1 The Honorable Richard H. Kyle, United States District Judge for the

District of Minnesota, sitting by designation.

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

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No. 07-2921

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Susan Vaughn, 

Appellee,

v.

Christopher Gray, et al., 

Appellants.

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Appeal from the United States

District Court for the

Eastern District of Arkansas.

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Submitted: December 12, 2008

Filed: March 6, 2009

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Before LOKEN, Chief Judge, BEAM, Circuit Judge, and KYLE,1

 District Judge.

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KYLE, District Judge.

Appellee, Susan Vaughn, commenced this action under 42 U.S.C. § 1983,

contending that Appellants were deliberately indifferent to the serious medical

needs of her brother, Phil Blount, which resulted in his death. Appellants, several

officers and employees of the Greene County, Arkansas Sheriff’s Department,
2

 The Honorable James M. Moody, United States District Judge for the

Eastern District of Arkansas. 

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moved for summary judgment based on qualified immunity, which was denied by

the district court.2

 Appellants appeal and we affirm. 

I. BACKGROUND

Vaughn first brought an action against Greene County and Sheriff Dan

Langston in his individual capacity. The district court denied summary judgment

on the ground of qualified immunity for Sheriff Langston, but we reversed, finding

he was entitled to qualified immunity. Vaughn v. Greene County, 438 F.3d 845

(8th Cir. 2006). While the first action was on appeal, Vaughn filed a second

action, asserting the same Section 1983 claims against four additional officers and

employees of the Greene County Sheriff’s Department in their individual and

official capacities: Christopher L. Gray, David Wanner, Michael Johnson, and

Chris Hall The two actions were consolidated, and thereafter the four new

defendants moved for summary judgment on the ground of qualified immunity.

The motion was granted with respect to Chris Hall, but denied for the remaining

defendants. Vaughn v. Greene County, Nos. 2:03CV00070, 2:04CV00213, 2007

WL 2409581, at *3-5 (E.D. Ark. Aug. 10, 2007). 

In determining that the remaining defendants (hereinafter the “Appellants”)

were not entitled to qualified immunity, the district court relied upon the following

facts as first described by this Court: 

On December 23, 2001, Blount, a 46-year-old moderately obese man,

was arrested and taken to the Greene County Jail (Jail), where he was

incarcerated on a charge of first-degree sexual assault. During the

Jail's intake procedure, Blount completed a medical intake form,

indicating he had a history of mental illness, headaches,

epilepsy/seizures, ulcers, and kidney/bladder problems, but indicating

he did not have a history of heart problems or high or low blood
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pressure. Although Blount had no medications with him upon his

arrival at the Jail, Blount's mother, Carolyn Barber (Barber), later

brought Blount's medications, including an anti-depressant. Inmate

medication logs from the Jail, as well as written jailer statements,

indicate Blount received his anti-depressant medication from

December 24, 2001, until January 2, 2002, when the Jail ran out of the

medication for Blount's last two dosages on that day. According to

these records, Blount's new prescription did not arrive until January 4,

2002, but would not be administered until the next day's shift starting

at 6:00 a.m.

On January 4, 2002, jailer Chris Hall (Hall) spoke with Blount's

cellmate, who said Blount had been ingesting shampoo and engaging

in other odd behavior. Hall repeated this information to Jail Sergeant

Mark Harmon, who in turn informed the other jailers. Around 3:00

p.m., Blount was moved to an isolation cell to be monitored. At

approximately 10:30 or 11:00 p.m., jailer Chris Gray (Gray) observed

Blount vomiting in the isolation cell. Blount asked Gray for a nurse

because his stomach was bothering him. Gray asked Blount if he was

vomiting because of the shampoo he had ingested, but Blount did not

respond. Blount was not given the opportunity to see a nurse

following his request. During the night and early morning hours,

Blount and the other inmates were checked by Jail personnel about

once every hour.

On January 5, 2002, at about 5:15 a.m., jailer Michael Johnson

(Johnson) observed Blount pacing in his cell and repeatedly drinking

water and throwing up. Approximately thirty minutes later, at 5:50

a.m., Johnson went to Blount's cell to give him his medications and

observed Blount lying naked on the floor of his cell. Johnson and the

shift supervisor entered Blount's cell, found him unresponsive,

initiated CPR, and called for an ambulance. Blount was transported to

the hospital, where he was pronounced dead. An autopsy led to the

determination Blount died of natural causes: arteriosclerotic

cardiovascular disease, causing a heart attack that resulted in Blount's

death. Detectable amounts of Blount's anti-depressant medication

were found in Blount's system during his autopsy.
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 Vaughn argues that the Court lacks jurisdiction over this interlocutory appeal.

However, it is well settled that “[a] denial of summary judgment on the grounds of

qualified immunity . . . may be reviewed on interlocutory appeal.” Pace v. City of Des

Moines, 201 F.3d 1050, 1052 (8th Cir. 2000) (citing Mitchell v. Forsyth, 472 U.S.

511, 528 n.9 (1985)). 

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According to Barber, Blount called her numerous times on January 3

and 4, 2002, and stated he was nauseated and vomiting. Barber

attempted to contact Sheriff Langston to ask for someone to take

Blount to a doctor, but Barber was unable to reach the sheriff. Barber

later went to the Jail twice on January 4, told a Jail staff member

Blount was sick, and was told Blount was receiving his medications.

Additionally, Vaughn, Blount's sister, called the Jail before Blount's

death to tell the Jail staff he was sick. Vaughn also wrote and faxed a

letter to Sheriff Langston, informing him Blount had mental problems

and needed to be placed in a different facility.

Id. at *1-2 (quoting Vaughn, 438 F.3d at 847-48). 

While Appellants do not deny their knowledge of Blount’s repeated

vomiting over a seven-hour period and his request for medical assistance, they

contend that there is no evidence in the record of their deliberate indifference to

Blount’s medical needs, and therefore, they are entitled to qualified immunity.

II. ANALYSIS

We review de novo the denial of a motion for summary judgment based on

qualified immunity. Vaughn v. Ruoff, 253 F.3d 1124, 1127 (8th Cir. 2001).3

 Such

review “is limited to issues of law, and we will not review the merits of the case or

the sufficiency of the evidence.” Id. “However, the nonmoving party is still given

the benefit of all relevant inferences at the summary judgment stage, and if a

genuine dispute exists concerning predicate facts material to the qualified

immunity issue, the defendant is not entitled to summary judgment.” Plemmons v.

Roberts, 439 F.3d 818, 822 (8th Cir. 2006) (internal quotations and citations

omitted). 
4 The conditions of confinement for pre-trial detainees, such as Blount, are

analyzed under the Due Process Clause of the Fifth and Fourteenth Amendments, not

the Eighth Amendment. Johnson-El v. Schoemehl, 878 F.2d 1043, 1048 (8th Cir.

1989) (citing Bell v. Wolfish, 441 U.S. 520, 535 (1979)). Nevertheless, we have held

that courts should “apply the identical deliberate-indifference standard” for pre-trial

detainees and convicted criminals. Crow v. Montgomery, 403 F.3d 598, 601 (8th Cir.

2005). 

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In deciding whether an official is entitled to qualified immunity, the Court

asks two questions: “(1) whether . . . there was a deprivation of a constitutional

right; and, if so, (2) whether the right was clearly established at the time of the

deprivation such that a reasonable official would understand his conduct was

unlawful.” Vaughn, 438 F.3d at 850. In this case, Appellants argue only that

Vaughn has not established the deprivation of a constitutional right, and therefore,

we need not address whether that right was “clearly established.” 

 “Deliberate indifference” to a prisoner’s serious illness or injury constitutes

cruel and unusual punishment under the Eighth Amendment. Estelle v. Gamble,

429 U.S. 97, 104 (1976); Gregoire v. Class, 236 F.3d 413, 417 (8th Cir. 2000) (“It

is well established that the Eighth Amendment prohibition on cruel and unusual

punishment extends to protect prisoners from deliberate indifference to serious

medical needs.”).4

 “Deliberate indifference has both an objective and a subjective

component.” Butler v. Fletcher, 465 F.3d 340, 345 (8th Cir. 2006). The objective

component requires a plaintiff to demonstrate an objectively serious medical need.

Grayson v. Ross, 454 F.3d 802, 808-09 (8th Cir. 2006); Moore v. Jackson, 123

F.3d 1082, 1086 (8th Cir. 1997). The subjective component requires a plaintiff to

show that the defendant actually knew of, but deliberately disregarded, such need.

Grayson, 454 F.3d at 808-09; Moore, 123 F.3d at 1086. Appellants do not contest

the district court’s finding of an “objectively serious medical need,” and thus we

only address the subjective component of whether Appellants “deliberately

disregarded” such need. 
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 A prison official cannot be held liable for deliberately disregarding the serious

medical needs of an inmate without proof of his actual knowledge of that serious

medical need. Grayson, 454 F.3d at 808-09; Moore, 123 F.3d at 1086. However, the

Supreme Court has held that knowledge may be inferred when a risk is so obvious

that a reasonable person would recognize it. Farmer, 511 U.S. at 842. The fact that

this inference can be drawn using a “reasonable person” framework is not a new legal

standard and does not misstate the law of deliberate indifference, as Appellants

contend. 

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In order to demonstrate that a defendant actually knew of, but deliberately

disregarded, a serious medical need, the plaintiff must establish a “mental state

akin to criminal recklessness: disregarding a known risk to the inmate’s health.”

Gordon v. Frank, 454 F.3d 858, 862 (8th Cir. 2006). However, while a deliberateindifference claim requires the establishment of a defendant’s actual, subjective

knowledge, such knowledge can be demonstrated with circumstantial evidence.

See Farmer v. Brennan, 511 U.S. 825, 842 (1994) (“Whether a prison official had

the requisite knowledge . . . is a question of fact subject to demonstration in the

usual ways, including inference from circumstantial evidence.”). Indeed, a

factfinder may determine that a defendant was actually aware of a serious medical

need, but deliberately disregarded it, “from the very fact that the [medical need]

was obvious.” Id. Moreover, this Court has noted that the “[i]ntentional delay in

providing medical treatment shows deliberate disregard if a reasonable person

would know that the inmate requires medical attention.” Gordon, 454 F.3d at 862.5

No Appellant claims that he was unaware of the physical symptoms

displayed by Blount in the hours before his death. In fact, Appellants were aware

that Blount was vomiting throughout the night and requesting medical attention.

Rather, Appellants claim that they did not deliberately disregard Blount’s serious

medical need because they believed that his vomiting was caused by the ingestion

of shampoo, and thus, they did not actually “draw the inference” that Blount’s

vomiting constituted a serious medical need. See Farmer, 511 U.S. at 837. 
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It is true that “an official’s failure to alleviate a significant risk that he

should have perceived but did not, while no cause for commendation, cannot . . . be

condemned.” Id. at 838. Indeed, defendants “do not violate the Eighth

Amendment when, in the exercise of their professional judgment, they refuse to

implement a prisoner’s requested course of treatment.” Long v. Nix, 86 F.3d 761,

765 (8th Cir. 1996). Nevertheless, based on their knowledge of Blount’s medical

symptoms, coupled with his request for medical assistance, a reasonable jury could

determine that Appellants were actually aware that Blount needed medical

attention, but simply chose to do nothing about it. Appellants’ self-serving

contention that they did not have the requisite knowledge does not provide an

automatic bar to liability in light of the objective evidence to the contrary.

Appellants were aware that Blount was a 46-year-old, mentally ill,

moderately obese man with several medical conditions. Blount was behaving

strangely and vomiting throughout the night, and Appellants do not deny their

knowledge of Blount’s continual vomiting over a seven-hour period. Moreover,

there was a significant period of time between the alleged ingestion of shampoo

and the beginning of Blount’s vomiting. Blount allegedly ingested shampoo

during the day on January 4, and at 3:00 p.m., he was placed in isolation. It wasn’t

until 10:30 p.m. that night that Blount was first discovered to be vomiting. Thus, a

jury may reasonably infer from these facts that, despite Appellants’ contention,

they did not actually believe Blount’s vomiting to be insignificant or caused by the

ingestion of shampoo. 

In addition, Blount requested medical attention. The record indicates that

Appellants did nothing to address Blount’s request for care. No Appellant

informed a superior officer of Blount’s condition or did anything to assist Blount.

A reasonable jury could conclude that Appellants’ knowledge of Blount’s

symptoms and his request for medical assistance, coupled with Appellants’ failure

to take any responsive action, is sufficient to establish deliberate indifference. See
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 Appellants also argue that Vaughn’s claims should be dismissed because

“[t]his court has . . . routinely rejected prisoners’ claims where there is no cure or

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Hartsfield v. Colburn, 491 F.3d 394, 401 (8th Cir. 2007) (noting that an inference

of deliberate indifference is strengthened when “an inmate communicates his

distress directly . . . and prison officials fail to respond”).

This Court has affirmed the denial of summary judgment based on qualified

immunity when confronted with facts similar to those at issue here. In Plemmons,

an inmate told prison staff that he felt he was having a heart attack when he was

experiencing arm and chest pain, nausea, profuse sweating, and had experienced

heart attacks in the past. 439 F.3d at 824. The inmate was in fact having a heart

attack, but a jailhouse official did not immediately call for medical assistance,

believing the inmate to be having a panic attack. Id. The inmate made further

complaints, but was then forced to wait for an undue period of time before an

ambulance was called. Id. We held that these facts created a genuine issue as to

whether the defendants deliberately disregarded the serious medical condition of

the inmate. Id.

Appellants rely on Pagels v. Morrison, 335 F.3d 736 (8th Cir. 2003), and

Jackson v. Everett, 140 F.3d 1149 (8th Cir. 1998), to support reversal. In both

cases, prison officials received notes from inmates warning of a threat of inmate

violence that later materialized, resulting in inmate injury. However, the officials

were found not to be deliberately indifferent to a serious risk of harm to the

inmates because they had conducted investigations into the notes and determined

them to be unfounded and unreliable. Pagels, 335 F.3d at 740-42; Jackson, 140

F.3d at 1151-53. In contrast, Appellants here took no action to investigate, or

otherwise respond to, the objective medical symptoms of Blount or his request for

medical care throughout the seven-hour period that he was vomiting. A reasonable

jury might well conclude that such inaction by Appellants constituted deliberate

indifference.6
treatment for the alleged serious medical need.” While the record indicates that

Blount suffered from a heart condition, this does not mean that if given prompt

medical attention, such care could not have saved or prolonged his life.

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Finally, because the individual Appellants are not entitled to dismissal based

on qualified immunity, the claims against Greene County also may stand. 

III. CONCLUSION

For all the foregoing reasons, we affirm the district court’s denial of

summary judgment for Appellants based on qualified immunity.

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