Court Opinion

ID: 9385450
Source: CourtListenerOpinion
Date Created: 2023-04-06 18:00:49.553318+00
Date Added: 2024-06-11T17:18:01.896630
License: Public Domain

Case: 22-30220    Document: 00516703373        Page: 1    Date Filed: 04/06/2023

          United States Court of Appeals
               for the Fifth Circuit                                 United States Court of Appeals
                                                                              Fifth Circuit

                                                                            FILED
                                                                         April 6, 2023
                                No. 22-30220                           Lyle W. Cayce
                                                                            Clerk

   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.
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                                          No. 22-30220

   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 Addington 1 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/diabetic-
   ketoacidosis/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 levels recorded 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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                                        No. 22-30220

           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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                                     No. 22-30220

   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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                                      No. 22-30220

                                           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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                                      No. 22-30220

                                          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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Case: 22-30220      Document: 00516703373          Page: 16   Date Filed: 04/06/2023

                                    No. 22-30220

   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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