Kyle Rusness v. Becker County, Minnesota ( 2022 )


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  •                   United States Court of Appeals
    For the Eighth Circuit
    ___________________________
    No. 21-1235
    ___________________________
    Kyle Allen Rusness
    lllllllllllllllllllllPlaintiff - Appellant
    v.
    Becker County, Minnesota, and its Personnel; Vivian Anderson; Josie Johnson
    lllllllllllllllllllllDefendants - Appellees
    Jane Doe
    lllllllllllllllllllllDefendant
    Matthew H. Johnson; John Freeman, acting in their individual capacities; Michele
    Clayson, acting in her individual capacities; Todd Glander, acting in his individual
    and official capacities; Paula Peterson, acting in her individual and official capacities
    lllllllllllllllllllllDefendants - Appellees
    Teresa Ullmer
    lllllllllllllllllllllDefendant
    ____________
    Appeal from United States District Court
    for the District of Minnesota
    ____________
    Submitted: December 16, 2021
    Filed: April 12, 2022
    ____________
    Before SMITH, Chief Judge, GRUENDER and KOBES, Circuit Judges.
    ____________
    SMITH, Chief Judge.
    Kyle Rusness arrived at Becker County Jail in Minnesota with a number of
    physical ailments. Two weeks later, he was taken to the hospital and subsequently
    diagnosed with acute myeloid leukemia. Rusness underwent successful cancer
    treatment. His cancer has gone into remission, but he continues to suffer from
    multiple lasting side effects. He filed an action against Becker County and its
    personnel, claiming deliberate indifference to his medical needs, failure to provide
    adequate training and supervision to corrections officers, and negligence. The district
    court1 granted summary judgment in favor of the defendants. The court held that they
    were entitled to qualified immunity on the deliberate indifference claim and that
    Rusness had failed to present sufficient evidence of negligence and of failure to train
    or supervise. We affirm.
    I. Background
    A. Facts
    In December 2014, Rusness was arrested for driving violations and
    incarcerated in Rigby, North Dakota. On January 6, 2015, while still incarcerated, a
    doctor diagnosed him with an infection on his leg. Rusness had already been taking
    penicillin for a dental infection. The doctor discontinued the penicillin prescription
    and instead prescribed another antibiotic, Bactrim, for both infections.
    1
    The Honorable Joan N. Ericksen, United States District Judge for the District
    of Minnesota.
    -2-
    Ten days later, on January 17, Rusness was transferred to Becker County Jail
    (BCJ) in Minnesota to be held as a pretrial detainee. On January 23, he was convicted
    of a probation violation and began serving his sentence. His intake form listed his
    medical concerns as: (1) MRSA (staph infection), (2) an infection in the mouth, (3)
    a body rash, and (4) cardiac issues. The form also noted that he was taking Bactrim.
    Shortly after his arrival at BCJ, Rusness submitted a Sick Call Request detailing his
    symptoms, including fatigue, dizziness, cardiac pain, night sweats, blurred vision, and
    bleeding gums.
    During the relevant period, Sunnyside Care Center (Sunnyside) provided
    nursing services at BCJ. Two Sunnyside nurses, Teresa Ullmer and Tami Sweep,
    served BCJ inmates. One or the other would be available on-site at BCJ two to three
    days per week. Sunnyside nurses were also available by phone 24 hours a day.
    On Monday, January 19, two days after Rusness’s arrival, Nurse Ullmer
    attempted to see Rusness pursuant to his Sick Call Request. However, Rusness
    declined to see her. The following day, January 20, Officer Paula Peterson wrote an
    Incident Report noting Rusness’s Sick Call Request, his refusal to see the nurse, and
    his Bactrim prescription.
    Rusness submitted another Sick Call Request the next day, January 21,
    complaining of a headache, fever, vomiting, and “gums [that] look[ed] really bad,”
    noting that his rash had cleared and requesting to see a doctor. R. Doc. 73-1, at 28.
    He agreed to see Nurse Sweep. Nurse Sweep visited Rusness and noted his
    complaints. She also described his appetite, temperature, blood pressure, and pulse
    as normal. She scheduled a dental appointment for him for February 4.
    That Friday, January 23, he submitted a third Sick Call Request seeking a
    higher dose of ibuprofen for “very severe” mouth pain. Id. at 30. The next day,
    Saturday, January 24, Rusness spoke with Officer Peterson as she distributed
    -3-
    medications. He asked her to look at a sore on his upper thigh. Officer Peterson told
    Rusness that a male corrections officer would need to examine the sore because of its
    location. She contacted Officers Vivian Anderson and John Freeman and asked them
    to check on Rusness. The officers met with Rusness, and Officer Freeman examined
    the sore. They decided to take him to the nearby Essentia Health walk-in medical
    clinic. Officer Freeman accompanied Rusness to the clinic. There, Rusness told the
    physician’s assistant (PA), Vonda Eidenschink, who examined him about his various
    symptoms, including his bleeding gums. PA Eidenschink diagnosed him with
    gingivitis and a skin infection and prescribed him another antibiotic, Clindamycin,
    for his skin infection and an oral rinse to treat his gingivitis until his upcoming dental
    appointment. She also noted that Rusness had a number of additional concerns and
    recommended he receive a full physical exam by a family practice physician. She
    wrote her instructions on an Inmate Medical Report, which Officer Freeman placed
    in the nurses’ inbox at BCJ. Officer Peterson wrote an Incident Report documenting
    Rusness’s complaints and his visit to the clinic.
    The next day, January 25, Officer Christopher Burton filled out a Sick Call
    Request for Rusness. The request asserted that his symptoms were getting worse.
    Rusness submitted an additional Sick Call Request later in the day reporting that his
    throat was closing and that he was unable to gargle the prescribed oral rinse and had
    difficulty eating and drinking. He also requested a doctor’s appointment. Later that
    day, Rusness’s aunt visited. He told her, “I think it’s serious, that’s—they think it’s
    serious. You know, [certain jailers] come and check on me all the time, make sure I’m
    doing okay. And they have sympathy, they’re waiting for somebody to let me go see
    a medical physician.” R. Doc. 60-1, at 19.
    On Monday, January 26, Nurse Ullmer reviewed Rusness’s Sick Call Requests
    and Inmate Medical Report. She did not, however, have access to PA Eidenschink’s
    examination note. Consequently, although she knew Rusness had visited the medical
    clinic and received prescriptions, she did not know of his gingivitis and skin infection
    -4-
    diagnoses. When Nurse Ullmer saw Rusness that day, she took down his complaints,
    including bleeding from the nose and mouth, vomiting, and seeing a “blood spot” in
    his eye when looking into the light. Id. at 97. Rusness told her that he could barely
    talk, but he spoke loquaciously, forcing her to interrupt him to complete her
    questions. She did not examine his nose or mouth during the visit. Rusness also
    repeatedly told Nurse Ullmer that he needed to go to the emergency room.
    Afterwards, she scheduled an appointment for Rusness to see a family practice
    physician per PA Eidenschink’s instructions for February 3, eight days later. She
    made Tylenol available to Rusness as needed. She wrote in the Nurse Logbook that
    he was continuing his antibiotic and mouth rinse and that she had scheduled a
    doctor’s appointment for him. She instructed BCJ staff to report if Rusness was
    bleeding or vomiting.
    Nurse Ullmer relayed this information to Officer Peterson, who wrote an
    Incident Report, which states, “The nurse does have some concerns but until
    [Rusness] is on the antibiotic for longer and the antibiotic starts working there is no
    reason for a follow-up with a doctor.” R. Doc. 73-1, at 53 (all caps omitted). Nurse
    Ullmer testified at her deposition that she believed that Rusness had “no current
    symptoms that would trigger following up with a doctor at [this] time.” R. Doc. 73-1,
    at 21.
    The following day, January 27, Officer Josie Johnson spoke with Rusness as
    she delivered medication. Rusness declined his pain medication. She noted seeing
    some watered-down blood near Rusness. Having reviewed the Nurse Logbook prior
    to distributing medications, Officer Johnson did not believe that Rusness’s condition
    was serious. However, she was concerned about the potential biohazard posed by the
    blood and called Officer Freeman to Rusness’s cell.
    -5-
    After arriving, Officer Freeman noticed blood on Rusness’s sheets as well as
    on the wall. He also saw bloody saliva in a cup on the floor. He reported the situation
    to Officer Anderson, the supervisor on duty, who also looked at Rusness’s cell and
    had Officer Freeman take photographs of it. Then Officers Freeman and Anderson
    took Rusness in a wheelchair to a medical observation cell, where he could be
    monitored by camera. Officer Freeman took Rusness’s temperature, which measured
    99.9 degrees, a low-grade fever. Jail staff, including Officers Freeman and Anderson,
    monitored Rusness by video feed and performed well-being checks every 30 minutes.
    Rusness’s temperature remained at 99.9 degrees when it was later checked. Officer
    Anderson also observed blood-tinged drool once while Rusness was sleeping.
    During this monitoring period, Officer Anderson reviewed Rusness’s file in the
    Nurse Logbook. From the file, she learned that (1) he recently had been to the clinic
    and given medical clearance to return to BCJ; (2) Nurse Ullmer had seen him the day
    before and concluded that his symptoms did not warrant another visit to the clinic;
    (3) Nurse Ullmer believed his antibiotic would need some additional time to start
    working; and (4) Nurse Ullmer anticipated that Rusness might experience additional
    bleeding and vomiting, which should be documented and reported. Officer Anderson
    also recalled learning from another officer that Rusness had been diagnosed with
    gingivitis at his clinic visit and had been prescribed an antibiotic and mouth rinse as
    treatment.
    As there was no nurse on duty at BCJ at this time, Officer Anderson contacted
    the on-call nurse at Sunnyside for further guidance. The Sunnyside nurse instructed
    BCJ staff to continue monitoring Rusness. In compliance with Nurse Ullmer’s
    logbook instruction to report any bleeding, Officer Freeman wrote a note about the
    incident and put it on a desk in the nurses’ office. Despite the call and the note, Nurse
    Ullmer testified that she was not made aware of the January 27 incident.
    -6-
    The following day, January 28, Rusness was moved out of medical observation.
    His aunt visited him that evening. Rusness told her about the bleeding incident,
    explaining that he did not know how it started or how the blood had gotten in his cell
    and that he “barely remembered what happened.” R. Doc. 60-1, at 33. At his
    deposition, he testified that he still does not remember much about the incident. For
    the next few days, Rusness reported no additional bleeding and continued with his
    prescribed medications.
    On January 31, Officer Freeman spoke with Rusness while distributing
    medications. Rusness called out from his bed, asking for his medication. Officer
    Freeman told him to come to the cart. Rusness then crawled 10 to 15 feet to the
    medication cart. Once at the cart, Rusness stood up, took his medication, and walked
    normally back to his bed.
    On February 1, Rusness told Officer Michele Clayson that his leg was numb
    and that his arm had been numb earlier. Officer Clayson, however, observed that
    Rusness was walking normally and did not appear to be in distress. Officer Clayson
    advised him to fill out a Sick Call Request. Rusness told her that his symptoms were
    worsening and that he had discontinued his antibiotic because it was causing him to
    vomit. He also stated that he had not left bed in a week and was experiencing great
    pain. Rusness also discussed his condition during a visit with his aunt later that day,
    telling her that his bleeding was improving but his fatigue was worsening. He also
    informed her of his upcoming medical and dental appointments.
    That day, Rusness submitted another Sick Call Request, reporting that all his
    symptoms were worsening. He reported feeling fatigue and experiencing additional
    bleeding. Officer Peterson later filed an Incident Report regarding Rusness’s Sick
    Call Request and his having discontinued his antibiotic. Nurse Ullmer met with him
    the following day, February 2. She saw no bleeding. Rusness’s temperature was
    slightly elevated at an even 100.00 degrees. Nurse Ullmer then called the dentist with
    -7-
    whom Rusness had an upcoming appointment for guidance. The dentist told her that
    the bleeding could have several causes, including Rusness’s use of
    methamphetamine, his extended time on antibiotics, a wisdom tooth issue, or a
    general body infection. The dentist instructed Nurse Ullmer that Rusness should
    continue his medications as prescribed, but, if he experienced any swelling of the face
    or elevated temperature, then the jail should arrange for him to see a doctor. Nurse
    Ullmer wrote an entry in the logbook informing BCJ staff that if Rusness’s
    temperature rose above 100.00 degrees, it should be reported. However, she did not
    instruct staff to take him to a doctor. Later that day, Officer Matthew Johnson moved
    Rusness to a medical observation cell.
    On the morning of February 2, Officer Freeman decided to take Rusness to the
    emergency room at Essentia hospital based on his condition at the time. While
    waiting for the car to transport him to the hospital, Officer Freeman noticed Rusness
    had difficulty walking and actually fell twice before getting into the car.
    At the hospital, the ER physicians performed blood tests and a CT scan. They
    diagnosed him with severe anemia, thrombocytopenia, and a subarachnoid
    hemorrhage, and they transferred him via airlift to Sanford Medical Center in Fargo,
    North Dakota. Two more CT scans revealed additional subarachnoid hemorrhaging
    at “multifocal regions of both cerebrum.” R. Doc. 73-1, at 129. Ultimately, doctors
    diagnosed him with acute myeloid leukemia. He spent approximately three weeks in
    the hospital receiving treatment. His leukemia went into remission in March 2018.
    However, he continues to suffer from two permanent conditions: clouding in his
    peripheral vision and post-traumatic stress disorder.
    B. Procedural History
    Relevant to this appeal, Rusness filed an amended complaint on September 6,
    2019, under 
    42 U.S.C. § 1983
    . He alleged that the individual defendants, through
    deliberate indifference, violated his rights under the Eighth and Fourteenth
    -8-
    Amendments to the United States Constitution. He also asserted claims against
    Becker County under Monell2 for failure to provide adequate training to corrections
    officers; enacting unconstitutional policies, customs, and practices; and failure to
    provide adequate supervision of corrections officers. Additionally, he brought a state-
    law negligence claim against Becker County, Nurse Ullmer, and Officers Peterson,
    Anderson, Matthew Johnson, Josie Johnson, Clayson, Freeman, and Todd Glander.
    On August 15, 2020, the defendants filed a motion for summary judgment,
    seeking dismissal of the claims against them.3 On January 7, 2021, the district court
    issued an order granting the defendants’ motion for summary judgment. The court
    determined that the individual defendants were entitled to qualified immunity against
    Rusness’s deliberate indifference claim. The court held that the rights that Rusness
    sought to enforce were not clearly established under existing precedent. The court
    also concluded that Rusness had failed to put forth sufficient evidence to support his
    supervisory liability claim against Officer Glander and that Officer Peterson could not
    be held liable on a theory of supervisory liability because she was not a supervisor
    when the events transpired. The court also concluded that Becker County was entitled
    to summary judgment on Rusness’s Monell claims because he had not put forth
    evidence that Becker County was on notice that any of its training procedures were
    inadequate or that its officials had engaged in misconduct. Finally, the court
    determined that Rusness had not provided sufficient evidence to support his
    negligence claim or to overcome defendants’ assertion that their actions were
    protected by official immunity. Judgment was entered in favor of defendants on
    January 8, 2021.
    2
    Monell v. Dep’t of Soc. Servs. of City of New York, 
    436 U.S. 658
     (1978).
    3
    Rusness settled his claims against Nurse Ullmer on October 21, 2020.
    -9-
    II. Discussion
    “We review the district court’s grant of summary judgment de novo, viewing
    the evidence and drawing all reasonable inferences in the light most favorable to [the
    nonmoving party].” Morris v. Cradduck, 
    954 F.3d 1055
    , 1058 (8th Cir. 2020).
    Summary judgment is proper only “if the movant shows that there is no genuine
    dispute as to any material fact and the movant is entitled to judgment as a matter of
    law.” Fed. R. Civ. P. 56(a). “To show a genuine dispute of material fact, a party must
    provide more than conjecture and speculation. Rather the nonmovant has an
    affirmative burden to designate specific facts creating a triable controversy.”
    McConnell v. Anixter, Inc., 
    944 F.3d 985
    , 988 (8th Cir. 2019) (cleaned up). “Only
    disputes over facts that might affect the outcome of the suit under the governing law
    will properly preclude the entry of summary judgment.” Doe v. Dardanelle Sch. Dist.,
    
    928 F.3d 722
    , 725 (8th Cir. 2019) (quoting Anderson v. Liberty Lobby, Inc., 
    477 U.S. 242
    , 248 (1986)).
    A. Deliberate Indifference
    Rusness claims that members of BCJ staff were deliberately indifferent to his
    medical needs in violation of the Eighth and Fourteenth Amendments. In general, a
    government official’s deliberate indifference to an inmate’s medical needs violates
    the inmate’s constitutional rights. Estelle v. Gamble, 
    429 U.S. 97
    , 104–05 (1976).
    Prison personnel, like corrections officers, without medical training demonstrate
    deliberate indifference by “intentionally denying or delaying access to medical care
    or intentionally interfering with the treatment once prescribed.” 
    Id.
     (footnotes
    omitted). Proof of deliberate indifference requires that an inmate show the following:
    “(1) he suffered from an objectively serious medical need, and (2) defendants knew
    of the need yet deliberately disregarded it.” Johnson v. Leonard, 
    929 F.3d 569
    , 575
    (8th Cir. 2019) (quoting Hartsfield v. Colburn, 
    371 F.3d 454
    , 457 (8th Cir. 2004)).
    Qualified immunity “shields government officials from liability when their
    conduct does not violate clearly established constitutional rights of which a
    -10-
    reasonable person would have known.” Ivey v. Audrain Cnty., 
    968 F.3d 845
    , 848 (8th
    Cir. 2020) (quoting Thiel v. Korte, 
    954 F.3d 1125
    , 1128 (8th Cir. 2020)). “Put simply,
    qualified immunity protects ‘all but the plainly incompetent or those who knowingly
    violate the law.’” Mullenix v. Luna, 
    577 U.S. 7
    , 12 (2015) (quoting Malley v. Briggs,
    
    475 U.S. 335
    , 341 (1986)). “The party asserting immunity always has the burden to
    establish the relevant predicate facts, and at the summary judgment stage, the
    nonmoving party is given the benefit of all reasonable inferences.” White v.
    McKinley, 
    519 F.3d 806
    , 813 (8th Cir. 2008).
    Qualified immunity analysis involves two inquiries: (1) whether there has been
    a violation of a constitutional right; and (2) whether that right was clearly established
    at the time of the violation. Saucier v. Katz, 
    533 U.S. 194
    , 201 (2001). Courts have
    liberty to choose the order of addressing the inquiries. Pearson v. Callahan, 
    555 U.S. 223
    , 236 (2009).
    Showing that a right was clearly established requires identifying controlling
    precedent with a close correspondence to the particulars of the present case. Anderson
    v. Creighton, 
    483 U.S. 635
    , 639–41 (1987); Mullenix, 577 U.S. at 12 (stating that the
    analysis requires considering the “particular conduct” and the “specific context”
    (internal quotation marks omitted)). This means that the right in question must be
    construed fairly narrowly and that facts in the present case must align with facts in
    precedent. See Ivey, 968 F.3d at 849 (reversing the district court for defining the right
    at issue too broadly). In effect, this standard requires a close examination of the facts
    to determine what right is at issue and thus whether qualified immunity is appropriate.
    On appeal, Rusness argues that the district court erred in two respects in its
    qualified immunity analysis: first, he argues that the court ignored a dispute of
    material fact involving Officer Anderson’s January 27, 2015 call to Sunnyside
    nursing staff; second, he argues that the court erroneously found that the right at issue
    was not clearly established.
    -11-
    On January 26, 2015, Nurse Ullmer instructed BCJ staff to report any further
    bleeding and vomiting that Rusness might experience. The next day, Rusness again
    experienced bleeding. Officer Anderson testified in her deposition that Rusness
    experienced these symptoms when there was no nurse on duty. She, therefore, either
    called or had another staff member call Sunnyside which had nurses available by
    phone around the clock. Nurse Ullmer, however, testified that she was never made
    aware of this incident.
    Rusness argues that whether his condition was reported to medical personnel
    on this occasion is a material fact. He contends that the discrepancy between the
    accounts of Officer Anderson and Nurse Ullmer, along with the absence of
    documentation confirming that the call was made, puts the call’s existence in dispute
    and that the district court should therefore be reversed. We disagree. Assuming that
    Rusness raised a genuine factual dispute, we conclude that it was immaterial. See
    Dardanelle, 928 F.3d at 725 (“Only disputes over facts that might affect the outcome
    of the suit under the governing law will properly preclude the entry of summary
    judgment.” (internal quotation marks omitted)). The undisputed facts show that
    Officers Freeman and Johnson wrote reports about the bleeding incident, which were
    placed in the nurses’ inbox at BCJ. These reports establish that jail staff complied
    with Nurse Ullmer’s orders to report further incidents. As to Officer Anderson, her
    negligence does not constitute the kind of “unnecessary and wanton infliction of
    pain” that would amount to deliberate indifference; nor would it suffice to overcome
    the evidence establishing her continued attentiveness to Rusness’s condition. Estelle,
    
    429 U.S. at 104
     (quoting Gregg v. Georgia, 
    428 U.S. 153
    , 173 (1976)). Therefore,
    Rusness’s first argument fails. No material fact is in dispute.
    On the basis of the undisputed facts, we conclude that no violation of the
    Eighth or the Fourteenth Amendments occurred. The instant undisputed facts do not
    provide sufficient proof that the defendants acted with deliberate indifference to
    -12-
    Rusness’s medical needs. The facts do not show intentional denial or delay in access
    to medical care nor any interference with the treatment provided.
    The threshold question is whether Rusness manifested signs of a serious
    medical need that would be sufficiently obvious to jail staff without medical training.
    See Jones v. Minn. Dep’t of Corr., 
    512 F.3d 478
    , 482–83 (8th Cir. 2008). In Jones,
    we confronted the same question. The inmate in Jones “was unable to stand or walk
    under her own power, was ‘google-eyed’ and unresponsive, was rolling on the ground
    while grunting and groaning, [had dried blood and cuts on her lips], smelled as if she
    had urinated on herself, and was breathing at a very rapid rate.” 
    Id. at 482
     (footnote
    omitted). Later, she was found unresponsive in her cell, having died of a pulmonary
    edema. 
    Id. at 481
    . Her underlying condition, however, only became evident after her
    autopsy. 
    Id.
     We declined to hold that prison officials violated her constitutional
    rights, reasoning that “[t]he question here. . . is not, in hindsight, whether Jones had
    a serious medical condition, but rather, whether the condition was so obvious that a
    layperson would have easily recognized the need for medical treatment.” 
    Id. at 483
    .
    Rusness’s symptoms were not as severe as those experienced by the inmate in
    Jones. Compare 
    id.,
     with Roberson v. Bradshaw, 
    198 F.3d 645
    , 647–48 (8th Cir.
    1999) (serious medical need obvious to laymen when inmate experienced excessive
    urination, diarrhea, sweating, weight loss, and dehydration related to known diabetes
    diagnosis), and Hartsfield, 
    371 F.3d at 457
     (holding serious medical need obvious to
    laymen where inmate had swollen and bleeding gums and complained of extreme
    tooth pain). Like the inmate in Jones, Rusness’s most serious underlying conditions,
    severe anemia and leukemia, were unknown to jail staff while he was under their
    supervision. To the extent that he complained of pain, Rusness gave mixed signals
    as to its severity: (1) he refused to take his medication, including medication for his
    pain; (2) asserted having difficulty speaking, yet spoke extensively; and (3) on two
    occasions, complained that he was unable to walk and then proceeded to do so.
    Unlike Jones, however, Rusness’s symptoms were connected to prior diagnoses—not
    -13-
    of leukemia, but of far less serious conditions like gingivitis. In other words, if
    medical professionals failed to grasp the seriousness of his condition, prison staff
    without medical training could not have been expected to do so.
    We also note that Nurse Ullmer’s instructions to staff included guidance that
    the antibiotics prescribed for his known conditions should be allowed time to show
    results. And moreover, all of the events of late January 2015 immediately preceded
    a scheduled doctor’s appointment on February 3. The actions of BCJ staff reflect
    efforts to comply with Nurse Ullmer’s orders and render care to Rusness.
    Rusness points to Foulks v. Cole County, 
    991 F.2d 454
     (8th Cir. 1993), to
    support his position that it should have been obvious to laymen that he suffered from
    a serious medical need that was not being addressed. There, the inmate had been
    taken to the hospital after being severely beaten. 
    Id. at 455
    . When he left the hospital
    in custody, a doctor provided police with written instructions for police to monitor
    his head injury. 
    Id.
     Once in jail, the inmate reported feeling sick and vomiting blood.
    
    Id. at 456
    . The next day, his mother, a nurse, spoke to him on the phone and noticed
    that he slurred his speech. 
    Id.
     She asked to see him or for him to be allowed to see a
    doctor at her expense, telling staff that she was concerned he may have had a head
    injury. 
    Id.
     Staff denied both requests, despite jail policy permitting inmates to see
    physicians at their own expense. 
    Id.
     Ultimately, his head injury required him to have
    surgery to remove a portion of his brain, leaving him permanently impaired. 
    Id.
    Foulks is inapposite. Here, rather than ignore sound medical judgment, the
    defendants attempted to follow the instructions they received from the nurse. Rusness
    repeatedly saw medical professionals, and jail staff monitored his condition. Far from
    refusing him treatment, BCJ staff attempted to care for his known conditions
    according to guidance from medical professionals.
    -14-
    Rusness suffered from leukemia, undoubtedly an objectively serious condition.
    But that condition was unknown to staff. A PA examined Rusness, diagnosed him
    with gingivitis and a leg infection, and prescribed treatment, which Nurse Ullmer told
    staff would take time to work. Here, unlike in Foulks, the jail staff had no basis for
    concluding that the instructions they received were so ineffective that following them
    might raise the specter of liability for deliberate indifference to an inmate’s medical
    need.
    The district court did not err in concluding that Rusness failed to show that the
    prison guards violated his rights protected by the Eighth and Fourteenth Amendments
    of the Constitution when they failed to recognize the seriousness of an underlying
    medical condition that repeatedly eluded trained medical professionals. See Roberts
    v. Kopel, 
    917 F.3d 1039
    , 1043 (8th Cir. 2019) (“It is well-established that, ‘[i]f
    trained health care officials could not find a serious medical need in these
    circumstances, then we decline to hold that a reasonable lay person should have done
    so.’” (alteration in original) (quoting Aswegan v. Henry, 
    49 F.3d 461
    , 465 (8th Cir.
    1995))). The defendants are therefore entitled to qualified immunity as to Rusness’s
    deliberate indifference claim.
    B. Monell Claims
    A municipality can be sued directly under 
    42 U.S.C. § 1983
    . Monell, 
    436 U.S. at 690
    . “[A] municipality can be found liable under § 1983 only where the
    municipality itself causes the constitutional violation at issue.” City of Canton v.
    Harris, 
    489 U.S. 378
    , 385 (1989). Hence, the existence of a constitutional violation
    is a threshold issue for a Monell claim to move forward. As the discussion in the
    preceding section demonstrates, Rusness’s constitutional rights were not violated. See
    Roberts, 917 F.3d at 1042–43; Jones, 
    512 F.3d 482
    –83. His Monell claims thus also
    fail.
    -15-
    C. Negligence
    Rusness also brings a negligence claim under Minnesota state law. To establish
    negligence, Rusness must show that (1) the defendants owed him a duty of care, (2)
    the defendants breached the duty of care, and (3) the breach caused him to suffer an
    injury. Lubbers v. Anderson, 
    539 N.W.2d 398
    , 401 (Minn. 1995). Jailers owe an
    affirmative duty of care to detainees and inmates. Sandborg v. Blue Earth Cnty., 
    615 N.W.2d 61
    , 64 (Minn. 2000).
    Appellees argue that Minnesota law entitles them to official immunity and that
    Rusness did not provide sufficient evidence of this claim to survive summary
    judgment. Official immunity shields government officials from claims that arise from
    officials’ discretionary, as opposed to ministerial, actions. Johnson v. Morris, 
    453 N.W.2d 31
    , 41 (Minn. 1990). “A discretionary act is one for which an official must
    exercise ‘judgment or discretion,’” while “[a] ministerial act involves merely the
    execution of a specific, absolute duty.” Dokman v. Cnty. of Hennepin, 
    637 N.W.2d 286
    , 296 (Minn. Ct. App. 2001) (first quoting Johnson v. State, 
    553 N.W.2d 40
    , 46
    (Minn. 1996), then citing Kari v. City of Maplewood, 
    582 N.W.2d 921
    , 923 (Minn.
    1998)). Immunity will not however shield an official who “commit[s] a willful or
    malicious wrong.” Elwood v. Rice Cnty., 
    423 N.W.2d 671
    , 679 (Minn. 1988).
    Rusness argues that defendants violated three separate ministerial duties: first,
    a duty to document Rusness’s medical problems and complaints during the course of
    his incarceration; second, a duty to go over his file to discover “any potential medical
    problems”; third, a duty “to respond to his requests for pain treatment and medical
    attention.” Appellant’s Br. at 45.
    The district court conceded that the duties to document medical problems and
    review his file may be ministerial, but it concluded that, nonetheless, Rusness had
    failed to present evidence sufficient for his claim to survive summary judgment. We
    agree. Rusness contends that had the appellees read his file, “it is likely that they
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    would have discovered, among other things, the Sick Request Call forms Rusness had
    submitted from the very beginning of his custody period[] and would have been more
    aware of his deteriorating and serious medical condition.” R. Doc. 74, at 34.
    However, even assuming that appellees breached a duty to document and review his
    medical complaints, Rusness fails to show that this caused his injury. Rusness
    presents no evidence that better attentiveness to documentation would have made
    appellees aware of the seriousness of his medical issues, such that they would have
    taken him to a doctor sooner. After all, appellees, not themselves physicians or
    nurses, were acting according to the advice of medical practitioners, who themselves
    failed to grasp the source and full extent of Rusness’s medical issues. Additionally,
    the evidence demonstrates that Officer Anderson reviewed his file, yet she still chose
    not to take him to the hospital.
    The third responsibility that Rusness discusses is not properly understood as
    a ministerial duty but rather as a discretionary function. An inmate’s requests for pain
    treatment and medical attention require an officer to exercise “judgment or
    discretion” as to how best to respond given the necessarily unique circumstances.
    Johnson, 453 N.W.2d at 41. There is moreover no evidence that appellees were
    malicious in their responses to Rusness’s requests. See Elwood, 423 N.W.2d at 677.
    The actions of the individual appellees in response to Rusness’s request for medical
    attention are thus subject to official immunity. Because the individual appellees are
    entitled to official immunity, Becker County is entitled to the same immunity
    vicariously. See Schroeder v. St. Louis Cnty., 
    708 N.W.2d 497
    , 508 (Minn. 2006).
    III. Conclusion
    Accordingly, we affirm the district court.
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