United States Court of Appeals

for the Fifth Circuit ____________

No. 23-30486

____________

Bobby Stevenson, 

Plaintiff—Appellee, 

versus

Paul M. Tocé, in his individual capacity; Randy Lavespere, in his 

individual capacity, 

Defendants—Appellants. 

______________________________

Appeal from the United States District Court 

for the Middle District of Louisiana

USDC No. 3:22-CV-472

______________________________

Before Clement, Graves, and Ramirez, Circuit Judges.

James E. Graves, Circuit Judge: 

Bobby Stevenson is a prisoner at the Louisiana State Penitentiary in 

Angola, Louisiana. He alleges that for years he has been forced to labor in the 

prison’s agricultural fields despite extreme pain in his ankle caused by two 

broken surgical screws. Now, he sues two prison physicians who he claims

refused to fix the broken screws or relieve him from field labor. The

physicians moved to dismiss the suit, invoking the defense of qualified 

immunity. The district court found Stevenson’s allegations sufficient to 

overcome the defense. We AFFIRM. 

United States Court of Appeals

Fifth Circuit

FILED

August 22, 2024

Lyle W. Cayce

Clerk

Case: 23-30486 Document: 88-1 Page: 1 Date Filed: 08/22/2024
No. 23-30486

2

I. BACKGROUND

a. Factual background

The following facts are contained in Stevenson’s operative complaint

or were explicitly incorporated into it from an earlier complaint. At the

motion to dismiss stage, we accept Stevenson’s allegations as true. Crane v. 

City of Arlington, 50 F.4th 453, 461 (5th Cir. 2022).

Stevenson fractured his right ankle playing basketball in the prison 

yard in 2003. He was treated outside the prison by an orthopedic surgeon, 

who installed surgical screws in Stevenson’s ankle to keep the bones in place. 

To keep the screws from breaking, Stevenson was permanently relieved of 

field duty status, meaning he could not be required to perform manual labor 

or even stand or walk for prolonged periods. 

For some reason, Stevenson’s duty status was later revoked, and he 

was required to return to work in the agricultural fields. The strain on his 

ankle caused one of the screws to break, as revealed in a May 2006 x-ray. The 

broken screw caused pain and swelling. Stevenson was again relieved of field 

duty status, but he was not told about the broken screw. 

In 2019, Stevenson’s out-of-field status was revoked again, this time 

by defendant Dr. Randy Lavespere. In 2020, a second x-ray revealed another 

broken screw in Stevenson’s ankle. Again, Stevenson was not told. But his 

ankle continued to cause him “tremendous pain” and “daily pain and 

torment” and affected his ability to walk normally, causing secondary 

injuries. He complained continually and requested a change in duty status to 

relieve him of work in the fields. But “[w]ithout knowledge of the broken 

screws,” Stevenson alleges, he “did not know to ask for their surgical 

removal or repair.”

Case: 23-30486 Document: 88-1 Page: 2 Date Filed: 08/22/2024
No. 23-30486

3

In April 2021, Stevenson saw another prison physician for a rash on 

his face. He also complained about his ankle, so the physician reviewed 

Stevenson’s records and found the 2006 and 2020 x-rays. Stevenson was 

finally informed about the broken screws. 

Several months later, Dr. Ronald Sylvest, an orthopedic specialist at 

the prison, examined Stevenson. Sylvest made two recommendations. First, 

he suggested that Stevenson be seen by an orthopedic surgeon. He opined 

that the broken screws were the likely cause of Stevenson’s severe ankle pain. 

He also suggested that Stevenson’s duty status be changed to relieve him 

from field work. He gave Stevenson a brace to stabilize his ankle until it could 

be evaluated by a surgeon. 

An x-ray taken in September 2021—ordered by Lavespere and 

approved by defendant Dr. Paul M. Tocé—revealed that the broken screws 

had “complicated” Stevenson’s ankle injury. 

On March 11, 2022, Stevenson reported severe nerve pain and was 

examined in the prison clinic. Ten days later, an orthopedic specialist

examined Stevenson and prescribed heel stretches. 

Stevenson alleges that Lavespere and Tocé (collectively, “the 

Defendants”) were involved in his medical care. He alleges that both 

personally examined him for complaints about his ankle. Both allegedly knew 

about the screws and had the authority to refer him to someone qualified to

repair them but did not. And both allegedly reviewed and declined his duty 

status requests.

Stevenson acknowledges he has received some medical care, but he 

claims it was either directed to other ailments, intended to be temporary, or

plainly insufficient to treat the broken screws. 

Case: 23-30486 Document: 88-1 Page: 3 Date Filed: 08/22/2024
No. 23-30486

4

At the time he filed this case, Stevenson remained on a duty status 

that required him to labor in the fields despite his severe ankle pain. He had

not been seen by a surgeon, and the screws had not been repaired. 

b. Procedural background

On July 13, 2022, Stevenson filed this lawsuit. He was not represented 

by an attorney at the time. He brought a single claim against the Defendants 

under 42 U.S.C. § 1983, alleging that they each violated his right under the 

Eighth Amendment to be free from cruel and unusual punishment. 

There are two componentsto Stevenson’s § 1983 claim. Asto the first 

component, he allegesthat the Defendants knew about the broken screws and 

fielded his complaints of severe pain but ignored the problem. Second, he 

claims that the Defendants knew that work in the fields was not appropriate

for him given his injury but refused to reassign him. He seeks monetary relief

and an injunction to force the Defendants to fix the screws and change his 

duty status. 

The Defendants moved to dismiss Stevenson’s case, arguing that the 

doctrine of qualified immunity protected them from liability. The magistrate 

judge granted Stevenson’s request to file a combined response and amended 

complaint. But the magistrate judge declined to consider various medical 

records that the Defendants had filed along with their motion to dismiss. 

The magistrate judge then recommended that the district judge deny 

the Defendants’ motion. The district court accepted the recommendation 

over the Defendants’ objections and denied the motion to dismiss. This 

appeal followed. 

II. STANDARD OF REVIEW

We review de novo a district court’s denial of a motion to dismiss 

based on qualified immunity. Brown v. Miller, 519 F.3d 231, 236 (5th Cir. 

Case: 23-30486 Document: 88-1 Page: 4 Date Filed: 08/22/2024
No. 23-30486

5

2008). Our review is based only on the specific factual allegations of the 

complaint and all reasonable inferences that can be drawn from them. Morgan 

v. Swanson, 659 F.3d 359, 370 (5th Cir. 2011) (en banc). We are also required 

to construe liberally complaints filed by prisoners who are not represented by 

attorneys. Jackson v. Cain, 864 F.2d 1235, 1241 (5th Cir. 1989).

III. DISCUSSION

The Defendants argue that Stevenson’s allegations do not amount to 

an Eighth Amendment violation. But even assuming they do, the Defendants

argue, governing law did not give officials fair warning that those actions were

unlawful, and therefore, qualified immunity applies.

Stevenson tries to rebut those arguments and also argues that we lack 

power to consider the appeal. He contends our jurisdiction is limited to 

whether the district court correctly applied the law when it denied qualified 

immunity. But the Defendants’ challenge, he argues, is not to the district 

court’s legal analysis but to the veracity of Stevenson’s allegations.

1

a. Appellate jurisdiction

We must resolve challenges to our jurisdiction first. Daves v. Dallas 

Cnty., 64 F.4th 616, 621 (5th Cir. 2023) (en banc). A court’s jurisdiction is its 

power to hear a case. See Carlsbad Tech., Inc. v. HIF Bio, Inc., 556 U.S. 635, 

639 (2009). We have the power to review a district court’s denial of qualified 

immunity at the motion to dismiss stage. Armstrong v. Ashley, 918 F.3d 419, 

422 (5th Cir. 2019). But at this early stage, we are restricted to determining 

“‘whether the facts pleaded establish’ ‘a violation of clearly-established 

_____________________

1 Stevenson also argues that recent scholarship undermines the foundation of 

Supreme Court precedent requiring the application of the qualified immunity doctrine to 

claims under 42 U.S.C. § 1983. Whatever the merits of Stevenson’s argument, we do not 

reach them. The Supreme Court alone has “the prerogative of overruling its own 

decisions.” Mallory v. Norfolk S. Ry. Co., 600 U.S. 122, 136 (2023).

Case: 23-30486 Document: 88-1 Page: 5 Date Filed: 08/22/2024
No. 23-30486

6

law.’” Ramirez v. Escajeda, 921 F.3d 497, 501 (5th Cir. 2019) (quoting 

Ashcroft v. Iqbal, 556 U.S. 662, 673 (2009)). In other words, a proper appeal 

asks us “whether the district court erred in concluding as a matter of law that 

officials are not entitled to [qualified immunity] on a given set of facts.” Id.

at 499 (citation omitted). 

Stevenson contends that we lack jurisdiction over the appeal because 

the Defendants predicate all of their arguments on disputed facts. We find 

the contention overly broad. Most of the Defendants’ arguments are in fact 

confined to the “given set of facts” before the magistrate judge—

Stevenson’s complaint, amended complaint, and exhibits. See Fed. R. Civ. 

P. 10(c). The Defendants’ arguments based on purported factual

inconsistencies or deficits within the four corners of the complaint are legal 

in nature; they challenge whether, as a matter of law, the complaint shows a 

violation of Stevenson’s rights. Cooper v. Brown, 844 F.3d 517, 522 (5th Cir. 

2016).

But we agree that one section of the Defendants’ appellate brief raises

arguments based on facts not in the pleadings. They center on twenty-three 

documents that the Defendants argue are part of Stevenson’s medical 

records. The documents were apparently referenced by the pleadings but not

actually attached to them as exhibits. 

As the Defendants concede, the magistrate judge had the discretion 

not to consider the twenty-three documents and did not consider them. See

Collins v. Morgan Stanley Dean Witter, 224 F.3d 496, 499 (5th Cir. 2000)

(explaining court may consider documents referenced in, but not attached to,

complaint if documents “assist[] the plaintiff in establishing the basis of the 

suit”). Because the magistrate judge did not consider the documents, they 

did not bear on the district court’s legal determination. The facts contained 

only in those documents are not part of the “given set of facts” before us. 

Case: 23-30486 Document: 88-1 Page: 6 Date Filed: 08/22/2024
No. 23-30486

7

Ramirez, 921 F.3d at 499. We lack jurisdiction to review arguments based on 

them.

b. Qualified immunity

Federal law, codified at 42 U.S.C. § 1983, creates a legal claim for 

individuals whose rights are violated by state officials. In response, officials

may raise the defense of qualified immunity. Cooper, 844 F.3d at 522. If they 

do, the plaintiff must make two showings. Id. First, he must show that he

adequately alleged that his rights were violated. Id. Second, he must show 

that, at the time his rights were violated, legal precedent clearly established 

the officials’ actions as unlawful. Id.

i. Eighth Amendment violation

Stevenson’s claims are based on the Eighth Amendment. The Eighth 

Amendment protects individuals convicted of crimes from cruel and unusual 

punishment. One facet of that protection is that prison officials must “ensure 

that inmates receive adequate . . . medical care.” Farmer v. Brennan, 511 U.S. 

825, 832 (1994).

To succeed on a § 1983 claim based on a violation of that duty, a 

prisoner must show that the officials acted with deliberate indifference. Id. at 

834. That means the official “knows of and disregards an excessive risk to 

[the prisoner’s] health or safety.” Id. at 837. The prisoner must do more than 

express dissatisfaction with his treatment. Easter v. Powell, 467 F.3d 459, 464 

(5th Cir. 2006). He must allege that officials “refused to treat him, ignored 

his complaints, intentionally treated him incorrectly, or engaged in any 

similar conduct that would clearly evince a wanton disregard for any serious 

medical needs.” Id. (quoting Domino v. Tex. Dep’t of Crim. Just., 239 F.3d 

752, 756 (5th Cir. 2001) (internal quotations omitted)).

Moreover, the prisoner’s medical need must be “serious”—meaning 

either treatment has been recommended, or the need for treatment is “so 

Case: 23-30486 Document: 88-1 Page: 7 Date Filed: 08/22/2024
No. 23-30486

8

apparent that even laymen would recognize” it. Gobert v. Caldwell, 463 F.3d 

339, 345 n.12 (5th Cir. 2006).

Thus, Stevenson needed to allege facts that reasonably lead to the 

conclusion that the Defendants knew of an excessive risk that Stevenson 

would suffer severe pain if they failed to act, and they still chose not to act. 

See Domino, 239 F.3d at 755. We start with his claim that the Defendants 

refused to treat him for the broken screws. He alleges that the broken screws 

caused him great pain and torment. He alleges the Defendants were each 

responsible for his medical care yet “allow[ed] [him] to suffer indefinitely . . 

. and refus[ed] to provide any treatment for the broken screws.” He also

alleges that the Defendants ignored a direct medical recommendation that 

Stevenson be examined by a surgeon. 

The Defendants principally argue that Stevenson’s own allegations

establish that they did treat Stevenson, and that he is just dissatisfied with the 

treatment. They point to several types of treatment that Stevenson admits, 

in the operative complaint, to having received—specifically, medication; a

low-sodium diet; TED hose (a type of compression sock); heel stretches; and 

an ankle brace. 

But Stevenson specifically alleges that those treatments were not 

intended to fix the broken screws. He alleges that the medication and diet 

were for high blood pressure. He alleges that the TED hose was for venous 

insufficiency. He alleges that the heel stretches were for a heel spur. He 

alleges that the brace he received from Sylvest was meant to temporarily

stabilize his ankle pending surgery, not as a permanent fix. Those plausible

factual allegations establish, for pleading purposes, that the Defendants never 

provided treatment for the broken screws. See Iqbal, 556 U.S. at 679.

The Defendants next argue that a letter attached to the amended 

complaint contradicts Stevenson’s allegation that Sylvest recommended 

Case: 23-30486 Document: 88-1 Page: 8 Date Filed: 08/22/2024
No. 23-30486

9

surgery. Tocé wrote the letter to Stevenson nearly a month after Stevenson 

filed this case. He wrote that Sylvest recommended the ankle brace and heel 

stretches as treatment and did not recommend consultation with a surgeon. 

If an exhibit to a complaint contradicts an allegation in the complaint, 

the exhibit controls. Sligh v. City of Conroe, 87 F.4th 290, 298 (5th Cir. 2023). 

But we find no contradiction. Stevenson’s attachment of the letter merely 

acknowledges that Tocé claims that Sylvest did not recommend surgery. But 

there is no evidence from Sylvest himself indicating that he never 

recommended consultation with a surgeon. 

Even if Sylvest never recommended surgery, we would not find that

fatal to Stevenson’s claim at this stage. Deliberate indifference does not 

require a showing that officials disregarded a recommendation if the medical 

need was “so apparent that even laymen would recognize that care is 

required.” Gobert, 463 F.3d at 345 n.12. We think, drawing on “judicial 

experience and common sense,” Iqbal, 556 U.S. at 679, that a layperson could 

see that a brace and heel stretches cannot fix broken ankle screws.

Next, Stevenson alleges that the Defendants denied his duty status 

requests despite knowing that keeping him in the fields would inflict 

unnecessary pain and risk further damage to his ankle. We have said that an 

official violates a prisoner’s Eighth Amendment rights if he requires the 

prisoner to do work that he “kn[o]w[s] w[ill] significantly aggravate [the 

prisoner’s] serious physical ailment.” Jackson, 864 F.2d at 1246; see also 

Calhoun v. Hargrove, 312 F.3d 730, 734 (5th Cir. 2002). Stevenson’s 

allegations satisfy that standard.

Contrary to the Defendants’ argument, we do not find Winston v. 

Stacks, 243 F. App’x 805 (5th Cir. 2007) to counsel otherwise. There, a

plaintiff’s Eighth Amendment claim based on working conditions failed 

because he had not alleged that his work assignment aggravated his medical 

Case: 23-30486 Document: 88-1 Page: 9 Date Filed: 08/22/2024
No. 23-30486

10

condition or otherwise caused him any harm. Id. at 806. Stevenson alleges 

that labor in the fields is what caused the screws to break—first in 2006 and 

again in 2020, after Lavespere himselfreturned Stevenson to field duty—and 

that, thereafter, the work caused him severe pain. Those allegations

distinguish Stevenson’s claims from Winston.

In sum, Stevenson sufficiently alleged that the Defendants violated his 

right to receive adequate medical care in prison.

ii. Clearly established

Next, Stevenson must demonstrate that the violation of his rights was 

“clearly established.” Cooper, 844 F.3d at 522. He must “point this court to 

a legislative directive or case precedent that is sufficiently clear such that 

every reasonable official would have understood that what he is doing violates 

that law.” Keller v. Fleming, 952 F.3d 216, 225 (5th Cir. 2020). Qualified 

immunity will not be granted if, in light of that precedent,“[a]ny reasonable 

person in [the Defendants’] position would have known that ignoring 

[Stevenson’s] complaints . . . would be a violation of his rights under the 

Eighth Amendment.” Rodrigue v. Grayson, 557 F. App’x 341, 347 (5th Cir. 

2014) (citing Gobert, 463 F.3d at 346).

The Defendants argue that Stevenson failed to identify any “cases 

that require [a prisoner] to be referred to an outside surgeon rather than the 

orthopedic specialist” or that entitle a prisoner to “the duty status [he] 

prefers.” 

The Supreme Court has instructed courts to not “define clearly 

established law at a high level of generality.” Ashcroft v. al-Kidd, 563 U.S. 731, 

742 (2011). Rather, precedent must speak to “the violative nature of [the]

particular conduct” and “the specific context of the case.” Mullenix v. Luna, 

577 U.S. 7, 12 (2015) (emphasis omitted). That means plaintiffs must point 

to “similar circumstances” rather than “generalized proposition[s]” to 

Case: 23-30486 Document: 88-1 Page: 10 Date Filed: 08/22/2024
No. 23-30486

11

show that caselaw established particular conduct as unlawful. Rogers v. 

Jarrett, 63 F.4th 971, 977 (5th Cir. 2023).

Still, the Defendants’ framing is too narrow. A plaintiff need not show 

that “the very action in question has previously been held unlawful.” Easter, 

467 F.3d at 465 (emphasis added) (quoting Anderson v. Creighton, 483 U.S. 

635, 640 (1987)). The test is whether every reasonable official would know 

that their actions are unconstitutional. Villarreal v. City of Laredo, 94 F.4th 

374, 395 (5th Cir. 2024) (en banc). At the end of the day, “[t]he sine qua non

of the clearly-established inquiry is ‘fair warning.’” Morgan, 659 F.3d at 372 

(quoting Hope v. Pelzer, 536 U.S. 730, 741 (2002)). To require Stevenson to 

produce cases about broken surgical screws or orthopedic surgeons is more 

than necessary for fair warning.

There are cases enough establishing the Defendants’ alleged acts as 

clearly unconstitutional. In Easter v. Powell, a prison nurse knew the plaintiff 

had a history of cardiac problems. 467 F.3d at 464. But when he reported 

severe chest pain, she first directed him to the pharmacy, and when she 

learned it was closed, she sent him back to his cell. Id. at 463–64. The nurse’s 

plainly ineffective “treatment” was tantamount to turning a deaf ear. Id. at 

464. And, we stated plainly, “the law [is] clearly established that a prison 

inmate [can] demonstrate an Eighth Amendment violation by showing that a 

prison official ‘refused to treat him . . . [or] ignored his complaints.’” Id. 

(quoting Domino, 239 F.3d at 756). 

In Carlucci v. Chapa, a dentist recommended that a prisoner’s 

fractured teeth be repaired. 884 F.3d 534, 536–37 (5th Cir. 2018). In the 

meantime, the dentist gave the prisoner a bite guard to avoid further damage. 

Id. at 537. Ultimately, and despite the prisoner’s repeated requests, prison 

officials never saw to it that the prisoner’s teeth were repaired. Id. As a result, 

he experienced extreme pain and further dental damage. Id. at 539. We

Case: 23-30486 Document: 88-1 Page: 11 Date Filed: 08/22/2024
No. 23-30486

12

concluded that the officials’ inaction constituted deliberate indifference. Id.

And again, we made the rule clear: “[t]he denial of recommended medical 

treatment is . . . sufficient to show deliberate indifference.” Id. at 538.

These cases gave the Defendants fair warning. They should have 

known from Easter that they had a duty to try to provide effective treatment 

for the broken screws. They should have known from Carlucci that they could 

not ignore a medical recommendation or rely on a temporary solution that is

clearly insufficient to meet their patient’s need.

The Defendants say these cases do not tell them “what measures 

[they] were required to take once they learned of the broken screws.” We 

disagree. The cases provide an answer that should have been obvious: fix the

screws.

As for Stevenson’s duty status claim, we look to Jackson v. Cain. 

There, a prisoner brought an Eighth Amendment claim based on work duties 

he claimed were “inappropriate to his medical condition.” 864 F.2d at 1246.

He specifically alleged that officials knew he suffered from syphilis and knew 

that exposure to sunlight would hinder his treatment but still forced him to 

work in the sun. Id. at 1239, 1246–47. We concluded that those allegations 

amounted to deliberate indifference.

Stevenson’s medical condition is different, but his circumstances are 

essentially the same. He alleges that the Defendants knew of the broken 

screws and knew that field labor was likely to worsen his condition and cause 

him severe pain but still forced him to do it. Jackson clearly established that 

such circumstances, if proven true, violate the Eighth Amendment. Id. at 

1244, 1246; see also Calhoun, 312 F.3d at 734–35 (finding a claim for deliberate 

indifference where a prison official purportedly knew of an inmate’s medical 

work restrictions, yet forced him to work far beyond those limitations). 

Case: 23-30486 Document: 88-1 Page: 12 Date Filed: 08/22/2024
No. 23-30486

13

Consequently, Stevenson has sufficiently alleged that the Defendants 

violated his Eighth Amendment rights through actions that, at the time, were 

clearly established as unconstitutional.

Stevenson has satisfied both prongs of the qualified immunity test. 

The district court did not err in denying the Defendants’ motion to dismiss.

IV. CONCLUSION

We AFFIRM.

Case: 23-30486 Document: 88-1 Page: 13 Date Filed: 08/22/2024