United States Court of Appeals

For the Eighth Circuit 

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No. 22-2749

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Clara Cheeks

 Plaintiff - Appellee

v.

Jon Belmar, Individually and in his Official Capacity as St. Louis County, 

Missouri, Chief of Police; Saint Louis County, Missouri; M. Broniec, M.SGT, 

Trooper of MSHP (Individually); Paul Kempke, SGT., Trooper of MSHP 

(Individually); B.A. Teague, CPL., Trooper for MSHP; Individually

 Defendants 

Mark Jakob, Individual capacity; 

Frank L. Maloy, as Personal Representative of the Estate of Alex Maloy

 Defendants - Appellants

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Appeal from United States District Court 

for the Eastern District of Missouri

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Submitted: April 13, 2023

Filed: September 1, 2023 

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Before BENTON, GRASZ, and STRAS, Circuit Judges. 

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GRASZ, Circuit Judge.
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Clara Cheeks sued under 42 U.S.C. § 1983 on behalf of her son, Mikel Neil, 

who died in a vehicle accident while fleeing St. Louis County police officers Alex 

Maloy1 and Mark Jakob. Cheeks claimed the officers failed to provide medical aid

in violation of the Due Process Clause of the Fourteenth Amendment of the U.S. 

Constitution, and the officers filed a motion for summary judgment based on 

qualified immunity. The district court2 denied the motion, concluding there were 

genuine disputes of material facts that prevented it from holding the officers were 

entitled to immunity at this stage of the proceedings. We affirm. 

I. Background3

On August 10, 2018, at approximately 9:30 p.m., Neil crashed into a tree and 

died at the scene of the accident. The parties agree that Officers Maloy and Jakob 

had pursued Neil, who was driving a Hyundai Elantra, for an alleged red-light 

violation. But the parties dispute what led to the accident. Officers Maloy and Jakob 

claim Neil simply lost control of his car, veered off the road, and collided with a 

tree. However, Cheeks maintains that Officer Maloy, who was driving the police 

vehicle, performed a “PIT” maneuver,4

 causing Neil’s car to “go into a spin” and

crash into the tree. To support this claim, Cheeks submitted evidence from an 

1

This action was initially brought against Alex Maloy, who has since passed 

away. His father, Frank Maloy, was substituted as the proper party. See Fed. R. 

Civ. P. 25(a). 

2

The Honorable Sarah E. Pitlyk, United States District Judge for the Eastern 

District of Missouri.

3

We recite the background facts as set forth in the district court’s summary 

judgment opinion. See Riggs v. Gibbs, 923 F.3d 518, 521 (8th Cir. 2019) (explaining 

we must accept as true the facts the district court found were adequately supported 

unless they are blatantly contradicted by the record). Certain additional facts are 

taken from the record.

4

In a PIT maneuver, a police officer will use his or her vehicle to make 

intentional contact with the suspect’s fleeing vehicle to force an end to the pursuit.
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eyewitness who stated under oath that he saw the police vehicle bump Neil’s vehicle, 

which caused it to crash. The officers deny utilizing a PIT maneuver. Cheeks 

contends that video recordings capturing the moments prior to the crash and witness 

testimony demonstrates Officers Maloy and Jakob either observed or should have 

observed the crash. Even though the officers did not render aid or call for medical 

assistance, an eyewitness to the accident called 911 within 30 seconds of the crash. 

Neil died at the scene. 

Cheeks asserts Officers Maloy and Jakob breached their duty to stop and 

attempt to render aid in violation of the Due Process Clause of the Fourteenth 

Amendment.

5

 The officers argue their failure to render aid did not change the 

outcome of the accident since emergency responders were called almost 

immediately. The district court held that Officers Maloy and Jakob were not entitled 

to qualified immunity because a reasonable jury could find they “were aware of the 

crash, and that their failure to call for emergency medical assistance violated Neil’s 

constitutional right under the Fourteenth Amendment.”

II. Analysis

 

“In an interlocutory appeal raising a defense of qualified immunity, this court 

has jurisdiction to address only an order deciding a purely legal issue of whether the 

facts alleged by a plaintiff show a violation of clearly established law.” Welch v.

Dempsey, 51 F.4th 809, 812 (8th Cir. 2022). “In other words, ‘we lack jurisdiction 

to consider an argument that the plaintiff has proffered insufficient evidence to create 

a genuine issue of fact, [but] we have jurisdiction to consider an argument that the 

disputed facts to which the plaintiff cites are unable to affect the outcome of the 

suit.’” Torres v. City of St. Louis, 39 F.4th 494, 502 (8th Cir. 2022) (quoting Just v. 

5

While there are cases analyzing police pursuits under substantive due 

process, neither party briefed a substantive due process claim. “[W]e rely on the 

parties to frame the issues for decision and assign to courts the role of neutral arbiter 

of matters the parties present.” Greenlaw v. United States, 554 U.S. 237, 243 (2008).
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City of St. Louis, 7 F.4th 761, 766 (8th Cir. 2021)). We employ a de novo standard 

when doing so. See Shannon v. Koehler, 616 F.3d 855, 861–62 (8th Cir. 2010).

“The qualified immunity inquiry involves two questions: ‘(1) whether the 

facts, viewed in the light most favorable to the plaintiff, demonstrate the deprivation 

of a constitutional or statutory right; and (2) whether the right was clearly established 

at the time of the deprivation.’” McDaniel v. Neal, 44 F.4th 1085, 1089 (8th Cir. 

2022) (quoting Jones v. McNeese, 675 F.3d 1158, 1161 (8th Cir. 2012)).

The Due Process Clause of the Fourteenth Amendment generally does not 

provide an “affirmative right to governmental aid,” but in “certain limited 

circumstances,” it does “impose[] upon the State affirmative duties of care and 

protection with respect to particular individuals.” DeShaney v. Winnebago Cnty. 

Dep’t of Soc. Servs., 489 U.S. 189, 196–98 (1989). “[W]e have recognized that an 

individual may be constitutionally entitled to police assistance under the Fourteenth 

Amendment . . . ‘in custodial and other settings in which the state has limited the 

individuals’ ability to care for themselves . . . .’” Gladden v. Richbourg, 759 F.3d 

960, 964–65 (8th Cir. 2014) (quoting Gregory v. City of Rogers, 974 F.2d 1006, 

1010 (8th Cir. 1992) (en banc)). 

“[W]hen the State takes a person into its custody and holds him there against 

his will, the Constitution imposes upon it a corresponding duty to assume some 

responsibility for his safety and general well-being.” DeShaney, 489 U.S. at 199–

200. This “affirmative duty to protect arises not from the State’s knowledge of the 

individual’s predicament . . . but from the limitation which it has imposed on his 

freedom to act on his own behalf.” Id. at 200. Consequently, “custody is effected 

for purposes of the Fourteenth Amendment only when the state ‘so restrains an 

individual’s liberty that it renders him unable to care for himself.’” Gladden, 759 

F.3d at 965 (quoting DeShaney, 489 U.S. at 200). This duty also requires a 

“governmental agency to provide medical care to persons . . . who have been injured 

while being apprehended by the police.” City of Revere v. Massachusetts Gen.

Hosp., 463 U.S. 239, 244 (1983). 
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We analyze failure to render medical aid claims under a deliberate 

indifference standard. See Tagstrom v. Enockson, 857 F.2d 502, 503–04 (8th Cir. 

1988). “Deliberate indifference has both an objective and a subjective component.” 

McRaven v. Sanders, 577 F.3d 974, 980 (8th Cir. 2009) (quoting Vaughn v. Gray, 

557 F.3d 904, 908 (8th Cir. 2009)). The plaintiff must show (1) “an objectively

serious medical need,” and (2) “that the defendant knew of and yet deliberately

disregarded.” Reese v. Hale, 58 F.4th 1027, 1030 (8th Cir. 2023). 

On appeal, the officers argue Cheeks failed to demonstrate a violation of a 

constitutionally protected right in two ways: (1) Neil was not in custody, and (2) 

there was no medical evidence that the delay in aid detrimentally altered Neil’s

outcome. We address each argument in turn.

A. Custody

We must begin by analyzing the officers’ argument—made for the first time 

on appeal—that Neil was not in custody for purposes of the Fourteenth Amendment. 

See Combs v. The Cordish Cos., Inc., 862 F.3d 671, 678–79 (8th Cir. 2017) 

(explaining we may “consider a newly raised argument ‘if it is purely legal and 

requires no additional factual development . . . .’” (quoting United States v. Hirani, 

824 F.3d 741, 751 (8th Cir. 2016))). It is undisputed Neil was never apprehended 

by the officers after the crash, and Officer Jakob alleges he did not witness Neil’s 

accident. Therefore, the critical question is whether Officers Maloy and Jakob “so 

restrain[ed] [Neil’s] liberty” through the use of a PIT maneuver during the police 

pursuit “that it render[ed] [Neil] unable to care for himself.” Gladden, 759 F.3d at 

965 (quoting DeShaney, 489 U.S. at 200). 

While the crash itself was not captured on video, Cheeks presented testimony 

from Lorenzo Johnson who said he witnessed the officers’ car bump the side of 

Neil’s car, which caused Neil’s car to go into a spin. The district court relied partly 

on this testimony of contact between vehicles to conclude “[a] reasonable juror could 
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find, based on circumstantial evidence . . . that [the officers] had actual knowledge 

of Neil’s serious medical need and disregarded it.” We do not have jurisdiction to 

second-guess this determination. See Thompson v. Dill, 930 F.3d 1008, 1014 (8th 

Cir. 2019). 

Officers Maloy and Jakob suggest we do have jurisdiction to disturb the 

conclusion because the video recording “blatantly contradicts” the eyewitness 

testimony. While it is true there is an exception to our normal jurisdiction limitation 

when a version of the facts “is blatantly contradicted by the record, so that no 

reasonable jury could believe it,” Scott v. Harris, 550 U.S. 372, 380 (2007), this 

exception is not applicable here. The video did not record the accident itself, instead 

capturing a few moments of the pursuit just prior to the crash. Because the crash 

itself occurs off screen, Cheeks’s contention that Officers Maloy and Jakob 

performed a PIT maneuver is not so “blatantly contradicted by the record . . . that no 

reasonable jury could believe it[.]” Id.

Nonetheless, the officers argue—again for the first time on appeal—that even 

assuming such contact between the two vehicles, this does not constitute custody as 

the term is defined in Gladden. We disagree. When the state limits an individual’s 

“freedom to act on his own behalf,” DeShaney, 489 U.S. at 200, by intentionally 

conducting a maneuver that causes a vehicle to spin out and collide with a tree, the 

duty arises “to provide medical care to persons . . . who have been injured while 

being apprehended by the police.” City of Revere, 463 U.S. at 244. 

Case law in the context of Fourth Amendment claims supports our conclusion. 

In such cases, the Supreme Court has distinguished between the constitutional 

implications of a mere police pursuit and an intentional police-imposed accident. A 

police pursuit itself does not amount to a seizure. California v. Hodari D., 499 U.S. 

621, 626 (1991). But it would be considered a seizure if “the police cruiser had 

pulled alongside the fleeing car and sideswiped it, producing the crash” as this would 

have been a “termination of the suspect’s freedom of movement[.]” Brower v. Cnty. 

of Inyo, 489 U.S. 593, 596–97 (1989); see also Scott, 550 U.S. at 381 (stating the 
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officer “does not contest that his decision to terminate the car chase by ramming his 

bumper into respondent’s vehicle constituted a ‘seizure’”). Conversely, “no Fourth 

Amendment seizure would take place where a ‘pursuing police car sought to stop 

the suspect only by the show of authority represented by flashing lights and 

continuing pursuit,’ but accidentally stopped the suspect by crashing into him.” 

Cnty. of Sacramento v. Lewis, 523 U.S. 833, 844 (1998) (quoting Brower, 489 U.S. 

at 597). So, in the Fourth Amendment context, a seizure arises if a police officer 

intentionally causes a crash to end a police chase whereas no seizure occurs if there 

is simply an accidental crash. The officers have offered no reason the same would 

not be true under the Fourteenth Amendment. 

To satisfy the second prong of the qualified immunity analysis, “[t]he 

contours of the right must be sufficiently clear that a reasonable official would 

understand that what he is doing violates that right.” Anderson v. Creighton, 483 

U.S. 635, 640 (1987). It is not required that there be “a case directly on point, but 

existing precedent must have placed the statutory or constitutional question beyond 

debate.” Ashcroft v. al-Kidd, 563 U.S. 731, 741 (2011). In other words, “a general 

constitutional rule already identified in the decisional law may apply with obvious

clarity to the specific conduct in question, even though ‘the very action in question 

has [not] previously been held unlawful.’” Hope v. Pelzer, 536 U.S. 730, 741 (2002) 

(quoting United States v. Lanier, 520 U.S. 259, 269 (1997)). 

As discussed above, it is clearly established that a custodial relationship is 

formed when law enforcement officers limit an individual’s “freedom to act on his 

own behalf.” DeShaney, 489 U.S. at 200. This is a “general constitutional rule 

already identified in the decisional law” that can be applied “with obvious clarity to 

the specific conduct in question” today. Hope, 536 U.S. at 741. If law enforcement 

officers intentionally force a suspect to crash his car to facilitate the end of a pursuit, 

the suspect no longer has the liberty “to care for himself.” Gladden, 759 F.3d at 965 

(quoting DeShaney, 489 U.S. at 200). When the state limits an individual’s 

“freedom to act on his own behalf,” DeShaney, 489 U.S. at 200, by purposely 

causing a car accident, a clearly established duty arises “to provide medical care to 
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persons . . . who have been injured while being apprehended by the police.” City of

Revere, 463 U.S. at 244. The state of the law gave the officers fair warning that 

failing to render aid or call for medical assistance for an accident they caused was 

unconstitutional. 

B. Detrimental Effect

Next, Officers Maloy and Jakob argue that they did not violate Neil’s 

constitutional right because their failure to summon medical aid had no detrimental 

effect on the outcome of the accident. We disagree. The first prong of the deliberate 

indifference test, which is utilized in failure to render medical aid claims, asks 

whether a plaintiff demonstrated an objectively serious medical need. Coleman v.

Rahija, 114 F.3d 778, 784 (8th Cir. 1997). “A serious medical need is ‘one that has 

been diagnosed by a physician as requiring treatment, or one that is so obvious that 

even a layperson would easily recognize the necessity for a doctor’s attention.’” Id.

(quoting Camberos v. Branstad, 73 F.3d 174, 176 (8th Cir. 1995)). But if a plaintiff 

“alleges that a delay in medical treatment constituted a constitutional deprivation, 

‘the objective seriousness of the deprivation should also be measured by reference 

to the effect of delay in treatment.’” Id. (emphasis added) (quoting Crowley v.

Hedgepeth, 109 F.3d 500, 502 (8th Cir. 1997)). In other words, if a plaintiff is 

relying on a delay in treatment theory, there is an additional requirement to place 

verifying medical evidence in the record to show there was a detrimental effect 

caused by the delay. A plaintiff’s “failure to place verifying medical evidence in the 

record to establish the detrimental effect of delay in medical treatment precludes a 

claim of deliberate indifference to medical needs.” Id. 

The officers rely on a series of cases applying this principle to argue Cheeks’s

failure to offer evidence of a detrimental impact is fatal to her case. See Jackson v.

Riebold, 815 F.3d 1114, 1120 (8th Cir. 2016) (holding evidence of a detrimental

effect was necessary because the plaintiff relied on a delay in treatment theory);

Hancock v. Arnott, 39 F.4th 482, 487 (8th Cir. 2022) (concluding the plaintiff’s

failure to establish the detrimental effect of the delay through medical evidence was
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fatal to his claim); Laughlin v. Schriro, 430 F.3d 927, 929 (8th Cir. 2005) (holding

a plaintiff alleging delay in medical treatment must demonstrate a detrimental effect

of the delay with medical evidence); and Redmond v. Kosinski, 999 F.3d 1116,

1120–21 (8th Cir. 2021) (determining it was necessary to demonstrate the effect of

the deprivation because the plaintiff did “not allege the defendants delayed all

treatment, but that they failed to provide the proper treatment at the proper time”). 

But these cases are distinguishable because they all involve a theory that the officials

delayed treatment. Cheeks does not argue that the officers simply delayed calling

for medical assistance. Instead, she argues the officers never called for medical

assistance—thus denying medical aid altogether. In such cases, where no medical

aid was provided, there is no need to provide evidence demonstrating the detrimental

effect of the lack of aid. See Jones v. Minnesota Dep’t of Corr., 512 F.3d 478, 482 

(8th Cir. 2008) (analyzing a claim where no medical aid was provided without 

requiring the plaintiff to also demonstrate the detrimental effect). Because the

officers failed to render any aid, rather than simply delaying in providing it, our

precedent does not require Cheeks to demonstrate the detrimental effect of the lack

of aid. Thus, we agree with the district court that, viewed in the light most favorable

to Cheeks, she has shown a clearly established constitutional violation. Id. at 481. 

III. Conclusion

We affirm the district court’s denial of summary judgment to Officers Maloy 

and Jakob. 

STRAS, Circuit Judge, dissenting. 

Not every tort is a constitutional violation. See DeShaney v. Winnebago Cnty. 

Dep’t of Soc. Servs., 489 U.S. 189, 202 (1989) (emphasizing that “the Due Process 

Clause of the Fourteenth Amendment . . . does not transform” one into the other). 

The officers may well have had a clear duty to try to save Mikel Neil’s life after 

causing the crash. The only problem is that, if they did, it arose under state tort law 

rather than the United States Constitution. Cf. Restatement (Third) of Torts § 39 
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(Am. L. Inst. 2012) (describing the duty to provide aid after “creat[ing] a continuing 

risk of physical harm”).

As the court recognizes, the Constitution only creates a duty to aid once 

officers “take[] a person into . . . custody and hold[] him there against his will.” 

DeShaney, 489 U.S. at 199–200 (emphasis added). But I could not locate a single 

case, much less a “robust consensus” of them, that extends it to someone they have 

seized by force but have not taken into custody. District of Columbia v. Wesby, 583 

U.S. 48, 63 (2018) (citation omitted) (explaining what it takes to “clearly establish[]” 

a constitutional rule); cf. Scott v. Harris, 550 U.S. 372, 381 (2007) (suggesting that 

a police-initiated crash counts as a seizure under the Fourth Amendment); Brower v. 

County of Inyo, 489 U.S. 593, 597 (1989) (same). We can debate whether we should

extend it to cover this situation, but no officer would be “on notice” that the 

Constitution does. Saucier v. Katz, 533 U.S. 194, 202 (2001). Qualified immunity 

applies in just these circumstances. See id.

The court, on the other hand, thinks it is “obvious” that Neil was in custody. 

Hope v. Pelzer, 536 U.S. 730, 741 (2002) (explaining that sometimes all it takes is 

“a general constitutional rule” that “appl[ies] with obvious clarity to the specific 

conduct in question” (citation omitted)). In its view, “rendering [Neil] unable to care 

for himself” was enough. Gladden v. Richbourg, 759 F.3d 960, 965 (8th Cir. 2014) 

(quoting DeShaney, 489 U.S. at 200). The problem with relying on “general” rules 

is that they often fail to “answer the specific and particularized question[s]” that arise 

in other situations. Dean v. Bearden, — F.4th —, 2023 WL 5421629, at *4 (8th Cir. 

Aug. 23, 2023) (citation omitted). Here, the question is whether something short of 

custody creates a duty to aid.

Gladden, the case that allegedly established the duty, never answered that 

question. It involved an alcoholic who voluntarily accepted a ride from officers and 

died of hypothermia several hours later. See Gladden, 759 F.3d at 963. We held 

that, on those facts, there was no Fourth Amendment seizure, much less the 

“something more” required for custody. Id. at 965. Gladden simply could not have 
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answered the “specific and particularized question” presented in this case. Dean, 

2023 WL 5421629, at *4 (citation omitted). No seizure meant no holding on whether 

it created a duty to aid. 

Notably, Gladden relied on DeShaney, which held only that “incarceration, 

institutionalization, [and] other similar restraint[s] of personal liberty” trigger the 

duty to provide aid. DeShaney, 489 U.S. at 200 (“The affirmative duty to protect 

arises not from the State’s knowledge of the individual’s predicament . . . , but from 

the limitation which it has imposed on his freedom . . . .”); Gladden, 759 F.3d at 965; 

see also City of Revere v. Mass. Gen. Hosp., 463 U.S. 239, 244 (1983) (recognizing 

a duty “to provide medical care” to an injured suspect after he was “apprehended by 

the police”). It is not obvious that leaving someone in a crashed car is similar to 

incarceration or institutionalization. See Wesby, 583 U.S. at 64 (noting that “obvious 

case[s]” are “rare” (citation omitted)). And by Gladden’s logic, the “fleeting” nature 

of a seizure by force, Torres v. Madrid, 141 S. Ct. 989, 999 (2021), makes it unlikely. 

See Gladden, 759 F.3d at 965 (explaining why seizures are different from custody).

As the Supreme Court has often reminded us, defeating qualified immunity 

requires a constitutional rule that was “clearly established,” not just “suggested 

by . . . precedent.” City of Tahlequah v. Bond, 142 S. Ct. 9, 11 (2021) (per curiam); 

accord, e.g., Wesby, 583 U.S. at 63. This one was not.

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