United States Court of Appeals

for the Fifth Circuit

No. 22-30220

Mallory Addington; Landon Addington, 

Plaintiffs—Appellees, 

versus

Damion Wells, Sergeant, 

Defendant—Appellant, 

______________________________

Cody Lane Addington,

Plaintiff—Appellee, 

versus

Damion Wells, Sergeant, 

Defendant—Appellant. 

Appeal from the United States District Court

for the Western District of Louisiana

USDC Nos. 5:18-CV-1116 and 5:19-CV-411

Before Richman, Chief Judge, and King and Higginson, Circuit 

Judges.

United States Court of Appeals

Fifth Circuit

FILED

April 6, 2023

Lyle W. Cayce

Clerk

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Per Curiam:*

Joshua Addington, a diabetic, died in custody. His children brought

constitutional and tort claims against various prison officials, including 

Defendant-Appellant Damion Wells. Wells appeals the district court’s denial 

of his qualified immunity defense as to the constitutional claims and the 

denial of his Louisiana state discretionary immunity defense as to the 

negligence claim. We REVERSE.

I.

On April 1, 2018, Joshua Addington1 died while incarcerated in the 

Bayou Dorcheat Correctional Center (“BDCC”). His children brought this 

suit against Defendant-Appellant Sergeant Damion Wells, BDCC, and other 

prison and state officials.

Addington had Type II diabetes, a condition affecting his ability to 

regulate blood sugar levels. He had been diabetic for about ten years at the 

time of his death, during which he had been frequently diagnosed with 

conditions arising from extreme blood sugar levels. Like many diabetics, 

Addington used insulin and food to manage his blood sugar.

Diabetics are vulnerable to both hyperglycemia (high blood sugar) and 

hypoglycemia (low blood sugar). Manage Blood Sugar, CDC, 

https://www.cdc.gov/diabetes/managing/manage-blood-sugar.html 

[hereinafter “Manage Blood Sugar”] (last visited Feb. 27, 2023). Diabetics 

often manage blood sugar levels by injecting insulin to lower blood sugar and 

eating to raise blood sugar. See id. Blood sugar levels outside of a normal range 

can cause severe consequences. A lack of insulin can cause hyperglycemia 

and make diabetics tired, thirsty, or nauseous; in extreme cases, low insulin 

* This opinion is not designated for publication. See 5th Cir. R. 47.5.

1 Unless otherwise differentiated, we use “Addington” to refer to both the 

deceased, Joshua Addington, and the Plaintiffs-Appellees, his children.

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can cause a diabetic ketoacidosis (“DKA”)-induced coma or death. See 

Diabetic Ketoacidosis, Mayo Clinic, 

https://www.mayoclinic.org/diseases-conditions/diabeticketoacidosis/symptoms-causes/syc-20371551 (last visited Feb. 27, 2023);

Manage Blood Sugar. Analogously, hypoglycemia can be triggered by too 

much insulin or missing a meal. See Manage Blood Sugar.

On March 17, 2018, Addington arrived at BDCC. As relevant, three 

events coincided with this arrival. First, on his intake health screening, 

Addington reported that he had Type II diabetes and that he had no history 

of alcohol abuse, drug abuse, or hospitalizations of which BDCC staff needed 

to be aware. Second, BDCC received a medical transfer form noting that 

Addington was prescribed insulin shots to be administered twice per day.

Third, Addington signed a form indicating he had read the explanation of 

how to request medical attention. Generally, while Addington was 

incarcerated, a diabetic inmate had to proactively seek blood sugar readings 

and insulin shots. If a shot was needed based on the reading, an officer would 

observe the inmate self-administering the shot and report and record both the 

reading and, if applicable, the shot. 

On March 21, Addington suffered a mild hypoglycemic event. His 

blood sugar level was 58, and he subsequently used a medical evaluation form 

to request a diabetic snack. 

On March 30, Addington suffered a significant hypoglycemic event. 

He received treatment at Minden Medical Center (“Minden”) for 

hypoglycemia. Minden discharged Addington with instructions to follow up 

as needed with a private physician; discharge papers also listed critical 

glucose levels as being below 50 or above 400 mg/dL (milligrams per 

deciliter: a unit of measure showing concentration of glucose). These 

discharge papers were later given to Sergeant Wells. When Addington 

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returned to BDCC, he was placed in a separate holding cell for continuous 

medical observation. This cell contained live-feed cameras and a buzzer that 

an inmate can use to alert officers of any medical needs. Addington’s blood 

sugar reading was 175 on the afternoon of March 30; approximately two hours 

later, his temperature was 101.2 degrees Fahrenheit. 

On March 31, Addington received medication for nausea. Multiple 

people took Addington’s blood sugar levels that day, and Wells prepared an 

Unusual Occurrence Report (the “UOR”) listing Addington’s blood sugar 

levels and “letting everybody to understand [sic] that this is where 

[Addington] was during these particular times throughout the day”; these 

levels were higher than on the previous day, ranging from 274 to 364 mg/dL.

Wells also stated that he believed the normal blood sugar level for a diabetic 

“shouldn’t be over 100” and that he would have notified medical staff with 

a “crazy” reading of “500 or something.” Warden John Lewis said that it 

was “common sense” to him that the blood sugar levelsrecorded in the UOR

were abnormal.

Addington’s condition deteriorated rapidly on April 1. At 6:15 a.m., 

he was responsive, moving, and talking when Deputy Wendell Wright came 

into the holding cell to check Addington’s blood sugar levels. Addington 

asked Wright for some water, which Wright provided. At 9:30 a.m., Deputy 

Nolan Slack brought Addington a food tray, which Addington refused. At 

1:21 p.m., Deputy David Edwards went to the holding cell to check on 

Addington’s blood sugar levels. Addington was unresponsive and not 

moving; Edwards and another deputy moved Addington upright and saw that 

he had soiled himself. The deputies alerted Wells at 1:33 p.m., an ambulance 

was called at 1:38 p.m., and Addington was pronounced dead at 1:55 p.m. An 

autopsy found no evidence of trauma and listed the cause of death as acute 

renal failure due to DKA complicating hypertensive cardiovascular disease.

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On August 29, 2018, Plaintiffs-Appellees Mallory and Landon 

Addington—Joshua Addington’s children—filed a complaint against, inter 

alia, various state and prison officials in their individual and official 

capacities.2 Following discovery responses and a motion by certain 

Defendants for summary judgment, the magistrate judge granted 

Addington’s motion to amend his complaint to join Wells, Debbie Claunch 

(a BDCC nurse), and Dr. Frederick Heard (a BDCC doctor) as additional 

parties. 

On July 8, 2020, Addington filed the operative amended complaint 

incorporating the allegations of the previous complaint. In the amended 

complaint, as relevant to this appeal, Addington additionally alleged that 

various doctors, nurses, and prison officials (including Wells) violated the 

Eighth Amendment by acting with deliberate indifference in failing to ensure 

that Addington received proper medical care. In their answer, Defendants 

Wells, Claunch, Warden John Lewis, and Sheriff Gary Sexton raised a 

qualified immunity defense.

These Defendants then filed a motion for summary judgment. There, 

they argued, inter alia, that they were entitled to qualified immunity as to the 

individual-capacity claims. On the Louisiana state law claims, they raised a 

state discretionary immunity defense and argued that they acted reasonably 

and did not cause Addington’s death.

On March 31, 2022, the district court ruled on Defendants’ motion 

for summary judgment. As relevant to this appeal, the court first denied this 

motion as to the Eighth Amendment individual-capacity claim that Wells was 

2 In June, the magistrate judge consolidated a substantively identical case brought 

by Cody Addington, another of Joshua Addington’s children. 

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deliberately indifferent in handling Addington’s medical complaints after the 

March 30 Minden discharge.

Considering the first prong of the qualified immunity analysis (i.e., 

whether there was a violation of a constitutional right) the district court ruled 

that there was a genuine dispute of material fact precluding summary 

judgment as to whether Wells had the necessary culpable state of mind to 

constitute deliberate indifference when he disregarded and did not mitigate 

the risk of harm caused by Addington’s elevated blood sugar levels. 

Specifically, the district court noted that Wells had created the UOR 

documenting elevated blood sugar levels without conveying his concerns to 

Nurse Claunch or Dr. Heard and without giving any insulin to Addington.

Wells additionally did not take any action when Addington complained of 

nausea and thirst, both of which are symptoms of DKA. Given these facts, 

the district court held that “a jury could reasonably conclude that Sergeant 

Wells chose not to take any action to alleviate the risk, such as contacting 

medical personnel or ensuring that Addington’s insulin was administered,” 

which would constitute deliberate indifference to Addington’s medical 

needs. 

On the second prong of the qualified immunity analysis (i.e., whether 

the right in question was clearly established), the court denied Wells qualified 

immunity by “conclud[ing] that an inmate’s right to adequate medical care 

was clearly established at the time of this incident and that prison officials 

were on notice that they cannot show a wanton disregard to an inmate in

obvious medical need.” 

Finally, on the state law negligence claim, the district court denied 

summary judgment as to Wells for the same reasons stated in its analysis of 

the Eighth Amendment claims. Wells timely appealed. 

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II.

We have limited jurisdiction over an interlocutory appeal of a denial 

of summary judgment based upon qualified immunity. Cole v. Carson, 935 

F.3d 444, 452 (5th Cir. 2019) (en banc). Our jurisdiction is limited “to the 

extent that [the denial of summary judgment] turns on an issue of law.” 

Hogan v. Cunningham, 722 F.3d 725, 730 (5th Cir. 2013) (alteration in 

original) (quoting Juarez v. Aguilar, 666 F.3d 325, 331 (5th Cir. 2011)). Thus, 

our jurisdiction does not extend to the review of the lower court’s factual 

findings. Lemoine v. New Horizons Ranch & Ctr., Inc., 174 F.3d 629, 633 (5th 

Cir. 1999). “Once we have narrowed the interlocutory appeal solely to issues 

of law, we review the district court’s resolution of these issues de novo.” 

Lytle v. Bexar Cnty., 560 F.3d 404, 409 (5th Cir. 2009).

In qualified immunity cases, “[t]he plaintiff must show that there is a 

genuine dispute of material fact and that a jury could return a verdict entitling 

the plaintiff to relief.” Joseph ex rel. Estate of Joseph v. Bartlett, 981 F.3d 319, 

330 (5th Cir. 2020). “But, to overcome qualified immunity, the plaintiff’s 

version of those disputed facts must also constitute a violation of clearly 

established law.” Id. Accordingly, a court reviews a motion for summary 

judgment based on qualified immunity in two steps. “First: ‘Taken in the 

light most favorable to the party asserting the injury, do the facts show the 

officer’s conduct violated a constitutional right.’” Romero v. City of 

Grapevine, 888 F.3d 170, 176 (5th Cir. 2018) (quoting Saucier v. Katz, 533 

U.S. 194, 201 (2001)). “Second, we ask ‘whether the right in question was 

“clearly established” at the time of the violation.’” Id. (quoting Tolan v. 

Cotton, 572 U.S. 650, 656 (2014) (per curiam)). We can review these steps in 

any order. Pearson v. Callahan, 555 U.S. 223, 236 (2009).

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III.

Our discussion of Wells’s qualified immunity defense begins and ends 

with the second step. We consider whether Addington has identified an 

analogous case showing that Wells’s conduct in not administering medical 

attention in this case is conduct that violates clearly established law. See Dyer 

v. Hous., 964 F.3d 374, 384 (5th Cir. 2020) (explaining the level of detail at 

which plaintiff must define clearly established law); see also Joseph, 981 F.3d 

at 338 (explaining that identified cases must prohibit the “challenged 

conduct” of a defendant acting under similar circumstances). “A 

Government official’s conduct violates clearly established law when, at the 

time of the challenged conduct, ‘[t]he contours of [a] right [are] sufficiently 

clear’ that every ‘reasonable official would [have understood] that what he is 

doing violates that right.’” Ashcroft v. al-Kidd, 563 U.S. 731, 741 (2011) 

(quoting Anderson v. Creighton, 483 U.S. 635, 640 (1987)). We hold that 

Addington has not. Accordingly, we need not consider whether Wells’s 

actions rise to the level of a constitutional violation.

Addington cites four cases as possible sources of clearly established 

law: Thompson v. Upshur County, 245 F.3d 447 (5th Cir. 2001); Dyer, 964 F.3d 

374; Fielder v. Bosshard, 590 F.2d 105 (5th Cir. 1979); and Estelle v. Gamble, 

429 U.S. 97 (1976). But these cases involve facts that are materially 

distinguishable from the present circumstances. Thompson involved a jail 

sergeant who was aware that Thompson, an inmate, had elevated blood 

alcohol content, was “hallucinating,” and “was injuring himself in his cell.” 

245 F.3d at 452, 463. The sergeant specifically knew Thompson had 

“beg[u]n to collide with objects in his cell, sometimes falling and striking his 

head against the window, floor or concrete bench of his cell.” Id. at 454. Dyer

involved officers who watched Dyer repeatedly bang his head approximately 

46 times against the inside of a patrol car en route to the prison but did not 

alert any prison staff to Dyer’s behavior. 964 F.3d at 378–79. And Fielder 

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involved an inmate who had requested medication and was hallucinating and 

physically shaking. 590 F.2d at 108. Concerning Estelle, 429 U.S. 97, we held

on remand that the actions of the prison officials overseeing the inmate’s 

treatment did not constitute deliberate indifference; accordingly, it cannot 

serve as a source of clearly established law. Gamble v. Estelle, 554 F.2d 653, 

654 (5th Cir. 1977) (per curiam).

These cases are inapposite here because their facts all involve some 

combination of a specific request for medical attention that was ignored by 

jail staff (Fielder) or circumstances involving obvious and externally visible 

injuries (Thompson, Dyer, and Fielder). The present facts are materially 

different. Addington did not explicitly request medical attention, and Wells 

thus did not ignore his requests. And while elevated blood sugar levels are 

exceptionally dangerous for diabetics, they are not as obvious and externally 

visible as the injuries in Thompson, Dyer, and Fielder.

A more factually analogous case is Cleveland v. Bell, 938 F.3d 672 (5th 

Cir. 2019). Cleveland involved a plaintiff who had various health problems 

logged at his initial prison health assessment. Id. at 674. Over the two months 

he spent at the prison, “Cleveland received medication for his conditions and 

had numerous visits with medical staff regarding a variety of health issues.” 

Id. A nurse, Bell, “told [Cleveland] to get a cup of water so he could take his 

pills” and, upon Cleveland saying he was too weak to get the cup, told him 

“to stop playing and come get your medication . . . there is nothing wrong 

with you.” Id. Bell said she would return; upon returning, she asked an officer 

how Cleveland was doing. Id. at 674–75. The officer told Bell that Cleveland 

was seemingly sleeping but that he “had been turning around in his bed and 

occasionally hit the wall with his fist.” Id. at 675. Bell did not return to 

Cleveland to give him his medication. Id. Later, officers found that Cleveland 

had defecated on himself and called Bell explaining that Cleveland was lying 

on the floor claiming he could not get up from exhaustion. Id. Bell said she 

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thought Cleveland was faking and trying to get transferred back to the 

infirmary. Id. Cleveland was found dead a few hours later. Id. 

The Cleveland court, considering the second prong of Bell’s qualified 

immunity defense, distinguished its case from Fielder. Id. at 677. In Fielder, 

the namesake plaintiff was arrested and taken to jail. 590 F.2d at 107. In jail, 

Fielder was sick and began to hallucinate, physically shake, and climb the 

bars. Id. at 108. Prison officials nonetheless denied Fielder’s request for 

medical attention. Id. The sheriff was notified of Fielder’s behavior and only 

asked a deputy to check on Fielder. Id. The next morning, Fielder was found 

dead. Id. The jury found that the named prison officials had been deliberately 

indifferent to Fielder’s medical needs; on appeal, this court affirmed the 

judgment. Id. at 107–09.

While jail staff never brought Fielder to a medical professional, the 

Cleveland court noted that, by contrast, “Cleveland received emergency 

medical attention two days before he died” and that “[t]he decision not to 

hospitalize him after he fainted on November 10th was based on a different 

nurse’s medical judgment after she examined Cleveland” before Bell became 

involved in Cleveland’s care. 938 F.3d at 677. Bell’s behavior, the Cleveland

court held, was thus “very different” from the staff in Fielder who ignored an 

inmate’s requests. Id. As a result, the “‘record of extensive medical 

treatment spanning the final two and one half months’ of an inmate’s 

incarceration—combined with ‘the lack of evidence to establish the 

necessary culpable intent’—was sufficient for qualified immunity.” Id.

(quoting Gobert v. Caldwell, 463 F.3d 339, 351–52 (5th Cir. 2006)).

The facts in Cleveland are analogous to the present events; 

accordingly, our analysis in that case guides our decision here. Like 

Cleveland, Addington received medical treatment in the days before his 

death. And, like in Cleveland and unlike in Fielder, Addington never made an 

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explicit request for medical treatment that was ignored by the prison staff. In 

sum, Addington’s proffered sources of clearly established law involve 

materially different facts, and our holding in Cleveland shows that an officer 

acting under similar circumstances does not violate clearly established law. 

Accordingly, we cannot say that Addington has met his burden of placing 

“beyond debate” the question of whether an officer acting under similar 

circumstances would have been on notice that he was violating clearly 

established law. al-Kidd, 563 U.S. at 741. We thus reverse the judgment of 

the district court on this prong of the qualified immunity analysis without 

reaching the question of whether Wells’s actions constituted a constitutional 

violation.3

IV.

We now turn to the Louisiana state immunity claim, which we have 

jurisdiction to review de novo. See Morin v. Caire, 77 F.3d 116, 119–20 (5th Cir. 

1996) (noting our jurisdiction over state law claims related to a qualified 

immunity appeal); cf. Vann v. City of Southaven, 884 F.3d 307, 309 (5th Cir. 

2018) (per curiam) (identifying the standard of review for legal issues on a 

motion for summary judgment on the basis of qualified immunity). The 

relevant Louisiana immunity statute immunizes public entities and their 

officers and employees from tort claims based on “policymaking or 

discretionary acts when such acts are within the course and scope 

of . . . lawful powers and duties.” Gregor v. Argenot Great Cent. Ins. Co., 851 

So. 2d 959, 967 (La. 2003) (quoting La. Stat. Ann. § 9:2798.1(B)). 

3 For clarity, our holding here should not be imputed to an analysis of the first 

prong; in other words, we are not holding that deliberate indifference arising to a 

constitutional violation must always require an explicit request for medical attention or 

involve obvious and externally visible injuries. We are concerned only with the narrow 

question of whether the cases discussed by Addington and the district court show that 

Wells’s conduct under these specific facts violated clearly established law.

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Louisiana courts have interpreted this immunity in line with the discretionary 

function immunity provided by the Federal Tort Claims Act. Com. and Indus.

Ins. Co. v. Grinnell Corp., 280 F.3d 566, 571 (5th Cir. 2002). Louisiana courts 

apply the two-step test outlined in Berkovitz v. United States, 486 U.S. 531 

(1988), to determine if this state immunity applies:

First, if a statute, regulation, or policy prescribes a particular 

course of action, there is no choice or discretion involved, and 

the immunity does not apply. However, when discretion is 

involved, the court must then determine whether that 

discretion is the kind that is shielded by the statutory 

immunity, that is, discretion grounded in social, economic or 

political policy. 

Aucoin v. Larpenter, 324 So. 3d 626, 637–38 (La. Ct. App. 2021); Com. and 

Indus. Ins. Co., 280 F.3d at 571.

We first consider whether a policy prescribed a particular action for 

Wells. BDCC’s general policy regarding inmates’ medical care provides 

guidelines for corrections officers; these guidelines state that doctors’ 

instructions dictate treatment and that officers should report medical 

problems to the medical officer. There are no further details beyond these 

general requirements in the absence of a request for medical care by the 

inmate. Accordingly, we read the policy as allowing officers to, for example, 

determine what is and is not a medical problem requiring a report. This 

involves discretion. See Roberts v. City of Shreveport, 397 F.3d 287, 296 (5th 

Cir. 2005) (stating that an action is policy-based if it “involves selection 

among alternatives”); see also Rombach v. Culpepper, 2021 WL 2944809, at *9

(5th Cir. July 13, 2021) (per curiam) (holding that “the officers’ decisions to 

provide (or not to provide) certain care to [plaintiff] were ultimately the 

result of their discretion”); Aucoin, 324 So. 3d at 638 (holding that a state 

regulation requiring a licensed physician to be “responsible for the health 

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care program” at a parish jail involved discretion concerning “the manner in 

which that care was administered and provided”). Accordingly, we proceed 

to the second step.

We next consider whether this discretionary conduct at issue falls 

within the general protections of the statute or is excluded by an exception. 

This “is purely a question of law[] and is within the province of the trial court 

to determine at the summary judgment stage.” Simmons v. Hughes, 316 So. 

3d 488, 497 (La. Ct. App. 2020); see also Rombach, 2021 WL 2944809, at *9 

(applying this framework). Here, the relevant question is whether Wells’s 

conduct falls within the intentional misconduct exception to this state 

immunity statue. See La. Stat. Ann. § 9:2798.1(C)(2). In considering this 

question, we ask whether Addington “put forth evidence showing that the 

conduct of the defendants rose to the level of misconduct required by” the

exception to the immunity statute; in other words, “whether the defendants’ 

actions constituted ‘criminal, fraudulent, malicious, intentional, willful, 

outrageous, reckless, or flagrant misconduct.’” Simmons, 316 So. 3d at 497, 

500 (quoting La. Stat. Ann. § 9:2798.1(C)(2)).

Addington argues that Wells was deliberately indifferent for purposes 

of the qualified immunity analysis and that Wells’s conduct thus rises to the 

requisite level of intentionality required to obviate the Louisiana state 

immunity’s protections.4 Addington argues the following events evince 

Wells’s “requisite knowledge and perception” that Addington “faced a 

substantial risk to his health”: (1) Addington’s March 30 transfer to a medical 

observation cell after his discharge from Minden; (2) Addington’s fever on 

4 We consider these arguments here only in the context of evaluating the Louisiana 

state immunity claim. As noted previously, we do not reach the issue of whether Wells’s 

conduct meets the “deliberate indifference” standard for qualified immunity purposes, 

and our analysis here thus has no bearing on this issue. See supra note 3.

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March 30; (3) Addington’s March 31 complaint of nausea; (4) Wells’s March 

31 completion of the UOR showing elevated blood sugar levels; and (5) 

Wells’s alleged failure to give Addington insulin on March 31 and April 1. In 

light of these events, Addington argues that Wells’s failure to seek medical 

attention for Addington indicates he was acting with the requisite level of 

intentionality.

We disagree and hold that Wells’s conduct does not constitute the 

requisite level of intentional misconduct that would take him outside the 

protections of section 9:2798.1’s immunity provisions. Louisiana courts 

presume that “when government employees exercise discretion given to 

them by a statute or regulation, they are doing so based on the same policy 

concerns that animate the controlling statute or regulation itself.” Dominique 

v. Parish, 313 So. 3d 307, 316 (La. Ct. App. 2020) (citing Louisiana v. Pub.

Invs., Inc., 35 F.3d 216, 221 (5th Cir. 1994)). Addington has not successfully 

rebutted this presumption. As an initial matter, most of the events Addington 

cites are not sufficient to establish intentional misconduct on Wells’s part.

5

Concerning Wells’s alleged failure to give Addington insulin, the record 

indicates that Addington knew how to request medical attention. No record 

evidence suggests that Addington requested (but did not receive) insulin on 

the day of his death, much less that Wells knew of but failed to complete such 

a request. Without more, this is not enough to establish the requisite degree 

of intentional misconduct on the part of Wells.

5 Concerning Addington’s transfer to a medical observation cell, this transfer 

suggests only that further observation was appropriate, not that the immediate notification 

of medical personnel was necessary. Regarding Addington’s fever, as noted by the district 

court, “there is no evidence that the fever was such a concern to require immediate medical 

care other than further observation.” And with respect to Addington’s nausea, Addington 

received medication for this ailment, after which there would presumably have been a 

reduced need for additional medical concern. .

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Wells’s filling out the UOR requires a more sustained discussion. In 

making this argument, Addington essentially asks us to hold that a medically 

untrained official filling out a UOR constitutes evidence of intentional or 

reckless conduct. We decline to do so under these facts. In his deposition, 

Wells indicated that he believed the normal blood sugar level for a diabetic 

“shouldn’t be over 100” and that he would have notified medical staff with 

a “crazy” reading of “500 or something.” His testimony thus suggests that 

Wells thought of blood sugar levels over 100 mg/dL as unusual and levels 

over 500 mg/dL as requiring medical attention. This latter range is mostly 

consistent with Addington’s discharge papers from Minden, which flagged 

below 50 or above 400 mg/dL as extreme blood sugar levels. 

But notably, the blood sugar levels recorded by Wells in the UOR 

ranged from 274 to 364 mg/dL; these levels were not within the extreme 

ranges identified in the Minden discharge papers or the “crazy” ranges 

understood by Wells as requiring medical attention. Accordingly, Wells’s 

filling out the UOR suggests that he thought these blood sugar readings were 

unusual but not so concerning as to require immediate medical attention.

Addington’s argument essentially asks us to eliminate this distinction by 

holding that filling out a UOR without requesting immediate medical 

attention evinces intentional misconduct. We will not do so here, where a 

medically untrained official was merely noting unusual events while abiding 

by Minden’s discharge instructions. Wells’s decision to not seek medical 

attention for Addington after this UOR is better characterized as a kind of 

“policy-based discretion,” Roberts, 397 F.3d at 296, where Wells, looking to 

the discharge medical instructions, determined that the recorded blood sugar 

levels did not rise to the level that would require his calling for immediate 

medical assistance.

The evidence in the record thus does not indicate that Wells was 

malicious, willful, or reckless in declining to pursue further medical care for 

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Addington. Accordingly, we cannot say that Wells’s actions (or lack thereof) 

rose to the level of intention, malice, willfulness, or recklessness that would 

place him under the intentional misconduct exception to section 9:2798.1’s 

immunity provisions. Section 9:2798.1 instead operates to shield Wells from 

state tort liability for negligence, and the district court erred in holding 

otherwise.

V.

For the foregoing reasons, we REVERSE the judgment of the district 

court.

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