Court Opinion

ID: 9408601
Source: CourtListenerOpinion
Date Created: 2023-07-13 15:01:34.726941+00
Date Added: 2024-06-11T17:20:45.037639
License: Public Domain

United States Court of Appeals
                            For the Eighth Circuit
                        ___________________________

                                No. 22-1459
                        ___________________________

Kevin Scott Karsjens, and all others similarly situated; Kevin John DeVillion, and
   all others similarly situated; Peter Gerard Lonergan, and all others similarly
situated; James Matthew Noyer, Sr., and all others similarly situated; James John
Rud, and all others similarly situated; James Allen Barber, and all others similarly
   situated; Craig Allen Bolte, and all others similarly situated; Dennis Richard
   Steiner, and all others similarly situated; Kaine Joseph Braun, and all others
 similarly situated; Christopher John Thuringer, and all others similarly situated;
Kenny S. Daywitt, and all others similarly situated; Bradley Wayne Foster, and all
 others similarly situated; David Leroy Gamble, and all others similarly situated;
                Brian K. Hausfeld, and all others similarly situated

                                      Plaintiffs - Appellants

                                          v.

  Jodi Harpstead; Kevin Moser, in their individual and official capacities; Peter
    Puffer; Ann Zimmerman, in their individual and official capacities; Nancy
   Johnston, in their individual and official capacities; Jannine Hebert, in their
                         individual and official capacities

                                     Defendants - Appellees

                             ------------------------------

                                   United States

                               Amicus on Behalf of Appellant(s)
                                 ____________

                     Appeal from United States District Court
                          for the District of Minnesota
                                 ____________
                             Submitted: April 12, 2023
                               Filed: July 13, 2023
                                  ____________

Before LOKEN, SHEPHERD, and KELLY, Circuit Judges.
                          ____________

SHEPHERD, Circuit Judge.

      This case was brought by a class of sex offenders (Appellants) civilly
committed to the Minnesota Sex Offender Program (MSOP) pursuant to the
Minnesota Civil Commitment and Treatment Act: Sexually Dangerous Persons and
Sexual Psychopathic Personalities, codified at Minnesota Statute § 253D (MCTA).
Appellants filed this action against various MSOP managers and officials, as well as
the Commissioner of the Minnesota Department of Human Services (collectively,
Appellees). On remand after a second appeal to this Court, the district court 1 granted
judgment in favor of Appellees on all of Appellants’ claims. Appellants appeal,
challenging the district court’s judgment. Having jurisdiction under 28 U.S.C.
§ 1291, we affirm.

                                          I.

       Our prior panel opinions contain the entire detailed factual and procedural
background of this case. See Karsjens v. Piper (Karsjens I), 845 F.3d 394, 398-403
(8th Cir. 2017); Karsjens v. Lourey (Karsjens II), 988 F.3d 1047, 1049-50 (8th Cir.
2021). Here, only a general recitation of this background is necessary to
contextualize the matters on appeal. Appellants initially brought 13 counts against
Appellees, which the district court divided into two “phases” for trial:

      1
        The Honorable Donovan W. Frank, United States District Judge for the
District of Minnesota.
                                   -2-
   • Phase 1, consisting of Count 1 (alleging that the MCTA is facially
     unconstitutional); Count 2 (alleging that the MCTA is unconstitutional as
     applied); Count 3 (alleging that Appellees failed to provide treatment, in
     violation of the Fourteenth Amendment and the Minnesota Constitution);
     Count 4 (alleging that Appellees failed to provide treatment, in violation of
     the MCTA); Count 5 (alleging that Appellees denied Appellants the right to
     be free from punishment, in violation of the Fourteenth Amendment and the
     Minnesota Constitution); Count 6 (alleging that Appellees denied Appellants
     the right to less restrictive alternative confinement, in violation of the
     Fourteenth Amendment and the Minnesota Constitution); Count 7 (alleging
     that Appellees denied Appellants the right to be free from inhumane
     treatment, in violation of the Fourteenth Amendment and the Minnesota
     Constitution); and Count 11 (alleging that Appellees violated court-ordered
     treatment).

   • Phase 2, consisting of Count 8 (alleging that Appellees denied Appellants the
     right to religious freedom, in violation of the First and Fourteenth
     Amendments); Count 9 (alleging that Appellees unreasonably restricted free
     speech and free association, in violation of the First Amendment and the
     Minnesota Constitution); Count 10 (alleging that Appellees conducted
     unreasonable searches and seizures, in violation of the Fourth Amendment
     and the Minnesota Constitution); Count 12 (alleging that individual Appellees
     breached Appellants’ contractual rights); and Count 13 (alleging that
     individual Appellees tortiously interfered with contractual rights and
     intentionally violated Minnesota Statute § 253B.03, subdiv. 7).

       The district court held a six-week bench trial on Phase 1 claims, ultimately
granting judgment in favor of Appellants on Counts 1 and 2 and entering a related
injunction. Appellees appealed the judgment and injunction. In Karsjens I, we held
that the district court applied the wrong standards to Counts 1 and 2, and, after
applying the correct standards, we reversed the decision, vacated the injunction, and

                                         -3-
remanded the case to the district court for further proceedings on the remaining
Phase 1 claims—Counts 3, 5, 6, and 7. 2 See 845 F.3d at 406-11.

       On remand, Appellees argued that Karsjens I required the district court to
apply the “shocks the conscience” standard to the remaining claims, which allege
unconstitutional conditions within the MSOP, because that was the standard we
applied to Appellants’ as-applied claims in Count 2. Appellants, on the other hand,
argued that the conditions-of-confinement claims were more appropriately reviewed
under the standard pronounced in Bell v. Wolfish, 441 U.S. 520 (1979), which held
that conditions of confinement for pretrial detainees that “amount to punishment of
the detainee” violate due process. Id. at 535. The district court agreed with
Appellees, applied the “shocks the conscience” standard to all remaining Phase 1
claims, and granted judgment in favor of Appellees, dismissing Appellants’ claims
with prejudice. Appellees also moved for summary judgment on the Phase 2 claims,
and the district court granted the same in favor of Appellees. Appellants appealed
only the dismissal of the Phase 1 claims. In Karsjens II, we first determined that
Count 3—which alleges constitutionally inadequate treatment—was duplicative of
previously decided Count 2. 988 F.3d at 1051. Then, we found that the district court
erred by not applying the “deliberate indifference” standard to that portion of
Count 7 which alleges a deprivation of adequate medical care. Id. at 1051-52.
Finally, we held that the district court erred by not applying the Bell standard to the
conditions-of-confinement claims alleged in Counts 5, 6, and 7. Id. at 1053.
Accordingly, we affirmed the dismissal of Count 3 but vacated the district court’s
dismissal of Counts 5, 6, and 7 and remanded for further consideration under the
appropriate standards. Id. at 1052-54.

      On remand for the second time, the parties again filed additional briefing on
the remaining claims: Counts 5, 6, and 7. The parties first disputed the scope of
remand. Appellees contended that Count 6—which alleges denial of the right to less

      2
      Prior to the district court’s order, Appellants moved to voluntarily dismiss
Phase 1 Counts 4 and 11 and Phase 2 Counts 12 and 13. The district court
subsequently granted the motion, dismissing the counts with prejudice.
                                         -4-
restrictive alternative confinement—was duplicative of previously decided Counts 1
and 2. Though the district court recognized that, in Karsjens II, we expressly
affirmed the dismissal of only Count 3 as duplicative of Count 2, it nonetheless found
that Count 6 was duplicative and dismissed it accordingly. However, in the
alternative, the district court considered whether the denial of access to less
restrictive confinement was punitive in violation of Bell. It noted that Appellants
“do not have a right to the ‘least restrictive alternative’ possible.” R. Doc. 1197, at
9 n.8 (quoting Beaulieu v. Ludeman, 690 F.3d 1017, 1032 (8th Cir. 2012)). The
district court found that, while not every Appellant can be housed in the least
restrictive facility in MSOP, “there is no evidence that the continuum of facilities
that [Appellees] offer is punitive.” Accordingly, the district court determined that
there was no constitutional violation and that it “must defer to [Appellees’]
‘execution of policies and practices that in [their] judgment [is] needed to preserve
internal order and discipline and to maintain institutional security.’” R. Doc. 1197,
at 9 n.8 (second and third alteration in original) (quoting Bell, 441 U.S. at 547). The
parties also disputed whether treatment-related claims—that is, claims regarding the
treatment of the illnesses that led to Appellants’ civil commitment—were properly
before the district court. However, the district court found that the remaining counts
before it did not contain any treatment-related claims and, accordingly, declined to
consider the same as beyond the scope of remand.

       Moving to the merits of the conditions-of-confinement claims in Counts 5
and 7, the district court found that the challenged conditions—the double occupancy
rooms, the “Behavioral Expectation Reports and Grievance Procedure,” the use of
the “High Security Area,” the movement of Appellants, the meals, the group therapy,
the treatment of Appellants’ property, the removal of furniture, the random searches,
the employment-related policies, and the use of restraints during transportation—
“serve legitimate governmental objectives that are not excessive, arbitrary, or
purposeless, and are not punitive under Bell,” even when considered as a whole.
Finally, it addressed Appellants’ inadequate-medical-care claim in Count 7. The
district court found that while there are no nursing or medical staff assigned to the
MSOP’s assisted-living unit, the record did not establish that Appellees were ever
                                         -5-
deliberately indifferent to any illness or injury or that any alleged indifference caused
any actual injury or harm. Accordingly, the district court granted judgment in favor
of Appellees and dismissed the remaining claims with prejudice.

                                           II.

       Appellants appeal from the district court’s judgment, contending that the
district court erred (1) in determining the scope of remand; (2) by finding that the
remaining conditions of confinement were not punitive under Bell; and (3) by
granting judgment in favor of Appellees on Appellants’ inadequate-medical-care
claim. “When the district court conducts a bench trial as it did here, we review the
district court’s fact finding for clear error, and we review legal conclusions and
mixed questions of law and fact de novo.” Fowler v. LAC Mins. (USA), LLC, 694
F.3d 930, 933 (8th Cir. 2012) (citation omitted).

                                           A.

       Appellants first contend that the district court erred in determining the scope
of remand by finding that Count 6 was previously decided by Karsjens I and by
ignoring their treatment-related claims. “Once we render a decision on appeal,
‘[u]nder the law[-]of[-]the[-]case doctrine, a district court must follow our mandate,
and we retain the authority to decide whether the district court scrupulously and fully
carried out our mandate’s terms.’” Marshall v. Anderson Excavating & Wrecking
Co., 8 F.4th 700, 711 (8th Cir. 2021) (alterations in original) (citation omitted). We
review whether the district court erroneously limited the scope of remand de novo.
United States v. Hamilton, 950 F.3d 567, 571 (8th Cir. 2020).

       Appellants first challenge the district court’s dismissal of Count 6—which
alleges that Appellees deny Appellants the right to less restrictive alternative
confinement—on the basis that it is duplicative of Count 2—which asserted an
as-applied due process claim focused on the statutory scheme and implementation
of the MCTA and was resolved in Karsjens I. In Karsjens II, we determined that
                                          -6-
Count 3—which alleged constitutionally inadequate treatment of illnesses that led
to Appellants’ civil commitment—was duplicative of Count 2. However, we
explicitly noted that the remaining claims, including Count 6, do not address the
statutory scheme or the implementation thereof, but rather “focus squarely on the
conditions of confinement, including . . . the lack of less restrictive alternatives.”
Karsjens II, 988 F.3d at 1051. “In other words, in Counts 5, 6, and 7, Appellants do
not challenge their inability to be released from the facility but rather the conditions
within the facility.” Id. (emphasis added). The district court interpreted this
distinction as this Court possibly “le[aving] space for [Appellants] to distinguish
their Count [6] claims from those already dismissed in the context of punitive
conditions.” R. Doc. 1197, at 9 n.8. Finding that Appellants had not made such
distinction, it dismissed Count 6 as duplicative.

       We agree with Appellants and continue to view Count 6 as a claim distinct
from the previously decided counts. Instead of attacking the constitutionality of the
treatment like Counts 1, 2, and 3, Count 6 alleges a conditions-of-confinement claim,
contending that Appellees’ failure to provide the least restrictive alternative
confinement amounts to punishment. See Karsjens II, 988 F.3d at 1051.
Accordingly, we find that the district court erroneously determined that Count 6 is
controlled by Karsjens I. However, the error is harmless because the district court
found, in the alternative, that failure to confine Appellants in the least restrictive
alternative is not punitive under Bell. As such, we will address the district court’s
alternative holding. See infra Section II.B.

       Appellants also contend that the district court erred by declining to address
their treatment-related claims, alleging that the district court found them to be
duplicative of previously decided counts. However, Appellants misconstrue the
district court’s order: The district court found simply that the counts alleged in the
Third Amended Complaint and properly before the district court “do not assert any
treatment-related claims.” R. Doc. 1197, at 10 (emphasis added). In making this
finding, the district court did not dismiss or otherwise ignore any of the counts before
it, which were all conditions-of-confinement and inadequate-medical-care claims.
                                          -7-
While Appellants attempted to “reanimate” these claims in a Fourth Amended
Complaint, the district court denied the amendment, and Appellants do not challenge
that decision on appeal. Accordingly, we perceive no error in the district court’s
treatment of Appellants’ treatment-related claims.

                                         B.

       Moving to the substance of Appellants’ claims, they contend that the district
court erred by finding that the conditions of confinement alleged in Counts 5, 6, and
7 3 were not punitive under Bell. “In analyzing whether a condition of confinement
is punitive, courts ‘decide whether the disability is imposed for the purpose of
punishment or whether it is but an incident of some other legitimate governmental
purpose.’” Karsjens II, 988 F.3d at 1052 (quoting Bell, 441 U.S. at 538). Absent
“‘an expressed intent to punish . . . , that determination generally will turn on
“whether an alternative purpose to which [the restriction] may rationally be
connected is assignable for it, and whether it appears excessive in relation”’ to such
alternative purpose.” Id. (alterations in original) (citation omitted).

     Appellants’ arguments rest largely on whether the district court erred on
remand by failing to analyze the conditions of confinement under the standard
pronounced in Youngberg v. Romero, 457 U.S. 307 (1982). Under Youngberg,

      [a] decision, if made by a professional, is presumptively valid; liability
      may be imposed only when the decision by the professional is such a

      3
       Although Appellants summarily contest the district court’s findings related
to Count 7’s conditions-of-confinement claims in the “Summary of the Argument”
section of their brief, they fail to meaningfully challenge those findings in the
“Argument” section, referring only to Counts 5 and 6. But Appellants must do more
than “merely mention an alleged error.” Sitzer v. Nat’l Ass’n of Realtors, 12 F.4th
853, 855 n.2 (8th Cir. 2021). A passing reference in an opening brief will not suffice
to preserve an issue for appeal. Id. Accordingly, we find any argument regarding
the district court’s treatment of the conditions-of-confinement claims alleged in
Count 7 waived.
                                         -8-
      substantial departure from accepted professional judgment, practice, or
      standards as to demonstrate that the person responsible actually did not
      base the decision on such a judgment.

Id. at 323 (footnote omitted). Under this standard, Appellants argue that the
testimony of the court-appointed experts—as permitted under Federal Rule of
Evidence 706—demonstrates that the conditions of the MSOP are not within the
scope of “accepted professional judgment, practice, or standards.” However, we
find that Appellants have waived reliance on Youngberg by failing to meaningfully
raise its professional-judgment standard until this second appeal.

       We begin by recognizing that while Youngberg informs the Bell analysis, it
is nonetheless distinct from Bell. In Youngberg, the Supreme Court reviewed the
very specific circumstances of a civilly committed person whose mental capacity
was severely limited. See id. at 309 (noting that although respondent was “33 years
old, he ha[d] the mental capacity of an 18-month-old child, with an I.Q. between 8
and 10” and was unable “to talk and lack[ed] the most basic self-care skills”).
Because the person was a danger to himself and others, he was physically restrained
at different times during his civil commitment. See id. at 310-11. After recognizing
that civilly committed persons “retain[] liberty interests [under the Fourteenth
Amendment] in safety and freedom from bodily restraint” while committed, see id.
at 319, the Supreme Court relied on Bell and other due process cases to express that
these liberty interests must be balanced against the relevant state interests, see id. at
320-21 (“The question then is not simply whether a liberty interest has been
infringed but whether the extent or nature of the restraint or lack of absolute safety
is such as to violate due process.”). It was against this backdrop, where a civilly
committed person was physically restrained—“the core of the liberty protected by
the Due Process Clause from arbitrary governmental action,” id. at 316 (citation
omitted)—that the Supreme Court held that this otherwise unconstitutional invasion
of a protected interest “is presumptively valid” if made by a professional, id. at 323.
And the presumption may only be overcome if “the decision by the professional is
such a substantial departure from accepted professional judgment, practice, or

                                          -9-
standards as to demonstrate that the person responsible actually did not base the
decision on such a judgment.” Id.

       In Beaulieu v. Ludeman, 690 F.3d 1017 (8th Cir. 2012), this Court reviewed
other conditions-of-confinement claims—at MSOP, no less. This Court applied
Youngberg’s professional-judgment standard narrowly in reviewing the MSOP’s
“full-restraints policy for transporting patients.” See id. at 1031-33. In doing so, we
noted that while the Youngberg and Bell standards were distinct, their outcomes
were similar. Id. at 1032 (“Ultimately, ‘whether one applies Youngberg’s
professional judgment standard or Bell’s punitive versus non-punitive distinction,
the outcome is the same.’ Either approach results in the court ‘defer[ring] to the
professional expertise of the institution’s administrators when evaluating the
relationship between the challenged condition and the government’s interest.’”
(alteration in original) (citations omitted)). However, when reviewing the
constitutionality of the other conditions of confinement—such as double bunking
and sanitation—we applied only the Bell standard. See id. at 1041-45. Whatever
the scope of Youngberg, its professional-judgment standard is distinct from Bell’s
non-punitive standard.

       Because the standards are distinct, the failure of a party to raise one before the
district court or this Court results in its waiver, see N. Bottling Co. v. PepsiCo, Inc.,
5 F.4th 917, 922 (8th Cir. 2021) (“It is well settled that a party’s failure to raise an
argument before a trial court typically waives that argument on appeal.”), and
Appellants have failed to ask us to apply the Youngberg standard until this appeal.
In Karsjens II, Appellants specifically asked this Court to reverse the district court
after it applied the shocks-the-conscience standard to their conditions-of-
confinement claims and urged us to instead apply the Bell standard. See Karsjens
II, 988 F.3d at 1050. In fact, the only reference to Youngberg in Appellants’ brief
was for the general proposition that civilly committed individuals may not be
punished—a reference to Bell’s non-punitive standard. See Appellants’ Br. at 8,
Karsjens II, 988 F.3d 1047 (8th Cir. 2021) (No. 18-3343). On remand, Appellants
again argued that their conditions were “unconstitutionally punitive” under Bell,
                                          -10-
mentioning Youngberg only three times and never in conjunction with the
professional-judgment standard. See R. Doc. 1175, at 1, 6, 16 (citing Youngberg for
the proposition that civil detainees may not be punished). Of course, there is no
quantitative threshold dictating the number of times an appellant must reference an
issue to properly preserve it for appeal, but the issue must nonetheless be
meaningfully raised and in a timely manner. See Calzone v. Summers, 942 F.3d
415, 420 (8th Cir. 2019) (en banc) (“But the test for forfeiture is not how many times
a litigant has raised a particular issue or fact, but rather whether it has been raised in
a timely manner.”); see also N. Bottling Co., 5 F.4th at 923 (“Happening to cite to a
case involving the same issue without developing an argument is not enough to
preserve an issue for appeal.”). Appellants’ argument that we should apply the
Youngberg standard, raised for the first time on the third appeal, is too late. See
Macheca Transp. Co. v. Phila. Indem. Ins. Co., 737 F.3d 1188, 1194 (8th Cir. 2013)
(“For over one hundred years, our court has repeatedly barred parties from litigating
issues in a second appeal following remand that could have been presented in the
first appeal.”).

       Appellants attempt to circumvent the above analysis by suggesting that this
Court’s passing reference to Youngberg in Karsjens II directed the district court to
apply the professional-judgment standard on remand. This reads too much into the
prior panel’s opinion. While Karsjens II references Youngberg, it does so for the
sole purpose of acknowledging that civilly committed persons are guaranteed
protections under the Due Process Clause—the same proposition that Appellants
cited the case for in briefing that appeal. See 988 F.3d at 1051-53. Indeed, this
Court explicitly instructed the district court to apply the Bell standard, going so far
as to quote language from Bell, not Youngberg. See id. at 1053-54. More telling, if
Appellants truly thought that Karsjens II directed the application of Youngberg, it
would have made arguments based on that jurisprudence before the district court.
Instead, they argued for the standard that they requested before the prior panel: the
Bell standard. Appellants are not permitted a second bite at the apple simply because
their claims failed before the district court under their proposed standard.

                                          -11-
      Though the effects of a waiver are sometimes harsh, the costs are
      justified by the systemic benefits: the rule of waiver is critically
      important to the orderly administration of justice. Nor is waiver a
      quixotic procedural trick: the waiver rule is grounded in principles of
      “fairness, judicial economy, and practical wisdom.”

             Waivers allow trial courts to narrow the issues and concentrate
      scarce judicial resources on genuinely contested matters—and when a
      trial court makes a reasoned decision, it is unfair to allow a party to
      subvert that decision by resurrecting a waived claim. Given the
      importance of waivers in the fabric of litigation, it is not surprising that
      appellate courts normally enforce waivers with “near-religious fervor.”

United States v. Orsini, 907 F.3d 115, 119 (1st Cir. 2018) (citations omitted). In
short, because Appellants waived the application of the Youngberg professional-
judgment standard by failing to raise it in their last appeal, the district court did not
err by not applying it.

       Appellants’ remaining challenges to their conditions, appropriately argued
under Bell, likewise fail. First, Appellants argue the potentially indefinite duration
of their confinement renders otherwise constitutional conditions unconstitutional.
However, before the district court, Appellants only argued in cursory fashion that
duration is a factor to be considered when reviewing whether conditions of
confinement are punitive. They did not explain, however, how an extended duration
transforms the conditions at-issue into unconstitutional, punitive ones. Accordingly,
we find that the matter of duration was not appropriately presented to the district
court and decline to address it in the first instance. Norwest Bank of N.D., N.A. v.
Doth, 159 F.3d 328, 334 (8th Cir. 1998) (“As a general rule, we will not consider
issues not presented to [the] [district court] in the first instance.” (first alteration in
original) (citation omitted)). Next, Appellants argue that the district court
erroneously found that the MSOP’s double-bunking practices are constitutional.
However, and as the district court noted, we have held that the double-bunking
practices at the MSOP are constitutional in light of the program’s need to facilitate

                                           -12-
the growing population of MSOP patients—a legitimate nonpunitive government
objective. Beaulieu, 690 F.3d at 1042-43.

       Appellants additionally attack the district court’s conclusion that the MSOP’s
Behavioral Expectation Report policy is constitutional. But Appellants focus only
on the impact of the policy on their treatment and fail to address the other legitimate
government objectives it addresses—such as preserving institutional order at the
MSOP. See Bell, 441 U.S. at 547 (“Prison administrators therefore should be
accorded wide-ranging deference in the adoption and execution of policies and
practices that in their judgment are needed to preserve internal order and discipline
and to maintain institutional security.”); see also Karsjens II, 988 F.3d at 1051
(“[T]he Supreme Court has not recognized a ‘due process right to appropriate or
effective or reasonable treatment of the illness or disability that triggered the
patient’s involuntary confinement.’” (citation omitted)). Finally, Appellants raise
issues related to their treatment progress. However, these are the treatment-related
claims that the district court determined were not found in the remaining counts. See
supra note 3. We agree and will not revisit arguments otherwise disposed of by
Karsjens I and Karsjens II. See Macheca Transp. Co., 737 F.3d at 1194 (“For over
one hundred years, our court has repeatedly barred parties from litigating issues in a
second appeal following remand that could have been presented in the first appeal.”);
see also Thompson v. Comm’r, 821 F.3d 1008, 1010-11 (8th Cir. 2016) (recognizing
that the law-of-the-case doctrine “prevents relitigation of a settled issue in a case and
requires that courts follow decisions made in earlier proceedings to insure uniformity
of decisions, protect the expectations of the parties[,] and promote judicial economy”
(alteration in original) (citation omitted)). Accordingly, we find that the district
court did not err in granting judgment in favor of Appellees and dismissing
Appellants’ conditions-of-confinement claims under Bell.

                                           C.

     Appellants also challenge the district court’s grant of judgment in favor of
Appellees on Appellants’ inadequate-medical-care claim alleged in Count 7. In
                                          -13-
Karsjens II, this Court instructed the district court to analyze Appellants’ claim under
the “deliberate indifference” standard as applied in Senty-Haugen v. Goodno, 462
F.3d 876, 889-90 (8th Cir. 2006). To succeed, Appellants must show that Appellees
“knew about excessive risks to [Appellants’] health but disregarded them and that
their unconstitutional actions in fact caused [their] injuries.” Id. at 890 (citation
omitted). The district court found that Appellants failed to demonstrate (1) that
Appellees were ever deliberately indifferent to any specific Appellant’s injuries,
(2) that such indifference happened on a policy level, and (3) that such alleged
indifference resulted in any actual injuries.

       On appeal, Appellants argue that Appellees are deliberately indifferent based
on their failure to staff qualified medical personnel in the units housing particularly
vulnerable patients (i.e., the elderly, those with disabilities, those with chronic
illnesses, etc.). However, in their sparse argument, Appellants fail to point to any
injuries resulting from this alleged deliberate indifference. Because Appellants have
failed to show “that the[ alleged] unconstitutional actions in fact caused [the]
injuries,” id., we find that the district court did not err in granting judgment in favor
of Appellees on Appellants’ inadequate-medical-care claim.

                                          III.

       For the foregoing reasons, we affirm the judgment of the district court.
Further, we deny Appellants’ February 9, 2023 motion to take judicial notice of
judicial opinions.
                      ______________________________

                                          -14-