[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

________________________

No. 15-12871

Non-Argument Calendar

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D.C. Docket No. 1:12-cv-01047-MHT-TFM

COURTNEY MCBRIDE, 

 Plaintiff - Appellee,

versus

HOUSTON COUNTY HEALTH CARE AUTHORITY,

d.b.a. Southeast Alabama Medical Center, et al.,

 Defendants,

MAMIE MCCORY, 

STEPHANIE JOHNSON, 

 Defendants - Appellants.

________________________

Appeal from the United States District Court

for the Middle District of Alabama

________________________

(September 30, 2016)

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Before JORDAN, JULIE CARNES and JILL PRYOR, Circuit Judges.

PER CURIAM: 

While detained in the City of Dothan Jail, Courtney D. McBride developed a 

painful, deteriorating skin condition. She contends that for more than four days, 

she was unable to eat or drink and her skin turned ashy, developed black splotches, 

and began to peel off. According to McBride, this condition, which led to a 

potentially lethal rash requiring treatment in the intensive care unit of a hospital, 

amounted to a serious medical need. She sued, among other defendants, two jail 

officers, Stephanie Johnson and Mamie McCory (the “officers”), alleging civil 

rights violations under 42 U.S.C. § 1983. Specifically, she alleged that the officers

were deliberately indifferent to her serious medical need in violation of the 

Fourteenth Amendment to the United States Constitution. The officers moved for 

summary judgment on qualified immunity grounds. Viewing the evidence in the 

light most favorable to McBride, the district court held that the officers were not 

entitled to qualified immunity. This interlocutory appeal followed.

Upon careful review, we affirm in part, reverse in part, and remand for 

further proceedings. McBride has amassed sufficient evidence to overcome 

Johnson’s assertion of qualified immunity, but the record does not support a 

finding that McCory was aware of McBride’s serious medical need. Thus,

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McBride cannot show that McCory violated a clearly established constitutional 

right, and McCory is entitled to qualified immunity.

I. BACKGROUND

We view the evidence and derive factual inferences therefrom in the light

most favorable to McBride as the non-movant on summary judgment. See Perez v. 

Suszczynski, 809 F.3d 1213, 1216 (11th Cir. 2016). So viewed, the record supports 

the following facts. 

On June 21, 2012, a municipal court ordered McBride to jail pending a 

domestic violence charge. While still in the courtroom, McBride suffered a 

psychological breakdown and was transported to the behavioral unit of Southeast 

Alabama Medical Center (“SAMC”),

1 where she remained for two weeks. There, 

Dr. Dinesh Karumanchi diagnosed McBride with, among other conditions, 

bipoloar disorder. He prescribed one 25mg tablet of Lamictal (the brand name for 

lamotrigine) twice a day. One of the potential side effects of Lamictal is a skin 

condition known as Stevens-Johnson Syndrome (“SJS”), which results in blisters 

covering up to 10% of the body. If blisters continue to spread and cover 30% or 

more of the body, the potentially lethal condition is known as Toxic Epidermal 

Necrolysis (“TEN”). Dr. Karumanchi warned McBride about the possibility of a 

 1 Southeast Alabama Medical Center is the trade name for Houston County Health Care 

Authority.

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lethal rash associated with her treatment, but he instructed her not to stop taking 

the medication without first consulting a doctor.

On July 4, 2012, Dr. Karumanchi discharged McBride into police custody, 

and she was admitted into the jail. At the time of the discharge, Dr. Karumanchi

verbally told the transferring officer, Arthur Schaefer, III, that if her condition 

worsened or she had “any problems,” she should return to the hospital. 

Karumanchi Dep. Tr. at 133, Doc. 172-12.2

 Although Schaefer denied receiving 

such verbal instructions, he agreed that if the doctor had given him any verbal 

instructions, he would have relayed them to the jail supervisor. It was then

standard operating procedure for the supervisor to share the doctor’s verbal 

instructions with all jail staff who might interact with the detainee. McBride was 

placed on suicide watch and sent to a holding cell separate from the general 

population.

On her second day in the jail, McBride started to feel sick. Her symptoms 

began with chapped lips, a swollen face, and chills. By the next day, July 6, she 

had a sore throat and fever and generally felt very ill. On that day, the jail brought 

her to a prescheduled follow-up appointment at SAMC. McBride does not 

remember complaining to jail officers or SAMC staff about feeling sick or 

suffering a skin rash.

 2 Citations to “Doc.” refer to docket entries in the district court record in this case.

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McBride returned to the jail after her appointment. From July 6 through 

July 10, her fever persisted and her condition worsened. She began to develop 

black splotches on her skin. She had a headache and a throat so sore that she had 

difficulty swallowing. During those four days, she was unable to eat or drink, and 

she regularly complained about needing medical attention during “every shift to 

everybody that opened [the cell] door.” McBride Dep. Tr. at 506-507, Doc. 172-

11. When she could muster the energy, she also banged on the door and screamed 

for help.

On July 9, Correctional Officer Stephanie Johnson commented that 

McBride’s lips “looked like they were peeling off.”3

 McBride Dep. Tr. at 504, 

Doc. 172-11. Johnson knew that McBride had not been eating, and McBride told 

Johnson she was unable to drink as well. In response, Johnson brought McBride 

Vaseline and ice water. McBride asked to go to the hospital, but Johnson ignored 

this request in violation of jail policy, which required that officers send detainees 

to the doctor on the same day they request medical attention.

McCory, who was the jail administrator during this time, was in her office 

on July 5, 6, 9, and 10. She confirmed that her office was about 20 feet from 

 3 McBride stated that she got sick sometime between July 6 and July 9, and it was during 

that time that she interacted with Johnson. McBride was unable to give a more precise date. 

Johnson attested that during this period she worked only July 9 and 10, and McBride offered no 

evidence to the contrary. The undisputed evidence thus supports the inference that the

interaction between McBride and Johnson occurred on July 9.

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McBride’s holding cell, close enough to hear McBride if she yelled. McCory 

maintained that she did not hear McBride screaming or calling from her cell at any 

time. The record contains no evidence that McCory checked on McBride during 

this time; McCory explained that it was the other jail officers’ responsibility to do 

that. Until July 10, none of the jail personnel reported to McCory that McBride 

suffered any medical problems, lodged any medical complaints, or had requested

any medical treatment.

On July 10, McBride complained of a sore throat and refused to eat 

breakfast or lunch. In response, after lunch, the jail transported her again to 

SAMC.

At SAMC, McBride met with a nurse and complained of a headache and 

sore throat. She also reported that she had not eaten or drunk any liquids in five 

days. The nurse’s notes show that McBride’s “[g]eneral [a]ppearance” was “well” 

and she was “[i]n no distress.” Pl.’s Resp. Ex. G, Doc. 172-10 at 4. But the notes 

further indicate that McBride had swollen tonsils, a 101.5 degree fever, and 

difficulty breathing. The nurse also observed that McBride’s eyes were “sunken” 

and she was “very weak and lethargic.” Id. Finally, the nurse reported that 

McBride’s skin was very dry [and] ashy” and her lips were “very dry [and] 

cracked” with moderate bleeding. Id. Although not reported in the nurse’s notes, 

McBride also exhibited “little black splotches . . . all over [her] face.” McBride 

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Dep. at 223. The nurse ran a lab test and confirmed that McBride had “Strep A.” 

Pl.’s Resp. Ex. G, Doc. 172-10 at 3. 

SAMC then sent McBride to the emergency room for further evaluation and 

hydration. The emergency room diagnosed her with “[p]haryngitis,” “[t]onsilitis,” 

a “[c]anker sore,” and a “rash” and prescribed antibiotics. Def. Mot. Summ. J. Ex. 

A, Doc. 131-16 at 399. The hospital discharged McBride. She was released from 

the jail later that day, July 10.

McBride returned home and her symptoms continued to worsen that night

and into the morning of July 11. She had trouble urinating, her ears and head hurt, 

and she still had splotches on her skin. She was in excruciating pain. Her 

headache and fever persisted. Her throat hurt, and she still could not eat or drink. 

Her lips, tongue, and vaginal area were swollen, and the skin on her lips was still 

peeling off. She went to the emergency room. The emergency room doctor who 

evaluated McBride diagnosed her with a fever blister and vaginitis. The doctor did 

not observe a rash, reported no fever, and did not diagnose a serious medical 

condition. McBride returned home.

By the next morning, July 12, the skin on McBride’s ear was falling off. 

She returned to the emergency room, where the doctor observed a rash over 99% 

of her skin. She was diagnosed with SJS, “most likely due to Lamictal.” Doc. 

131-16 at 68. The doctor ordered her to stop taking Lamictal and, after a few days, 

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she was transferred to the medical intensive care unit (“ICU”) at the University of 

Alabama, Birmingham. Once in the ICU, she was diagnosed with TEN, 

considered “critically ill” due to a significant loss of skin, which “was similar to a 

severe burn involving greater than 30 percent of the body surface area.” Doc. 172-

16 at 20. She was treated for nine days and then released.

McBride filed this lawsuit in the district court naming, among other 

defendants, McCory and Johnson.4

 Relevant to this appeal, she alleged that 

McCory and Johnson acted with deliberate indifference to her serious medical need 

in violation of the Fourteenth Amendment. McCory and Johnson filed a motion 

for summary judgment raising a qualified immunity defense. The district court 

denied their motion, holding that a reasonable jury could conclude that McCory 

and Johnson violated McBride’s clearly established constitutional right. The 

officers timely filed this interlocutory appeal. See Scott v. Harris, 550 U.S. 372, 

376 n.2 (2007) (“[A]n order denying qualified immunity is immediately appealable 

even though it is interlocutory; otherwise, it would be effectively unreviewable.” 

(internal quotation marks omitted)).

 4 All of the other defendants were dismissed before trial except Karumanchi and the City 

of Dothan. McBride’s claim against Karumanchi was tried before a jury in July 2015. The jury 

found that Karumanchi had not breached the standard of care in his treatment of McBride, and 

the district court entered judgment in favor of Karumanchi pursuant to Federal Rule of Civil 

Procedure 54(b). The only claim against the City to survive summary judgment is a state law 

negligence claim, which has not proceeded to trial because the court stayed this action as to the 

claims against the City, McCory, and Johnson pending this appeal.

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II. STANDARD OF REVIEW

“On an interlocutory appeal from the denial of qualified immunity, this 

Court conducts a de novo review.” Kjellsen v. Mills, 517 F.3d 1232, 1236 (11th 

Cir. 2008). As with any review of a summary judgment decision, “we view all 

evidence and factual inferences in the light most favorable to the non-moving 

party.” Perez, 809 F.3d at 1217. “We must review the evidence in this manner 

because the issues appealed here concern not which facts the parties might be able 

to prove, but, rather, whether or not certain given facts showed a violation of 

clearly established law.” Id. (internal quotation marks omitted). Summary 

judgment should be granted when the record evidence shows there is no genuine 

dispute concerning any material fact and the movant is entitled to judgment as a 

matter of law. Feliciano v. City of Miami Beach, 707 F.3d 1244, 1247 (11th Cir.

2013) (citing Fed. R. Civ. P. 56(a)).

III.ANALYSIS

The officers argue that the district court erred in denying their motion for 

summary judgment on qualified immunity grounds. “Qualified immunity shields 

government officials acting within their discretionary authority from liability 

unless the officials violate clearly established statutory or constitutional rights of 

which a reasonable person would have known.” Franklin v. Curry, 738 F.3d 1246, 

1249 (11th Cir. 2013) (internal quotation marks omitted). The parties do not 

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dispute that McCory and Johnson were acting within their discretionary authority 

at all relevant times. Thus, the burden shifts to McBride to show that “(1) the 

defendant[s] violated a constitutional right, and (2) this right was clearly 

established at the time of the alleged violation.” Valderrama v. Rousseau, 780 

F.3d 1108, 1112 (11th Cir. 2015) (internal quotation marks omitted). We consider 

each element in turn.

A. Constitutional Violation: Deliberate Indifference under the Fourteenth 

Amendment

McBride contends that McCory and Johnson were deliberately indifferent to 

her serious medical needs in violation of her rights under the Fourteenth 

Amendment. Pretrial detainees like McBride “plainly have a Fourteenth 

Amendment due process right to receive medical treatment for illness and 

injuries.” Jackson v. West, 787 F.3d 1345, 1352 (11th Cir. 2015) (internal 

quotation marks omitted).5

 “To prevail on a § 1983 claim alleging a violation of 

that right, a plaintiff must satisfy both an objective and a subjective inquiry.” 

Valderrama, 780 F.3d at 1116 (internal quotation marks omitted). 

As regards the objective inquiry, McBride must show that she suffered an 

objectively serious medical need. See id.; Farrow v. West, 320 F.3d 1235, 1243 

 5 The standard for deliberate indifference claims under the Fourteenth Amendment is the 

same as the standard applicable for prison inmates under the Eighth Amendment. Cottrell v. 

Caldwell, 85 F.3d 1480, 1490 (11th Cir. 1996). Thus, “decisional law involving prison inmates 

applies equally to cases involving arrestees or pretrial detainees.” Id.

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(11th Cir. 2003). “In our circuit, a serious medical need is considered one that has 

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

that even a lay person would easily recognize the necessity for a doctor’s 

attention.” Farrow, 320 F.3d at 1243 (internal quotation marks omitted); accord 

Goebert v. Lee Cty. 510 F.3d 1312, 1327 (11th Cir. 2007). Either way, the medical 

need must be “one that, if left unattended, pos[es] a substantial risk of serious 

harm.” Farrow, 320 F.3d at 1243 (alteration in original) (internal quotation marks 

omitted).

On this record, a jury could find that McBride suffered an objectively 

serious medical need while detained in the jail. A person who is calling for help,

in obvious pain; has a fever; is unable to eat or drink for days; and whose lips are 

blistered and “peeling off,” objectively needs a doctor’s attention. See, e.g., id. at 

1243-44 (holding that the pain and weight loss from having virtually no teeth 

constituted a medical need warranting treatment). Moreover, McBride ultimately 

was diagnosed with SJS, a painful skin condition that, when left untreated, led to 

its more severe form, TEN, that put her in critical condition with a rash over 99% 

of her body. With these facts, a reasonable jury could infer that McBride suffered 

a serious, deteriorating medical need sometime between July 6 and July 9, while 

detained in the jail.

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The officers argue that, because McBride was not diagnosed with SJS until 

about two days after her release from the jail, and because some medical 

professionals failed to diagnose it earlier, a reasonable jury could not conclude that 

McBride suffered a serious medical condition while detained. We disagree. A 

reasonable jury could conclude on this record that McBride suffered with SJS—a 

known side effect of her medication—on the days leading up to her diagnosis and 

that the medical professionals who overlooked her condition were themselves 

grossly negligent. See Goebert, 510 F.3d at 1327 (explaining that the fact that a 

pregnant inmate leaking amniotic fluid had been seen by medical staff did not 

mean that a layperson could not tell she suffered from a serious medical need 

because, as the inmate alleged, the medical staff themselves failed to attend to her 

needs). In any event, a diagnosis is unnecessary where, as here, the serious 

condition would be obvious even to lay persons. See id. In sum, McBride has 

presented a triable issue regarding whether she suffered an objectively serious 

medical need while she was detained in the jail.

We now turn to the subjective inquiry. To satisfy this inquiry, McBride 

“must prove that the officers were deliberately indifferent to [her] serious medical 

need.” Valderrama, 780 F.3d at 1116. 

More specifically, the plaintiff must present, for each officer, evidence 

from which a reasonable jury could conclude that (1) the officer was 

aware of facts from which the inference could be drawn that a 

substantial risk of serious harm exists, (2) the officer actually drew 

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that inference, (3) the officer disregarded the risk of serious harm, and 

(4) the officer’s conduct amounted to more than gross negligence.

Id. An unreasonable delay in treatment may constitute unconstitutional deliberate 

indifference, whether or not it exacerbated the condition, if the delay results in “a 

wanton infliction of pain.” Id. And when officials “ignore without explanation a[n 

arrestee’s] serious condition that is known or obvious to them, the trier of fact may 

infer deliberate indifference.” Id. (alteration in original) (internal quotation marks 

omitted); accord Carswell v. Bay Cty., 854 F.2d 454, 457 (11th Cir. 1988) (holding 

that jail personnel who are aware of an inmate’s need for medical care but fail to 

provide it act with deliberate indifference); Ancata v. Prison Health Servs., Inc., 

769 F.2d 700, 704 (11th Cir. 1985) (holding that a jailer who was aware of a 

serious medical problem but provided medical care “so cursory as to amount to no 

treatment at all . . . may violate the Fourteenth Amendment”). We apply this 

standard to McBride’s claims against McCory and Johnson.

As regards McCory, the record contains insufficient evidence from which a 

reasonable jury could find that she was aware of McBride’s serious medical need. 

There is no evidence that McCory ever saw McBride or communicated with her 

about McBride’s medical condition. The uncontroverted evidence shows that none 

of the jail personnel who regularly checked on detainees reported to McCory that 

McBride suffered any medical problems or requested to go to the hospital. Even 

drawing the inference, as we must based on this record, that McCory heard 

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McBride screaming, there is no evidence to suggest that McCory actually was 

aware that McBride was screaming because of a medical need. We readily 

conclude that on this record a reasonable jury could find that McCory acted 

negligently; as jail administrator, McCory should have personally checked on 

McCory, a screaming detainee on suicide watch in a cell just 20 feet from her 

office, rather than relying on jail officers to do so. But negligence is insufficient to 

trigger liability under § 1983. See, e.g., Goodman v. Kimbrough, 718 F.3d 1325, 

1332-33 (11th Cir. 2013) (holding that a failure to conduct a cell check and head 

count amounted to negligence but could not support a deliberate indifference claim 

absent evidence that the officers knew of a substantial risk of serious harm). 

Because there is no evidence indicating that McCory knew McBride needed 

medical attention, McCory’s failure to send McBride to the hospital or provide 

other medical care did not violate McBride’s constitutional rights. See Jackson, 

787 F.3d at 1354 (holding that, without evidence that officers subjectively knew of 

a risk of suicide, the officers cannot be deliberately indifferent to the suicide risk 

for qualified immunity purposes). Accordingly, the district court erred in denying 

McCory qualified immunity.

In contrast, McBride has come forward with sufficient evidence, viewed in 

the light most favorable to her, that Johnson acted with deliberate indifference in 

violation of McBride’s constitutional rights. First, a reasonable jury could find that 

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Johnson knew McBride suffered from a serious medical need. The evidence shows

that Johnson was aware on July 9 that McBride was unable to eat or drink. The 

jury could also credit McBride’s testimony that Johnson observed and commented 

on what looked like McBride’s lips “peeling off.” McBride Dep. Tr. at 504, Doc.

172-11. Moreover, a reasonable jury could find that Johnson knew the doctor had 

instructed jail staff to return McBride to the hospital if her condition worsened or 

she had any problems. Karumanchi testified that he relayed this instruction to the 

transferring officer, and the officer confirmed that he would have then relayed the

information to the jail supervisor. Pursuant to jail policy, the jail supervisor then 

would have relayed the doctor’s instruction to jail staff, including Johnson. See 

Campbell v. Johnson, 586 F.3d 835, 841 (11th Cir. 2009) (acknowledging that it is 

reasonable to infer that a jail would follow its policies). From these facts, the jury 

could find that on July 9, Johnson was aware of McBride’s serious medical need 

and the doctor’s instruction to seek medical attention.

Second, a reasonable jury could find that Johnson disregarded the risk of 

serious harm McBride faced and that Johnson’s conduct was more than grossly 

negligent. Rather than granting McBride’s requests to receive immediate medical 

attention for her readily observable conditions, as required under jail policy and 

directed by the doctor, Johnson offered Vaseline and ice water. Johnson’s failure 

to seek medical attention for McBride under these circumstances can support a 

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§ 1983 claim of deliberate indifference. See Carswell, 854 F.2d at 458 (holding 

that, after specific requests for medical attention, the failure to provide medical 

care for an inmate who suffered from a skin rash, constipation, and significant 

weight loss constituted deliberate indifference); Ancata, 769 F.2d at 702, 704 

(holding that providing non-prescription drugs such as Ben Gay and Tylenol II to 

treat a serious medical need —“swelling of the ankle, inability to sleep, chills, 

lower back pain, tingling and numbness of [the] hands, hyperventilation, severe 

pain in [the] back and right leg, [and] double vision”—amounted to far more than 

negligence and supported a deliberate indifference claim). For these reasons, we 

agree that the record supports a finding that Johnson violated McBride’s 

constitutional right.

B. Clearly Established Constitutional Right

Next, we must decide whether McBride’s constitutional right was clearly 

established at the time of Johnson’s conduct; if not, Johnson is entitled to qualified 

immunity. See Perez, 809 F.3d at 1221-22. “A right is ‘clearly established’ if it 

would have been apparent to every reasonable officer in [the defendant’s] position” 

that her conduct was unlawful. Id.; see also Valderrama, 780 F.3d at 1112. 

There are three ways in which [the plaintiff] may show that the right 

violated was clearly established: (1) case law with indistinguishable 

facts clearly establishing the constitutional right; (2) a broad statement 

of principle within the Constitution, statute, or case law that clearly 

establishes a constitutional right; or (3) conduct so egregious that a 

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constitutional right was clearly violated, even in the total absence of 

case law.

Perez, 809 F.3d at 1222 (internal quotation marks omitted). 

This case falls into the second category: The broad principles of our case 

law clearly establish the constitutional right violated. See Danley v. Allen, 540 

F.3d 1298, 1313 (11th Cir. 2008), overruled on other grounds by Ashcroft v. Iqbal, 

556 U.S. 662 (2009). “Our earlier deliberate indifference decisions have stated 

that when jailers are aware of serious medical needs they may not ignore them or 

provide grossly inadequate care.” Id. (citing Bozeman v. Orum, 422 F.3d 1265, 

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

135 S. Ct. 2466, 2472, 2476-77 (2015); McElligott v. Foley, 182 F.3d 1248, 1256 

(11th Cir. 1999)); see, e.g., Carswell, 854 F.2d at 457 (holding that the failure to 

provide medical care in the face of a known, serious medical need constitutes 

deliberate indifference); Ancata, 769 F.2d at 704 (“[K]nowledge of the need for 

medical care and intentional refusal to provide that care has consistently been held 

to surpass negligence and constitute deliberate indifference.”). As discussed 

above, viewing the evidence in McBride’s favor, her condition—a headache and 

sore throat so painful that McBride had been unable to eat or drink for days and a 

serious rash resulting in the skin on McBride’s lips peeling off—along with her 

screaming for help, indicated the need for medical care which Johnson failed to 

provide. Reasonable jailers would have been aware that Johnson’s conduct as 

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described here violated clearly established constitutional rights. Accordingly, the 

district court did not err in denying Johnson’s motion for summary judgment on 

qualified immunity grounds.

IV. CONCLUSION 

For the foregoing reasons, we conclude that, viewing the evidence in the 

light most favorable to McBride, Johnson is not entitled to qualified immunity on 

McBride’s claim of deliberate indifference to her serious medical need under 42 

U.S.C. § 1983. But, because McBride has failed to point to evidence suggesting 

that McCory was aware of McBride’s serious medical need while she was detained 

in the City of Dothan Jail, McBride cannot establish that McCory violated a clearly 

established constitutional right, and thus the claim against McCory must be 

dismissed on qualified immunity grounds. We therefore affirm in part, reverse in 

part, and remand for further proceedings.

AFFIRMED IN PART, REVERSED IN PART, AND REMANDED. 

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