Joe Marsh v. Butler County, Alabama , 225 F.3d 1243 ( 2000 )


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  •                                                                         [PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT                     FILED
    __________________________          U.S. COURT OF APPEALS
    ELEVENTH CIRCUIT
    MAY 30 2000
    No. 99-12813
    THOMAS K. KAHN
    __________________________                   CLERK
    D.C. Docket No. 97-01421-CV-D-N
    JOE MARSH, LEROY OWENS,
    Plaintiffs-Appellants,
    versus
    BUTLER COUNTY, ALABAMA,
    THE BUTLER COUNTY COMMISSION, et al.
    Defendants-Appellees.
    __________________________
    Appeal from the United States District Court
    for the Middle District of Alabama
    __________________________
    (May 30, 2000)
    Before BIRCH and BARKETT, Circuit Judges, and ALARCON*, Senior Circuit
    Judge.
    BARKETT, Circuit Judge:
    *
    Honorable Arthur L. Alarcon, Senior U.S. Circuit Judge for the Ninth Circuit,
    sitting by designation.
    Joe Marsh and Leroy Owens, former inmates at Butler County Jail in
    Greenville, Alabama, appeal the district court’s dismissal pursuant to Federal Rule
    of Civil Procedure 12(b)(6) of their complaint against Butler County, the Butler
    County Commission, and Sheriff Diane Harris in both her individual and official
    capacities. Marsh and Owens sued under 
    42 U.S.C. § 1983
    , claiming that their
    rights under the Eighth and Fourteenth Amendments were violated by the County,
    the County Commission, and the Sheriff’s deliberate indifference to the substantial
    risk of serious harm to inmates at Butler County Jail. Owens also claimed that his
    rights under the Fourteenth Amendment were violated by their deliberate
    indifference to his serious medical needs. Marsh and Owens claim that the injuries
    they suffered, although arising from distinct incidents, were caused by the same
    unconstitutional jail conditions and jail practices. The district court dismissed the
    complaint under Federal Rule of Civil Procedure 12(b)(6), on the grounds that
    Butler County and the Butler County Commission are protected from this suit by
    legislative immunity, and that Sheriff Harris is protected by qualified immunity.
    We reverse.
    DISCUSSION
    The dismissal of a complaint for failure to state a claim is reviewed de novo.
    In re Johannessen, 
    76 F.3d 347
    , 349 (11th Cir. 1996) In conducting such a review,
    2
    appellate courts must keep in mind that “a complaint should not be dismissed for
    failure to state a claim unless it appears beyond doubt that the plaintiff can prove
    no set of facts in support of his claim which would entitle him to relief.” Scheuer
    v. Rhodes, 
    416 U.S. 232
    , 236-37 (1974). In interpreting Federal Rule of Civil
    Procedure 8, which governs the filing of complaints, the Supreme Court has held
    that a plaintiff need only set out “‘a short and plain statement of the claim’ that will
    give the defendant fair notice of what the plaintiff’s claim is and the grounds upon
    which it rests.” Conley v. Gibson, 
    355 U.S. 41
    , 47 (1957). That requirement is no
    different in cases brought under Section 1983. Indeed, the Court has explicitly
    held that courts may not apply a “heightened pleading standard” over and above
    the dictates of Federal Rule of Civil Procedure 8(a) to claims under Section 1983.1
    Leatherman v. Tarrant County Narcotics Intelligence & Coordination Unit, 
    507 U.S. 163
    , 168 (1993).
    1
    Federal Rule of Civil Procedure 8(a) states:
    (a) Claims for Relief. A pleading which sets forth a claim for relief,
    whether an original claim, counterclaim, cross-claim, or third-party
    claim, shall contain (1) a short and plain statement of the grounds upon
    which the court's jurisdiction depends, unless the court already has
    jurisdiction and the claim needs no new grounds of jurisdiction to
    support it, (2) a short and plain statement of the claim showing that the
    pleader is entitled to relief, and (3) a demand for judgment for the relief
    the pleader seeks. Relief in the alternative or of several different types
    may be demanded.
    3
    This case involves a complaint filed against Butler County, the Butler
    County Commission, and Sheriff Diane Harris. The claims against the County and
    the County Commission on the one hand and Sheriff Harris on the other involve
    different questions of liability and immunity as different types of governmental
    entities are entitled to different types of immunity. In order to determine whether
    Marsh and Owens have stated legal claims against Butler County, the Butler
    County Commission, and Sheriff Harris, we must first ascertain the type of
    governmental body or officer each represents, which will determine the type of
    conduct each may be held liable for under Section 1983. In determining the
    particular functions of a governmental body or official, we must refer to the state
    law definitions of that entity’s functions. Turquitt v. Jefferson County, Ala., 
    137 F.3d 1285
    , 1287 (11th Cir. 1998) (en banc). This Court has stated that “[o]ur
    analysis of Alabama law persuades us that an Alabama sheriff acts exclusively for
    the state rather than for the county in operating a county jail.” 
    Id. at 1288
    . Thus,
    we examine Marsh and Owens’ complaint to determine both whether it states a
    claim against the County and County Commission as local governmental bodies,
    and whether it states a claim against Sheriff Harris as a state official in either her
    official or personal capacity. Accordingly, we discuss the claims against the
    County and the Commission separately from those against Harris.
    4
    I. Claims against Butler County and the Butler County Commission2
    A. Allegations in the Complaint
    In order to state a claim under Section 1983 against a local governing body,
    a plaintiff must allege that he suffered a constitutional injury, and that his injury
    was caused by “a policy statement, ordinance, regulation, or decision officially
    adopted and promulgated by that body’s officers.” Monell v. Dept. of Social
    Servs., 
    436 U.S. 658
    , 690 (1978). A local governing body may also be held liable
    for “constitutional deprivations visited pursuant to governmental ‘custom’ even
    though such a custom has not received formal approval through the body’s official
    decisionmaking channels,” but may not be held liable under a theory of vicarious
    liability. 
    Id. at 690-91
    . The extent to which the County may be held liable for
    constitutional violations at the Butler County Jail is proscribed by the extent to
    which the County is responsible for the conditions therein. In Alabama, the
    distinct responsibilities of counties and sheriffs with respect to the operation and
    maintenance of county jails have been recognized by this Court. We have held that
    the “duties of the counties with respect to the jails ‘are limited to funding the
    operation of the jail and to providing facilities to house the jail.’” Turquitt v.
    2
    We henceforth refer to Butler County and the Butler County Commission
    collectively as “the County.” The County Commission is the governing body of the
    County, and the liability and immunity analyses are identical for both entities.
    5
    Jefferson County, Ala., 
    137 F.3d 1285
    , 1289 (11th Cir. 1998) (en banc) (quoting
    Stark v. Madison County, 
    678 So.2d 787
    , 787 (Ala. Civ. Ct. App. 1996)). “The
    county commission is charged with erecting and maintaining jails, and each county
    is required to maintain a jail of sufficient size and strength to secure the prisoners.”
    Id. at 1289-90 (quoting 
    Ala. Code §§ 11-14-10
    , 11-14-13 (1989)).
    In their complaint, Marsh and Owens claim that the County’s “deliberate
    indifference to the substantial risk of serious harm to inmates at Butler County
    Jail” resulted in substantial injury to them, in violation of their Eighth and
    Fourteenth Amendment rights. In order to state such a claim successfully for the
    purposes of a Rule 12(b)(6) motion, Marsh and Owens must allege facts supporting
    each element of a deliberate indifference claim. Thus, the complaint must allege
    facts demonstrating: 1) that inmates at Butler County Jail were subjected to a
    substantial risk of serious harm; 2) that the County was deliberately indifferent to
    that risk; 3) that there was a causal link between the acts or omissions of the
    County and the excessive risk of violence; and 4) that there was a causal link
    between the excessive risk of violence and the injuries suffered by Marsh and
    Owens. Hale v. Tallapoosa County, 50 F.3d For the purposes of reviewing the
    district court’s dismissal of the plaintiffs’ complaint, we must accept all facts
    alleged in the complaint as true. Fortner v. Thomas, 
    983 F.2d 1024
    , 1027 (11th
    6
    Cir. 1993). Of course the facts as stated herein may differ from the facts ultimately
    determined by a jury. 1579, 1582-84 (11th Cir. 1995); see also Farmer v. Brennan,
    
    511 U.S. 825
    , 837, 847 (1994).
    The complaint in this case makes the following allegations about conditions
    in Butler County Jail. The Butler County Jail, a two-story building located in
    downtown Greenville, Alabama, was constructed in 1929 and 1930. By 1996,
    because the County failed to maintain the facility over the years, the building was
    in an extremely dilapidated and poor physical condition. Sewage leaked from
    overhead pipes. Showers were covered with rust, mildew and peeling paint. Sinks
    and toilets were dilapidated and inoperable. Hallways were littered with trash.
    Windows were cracked and could not be closed. Shards of broken glass lay in the
    window sills. Rats, cockroaches and other rodents and vermin entered the jail
    through broken windows and cracks in the walls. The locks on inmate cells on the
    second floor of the Jail had been inoperable since at least 1995. As a result,
    inmates housed on the second floor have been able at all times to open their cell
    doors and walk into the hall, other cells, or the dayrooms whenever they wished,
    and they did so.
    7
    The complaint further alleged that the Jail was grossly understaffed. Despite
    the fact that jailers had numerous duties,3 the Jail was often staffed by only one
    person. Jailers spent most of their time sitting at a desk at the entrance to the Jail
    on the first floor, from which position they could not view any of the inmate cells,
    dayrooms, or the kitchen. In fact, most inmate living areas at the Jail were
    completely unsupervised. Jailers were “too afraid to conduct visual inspections of
    inmate cells on the second floor” because the broken locks prevented them from
    ever locking down the inmates. The Jail had no visual or audio surveillance
    system on the second floor, and no jailer was assigned there.
    Because of the poor condition of the Jail, inmates were able “to vandalize
    [the facility], break windows, and rip metal pipes and other dangerous objects from
    the structure.” Due in part to the low perimeter fence around the exercise yard,
    inmates were also “able to obtain screwdrivers, sticks, and [make-shift knives
    called] ‘shanks’ from outside the exercise yard.”
    3
    Jailers’ duties included controlling the inmate population, which could exceed
    fifty persons; administering inmate intake and release; controlling the electronic gate
    in the fence surrounding the Jail; supervising visitation and outdoor exercise; handling
    mail; coordinating food service; dispensing medication; supervising trustees; and
    answering the Jail telephone. On weekends, jailers were also responsible for
    answering telephone calls to the Butler County Sheriff’s Department and for operating
    the dispatch radio. Because their duties were so overwhelming, jailers often relied on
    unsupervised inmate trustees to assist them by, e.g., distributing medicine, unloading
    supplies, and sometimes handling the Jail’s keys.
    8
    As a result of the County’s failure to maintain a jail of sufficient size and strength
    to adequately secure and protect the prisoners, Marsh and Owens contend that
    inmates at Butler County Jail faced a substantial risk of serious harm at the hands
    of other inmates. Inmates were able to acquire weapons from in and around the
    Jail facility, and were able to roam freely among the rooms on the second floor
    without supervision. In the event that those unsupervised and armed inmates
    attacked someone, inmates on the second floor were unable to contact jailers
    directly. If they needed assistance, they either shouted out the windows or banged
    on the walls. Even then, “[j]ailers often did not respond.”
    The complaint further alleges that the County “knew and should have known
    about [the] risk” to inmates, and “failed to take measures to abate [the] substantial
    risk of serious harm.” Marsh and Owens alleged that the County was “repeatedly
    informed that more staff was needed at the jail” and that “the jail was not
    reasonably secure.” Critical reports from the Alabama Department of Corrections
    and several other state agencies, numerous inmate complaints and requests for
    assistance, and a federal civil rights action filed in May 1996 put the County on
    notice of the poor conditions at the Jail. In spite of these warnings, by July 1996, it
    had failed to take measures to ameliorate the situation. The County “did not
    9
    improve the physical condition of the jail or maintenance practices . . ., did not
    repair the locks on the second floor,” and did not increase staffing at the Jail.
    In their complaint, Marsh and Owens alleged that the substantial risk of
    harm faced by the inmates at Butler County Jail was traceable to the acts and
    omissions of the County. In particular, they alleged that they were subject to a
    substantial risk of serious harm because inmates were able to fashion weapons by
    vandalizing the decrepit Jail facility. Inmates were also able to secure weapons
    from in and around the outdoor exercise area due in part to the inadequacy of the
    perimeter fence. Moreover, Marsh and Owens alleged that inmates faced
    substantial risk of harm as a result of the broken locks on the second floor of the
    Jail. Because jailers were not able to lock down inmates on the second floor, the
    jailers were afraid to enter the floor, and thus could not perform necessary health
    and safety checks. Inmates were also permitted to roam freely among the cells and
    other rooms on the second floor because of the broken locks. In addition, the Jail
    did not utilize any visual or audio surveillance system. Finally, Marsh and Owens
    alleged that the Jail was chronically under-staffed, resulting in inadequate
    supervision and discipline of the inmates.
    The complaint then delineates the injuries suffered by Marsh and Owens as a
    result of the deplorable jail conditions and the County’s failure to address them.
    10
    As to Marsh, the complaint alleges the following. On July 2, 1996, Joe Marsh was
    resting on a bunk bed in a cell on the second floor of the Jail when four inmates
    entered the cell and one of them challenged Marsh to a fight in the dayroom.
    “When Marsh refused, the inmate struck him across the head with a metal pipe.”
    The three other inmates joined in the assault on Marsh, which lasted for several
    minutes. “They punched, kicked, and hit Marsh with the pipe while he was balled
    up in a corner. One inmate cut Marsh with a screwdriver while the other three held
    him.” While the assault was in progress, other inmates on the second floor
    “shouted and pounded on the walls” in an attempt to procure assistance from the
    jailers on the first floor. After being struck with the pipe a final time in the head,
    Marsh managed to walk toward the entrance to the back side to seek help. His face
    and head were covered in blood. As a result of the assault, Marsh suffered
    lacerations on his face, on the back of his head, and on this back. In addition, he
    sustained a fracture to the bone above his left eye. Since leaving the Jail, Marsh
    has suffered from frequent headaches and nightmares about the assault.
    On the evening of July 3, Leroy Owens entered the dayroom on the second
    floor of the Jail, followed by the four inmates who had assaulted Marsh. One of
    those inmates “hit Owens over the head with a metal pipe,” and “[a]nother hit him
    with a water cooler.” They proceeded to smash his head against a metal table, kick
    11
    him, stomp on him, stab him, and beat him. Owens screamed for help. A number
    of other inmates pounded on the walls and called for help, one of them yelling,
    “[t]hey’re killing him up here.” Only one jailer was on duty, and he did not come
    to Owens’ assistance. Instead, he called the Greenville City Police, who refused to
    approach the second floor when they arrived at the Jail. The jailer then called
    Sheriff Harris and the jail administrator, both of whom refused to come to the Jail.
    The jailer finally called the chief deputy of the Sheriff’s Department, who came to
    the Jail.
    The assault lasted between 30 minutes and an hour, during which time the
    four inmates stopped beating Owens and returned to their cells several times
    because they mistakenly thought they heard approaching jailers. Each time, they
    returned to the dayroom and continued to beat Owens when they realized that
    nobody was coming. When the assault was over, Owens lay on the floor of the
    dayroom in a pool of his blood. Inmates continued to call for help. Approximately
    20 minutes after the assault ended, the chief deputy removed Owens from the
    second floor and had him transported to the emergency room.
    B. District Court’s Ruling
    The County moved for dismissal on the ground that it “does not have
    authority to control or set policies or customs for the operation of the Butler
    12
    County Jail, nor does it have the authority to promulgate policies for treatment of
    inmates housed in the Butler County Jail.” The district court granted the County’s
    motion to dismiss without holding a hearing on the ground that the County and
    County Commission both enjoyed legislative immunity under the purview of 
    28 U.S.C. § 1915
    (e)(2)(B)(iii). Clearly, legislative immunity is not applicable in this
    case. As is plain from the title of Section 1915, that statute applies only to
    proceedings in forma pauperis, which this suit was not. More importantly,
    however, it is well settled that legislative immunity protects individual legislators
    from suit, but does not protect governmental entities. See Lake Country Estates,
    Inc. v. Tahoe Regional Planning Agency, 
    440 U.S. 391
    , 403 (1979) (finding that
    “Congress, in enacting Section 1983 . . . , could not have intended to overturn” the
    “immunity of legislators from civil suit for what they do or say as legislators”);
    Bogan v. Scott-Harris, 
    523 U.S. 44
    , 54 (1998). In this case, the County
    Commissioners were not sued in their individual capacities. Therefore, legislative
    immunity has no bearing on the complaint in this case. The district court clearly
    erred in concluding that the County and County Commission enjoyed any sort of
    legislative immunity from this suit.
    The County concedes that the district court clearly erred in dismissing the
    suit on this basis, but asks that we nonetheless affirm the dismissal because the
    13
    complaint fails to state claims of constitutional deprivations for which the County
    is responsible under this Court’s en banc decision in Turquitt v. Jefferson County,
    Ala., 
    137 F.3d 1285
     (11th Cir. 1998). Alternatively, the County asks that we
    affirm the dismissal because the complaint fails to allege that the County was on
    notice of the constitutional deficiencies at the Jail.
    Looking anew at the allegations in the complaint, we find that Marsh and
    Owens alleged sufficient facts to state a claim against the County under Section
    1983 for deliberate indifference to a substantial risk of serious harm at the Butler
    County Jail. It is true that the County may not be responsible for all of the
    conditions at the Butler County Jail. The extent to which the County may be
    considered to have caused conditions leading to a constitutional deprivation is
    proscribed by the duties and responsibilities Alabama counties have with regard to
    county jails. This Court has found that:
    The duties of the counties with respect to the jails are limited to
    funding the operation of the jail and to providing facilities to house
    the jail. . . . The county commission is charged with erecting and
    maintaining jails, and each county is required to maintain a jail of
    sufficient size and strength to secure the prisoners. . . . In construing
    these provisions, the Alabama courts have made it clear that the duty
    of the county to erect and maintain a county jail pertains exclusively
    to the physical plant of the jail. The duty to maintain a jail under
    [Alabama Code] § 11-14-10 is merely the duty to keep the jail and all
    equipment therein in a state of repair and to preserve it from failure or
    decline.
    14
    Turquitt v. Jefferson County, Ala., 
    137 F.3d 1285
    , 1289-90 (11th Cir. 1998) (en
    banc) (internal quotation marks and citations omitted). Although these duties are
    not as extensive as those owed by the Sheriff, there is in fact a nexus between the
    County’s sphere of responsibility and the jail conditions alleged to have caused the
    substantial risk of serious harm.
    The complaint alleged that the risk of harm at the Jail stemmed in part from
    the inmates’ ability to fashion weapons by vandalizing the dilapidated physical
    structure of the Jail and by removing dangerous objects such as metal pipes and
    broken glass from the ailing building. It is the County that is charged with the duty
    of maintaining the physical structure of jails and keeping those structure and the
    equipment therein in a state of repair. Marsh and Owens also alleged that inmates
    were able to obtain weapons from outside the outdoor exercise area because the
    perimeter fence was too low. The County was also charged with erecting and
    maintaining a jail facility of sufficient size and strength to secure the inmates. The
    complaint also charged that, because all the cell locks on the second floor were
    broken for at least a year, jailers were afraid to supervise inmates adequately and
    inmates were able to roam freely among different cells, which created a risk of
    assault and intimidation. The lack of surveillance was exacerbated by the Jail’s
    failure to use a video or audio surveillance system. Again, it is the responsibility
    15
    of the County to establish and maintain a jail that is in good repair and is
    sufficiently secure. Finally, the Jail’s alleged under-staffing problems may have
    been caused by insufficient funding. The County is responsible for funding the
    operation of the jails.
    Moreover, Marsh and Owens did in fact allege that the County was actually
    aware of the dangerous conditions and did nothing to remedy the problems,
    evidencing deliberate indifference to the risk of harm. We also find that the
    complaint contained sufficient facts to allege a causal link both between the acts or
    omissions of the County and the excessive risk of harm, and between the excessive
    risk of violence and the injuries suffered by Marsh and Owens.
    Because the complaint filed by Marsh and Owens alleged with sufficient
    particularity all of the elements necessary to find municipal liability for a
    constitutional deprivation under Section 1983, we find that the district court erred
    in dismissing this case against Butler County and the Butler County Commission.
    II. Claims against Sheriff Harris
    In their complaint, Marsh and Owens alleged that Sheriff Harris, in her
    personal capacity,4 was deliberately indifferent “to the substantial risk of harm to
    4
    Although the complaint states that “Diane Harris is sued in her official
    capacity as Sheriff of Butler County,” the caption states that Harris is sued in her
    personal as well as her official capacity, which is sufficient to put Harris on notice that
    16
    inmates at the Butler County Jail.” In addition, Owens alleged that Sheriff Harris,
    in her personal capacity, was deliberately indifferent to his serious medical needs.5
    In order to find that the district court erred in dismissing Marsh and Owens’ claims
    against Sheriff Harris, we must find that they alleged sufficient facts to
    demonstrate that Harris, acting within her discretionary functions, violated their
    clearly established constitutional rights.
    This Court has found that an Alabama sheriff “acts exclusively for the state
    rather than for the county in operating a county jail.” Turquitt, 
    137 F.3d at 1288
    .
    Because she is an officer of the State, the Eleventh Amendment immunizes Harris
    from being sued in her official capacity. Zatler v. Wainwright, 
    802 F.2d 397
    , 400
    (11th Cir. 1986). Thus, the district court was correct in dismissing the claims
    against Harris in her official capacity. In order to state a successful claim under
    Section 1983 against a state official in her personal capacity, a plaintiff must first
    overcome the protections of qualified immunity. Qualified immunity protects
    she was subject to suit under Section 1983. Because Harris is immune from suit
    against her in her official capacity, we will consider all claims against her as against
    her in her personal capacity.
    5
    In the complaint, Owens asserts this claim against the “Defendants.” Because
    there is no allegation anywhere else in the complaint to support a theory that the
    County showed deliberate indifference to his serious medical needs, we will consider
    this claim as against Sheriff Harris only.
    17
    government officials from civil suit when they have acted within their
    discretionary functions in a manner that violates “no clearly established statutory
    or constitutional rights of which a reasonable person would have known.” Harlow
    v. Fitzgerald, 
    457 U.S. 800
    , 818 (1982). “Defendants are entitled to qualified
    immunity in a Rule 12(b)(6) motion to dismiss only if the complaint fails to allege
    facts that would show a violation of a clearly established constitutional right.”
    Kyle K. v. Chapman, 
    208 F.3d 940
    , at *2 (11th Cir. Apr. 5, 2000).
    A. Marsh and Owens’ Claim of Deliberate Indifference to a Substantial
    Risk of Serious Harm
    1. Allegations in the Complaint
    It is well settled law that a “prison official’s deliberate indifference to a
    substantial risk of serious harm to an inmate violates the Eighth Amendment.”
    Farmer, 
    511 U.S. at 828
    . In order to survive Rule 12(b)(6) motion, the Complaint
    in this case must have alleged that 1) inmates were subjected to a substantial risk of
    serious harm, 2) Sheriff Harris was deliberately indifferent to that risk, 3) the
    Sheriff’s deliberate indifference caused that risk, and 4) her deliberate indifference
    caused the harm suffered by Marsh and Owens. See Zatler, 
    802 F.2d at 400-01
    . In
    order to state the requisite causal connections, Marsh and Owens need not have
    alleged that Harris was personally involved in the actions that violated their
    constitutional rights. This Court has made clear that “[p]ersonal participation is
    18
    only one of several ways to establish the requisite causal connection. . . . An
    official may also be liable where a policy or custom that [she] established or
    utilized results in deliberate indifference to an inmate’s constitutional rights.”
    Zatler, 
    802 F.2d at 401
     (internal citations omitted).
    Many of the complaint’s factual allegations that are outlined above also
    implicate the Sheriff in the alleged constitutional deprivations. Marsh and Owens
    alleged that inmates were able to acquire or fashion weapons due in part to both
    inadequate supervision by prison personnel and a systematic failure to search
    inmates when they returned from the exercise yard. They also alleged that jailers
    failed to inspect cells and inmates on the second floor, and thus could not conduct
    “counts” to ensure the health and safety of the inmates. They further alleged that
    the personnel at the Jail were inadequately trained and that the Jail was routinely
    “grossly understaffed.” They charged that the Jail did not have any system for
    screening entering inmates, and “did not ask new inmates about their mental health
    background or other medical conditions.” Nor did they ascertain whether
    incoming inmates had any existing conflicts with persons already imprisoned at the
    Jail. Moreover, they claimed that the Jail had no system for classifying or
    separating inmates, instead housing violent offenders with non-violent offenders,
    serious felons with misdemeanants, juveniles with adults, and mentally ill persons
    19
    with those in good mental health. Finally, Marsh and Owens alleged that the Jail
    employed “[n]o system of discipline,” and “did not discipline or even segregate
    inmates who cursed, flooded cells, broke windows, destroyed property, attempted
    to escape, threatened jailers, or assaulted other inmates.” As a result of these
    alleged failures in supervision, security, and other inmate-related policies, Marsh
    and Owens alleged that the conditions at Butler County Jail created “an intolerably
    high risk of intimidation, assault, and other abuse among inmates at the jail.”
    Marsh and Owens also alleged that Sheriff Harris was aware of the problems
    and conditions that led to the substantial risk to inmates, and, by failing to remedy
    those problems, evidenced deliberate indifference to the risk of harm faced by
    inmates. They alleged that the Jail Administrator had informed Sheriff Harris that
    the Jail was understaffed, and that the three inmate escape attempts during the first
    half of 1996 all occurred when only one jailer was on duty. They also contended
    that the jail inspector for the Alabama Department of Corrections had informed the
    Sheriff that the Jail was not reasonably secure, and that the Sheriff had received
    numerous critical inspection reports and inmate complaints. Notwithstanding this
    notice, Marsh and Owens alleged that the Sheriff did nothing to address the
    problems in the Jail or to alleviate the substantial risk of harm.
    20
    Marsh and Owens alleged in their complaint that Sheriff Harris is
    responsible under Alabama law for the general operation of the Jail, and thus acts
    as final policy maker with respect to the operation of the Jail. They further alleged
    that the substantial risk of harm they faced was a direct result of the staffing and
    operational policies of the Jail. They alleged that the risk of harm arose from the
    ability of the inmates to bring weapons from the exercise yard into the Jail, from
    the inadequate supervision of inmates, from the Jail’s failure to classify and
    segregate inmates, and from the Jail’s lack of a disciplinary system.
    Finally, Marsh and Owens alleged that Sheriff Harris’ failure to remedy the
    problems at the Jail – that is, her deliberate indifference to the substantial risk of
    harm faced by the inmates – caused them to suffer injuries. Both Marsh and
    Owens alleged that they were attacked by inmates who brandished weapons such
    as a screwdriver that they may have acquired while outside in the exercise yard.
    Both victims alleged that they were subjected to prolonged attacks because jailers
    refused to come to their assistance. In the case of Owens, the only jailer on duty
    refused to come to his assistance until other Jail personnel could accompany him.
    After the four attacking inmates allegedly assaulted Marsh, they were not
    disciplined, interrogated, or segregated, even after they were later heard plotting to
    assault a female guard. Marsh and Owens alleged that those four inmates were left
    21
    to roam freely among the rooms on the second floor, where they later assaulted
    Owens and again attacked Marsh with a fire extinguisher after he returned from the
    emergency room. Indeed, it was the very day after Marsh was beaten that Owens
    was extensively beaten while no jailer came to his aid. After being left in a pool of
    his own blood, Owens was finally removed from the second floor and taken to the
    emergency room. Owens was treated at the hospital, after which the deputies once
    again took him into their custody, agreeing to monitor his injuries and his health.
    Nonetheless, the deputies left him without shoes or supervision by the side of an
    interstate.
    Owens further alleged that he was injured partly as a result of the fact that
    the Jail did not have any system for screening or segregating inmates. He alleged
    that he has suffered from mental illness since at least 1979, has been diagnosed as a
    paranoid schizophrenic with borderline intellectual functioning, and has been
    institutionalized in a number of mental health facilities. He alleged that the
    affidavit upon which his arrest warrant was based in July 1996 stated that Owens
    was a “mental patient” and that he was “talking nonsense.” When Owens arrived
    at the Jail, nobody asked him about his mental illness, and he was placed in the
    general population on the back side of the second floor. While he was incarcerated
    at the Jail, Owens alleged that his mental health problems were obvious as he
    22
    allegedly proclaimed that he was a prophet of God. Another inmate informed a
    jailer that Owens should be moved because he was “not right in the head” and was
    aggravating other inmates. Some inmates complained about Owens’ hygiene and
    harassed him, forcing him to move from cell to cell. Owens requested that he be
    placed in a cell by himself, but his request was refused.
    2. District Court’s Ruling
    The district court found that Marsh and Owens had failed to state a claim of
    deliberate indifference to a substantial risk of serious harm against Sheriff Harris
    because they had stated insufficient facts to overcome her qualified immunity. In
    so holding, the court concluded that Marsh and Owens had failed to allege that
    Harris had crossed a “bright line” into violations of clearly established law.
    In order to state a claim that Harris violated clearly established law by
    displaying deliberate indifference to a substantial risk of serious harm to inmates,
    Marsh and Owens needed to allege 1) that they were “incarcerated under
    conditions posing a substantial risk of serious harm,” and 2) that prison officials –
    in this case Sheriff Harris – demonstrated “‘deliberate indifference’ to inmate
    health or safety.” Farmer, 
    511 U.S. at 834
    . Marsh and Owens clearly did so in this
    case. In Hale v. Tallapoosa County, 
    50 F.3d 1579
    , 1582-84 (11th Cir. 1995), this
    Court found that an inmate alleged sufficient facts to survive the jailer defendants’
    23
    motion for summary judgment based on qualified immunity. The inmate plaintiff
    in that case complained that he faced a substantial risk of serious harm from
    inmate-on-inmate violence, and had in fact been assaulted by other inmates, due in
    part to the jail’s failure to segregate inmates, the jail’s under-staffing, the
    inadequate training of jailers, and the jailers’ inadequate supervision and
    monitoring of inmates. The district court in this case stated that, although Marsh
    and Owens “have asserted essentially the same claims as the inmates in the Hale
    case,” this case is distinguishable because Marsh and Owens had failed to allege
    that “inmate-on-inmate violence occurred regularly when the jail was over-
    crowded,” as was the case in Hale. We do not find that fact to be distinguishing.
    Marsh and Owens do not need to allege that previous incidents of violence
    occurred at the Jail in order to state a claim for deliberate indifference to a
    substantial risk of serious harm. Indeed, the Supreme Court has held that the
    standard for demonstrating deliberate indifference “does not require a prisoner
    seeking ‘a remedy for unsafe conditions [to] await a tragic event [such as] an
    actua[l] assaul[t] before obtaining relief.’” Farmer, 
    511 U.S. at 845
     (quoting
    Helling v. McKinney, 
    509 U.S. 25
    , 33-34 (1993) (alternations in original)).
    The conditions at the jail in Hale that gave rise to the history of inmate-on-
    inmate violence are substantially similar to the conditions alleged in this case to
    24
    have created the substantial risk of serious harm at Butler County Jail. Indeed, the
    living conditions at Butler County Jail are a good deal worse than were the
    conditions in Hale. Butler County inmates were forced to endure squalid
    conditions that in fact put prisoners in harm’s way rather than securing their safety.
    Although the “Constitution ‘does not mandate comfortable prisons,’ . . . neither
    does it permit inhumane ones.” Farmer, 
    511 U.S. at 832
     (quoting Rhodes v.
    Chapman, 
    452 U.S. 337
    , 349 (1981)). Rather, prison officials have a duty to
    provide humane conditions of confinement and to protect prisoners from violence
    at the hands of other prisoners. Farmer, 
    511 U.S. at 832
    . “Having incarcerated
    ‘persons [with] demonstrated proclivit[ies] for antisocial criminal, and often
    violent, conduct,” . . . having stripped them of virtually every means of self-
    protection and foreclosed their access to outside aid, the government and its
    officials are not free to let the state of nature take its course.” 
    Id.
     (quoting Hudson
    v. Palmer, 
    468 U.S. 517
    , 526 (1984)). Marsh and Owens alleged that armed
    inmates were permitted to roam freely and unsupervised among second floor
    rooms, which housed all classes of detainees. Moreover, the jailers themselves
    were afraid to perform health and safety checks on the second floor because they
    were unable to lock down the inmates. These allegations are sufficient to state a
    claim that inmates at Butler County Jail faced a substantial risk of serious harm at
    25
    the hands of other inmates. Moreover, the allegations are sufficient to state a claim
    that Sheriff Harris, as final policy maker for Butler County Jail, violated clearly
    established laws by creating the conditions at the Jail that gave rise to the threat of
    danger.
    Marsh and Owens also alleged sufficient facts to demonstrate that Sheriff
    Harris was deliberately indifferent to the risk of harm at the Jail. “Whether a
    prison official had the requisite knowledge of a substantial risk is a question of fact
    subject to demonstration in the usual ways, including inference from circumstantial
    evidence, . . . and a factfinder may conclude that a prison official knew of a
    substantial risk from the very fact that the risk was obvious.” Farmer, 
    511 U.S. at 841
    . Marsh and Owens alleged both that Sheriff Harris had been put on notice by
    numerous sources that the Jail was understaffed and that it was “not reasonably
    secure,” and that she had failed to take any steps to alleviate the risk of harm.
    Allegations that “the defendant-official being sued had been exposed to
    information concerning the risk and thus ‘must have known’ about it . . . could be
    sufficient to permit a trier of fact to find that the defendant-official had actual
    knowledge of the risk.” Farmer, 
    511 U.S. at 842-43
    . Marsh and Owens alleged
    sufficient facts in their complaint to state a claim that Sheriff Harris was
    26
    deliberately indifferent to the substantial risk of serious harm at the Butler County
    Jail.
    Because Marsh and Owens alleged all of the elements necessary for a
    successful claim against a state official in her personal capacity under Section 1983
    for deliberate indifference to the substantial risk of serious harm, and because they
    alleged those elements with sufficient specificity to put Sheriff Harris on notice of
    the grounds upon which their claim rested, we find that the district court erred in
    dismissing their claim.
    B. Owens’ Claim of Deliberate Indifference to Serious Medical Needs
    1. Allegations in the Complaint
    We now turn to Owens’ claim against Harris for deliberate indifference to
    his serious medical needs, which must meet criteria similar to that of the serious
    harm claim in order to survive a Rule 12(b)(6) motion. The Supreme Court has
    held that “deliberate indifference to serious medical needs of prisoners constitutes
    the ‘unnecessary and wanton infliction of pain’ proscribed by the Eighth
    Amendment.” Estelle v. Gamble, 
    429 U.S. 97
    , 104 (1976) (quoting Gregg v.
    Georgia, 
    428 U.S. 153
    , 173 (1976)). In order to state such a claim, an inmate must
    allege more than negligence; he must “allege acts or omissions sufficiently harmful
    to evidence deliberate indifference to serious medical needs.” Estelle, 
    429 U.S. at
    27
    105. Moreover, a “finding of deliberate indifference necessarily precludes a
    finding of qualified immunity.” Hill v. Dekalb Regional Youth Detention Center,
    
    40 F.3d 1176
    , 1186 (11th Cir. 1994).
    In order to survive Rule 12(b)(6) motion, the complaint in this case must
    have alleged that 1) Owens suffered from a serious medical need, 2) Sheriff Harris
    was deliberately indifferent to that need, and 3) Harris’ deliberate indifference
    caused Owens to suffer harm. See McElligot v. Foley, 
    182 F.3d 1248
    , 1254-55
    (11th Cir. 1999).
    With respect to his claim for deliberate indifference to serious medical
    needs, Owens has alleged that he suffered from “serious medical needs” after being
    released from the hospital following his assault at the Jail. He claims that the
    hospital staff “instructed the Sheriff’s Department to follow specific procedures to
    care for Owens’s head wounds and other injuries. It instructed them to monitor his
    level of consciousness, pupils, vision, and coordination, and to call the hospital
    immediately if any change occurred.” His condition was diagnosed by a physician
    as mandating treatment and monitoring, and he was in a great deal of pain.
    Owens also contended that the Sheriff’s Department was deliberately
    indifferent to his serious medical needs. Rather than adhering to the written
    instructions they received when they signed Owens out of the hospital, the officers
    28
    released Owens, instructing him to sign his own bond, and dropped him off near an
    interstate outside of a motel. Owens was barefoot, wearing bloodied clothing, and
    was severely swollen and bruised, and when he stepped out of the officer’s car, the
    officer drove away. Owens was unable to secure a room at that motel, and, after
    walking dazedly across the interstate, was also denied entrance to a restaurant. At
    that point, a city police officer picked him up and ordered a clerk at a Holiday Inn
    to rent a room to Owens.
    Owens did not allege that Sheriff Harris was personally involved in these
    events. He did, however, allege that the deliberate indifference shown by the
    officers was pursuant to an official policy of the Sheriff’s Department. Owens
    claimed that the acts allegedly constituting deliberate indifference occurred when
    the officers of the Sheriff’s Department dropped him on the side of the road
    without administering the medical care the hospital had instructed them to deliver.
    Owens also alleged that the officers released him in such a manner pursuant to a
    “policy and custom of releasing sick or injured inmates.”
    Finally, Owens also alleged that, when he awoke alone on the day following
    the assault, he was in a great deal of pain and had to be taken back to the hospital
    in an ambulance. He also alleged that he had to be readmitted to the hospital
    29
    several days later and that he still experiences pain and limited mobility in his right
    shoulder as well as uncontrollable shaking in his right arm.
    2. District Court’s Ruling
    This Court has defined a “serious medical need” as “one that has been
    diagnosed by a physician as mandating treatment or one that is so obvious that
    even a lay person would easily recognize the necessity for a doctor’s attention.”
    Hill, 
    40 F.3d at 1187
    . The condition Owens alleges he was in when he was
    released by the hospital into the care of the Sheriff’s Department qualifies at this
    stage of the proceedings as a “serious medical need.” Moreover, by alleging that
    the officers of the Sheriff’s Department failed to follow the instructions given to
    them at the hospital for caring for Owens’ medical needs, and instead left him
    barefoot by the side of the road, Owens has alleged that they were deliberately
    indifferent to his serious medical needs.
    In order to state a claim against Harris, however, Owens must do more than
    allege that her employees were deliberately indifferent. In dismissing Owens’
    claim for deliberate indifference to serious medical needs, the district court
    concluded that Owens did not “show that the sheriff was personally involved in the
    acts or omissions that resulted in the constitutional deprivation,” and that he
    therefore failed to establish a constitutional violation. As this Court has previously
    30
    held, however, “[p]ersonal participation is only one of several ways to establish the
    requisite causal connection. . . . An official may also be liable where a policy or
    custom that [she] established or utilized results in deliberate indifference to an
    inmate’s constitutional rights.” Zatler, 
    802 F.2d at 401
     (internal citations omitted).
    Owens did allege that the officers of the Sheriff’s Department acted pursuant to a
    “policy and custom of releasing sick and injured inmates” when they acted with
    deliberate indifference. Because Sheriff Harris is the final policy maker of Butler
    County Jail, these allegations are sufficient to state a claim that she acted with
    deliberate indifference to Owens’ serious medical needs.
    Finally, Owens alleged sufficient facts to demonstrate that he was injured by
    Harris’ deliberate indifference. When he awoke alone the day following the
    assault, he was “in terrible pain” and had to be taken back to the hospital in an
    ambulance. He returned to the hospital several days later for further treatment.
    Because we find that Owens alleged sufficient facts to state a claim against Sheriff
    Harris under Section 1983 for deliberate indifference to serious medical needs, we
    conclude that the district court erred in dismissing the complaint under Rule
    12(b)(6).
    REVERSED and REMANDED for further proceedings in accordance
    herewith.
    31