Court Opinion

ID: 9916349
Source: CourtListenerOpinion
Date Created: 2024-01-09 20:01:01.543034+00
Date Added: 2024-06-11T13:25:05.651551
License: Public Domain

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                                                       [DO NOT PUBLISH]
                                       In the
                 United States Court of Appeals
                           For the Eleventh Circuit

                             ____________________

                                     No. 23-10825
                             Non-Argument Calendar
                             ____________________

        LAWRENCE DEMPSEY,
        as personal representative of the estate of
        Nicole Dempsey deceased for the beneﬁt
        of her survivors and estate,
                                                          Plaintiﬀ-Appellee,
        versus
        SHERIFF, BAY COUNTY FLORIDA,
        et al.,

                                                                Defendants,

        SHELLY WINTERS,
        in her individual capacity
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        2                        Opinion of the Court               23-10825

        f.k.a. Shelly Ziegler,
        TABITHA BURKES,
        KATHRYN AYERS,
        JILLIAN LESKO,

                                                     Defendants-Appellants.

                             ____________________

                  Appeals from the United States District Court
                      for the Northern District of Florida
                   D.C. Docket No. 5:21-cv-00134-TKW-MJF
                            ____________________

        Before ROSENBAUM, JILL PRYOR, and BRANCH, Circuit Judges.
        PER CURIAM:
               This interlocutory appeal arises out of Nicole Dempsey’s
        death due to endocarditis, a bacterial infection of the inner lining
        of the heart’s chambers and valves, while being held as a pre-trial
        detainee at the Bay County Jail (“BCJ”) in Panama City, Florida.
        Shelly Winters, Tabitha Burks, Kathryn Ayers, and Jillian Lesko
        (collectively the “Nurses”), seek review of the district court’s order
        denying them qualified immunity at summary judgment for their
        medical treatment of Dempsey. On appeal, the Nurses argue that
        (1) they were not deliberately indifferent to Dempsey’s serious
        medical needs because they did not know that Dempsey had acute
        endocarditis; and (2) their medical treatment of Dempsey did not
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        23-10825                 Opinion of the Court                             3

        violate clearly established law. After careful review, we affirm in
        part and reverse in part.
                                  I.      Background
               On April 18, 2019, Dempsey was arrested on outstanding
        warrants and brought to the BCJ. During the booking process,
        Nurse Lesko, an advanced registered nurse practitioner (“ARNP”),
        conducted a medical evaluation and determined that Dempsey was
        likely suffering from sepsis. The previous night, Dempsey, who
        had been hospitalized at the Gulf Coast Medical Center (“GCMC”),
        left the hospital against medical advice. Because of Lesko’s
        concerns, Dempsey was unable to be accepted into the BCJ and she
        was released into the custody of Emergency Medical Services
        (“EMS”) who transported her back to GCMC. The police declined
        to book her pursuant to the arrest warrants or to maintain custody
        over Dempsey while she was at GCMC.
               After returning to GCMC, Dempsey was referred for a
        cardiology consultation. The cardiologist noted that Dempsey
        appeared frail, confused, and chronically ill. He determined that
        Dempsey was making decreased breathing sounds and had an
        abnormal skin color with lesions, but that her lower extremities did
        not show any signs of edema. The cardiologist ultimately
        diagnosed Dempsey with endocarditis and sepsis. 1              The

        1  As the district court emphasized, endocarditis is a life-threatening
        inflammation of the inner lining of the heart’s chambers and valves which is
        caused by a bacterial infection. This infection can damage or destroy the
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        4                       Opinion of the Court                    23-10825

        cardiologist determined that Dempsey “[was] in a very tough spot”
        because she “[had] severe tricuspid regurgitation probably due to
        degeneration of the valve” resulting from her continual
        intravenous drug use and that it was “uncertain that [GCMC] could
        find a surgeon to operate on [Dempsey’s] valve any further because
        it would likely be [a] replacement.” He stated that Dempsey
        “[would] obviously need at least 6 weeks of antibiotics” but that
        “[h]er prognosis [was] very poor overall.” Prior to Dempsey’s
        cardiologist consultation, GCMC had already started her on three
        antibiotics—Vancomycin, Azithromycin, and Ceftriaxone.
        Following the cardiologist’s diagnosis of endocarditis, GCMC
        continued to treat Dempsey with Vancomycin and Azithromycin.
               On April 26, 2019, after being hospitalized at GCMC for
        eight days, medical personnel became concerned that Dempsey
        was using drugs in her bathroom. Hospital security discovered
        drug paraphernalia in Dempsey’s purse and a doctor requested
        permission from Dempsey to have security search the remainder
        of her belongings. The doctor explained to Dempsey “that she
        could refuse to be searched, against medical advice, or she could
        consent to a search of her belongings to eliminate outside drugs
        that could harm or interfere with her care [at GCMC].” She refused
        the doctor’s request and left GCMC for a second time against
        medical advice.

        heart’s valves. See Endocarditis, https://www.mayoclinic.org/diseases-
        conditions/endocarditis/symptomscauses/syc-20352576 (last visited Nov. 28,
        2023).
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        23-10825                  Opinion of the Court                              5

               A few hours after leaving GCMC, Dempsey overdosed on
        heroin and was found unresponsive in a parked van. Police
        conducted a warrant check on Dempsey, discovered her
        outstanding warrants, and followed EMS to the Bay Medical Beach
        Emergency Room (“Bay Medical”). Dempsey’s doctor at Bay
        Medical gave her a physical examination and determined that her
        lungs did not show any signs of distress and that she had a regular
        heart rhythm. Her discharge paperwork from Bay Medical stated
        that she was treated for a heroin overdose with Narcan and
        “discharged to the remand of the police.” The discharge
        paperwork noted that Dempsey’s physician “[had] given
        [Dempsey] specifics regarding signs and symptoms of when to
        immediately return to the emergency department.” These
        symptoms included “any recurrence of difficulty breathing, chest
        pain, shortness of breath, rashes or fevers, nausea or vomiting,
        abdominal pain, neck stiffness, mental status change or any other
        concerns.”
              After being discharged from Bay Medical, the police took
        Dempsey to BCJ where she was booked on the outstanding arrest
        warrants. Dempsey filled out an Intake Health Screening Form,
        where she noted that she had endocarditis and was being treated
        with Azithromycin and Coreg.2 A Certified Medical Technician

        2 According to the Mayo Clinic, intravenous Azithromycin is an antibiotic that

        is used to treat bacterial infections in different parts of the body. See
        Azithromycin (Intravenous Route) https://www.mayoclinic.org/drugs-
        supplements/azithromycin-intravenous-route/description/drg-20062196.
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        6                         Opinion of the Court                       23-10825

        (CMT), who is not a party to this case, also completed a
        Preliminary Medical Assessment Form which indicated that
        Dempsey had a history of cardiac issues and was suffering from
        endocarditis. This Preliminary Medical Assessment Form also
        stated that Dempsey was taking Azithromycin and Coreg.
        Dempsey signed a Request for Medical Records which authorized
        BCJ to obtain Dempsey’s medical records from any healthcare
        facility. Nurse Burks, a licensed practical nurse (“LPN”) assigned
        to Dempsey’s dorm, reviewed Dempsey’s intake health screening
        form on April 27, 2019.
              On the evening of April 28, 2019, Dempsey complained to
        Nurses Burks and Dugosh of chest pains. Burks and Dugosh
        advised Dempsey that they would let Lesko know of her
        complaint.3
              On the morning of April 29, 2019, Nurse Ayers, another
        LPN, examined Dempsey and took her vitals, noting that Dempsey
        had a blood pressure reading of 138/88, which was high.4 All

        Coreg is a beta-blocker that is used to treat high blood pressure and reduce the
        risk of heart attacks.             See Carvedilol (Brand Name Coreg)
        https://www.mayoclinic.org/drugs-supplements/carvedilol-oral-
        route/description/drg-20067565.
        3 Lesko, as the ARNP, worked under the supervision of a medical doctor at

        BCJ and was above the other nurses at the BCJ, but she did not directly
        supervise the other nurses. The medical doctor is not a party to this lawsuit.
        4 According to the American College of Cardiology, a normal blood pressure

        reading should show a top number below 120 and a bottom number below
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        23-10825                  Opinion of the Court                              7

        parties agree that Lesko subsequently examined Dempsey’s
        medical records including her discharge paperwork from Bay
        Medical and at 12:48 P.M. ordered that (1) Dempsey be given
        Coreg to treat Dempsey’s high blood pressure and (2) her vitals
        continue to be monitored. Less than two hours later, around 2:35
        P.M., Dempsey complained again about having chest pains. At that
        time, while Ayers did not physically examine Dempsey, Ayers
        contacted Lesko and received the order for Coreg, noting that
        Dempsey was to be started on medication.
               In the early morning hours of April 30, 2019, Dempsey
        submitted a sick call request which indicated her reason for asking
        to be seen was “Endocarditis [G]ulf Coast Hospital.” Nurse
        Paramore, an LPN and a non-party to this case, responded to the
        request, examined Dempsey, and filled out a Chest Pain Form.
        Paramore noted on the Chest Pain Form that Dempsey had
        suffered pain on the left side of her chest all day; Dempsey’s blood
        pressure was 162/114; Dempsey had been treated at GCMC
        beginning on April 18, 2019, but had left against medical advice;
        both of Dempsey’s lungs were making a wheezing sound;
        Dempsey’s hands were swollen; and Dempsey had pitting edema
        in both of her lower extremities. Paramore contacted Lesko who

        80. A top number between 120 to 129 equates to elevated blood pressure.
        High blood pressure, also called hypertension, is indicated by a top number of
        130 or above or a bottom number above 80. See Blood Pressure,
        https://www.cardiosmart.org/docs/default-
        source/assets/infographic/blood-pressure.pdf?sfvrsn=dfcd6c1_1 (last visited
        Nov. 28, 2023).
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        8                      Opinion of the Court                 23-10825

        prescribed Dempsey with Albuterol, Lasix, Clonidine and ordered
        an electrocardiogram. Lesko also scheduled a follow-up with
        Dempsey for later that day.
               At Dempsey’s follow-up appointment with Lesko, Lesko
        noted that Dempsey had pitting edema in both of her lower
        extremities. She also identified that Dempsey had a history of
        endocarditis and left GCMC against medical advice only four days
        prior. Dempsey informed Lesko that she was being treated with
        antibiotics for her endocarditis while at GCMC, and Lesko made a
        note to check Dempsey’s medical records. Despite this, Lesko did
        not prescribe antibiotics although she did order an x-ray for
        Dempsey which showed that Dempsey had left-lung airspace
        disease. Lesko left for a trip the following day and did not have any
        further personal interaction with Dempsey.
               According to the sworn-declaration of Megan Scelfo, a
        detainee at BCJ and dormmate of Dempsey, on May 1 and 2, 2019,
        Dempsey complained to correctional officers that she was
        experiencing chest pain, had a difficult time breathing, and needed
        to be sent to the hospital to be treated for endocarditis. Scelfo
        stated that Dempsey’s condition was visibly deteriorating and that
        Dempsey had lost control over her bowels and bladder, resulting
        in Dempsey defecating and urinating in her bed. Scelfo also
        declared that Dempsey felt hot to the touch, appeared disoriented,
        and began walking through the dormitory without any pants or
        shoes on. Scelfo asserted that the correctional officers relayed these
        concerns to medical personnel via radio, but that Dempsey was not
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        23-10825               Opinion of the Court                         9

        seen by medical personnel or sent to the hospital. Accordingly,
        Dempsey filled out a second sick call request on May 2, 2019, again
        indicating her endocarditis diagnosis and difficulty breathing.
        Nurse Winters, an LPN, responded to that request by stating that
        Dempsey “[had] been seen by ARNP [Lesko] for this already” and
        that Dempsey just needed to wait for the medication she had been
        prescribed to work. Earlier that morning, Winters had physically
        examined Dempsey and given her the drugs prescribed by Lesko.
               By 8:40 A.M. on May 3, 2019, Dempsey’s condition had
        deteriorated to such a state that the correctional officer reported to
        medical staff that Dempsey had been laying in her urine and feces
        all night. Ayers responded and noted that Dempsey’s breathing
        was “rapid and labored” and that she appeared “very weak.”
        Dempsey’s blood pressure was 100/69 and she had a pulse of 120
        beats per minute. Ayers called Lesko who instructed Ayers to take
        Dempsey to the medical unit in BCJ, hydrate her, treat her with
        Imodium, give her an electrocardiogram, and monitor her status.
        By 10:00 A.M., Nurse Smith, a registered nurse and non-party to
        this case, sent Dempsey to GCMC via ambulance.
              Dempsey was admitted to GCMC and was diagnosed with
        endocarditis and septic shock. She was intubated and was treated
        with Vancomycin and Cefepime. Over the next two days,
        Dempsey’s condition did not improve and her father “request[ed]
        comfort care only” because he “underst[ood] the poor prognosis
        and [did] not wish to prolong the inevitable.” Dempsey was
        pronounced dead at 5:21 P.M. on May 5, 2019. Dempsey’s official
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        10                    Opinion of the Court                23-10825

        cause of death was listed as endocarditis due to chronic drug use
        with HIV as a contributing factor.
               On April 27, 2021, Dempsey’s estate (hereinafter “the
        Estate”) filed a wrongful death lawsuit in Florida state court
        predicated on 42 U.S.C. § 1983 and Florida’s Wrongful Death Act,
        Fla. Stat. § 768.16, et. seq., against Tommy Ford in his official
        capacity as the Sheriff of Bay County, Florida, alleging among other
        things that Ford’s deliberate indifference to Dempsey’s serious
        medical needs caused Dempsey’s death. The Sheriff timely
        removed the complaint to the U.S. District Court for the Northern
        District of Florida based on federal question jurisdiction. The
        Estate amended the complaint to add deliberate indifference claims
        against Nurses Ayers, Burks, Dugosh, Lesko, and Winters. The
        operative Second Amended Complaint (“SAC”) asserts six
        deliberate indifference claims under Section 1983, one claim each
        against the Sheriff and the five Nurses.
               After extensive discovery, the Nurses and Sheriff filed
        motions for summary judgment, arguing that they were not
        deliberately indifferent to Dempsey’s serious medical needs and
        that they were entitled to qualified immunity. The district court
        granted summary judgment in favor of Dugosh and the Sheriff, but
        held that Ayers, Burks, Lesko, and Winters were not entitled to
        summary judgment. In doing so, the district court determined that
        “a reasonable jury could find that the medical care provided by
        each of the Nurse Defendants except Dugosh was grossly
        inadequate, cursory, and/or unduly delayed.” It concluded that
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        23-10825                   Opinion of the Court                             11

        this inadequate care would constitute a deliberate indifference to
        Dempsey’s serious medical needs and that the law was clearly
        established at the time of Dempsey’s incarceration that the Nurses’
        treatment of Dempsey was unconstitutional. Accordingly, the
        district court determined that the Nurses were not entitled to the
        defense of qualified immunity at summary judgment. Ayers,
        Burks, Lesko, and Winters appeal the district court’s denial of
        qualified immunity at summary judgment.5
                             II.     Appellate Jurisdiction
                “[A]s a court of limited jurisdiction, we are generally barred
        from entertaining appeals of non-final orders because we have no
        congressional grant to do so.” Hall v. Flournoy, 975 F.3d 1269, 1274
        (11th Cir. 2020). Under the collateral order doctrine, however, we
        may review “some determinations, including certain denials of
        qualified immunity. . . .” Id. “In particular, we may review the
        denial of a claim of qualified immunity to the extent that it turns
        on an issue of law.” Spencer v. Benison, 5 F.4th 1222, 1229 (11th Cir.
        2021) (quotation omitted).           But “[w]e lack interlocutory
        jurisdiction where the only issues appealed are evidentiary
        sufficiency issues.” English v. City of Gainesville, 75 F.4th 1151, 1155
        (11th Cir. 2023) (quotation omitted).
              A district judge’s determination on qualified immunity
        “involves a two-part analysis: (1) defining the official’s conduct,

        5 The district court’s granting of summary judgment in favor of the Sheriff and

        Dugosh is not before us.
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        12                     Opinion of the Court                 23-10825

        based on the record and viewed most favorably to the non-moving
        party, and (2) determining whether a reasonable public official
        could have believed that the questioned conduct was lawful under
        clearly established law.” Koch v. Rugg, 221 F.3d 1283, 1295 (11th
        Cir. 2000). “Our precedents establish [] only that a plaintiff may
        not base an interlocutory appeal on the district court’s first
        determination by itself.” English, 75 F.4th at 1155–56 (brackets and
        italics in original) (quotation omitted). When, as here, “both core
        qualified immunity issues are involved, we have jurisdiction for de
        novo review[.]” Id. at 1156 (brackets and italics in original)
        (quotation omitted).
                                 III.   Discussion
               The Nurses argue that the district court erred in denying
        them qualified immunity for a variety of reasons, each of which
        will be addressed below. To overcome each Nurse’s invocation of
        the defense of qualified immunity, the Estate must show that (1)
        the Nurse individually violated one of Dempsey’s constitutional
        rights and (2) that the right was “clearly established” at the time of
        Nurse’s purported misconduct. Pearson v. Callahan, 555 U.S. 223,
        232 (2009). We proceed by first assessing whether the facts viewed
        in the light most favorable to the Estate could lead a reasonable
        juror to determine that Ayers, Burks, Lesko, and Winters each
        violated Dempsey’s constitutional right to receive adequate care
        for her serious medical needs. After concluding that a reasonable
        juror could make such a determination with respect to Burks,
        Lesko, and Winters, we move to the second prong of qualified
        immunity and conclude that Dempsey’s constitutional right was
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        23-10825               Opinion of the Court                           13

        clearly established at the time of their actions. Accordingly, we
        affirm the district court’s denial of qualified immunity to Burks,
        Lesko, and Winters at summary judgment. With respect to Ayers,
        however, there is no evidence from which a reasonable juror could
        conclude that she was subjectively aware that Dempsey had
        endocarditis. Thus, a reasonable juror could not conclude that
        Ayers violated Dempsey’s constitutional rights and therefore Ayers
        is entitled to qualified immunity. Accordingly, we reverse the
        district court’s denial of summary judgment as to Ayers.
              A. Deliberate Indifference of Dempsey’s Serious Medical Needs
               “The Fourteenth Amendment requires government officials
        to provide basic necessities, including medical care, to pretrial
        detainees.” Ireland v. Prummell, 53 F.4th 1274, 1287 (11th Cir. 2022).
        The minimum standard of medical care allowed by the due process
        clause of the Fourteenth Amendment “is the same as that allowed
        by the [E]ighth [A]mendment for convicted persons.” Hamm v.
        DeKalb Cnty., 774 F.2d 1576, 1574 (11th Cir. 1985). The Supreme
        Court has held that because the Eighth Amendment to the U.S.
        Constitution prohibits “the unnecessary and wanton infliction of
        pain,” Estelle v. Gamble, 429 U.S. 97, 104 (1976) (quoting Gregg v.
        Georgia, 428 U.S. 153, 173 (1976)), it also prohibits “deliberate
        indifference to serious medical needs of prisoners.” Id. Thus,
        “deliberate indifference to a prisoner’s serious illness or injury
        states a cause of action under § 1983.” Id. at 105.
               “To show that a prison official acted with deliberate
        indifference to serious medical needs, a plaintiff must satisfy both
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        14                     Opinion of the Court                 23-10825

        an objective and a subjective inquiry.” Hoffer v. Sec’y, Fla. Dep’t of
        Corr., 973 F.3d 1263, 1270 (11th Cir. 2020) (quoting Farrow v. West,
        320 F.3d 1235, 1243 (11th Cir. 2003)). “A plaintiff must show that
        (1) he suffered from an ‘objectively serious medical need’ and (2) a
        prison official acted with subjective deliberate indifference to that
        medical need.” Johnson v. Lewis, 83 F.4th 1319, 1327 (11th Cir. 2023)
        (quoting Hoffer, 973 F.3d at 1270). Additionally, “as with any tort
        claim, [a plaintiff] must show that the injury was caused by the
        defendant’s wrongful conduct.” Goebert v. Lee Cnty., 510 F.3d 1312,
        1326 (11th Cir. 2007). “As to step one (the objective component), a
        medical need that is objectively serious ‘is 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.’” Johnson, 83 F.4th at 1327 (quoting
        Goebert, 510 F.3d at 1326). “As to step two (the subjective
        component), a plaintiff must establish that the defendant (1) had
        subjective knowledge of a risk of serious harm, (2) disregarded that
        risk, and (3) acted with more than gross negligence.” Id.
              The deliberate indifference standard “is far more onerous
        than normal tort-based standards of conduct sounding in
        negligence” and “medical treatment violates the Eighth
        Amendment only when it is so grossly incompetent, inadequate,
        or excessive as to shock the conscience or to be intolerable to
        fundamental fairness.” Hoffer, 973 F.3d at 1271 (internal quotations
        omitted). This standard requires a plaintiff to show that a
        defendant “had a sufficiently culpable state of mind which is the
        equivalent of recklessly disregarding a substantial risk of serious
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        23-10825                  Opinion of the Court                               15

        harm to the inmate.” Ireland, 53 F.4th at 1288 n.5 (quotation
        omitted). Furthermore, “[e]ven where medical care is ultimately
        provided, a prison official may nonetheless act with deliberate
        indifference by delaying the treatment of serious medical needs,
        even for a period of hours[.]” McElligott v. Foley, 182 F.3d 1248, 1255
        (11th Cir. 1999). While this bar is certainly high, it is not
        insurmountable. Johnson, 83 F.4th at 1330. We begin our
        deliberate indifference analysis by first addressing the objective
        component before moving onto the subjective component for each
        Nurse. 6
               The Nurses concede for purposes of the objective
        component that endocarditis is a serious medical condition.
        However, they argue that the Estate failed to and cannot establish
        that Dempsey “was suffering from acute endocarditis from April
        26, 2019, through May 3, 2019.” This argument is without merit.
        The Estate has provided ample evidence that could lead a
        reasonable juror to conclude that Dempsey was suffering from
        endocarditis while she was held as a pre-trial detainee at BCJ on the

        6 In the proceedings below, the Nurses did not challenge causation and instead

        argued only that the Estate could not satisfy the objective or subjective
        components of a deliberate indifference claim. On appeal, the Nurses argue
        that their actions did not cause Dempsey’s death and that they are entitled to
        summary judgment. Because the Nurses did not argue a lack of causation
        below, we do not address it here. See Hurley v. Moore, 233 F.3d 1295, 1297 (11th
        Cir. 2000) (“Arguments raised for the first time on appeal are not properly
        before this Court.”). As the district court noted, the Estate will need to prove
        all elements of a deliberate indifference claim, including causation, to prevail
        at trial.
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        16                       Opinion of the Court                     23-10825

        dates in question. This evidence includes hospital records showing
        (1) Dempsey was being treated for endocarditis at GCMC from
        April 18, 2019, until April 26, 2019, when she left the hospital
        against medical advice; and (2) she died of endocarditis on May 5,
        2019, two days after being transported by ambulance from BCJ
        back to GCMC. Additionally, evidence shows that Dempsey was
        displaying symptoms of endocarditis—including chest pains,
        pitting edema, and high blood pressure—and informed medical
        staff at BCJ at least three times that she had endocarditis. This is
        enough evidence that a reasonable juror could determine that
        Dempsey had an active endocarditis infection while being held as a
        pre-trial detainee at BCJ. Accordingly, the district court did not err
        in determining the Estate had met its burden of providing evidence
        “to establish the objective element of [its] deliberate indifferen[ce]
        claims.” 7 We now address the subjective component for each
        individual nurse.

        7 The Nurses also argue      that (1) the district court improperly relied on
        Dempsey’s discharge paperwork from BCJ, which instructed Dempsey to
        return to the emergency room if she experienced difficulty breathing, chest
        pain, or shortness of breath, because the discharge paperwork was given under
        the assumption that Dempsey was returning home and not going to jail where
        she would have medical care; and (2) there is no evidence that shows the
        Nurses would be on notice that Dempsey had endocarditis or any serious
        medical need until May 3, 2019, when she was taken to GCMC via ambulance
        The former argument fails because the BCJ discharge paperwork explicitly
        stated that Dempsey was to be “discharged to the remand of the police.” The
        latter argument conflates the subjective prong of a deliberate indifference
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        23-10825                  Opinion of the Court                              17

               The district court determined that there was evidence “from
        which a reasonable jury could find that, at different points between
        April 27 and May 3, Burks, Lesko, Winters, and Ayers each
        subjectively knew that Ms. Dempsey had a serious medical
        condition that needed emergency care.” The district court also
        concluded that there was sufficient evidence “from which a
        reasonable jury could find that the medical care provided by each
        of the Nurse Defendants . . . was grossly inadequate, cursory,
        and/or unduly delayed.” More specifically, the district court
        determined that there was evidence that Burks, Lesko, Winters,
        and Ayers each knew of Dempsey’s endocarditis diagnosis; knew
        of her symptoms consistent with that diagnosis; in some instances,
        failed to physically examine Dempsey despite her repeated
        complaints; and instead of sending Dempsey to emergency care or
        treating her with antibiotics, the Nurses merely treated Dempsey’s
        symptoms without addressing the root cause.
              On appeal, the Nurses argue that the district court failed to
        apply the “more than mere negligence” standard and that their
        conduct did not amount to “subjective recklessness as used in
        criminal law” which is what they assert is required for a deliberate

        claim with the objective prong and as discussed later in this opinion, fails in
        any event.
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        18                         Opinion of the Court                       23-10825

        indifference claim. 8 They assert that the care they provided to
        Dempsey—treating Dempsey’s symptoms with medication,
        ordering an x-ray and an echocardiogram, and continually
        monitoring her vitals—proves they were not deliberately
        indifferent to Dempsey’s needs. 9 The Nurses also point to
        Dempsey’s physical demeanor as proof that they had no reason to
        believe that Dempsey was suffering from a serious medical
        condition because she was not showing signs of distress. 10 Instead,

        8 Panels of our Court have applied two different standards in evaluating

        deliberate indifference claims. Some panels have applied a “more than mere
        negligence” standard while others have applied a “more than gross negligence
        standard” which equates to a reckless disregard. Wade v. McDade, 67 F.4th
        1363, 1371–72 (11th Cir. 2023) (collecting cases), reh’g en banc granted, opinion
        vacated sub nom. No. 21-14275, 2023 WL 6613842 (11th Cir. Oct. 11, 2023). We
        need not determine the proper standard in the present case because a
        reasonable juror could determine that the actions of Burks, Lesko, and
        Winters satisfied the more demanding “more than gross negligence” standard.
        9 The Nurses argue that they believed Dempsey’s symptoms were consistent

        with heroin withdrawal and were therefore not related to acute endocarditis.
        Thus, they assert they were treating Dempsey for withdrawal. However, at
        summary judgment we must view the facts in the light most favorable to the
        Dempsey as the nonmoving party. When viewed in this light, Dempsey’s
        symptoms support an inference that Burks, Lesko, and Winters each
        subjectively knew of Dempsey’s endocarditis infection.
        10 In making this argument, the Nurses argue that in accordance with Scott v.

        Harris, 550 U.S. 372 (2007), the district court improperly considered Scelfo’s
        sworn statement regarding Dempsey’s physical condition because video
        evidence supports the Nurses’ position that Dempsey was not in physical
        distress. In Scott, the Supreme Court held that “[w]hen opposing parties tell
        two different stories, one of which is blatantly contradicted by the record, so
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        23-10825                  Opinion of the Court                               19

        they assert that the district court improperly applied a 20/20
        hindsight standard in determining whether the Nurses had the
        subjective knowledge required for the Estate to prevail on its
        deliberate indifference claims. The Estate, in turn, argues that the
        district court properly determined that there was sufficient
        evidence from which a reasonable juror could conclude that each
        of the Nurses subjectively knew about Dempsey’s serious medical
        needs and were deliberately indifferent to those needs by either
        delaying treatment, providing grossly inadequate care, taking an
        easier but less efficacious court of treatment, or providing utterly
        cursory medical treatment.
               Upon review, we agree with the Estate in part. As we
        explain below, the district court was correct in holding that there
        was sufficient evidence from which a reasonable juror could
        conclude that Burks, Lesko, and Winters were subjectively aware
        of Dempsey’s endocarditis infection and that each failed to provide

        that no reasonable jury could believe it, a court should not adopt that version
        of the facts for the purposes of ruling on a motion for summary judgment.”
        550 U.S. at 380. As we recently noted, however, Scott “applies only when the
        video actually proves that the plaintiff’s version of the facts cannot be true.”
        Brooks v. Miller, 78 F.4th 1267, 1271. Nothing in the May 2, 2019, videos—
        which in total is only a little more than seven minutes of video footage—
        disproves Scelfo’s sworn statement that Dempsey felt hot to the touch,
        defecated and urinated in her bed, complained to staff about chest pains, and
        was behaving oddly on the nights of May 1 and 2, 2019. Accordingly, the
        district court did not err in considering Scelfo’s sworn statement in ruling on
        the motions for summary judgment.
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        20                      Opinion of the Court                  23-10825

        the adequate level of care. We disagree with the district court,
        however, as to Ayers.
                We turn first to the evidence supporting the inference that
        each Nurse had the subjective knowledge that Dempsey was
        suffering from a serious medical condition. With respect to Burks,
        there is evidence that she knew as early as April 27, 2019—when
        she reviewed Dempsey’s intake paperwork—that Dempsey had
        endocarditis and was being treated with Azithromycin. Likewise,
        Lesko’s notes from her examination of Dempsey on April 30,
        2019—which stated Dempsey had a history of endocarditis and
        intravenous heroin use, had pitting edemas in both lower
        extremities, and had left GCMC against medical advice only four
        days prior—support a reasonable inference that she was aware
        Dempsey was being treated for an endocarditis infection as
        recently as April 26, 2019. As to Winters, she responded to
        Dempsey’s second sick call request, which stated Dempsey was
        having trouble breathing and had endocarditis. Combined with
        Winters’s response that Dempsey had already been seen and just
        needed to let the medication work, it is reasonable to infer that
        Winters knew on May 2, 2019, about Dempsey’s endocarditis.
        Thus, the district court did not err in concluding that the material
        facts of this case, construed in the light most favorable to the Estate,
        could lead a reasonable juror to conclude “that [Burks, Lesko, and
        Winters] knew at different points that [Dempsey] had
        endocarditis[.]”
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        23-10825              Opinion of the Court                      21

               With respect to Ayers, however, a reasonable juror could
        not conclude that she was subjectively aware of Dempsey’s
        endocarditis infection. Ayers only had two interactions with
        Dempsey. On the morning of April 29, 2019, Ayers examined
        Dempsey and took her vitals. After Dempsey complained about
        chest pains for the second time in the afternoon of April 29, Ayers
        contacted Lesko who confirmed she had ordered that Dempsey be
        treated with Coreg. Nothing in these April 29 interactions
        indicated to Ayers that Dempsey was suffering from a serious
        medical condition, let alone endocarditis. And while Ayers may
        have learned on the morning of May 3, 2019, that Dempsey was
        suffering from a serious medical condition—evidenced by the fact
        that Dempsey (1) had rapid and labored breathing; (2) a high pulse
        rate (3) had been laying in her feces and urine all night; and (4)
        required a correctional officer’s assistance to shower—there is no
        evidence indicating she knew this condition was endocarditis.
        Accordingly, the care Ayers provided on May 3—calling Lesko and
        following orders to take Dempsey to the medical unit for further
        evaluation and treatment—was not so grossly inadequate as to
        constitute a reckless disregard of the substantial risk of serious
        harm to Dempsey.
               With it established that there is sufficient evidence for a
        reasonable juror to conclude that each of the Nurses (except for
        Ayers) subjectively knew that Dempsey had endocarditis, we next
        assess whether a reasonable juror could conclude that their medical
        care constituted a reckless disregard of a substantial risk to
        Dempsey’s health. We hold that a reasonable juror could reach
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        22                     Opinion of the Court                 23-10825

        this conclusion with respect to Burks, Lesko, and Winters. For
        starters, the evidence shows that none of these three sent Dempsey
        to the hospital before May 3, 2019, despite the fact that endocarditis
        requires treatment of intravenous antibiotics which the jail could
        not administer. Lesko failed to prescribe any antibiotics, nor did
        she contact the prison doctor at any point to discuss Dempsey’s
        complaint of endocarditis. Instead of taking Dempsey’s complaints
        of endocarditis seriously, Lesko merely prescribed medication that
        addressed Dempsey’s symptoms of high blood pressure, difficulty
        breathing, and pitting edema, not the root cause of these
        symptoms.        Similarly, on May 2, 2019—when Dempsey
        complained about difficulty breathing and endocarditis—Winters
        merely responded that Dempsey needed to wait for the non-
        antibiotic drugs that Lesko had prescribed to work. Likewise, on
        the night of April 28 when Burks responded to Dempsey’s
        complaints of chest pains, Burks merely placed Dempsey back in
        the dorm and informed her that she would contact Lesko, even
        though Burks was already aware of the fact that Dempsey had
        endocarditis and had recently been treated with Azithromycin.
        Burks and Winters continued with the cursory treatment that
        Lesko prescribed and ignored the root cause of Dempsey’s
        complaints. Given the severity of endocarditis and Dempsey’s
        continual complaints and deteriorating condition over the days she
        was held as a pretrial detainee at BCJ, we conclude that a
        reasonable juror could conclude that Burks, Lesko, and Winters
        recklessly disregarded the risk to Dempsey’s healthy by not
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        23-10825                 Opinion of the Court                             23

        ensuring she received the intravenous antibiotics required to treat
        endocarditis. 11
               B. Dempsey’s Right Was Clearly Established
               Our determination that a reasonable juror could determine
        that Burks, Lesko, and Winters were deliberately indifferent to
        Dempsey’s serious medical needs does not end our inquiry. We
        must also determine whether binding precedent clearly
        established, at the time of Dempsey’s detention, that Burks, Lesko,
        and Winters were required to ensure that Dempsey’s endocarditis
        was treated. We hold that the law was clearly established at the
        time of Dempsey’s detainment at BCJ.
               For a law to be clearly established, “pre-existing law must
        dictate, that is, truly compel (not just suggest or allow or raise a
        question about), the conclusion for every like-situated, reasonable
        government agent that what [the] defendant is doing violates
        federal law in the circumstances.” King v. Pridmore, 961 F.3d 1135,
        1145 (11th Cir. 2020) (quotation omitted). In undertaking this
        analysis, we must be careful “not to define clearly established law
        at a high level of generality.” Ashcroft v. al-Kidd, 563 U.S. 731, 742
        (2011). However, “there need not be a case ‘on all fours’ with
        materially identical facts, before we allow suits against

        11 As discussed above, there is no evidence that Ayers was subjectively aware

        that Dempsey had endocarditis. While she may have been aware on May 3,
        2019, that Dempsey had a serious medical condition, Ayers’s treatment of this
        condition—taking Dempsey to BCJ’s medical unit for further care—does not
        constitute a reckless disregard to Dempsey’s health.
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        24                      Opinion of the Court                   23-10825

        [government officials].” Holloman ex rel. Holloman v. Harland, 370
        F.3d 1252, 1277 (11th Cir. 2004). Accordingly, a plaintiff can satisfy
        the clearly established requirement in one of three ways. Powell v.
        Snook, 25 F.4th 912, 920 (11th Cir. 2022). First, a plaintiff can
        “point[] to a materially similar decision of the Supreme Court, of
        this Court, or of the supreme court of the state in which the case
        arose.” Id. Second, a plaintiff can “establish[] that a broader clearly
        established principle should control the novel facts of the case.” Id.
        (internal quotations omitted). Finally, a plaintiff can “convinc[e] us
        that the case is one of those rare ones that fits within the exception
        of conduct which so obviously violates th[e] constitution that prior
        case law is unnecessary.” Id. (second brackets in original) (internal
        quotations omitted).
               Burks, Lesko, and Winters argue that the district court erred
        in concluding that the law was clearly established that their actions
        violated Dempsey’s constitutional right to adequate medical care.
        They assert that the district court improperly relied on our decision
        in McElligott v. Foley in coming to its decision because the factual
        situation in the instant matter is not substantially similar to the facts
        present in that case. We disagree. In McElligott, we considered
        whether a doctor and nurse were deliberately indifferent to a
        prisoner’s serious medical needs when, over the course of a period
        of six months, they continually ignored his complaints of severe
        abdominal pain and merely treated him with Tylenol and Pepto-
        Bismol. 182 F.3d at 1252–53. After the prisoner was finally sent to
        the hospital, the prisoner was diagnosed with terminal stomach
        cancer. Id. at 1254. We held that a reasonable jury could determine
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        23-10825                    Opinion of the Court                                 25

        that the nurse and doctor were deliberately indifferent to the
        prisoner’s serious medical condition because (1) instead of
        attempting to diagnose and treat his worsening condition, they
        took an easier and less efficacious course of treatment; and (2) the
        medication they prescribed did not address the prisoner’s severe
        pain he was experiencing as evidenced by his continual complaints
        and thus the care provided by the doctor and nurse was so cursory
        as to amount to no care at all. 12 Id. at 1257–58.
               There are certainly some factual differences between the
        situation in McElligott and the instant case, the most obvious being
        the fact that the prisoner in McElligott suffered for a period of
        months and Dempsey was only in the care of BCJ for eight days.
        However, unlike the medical staff in McElligott who did not know
        that the prisoner had cancer, here the evidence could lead a jury to
        conclude that Burks, Lesko, and Winters each individually knew
        that Dempsey had endocarditis which is a serious condition
        requiring treatment with intravenous antibiotics. Lesko failed to
        prescribe such antibiotics to Dempsey and only prescribed drugs to
        address some of her symptoms, even as her condition worsened.

        12 We reached a similar conclusion in Carswell v. Bay County, 854 F.2d 454 (11th

        Cir. 1988). In Carswell, the medical staff diagnosed and provided some
        medication to a prisoner who made continual requests for additional medical
        care. Nevertheless, we affirmed a jury verdict in favor of the prisoner because
        as his condition continued to worsen, the medical staff failed to respond. Id.
        at 457. See also Ancata v. Prison Health Servs., Inc., 769 F.2d 700 (11th Cir. 1985)
        (holding that medical providers’ delay in in providing necessary medical
        treatment to a prisoner who was later diagnosed and died from leukemia
        constituted deliberate indifference).
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        26                     Opinion of the Court                23-10825

        Burks and Winters knew that Dempsey was not being treated with
        antibiotics and they failed to take any action to address Dempsey’s
        endocarditis. This amounts to care that is so cursory as to amount
        to no care at all. Thus, the law was clearly established at the time
        of Dempsey’s detainment at BCJ that Burks’s, Lesko’s, and
        Winters’s medical treatment of Dempsey was constitutionally
        deficient.
               Accordingly, for the above reasons, the district court did not
        err in denying Burks, Lesko, and Winters qualified immunity at
        summary judgment. The district did err in denying summary
        judgment to Ayers.
              AFFIRMED IN PART AND REVERSED IN PART.