
The Deputies asserted qualified immunity in the district court, so Plaintiffs bear the burden of overcoming the defense. To overcome it, Plaintiffs must prove (1) that the officials violated a statutory or constitutional right, and (2) that the right was ‘clearly established’ at the time of the challenged conduct. We can base our decision on either prong.
As to the first prong, Plaintiffs present only a Fourteenth Amendment Due Process claim. We have held that due process implicitly provides substantive protection against “deliberate indifference” to pretrial detainees’ “serious medical needs.” See Thompson. A serious medical need is one for which treatment has been recommended or for which the need is so apparent that even laymen would recognize that care is required. See Sims.
And deliberate indifference to such needs is an extremely high standard to meet. See Domino. Specifically, Plaintiffs must prove the officers (1) were “aware of facts from which the inference could be drawn that a substantial risk of serious harm exists,” (2) that they “actually drew the inference,” and (3) that they “disregarded that risk.” See Baldwin. In other words, Plaintiffs must show that Deputies Holland and May subjectively believed Musgrove was at a substantial risk of overdosing and that they nevertheless refused to treat her, ignored her complaints, intentionally treated her incorrectly, or engaged in any similar conduct that would clearly evince a wanton disregard for her serious medical needs. See Davis.
Plaintiffs do not meet their burden. Even if we assume Plaintiffs could satisfy the first deliberate-indifference prong, there is no way they could satisfy prongs two or three.
A. Officers Drawing Inference Prong
We start with prong two. Plaintiffs have not identified any evidence that would suggest Deputies Holland and May believed Musgrove had a substantial risk of overdosing. The only direct evidence comes from their depositions. There, both Deputies explained that they did not believe Musgrove was in immediate danger. Even if the Deputies were mistaken in this belief, it is well established that the failure to alleviate a significant risk that the Deputies should have perceived, but did not, is insufficient to show deliberate indifference.
Footage from the Deputies’ bodycams does not change that result. True, Musgrove made sporadic claims for help and cryptically referred to a man named Charlie. But in context, Musgrove’s statements would not suggest to a reasonable observer that she was at serious risk of overdosing. That is because Musgrove repeatedly told the Deputies and paramedics that she had not ingested any drugs or alcohol, that she was acting the way she was because she had not taken her anxiety medication, and that she did not need to go to the hospital. The videos clearly show that Musgrove was conscious, able to stand by herself, and capable of carrying on a conversation (albeit a disjointed one). Thus, the bodycam footage suggests at the very most that Musgrove needed the Deputies to help protect her and her daughter from someone named Charlie and that she might be under the influence of something, not that she was at a substantial risk of overdosing.
Plaintiffs assert the Deputies believed Musgrove had taken some substance, and that should be sufficient to create a triable issue of fact on the Deputies’ awareness of a substantial risk. Our precedent forecloses that contention. See Brown and O’Neal.
Plaintiffs also assert that the Deputies were on notice of a substantial risk because the paramedics told them that Musgrove needed to go to the hospital. But the paramedics said no such thing. As the bodycam footage and the Deputies’ depositions make abundantly clear, the paramedics voluntarily released Musgrove into police custody after she refused examination, and the paramedics never told Deputy Holland or May that Musgrove needed urgent medical attention.
Finally, Plaintiffs claim that Musgrove’s behavior in the back seat of Holland’s patrol vehicle was a marked change from Ms. Musgrove’s prior state and should have alerted the officers to an increased need for a hospital. Again, Plaintiffs have no evidence for this assertion. Deputy Holland explained that Musgrove talked on and off throughout the drive, and both Deputies claimed that Musgrove sat up at least once during that same 15-mile ride. Absent other information, this behavior does not indicate a substantial risk of an overdose. Regardless, deliberate-indifference liability attaches only if the Deputies actually knew—not merely should have known—about the risk. See Olabisiomotosho.
B. Disregarding Risk Prong
The Deputies responded to the situation with tact and care, not reckless disregard. Recall that to satisfy the third prong, Plaintiffs must prove that the Deputies refused to treat Musgrove, ignored Musgrove’s complaints, intentionally treated Musgrove incorrectly, or engaged in any similar conduct that would clearly evince a wanton disregard for Musgrove’s serious medical needs.
Deputies Holland and May did none of the above. Instead, they called an ambulance—even after Musgrove had repeatedly denied consuming any drugs or alcohol and repeatedly refused medical attention. They went out of their way to comfort A.A. and place the child with relatives so that she wouldn’t be surrendered to DHS. While they were transferring A.A. to Evans and Danos, May informed Danos he would have the nurse assess Musgrove again at the police station. And once they finally arrived at the police station and found Musgrove unresponsive, they quickly took her from the car, removed her handcuffs, sat her up in a chair, and called another ambulance. Even if those steps were ‘ineffectual,’ they do not demonstrate deliberate indifference.
To all this, Plaintiffs simply assert that the Deputies were deliberately indifferent by taking Musgrove to the police station and not directly to the hospital. But to accept appellant’s claim would be to mandate as a matter of constitutional law that officers take all criminal suspects under the influence of drugs or alcohol to hospital emergency rooms rather than detention centers. That would be a startling step to take.
There is no evidence that Deputies Holland and May were aware of a substantial risk to Musgrove, much less that they chose to disregard it. And because the Monell claims against Scott County cannot proceed without an underlying constitutional violation, summary judgment as to both the Deputies and the County is AFFIRMED.