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[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT ________________________
No. 20-11962 ________________________
D.C. Docket No. 1:16-cv-03691-AT
CHARLES WADE,
Plaintiff-Appellee,
versus
UNITED STATES OF AMERICA, et al.,
Defendants,
GORDON LEWIS,
Defendant-Appellant.
________________________
Appeal from the United States District Court for the Northern District of Georgia ________________________
(September 17, 2021)
Before BRANCH, GRANT, and TJOFLAT, Circuit Judges.
BRANCH, Circuit Judge: USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 2 of 30
While he was incarcerated in a federal prison, Charles Wade punched
another inmate and seriously injured him. Either because of the punch, or while
opening cans of vegetables moments later, Wade cut his hand, which caused
bleeding. After the victim identified Wade as the assailant, a prison officer,
Captain Gordon Lewis, escorted Wade for to a holding cell for further
investigation. During that approximately ten-minute escort, Wade’s hand
continued to bleed, and he asked Lewis whether he would be taken to the medical
unit. Although Captain Lewis declined to answer, he left Wade in the custody of
other officers in a cell that was located three feet from the prison’s medical
examination room. Captain Lewis then departed the scene. Unfortunately for
Wade, it was not until several hours later that a prison nurse provided initial
medical care for his wound. Eventually, Wade was transferred to a hospital where
he received treatment for a broken bone and partially-severed tendon.
Wade sued several prison officials, including Lewis, alleging that the delay
in treatment amounted to deliberate indifference to a serious medical need.
Captain Lewis asserted a qualified immunity defense, which the district court
denied. Relevant here, on summary judgment, the district court denied qualified
immunity to Captain Lewis because, in its view, our decision in Aldridge v.
Montgomery, 753 F.2d 970 (11th Cir. 1985) (per curiam), clearly established that
Captain Lewis’s failure to ensure that Wade received prompt medical treatment
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violated Wade’s constitutional rights. Captain Lewis appeals, arguing that his case
is materially distinguishable from Aldridge. Thus, he contends that the law was
not clearly established, and the district court erred in denying him qualified
immunity.
After careful consideration and with the benefit of oral argument, we agree
with Captain Lewis and conclude that Aldridge did not place an objectively
reasonable officer in Captain Lewis’s position on notice that his conduct was
unconstitutional. Accordingly, because Captain Lewis was entitled to qualified
immunity, we reverse the district court’s decision.
I. BACKGROUND
A. Factual Background
Wade was a federal inmate at the United States Penitentiary in Atlanta,
Georgia (“USP-Atlanta”). On October 15, 2014, Wade was assigned to work in
food service and was preparing for the lunchtime meal. At approximately 1:35
p.m., Wade got into an altercation with another inmate and punched that inmate in
the face. Wade’s punch knocked the other inmate unconscious, the inmate fell to
the floor, and Wade walked away to open cans of vegetables. Wade claims to have
cut his hand while opening one of the cans. 1 He went to the restroom to wash his
1 Wade gave inconsistent explanations for how he cut his hand. In addition to claiming that he cut it on a can of vegetables, Wade later told a nurse that he cut his hand “on a box.” 3 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 4 of 30
hands and believed that he had stopped the bleeding. However, the wound
continued to cause him pain.
Six minutes later, at approximately 1:41 p.m., Bureau of Prisons (“BOP”)
staff observed Wade’s victim lying on the floor behind the food service area. A
BOP officer triggered a radio body alarm, notifying all USP-Atlanta personnel of
an emergency in the food service hall. A second BOP officer arrived and
characterized the scene as “dangerous” because there were approximately 250
inmates in a “small space.” This second officer also observed that the injured
inmate’s lip was bleeding profusely and “dripping blood all over the ground.” The
injured inmate indicated that he was assaulted by Wade.
An officer then approached Wade and saw that his right hand was wounded
in a manner consistent with an injury from a recent fight and was bleeding.
Gordon Lewis, then serving as Acting Captain, also reported to the food service
area in response to the alarm. Captain Lewis handcuffed Wade and escorted him
to the Special Housing Unit (“SHU”).2 As he was being escorted to the SHU,
How Wade cut his hand is not ultimately relevant, as it is undisputed that Wade cut his hand, and the cut caused him to bleed. 2 Inmates suspected of fighting are typically separated from the rest of the inmate population for their safety and for the safety of others. See BOP Program Statement 5270.10, https://www.bop.gov/policy/progstat/5270_010.pdf (July 29, 2011). Therefore, Wade was placed in the SHU pending the outcome of an investigation into whether he fought with the other inmate.
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Wade asked Captain Lewis, “you’re not going to take me to medical?” and Captain
Lewis responded, “don’t ask me how to be a captain and [I] won’t tell [you] how to
be an inmate.” Wade then told Captain Lewis, “okay . . . you know, I’m bleeding
all over this, you know, the place.” According to Wade, as he was being escorted
to the SHU, he was “leaking blood all over,” and there was “a path of blood
following us.”
The SHU and the main medical unit are in the same building. Medical staff
determine how and when to treat inmates and, unless it is a medical emergency,
there is no typical amount of time for medical staff to respond to an inmate’s
injury. Regardless of how an inmate receives an injury, “medical staff needs to be
notified.”
Wade was taken to the SHU where he could be medically assessed. When
Wade arrived there at approximately 1:50 p.m., he was placed in a holding cell that
had a wire mesh door. According to Wade, that was “the last time [he] saw
[Captain Lewis].” Wade’s holding cell was “no more than three feet from the
medical exam room where medical staff rendered medical care to SHU inmates.”
Once Wade was in the holding cell, a different SHU officer removed Wade’s
handcuffs.3 Soon after he was placed in the holding cell, Wade asked SHU
3 Wade claimed that he saw Captain Lewis “intimidating” other SHU officers by “giving orders” before leaving the SHU in order to prevent Wade from receiving medical attention, but he admitted that he did not hear any words uttered by Captain Lewis.
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officers if he was going to go to the medical unit, but the officers told him he
needed to wait. Sometime between 2:01 and 2:04 p.m., three photographs were
taken of Wade’s right hand, two of which showed some blood, but that it was
“tapering off.”
Wade was “bleeding all that time” from when he was placed in the SHU
until he got the attention of a USP-Atlanta medical employee, Nurse Ashley Inniss,
several hours later. 4 According to Nurse Inniss’s clinical notes, she took Wade to
the medical exam room where she noted a 3.4 cm (or 1.34 inch) laceration on his
right hand near the thumb, cleaned the wound with soap, water, and wound
cleaner, applied a topical antibiotic, and covered it with steri-strips and gauze. The
clinical notes also indicate that Nurse Inniss prescribed Motrin, instructed Wade
about signs of infection, and told him to notify medical staff if any of those signs
materialized. Thus, Nurse Inniss’s clinical encounter notes document that an “MD
[was] notified” and “Staff [were] notified to follow up with inmate.”
The next morning, Wade noticed swelling in his hand and put in sick call
requests to medical staff, but he did not receive treatment until a day later when he
got the attention of an officer walking by. Nurse Stanley Coleman then examined
4 In his deposition, Wade testified that he saw Nurse Inniss “like, two, three hours later.” But Nurse Inniss testified that she completed a Clinical Encounter form immediately after examining Wade, and that form indicated that she examined him at 9:35 p.m. on October 15, 2014.
6 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 7 of 30
Wade at 3:24 p.m. on October 17, 2014. Nurse Coleman changed the dressing on
the “deep laceration,” noted swelling and a decreased range of motion in Wade’s
right hand, and documented that Wade reported his pain as a ten on the pain scale.
Nurse Coleman then immediately ordered that Wade be transported to Atlanta
Medical Center (“AMC”).
At 6:40 p.m., Wade was transported to AMC’s emergency room. There,
Wade received an x-ray at 12:41 a.m., which revealed that he “had a broken bone
in his hand” and that the fracture was “intra-articular,” i.e., “inside the metacarpal
phalangeal joint between the hand and the finger, the little finger.” The 3.4-cm
laceration went all the way down to the broken bone, partially cutting the tendon.
This wound was consistent with a “fight bite,” which occurs when a wound
becomes infected based on “difficult-to-control bacteria in the mouth.” At 8:53
a.m. the next morning, Dr. Howard McMahan performed an irrigation and
debridement of the wound, which involved washing the wound with saline
solution, cutting the skin with a scalpel, removing any “devitalized tissue and any
pus,” scraping out any foreign material from the subcutaneous tissue, irrigating the
wound thoroughly, assessing the tendon to make sure it is functional, looking at the
bone to make sure it does not need “any kind of fixation,” placing a drain, and then
closing the wound.
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According to Dr. McMahan, the open wound nature of the “fight bite” injury
combined with the delay of getting treatment increased the risk of infection to
Wade’s hand. He added that the infection would have been less likely to occur if
Wade avoided the fight, avoided hitting the other inmate in the mouth, or had the
wound cleaned shortly after his injury with antibiotics. After his surgery, Wade
was returned to USP-Atlanta where he received medication for pain.
B. Procedural History
Wade, proceeding pro se, filed a complaint against Captain Lewis under
Bivens v. Six Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S.
388 (1971). 5 Wade alleged that Captain Lewis was deliberately indifferent to his
serious medical needs, in violation of the Eighth Amendment. The district court
appointed counsel on Wade’s behalf.
After discovery, Captain Lewis moved for summary judgment. First,
Captain Lewis argued that he was not deliberately indifferent to Wade’s serious
medical needs because there was no evidence that he was aware of Wade’s serious
medical needs and disregarded the risk of serious harm to Wade. He further
argued that he was not the cause of any delay or denial of treatment to Wade.
5 Wade also sued the United States, two health care professionals at USP-Atlanta, and the warden. His complaint also brought claims against all defendants under the Federal Tort Claims Act (“FTCA”). The district court dismissed those defendants and Wade’s FTCA claims as barred by the Inmate Accident Compensation Act. The dismissal of those claims and defendants is not at issue in this appeal.
8 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 9 of 30
Second, Captain Lewis argued that he was entitled to qualified immunity. He
contended that he did not violate Wade’s Eighth Amendment rights by taking
Wade to the SHU instead of the medical unit. He also maintained that there was
no clearly established law that would put him on notice “that placing an inmate in
the SHU after a fight with another inmate rather than taking the inmate to the
Medical Unit was a constitutional violation.”
A magistrate judge issued a report and recommendation (“R&R”),
recommending the denial of Captain Lewis’s summary judgment motion. First, the
magistrate judge determined that that there was a genuine dispute of material fact
concerning the alleged constitutional violation: whether Captain Lewis was
deliberately indifferent to Wade’s serious medical needs. Because Wade shed an
indeterminate amount of blood and suffered a broken bone and partially severed
tendon, the magistrate judge reasoned that a jury could find that Wade’s injury was
so obvious that a lay person would recognize the need for medical attention. The
magistrate judge also determined that there was a dispute of material fact
concerning Captain Lewis’s knowledge of the seriousness of the medical need
because Captain Lewis may have seen the blood, and Wade brought his bleeding
injury to Captain Lewis’s attention. Further, the magistrate judge determined that
there was a genuine issue of material fact concerning whether Captain Lewis
caused the delay in treatment to Wade because a reasonable jury could infer that
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Captain Lewis failed to notify medical staff about Wade’s injury. And second, the
magistrate judge concluded that our decision in Aldridge clearly established that
Captain Lewis’s actions would violate Wade’s constitutional rights. Accordingly,
the magistrate judge recommended denying Captain Lewis’s motion for summary
judgment.
The district court adopted the magistrate judge’s R&R over Captain Lewis’s
objections. Captain Lewis timely appealed.
II. STANDARD OF REVIEW
We review the district court’s denial of qualified immunity on a motion for
summary judgment de novo. Lee v. Ferraro, 284 F.3d 1188, 1190 (11th Cir.
2002). We review the evidence in the light most favorable to the nonmovant.
Smith v. Fla. Dep’t of Corr., 713 F.3d 1059, 1063 (11th Cir. 2013). Summary
judgment is appropriate “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); Smith, 713 F.3d at 1063.
III. DISCUSSION
This appeal presents two questions. First, whether Captain Lewis’s qualified
immunity appeal revolves solely around a factual dispute such that we do not have
jurisdiction to consider it. Second, if we do have jurisdiction, whether it was
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clearly established that Captain Lewis’s conduct violated Wade’s constitutional
rights. We address each issue in turn.
A. Jurisdiction
Wade argues that we lack jurisdiction over this appeal because Captain
Lewis asks us to resolve only factual disputes concerning the denial of his motion
for summary judgment for qualified immunity, which is not an immediately
appealable final decision. According to Wade, Captain Lewis presents only factual
challenges to the nature of Wade’s injury, the extent of his subjective knowledge
of the severity of Wade’s injury, and the district court’s failure to analyze other
factors that caused the delay in treatment. Captain Lewis responds that his appeal
concerns an appealable issue of law about qualified immunity: whether the
undisputed facts in the record showed a violation of clearly established law.
Captain Lewis is correct and, therefore, we have jurisdiction to hear his appeal.
“In general, ‘we are . . . barred from entertaining appeals of non-final
orders.’” Spencer v. Benison, 5 F.4th 1222, 1229 (11th Cir. 2021) (quoting Hall v.
Flournoy, 975 F.3d 1269, 1274 (11th Cir. 2020)); see 28 U.S.C. § 1291 (“The
courts of appeals . . . shall have jurisdiction of appeals from all final decisions of
the district courts of the United States . . . .”). “But under the ‘collateral order
doctrine,’ we may review some determinations, including certain denials of
qualified immunity even though the underlying case is still ongoing in the trial
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court.” Id. (quotation omitted) (alteration adopted). In particular, we may consider
purely legal questions that “concern[] only the application of established legal
principles to a given set of facts.” Koch v. Rugg, 221 F.3d 1283, 1296 (11th Cir.
2000) (quotation omitted); see Mitchell v. Forsyth, 472 U.S. 511, 530 (1985) (“[A]
district court’s denial of a claim of qualified immunity, to the extent that it turns on
an issue of law, is an appealable ‘final decision’ within the meaning of 28 U.S.C.
§ 1291 notwithstanding the absence of a final judgment.”); see also Cottrell v.
Caldwell, 85 F.3d 1480, 1485 (11th Cir. 1996) (holding that we have jurisdiction
when “the denial is based even in part on a disputed issue of law”). However, we
lack jurisdiction over appeals that involve “only . . . issues of evidentiary
sufficiency.” Spencer, 5 F.4th at 1229; see also Cottrell, 85 F.3d at 1485 (“[W]e
lack interlocutory appellate jurisdiction . . . [when] the sole issues on appeal are
issues of evidentiary sufficiency.”). An issue of evidentiary sufficiency arises
“when a defendant’s only challenge to the denial of qualified immunity is that the
record did not contain sufficient facts to conclude that the defendant violated the
plaintiff’s rights.” Hall, 975 F.3d at 1275 (emphasis omitted).
Captain Lewis’s appeal presents a pure question of law. He does not
challenge the district court’s determination that genuine disputes of material fact
precluded summary judgment on the question of whether he was deliberately
indifferent. Rather, Captain Lewis argues that the district court erred when it
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determined that it was clearly established that his actions violated Wade’s
constitutional rights. To that end, Captain Lewis relies on undisputed material
facts in the record to show that his case is distinguishable from Aldridge—the only
authority that the district court and Wade identify for the proposition that the law
was clearly established. Captain Lewis argues that, even if the undisputed facts are
construed in a light most favorable to Wade, those undisputed facts distinguish this
case from Aldridge and, thus, the district court erred in denying him qualified
immunity on the ground that Captain Lewis’s conduct violated clearly established
law. In other words, Captain Lewis’s appeal “concerns only the application of
established legal principles to a given set of facts.” Koch, 221 F.3d at 1296
(quotation omitted); see also Plumhoff v. Rickard, 572 U.S. 765, 773 (2014)
(explaining that defendants “raise[d] legal issues” when they “contend[ed] that
their conduct did not violate the Fourth Amendment and, in any event, did not
violate clearly established law”). Accordingly, we have jurisdiction over Captain
Lewis’s appeal.
B. Clearly Established Law
Next, we address the central question raised in this appeal, namely: whether
our decision in Aldridge clearly established that Captain Lewis’s conduct violated
Wade’s constitutional rights. Captain Lewis argues that key factual differences
between this case and Aldridge demonstrate that the law was not clearly
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established and, thus, he is entitled to qualified immunity. Wade contends not only
that this case is indistinguishable from Aldridge, but also that Captain Lewis’s
conduct was more egregious than that of the defendants in Aldridge. For the
reasons that follow, we agree with Captain Lewis and, therefore, we reverse the
district court’s decision.
The Eighth Amendment forbids “cruel and unusual punishments.” U.S.
Const. amend. VIII. A prison official’s “deliberate indifference to serious medical
needs of prisoners” constitutes cruel and unusual punishment. Estelle v. Gamble,
429 U.S. 97, 104 (1976). To establish an Eighth Amendment claim for deliberate
indifference to a serious medical need, a plaintiff must satisfy three elements.
First, a plaintiff must show that he had an objectively serious medical need.
Goebert v. Lee Cnty., 510 F.3d 1312, 1326 (11th Cir. 2007). Second, a plaintiff
must show that a prison official acted with deliberate indifference to his serious
medical need. Id. And third, a plaintiff must show that his injury was caused by a
prison official’s wrongful conduct. Id.
Under the doctrine of qualified immunity, “government officials performing
discretionary functions[] generally are shielded from liability [or suit] for civil
damages insofar as their conduct does not violate clearly established statutory or
constitutional rights of which a reasonable person would have known.” Harlow v.
Fitzgerald, 457 U.S. 800, 818 (1982); Echols v. Lawton, 913 F.3d 1313, 1319
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(11th Cir. 2019) (same). The parties do not dispute that Captain Lewis was acting
as a government official and carrying out a discretionary function.
“After a government official has demonstrated that the conduct at issue falls
within the discretionary job responsibilities of the officer, a plaintiff must meet two
requirements before qualified immunity may be rejected.” Hall, 975 F.3d at 1275.
First, a plaintiff must show “that the official violated [his] statutory or
constitutional right.” Echols, 913 F.3d at 1319 (quotation omitted); Hall, 975 F.3d
at 1275 (same). Second, a plaintiff must show “that the right was ‘clearly
established’ at the time of the challenged conduct.” Echols, 913 F.3d at 1319
(quotation omitted); Hall, 975 F.3d at 1275 (same). Ordinarily, we decide “which
of the two prongs of the qualified immunity analysis should be addressed first in
light of the circumstances in the particular case at hand.” Pearson v. Callahan,
555 U.S. 223, 236 (2009). Here, because the district court determined that genuine
issues of material fact precluded summary judgment on the first prong of the
qualified immunity analysis, we address only the question of whether a right was
clearly established at the time of the challenged conduct.
Under the clearly established prong, the dispositive question is whether the
law at the time of the challenged conduct gave the government official fair warning
that his conduct was unconstitutional. Hope v. Pelzer, 536 U.S. 730, 741 (2002);
Corbitt v. Vickers, 929 F.3d 1304, 1311 (11th Cir. 2019) (“For a right to be clearly
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established, the contours of the right must be sufficiently clear that a reasonable
official would understand that what he is doing violates that right.” (quotation
omitted) (alteration adopted)). The “law is clearly established if the preexisting
law dictates, that is, truly compels, the conclusion for all reasonable, similarly
situated public officials that what Defendant was doing violated Plaintiffs’ federal
rights in the circumstances.” Evans v. Stephens, 407 F.3d 1272, 1282 (11th Cir.
2005) (en banc) (quotation omitted) (alteration adopted); District of Columbia v.
Wesby, 138 S. Ct. 577, 589 (2018) (“‘Clearly established’ means that, at the time
of the officer’s conduct, the law was sufficiently clear that every reasonable
official would understand that what he is doing is unlawful.” (quotation omitted)).
Thus, we consider what an “objectively reasonable official must have known at the
pertinent time and place” and ask “whether it would be clear to a reasonable officer
that his conduct was unlawful in the situation the defendant officer confronted.”
Youmans v. Gagnon, 626 F.3d 557, 563 (11th Cir. 2010) (per curiam) (quotation
omitted) (alteration adopted).
A plaintiff can show that the contours of a right were clearly established in
one of three ways. First, a plaintiff can point to a “materially similar case that has
already been decided.” Echols, 913 F.3d at 1324 (quotation omitted); Goebert,
510 F.3d at 1330 (same). The case need not be “directly on point,” but the
“existing precedent must have placed the constitutional question beyond debate.”
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Echols, 913 F.3d at 1324 (quotation omitted) (alteration adopted). Additionally,
because “judicial precedents are tied to particularized facts,” Corbitt, 929 F.3d at
1312 (quotation omitted), “[m]inor variations between cases may prove critical,”
Youmans, 626 F.3d at 563. Second, a plaintiff can point to a “a broader, clearly
established principle that should control the novel facts of the situation.” Echols,
913 F.3d at 1324 (quotation omitted). But a broader principle “must establish with
obvious clarity that in the light of pre-existing law the unlawfulness of the
official’s conduct is apparent.” Id. (quotation omitted) (alteration adopted);
Goebert, 510 F.3d at 1330 (“The more general the statement of law is that puts the
official on notice, the more egregious the violation must be before we will find that
the official is not entitled to qualified immunity.”). And third, a plaintiff can show
that “the conduct involved in the case may so obviously violate the Constitution
that prior case law is unnecessary.” Echols, 913 F.3d at 1324 (quotation omitted)
(alteration adopted). “This narrow category encompasses those situations where
the official’s conduct lies so obviously at the very core of what the relevant
constitutional provision prohibits that the unlawfulness of the conduct was readily
apparent to the official, notwithstanding the lack of case law.” Id. at 1325
(quotation omitted).
Our analysis begins with Aldridge, which Wade asserts is a factually similar
case that clearly establishes that Captain Lewis’s conduct violated Wade’s
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constitutional rights. In Aldridge, several defendant police officers “scuffle[d]”
with the plaintiff during his arrest, resulting in a 1.5-inch cut above the plaintiff’s
right eye. 753 F.2d at 971. The plaintiff was then placed in a county jail cell
where the jailer, whose responsibility it was “to advise the officer in charge when
someone might need medical treatment,” informed the detective in charge that the
plaintiff required medical care. Id. at 971, 973. Nevertheless, the officers ignored
the plaintiff for two-and-a-half hours, during which time “[t]he cut continued to
bleed, forming a pool of blood on the floor approximately the size of two hands.”
Id. at 971. Later, the plaintiff was taken to the hospital where he received six
stitches, and the doctors instructed the defendants to give the plaintiff icepacks and
aspirin to treat the wound. Id. But the defendants never provided the icepacks or
aspirin. Id.
The plaintiff sued the officers under 42 U.S.C. § 1983, alleging that they
were deliberately indifferent to his serious medical needs, in violation of the Eighth
Amendment. Id. at 971–72. The district court entered a directed verdict in favor
of the defendants on the issue of deliberate indifference. Id. at 971. We reversed
because “opposing contentions [on the issue of deliberate indifference] could not
be resolved by a directed verdict.” Id. at 973.
In subsequent years, we have read Aldridge as holding that a defendant is
not entitled to a qualified immunity defense when he: (1) ignores a serious cut on
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an individual’s head, which continued to bleed for two-and-a-half hours and form a
puddle on the floor about the size of two hands, or (2) ignores a doctor’s
instructions for treating an injury. See Youmans, 626 F.3d at 565 (noting that in
Aldridge “we denied qualified immunity to a defendant who delayed treatment of a
serious bleeding cut for approximately two and a half hours”); Pourmoghani-
Esfahani v. Gee, 625 F.3d 1313, 1318 (11th Cir. 2010) (describing Aldridge as
“finding deliberate indifference whe[n an] inmate had [a] bleeding cut [above] his
eye with treatment delayed for two and a half hours”); McElligott v. Foley, 182
F.3d 1248, 1257 (11th Cir. 1999) (noting that Aldridge “revers[ed] [a] directed
verdict to officers who failed to provide ice pack and aspirin for pain caused by [a]
bleeding cut”); Brown v. Hughes, 894 F.2d 1533, 1538 (11th Cir. 1990)
(explaining that Aldridge held that a “two and a half hour delay in treatment for a
bleeding cut [above] the eye [was] actionable”). Accordingly, we must determine
whether Captain Lewis’s conduct is “materially similar” to the conduct of the
defendants in Aldridge. See Echols, 913 F.3d at 1324 (quotation omitted).
Several critical facts materially distinguish this case from Aldridge. First,
the nature of the injuries is different. In Aldridge, the plaintiff suffered an injury to
his head—one of the most sensitive areas of the human body—whereas here, Wade
suffered an injury to his hand. Considering that both cuts were about the same
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size, the injury to a bodily extremity, such as Wade’s hand, is less serious than the
injury in Aldridge.
Second, there is a substantial difference between what the defendants
observed about the plaintiff’s wound in each case. In Aldridge, the defendants
observed that the plaintiff continued to bleed for two-and-a-half hours while in
their custody. Thus, their awareness of the seriousness of the injury increased over
time and was readily apparent. Here, all that can be said is that Captain Lewis was
aware that Wade’s hand was still bleeding during a brief 10-minute escort to the
SHU, at which point he left Wade in the custody of other personnel.6 That is to
say, Captain Lewis did not have the benefit of extended observation like the
defendants in Aldridge.
Third, the quantity of blood is different. Although Wade testified that he
told Captain Lewis that he was “leaking” an indeterminate amount of blood “all
over” and leaving a “path of blood” as they walked, Wade has never alleged that
6 Both the magistrate judge and the district court imputed to Captain Lewis knowledge of the broken bone and partially-severed tendon. That determination was error. Courts are to consider what an “objectively reasonable official must have known at the pertinent time and place.” Youmans, 626 F.3d at 563; id. at 564 n.8 (“[T]he proper test is whether a lay person would easily recognize the need as serious. In addition, that a medical need might be recognizable by a trained medical professional, such as a nurse, is not enough. Instead, the need for immediate medical assistance must have been apparent to the untrained eye of a layperson.”). An objectively reasonable officer who is not medically trained cannot diagnose such injuries while escorting a prisoner to a cell. Even Nurse Inniss, who was the first medical professional to examine Wade, did not recognize that Wade suffered from a broken bone and partially-severed tendon.
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the blood soaked his clothing or pooled on the floor of the SHU cell, as was the
case in Aldridge. To the contrary, by Wade’s own admission, the blood was
“tapering off” almost immediately after he and Captain Lewis completed their 10-
minute walk to the SHU. Perhaps most importantly, it is undisputed that Captain
Lewis left the SHU shortly after Wade arrived there and, thus, Captain Lewis did
not observe a puddle of blood—a puddle that Wade never alleges even existed. 7
“Critical to our decision in [Aldridge] was that the plaintiff’s cut bled continuously
[for over two hours], causing blood to pool on the plaintiff’s clothing and the
floor.” Youmans, 626 F.3d at 565. Those facts are critical also to our decision
today because they are noticeably absent here.
Fourth, and finally, Captain Lewis left Wade under the supervision of other
personnel who were equipped to treat Wade. Shortly after Captain Lewis and
Wade reached the cell, other USP-Atlanta officers arrived, removed Wade’s
handcuffs, and took custody of him. Wade’s holding cell was no more than three
feet from the medical exam room where medical staff rendered medical care to
SHU inmates. These circumstances stand in stark contrast to those in Aldridge,
7 Although our analysis is limited to what an objectively reasonable officer in Captain Lewis’s position would have known, we note that Wade never alleged that, after he reached the SHU cell and the blood began to “taper[] off,” he continued to bleed for hours or that his blood pooled in the cell.
21 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 22 of 30
when the defendants were informed that the plaintiff required medical attention at
a different location—a hospital—but ignored that need for two-and-a-half hours.8
Taking all these important factual distinctions together, we have no
difficulty concluding that it would not have been clear to an objectively reasonable
officer in Captain Lewis’s situation that his conduct violated clearly established
law. See Youmans, 626 F.3d at 563.
Our conclusion is strengthened by our decision in Youmans. In Youmans,
the plaintiff was beaten in connection with his arrest for robbery, leaving “visible
abrasions on his head, face, shoulder, elbow, and hand.” 626 F.3d at 561. Plaintiff
was then detained at a police station for four hours while officers interviewed and
booked him. Id. During that time, the plaintiff complained of pain, “appeared to
be disoriented,” told officers he had “‘cracked something’ in his hand,” reported
blurred vision, and “blood was visible.” Id. The plaintiff was later taken to a
8 Captain Lewis correctly notes that the reason for a delay in medical treatment might be relevant in determining whether the law was clearly established. In the deliberate indifference inquiry, “[t]he tolerable length of delay in providing medical attention depends on the nature of the medical need and the reason for the delay.” Harris v. Coweta Cnty., 21 F.3d 388, 393–94 (11th Cir. 1994); see also Youmans, 626 F.3d at 564 (noting that “the reason for the delay must weigh in the [deliberate indifference] inquiry”). Thus, a defendant might be able to show that his case is materially distinguishable from a prior case that held that a delay in medical treatment was intolerable and amounted to a constitutional violation in a particular factual scenario. Here, Captain Lewis argues that the delay was justified by the fact that USP-Atlanta was on lockdown, officers had to secure 250 inmates, and prison officials had to tend to Wade’s victim. But the record evidence does not establish whether these considerations played a role in the delay in treatment of between two-to-seven hours. Without knowing more, we decline to consider the reason for the delay in our analysis.
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hospital where he was diagnosed with “with injuries consistent with blunt trauma”
and prescribed medications and scheduled for follow-up treatment. Id. at 562. The
plaintiff later sued the officers for deliberate indifference. In reversing the district
court’s denial of qualified immunity and analyzing whether there was clearly
established law, we distinguished Aldridge. We explained that in Aldridge, “we
denied qualified immunity to a defendant who delayed treatment of a serious
bleeding cut for approximately two and a half hours.” Id. at 565. And we noted
that “[c]ritical to our decision in that case was that the plaintiff’s cut bled
continuously during that time, causing blood to pool on the plaintiff’s clothing and
the floor.” Id. We then explained that:
[n]othing in the record in the present case shows that Plaintiff’s cuts bled while in Defendant’s custody . . . . Significant, sustained bleeding requiring later stitches is a far greater indicator of a need for urgent medical care than the mere presence of cuts and bruises as in the present case. This factual variance is the kind of variation between cases that makes a critical difference in determining whether the applicable law was already clearly established at the time the occurrence underlying this case arose. We cannot say that Aldridge would provide an objective police officer with adequate advance notice that the conduct at issue in this case would violate Plaintiff’s constitutional rights.
Id. at 565–66 (internal citation omitted). Although Wade’s cut was bleeding while
he was in Captain Lewis’s custody, nothing in the record supports the inference
that, during Captain Lewis’s brief interaction with Wade, Wade’s cut bled so
continuously or profusely that it rose to the level of the circumstances in Aldridge.
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Thus, the facts “[c]ritical to our decision” in Aldridge were absent in Youmans and
are absent here.9
Wade argues that, even apart from Aldridge, the law was clearly established
at a higher level of generality. Specifically, he submits that on the date of his
injury, it was clearly established that “[u]nder the Eighth Amendment, prisoners
have a right to receive medical treatment for their illnesses and injuries.” Taylor v.
Hughes, 920 F.3d 729, 732–33 (11th Cir. 2019) (citing Estelle, 429 U.S. at 104).
By pointing to “a broader, clearly established principle that should control the
novel facts of the situation,” Wade has the burden of showing that the broad
principle established “with obvious clarity that in the light of pre-existing law the
unlawfulness of the official’s conduct is apparent.” Echols, 913 F.3d at 1324
(quotation omitted) (alteration adopted); cf. Priester v. City of Riviera Beach, 208
F.3d 919, 926 (11th Cir. 2000) (“[A] plaintiff must show that the official’s conduct
was so far beyond the hazy border between excessive and acceptable force that the
official had to know he was violating the Constitution even without caselaw on
point.” (quotation omitted) (alteration adopted)). Wade cannot meet his burden
9 Wade contends that this case is more “egregious” than Aldridge because he suffered a broken bone, partially torn tendon, bacterial infection, and required surgery. We reject this argument for two reasons. First, the relevant question is what was known by an objectively reasonable officer in Captain Lewis’s situation, and there is no evidence that he was aware of the extent of Wade’s injury. And second, as we have explained, Wade’s injury was less severe than the injury in Aldridge.
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here. Nothing about this case suggests that it is “obvious” that Captain Lewis
violated Wade’s “right to receive medical treatment for [his] . . . injur[y],” Taylor,
920 F.3d at 732–33, when he escorted Wade for 10 minutes to the SHU cell
located three feet from a medical examination room and left him in the custody of
other officers.
* * *
In determining whether the law was clearly established for purposes of
qualified immunity, we have explained that “judicial precedents are tied to
particularized facts,” Corbitt, 929 F.3d at 1312 (quotation omitted), and “[m]inor
variations between cases may prove critical,” Youmans, 626 F.3d at 563. Thus,
district courts are obliged to analyze carefully whether “preexisting law dictates,
that is, truly compels, the conclusion for all reasonable, similarly situated public
officials that what Defendant was doing violated Plaintiffs’ federal rights in the
circumstances.” Evans, 407 F.3d at 1282 (quotation omitted) (alteration adopted).
Here, the district court failed to undertake this careful analysis, and Aldridge does
not clearly establish that Captain Lewis violated Wade’s constitutional right.
Accordingly, Captain Lewis is entitled to qualified immunity.
IV. Conclusion
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For these reasons, we reverse the district court’s order denying Captain
Lewis’s motion for summary judgment on the ground that he is entitled to qualified
REVERSED.
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TJOFLAT, Circuit Judge, concurring: I agree with the court that defendant Lewis is entitled to qualified immunity,
but I write separately to highlight why we have jurisdiction over this appeal and to
suggest that the qualified immunity analysis is simpler than the court suggests.
When a district court denies qualified immunity on a summary judgment
motion, this Court has jurisdiction over that appeal “to the extent that it turns on an
issue of law” because it “is an appealable ‘final decision’ within the meaning of 28
U.S.C. § 1291.” Hunter v. City of Leeds, 941 F.3d 1265, 1271 n.2 (11th Cir. 2019)
(quoting Mitchell v. Forsyth, 472 U.S. 511, 530, 105 S. Ct. 2806, 2817 (1985)). In
reviewing such an appeal of qualified immunity, we “review the denial of
summary judgment based on qualified immunity de novo, viewing the facts in the
light most favorable to the nonmovant.” Id. at 1274 n.8 (citing Salvato v. Miley,
790 F.3d 1286, 1292 (11th Cir. 2015)).
In this case, Wade is the nonmoving party, so we are required to draw all
factual inferences in his favor. We do that to create a “purely legal question.”
Mitchell, 472 U.S. at 530, 105 S. Ct. at 2817. The record contains the following
relevant facts: 1) Wade broke a bone in his hand and had an accompanying
laceration spanning 1.34 inches; 2) Lewis escorted Wade on a ten-minute walk to
the Special Housing Unit (“SHU”), and Wade’s hand bled on the entire walk; 3)
27 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 28 of 30
When Wade asked Lewis if they were going to go to the medical unit on this walk,
Lewis said something to the effect of, “Don’t tell me how to be a captain, and I
won’t tell you how to be an inmate;” 4) Once in the SHU, Lewis handed Wade
over to an officer who removed Wade’s handcuffs; and 5) Lewis left the scene.
Although Wade tries to create a factual dispute here in order to defeat our
jurisdiction, none exists, because Lewis does not dispute these facts. And it is
worth noting that a factual dispute will never exist in this context, where an officer
appeals a denial of qualified immunity based on the clearly established prong and
not on the sufficiency of the evidence. This is the case because we, as the
reviewing court, will always take the facts in the light most favorable to the
nonmoving party when analyzing the clearly established prong, regardless of how
an officer tries to color them.1
Wade tries to create factual disputes in this case by saying that Lewis
“downplays the severity” of Wade’s injury, Lewis “challenges the extent of his
subjective knowledge,” and Lewis “questions the reason why he refused to provide
access to the requested medical attention.” Wade characterizes these supposed
factual disputes as “challenges to the district court’s factual determinations.”
Wade’s characterization of Lewis’s arguments is wrong. In order to perform an
1 At this stage of litigation, we are not concerned with what Wade might ultimately be able to prove at trial. Hunter, 941 F.3d at 1277 n.15. The question is whether, if we view all the facts in Wade’s favor, they demonstrate that Lewis violated a clearly established right. See id. 28 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 29 of 30
analysis of the clearly established prong of qualified immunity, Lewis had to
evaluate the facts of the case, and nothing Lewis said contradicted the District
Court’s factual findings. Moreover, even if Lewis had tried to downplay or
contradict the facts as established by the District Court, we would still take the
version of facts most favorable to Wade and thereby create a pure question of law.
All that is left to decide based on these facts, then, is whether Lewis is entitled to
qualified immunity.
Turning to the qualified immunity analysis, the court distinguishes Aldridge
on four grounds to hold that the right was not clearly established here. I agree that
Lewis is entitled to qualified immunity, but I write separately to highlight the fact
that Lewis’s role in this incident as reflected in the record is what best
differentiates this case from that of the liable officers in Aldridge.
Facially, there are some similarities between Aldridge and this case. The
plaintiffs in both cases sustained bleeding injuries and went without medical
assistance for hours in officers’ custody. See Aldridge v. Montgomery, 753 F.2d
970, 971 (11th Cir. 1985) (per curiam). The court differentiates this case from
Aldridge on four grounds: 1) The plaintiff in Aldridge had a head injury while
Wade suffered a hand injury; 2) the defendants in Aldridge observed the plaintiff
bleeding for two hours while Lewis’s walk with Wade only lasted ten minutes; 3)
the plaintiff in Aldridge bled more than Wade; and 4) the defendants in Aldridge 29 USCA11 Case: 20-11962 Date Filed: 09/17/2021 Page: 30 of 30
neglected to take the plaintiff to the hospital for over two hours while Lewis left
Wade under the supervision of other officers who could treat Wade.
While I appreciate the court’s thorough analysis of Aldridge, this case can be
distilled to one simple point. The key difference between these cases in my
estimation is not necessarily where the injury was or how much the inmate bled
over the course of the day, but instead who is being sued and under what theory of
law. Wade is not suing the officers who kept him in custody for hours without
medical treatment, like the plaintiff in Aldridge. He is suing Lewis, who escorted
him from the dining hall area to the SHU, located right next to the medical unit,
where Lewis then handed Wade over to other officers. Narrowing our focus from
the time Lewis entered the scene to the time he left Wade in other officers’
custody, the time period for which there is an utter lack of evidence in the record,
we have no facts from which to draw inferences in Wade’s favor. There is no
evidence in the record that Lewis did anything more than escort Wade to the SHU.
The dialogue between the two on the walk as reflected in the record certainly does
not indicate that Lewis violated a clearly established right. And Wade has pointed
to no other case to establish that Lewis is not entitled to qualified immunity. Lewis
is entitled to qualified immunity, not because this case is so much different from
Aldridge on the facts, but because there are no facts in the record suggesting that
this particular defendant is liable.