[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT

________________________ No. 15

- 12871 Non

- Argument Calendar

________________________ D.C. Docket No. 1:12

- cv - 01047

- MHT

- TFM

COURTNEY MCBRIDE, Plaintiff

- Appellee,

versus HOUSTON COUNTY HEALTH CARE AUTHORITY, d.b.a. Southeast Alaba ma Medical Center, et al., Defendants, MAMIE MCCORY, STEPHANIE JOHNSON, Defendants

- Appell ants.

________________________ Appeal from the United States District Court for the Middle District of Alabama

________________________ (September 30, 2016) Case: 15-12871 Date Filed: 09/30/2016 Page: 1 of 182 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 f or 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 med ical need . T hus ,

Case: 15-12871 Date Filed: 09/30/2016 Page: 2 of 183 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 McB ride 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 effec ts 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 Ep idermal Necrolysis (“TEN”). Dr. Karumanchi warned McBride about the possibility of a

1 South east Alabama Medical Center is the trade name for Houston County Health Care Authority. Case: 15-12871 Date Filed: 09/30/2016 Page: 3 of 184 lethal rash associated with her treatment, but he instructed her not to stop taking the medication with out first consulting a doctor. On July 4, 2012, Dr. Karumanchi discharged McBride into police custody , and she was admitted into the j ail . At the time of the discharge, Dr. Karumanchi verbally told the transferring officer, Arthur Schaefer, III, that i f her condition worsened or she had “any problems,” she should ret urn 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 j ail supervisor

. I t was the n 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 separat e from the general population. On her second day in the j ail, M cBride 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, t he jail brought her to a p rescheduled follow

- up appointment at SAMC . McBride does not remember complain ing 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. Case: 15-12871 Date Filed: 09/30/2016 Page: 4 of 185 McBride returned to the j ail after her appointment. From July 6 through July 10 , her fever persis ted and her condition wors ened. 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

s he 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 t he door and screamed for help. On July 9 , Correctional Officer Stepha nie 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 M cBride Vaseline and ice water. McBride asked to go to the hospital, but Johnson ignored this request in violation of j ail policy , which required that officers send detainees to the doctor on the same day they request medical attention

. McCory, who was t he jail a dministrator 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 infer ence that the interaction be tween McBride and Johnson occurred on July 9.

Case: 15-12871 Date Filed: 09/30/2016 Page: 5 of 186 McBride’s ho lding cell , close enough to hear McBride if she yelled. McCory maintained that she did not hear McBride scre aming 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 report ed 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 trans ported 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 dr u nk 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 d ry [and] cracked” with moderate bleeding

. Id. Althoug h not reported in the nurse’s notes, McBride also exhibited “little black splotches . . . all over [her] face.” McBride

Case: 15-12871 Date Filed: 09/30/2016 Page: 6 of 187 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

- 1 6 at 399. The hos pital discharged McBride. She was released from the j ail 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 n ext 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,

Case: 15-12871 Date Filed: 09/30/2016 Page: 7 of 188 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 fo r 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 den ied 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 woul d 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 neg ligence claim, which has not proceeded to trial because the court stayed this action as to the claims against the City, McCory, an d Johnson pending this appeal.

Case: 15-12871 Date Filed: 09/30/2016 Page: 8 of 189 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, “w e view all evidence and factual infere nces in the light most favorable to the non

- moving party

. ” Perez , 809 F.3d at 1217. “ We must revi ew 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 certa in 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) (c iting 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 authorit y 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 d o not

Case: 15-12871 Date Filed: 09/30/2016 Page: 9 of 1810 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 right s under the Fourteenth Amendment . Pretrial detainees like McBride “plainly have a Fourteenth Amendment due process right to receiv e 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 violat ion of that right, a plaintiff must satisfy both an objective and a s ubjective 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.

Case: 15-12871 Date Filed: 09/30/2016 Page: 10 of 1811 (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 recog nize the necessity for a doctor’ s attention.” Farrow , 320 F. 3d at 1243 (in ternal quotation marks omitted); accord Goebert v. Lee Cty. 510 F.3d 1312, 1327 (11th Cir. 2007). Either way, the medical need must be “one th at, if left unattended, pos [ es ] a sub stantial 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 j ail. 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 jur y could infer that McBride suffered a serious , deteriorating medical need sometime between July 6 and July 9 , while detained in the j ail.

Case: 15-12871 Date Filed: 09/30/2016 Page: 11 of 1812 The officers argue that, because McBride was not diagnosed with SJS until about two d ays after her release from the j a il, 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 suf fered with SJS

— a known side effect of her medication

— on the days leading up to her diagnosis and that t he 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 staf f 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 obj ective ly serious medical need while she was detained in the j ail. We now turn to the subjective inquiry. T o 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 Case: 15-12871 Date Filed: 09/30/2016 Page: 12 of 1813 that inference, (3) the officer disregarded the risk of se rious harm, and (4) the officer’ s conduct amounted to more than gross negligence. Id. An unreasonable delay in treatment may constitute unconstitutional deliberate ind ifference, whether or not it exacerbated the condition, if the delay results in “a wanton infliction of pain.” Id. And when officials “ignore w ithout explanation a[n
arrestee’ s] serious condition that is known or obvious to them, the trier of fact may
in fer deliberate indifference.” Id. (alteration in original) (internal quotation marks

om itted); 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 ac t 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 t o amount to no

treat ment at all

. . . may v iolate the Fourteenth Amendment ” ). We apply this standard to McBride’s claims against McCory and Johnson. As regards McCory, the record contains in sufficient evidence from which a reasonable jury could find that she was aware of McB ride’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 n one of the jail personnel who regularly checked on detainee s reported to Mc Cory 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

Case: 15-12871 Date Filed: 09/30/2016 Page: 13 of 1814 McBride screaming, there is no evidence to suggest that McCory actually was

aware that McBri de was screaming because of a medical need. We readily conclude that on this record a reasonable jury could find that McCory acted negligently; a s 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).
B ecause there is no evidence indicating that McCory knew McBrid e needed medical attention, McCory’s failure to send McBride to the hospital or provide other medical care did not violate McBride’s constitutional right s . 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 eviden ce , viewed in the light most favorable to her, that Johnson acted with deliberate indifference in violation of McBride’s constitutional right s . First, a reasonable jury could find that

Case: 15-12871 Date Filed: 09/30/2016 Page: 14 of 1815 Johnson knew McBride suffered from a serious medical need. T he 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

trans ferring officer , and the officer confirmed that he would have then relayed the information to the j ail supervisor. P ursuant to jail policy, the j ail supervisor then would have relayed the doctor’s instruction to j ail staff, including Johnson. See Campbel l 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 gross ly negligent. R ather than granting McBride’s requests to receive immediate medical attention for her readily observable conditions , as required under j ail policy and directed by the doctor , Johnson offered Vaseline and ice water. Johnson’s failure

to see k medical attention for McBride under these circumstances can support a

Case: 15-12871 Date Filed: 09/30/2016 Page: 15 of 1816 § 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

— “swel ling 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 indifferen ce 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, w e 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 conduc t was unlawful. Id. ; see also Valderrama , 780 F.3d at 1112. There are three ways in which [the plaintiff] may show that the right vio lated 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 Case: 15-12871 Date Filed: 09/30/2016 Page: 16 of 1817 constitutional right was clearly violated, even in the total absence of case law. Perez , 8 09 F.3d at 1222 (internal quotation marks omitted). This case falls into the second category: T he broad principles of our case law clearly establish the constitutional r ight violated. See Danley v. Allen , 540 F.3d 1298, 1313 (11th Cir. 2008), overrule d 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 Bozema n v. Orum , 422 F.3d 1265, 1273 (11th Cir. 2005), abrogated on other grounds by Kingsley v. Hendrickson , 135 S. Ct. 2466, 2472, 247 6

- 7 7 (2015); McElligott v. Foley , 182 F.3d 1248, 1256 (1 1th 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 70 4 (“[K] nowledge of the need for medical care and intentional refusal to provide tha t care has consistently been held to surpass negligence and constitute deliberate indifference .”). As discussed above, v iewing the evidence in McBride’s favor, her condition

— a headache and sore throat so painful that McBride had been unable to eat or drin k 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

Case: 15-12871 Date Filed: 09/30/2016 Page: 17 of 1818 de scribed 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 sugg esting 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 vi olated 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. Case: 15-12871 Date Filed: 09/30/2016 Page: 18 of 18