Court Opinion

ID: 9952519
Source: CourtListenerOpinion
Date Created: 2024-03-19 21:01:02.88587+00
Date Added: 2024-06-11T14:40:05.659208
License: Public Domain

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                                               PUBLISHED

                              UNITED STATES COURT OF APPEALS
                                  FOR THE FOURTH CIRCUIT

                                                No. 22-6313

        DANIEL W. PHOENIX, a/k/a Daniel W. Jamison,

                    Plaintiff – Appellant,

              v.

        MARK AMONETTE, Virginia Department of Corrections Chief Medical Director;
        PAUL OHAI, Doctor, Dillwyn Correctional Center,

                    Defendants – Appellees,

              and

        CHADWICK DOTSON, Director of Virginia Department of Corrections;
        NATARCHA GREGG, MSA, RD, State wide Dietitian for VADOC; DANA
        RATLIFFE, Warden, Dillwyn Correctional Center; MR. JONES, Asst. Warden
        Dillwyn Correctional Center; C. MORGAN, RNCB, Health Authority, Dillwyn
        Correctional Center; J. D. OATS, Chief of Housing and Programs, Dillwyn
        Correctional Center; MRS. HOUSE, Nurse, Dillwyn Correctional Center; T.
        TOWNES, Director of Food Service, Dillwyn Correctional Center; M.E.
        MORGAN, Asst. Director of food services, Dillwyn Correctional Center; C.
        POWELL, Food Services Supervisor, Dillwyn Correctional Center; L. MASON,
        Institutional Ombudsman, Dillwyn Correctional Center; D. CALL, Warden,
        Nottaway Correctional Center; K. SCHLOBOHM, Asst. Warden, Nottaway
        Correctional Center; D. LEWIS, Institutional Ombudsman, Nottoway Correctional
        Center; DR. LEON DIXON, Doctor, Nottaway Correctional Center; DR. YOUNG,
        Doctor, Nottaway Correctional Center; P. MCCABE, RNCA Health Authority,
        Nottaway Correctional Center; NURSE FORD, Nurse, Nottaway Correctional
        Center; MR. ALLEN, Food Service Director, Nottaway Correctional Center,

                    Defendants.
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        Appeal from the United States District Court for the Western District of Virginia, at
        Roanoke. Thomas T. Cullen, District Judge. (7:18-cv-00504-TTC-JCH)

        Argued: January 25, 2024                                    Decided: March 18, 2024

        Before WILKINSON, GREGORY, and HEYTENS, Circuit Judges.

        Vacated and remanded by published opinion. Judge Heytens wrote the opinion, in which
        Judge Gregory joined and Judge Wilkinson joined as to Parts I, II, and III(A). Judge
        Wilkinson wrote an opinion concurring in part and dissenting in part.

        ARGUED: Libby Andrea Baird, WILLIAMS & CONNOLLY LLP, Washington, D.C.,
        for Appellant. Rosalie Fessier, TIMBERLAKESMITH, Staunton, Virginia, for Appellees.
        ON BRIEF: Clayton P. Phillips, WILLIAMS & CONNOLLY LLP, Washington, D.C.,
        for Appellant. Laura H. Cahill, Martin J. Minot, Stacie A. Sessoms, OFFICE OF THE
        ATTORNEY GENERAL OF VIRGINIA, Richmond, Virginia, for Appellee Mark
        Amonette. Brittany E. Shipley, TIMBERLAKESMITH, Staunton, Virginia, for Appellee
        Paul Ohai.

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        TOBY HEYTENS, Circuit Judge:

               An incarcerated person who has celiac disease sued a doctor for depriving him of a

        gluten free diet. The district court granted summary judgment to the doctor because the

        plaintiff did not have an expert witness who could testify about the standard treatment for

        celiac disease or the causal link between the doctor’s conduct and the plaintiff ’s asserted

        harm. We hold no expert testimony was needed to avoid summary judgment here. We thus

        vacate the district court’s judgment and remand for further proceedings.

                                                      I.

               Daniel Phoenix is an inmate in the Virginia prison system. In 2018, he sued a slew

        of state officials for failing to treat his celiac disease. Only two of Phoenix’s claims remain

        at issue: an Eighth Amendment claim for deliberate indifference against Dr. Paul Ohai and

        a related claim seeking injunctive relief against Dr. Mark Amonette, the Chief Medical

        Director of the Virginia Department of Corrections.

                                                      A.

               The relevant allegations stem from Phoenix’s time at Dillwyn Correctional

        Facility. 1 Ohai worked as a “contract physician” at Dillwyn while Phoenix was there.

        JA 223. It is undisputed that Ohai saw Phoenix several times after Phoenix complained of

        “abdominal” and “gastric symptoms.” Id. What Ohai knew about Phoenix’s condition, and

        how he treated Phoenix, however, are much disputed. Because the case comes to us via an

        appeal from a decision granting Ohai’s motion for summary judgment, we recount the facts

               1
                   It appears Phoenix is now confined at St. Brides Correctional Center.
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        in the light most favorable to Phoenix. See Perdue v. Sanofi-Aventis U.S., LLC, 999 F.3d

        954, 958 (4th Cir. 2021).

               When he first saw Phoenix, Ohai noted Phoenix’s “medical history of celiac

        disease.” JA 223. Celiac disease is an allergy to gluten. “When a person with celiac disease

        eats” gluten, their immune system “attacks the cells that line the small intestine.” JA 182.

        “Over time, this reaction damages the small intestine and makes the small intestine unable

        to absorb nutrients from food.” Id. Ohai’s “assessment” during that first meeting “was that”

        Phoenix “was suffering from an exacerbation of celiac disease.” JA 224.

               Having concluded Phoenix’s symptoms were celiac related, Ohai “advised” him “to

        avoid gluten items from the commissary as much as possible” and notified the “dietary

        service” about Phoenix’s “gluten sensitivity.” JA 224. Although Phoenix’s “diet order”

        from that period said he was allergic to gluten, Ohai says the Virginia Department of

        Corrections “does not have a specific gluten free diet.” JA 172, 224.

               Over the next month, Phoenix saw Ohai several times. During one visit—after

        Phoenix reported “sharp abdominal pain” and that he had been “vomiting blood”—Ohai

        sent Phoenix to the emergency room for evaluation. JA 225. Phoenix returned from the

        hospital with discharge instructions that included information about celiac disease and a

        handwritten note stating: “strict gluten free diet.” JA 201. Beneath the handwritten note is

        an illegible signature followed by the letters “M.D.” Id. Although Ohai’s signature does

        not appear on that page, he signed and dated several pages of the discharge instructions,

        including the page right before the one with the “strict gluten free diet” note.

               Less than a week after Phoenix returned from the emergency room, however, Ohai

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        “discontinued” Phoenix’s “special diet order.” JA 226. Ohai had heard reports that Phoenix

        was “ordering foods containing gluten from the commissary.” Id. Ohai says that fact, along

        with his other interactions with Phoenix, led him to “question[ ]” his “own prior

        assumption” that Phoenix’s symptoms were “secondary to celiac disease.” Id.

               Phoenix continued to complain about gastric symptoms and his diet. At the end of

        July 2018—the same month Ohai discontinued Phoenix’s special diet order—another

        physician at Dillwyn ordered a battery of tests for Phoenix, including one for celiac. Days

        later, that test came back positive for celiac disease. Although Ohai never signed the form

        containing the test results, he signed another lab report ordered the same day as Phoenix’s

        positive celiac test.

               Even after the positive test, Ohai refused to reinstate Phoenix’s special diet order,

        declining such requests in August and September 2018. In September 2018, a nurse entered

        a new “offender diet order” for Phoenix stating that he was allergic to “wheat, eggs, [and]

        poultry.” JA 173. But that order was seemingly initiated by someone other than Ohai, who

        insists he continued to refuse Phoenix’s requests for a special diet throughout that month.

                                                    B.

               In October 2018, Phoenix filed this lawsuit, initially proceeding pro se. Many of

        Phoenix’s claims did not survive preliminary motions practice, and all defendants except

        Ohai and Amonette soon exited the litigation.

               The district court at first denied summary judgment to Ohai and Amonette on

        Phoenix’s Eighth Amendment claim. The court concluded Phoenix had created a genuine

        dispute of material fact about whether Ohai violated the Constitution by displaying

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        deliberate indifference to Phoenix’s serious medical needs. The court retained Amonette

        as a defendant “solely for purposes of ” granting injunctive relief if Phoenix prevailed on

        his claims against Ohai. JA 296.

               Phoenix later secured counsel, and the case was set for mediation. Around the same

        time, the case was transferred to a different district court judge. After mediation failed, the

        new judge set a date for a jury trial.

               Before trial, however, Phoenix missed the deadline for disclosing his expert

        witnesses as required by Federal Rule of Civil Procedure 26(a)(2). Ohai then filed two

        motions—one to exclude Phoenix’s experts and a renewed motion for summary judgment.

                The district court ruled on Ohai’s two motions together. The court first excluded

        Phoenix’s experts because Phoenix did not timely submit expert reports. Phoenix does not

        challenge that ruling on appeal, so we take that issue as settled.

               The district court then granted summary judgment to Ohai and Amonette. Before

        addressing the merits of that motion, the court acknowledged it had denied a summary

        judgment motion by the same defendants. But the court determined it could revisit its

        previous ruling because Ohai’s second motion “raise[d] an issue—the lack of experts—

        that could not have been raised at the time of the first summary judgment motion.” JA 462–

        63. The court granted summary judgment to Ohai, concluding Phoenix could not prove his

        claim without an expert to testify about the “threshold standard of care or on the presence

        of an injury caused by” Ohai. JA 467. The court granted summary judgment to Amonette

        because Phoenix’s inability to prove that Ohai violated his constitutional rights meant there

        was “no basis on which to award injunctive relief ” against Amonette. JA 469.

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                                                        II.

               Phoenix’s first challenge to the district court’s decision is that the court committed

        procedural error by reconsidering its earlier denial of summary judgment to the same two

        defendants. Reviewing that decision for an abuse of discretion, see Carlson v. Boston Sci.

        Corp., 856 F.3d 320, 325 (4th Cir. 2017), we see none here.

               Federal Rule of Civil Procedure 54(b) says “any order . . . that adjudicates fewer

        than all the claims or the rights and liabilities of fewer than all the parties . . . may be revised

        at any time before the entry of ” final judgment. Despite that sweeping language, this Court

        has stressed that the “discretion” afforded by Rule 54(b) “is not limitless.” Carlson,

        856 F.3d at 325. Instead, a district court may revisit a previous interlocutory ruling only in

        “circumstances in which it may depart from the law of the case.” Id.

               We start by rejecting Ohai’s argument that these limits do not apply when a district

        court is deciding whether to revisit a previous denial of summary judgment. Such orders

        are a textbook example of an interlocutory order that “adjudicates fewer than all the claims

        or the rights and liabilities of fewer than all the parties.” Fed. R. Civ. P. 54(b); see Hicks v.

        Ferreyra, 965 F.3d 302, 308 (4th Cir. 2020) (“[ D]enials of summary judgment are

        interlocutory orders[.]”). It is thus unsurprising that other courts have applied the usual

        Rule 54(b) standards to decisions reconsidering denials of summary judgment.

        See 11 Moore’s Fed. Prac. § 56.124[1] (3d ed. 2023) (citing cases). And although this

        Court does not appear to have considered this precise question, we have said that the

        general Rule 54(b) standard applies when a district court is asked to revisit a decision

        denying a motion to dismiss for failure to state a claim. See Nadendla v. WakeMed,

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        24 F.4th 299, 303–04 (4th Cir. 2022). We see no reason to think a different standard should

        apply here. We thus hold that a district court’s discretion to revisit an order denying

        summary judgment is “cabined” by the same principles that govern other types of

        interlocutory orders. Carlson, 856 F.3d at 325.

               The district court acknowledged that the principles announced in Carlson

        constrained its discretion here. The court concluded, however, that considering Ohai’s

        second summary judgment motion was appropriate because its exclusion of Phoenix’s

        proposed experts meant the evidentiary landscape had shifted since its prior ruling. We see

        no abuse of discretion in that conclusion.

               This Court has described the most relevant exception to the law of the case doctrine

        as covering situations where later developments produce “different evidence” than was

        anticipated. Carlson, 856 F.3d at 325. True, that is not quite the situation we have here,

        where evidence was excluded because of a failure to timely disclose expert reports. But a

        basic aim of Rule 54(b) is to give district courts “flexibility to revise” their rulings “as the

        litigation develops and new facts or arguments come to light.” Id. Treating the exclusion

        of anticipated evidence as categorically different from a failure to predict what the evidence

        will ultimately show would conflict with that approach.

               In addition, permitting district courts to revisit a previous denial of summary

        judgment after key evidence is excluded does not trigger the concerns that animate the

        limits on a court’s ability to revise their previous interlocutory orders. The basis for the

        district court’s decision to revisit the summary judgment question—that its exclusion of

        Phoenix’s experts left him unable to meet his burden of proof—did not give Ohai “a second

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        bite at the apple” to make arguments he should have made in his first motion for summary

        judgment. Nadendla, 24 F.4th at 304 (quotation marks removed). Instead, the court

        considered an evidentiary development that would have been premature had Ohai raised it

        as a basis for summary judgment in his first motion. As the district court pointed out, when

        Ohai filed his first summary judgment motion, “the deadline for identifying experts had

        not yet been set, let alone passed.” JA 463. Perhaps, as Phoenix argues, Ohai could have

        raised the need for an expert witness when he filed his first motion for summary judgment.

        But had Ohai raised the issue then, one can easily imagine Phoenix arguing Ohai had

        jumped the gun. See Fed. R. Civ. P. 56(d) (district court can “defer considering” a summary

        judgment motion, or allow the nonmovant more time to obtain evidence, when facts are

        not yet available). 2

               To the extent even greater caution is warranted when revisiting a ruling issued by a

        different district court judge, we conclude the district court’s handling of Ohai’s second

        summary judgment motion displayed the required sensitivity. See United States Tobacco

        Coop. Inc. v. Big S. Wholesale of Va., LLC, 899 F.3d 236, 257 (4th Cir. 2018) (noting that

        a district court should be “hesitant to overrule the earlier determination” of a different

        district court judge). Before the district court, Phoenix only vaguely gestured at why

               2
                This case arrives in an odd procedural posture, including a denial of a summary
        judgment motion before the close of discovery, a transfer to a different district court judge,
        a second motion for summary judgment, and a grant of that motion. In the future, this
        unusual posture could perhaps be avoided by waiting until discovery closes to rule on
        summary judgment motions. Of course, there will be situations when this does not make
        sense or is not the most efficient approach. But, in many cases, use of the Rule 56(d)
        mechanism will be helpful in streamlining litigation.
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        revising the court’s previous ruling could be inappropriate, and he did so without citing

        Rule 54(b) or the standards governing such a decision. Even so, the district court asked the

        parties to address the reconsideration issue at a hearing, and then offered a thoughtful

        analysis in its opinion. For that reason as well, we see no abuse of discretion here.

                                                      III.

               Having decided the district court did not exceed the bounds of its discretion in

        revisiting its denial of Ohai’s first summary judgment motion, we turn to the merits of the

        ruling before us. “As always, we review the district court’s summary judgment ruling de

        novo, applying the same legal standards as that court.” Harriman v. Associated Indus. Ins.,

        91 F.4th 724, 728 (4th Cir. 2024).

                                                      A.

               At times, Ohai’s defense of the district court’s decision comes close to suggesting

        that expert testimony is needed in every Eighth Amendment claim involving deliberate

        indifference to a serious medical need. We do not read the district court as having adopted

        that view. And we firmly reject it.

               This Court has never applied any special type of proof requirement to Eighth

        Amendment claims. In Scinto v. Stansberry, 841 F.3d 219 (4th Cir. 2016), for example, the

        Court held no expert was needed to prove a deliberate indifference claim where the “jury

        [was] capable of understanding, unaided, the risks of failing to provide insulin to a

        diabetic.” Id. at 230. So too in Miltier v. Beorn, 896 F.2d 848 (4th Cir. 1990), which noted

        that, “[e]ven aside from” the expert witness testimony in the record, there was other

        evidence to support the deliberate indifference claims. Id. at 853. The Court explained that

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        a treating physician “could be found” to be deliberately indifferent based on evidence of a

        “[f]ailure to provide the level of care” the physician “believe[d]” to be “necessary”—

        evidence that can be presented to a jury without the aid of an expert. Id.

               Requiring experts for all Eighth Amendment deliberate indifference claims would

        also contradict the Supreme Court’s repeated rejection of special procedural rules based on

        the type of claim at issue. Under the Federal Rules of Civil Procedure, “[t]here is one form

        of action—the civil action.” Fed. R. Civ. P. 2. Just as Rule 8(a)(2) does not require a litigant

        to cite any special type of evidence in support of its “short and plain statement of the claim

        showing that [it] is entitled to relief,” Rule 56(a) does not require any specific type of

        evidence to generate a “genuine dispute as to any material fact.” See, e.g., Desert Palace,

        Inc. v. Costa, 539 U.S. 90, 99–102 (2003) (rejecting argument that Title VII plaintiffs need

        “direct” evidence of discrimination to prevail in “mixed-motive” cases). Indeed, the

        Supreme Court has “consistently declined . . . invitations to revise” the Federal Rules of

        Civil Procedure by judicial fiat, even when faced with “perceived problem[s]” created by

        “suits by inmates.” Crawford-El v. Britton, 523 U.S. 574, 595–96 (1998).

               To sum up: There is no per se rule that expert testimony is necessary to establish an

        Eighth Amendment deliberate indifference claim. Instead, the question is whether, in the

        context of a particular case, the plaintiff has produced sufficient evidence—of whatever

        kind—to create a genuine dispute of material fact about each of the required elements.

                                                      B.

               We turn now to the necessarily case-specific inquiry of whether Phoenix needed an

        expert to avoid summary judgment here. We hold the answer is no. Because Phoenix did

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        not need an expert witness to defeat Ohai and Amonette’s motion for summary judgment,

        we vacate the district court’s judgment and remand for further proceedings.

               The Eighth Amendment forbids “cruel and unusual punishments.” U.S. Const.

        amend. VIII. “A prison official’s deliberate indifference to an inmate’s serious medical

        needs” violates that provision. Jackson v. Lightsey, 775 F.3d 170, 178 (4th Cir. 2014).

               A successful medical deliberate indifference claim has “two components, objective

        and subjective.” Jackson, 775 F.3d at 178. The objective component requires that the

        plaintiff’s “medical condition . . . be serious—one that has been diagnosed by a physician

        as mandating treatment or one that is so obvious that even a lay person would easily

        recognize the necessity for a doctor’s attention.” Id. (quotation marks removed). The

        subjective component requires showing that the defendant “had actual subjective

        knowledge of both the [plaintiff ’s] serious medical condition and the excessive risk posed

        by the official’s action or inaction.” Id.

               Phoenix has created a genuine dispute of material fact about the objective prong.

        The record abounds with evidence that Phoenix has celiac disease, and that the disease

        requires treatment. As for the former, Ohai concedes that Phoenix had a “positive celiac

        test.” Ohai Br. 27. And both Ohai’s instruction to Phoenix to “avoid gluten items . . . as

        much as possible” (JA 224) and the discharge instructions from Phoenix’s visit to the

        emergency room underscore the dangers posed by celiac disease and the need to avoid

        foods that will aggravate it.

               Phoenix likewise did not need an expert witness to create a genuine dispute of

        material fact about the subjective prong. To meet his burden on that point, Phoenix needed

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        to produce sufficient evidence for a reasonable jury to find that Ohai “knew of and

        disregarded an excessive risk to” Phoenix’s “health or safety.” Hixson v. Moran, 1 F.4th

        297, 302 (4th Cir. 2021). That standard is high. “Disagreements between an inmate and a

        physician over the inmate’s proper medical care” do not cut it, Wright v. Collins, 766 F.2d

        841, 849 (4th Cir. 1985), and evidence that might show “medical malpractice” is not

        necessarily sufficient. Jackson, 775 F.3d at 178. Instead, “[o]nce prison officials are aware

        of a serious medical need, they need only to respond reasonably to the risk.” Hixson, 1 F.4th

        at 302 (quotation marks and brackets removed).

               True, determining whether medical professionals responded reasonably to a

        particular risk can involve an examination of the relevant standard of care. If, for example,

        an incarcerated person sues a doctor because they think the doctor chose the wrong course

        of treatment in a particular situation, showing the right course of treatment will be a

        necessary step in proving the doctor failed to respond reasonably. As a practical matter,

        that often may require testimony from a physician because lay jurors may “not be in a

        position to determine that the particular treatment or diagnosis fell below a professional

        standard of care.” Pearson v. Prison Health Serv., 850 F.3d 526, 536 (3d Cir. 2017).

               But the fact that expert testimony may be necessary in some cases does not mean it

        was in this one. Even without an expert, Phoenix produced evidence from which a

        reasonable jury could conclude Ohai “knew of ” Phoenix’s celiac disease and “disregarded”

        the excessive risk it posed to his “health or safety” by failing to “respond[ ] reasonably.”

        Hixson, 1 F.4th at 302 (quotation marks removed).

               First, a rational jury could conclude Ohai knew Phoenix had celiac disease. During

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        their initial meeting, Phoenix told Ohai about his history with celiac disease and Ohai

        credited that information by concluding Phoenix’s symptoms were “an exacerbation of

        celiac disease.” JA 223–24. Phoenix also can point to the handwritten note on his

        emergency room discharge papers instructing him to follow a “strict gluten free diet”

        (JA 201) and the presence of Ohai’s signature on different pages of the same form. What

        is more, Phoenix tested positive for celiac disease while he was in custody at the facility

        where Ohai worked, and Ohai signed reports from labs taken the same day as the positive

        celiac test. That combination of direct and circumstantial evidence would permit a

        reasonable jury to find that Ohai knew Phoenix had celiac disease. See Scinto, 841 F.3d at

        226 (“A plaintiff can meet the subjective knowledge requirement through direct evidence

        of a prison official’s actual knowledge or circumstantial evidence tending to establish such

        knowledge[.]”).

               Second, even without an expert, Phoenix marshalled evidence from which a

        reasonable jury could conclude that Ohai disregarded the risk posed by his celiac disease

        by failing to respond reasonably. Ohai’s own declaration is useful for Phoenix here. As

        already mentioned, during the period when Ohai admits having believed Phoenix had celiac

        disease, Ohai told the prison’s “dietary service” about Phoenix’s “gluten sensitivity” and

        instructed Phoenix to “avoid gluten.” JA 224. Phoenix can thus use Ohai’s own words and

        actions to show that Ohai believed the appropriate treatment for celiac disease was a gluten

        free diet. The discharge information from Phoenix’s trip to the emergency room—which

        says a gluten free “diet must become a way of life” for people with celiac disease—

        provides more evidence about the appropriate treatment for the disease. JA 203.

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               Despite the evidence establishing his belief about the proper response to celiac

        disease, Ohai admits he “discontinued” Phoenix’s “special diet order” and refused to

        reinstate it even after Phoenix tested positive for celiac disease. JA 226. Even without an

        expert, a reasonable jury could conclude that Ohai’s “[f]ailure to provide the level of care”

        he “himself believe[d] is necessary” for celiac disease amounted to a failure to “respond[ ]

        reasonably” to a serious medical need of which he was subjectively aware. Miltier,

        896 F.2d at 853 (first two quotes); Hixson, 1 F.4th at 302 (third quote) (brackets in

        original).

               Finally, we disagree with the district court’s conclusion that an expert was needed

        for Phoenix to prove “the presence of an injury caused by Dr. Ohai.” JA 467. That analysis

        conflates Phoenix’s ability to succeed on the merits of his claim (and thus avoid summary

        judgment) with his ability to prove all the damages he might seek. This Court has been

        clear that “[a]n actionable deliberate-indifference claim does not require proof that the

        plaintiff suffered an actual injury. Instead, it is enough that the defendant’s actions exposed

        the plaintiff to a substantial risk of serious harm.” Heyer v. United States Bureau of Prisons,

        849 F.3d 202, 210 (4th Cir. 2017) (quotation marks and emphasis removed). Without an

        expert, Phoenix may face challenges proving the symptoms he experienced are attributable

        to Ohai’s actions, which may curtail Phoenix’s ability to prove damages. See Price v. City

        of Charlotte, 93 F.3d 1241, 1246 (4th Cir. 1996) (“[T]o recover more than nominal

        damages” in a Section 1983 suit, “actual injury caused by the constitutional violation must

        be proved by sufficient evidence.”). But—even without an expert—the record is sufficient

        for Phoenix to prevail on his claim by showing that the “absence of ” the special diet order

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        “exposed” him “to a substantial risk of serious harm.” Heyer, 849 F.3d at 211.

                                              *      *      *

               The district court granted summary judgment to Ohai and Amonette because it

        concluded that Phoenix needed an expert witness. That was legal error. We thus vacate the

        district court’s judgment and remand for further proceedings consistent with this opinion. 3

                                                                                    SO ORDERED

               3
                  We decline to consider Ohai’s argument that we should affirm on the alternative
        ground that the second supplemental declaration he filed along with his renewed summary
        judgment motion renders Phoenix unable to create a genuine dispute of material fact about
        whether Ohai was subjectively aware that Phoenix had celiac disease. The district court
        did not consider that argument or the declaration, and Phoenix argues that the new
        declaration is procedurally improper because it seeks to relitigate matters resolved by the
        district court’s first summary judgment order. See Carlson, 856 F.3d at 326 (noting this
        Court has “consistently affirmed denials of motions to reconsider summary judgment
        rulings where the motion is merely a vessel for the very evidence that was initially
        lacking”). “Mindful that we are a court of review, not of first view, we leave any such
        questions to the court of first instance.” United States v. Buster, 26 F.4th 627, 636 n.3
        (4th Cir. 2022) (brackets, quotation marks, and citation removed).
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        WILKINSON, Circuit Judge, concurring in part and dissenting in part:

               I readily concur in Judge Heytens’s fine analysis in Section II that the district court

        did not abuse its discretion in reconsidering the earlier summary judgment ruling. I also

        agree with Section III.A that there was legal error here and join in the judgment. The fact

        that experts may be helpful to a prison inmate’s claim of inadequate medical care does not

        mean that experts are required in every case.

               I disagree, however, with the majority’s decision to reject the defendants’ position

        on the merits in this appeal. Frequently the Supreme Court announces stringent limitations

        on a cause of action, only to see the limitations diluted by the Courts of Appeal. The circuit

        decisions are both so numerous and so fact specific as to be uncertworthy. And the Supreme

        Court’s ruling goes effectively unenforced.

               That’s essentially what happened here. While lip service is often given the

        “deliberate indifference” standard, it is a negligence standard that is often applied to these

        cases in practice. The majority’s rendition of the evidence here may create an issue of

        triable fact as to Ohai’s negligence, but “deliberate indifference” requires a culpability

        measurably greater than mere carelessness. Estelle v. Gamble, 429 U.S. 97, 105–06 (1976)

        (“Medical malpractice does not become a constitutional violation merely because the

        victim is a prisoner.”).

               The majority faults Ohai for not being more insistent on the matter of Phoenix’s

        gluten-free diet and more attentive to Phoenix generally. There was, however, evidence

        that Ohai saw Phoenix as a patient numerous times. Ohai provided care to Phoenix by

        ordering medications and tests and advising Phoenix on a special diet that he sometimes

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        chose not to follow. He sent Phoenix to the emergency room when his condition so

        required. The majority acknowledges some of this evidence in its opinion, but then

        astonishingly turns the evidence against Ohai and views his various interactions with

        Phoenix as evidence of indifference. While Phoenix disagrees with the treatment he

        received, he does not dispute that treatment occurred. Phoenix’s claim is not of deliberate

        indifference, but instead describes, at most, “a constitutionally noncognizable instance of

        medical malpractice.” Neitzke v. Williams, 490 U.S. 319, 321–22 (1989).

               A constitutional cause of action, moreover, is not the only game in town. The state

        prison system, here Virginia’s, regulates those who work in it, and states themselves are

        free to calibrate state causes of action as they see fit. Dropping constitutional negligence

        into this mix, as the majority does here, is an unwarranted rebuke to the state’s sovereign

        right to govern its own institutions. See Procunier v. Martinez, 416 U.S. 396, 404–406

        (1974).

               At the very least, I would give the able district judge the opportunity to review the

        summary judgment record under what the majority identifies as the correct legal standard.

        The parties should be granted leave to supplement that record. The merits briefing here was

        skimpy. Indeed, the defendants’ brief to this court hardly discussed the merits of summary

        judgment under the correct legal standard, and Phoenix expressly contemplated the

        appropriateness of remand on the merits of the summary judgment motion if we held in his

        favor that an expert was not required. Appellant’s Opening Br. at 24.

               The majority’s premature ruling regrettably trespasses on the role of district courts,

        on the fair process due the parties, on the meaning of deliberate indifference in our own

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        deliberations, on the authority of states to govern their own institutions, and on the need

        for prison doctors to have some semblance of the protections that physicians outside these

        facilities enjoy. We do inmates no favor in telegraphing unique burdens that will make

        prison practice a medical professional’s least attractive option.

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