United States Court of Appeals

For the First Circuit

No. 22-1507

LIDIA LECH,

Plaintiff, Appellant,

v.

DOROTHEA VON GOELER; BAYSTATE MEDICAL PRACTICES, INC.; HAMPDEN 

COUNTY SHERIFF'S DEPARTMENT; MARIA DIAZ; NICOLE SKORUPSKI; 

ELIZABETH MEAUX; SHANTELLE ROSADO; JULIE BELLE-ISLE; LYNN CHASE; 

MICHAEL J. ASHE, JR.; PATRICIA MURPHY; NICHOLAS COCCHI; NATALIE 

CRUZ; and MICHAEL VANCINI,

Defendants, Appellees,

JOHN DOE 1 and JOHN DOE 2,

Defendants.

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF MASSACHUSETTS

[Hon. Katherine A. Robertson, U.S. Magistrate Judge]

Before

Rikelman, Selya, and Howard,

Circuit Judges.

Daniel Volchok, with whom Allison M. Schultz, Joseph M. Meyer, 

Michael Moorin, Wilmer Cutler Pickering Hale and Dorr LLP, and 

John R. Godleski were on brief, for appellant.

Thomas E. Day, with whom Lauren F. Olanoff and Egan, Flanagan 

and Cohen, P.C. were on brief, for appellees Hampden County 

Sheriff's Department, Maria Diaz, Nicole Skorupski, Elizabeth 
Meaux, Shantelle Rosado, Julie Belle-Isle, Lynn Chase, Michael J. 

Ashe, Jr., Patricia Murphy, Nicholas Cocchi, Natalie Cruz, and 

Michael Vancini.

Michael B. Doherty, with whom Kevin C. Giordano and Keyes and 

Donnellan, P.C. were on brief, for appellees Dorothea von Goeler 

and Baystate Medical Practices, Inc.

February 2, 2024
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RIKELMAN, Circuit Judge. When she was thirty-four weeks 

pregnant and during a three-month period of incarceration at a 

correctional facility in Western Massachusetts, Lidia Lech 

experienced a stillbirth. She sued healthcare providers and other 

staff affiliated with the facility, alleging that they disregarded 

her concerns about the serious medical symptoms she was 

experiencing and denied her repeated requests to go to a hospital, 

resulting in her baby's death. The district court granted summary 

judgment to one of the defendants but permitted most of Lech's 

other claims to proceed to trial, after which a jury returned a 

defense verdict.

Lech now challenges the grant of summary judgment and 

two of the district court's evidentiary rulings at trial.

According to Lech, the erroneous evidentiary rulings reinforced 

each other and precluded her from responding fully to the defense's 

central theory of the case: that the jury should believe the 

medical staff and not Lech.

After careful review and on the undisputed facts here, 

we conclude that the district court did not err in granting summary 

judgment to a correctional officer on Lech's claims of deliberate 

indifference and intentional infliction of emotional distress. We 

determine, however, that the district court did abuse its 

discretion in the two evidentiary rulings challenged on appeal. 

Together, the rulings permitted the defense to use extrinsic 
-4-

evidence to impugn Lech's character for truthfulness while

simultaneously precluding Lech from introducing testimony 

corroborating her version of events. Because we conclude that at 

least one of these evidentiary rulings was not harmless, we vacate 

the jury verdict and remand for a new trial against most of the 

defendants.

I. BACKGROUND

A. Relevant Facts

We present the facts relevant to the challenged 

evidentiary rulings in a "balanced" manner, "objectively view[ing]

the evidence of record." United States v. Velazquez-Fontanez, 6 

F.4th 205, 212 (1st Cir. 2021) (citation omitted).1

On October 4, 2013, when she was approximately twentytwo weeks pregnant, Lech was incarcerated at the Western 

Massachusetts Regional Women's Correctional Center (WCC) for a 

probation violation. Lech's 2013 pregnancy was high-risk because

she had experienced a uterine rupture during a previous pregnancy 

and then miscarried. During her intake with medical staff at WCC 

on October 4, Lech reported that she had a high-risk pregnancy. 

Shortly thereafter, WCC received, and medical staff members 

1 When we review the district court's grant of summary 

judgment infra, we recite the facts relevant to that issue in the 

light most favorable to Lech "consistent with record support." 

Lahens v. AT&T Mobility P.R., Inc., 28 F.4th 325, 328 (1st Cir. 

2022).
-5-

reviewed, Lech's medical records documenting her prior uterine 

rupture and miscarriage. Lech's medical records at WCC likewise 

noted that her "principal diagnosis" was high-risk pregnancy. A 

few weeks later, in November, Lech was referred to a maternalfetal medicine physician, a specialist who receives additional 

training within the field of obstetrics and gynecology focusing on 

high-risk pregnancy. The specialist recommended that she deliver 

via cesarean section (C-section) because labor would increase the 

risk of another uterine rupture, which would be life-threatening 

to Lech and her baby. Lech's C-section was scheduled for midJanuary.

Lech's claims in this case focus on the period of 

December 22, 2013, to January 1, 2014, when Lech was about two to 

three weeks away from her scheduled C-section. Lech testified at 

trial that, during this time period, she sought near-daily medical 

attention for her pregnancy and became extremely concerned that 

something was wrong. She stated that she reported to WCC medical 

staff increasing signs of serious problems with her pregnancy, 

including decreased fetal movement, vaginal discharge, cramping, 

a "dropping feeling" in her abdomen, a "bulging sensation" on her 

right side, and, later, vaginal bleeding. Lech also stated that, 

because of these symptoms, she repeatedly requested to go to the 

hospital. And yet, she maintained, WCC medical staff either 

belittled or ignored her symptoms. WCC medical staff, by contrast, 
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denied that Lech reported any pregnancy-related symptoms other 

than those contained in the medical notes for each of Lech's 

visits -- which report either no pregnancy-related symptoms at all 

or only a small subset of them.2 The staff further denied that 

Lech ever asked them to send her to the hospital.

Eventually, on January 1, 2014, Lech was transported to 

the hospital. That night, she had told Natalie Cruz, a 

correctional officer at WCC, and a nurse on staff that she was 

experiencing vaginal bleeding; Lech testified that she had also 

told them she believed she was going into labor. The nurse 

contacted the on-call certified nurse midwife, who directed that 

Lech should be sent to the hospital.

Lech arrived at the hospital on the morning of January 

2, 2014. There, she was told that her baby had passed away. 

Physicians diagnosed her with a suspected placental abruption, a 

condition in which the placenta separates from the uterus, 

depriving the fetus of oxygen. Lech had a C-section later that 

day.

2 Specifically, defendants agree that Lech reported decreased 

fetal movement once, on December 23, 2013, vaginal discharge once, 

on December 30, 2013, and some vaginal bleeding and cramping on 

January 1, 2014, as the providers' medical records document, but 

they deny that Lech reported any other pregnancy-related symptoms.
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B. Legal Proceedings

Lech filed this action in 2017, naming as defendants 

several healthcare providers and correctional personnel at WCC 

with whom she interacted in the days before she learned of her 

stillbirth, as well as their employers. The defendants included 

six nurses, two correctional officers, and the assistant 

superintendent at WCC; the Hampden County Sheriff's Department, 

which employs those staff; and the Hampden County Sheriff 

(collectively, "the Hampden County defendants"). They also 

included Dr. Dorothea von Goeler, an internal medicine physician 

who provides medical care at WCC as an independent contractor, and 

her employer, Baystate Medical Practices, Inc. (collectively, "von 

Goeler"). In her complaint, Lech alleged that defendants 

disregarded her concerns about her pregnancy and denied her 

repeated requests to go to the hospital, which resulted in her 

baby's death. She brought Eighth Amendment claims based on 

defendants' deliberate indifference to her serious medical needs

and Massachusetts state-law claims of deliberate indifference, 

negligence, medical malpractice, and intentional infliction of 

emotional distress (IIED). The parties agreed to have a magistrate 

judge conduct all proceedings.3

3 We refer to the magistrate judge as the district court 

throughout this opinion.
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The district court resolved some of Lech's claims at the 

summary-judgment stage. As relevant here, it found that Natalie 

Cruz, whom Lech told that she needed medical care on January 1, 

2014, was entitled to summary judgment on Lech's deliberate 

indifference and IIED claims against her.

Most of Lech's other claims proceeded to a jury trial, 

which was held over 17 days. The fact witnesses included Lech,

members of the medical and correctional staff at WCC, Lech's 

mother, and Lech's close friend, Alfred Zygmont, who had visited 

her at the facility twice during the critical time period. Both 

parties also offered expert testimony, which primarily focused on 

the timing and cause of Lech's stillbirth and whether the medical 

staff's treatment as documented in their medical notes complied 

with the standard of care.

Throughout trial, the defendants all agreed on one

central theory of the case: that Lech never told the facility's 

medical staff about most of the pregnancy-related concerns she 

claimed to have reported and that the medical providers' version 

of events, not Lech's, was credible.4 Defendants focused on this

theory in their opening statement, asserting that the jury would 

"hear two stories," the first of which was alleged in Lech's 

4 In addition, von Goeler offered a causation theory, claiming

that Lech's stillbirth occurred before she saw von Goeler on 

December 30, 2013, and was caused in part by Lech's underlying 

risk factors.
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complaint and in her testimony, and the second of which was told 

by medical providers, their medical records, and "Lech's own 

recorded phone calls." As the defense framed the case, the true 

story of what transpired "is told not by what [Lech] says but what 

she doesn't say."

Recorded phone calls that Lech made to her family and 

then-boyfriend while at WCC took center stage in the defense.5 

Defendants used the contents of the calls in two key ways. First, 

they argued that Lech's calls undercut her own testimony because 

"what [the jury] w[ould not] hear" in those calls was Lech stating

that she "th[ought] she need[ed] to go to the hospital" or "that 

[she] ha[d] asked the medical providers to send her to the hospital 

and they ha[d] refused." Thus, defendants maintained, Lech's 

failure to mention her symptoms or appointments with WCC medical 

staff during the calls "contradict[ed] the story . . . Lech [was]

trying to tell [the jury] through this lawsuit." Second, 

defendants used other portions of Lech's calls to demonstrate 

specific occasions on which she allegedly lied about topics 

unrelated to her health or medical care, contending that those 

lies showed her general character for untruthfulness.

At trial, the district court made two evidentiary 

rulings that Lech challenges on appeal, both of which implicate 

5 It appears that WCC records all phone calls made by

individuals incarcerated there.
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defendants' attacks on her credibility. During Lech's 

cross-examination, the district court allowed defendants to play 

recordings of Lech's phone calls to prove her purportedly 

untruthful character. It then excluded testimony from Zygmont 

about statements Lech made to him when he visited her at WCC on 

December 26 and 28, 2013. Based on Lech's proffer at trial, 

Zygmont would have corroborated her version of events by testifying

that, during those visits, Lech told him that she was concerned 

about her pregnancy, that she thought she needed to go to the 

hospital, and that WCC staff were not paying attention to her.

The jury ultimately found in favor of defendants on all 

claims. This timely appeal followed.

II. STANDARD OF REVIEW

We review preserved objections to the district court's 

evidentiary rulings for abuse of discretion. United States v. 

Kilmartin, 944 F.3d 315, 335 (1st Cir. 2019). An abuse of 

discretion occurs "when a material factor deserving significant 

weight is ignored, when an improper factor is relied upon, or when 

all proper and no improper factors are assessed, but the court 

makes a serious mistake in weighing them." Ruiz-Troche v. Pepsi 

Cola of P.R. Bottling Co., 161 F.3d 77, 83 (1st Cir. 1998) (quoting 

Foster v. Mydas Assocs., Inc., 943 F.2d 139, 143 (1st Cir. 1991)). 

An error of law qualifies as an abuse of discretion. Torres-Rivera

v. O'Neill-Cancel, 524 F.3d 331, 336 (1st Cir. 2008).
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If we determine that the district court erroneously 

admitted or excluded evidence, we then review that ruling for 

harmless error. Duval v. Dep't of Veterans Affs., 69 F.4th 37, 42 

(1st Cir. 2023) (quoting Gay v. Stonebridge Life Ins. Co., 660 

F.3d 58, 62 (1st Cir. 2011)). An error is harmless if it is 

"highly probable that [it] did not affect the outcome of the case." 

McDonough v. City of Quincy, 452 F.3d 8, 19-20 (1st Cir. 2006); 

see also Nieves-Villanueva v. Soto-Rivera, 133 F.3d 92, 102 (1st 

Cir. 1997) (explaining that in a civil case, the party claiming

error has the burden of demonstrating that the error was not 

harmless). To determine the probable impact of improperly admitted 

or excluded evidence on the jury verdict, we consider factors such 

as "[t]he centrality of the evidence, its prejudicial effect, 

whether it is cumulative, the use of the evidence by counsel, and 

the closeness of the case." Kowalski v. Gagne, 914 F.2d 299, 308 

(1st Cir. 1990) (quoting Lataille v. Ponte, 754 F.2d 33, 37 (1st 

Cir. 1985)); accord Nieves-Villanueva, 133 F.3d at 102. We weigh 

these factors "in the context of the case," as drawn "from the 

record as a whole." Nieves-Villanueva, 133 F.3d at 102 (citation 

omitted).

A different standard applies to the district court's 

grant of summary judgment to Cruz. We review that ruling de novo, 

drawing all reasonable inferences in favor of Lech, the nonmoving 

party. Fincher v. Town of Brookline, 26 F.4th 479, 485 (1st Cir. 
-12-

2022). "Summary judgment is proper if the movant," here Cruz, 

"shows that there is no genuine dispute as to any material fact 

and [she] is entitled to judgment as a matter of law." Id. (quoting 

Fed. R. Civ. P. 56(a)).

III. DISCUSSION

We begin by discussing Lech's challenge to the district 

court's evidentiary rulings. We ultimately determine that the 

district court abused its discretion both by permitting defendants 

to use Lech's recorded phone calls to attack her character for 

truthfulness and by excluding Zygmont's proffered testimony. At 

least one of these errors was not harmless as to the Hampden County 

defendants, whose defense hinged on the jury finding that Lech's 

version of events was not believable, and thus requires a new trial 

as to those defendants. We cannot say that the evidentiary rulings 

affected the outcome of the trial as to von Goeler, however, 

because she offered a causation defense that did not implicate 

Lech's credibility and instead relied on a concession by Lech's 

own expert: that it was possible Lech's stillbirth occurred before 

her appointment with von Goeler. After addressing the evidentiary 

rulings, we turn to the grant of summary judgment to Cruz on the 

deliberate indifference and IIED claims, which we affirm.
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A. Evidentiary Rulings

1. Use of Lech's Recorded Phone Calls

In her first challenge to the district court's 

evidentiary rulings, Lech argues that the district court erred 

when it allowed defendants to play portions of recorded calls she

made at WCC to prove her purportedly untruthful character. She 

asserts that this use of the recordings violated Federal Rule of 

Evidence 608(b).

We address the standard of review before turning to the 

substance of Lech's argument. The Hampden County defendants

contend that we must review Lech's claim for plain error because 

she did not object to the admission of the phone calls, which 

occurred during Lech's direct examination, but only to defendants'

inquiry into whether certain statements she made on the phone calls

were false. But Lech did specifically object below on Rule 608(b) 

grounds to defendants' use of the recorded calls for the purpose 

of proving her purportedly untruthful character, which is the exact 

issue she now raises. Lech thereby preserved her evidentiary 

objection, and we review her 608(b) claim for abuse of discretion.

Rule 608(b) "bars the credibility-related use of some 

extrinsic evidence." United States v. Winchenbach, 197 F.3d 548, 

557 (1st Cir. 1999). Under the rule, "extrinsic evidence is not 

admissible to prove specific instances of a witness's conduct in 

order to attack or support the witness's character for 
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truthfulness." Fed. R. Evid. 608(b). But the district court "may, 

on cross-examination, allow [such specific instances] to be 

inquired into if they are probative of [the witness's] character 

for truthfulness or untruthfulness." Id.; see also United States

v. Abel, 469 U.S. 45, 55 (1984).

At trial, defendants played portions of recorded phone 

calls Lech made to her family while she was at WCC. They then 

asked her whether specific statements she made in those recordings

unrelated to her medical care -- such as the basis for her 

probation violation, whether her then-boyfriend was living in a 

sober house, and her boyfriend's employment history -- were 

untruthful. Similarly, defendants played portions of recorded

calls Lech made to her then-boyfriend. They asked her to confirm 

that, in those recordings, she discussed participating in or

planning deceitful conduct unrelated to her medical care, such as 

lying to her family for her boyfriend, telling her boyfriend not 

to appear for an upcoming court date, and discussing how her 

boyfriend could obtain a false negative on a drug test.

The district court initially ruled that such use of the 

recorded calls violated Rule 608(b), but it invited defendants to 

file a motion on the issue. Defendants did so, arguing in part 

that the phone calls were not extrinsic because they already had 

been admitted into evidence, and that, even if the rule's

prohibition on the use of extrinsic evidence applied, defendants 
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were permitted on cross-examination to inquire into Lech's 

untruthful statements on the calls. The district court then 

reversed its earlier ruling and determined that "the specific 

instances of untruthfulness reflected in the phone calls" were 

admissible, although it did not explain its reasoning.

We conclude that the district court ran afoul of Rule 

608(b) when it allowed defendants to play the recordings before 

the jury. Defendants recognize on appeal, as they did below, that 

Lech's allegedly untruthful statements on the recordings were 

specific instances of her conduct and that they sought to use the 

recordings to attack Lech's character for truthfulness. 

Defendants argue, however, that the recordings were not extrinsic 

evidence because they were admitted and used during Lech's direct 

testimony and so are not covered by Rule 608(b).

But we have stated that "extrinsic evidence includes any 

evidence other than trial testimony." United States v. Balsam, 

203 F.3d 72, 87 n.18 (1st Cir. 2000); see also 4 Jack B. Weinstein 

& Margaret A. Berger, Weinstein's Federal Evidence § 608.20[1] 

(2023) ("Evidence is 'extrinsic' if offered through documents or 

other witnesses, rather than through cross-examination of the 

witness himself or herself."). Indeed, in Balsam, we held that 

taped recordings of jailhouse phone conversations were 

inadmissible under Rule 608(b) because "the tapes were just such 

nontestimonial evidence." 203 F.3d at 87 n.18; see also United 
-16-

States v. Sabean, 885 F.3d 27, 39 (1st Cir. 2018) (holding that

the district court properly excluded an audio recording of a 

witness's testimony in a previous case when the recording was 

offered to impeach the witness's truthful character, given that 

such use would "ru[n] headlong into Federal Rule of Evidence 

608(b)").6 Here, Lech's statements on the recordings were not 

developed in her trial testimony and therefore were extrinsic. 

And the fact that Lech's counsel used portions of the calls for 

one purpose -- to bolster her testimony on direct examination --

does not answer the question of whether defendants' use of 

6 The Hampden County defendants offer different definitions 

of extrinsic evidence and contend that the recordings do not 

qualify. But their arguments do not stand up to scrutiny. First, 

relying on United States v. Ofray-Campos, 534 F.3d 1, 18 (1st Cir. 

2008), defendants contend that extrinsic evidence is evidence 

other than that developed or introduced at trial. Ofray-Campos, 

however, did not involve Rule 608(b) and examined only whether a 

judge's response to a jury note during deliberations 

inappropriately exposed the jury to "extrinsic information," 

meaning "any outside influence," in violation of the defendant's 

Sixth Amendment rights. Ofray-Campos, 534 F.3d at 18-19 (quoting 

Patterson v. Colorado, 205 U.S. 454, 462 (1907)).

Second, defendants assert that the recordings were highly 

relevant to the litigation and that extrinsic evidence is evidence 

that is "'not relevant in the litigation to establish a fact of 

consequence,' i.e., evidence of a 'collateral matter.'" United 

States v. Boulerice, 325 F.3d 75, 82 n.5 (1st Cir. 2003) (quoting 

United States v. Andújar, 49 F.3d 16, 26 (1st Cir. 1995)). But

whether the recordings were "highly relevant" has no bearing on 

whether they are extrinsic. The recordings went beyond Lech's own 

testimony during her cross-examination and are therefore 

extrinsic. See id. (contrasting evidence offered through 

documents or another witness, which is extrinsic, and testimony 

elicited on the witness's own cross-examination, which is not).
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different portions of the calls for a different purpose violated 

Rule 608(b). See Fed. R. Evid. 105 (explaining that evidence may 

be admissible for one purpose but not another).

Defendants offer several reasons for why it was 

permissible for them to play the recordings, but we find none 

persuasive. First, the Hampden County defendants contend that 

Lech's calls were admissible as statements of a party opponent. 

See Fed. R. Evid. 801(d)(2)(A). But that rule provides only that 

an opposing party's statements are not hearsay. Fed. R. Evid. 

801(d). It does not establish that the statements are admissible 

in violation of another rule. See Fed. R. Evid. 105.

Next, the Hampden County defendants argue that, on 

cross-examination, they were permitted to inquire into false 

statements Lech made on the recorded calls to demonstrate her 

allegedly untruthful character. Defendants are correct that Rule 

608(b) allows a party to ask a witness about a specific instance 

of past conduct if it is probative of the witness's character for 

truthfulness, with the understanding that the party is then "stuck" 

with the witness's answer. See United States v. A.S., 939 F.3d 

1063, 1072 (10th Cir. 2019) (quoting Seifert v. Unified Gov't, 779 

F.3d 1141, 1154 (10th Cir. 2015)); see also Fed. R. Evid. 608(b); 

Abel, 469 U.S. at 55. So, when defendants asked Lech on 

cross-examination whether she lied during the phone calls, the 

rule did not render Lech's answers inadmissible. But the rule did
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prohibit defendants from playing the recordings to introduce 

specific instances of her past conduct for the purpose of showing 

her alleged penchant for untruthfulness. See United States v. 

Mateos-Sanchez, 864 F.2d 232, 237 (1st Cir. 1988) (distinguishing 

between inquiry on cross-examination to demonstrate untruthful 

character, which is permissible, and presentation of physical 

evidence, which is not); Sabean, 885 F.3d at 39 (determining that 

the district court properly permitted the defendant to crossexamine a witness about testimony she had given in a prior case to 

impeach her general truthfulness while excluding an audiotape of 

that testimony). And that is what defendants did here. They told

the district court they sought to play the calls because specific 

statements on the recordings were either false on their face or 

demonstrated that Lech lied on other occasions, all of which was 

"highly probative of her character for untruthfulness."

As their last line of defense, the Hampden County 

defendants contend that, even if the phone calls were extrinsic 

evidence, they were admissible because Rule 608(b) does not bar 

extrinsic evidence unless "the sole purpose" for offering the 

evidence was to prove a witness's character for untruthfulness. 

See Fed. R. Evid. 608(b) advisory committee's note to 2003 

amendment. They note that both parties used Lech's calls for 

different purposes throughout trial. But defendants fail to offer 

important context for the authority upon which they rely. A 
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previous version of Rule 608(b) stated that extrinsic evidence 

could not be used to prove specific instances of conduct for the 

purpose of "attacking or supporting the witness' credibility." 

United States v. Epstein, 426 F.3d 431, 439 n.4 (1st Cir. 2005). 

The rule was later amended to substitute "character for 

truthfulness" for "credibility." Id. The advisory committee's

note explains that the amendment intended to "clarify that the 

absolute prohibition on extrinsic evidence applies only when the 

sole reason for proffering that evidence is to attack or support 

the witness' character for truthfulness," thereby "leav[ing] the 

admissibility of extrinsic evidence offered for other grounds of 

impeachment (such as contradiction, prior inconsistent statement, 

bias and mental capacity)" to other rules. Fed. R. Evid. 608(b)

advisory committee's note to 2003 amendment; see also United States

v. Delgado-Marrero, 744 F.3d 167, 179 (1st Cir. 2014) (explaining 

that the amendment sought to make clear that the rule "exclude[d]

extrinsic evidence of a witness's general propensity for honesty 

and truth, rather than . . . for other non-propensity purposes"). 

Critically, in defendants' own words, they sought to use the

recordings in the manner challenged here to demonstrate Lech's 

"character for untruthfulness." Accordingly, Rule 608(b) applies.

Finally, von Goeler recognizes that Rule 608(b), "read 

narrowly," would prohibit a party from using previously admitted 

exhibits when cross-examining a witness about allegedly untruthful 
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conduct. But she states that a narrow construction would have 

been inefficient here. She asserts that, because the recorded 

calls were already in evidence, it was more efficient for 

defendants to use the recordings to establish that Lech made the 

statements, rather than proceed through the more extended process 

of using the recording to refresh Lech's recollection or impeach 

her. But the issue here is not that defendants played the 

recordings simply to confirm that Lech made certain statements in 

her phone calls. Rather, it is that defendants played the 

recordings to prove that Lech had lied in the calls, with the 

ultimate aim of depicting her as habitually untruthful.

To summarize, we conclude that the district court abused 

its discretion when it allowed defendants to play the recordings 

of Lech's calls to prove she had lied in the past and impugn her 

truthful character, in violation of Rule 608(b). We next turn to

Lech's second evidentiary argument.

2. Exclusion of Zygmont's Testimony

Lech argues that the district court erred when it 

excluded testimony from her friend Alfred Zygmont about 

corroborating statements she made to him when he visited her at 

WCC. The parties agree that she preserved this objection, and 

that the abuse of discretion standard applies.

Below, Lech proffered that Zygmont would testify that, 

during his visits with her on December 26 and 28, 2013, "Lech 
-21-

complained WCC medical staff were not paying attention to her, she 

was experiencing decreased fetal movement, felt that something was 

wrong, and that she thought she needed to go to the hospital." 

Lech contends that those statements were admissible as prior 

consistent statements under Federal Rule of Evidence 

801(d)(1)(B)(i).

We have explained that under Federal Rule of Evidence 

801(d)(1)(B)(i), "a witness's prior statement is excluded from the 

rule against hearsay -- and thus may be admissible -- 'when (1) 

the declarant testifies at trial and is subject to 

cross-examination; (2) the prior statement is consistent with the 

declarant's trial testimony; and (3) the prior statement is offered 

to rebut an express or implied charge against the declarant of 

recent fabrication or improper influence or motive.'" United 

States v. Chiu, 36 F.4th 294, 300 (1st Cir. 2022) (quoting United 

States v. Jahagirdar, 466 F.3d 149, 155 (1st Cir. 2006)); see also

Fed. R. Evid. 801(d)(1)(B)(i).

In rejecting the proffer, the district court focused on 

the third element -- that Zygmont's testimony must be offered to 

rebut an express or implied charge of recent fabrication levied 

against Lech. It concluded that there was no such charge of 

fabrication because on cross-examination, defendants did not 

challenge Lech on whether she told the medical providers about all 

of her pregnancy-related symptoms or whether she asked those 
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providers to go to the hospital but was ignored. In the district 

court's view, therefore, Lech was offering impermissible 

bolstering testimony. On appeal, the parties also focus primarily 

on this third element.7 Accordingly, we turn to whether that 

element is satisfied here.

For this inquiry, we consider whether there is "some 

degree of fit between the alleged fabrication and the prior 

statement." Chiu, 36 F.4th at 301. To meet this standard, a 

charge of recent fabrication does not have to be "expressly made." 

United States v. Lozada-Rivera, 177 F.3d 98, 104 (1st Cir. 1999). 

But the person who seeks to introduce prior consistent statements, 

here Lech, must "point to specific questions" during the opposing

party's examination "that suggest recent fabrication or bias." 

Id. "Merely appealing to credibility as a live issue will not do 

the trick." Id.; see also Chiu, 36 F.4th at 300–01 (examining 

whether the government challenged the defendant on the "specific 

subject of the rehabilitative, prior consistent statement" or 

launched only a generalized attack on his credibility); United 

States v. Wilkerson, 411 F.3d 1, 5 (1st Cir. 2005) (explaining 

7 The Hampden County defendants concede that the first two 

elements set forth in Chiu are satisfied, although von Goeler 

briefly suggests that Zygmont's testimony would not have been 

consistent with Lech's. She contends that Zygmont would have 

testified as to broad, generalized statements that Lech made to 

him, but that Lech's testimony was about specific medical issues 

she experienced. We reject this argument based on our review of 

the proffer and the record.
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that prior consistent statements "must at least have some rebutting 

force beyond the mere fact that the witness has repeated on a prior 

occasion a statement consistent with [their] trial testimony" 

(internal quotation marks omitted) (quoting United States v. 

Simonelli, 237 F.3d 19, 27 (1st Cir. 2001))).

Lech easily satisfies that standard here. The trial 

record makes abundantly clear that defendants accused Lech of 

fabrication and that there is at least "some degree of fit" between 

Zygmont's testimony and the charge of fabrication it was offered 

to rebut. Chiu, 36 F.4th at 301. One of the central theories 

pursued by all defendants at trial was that the jury should believe 

the medical providers and their medical records, not Lech. As 

defendants recognized at oral argument before us, that theory

required the jury to reject Lech's contrary testimony that she 

raised all her pregnancy-related concerns to the medical staff, 

who ignored her. Indeed, throughout trial, defendants compared 

(i) what Lech stated she told medical providers with (ii) what she 

discussed on her recorded calls with family members and her 

then-boyfriend to imply that her testimony about experiencing 

symptoms, reporting all those symptoms to medical staff, and 

requesting to go to the hospital was all fabricated.

For instance, during their cross-examination of Lech, 

defendants confirmed that she had just testified that she reported 

pregnancy-related symptoms to medical staff. They then played 
-24-

recorded calls Lech had with her mother, brother, and 

then-boyfriend on the same day as those appointments and asked her 

to confirm that during those calls she did not mention anything 

about her pregnancy, the appointments, or the health of her baby, 

or that she needed to go to the hospital and medical staff refused 

to send her.

The implication of defendants' cross-examination was 

that Lech fabricated her testimony that she communicated concerns 

about her pregnancy to WCC medical staff. Defendants argued that 

the omissions in Lech's calls to family members made it unlikely 

that Lech experienced her symptoms at all or shared her symptoms 

with anyone, providers included, and more likely that she never 

told providers what she claimed.

In their opening statement, defendants confirmed that 

the purpose of using the recorded calls was to undermine Lech's 

testimony that she told providers her concerns about her pregnancy. 

So, too, in their closing argument, when defendants contended that 

Lech's pleas to the medical providers "are not supported by the 

medical records, and . . . are not supported by the recorded phone 

calls for a simple reason: Because they did not happen." In fact, 

at closing, defendants implored the jury, "[i]f [they were] having 

any doubt as to the v[e]racity of [defendants'] story," to 

"[d]ecide . . . whether [Lech's] phone conversations, the topics, 

the tone . . . are consistent with a woman who feels that her baby 
-25-

is dying within her, who has been repeatedly begging to be sent to 

the hospital, and who has repeatedly been refused by every single 

medical provider she encountered over that 10-day period." To 

believe Lech, defendants asserted, the jury had to believe that, 

"in spite of [her] pressing concerns that she told [the jury] 

about, it is entirely reasonable that [she] made almost no mention 

of them" in her recorded conversations.

Zygmont's testimony would have rebutted defendants' 

theory that Lech fabricated either experiencing certain symptoms 

or sharing them with others (or both). As to Lech's symptoms, 

Zygmont would have testified that, when he visited Lech at WCC 

twice during the critical time period, Lech told him that she "was 

experiencing decreased fetal movement, felt that something was 

wrong, and that she thought she needed to go to the hospital." As 

to her communications with the providers, he would have testified 

that "Lech complained WCC medical staff were not paying attention 

to her." Lech contended that his testimony would have helped to 

establish that she was concerned about her pregnancy, communicated 

those concerns to her close friend, and felt that medical staff 

were dismissive of her. It also would have shown that Lech 

specifically mentioned experiencing decreased fetal movement 

multiple times and not just once. Further, a jury could have 

viewed Zygmont's testimony that Lech told him about her symptoms 

and thought she needed to go to the hospital as making it more 
-26-

likely that Lech reported those symptoms to WCC staff and asked 

them to send her to the hospital. Accordingly, Zygmont's testimony 

would not have rebutted merely a broad attack on Lech's 

credibility. See Lozada-Rivera, 177 F.3d at 104; Chiu, 36 F.4th

at 300–01. Rather, it would have rebutted the specific charge 

that she fabricated either her symptoms or her communication of 

those symptoms to providers. Chiu, 36 F.4th at 301.

Moreover, Zygmont's proposed testimony would not have 

been impermissible bolstering testimony. See Wilkerson, 411 F.3d 

at 5; Simonelli, 237 F.3d at 28. Its "rebutting force" was that, 

although Lech did not mention to some people in her life the 

concerns she said she raised to the providers, Lech told the one 

person who visited her while she was incarcerated at WCC that she 

was worried about her pregnancy. Wilkerson, 411 F.3d at 5

(citation omitted).

For these reasons, Zygmont's testimony was admissible as 

evidence of Lech's prior consistent statements under Rule 

801(d)(1)(B)(i). See United States v. Washington, 434 F.3d 7, 15 

(1st Cir. 2006) (finding that a prior consistent statement was 

properly admitted when the opposing party "had suggested that the 

entirety of [the declarant's] testimony on direct examination had 

been false," including testimony about the specific subject of the 

prior consistent statement (emphasis omitted)). The district 

court abused its discretion when it excluded his testimony. Its 
-27-

determination that there was no charge of fabrication for that 

testimony to rebut simply does not reflect what occurred at trial.

Having found that the district court abused its 

discretion by allowing defendants to play recordings of Lech's 

calls to assail her character for truthfulness and by excluding 

Zygmont's testimony, we proceed to a harmless-error analysis.

3. Harmless-Error Inquiry

The district court's erroneous exclusion of Zygmont's 

testimony was not harmless as to the Hampden County defendants. 

The theme that they revisited at opening, at closing, in their 

cross-examination of Lech, and with virtually every fact witness 

was that the medical providers' account, not Lech's, was 

believable. In pursuit of that strategy, defendants emphasized 

that Lech's alleged silence about her pregnancy-related concerns 

on her recorded calls and her lack of corroborating evidence backed 

up their version of events and disproved Lech's. Indeed, 

defendants ended their closing argument by stating that "[t]he 

conflicts between . . . [Lech's] story and virtually all of the 

other evidence in this case" was "why such an important part" of 

the jury's job "is deciding who is telling the truth, whom do you 

believe is credible." In a similar manner, they contrasted Lech's 

testimony with that of the medical providers, which was "entirely 

corroborated" by the medical records and "all of the percipient 

witnesses."
-28-

Given that the case centered on a credibility battle 

between Lech and the medical providers, it cannot be harmless error 

to exclude corroborating testimony from the sole person who visited 

Lech at WCC during the relevant time period. Zygmont's testimony 

would have buttressed Lech's account, rebutted the argument that 

she never told anyone about all her symptoms, and made it more 

likely that she either discussed her concerns with providers or 

requested to be sent to the hospital.8 See United States v. Awon, 

135 F.3d 96, 101 (1st Cir. 1998), abrogated on other grounds by

United States v. Piper, 298 F.3d 47 (1st Cir. 2002) (explaining 

that the impact of prior consistent statements is that they 

corroborate other evidence).

The district court's ruling excluded exactly the type of 

evidence that defendants emphasized was missing from Lech's case. 

It also excluded the only corroborating account from another 

witness that Lech sought to introduce. And because Zygmont's 

testimony was her sole corroborating account, it was not 

cumulative. Its value is precisely that it came from someone other 

than Lech.

8 We note that the district court characterized Zygmont's 

testimony differently than the way that testimony was described in 

the proffer. The district court understood that Zygmont would 

testify that Lech told him she had relayed to medical staff her 

various pregnancy-related symptoms and asked medical staff to go 

to the hospital but was ignored. Zygmont's testimony would have 

had even more rebutting force -- and its exclusion would therefore 

have been more harmful -- when characterized in such a way.
-29-

Moreover, as Lech notes, the district court permitted 

Zygmont to testify about his visits but only as to what he observed 

about Lech, not what she stated to him. The exclusion of Lech's 

statements to Zygmont could have implied to the jury that Lech did 

not mention any issues with her pregnancy to him either. The jury 

therefore could have been misled into thinking that what was 

actually corroborating evidence undermined Lech's account.

To be sure, the accounts of seven medical providers and 

their notes conflicted with Lech's version of events. In addition, 

Lech had to contend with defendants' argument that it was 

inherently unlikely that providers ignored and failed to document 

some of Lech's pregnancy-related symptoms, while simultaneously 

responding to and documenting other symptoms that Lech agreed she 

reported. However, that backdrop only reinforces that the case 

hinged on competing credibility assessments. Lech's inability to 

offset defendants' account with evidence of her own is, in part, 

what helped defendants argue her account was false. And although 

Zygmont's testimony would not have changed Lech's omissions on the 

recorded calls, Lech explained at trial that she did not speak to 

her then-boyfriend or family members about her health because her 

boyfriend was not sympathetic and her family was dismissive of her 

concerns. Zygmont, by contrast, was the only person who visited 

her at WCC. The jury, if it had Zygmont's testimony, could have 

found that Lech was more likely to have confided in Zygmont about 
-30-

her medical issues than the people she spoke with on the phone. 

Accordingly, his testimony was particularly important to rebutting 

the attacks on Lech's credibility.

Indeed, the exclusion of Zygmont's testimony is 

especially harmful when we consider it alongside defendants' use 

of the recorded calls to show Lech's alleged penchant for 

untruthfulness. We agree with Lech that, as a practical matter, 

it is necessary to evaluate the evidentiary rulings in combination. 

The jury would have reviewed the trial evidence holistically and 

could have weighed together -- and was encouraged by defendants to 

weigh together -- the evidence of Lech's alleged untruthfulness 

and the presence or absence of corroborating evidence for each 

side's version of events. The district court rejected Lech's 

proffer after defendants had spent part of their cross-examination 

attempting to show that Lech had a propensity to lie. With that 

ruling, Lech was deprived of the opportunity to introduce Zygmont's 

testimony to bolster her credibility, rebut the claim that she 

fabricated her account, and challenge defendants' account. At the 

same time, defendants were allowed to use statements unrelated to 

her medical care to show her alleged character for untruthfulness 

and to shore up their version of events. The two errors are 

mutually reinforcing.

Finally, Zygmont's testimony would have been relevant to 

Lech's contention that defendants unjustifiably delayed her access 
-31-

to medical care. A jury could have found that his testimony helped 

show that Lech consistently noted decreased fetal movement over a 

period of days and that, as of December 26 and 28, she believed 

she needed to go to the hospital, but WCC medical staff did not 

send her there until the morning of January 2.

In considering the centrality of Zygmont's testimony to 

the trial and the prejudicial effect of its exclusion, see

Nieves-Villanueva, 133 F.3d at 102, we conclude that it is not 

"highly probable that the error did not affect the outcome of the 

case" against the Hampden County defendants. McDonough, 452 F.3d 

at 19-20.9 Because we determine that the exclusion of Zygmont's 

testimony was not harmless as to the Hampden County defendants and 

vacate the jury verdict as to those defendants on that ground, we 

need not determine whether the use of the recorded phone calls in 

violation of Rule 608(b) was also harmful.

4. Effect of the Evidentiary Rulings as to von Goeler

We reach a different conclusion about the impact of the 

evidentiary errors on the verdict as to von Goeler. Like the 

Hampden County defendants, von Goeler also attacked Lech's 

credibility. However, she offered an additional defense theory: 

9 Because we resolve Lech's claim on the ground that Zygmont's 

testimony was admissible as evidence of prior consistent 

statements and its exclusion was harmful, we need not address 

Lech's additional argument that the testimony was also admissible 

as evidence of her then-existing condition under Rule 803(3).
-32-

that Lech's stillbirth had already happened by the time von Goeler

saw Lech on December 30, 2013. She presented that theory at 

opening, in closing, and through expert testimony. This theory

relied on von Goeler's own expert, who estimated that Lech's 

placental abruption occurred one week before Lech's C-section on 

January 2, 2014, or on approximately December 26, 2013. But it 

also relied on a concession by Lech's expert, who testified that 

it was "not likely" but "possible" that the placental abruption 

occurred 72 hours before the C-section. Under that timeline, 

Lech's stillbirth would have occurred before Lech's December 30

appointment with von Goeler that formed the basis of her claims. 

Thus, if the jury credited Lech's own expert, it could have found

that, even under Lech's version of events, von Goeler's actions 

did not cause Lech to lose her baby. That lack of causation would 

have been fatal to Lech's claims against von Goeler. As the 

district court's jury instructions made clear, each claim --

deliberate indifference, medical malpractice, and IIED -- required 

Lech to prove by a preponderance of the evidence that von Goeler's 

conduct was a but-for cause of Lech's harm. 10 See

Nieves-Villanueva, 133 F.3d at 102 (considering jury instructions 

10 Although the loss of Lech's baby may not be the only 

relevant harm as to Lech's IIED claim against von Goeler, Lech 

offers no argument on appeal that von Goeler's actions caused her 

some type of other, independent emotional distress that is 

sufficient to sustain an IIED claim.
-33-

in assessing the centrality of the evidence and any prejudicial 

effect on the jury's decision).

Although the parties did not discuss von Goeler's

causation theory as part of their harmless-error arguments on 

appeal, we may affirm the judgment on any ground apparent in the 

record. United States v. George, 886 F.3d 31, 39 (1st Cir. 2018). 

Given the evidence supporting von Goeler's theory, which was the 

only defense theory that did not implicate Lech's credibility, the 

exclusion of Zygmont's testimony "cannot reasonably be understood 

as the pivotal evidence that tipped the verdict in favor of [von 

Goeler]." Gay, 660 F.3d at 64. Because we "cannot say that the 

[district court's evidentiary ruling] affected the outcome of the 

trial" as to von Goeler, we find that error harmless as to her. 

Nieves-Villanueva, 133 F.3d at 102.

B. Summary Judgment

Next, we address Lech's argument that the district court 

should not have granted summary judgment to correctional officer 

Natalie Cruz on the deliberate indifference and IIED claims against 

her. We first address a threshold issue before turning to the 

relevant facts and legal standard.

Defendants argue that, even if the district court erred 

by granting summary judgment to Cruz on the deliberate indifference 

and IIED claims, any error was harmless given that the jury found 

that Cruz was not liable for negligence. We have declined to 
-34-

"reenter the morass" of summary judgment when it is "perfectly 

clear that, even if a plaintiff's claim should not have been 

dismissed[,] . . . any such mistake was harmless, given the jury's 

verdict in the defendant's favor on other claims addressed to the 

very same factual circumstances." In re Nexium (Esomeprazole) 

Antitrust Litig., 842 F.3d 34, 62 (1st Cir. 2016) (cleaned up)

(quoting Fite v. Dig. Equip. Corp., 232 F.3d 3, 6 (1st Cir. 2000)). 

Because we have determined that one of the evidentiary rulings 

discussed above affected the jury verdict, it is not "perfectly 

clear" that the verdict on the negligence claim renders the grant 

of summary judgment to Cruz on the deliberate indifference and 

IIED claims harmless. Id. Accordingly, we proceed to evaluate de 

novo the merits of the district court's entry of summary judgment. 

We begin by setting forth the facts related to the motion in the 

light most favorable to Lech consistent with record support. 

Johnson v. Johnson, 23 F.4th 136, 139 (1st Cir. 2022).

Lech interacted with Cruz the night before she was 

eventually transported to the hospital, where she was told her 

baby had passed away. At around 10 p.m. on January 1, 2014, Lech

stood up to have her identification bracelet scanned as part of 

the facility's evening count. Lech felt a "gushing sensation" and 

a "wetness," in addition to abdominal cramping and bulging. She 

noticed that she was having vaginal bleeding and that her clothes 

were stained and wet. Lech used the intercom in her cell to call 
-35-

the correctional officers' station, and Cruz answered. Cruz, who 

had received first-responder training as part of her job as a 

correctional officer, knew that Lech was pregnant both because it 

was clear to Cruz from Lech's appearance and because a list of 

prisoner information that Cruz possessed noted Lech's pregnancy. 

When she called Cruz, Lech told Cruz that her water had broken, 

that she believed she was in labor, and that she "need[ed] to go 

to medical or [she] need[ed] to go to the hospital."

WCC correctional officers like Cruz have two options for 

responding to inmates' medical needs: (1) they can "call medical 

[staff] and let them know the inmate is requesting medical," in 

which case the individual will be sent from their cell to the 

medical unit if the medical staff deems it necessary, or (2) they 

can "call a medical emergency via the radio," in which case medical 

staff will go to the individual's cell immediately to assess the 

individual. In responding to Lech, Cruz used the first option. 

Cruz told Lech that everything was fine, and that she would contact 

medical staff after finishing her count. After Cruz finished the 

count, which takes between two-and-a-half and three minutes to 

complete, and at some point between 10 p.m. and 10:19 p.m., Cruz

called WCC medical staff. After speaking with medical staff, Cruz 

called Lech on the intercom and told her that medical staff wanted 

to know how serious her symptoms were and if she could wait until 

the morning to be seen. Lech told Cruz "why" she needed to see 
-36-

medical, and her roommate shouted through the intercom that Lech 

"need[ed] to go [to] medical" and that "[Lech's] water broke." 

Cruz then spoke with the medical staff again, and they directed 

Cruz to send Lech to the medical unit. Cruz did so, and Lech was 

scanned out of the housing unit on her way to medical at 10:19 

p.m. -- about twenty minutes after she first called Cruz. Lech 

walked to the medical unit with another WCC staff member.

In granting summary judgment to Cruz, the district court 

determined that "[t]he twenty−minute delay in transferring [Lech] 

from her cell to the medical unit while she was bleeding may have 

been negligence on Cruz's part, but it was not deliberate 

indifference." It also held that "[b]ecause the bar for IIED

liability may be as high as the standard for a finding of 

deliberate indifference," Lech failed to show that Cruz's delay

rose to the level of intentional infliction of emotional distress

under Massachusetts law. We address the deliberate indifference 

and the IIED claim in turn.

1. Deliberate Indifference Claim

Prison officials violate the Eighth Amendment when they 

act with deliberate indifference to a prisoner's serious medical 

needs. Estelle v. Gamble, 429 U.S. 97, 104 (1976). To establish

an Eighth Amendment violation, a prisoner must satisfy both an 

objective element, which requires proof of a serious medical need, 

and a subjective element, which requires a showing that a prison 
-37-

official had a "sufficiently culpable state of mind" such that 

they were deliberately indifferent to that need. Leite v. 

Bergeron, 911 F.3d 47, 52 (1st Cir. 2018) (quoting Farmer v. 

Brennan, 511 U.S. 825, 834 (1994)).

The district court concluded that Lech had a serious 

medical need, and defendants do not contest that conclusion. We 

agree that Lech's medical needs were sufficiently serious at the 

time she interacted with Cruz to satisfy the objective element. 

"A medical need is sufficiently serious if it 'has been diagnosed 

by a physician as mandating treatment,' or is 'so obvious that 

even a lay person would easily recognize the necessity for a 

doctor's attention.'" Sosa v. Mass. Dep't of Corr., 80 F.4th 15, 

27 (1st Cir. 2023) (quoting Zingg v. Groblewski, 907 F.3d 630, 635 

(1st Cir. 2018)). On the evening of January 1, 2014, Lech had 

vaginal bleeding and had reported that her water broke and that 

she was in labor. Those symptoms are obvious enough that a 

layperson presented with them would recognize that Lech needed 

medical attention. Accordingly, the open issue is whether Lech

has produced enough evidence for a jury to conclude that Cruz was 

deliberately indifferent.

Prison officials are deliberately indifferent when they

"know[] of and disregard[] an excessive risk to inmate health or 

safety." Farmer, 511 U.S. at 836–37. To meet this standard, 

"prison officials must either deny needed medical treatment in 
-38-

order to punish the inmate, or display wanton or criminal 

recklessness in the treatment afforded." Sosa, 80 F.4th at 27

(internal quotation marks omitted) (quoting Zingg, 907 F.3d at

635). That is, deliberate indifference may take the form of 

"'wanton' decisions to deny or delay care where the action is 

recklessness, 'not in the tort law sense but in the appreciably 

stricter criminal-law sense, requiring actual knowledge of 

impending harm, easily preventable.'" Watson v. Caton, 984 F.2d 

537, 540 (1st Cir. 1993) (citations omitted). It is that form of 

deliberate indifference that Lech argues a jury could find here. 

Thus, to survive summary judgment, she must present enough evidence 

for a factfinder to conclude that, in taking about twenty minutes 

to transfer Lech to the medical unit, Cruz acted with "wanton 

disregard" for Lech's serious medical needs -- that is, Cruz knew 

Lech faced a substantial risk of serious harm and yet failed to 

take reasonable measures to prevent it. Zingg, 907 F.3d at 635.

On the particular facts here, given Lech's own framing 

of her request, what Cruz knew at the time, and Cruz's multiple 

calls to Lech and medical staff within the twenty-minute period, 

we conclude that the district court did not err in granting summary 

judgment to Cruz. Lech herself asked Cruz to send her to the 

medical unit or to the hospital. After finishing her count, Cruz 

responded to Lech's request by calling the medical unit and went 

back and forth with the medical unit and Lech. Critically, no 
-39-

evidence indicates that Cruz knew Lech had a high-risk pregnancy. 

See Burnette v. Taylor, 533 F.3d 1325, 1331 (11th Cir. 2008)

(explaining that each defendant's subjective awareness of a risk 

of harm must be assessed individually). The evidence shows only 

that Cruz knew Lech's water had broken and Lech believed she was 

in labor. Within that context, neither Cruz's completion of all 

the steps needed to send Lech to the medical unit within twenty 

minutes of Lech's request nor Cruz's decision to call the medical 

unit, as opposed to using the radio to announce a medical 

emergency, is sufficient to support a finding that Cruz wantonly 

delayed care.

To be sure, "short[] delays" in providing medical care 

"may . . . constitute a constitutional violation if injuries are 

sufficiently serious." Youmans v. Gagnon, 626 F.3d 557, 564 (11th 

Cir. 2010). As Lech points out, in other cases, courts have found 

sufficient evidence to permit a finding of deliberate indifference

by prison officials when medical care was delayed for fewer than 

twenty minutes. But cases with shorter or comparable delays 

involved prison officials' knowledge of readily apparent lifethreatening injuries. See Beauford v. Mesa County, 35 F.4th 1248, 

1267 (10th Cir. 2022) (finding that waiting ten minutes to seek 

medical assistance when prison official was not sure if prisoner 

was breathing may constitute deliberate indifference); Bradich ex 

rel. Est. of Bradich v. City of Chicago, 413 F.3d 688, 691-92 (7th 
-40-

Cir. 2005) (same when three prison officials waited ten minutes to 

seek help after prisoner's attempted hanging and in that time 

provided unhelpful assistance); Bozeman v. Orum, 422 F.3d 1265, 

1273 (11th Cir. 2005), abrogated on other grounds by Kingsley v. 

Hendrickson, 576 U.S. 389 (2015) (same when officers knew prisoner 

was either unconscious or not breathing (or both) and failed to 

summon help for fourteen minutes); Tlamka v. Serrell, 244 F.3d 

628, 632–35 (8th Cir. 2001) (same when correctional officers forced

prisoners who were providing CPR to another prisoner who had 

suffered a heart attack to stop and then failed to approach the 

prisoner or provide CPR for a period of up to ten minutes). As we 

noted above, because Lech did not dispute that Cruz was unaware of 

her high-risk pregnancy, no such readily apparent life-threatening 

injury was presented here.

Relying on Giroux v. Somerset County, 178 F.3d 28 (1st 

Cir. 1999) and Goebert v. Lee County, 510 F.3d 1312 (11th Cir. 

2007), Lech also argues that Cruz's failure to enter her cell and 

investigate her condition is enough to support her deliberate 

indifference claim. But, again, the defendants' conduct in those 

cases is different than Cruz's conduct. In Giroux, we explained 

that the evidence showed a correctional-officer defendant was 

"aware of a high probability that [a prisoner] was vulnerable to 

attack from another inmate but took no action despite that 

awareness." 178 F.3d at 33. And in Goebert, a jail official 
-41-

failed to act in response to a pregnant woman's complaint that she 

had been leaking fluid for more than nine days for no reason other 

than that he "automatically disbelieve[d] all inmate statements 

about medical care." 510 F.3d at 1316–19, 1327–29. Here, by 

contrast, Cruz completed the steps to arrange for medical 

assistance for Lech within twenty minutes of Lech's request.

We therefore affirm the district court's grant of 

summary judgment to Cruz on the deliberate indifference claim.

2. IIED Claim

We must next determine whether the district court

correctly ruled that Cruz's conduct failed to rise to the level 

required for an IIED claim. "The standard for making a claim of 

intentional infliction of emotional distress is very high." Polay

v. McMahon, 10 N.E.3d 1122, 1128 (Mass. 2014) (citation omitted). 

To sustain an IIED claim under Massachusetts law, a plaintiff must 

show "(1) that [the defendant] intended, knew, or should have known 

that [their] conduct would cause emotional distress; (2) that the 

conduct was extreme and outrageous; (3) that the conduct caused 

emotional distress; and (4) that the emotional distress was 

severe." Id. Massachusetts courts have interpreted "extreme and 

outrageous conduct" to mean behavior that is "so outrageous in 

character, and so extreme in degree, as to go beyond all possible 

bounds of decency, and to be regarded as atrocious, and utterly 

intolerable in a civilized community." Roman v. Tr. of Tufts 
-42-

Coll., 964 N.E.2d 331, 341 (Mass. 2012) (quoting Foley v. Polaroid 

Corp., 508 N.E.2d 72, 82 (Mass. 1987)). In determining whether 

conduct rises to that level, a factfinder is entitled to "put as 

harsh a face on the actions of the [defendant] as the basic facts 

would reasonably allow." Richey v. Am. Auto. Ass'n, 406 N.E.2d 

675, 678 (Mass. 1980).

We determine that it was not error for the district court 

to conclude that Cruz's conduct fails to rise to the level of

extreme or outrageous. The fact that Cruz, who did not know that 

Lech had a high-risk pregnancy, engaged in all the steps to send 

Lech to medical within twenty minutes of Lech's request and did so 

rather than call a medical emergency via radio is insufficient to 

permit a jury to find that she engaged in conduct that exceeds 

"all possible bounds of decency" and is "utterly intolerable in a 

civilized community." Polay, 10 N.E.3d at 1128 (citation omitted).

We therefore affirm the district court's grant of 

summary judgment to Cruz on the IIED claim.

IV. CONCLUSION

For these reasons, we affirm in part and vacate and 

remand in part. The parties shall bear their own costs.