Three Forks Regional Jail v. the Estate of Ricky Combs by and Through Connie Hollan, Administratrix ( 2020 )


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  •           RENDERED: SEPTEMBER 4, 2020; 10:00 A.M.
    NOT TO BE PUBLISHED
    Commonwealth of Kentucky
    Court of Appeals
    NO. 2018-CA-001897-MR
    THREE FORKS REGIONAL
    JAIL; HARVEY PELFREY
    INDIVIDUALLY AND IN HIS CAPACITY
    AS JAIL ADMINISTRATOR OF
    THREE FORKS REGIONAL JAIL; AND
    THE FOLLOWING INDIVIDUALLY AND AS
    AGENTS, EMPLOYEES AND/OR
    REPRESENTATIVES OF THREE FORKS
    REGIONAL JAIL: JULIE ADAMS, CONNIE
    PERRY, JEROD GRIFFITH, JONI HAYES,
    EMORY CRAWFORD, JOSHUA WARD,
    AMANDA STAMPER, CHARLOTTE CONDY,
    ANDREA COLLINS, JONATHAN HARRIS,
    DAVID CAUDILL, AND RONALD DICKERSON        CROSS-APPELLANTS
    CROSS-APPEAL FROM LEE CIRCUIT COURT
    v.          HONORABLE MICHAEL DEAN, JUDGE
    ACTION NO. 15-CI-00105
    JIMMY VANOVER; ROBERT
    FUGATE; AND THE ESTATE OF
    RICKY COMBS, BY AND THROUGH
    CONNIE HOLLAN,
    ADMINISTRATRIX                              CROSS-APPELLEES
    AND                 NO. 2019-CA-000306-MR
    THE ESTATE OF RICKY COMBS,
    BY AND THROUGH CONNIE
    HOLLAN, ADMINISTRATRIX                         APPELLANT
    APPEAL FROM LEE CIRCUIT COURT
    v.            HONORABLE MICHAEL DEAN, JUDGE
    ACTION NO. 15-CI-00105
    HARVEY PELFREY, INDIVIDUALLY
    AND IN HIS CAPACITY AS THE JAIL
    ADMINISTRATOR OF THREE
    FORKS REGIONAL JAIL; THREE
    FORKS REGIONAL JAIL; AND THE
    FOLLOWING INDIVIDUALLY AND
    IN THEIR OFFICIAL CAPACITIES
    AS EMPLOYEES, AGENTS AND/OR
    REPRESENTATIVES OF THREE
    FORKS REGIONAL JAIL: JULIE
    ADAMS, CONNIE PERRY, JEROD
    GRIFFITH, JONI HAYES, EMORY
    CRAWFORD, JOSHUA WARD,
    AMANDA STAMPER, CHARLOTTE
    CONDY, ANDREA COLLINS,
    JONATHAN HARRIS, DAVID
    CAUDILL, RONALD DICKERSON;
    JIMMY VANOVER; AND
    ROBERT FUGATE                                  APPELLEES
    -2-
    AND                NO. 2019-CA-000507-MR
    THREE FORKS REGIONAL
    JAIL; HARVEY PELFREY
    INDIVIDUALLY AND IN HIS
    CAPACITY AS THE JAIL ADMINISTRATOR OF
    THREE FORKS REGIONAL JAIL; JULIE ADAMS,
    INDIVIDUALLY AND IN HER CAPACITY
    AS AN AGENT, REPRESENTATIVE, AND NURSE
    OF THREE FORKS REGIONAL JAIL; AND
    THE FOLLOWING INDIVIDUALLY AND IN THEIR
    CAPACITY AS AGENTS, REPRESENTATIVES, AND
    EMPLOYEES OF THREE FORKS
    REGIONAL JAIL: CONNIE
    PERRY, JEROD GRIFFITH, JONI HAYES,
    EMORY CRAWFORD, JOSHUA WARD,
    AMANDA STAMPER, CHARLOTTE CONDY,
    ANDREA COLLINS, JONATHAN HARRIS,
    DAVID CAUDILL, AND RONALD DICKERSON      CROSS-APPELLANTS
    CROSS-APPEAL FROM LEE CIRCUIT COURT
    v.           HONORABLE MICHAEL DEAN, JUDGE
    ACTION NO. 15-CI-00105
    THE ESTATE OF RICKY
    COMBS, BY AND THROUGH
    CONNIE HOLLAN,
    ADMINISTRATRIX; JIMMY
    VANOVER; AND ROBERT
    FUGATE                                     CROSS-APPELLEES
    -3-
    OPINION
    AFFIRMING
    ** ** ** ** **
    BEFORE: CLAYTON, CHIEF JUDGE; MAZE AND K. THOMPSON, JUDGES.
    CLAYTON, CHIEF JUDGE: Ricky Combs, an inmate of the Three Forks
    Regional Jail (hereinafter “the Jail”), suffered a ruptured spleen in an altercation
    with another inmate and died several days later. His Estate brought suit against the
    Jail, the Jail administrator, and several employees of the Jail, claiming they
    negligently failed to prevent the fight and fatally delayed in obtaining medical
    treatment for Combs. The Lee Circuit Court granted summary judgment to the Jail
    on the grounds of sovereign immunity and to the other defendants in their official
    capacities. It determined that the administrator and employees were not entitled to
    individual immunity, however, because genuine issues of material fact existed
    regarding whether they had violated their ministerial duties in controlling and
    supervising the inmates and providing reasonable medical treatment to Combs.
    The circuit court denied summary judgement on the individual capacity claims.
    The Estate brings this interlocutory appeal from the circuit court’s opinion and
    order, arguing that the Jail is not entitled to any form of immunity. The defendants
    have cross-appealed, arguing they are entitled to qualified official immunity.
    -4-
    Background
    Combs was an inmate of the Jail in 2015 when he was involved in a
    fight with one or two other inmates. According to Melvin Newton, Jr., an inmate
    with whom Combs shared a cell, the altercation was “just a push and a shove” in
    which Combs fell from a bed onto the floor. Combs did not experience any
    physical symptoms immediately following the fight, nor was it reported to the
    correctional officers. Over the course of the next few days, however, Combs
    complained of feeling unwell, running a fever, sweating, stomach pain and
    cramping, feeling that his kidneys were shutting down, and difficulty using the
    bathroom. Newton claimed that in the three days preceding his death, Combs
    made ten to fifteen requests for medical help to correctional officers Emory
    Crawford and Jerod Griffith and to the kitchen supervisor, Charlotte Condy.
    Newton recalled that approximately two days before his death, Combs told Officer
    Crawford he needed to go to the doctor. His complaints were apparently ignored.
    On Saturday, July 4, 2015, Combs’s symptoms worsened. Because it
    was a holiday weekend, Harvey Pelfrey, the Jail administrator, was not present.
    Nurse Julie Adams, a salaried employee of the Jail, was also not present. Nurse
    Adams worked regular hours at the Jail from Monday to Friday and was available
    -5-
    by telephone for consultation at all other times. Her assistant, Joni Hayes,1 who
    did not have any type of nursing certification, was also not present at the Jail that
    day. The Jail also had a contract for medical services with a physician, Dr. Derrick
    Hamilton, who was not regularly present at the Jail but could be contacted at any
    time.
    Early that morning at pill call, Newton told Officers Crawford and
    Griffith that Combs needed help because he was sick and curled up in the fetal
    position. Officer Griffith said he was first made aware of Combs’s medical
    complaints that morning, contradicting Newton’s claim that Combs had already
    asked Griffith for help during the previous three days. Combs told Griffith he was
    experiencing left-sided abdominal pain and cramping. Griffith said he informed
    the acting captain, Connie Perry, of these complaints at around 6:45 a.m. Perry
    was serving as the acting captain that day because the regular captain was on
    vacation. According to Perry, no one informed her that she would be acting
    captain that day or what she was required to do in that position. The other
    correctional officers simply decided she should serve as acting captain because she
    had been employed the longest at the Jail.
    1
    Hayes’s first name is spelled “Joanie” in her deposition and “Joni” in the notice of appeal and
    elsewhere in the record. We have adopted the latter spelling for the sake of consistency.
    -6-
    According to Officer Griffith, Captain Perry told him she was already
    aware of Combs’s complaints because he had made similar complaints to her and
    Nurse Adams on the previous day during pill call. Newton claims Griffith and
    Crawford told him that the nurse had been called, told them Combs was fine, and
    that the officers were not going to do anything but keep him in the cell. Griffith,
    on the other hand, testified he was not aware of anyone calling Nurse Adams that
    morning. Nurse Adams testified that the Jail did not contact her about Combs’s
    condition until about 6:00 p.m. that evening.
    At around 9:00 a.m., Newton had to help Combs to the bathroom
    because he was unable to go on his own and he fell off the commode. As Combs’s
    condition continued to worsen, Newton and his fellow inmates yelled and banged
    on the cell windows to get the attention of the Jail employees. According to
    Pelfrey, the Jail administrator, and to the specific terms of the Jail’s own policies
    and procedure, this was an acceptable method for the inmates to alert the
    employees to a medical emergency.
    At some time between 1:30 p.m. and 2:30 p.m., correctional officer
    Jonathan Harris radioed to the booking area that an officer needed to respond to
    Combs’s cell. Officers Griffith and Crawford and acting Captain Perry heard the
    request but did not respond because they were busy dealing with someone in the
    booking area. Officer Harris followed up with a phone call and told Griffith that
    -7-
    the inmates were requesting an officer to check on Combs. Griffith responded by
    telling Officer Harris, who was a new employee, to turn off the television and
    microwave to the cell. Newton claimed that switching off the television was
    retaliation for the inmates’ disturbance whereas Griffith testified it was turned off
    for safety and security reasons.
    When Officers Crawford and Griffith came to the cell they found
    Combs “hunkered over” on his bed holding his left side, complaining of abdominal
    pain. They took him to the medical cells in the booking area. According to
    Newton, they had to drag Combs down the hallway because he was unable to walk
    on his own. Griffith described Combs as being in such severe pain he had to be
    assisted. According to Newton, he was subsequently punished for trying to get
    help for Combs by being placed in solitary confinement for fifteen days.
    Officers Griffith and Crawford stated that Combs’s vital signs (blood
    pressure and oxygenation) were normal when he was brought to the medical area
    of the Jail. Combs told them he had blood in his stool two days before and had not
    had a bowel movement since. Griffith placed Combs in a cell for medical
    observation and strip searched him for contraband. He observed a palm-sized
    bruise on his right hip. Griffith again reported Combs’s complaints to Captain
    Perry, who told him the nurse had instructed them to give Combs two Tylenol and
    to keep him under observation for any change in his condition. Combs said he was
    -8-
    feeling better after taking the Tylenol, asked to be returned to his cell and
    apparently ate lunch. Griffith stated he continued to check on Combs whom he
    described as seeming to “do okay” until a little after 5:55 p.m. when Griffith left
    because he was needed in the booking area. When he returned he found Combs on
    his hands and knees in front of the door, claiming he could not breathe and his
    chest was hurting. According to Griffith, Combs appeared to be in a great deal of
    pain and his vital signs were erratic.
    At around the same time, correctional officers Amanda Stamper and
    Captain Josh Ward arrived for their 6:00 p.m. shift. Stamper described Combs as
    shouting that his side hurt and he could not breathe. She observed a large bruise on
    his left side. Officer Griffith described Combs as having a grayish appearance and
    a cold clammy feeling. Captain Perry called Nurse Adams and reported that
    Combs’s oxygen statistics were not registering and his blood pressure was
    200/100. The nurse immediately told Perry to call 911.
    Combs lost consciousness approximately two minutes before EMS
    arrived. Captain Ward asked David Caudill, another corrections officer who had
    just arrived for his shift, to relieve Officer Harris, who accompanied Combs.
    Combs died in the ambulance a short time later before reaching the hospital.
    According to Dr. John Hunsaker, III, a forensic pathologist and the
    medical examiner who performed an autopsy on Combs, Combs suffered from a
    -9-
    delayed rupture of the spleen. Dr. Hunsaker opined that some trauma caused the
    spleen to rupture and bleed, clot, and resume bleeding until eventually it burst and
    continuously bled. He described the typical symptoms of a delayed ruptured
    spleen as pain in the upper left abdomen, shortness of breath, possible chest pain,
    collapse, and eventual loss of consciousness. Dr. Hunsaker agreed that a layperson
    would not typically recognize the symptoms of a delayed ruptured spleen. He
    testified that it could be revealed by medical examinations such as X-rays, CT
    scans, or an MRI. Dr. Hunsaker stated that a ruptured spleen can be successfully
    treated by replacing any lost blood and then surgically removing the spleen. He
    opined that Combs died of hypovolemic shock caused by his vital organs not
    getting enough blood due to blood loss from the ruptured spleen.
    Dr. Preston Miller, a general surgeon at Wake Forest University who
    practices mainly in traumatic surgery, and was retained as an expert by the Estate,
    also testified he would not expect a layperson to be able to recognize the signs and
    symptoms of a ruptured spleen because this diagnosis requires evaluation by a
    physician. Often, he explained, a person with a ruptured spleen will have normal
    vital signs, such as blood pressure and oxygen saturation level, which would make
    it difficult for a layperson to determine what was wrong. Dr. Miller reviewed
    Combs’s case and opined that if he had been evaluated earlier by a medical
    professional, even as late as 2:45 p.m. when he was taken to the observation cell,
    -10-
    he could have been diagnosed, appropriately treated, and would likely have
    survived.
    At the time of Combs’s death, the Three Forks Regional Jail Policies
    & Procedures Manual, revised in October 2013, stated: “You [the inmate] will
    receive all necessary medical and mental health care as prescribed in KRS
    [Kentucky Revised Statutes] 441.045. The jail staff will take every effort to ensure
    that your rights are protected and that you are safe from harm.”
    KRS 441.045(1) provides that “[t]he county governing body shall
    prescribe rules for the government, security, safety, and cleanliness of the jail and
    the comfort and treatment of prisoners, provided such rules are consistent with
    state law. The county judge/executive may inspect the jail at any reasonable time.”
    The statute thereafter sets forth the allocation of responsibility among the federal
    government, the state, counties, cities and the inmates for expenses incurred in the
    necessary medical, dental, and psychological treatment of inmates. “Necessary
    care” is defined by the statute as “care of a nonelective nature that cannot be
    postponed until after the period of confinement without hazard to the life or health
    of the prisoner.” KRS 441.045(10).
    Under a section entitled MEDICAL PROCEDURES, the Manual
    provides:
    -11-
    Medical treatment is given under KRS 441.045, Section
    10. For the purpose of this section, “Necessary Care”
    means care of a non-elective nature that cannot be
    postponed until after your release from jail without
    hazard to life or health. . . . No inmate shall be refused
    necessary health care that cannot wait until the end of his
    or her incarceration. . . . In order to be seen by the
    medical staff for any non-emergency issues you must fill
    out a “Sick call request.” These forms may be turned in
    anytime to the walk officer. Medical staff will perform
    sick call as needed on a 24 hr basis.
    For routine medical complaints, the Manual directs inmates to fill out a “Sick Call
    Request” form. It explains that “[t]he walk officer will read your request to
    determine if your complaint needs immediate attention.” Then, the on-duty nurse
    “will evaluate your medical condition to determine if you need further evaluation
    by the jail doctor.”
    In the event of a medical emergency, the Manual directs inmates to
    “push the call button in the cell” or “utilize the intercom system.” The Manual
    further states: “You may also beat on the window and door to attract attention of
    an officer. Frivolous or fraudulent emergencies may result in disciplinary actions.”
    The Manual also states:
    a. Inmates shall be informed verbally at the time of
    admission the method of gaining access to medical care
    or medical services in the jail. All Three Forks Regional
    Detention Center inmates shall be entitled to health care.
    Medical Care of the facility shall be delivered under the
    direction of a licensed physician. No deputy Jailer shall
    -12-
    ever arbitrarily deny an inmate’s request for medical
    services.
    1. A deputy Jailer or the Jailer shall take inmates to
    contracted doctors.
    2. Emergency treatment is available at all times through
    the Kentucky River Regional Medical Center emergency
    room.
    ...
    b. The Jail Jailers and all deputy Jailers shall be trained,
    and be certified, by the appropriate agency in first aid and
    all deputy Jailers shall be trained in CPR.
    Under the section entitled Emergency Medical/Dental/Psychiatric Care, the
    Manual provides that “Emergency medical/dental/psychiatric care shall be
    available at all times to all inmates[,]” and lists the following occurrences as
    constituting an emergency:
    1. Severe bleeding
    2. Unconsciousness or seizures
    3. Serious breathing difficulties
    4. Serious head injury
    5. Serious burn
    6. Serious pain
    7. Serious suicide attempt
    8. Sudden onset of bizarre behavior
    -13-
    9. Health or life threatening situation
    10. Severe alcohol or drug withdrawal
    When a deputy jailer is confronted with an emergency, the Manual
    states the deputy jailer “shall immediately administer first aid and notify the shift
    commander. The shift commander shall make the decision whether to transport the
    inmate to the emergency room or doctor’s office or call the contracted physician
    for instructions.”
    The Manual provides that “Jail personnel shall have current training in
    standard first aid equivalent to that provided by the American Red Cross,
    American Heart Association, or an equivalent nationally recognized organization.
    New jail personnel shall receive training within their first year of employment.”
    Further, “Jail personnel shall be certified to perform CPR (Cardiopulmonary
    Resuscitation), equivalent to that provided by the American Red Cross, American
    Heart Association, or an equivalent nationally recognized organization. New jail
    personnel shall receive certification within their first year of employment.”
    In addition to these provisions relating to medical care of inmates, the
    Manual contains a list of duties and job requirements for employees relating to
    supervision of inmates. Employees are required to check the cells regularly to
    monitor the condition of the inmates and their activities and to supervise the
    -14-
    inmates during recreation, visitation, library, and all scheduled daily or weekly
    functions.
    In his deposition, Harvey Pelfrey, the Jail administrator, described
    himself as the main supervisor of the Jail, answerable to the Board which meets
    monthly. Directly beneath him is his Chief of Security, Keith Combs. Under
    Combs are the captains, then four sergeants per captain and then the correctional
    officers. He testified that the correctional officers receive all their training from
    the Kentucky Department of Corrections. When questioned about the Manual, he
    explained that he did not write it and personally did not have anything to do with it
    except hiring a former Deputy Commissioner to update it. He testified that he has
    familiarized himself with the Manual but did not personally know if new inmates
    are informed about access to medical care. He was asked: “If a correctional
    officer receives some medical complaints and doesn’t know what exactly the
    problem is with the inmate, is that a situation where the nurse should be contacted
    to assess the inmate?” He replied: “They should call the nurse if they are not
    sure.” He also testified that any Jail employee can contact the nurse directly if the
    nurse is not present, adding, “Usually the captain will unless they are involved
    helping an inmate but any of them can.”
    When he was questioned about why Connie Perry was the acting
    officer on the day Combs died, he replied that he did not know if it was a policy of
    -15-
    the Jail that the senior officer would take charge if there wasn’t a captain on duty
    but explained it was “something we did in-house.” He further testified that
    captains don’t receive any additional training but are chosen based on his
    experience of them. He testified that he had no idea if he had told Perry anything
    beyond she should call him or Keith Combs if she had problems.
    Cam Lindsey, a former federal prison warden and jail administration
    expert with a long history of working in corrections, evaluated the case as an
    expert for the Estate. He opined that the Jail administrator and staff breached their
    duties to Combs as they are defined by the policies and procedures of the Jail, by
    statute, by professional correctional standards, and by the Kentucky Constitution.
    In Lindsey’s opinion, the Jail staff’s failure to follow the Jail policies resulted in
    Combs’s death. Specifically, he stated that Jail staff had no discretion when it
    came to addressing medical complaints, which should be immediately referred to a
    medical professional. Further, in Lindsey’s view, Pelfrey failed to clearly
    delineate a chain of command at the Jail which resulted in Connie Perry being
    appointed as captain by the correctional officers themselves, even though she had
    no training or experience as a captain. He opined that the Jail staff present on the
    day of Combs’s death was not qualified to determine what type of medical
    treatment he needed and should have immediately contacted a medical professional
    -16-
    rather than delaying treatment and turning off the TV to Combs’s cell as
    punishment for the inmates banging on the windows to get their attention.
    By contrast, according to Donald Leach, a corrections expert retained
    by the defendants, the care and custody of Combs met acceptable correctional
    practice as expected by a reasonable corrections administrator. He opined that
    Combs was provided with the appropriate level of medical care based upon the
    information he provided custody staff, and that when the staff became aware
    Combs was experiencing a serious medical need, they took appropriate action. In
    his view, the Jail and its staff complied with the Kentucky Department of
    Corrections Jail Standards for training, for providing a policy and procedure
    manual, and with the requirement for the provision of medical care, including
    conducting sick calls five days per week and emergency services when the need
    was identified.
    The complaint filed by Combs’s Estate alleged that Combs was
    physically beaten as a result of the defendants’ failure to properly supervise and
    control the Jail inmates. The complaint further alleged that his requests for
    medical attention following the beating were either ignored or inadequately
    addressed and that the beating caused him pain and suffering and ultimately
    resulted in his death. The complaint included claims of negligence, gross
    negligence, recklessness, and wanton conduct; violation of the Jail’s own policies
    -17-
    and procedures; violation of Sections 1, 2, 10, 11, 12, and 17 of the Kentucky
    Constitution; violation of the Kentucky Civil Rights Act and other provisions of
    the Kentucky Revised Statutes, including Chapter 441; violations of the United
    States Constitution; and violations of the Kentucky Administrative Regulations
    (KAR).
    The named defendants, in addition to the Jail itself, were Harvey
    Pelfrey; the Jail administrator; Julie Adams, the nurse; Joni Hayes, the nurse’s
    assistant; Charlotte Condy, the kitchen supervisor; and the following correctional
    officers: Connie Perry, Joshua Ward, Amanda Stamper, David Caudill, Jerod
    Griffith, Emory Crawford, Andrea Collins, and Jonathan Harris. The complaint
    also named as defendants Dr. Ronald Dickerson, the coroner, and Jimmy Vanover
    and Robert Fugate, the inmates allegedly involved in the fight with Combs. The
    individual defendants were named officially and also in their individual capacities
    as employees, agents, and/or representatives of the Jail.
    Following extensive discovery, the defendants filed a motion for
    summary judgment in which they argued that the Jail and its employees in their
    official capacity were entitled to sovereign immunity, that the Jail employees were
    entitled to qualified official immunity for the claims against them in their
    individual capacities, and that the Estate had failed to prove the Jail was negligent.
    The Estate responded that the defendants were not entitled to any form of
    -18-
    immunity and that a genuine issue of material fact existed regarding the negligence
    of the Jail and its employees.
    The trial court entered an opinion and order in which it granted the
    defendants’ motion for summary judgment insofar as the claims against the Jail
    and the claims against the Jail employees in their official capacities were barred by
    sovereign immunity. It found that genuine issues of material fact existed as to
    whether Jail officials and employees violated Jail policies and procedures and
    applicable laws and regulations in their control and supervision of the inmates, and
    in providing medical treatment to Combs. It characterized these duties as
    ministerial and consequently denied summary judgment on the grounds of
    qualified immunity as to all the claims against the defendants in their individual
    capacities.
    Standard and Scope of Review
    In reviewing a grant of summary judgment, our inquiry focuses on
    “whether the trial court correctly found that there were no genuine issues as to any
    material fact and that the moving party was entitled to judgment as a matter of
    law.” Scifres v. Kraft, 
    916 S.W.2d 779
    , 781 (Ky. App. 1996) (citing Kentucky
    Rules of Civil Procedure (CR) 56.03). Generally, the “denial of a motion for
    summary judgment is . . . not appealable because of its interlocutory nature[.]”
    Transportation Cabinet, Bureau of Highways, Com. of Ky. v. Leneave, 
    751 S.W.2d -19-
    36, 37 (Ky. App. 1988). An important exception is “an order denying a substantial
    claim of absolute immunity [which] is immediately appealable even in the absence
    of a final judgment.” Breathitt County Bd. of Educ. v. Prater, 
    292 S.W.3d 883
    ,
    887 (Ky. 2009). This is because the cloak of immunity entitles its possessor to be
    free “from the burdens of defending the action, not merely just an immunity from
    liability.” Rowan County v. Sloas, 
    201 S.W.3d 469
    , 474 (Ky. 2006) (citations
    omitted). Whether a defendant is entitled to “immunity is a question of law . . . ,
    which we review de novo.”
    Id. at 475
    (citations omitted).
    The extent of our review in this type of appeal is strictly
    circumscribed. It is limited “to the issue of immunity, and no substantive issues.”
    Baker v. Fields, 
    543 S.W.3d 575
    , 578 (Ky. 2018). The reason for this is that
    “[o]therwise, interlocutory appeals would be used as vehicles for bypassing the
    structured appellate process.”
    Id. The Kentucky Supreme
    Court has specifically
    held “that an appellate court reviewing an interlocutory appeal of a trial court’s
    determination of a defendant’s immunity from suit is limited to the specific issue
    of whether immunity was properly denied, nothing more.”
    Id. Thus, we are
    not
    permitted to address the parties’ arguments regarding the underlying merits of the
    case because it would exceed our appellate jurisdiction, which is strictly limited to
    determining the availability of the defenses of sovereign, governmental and/or
    qualified immunity. Maggard v. Kinney, 
    576 S.W.3d 559
    , 566 (Ky. 2019).
    -20-
    Analysis: The Availability of Immunity Defenses
    a) The Jail
    With these principles in mind, we turn to the Estate’s first allegation
    that the trial court erred in holding that the Jail and, by extension, its employees in
    their official capacities were entitled to the absolute defense of sovereign
    immunity. The Estate contends that the Jail is an agency that is entitled to
    immunity only insofar as it is performing a governmental, as opposed to a
    proprietary, function. Housing inmates and providing medical treatment, the
    Estate contends, are the types of undertakings that private businesses engage in for
    profit and consequently the Jail is not shielded by immunity in this case.
    It is undisputed that “[s]overeign immunity affords the state absolute
    immunity from suit[.]” Transit Authority of River City v. Bibelhauser, 
    432 S.W.3d 171
    , 173 (Ky. App. 2013). Similarly, “[c]ounties, which predate the existence of
    the state and are considered direct political subdivisions of it, enjoy the same
    immunity as the state itself.” Comair, Inc. v. Lexington-Fayette Urban County
    Airport Corp., 
    295 S.W.3d 91
    , 94 (Ky. 2009) (citing Lexington-Fayette Urban
    County Government v. Smolcic, 
    142 S.W.3d 128
    , 132 (Ky. 2004)).
    Below the level of the state and the counties, immunity extends to
    governmental and quasi-governmental agencies and departments, but only if it can
    be shown the entity in question was (1) established by an immune entity and (2)
    -21-
    performs a “function integral to state government.”
    Id. at 99-100.
    Governmental
    immunity “does not extend, however, to agency acts which serve merely
    proprietary ends, i.e., non-integral undertakings of a sort private persons or
    businesses might engage in for profit.” 
    Prater, 292 S.W.3d at 887
    .
    The establishment of jails in Kentucky is governed by Chapter 441 of
    the Kentucky Revised Statutes. KRS 441.025(1) mandates that “[t]he fiscal court
    of each county shall provide for the incarceration of prisoners arrested in the
    county or sentenced or held by order of the courts in the county.” The statute
    permits the fiscal court to provide and maintain a jail facility that complies with the
    health and safety standards defined in KRS 441.055 or it may contract “with
    another county or a city for the incarceration and care of its prisoners[.]” KRS
    441.025(2)(a)-(c).
    Elsewhere in Chapter 441, provision is made for two or more counties
    by ordinances to establish a regional jail authority. KRS 441.800(1). Such an
    authority “shall constitute a public body corporate and politic, exercising public
    and essential governmental functions, and having all the powers necessary or
    convenient to carry out and effectuate the purposes and provisions of this
    section[.]” KRS 441.800(2) (emphasis added). KRS 441.810(1) provides that
    “[t]he regional jail authority shall be composed of members appointed by the
    county judges/executive of the respective counties within the authority and the
    -22-
    jailer of the county where the regional jail is located. The county judge/executive
    of the most populous county shall appoint three (3) members to the authority, and
    the remainder of the county judges/executive shall each appoint two (2) members.”
    According to the motion for summary judgment, Three Forks
    Regional Jail was established under KRS 441.810 as a regional jail for Lee,
    Breathitt, Wolfe, and Owsley Counties. The Articles of Incorporation state that the
    Jail is an entity under the authority of a Board whose members are appointed by
    the Judges Executive of Lee, Wolfe, and Owsley Counties. The board of the Jail is
    composed of six members, two from each of those counties. A permanent position
    on the board is held by the elected jailer of Lee County, due to the Jail’s
    geographic location in Lee County.
    The question of whether the Jail is entitled to sovereign immunity
    appears to be resolved definitively by Bryant v. Pulaski County Detention Center,
    
    330 S.W.3d 461
    , 465 (Ky. 2011), as modified (Feb. 25, 2011). In that case, an
    inmate of the Pulaski County Detention Center who was injured on work detail
    sued the Detention Center but failed to name the Detention Center Corporation as a
    party. The Kentucky Supreme Court ruled that although the trial court erred in
    refusing to allow him to amend his complaint to add the Corporation, the error was
    harmless because the Corporation was shielded by sovereign immunity. The
    Supreme Court stated that the Pulaski County Detention Center Corporation was
    -23-
    “bonded, built and holds title to the Detention Center property only to provide
    incarceration space for inmates who have been charged with or convicted of
    breaking the law and are serving a penalty in the county jail. Its only identity is to
    serve as a tool of county government, which furthers the state purpose of
    incarcerating lawbreakers.”
    Id. at 465.
    It concluded that the Corporation was
    entitled to summary judgment as a matter of law on the basis of sovereign
    immunity because it was an alter ego of the county.
    Id. The Jail in
    this case holds a position analogous to that of the Pulaski
    County Detention Center Corporation, as its only identity is to serve as a tool of
    county governments which established it. The Estate argues, however, that the
    Bryant Court actually intended to use the term “governmental” rather than
    “sovereign” immunity in reference to the Detention Center Corporation, and that
    the Jail is not entitled to sovereign immunity nor to governmental immunity
    because it was engaged in a proprietary function. As evidence for this, the Estate
    points to the Bryant Court’s reliance on Autry v. Western Kentucky University, 
    219 S.W.3d 713
    (Ky. 2007). In Autry, Western Kentucky University and the
    University’s Student Life Foundation, which was created to build and operate the
    university’s student dormitories, were found to be entitled to governmental
    immunity. In its analysis, the Bryant Court equated the relationship between the
    Pulaski County Detention Center and the Detention Corporation to that existing
    -24-
    between the University and the Student Life Foundation, describing the position of
    the Detention Center Corporation as “on all fours” with the Student Life
    Foundation described in Autry. 
    Bryant, 330 S.W.3d at 465
    .
    The Kentucky Supreme Court has acknowledged that the terms
    governmental and sovereign immunity are often used interchangeably, because
    governmental immunity is itself an extension of sovereign immunity. Bryant v.
    Louisville Metro Housing Authority, 
    568 S.W.3d 839
    , 845 (Ky. 2019).
    Governmental immunity “is based in the concept that ‘sovereign immunity should
    “extend . . . to departments, boards or agencies that are such integral parts of state
    government as to come within regular patterns of administration organization and
    structure.”’”
    Id. at 845-46
    (citations omitted).
    Under this reasoning, the Jail is entitled to immunity because it is an
    integral part of state government. First, the Jail was established pursuant to statute
    by a group of undeniably immune entities: the named counties. Although the
    Estate argues that there is a distinction between a county detention center and a
    regional detention center and that sovereign immunity cannot extend to regional
    detention centers, it provides no support for this contention. There appears to be
    no substantive difference for purposes of the immunity analysis between a
    detention center established by one county or a Jail established by multiple
    counties. See Regional Jail Authority v. Tackett, 
    770 S.W.2d 225
    , 229 (Ky. 1989).
    -25-
    The Bryant Court’s characterization of the Pulaski County Detention
    Center Corporation as “a tool of county government, which furthers the state
    purpose of incarcerating lawbreakers” applies equally to the Jail in this case.
    
    Bryant, 330 S.W.3d at 465
    . “[T]here can be no doubt that the operation of a
    county jail is a government function. No one suggests that a jail, a state prison, or
    federal penal institution can be operated by the private sector without
    governmental consent, contract, and regulation.” City of Louisville Bd. of Zoning
    Adjustment v. Gailor, 
    920 S.W.2d 887
    , 889 (Ky. App. 1996).
    The Estate argues that housing and providing medical care for inmates
    is the sort of proprietary undertaking in which private businesses engage; it refers
    specifically to the numerous jails in Kentucky which hire private, for-profit
    corporations to provide medical services to inmates. The Jail itself is required to
    pay for the medical treatment of inmates outside the facility and contracts with a
    doctor to perform medical treatment. The Estate contends that “[w]hen the Jail’s
    non-medical staff took it upon themselves to attempt to perform medical
    evaluations and services for Combs, rather than have medical professionals
    perform these evaluations, they were engaging in a proprietary function and
    consequently neither the Jail nor its employees in their official capacity are entitled
    to governmental immunity.” Appellant’s Brief, p. 24. But the fundamental claim
    against the Jail concerns the failure to procure professional medical assistance for
    -26-
    Combs in a timely manner in accordance with the Jail’s own policies and
    procedures and the related claim that the administrator failed to train Jail personnel
    to follow the policies and procedures in obtaining such assistance promptly. When
    the staff allegedly failed to procure medical assistance, their inaction did not alter
    the fundamentally governmental nature of the Jail.
    Operating a jail is a quintessentially governmental function which
    encompasses providing security and medical care to the inmates. Although a jail
    may contract with private individuals or entities to provide medical care to
    inmates, it is not automatically converted into a proprietary enterprise when it does
    so. The provision of these services is integral to the function of the Jail and does
    not transform it from a governmental entity into a proprietary one.
    b) The Individual Defendants in their Official Capacities
    Because the Jail is entitled to sovereign or governmental immunity, its
    officers and employees are entitled to official immunity in their representative
    capacities. “[W]hen an officer or employee of the state is sued in his/her
    representative capacity, . . . his/her actions are included under the umbrella of
    sovereign immunity[.] Similarly, when an officer or employee of a governmental
    agency is sued in his/her representative capacity, the officer’s or employee’s
    actions are afforded the same immunity, if any, to which the agency, itself, would
    be entitled[.] Yanero v. Davis, 
    65 S.W.3d 510
    , 521-22 (Ky. 2001). “If a state
    -27-
    agency is deemed to have governmental immunity, its officers or employees have
    official immunity when they are sued in their official or representative capacity.”
    
    Autry, 219 S.W.3d at 717
    . Simply because these officers or employees may have
    performed their duties in a negligent manner, as alleged in the complaint, does not
    divest them of official immunity in their representative capacity.
    c) The Defendants in their Individual Capacities
    Finally, the Jail defendants argue that the trial court erred in ruling
    that qualified official immunity was not available to Pelfrey and the Jail employees
    in their individual capacities. The complaint alleged negligence against the
    defendants not only for their alleged failure to provide timely medical care for
    Combs but also for their alleged failure to prevent the altercation with other
    inmates which led to Combs’s injury.
    “[W]hen sued in their individual capacities, public officers and
    employees enjoy only qualified official immunity, which affords protection from
    damages liability for good faith judgment calls made in a legally uncertain
    environment.” 
    Yanero, 65 S.W.3d at 522
    (citation omitted). “Qualified official
    immunity applies to the negligent performance by a public officer or employee of
    (1) discretionary acts or functions, i.e., those involving the exercise of discretion
    and judgment, or personal deliberation, decision, and judgment, . . . ; (2) in good
    -28-
    faith; and (3) within the scope of the employee’s authority.”
    Id. (citations omitted). Conversely,
    “[a] government official is not afforded immunity from
    tort liability for the negligent performance of a ministerial act.” Patton v. Bickford,
    
    529 S.W.3d 717
    , 724 (Ky. 2016), reh’g denied (Aug. 24, 2017). A ministerial duty
    is defined as one that “requires only obedience to the orders of others.”
    Id. (citations omitted). A
    duty is ministerial “when the officer’s duty is absolute,
    certain, and imperative, involving merely execution of a specific act arising from
    fixed and designated facts.”
    Id. A ministerial duty
    does not, however, always
    involve “the simple rote application of a set of rules.”
    Id. It may require
    “ascertainment of . . . facts,” and an officer may be permitted “some discretion
    with respect to the means or method to be employed[.]”
    Id. (citations omitted). i)The
    Jail Administrator
    The trial court ruled that although a Jail official’s decision regarding
    the contents of the Jail’s emergency medical services policy was a discretionary
    function, his duty to train his employees to follow the policy was ministerial. We
    agree with the trial court’s analysis, which is fully consonant with our case law.
    Pelfrey’s adoption and dissemination of the Jail’s Policies & Procedures Manual
    was a discretionary function. Our state’s highest court has repeatedly stated that
    “[p]romulgation of rules is a discretionary function; enforcement of those rules is a
    -29-
    ministerial function.” Williams v. Kentucky Dep’t of Educ., 
    113 S.W.3d 145
    , 150
    (Ky. 2003) (citing 
    Yanero, 65 S.W.3d at 529
    ); Marson v. Thomason, 
    438 S.W.3d 292
    , 297 (Ky. 2014).
    But Pelfrey’s duty to supervise and train his employees to follow the
    rules is ministerial. In Finn v. Warren County, Kentucky, 
    768 F.3d 441
    (6th Cir.
    2014), an opinion relied upon by the trial court, the court held that although a
    supervisor’s decision “on the content of policies and training is a discretionary
    function, the training of employees to adhere to their duties once that content is
    decided is a ministerial function.”
    Id. at 449
    (citations omitted).
    The Jail defendants argue that Pelfrey cannot be held vicariously
    liable for the allegedly negligent acts of his employees or for negligent hiring. But
    Kentucky law does recognize that an employer can be held liable for the negligent
    supervision, training, or insufficient training of its employees. McDonald’s Corp.
    v. Ogborn, 
    309 S.W.3d 274
    , 291 (Ky. App. 2009). Thus, although Pelfrey may
    invoke the defense of qualified official immunity as to the contents of the Jail
    Manual, it does not serve to protect him from claims that he was negligent in
    training his employees to be familiar with the contents of the Manual relating to
    inmate safety and medical care.
    -30-
    ii) The Jail Employees
    As to the Jail employees, the trial court held that their actions or
    inactions in carrying out the Jail’s policies and procedures for the supervision of
    inmates and the provision of medical treatment were ministerial. Its decision is
    supported by the Kentucky Supreme Court’s consistent holding that the general
    supervision of students by teachers is ministerial in nature “as it requires
    enforcement of known rules.” 
    Patton, 529 S.W.3d at 727
    .
    Supervision of students is not ministerial when the official is given
    “little or no direction or guidance on how the supervision was to be performed.”
    Id. (citing Haney v.
    Monsky, 
    311 S.W.3d 235
    (Ky. 2010); Sloas, 
    201 S.W.3d 469
    ).
    In Sloas, a case relied upon by the Jail defendants, a deputy jailer was tasked with
    supervising a group of six inmates on work detail cutting down trees and brush by
    the roadside. He was provided with no guidance or clear directives beyond
    clearing the brush from the side of the road. The Court described his task as “he
    has to watch them, and try as best he can to anticipate what they might do, correct
    them as necessary, determine their capabilities, sometimes by asking them
    forthright whether they can or can’t do the job, assign the duties and see that the
    work is performed.” 
    Sloas, 201 S.W.3d at 480
    . The deputy jailer was not
    provided with any clear directives or orders as to how to accomplish this complex
    and highly-discretionary task. By contrast, the Jail Policies & Procedures Manual
    -31-
    contained clear directives relating to the supervision and medical treatment of
    inmates. This is not a situation in which an officer was expected to perform a
    governmental act that was “not prescribed” or was left “without clear directive.”
    
    Patton, 529 S.W.3d at 727
    .
    Thus, in cases in which employees are properly trained regarding their
    supervisory duties, they are acting in a ministerial capacity. On the other hand,
    when the guidance is not clear, as in Sloas, employees may invoke qualified
    immunity. In this case, a question of fact remains as to whether the Jail employees
    were adequately trained by Pelfrey.
    The Jail defendants argue that the altercation between Combs and his
    fellow inmates was not reasonably foreseeable and consequently the duty element
    of the negligence claim against the correctional officers could not be met. But this
    argument is directed to the sufficiency of the evidence supporting the claim of
    negligence, not to the availability of qualified official immunity. A similar
    question was addressed by the Kentucky Supreme Court in the context of a teacher
    supervising students:
    There is certainly the temptation to say that a person such
    as a teacher acts in a discretionary manner, so that he
    may have immunity from suit, when the ministerial act
    he is required to do—here supervision of bus duty—can
    have unexpected events occur. One might reason that it
    is impossible for a teacher to fully perform the ministerial
    duty of supervision of students because there are so many
    -32-
    things involved in that process that are beyond what the
    teacher can control. For example, if a teacher is working
    with a student on one side of the room, and on the other
    side of the room a student stabs his desk mate with
    a pencil, it could rightfully be argued that no teacher
    could prevent all harm from coming to the children in his
    care. But that does not mean his supervision duty was
    discretionary, such that he would have immunity from
    suit.
    Instead, the ministerial duty of supervision must be
    viewed through the lens of negligence. It is possible that
    some acts that happen when a teacher is supervising are
    outside the scope of what his supervision requires, and he
    will be entitled to a summary judgment as a matter of
    law. Or, as with the pencil stabbing, the question may be
    whether the teacher was negligent in his supervision, and
    then the reasonableness of the teacher’s actions will be
    taken into account. Certainly, there are defenses to the
    claim that a teacher (or any official) has breached his
    ministerial duty. But that does not mean such a claim is
    barred by immunity. The nature of the acts performed by
    the teacher, or any governmental employee, determines
    whether they are discretionary or ministerial.
    Immunity is reserved for those governmental acts that are
    not prescribed, but are done, such as policy-making or
    operational decision making, without clear directive.
    
    Marson, 438 S.W.3d at 301-02
    .
    The Jail employees may well be found not to have acted negligently in
    supervising the inmates or in procuring medical assistance for Combs, but that
    does not mean the negligence claims against them are barred by immunity.
    -33-
    Finally, we turn to a brief consideration of the status of Dr. Dickerson,
    Nurse Adams, and her assistant, Joni Hayes. Dr. Dickerson is the coroner who
    performed the autopsy on Combs. He is not an employee of the Jail and did not
    have any contact with Combs before his death. The Estate makes no specific
    claims against him in his role as coroner. Whether any form of immunity is
    available to Dr. Dickerson was never directly addressed by the trial court.
    Although Dr. Dickerson is a named party to this appeal, his status for purposes of
    immunity will not be reviewed here because it was never addressed by the trial
    court.
    Adams and her assistant Hayes were both employees of the Jail.
    There is some evidence in the record, in the deposition testimony of Officer
    Griffith, that Nurse Adams was made aware of Combs’s complaints before July 4,
    2015, although she testified that she was not informed of his condition until 6:00
    p.m. that day, when she directed the correctional officers to immediately call 911.
    It is a central contention of the Estate’s case that Combs was not evaluated by a
    medical professional at the Jail until after 6:00 p.m. on the date of his death. The
    Jail defendants argue no evidence was presented that either Adams or Hayes
    deviated from the appropriate standard of care. Because Nurse Adams and her
    assistant were both employees of the Jail, and no specific arguments have been
    made that they should be treated differently for immunity purposes than the other
    -34-
    employees, the trial court’s holding regarding the availability of immunity to the
    Jail employees is applicable to them. Thus, they also are entitled to immunity in
    their official capacities but not in their individual capacities.
    For the foregoing reasons, we affirm the Lee Circuit Court’s order and
    opinion holding that (1) the Jail is protected by sovereign or governmental
    immunity; (2) the Jail employees in their official capacities are cloaked in the Jail’s
    absolute immunity; and (3) the Jail officials and employees are not entitled to
    qualified official immunity.
    ALL CONCUR.
    BRIEFS AND ORAL ARGUMENT                    BRIEFS AND ORAL ARGUMENT
    FOR APPELLANT/                              FOR APPELLEES/CROSS-
    CROSS-APPELLEE ESTATE OF                    APPELLANTS:
    RICKY COMBS:
    Jason E. Williams
    L. Dustin Riddle                            London, Kentucky
    Salyersville, Kentucky
    -35-