Court Opinion

ID: 9929646
Source: CourtListenerOpinion
Date Created: 2024-02-02 22:00:29.466506+00
Date Added: 2024-06-11T10:40:53.371419
License: Public Domain

United States Court of Appeals
                      For the First Circuit

No. 22-1507

                           LIDIA LECH,

                      Plaintiff, Appellant,

                                v.

 DOROTHEA VON GOELER; BAYSTATE MEDICAL PRACTICES, INC.; HAMPDEN
   COUNTY SHERIFF'S DEPARTMENT; MARIA DIAZ; NICOLE SKORUPSKI;
ELIZABETH MEAUX; SHANTELLE ROSADO; JULIE BELLE-ISLE; LYNN CHASE;
MICHAEL J. ASHE, JR.; PATRICIA MURPHY; NICHOLAS COCCHI; NATALIE
                   CRUZ; and MICHAEL VANCINI,

                      Defendants, Appellees,

                    JOHN DOE 1 and JOHN DOE 2,

                           Defendants.

          APPEAL FROM THE UNITED STATES DISTRICT COURT
               FOR THE DISTRICT OF MASSACHUSETTS

      [Hon. Katherine A. Robertson, U.S. Magistrate Judge]

                              Before

                   Rikelman, Selya, and Howard,
                         Circuit Judges.

     Daniel Volchok, with whom Allison M. Schultz, Joseph M. Meyer,
Michael Moorin, Wilmer Cutler Pickering Hale and Dorr LLP, and
John R. Godleski were on brief, for appellant.

     Thomas E. Day, with whom Lauren F. Olanoff and Egan, Flanagan
and Cohen, P.C. were on brief, for appellees Hampden County
Sheriff's Department, Maria Diaz, Nicole Skorupski, Elizabeth
Meaux, Shantelle Rosado, Julie Belle-Isle, Lynn Chase, Michael J.
Ashe, Jr., Patricia Murphy, Nicholas Cocchi, Natalie Cruz, and
Michael Vancini.

     Michael B. Doherty, with whom Kevin C. Giordano and Keyes and
Donnellan, P.C. were on brief, for appellees Dorothea von Goeler
and Baystate Medical Practices, Inc.

                        February 2, 2024
            RIKELMAN, Circuit Judge.             When she was thirty-four weeks

pregnant and during a three-month period of incarceration at a

correctional       facility    in     Western      Massachusetts,     Lidia    Lech

experienced a stillbirth.           She sued healthcare providers and other

staff affiliated with the facility, alleging that they disregarded

her   concerns      about     the    serious      medical   symptoms    she     was

experiencing and denied her repeated requests to go to a hospital,

resulting in her baby's death.             The district court granted summary

judgment to one of the defendants but permitted most of Lech's

other claims to proceed to trial, after which a jury returned a

defense verdict.

            Lech now challenges the grant of summary judgment and

two   of   the    district     court's      evidentiary     rulings    at     trial.

According to Lech, the erroneous evidentiary rulings reinforced

each other and precluded her from responding fully to the defense's

central theory of the case: that the jury should believe the

medical staff and not Lech.

            After careful review and on the undisputed facts here,

we conclude that the district court did not err in granting summary

judgment to a correctional officer on Lech's claims of deliberate

indifference and intentional infliction of emotional distress.                   We

determine,       however,   that     the    district    court   did    abuse    its

discretion in the two evidentiary rulings challenged on appeal.

Together, the rulings permitted the defense to use extrinsic

                                           -3-
evidence    to    impugn     Lech's    character       for   truthfulness        while

simultaneously       precluding       Lech      from    introducing           testimony

corroborating her version of events.              Because we conclude that at

least one of these evidentiary rulings was not harmless, we vacate

the jury verdict and remand for a new trial against most of the

defendants.

                                   I. BACKGROUND

                               A. Relevant Facts

            We    present     the     facts     relevant     to    the    challenged

evidentiary rulings in a "balanced" manner, "objectively view[ing]

the evidence of record."            United States v. Velazquez-Fontanez, 6

F.4th 205, 212 (1st Cir. 2021) (citation omitted).1

            On October 4, 2013, when she was approximately twenty-

two   weeks      pregnant,    Lech     was    incarcerated        at    the    Western

Massachusetts Regional Women's Correctional Center (WCC) for a

probation violation.         Lech's 2013 pregnancy was high-risk because

she had experienced a uterine rupture during a previous pregnancy

and then miscarried.         During her intake with medical staff at WCC

on October 4, Lech reported that she had a high-risk pregnancy.

Shortly    thereafter,       WCC    received,    and    medical        staff   members

      1When we review the district court's grant of summary
judgment infra, we recite the facts relevant to that issue in the
light most favorable to Lech "consistent with record support."
Lahens v. AT&T Mobility P.R., Inc., 28 F.4th 325, 328 (1st Cir.
2022).

                                        -4-
reviewed, Lech's medical records documenting her prior uterine

rupture and miscarriage.    Lech's medical records at WCC likewise

noted that her "principal diagnosis" was high-risk pregnancy.       A

few weeks later, in November, Lech was referred to a maternal-

fetal medicine physician, a specialist who receives additional

training within the field of obstetrics and gynecology focusing on

high-risk pregnancy.    The specialist recommended that she deliver

via cesarean section (C-section) because labor would increase the

risk of another uterine rupture, which would be life-threatening

to Lech and her baby.      Lech's C-section was scheduled for mid-

January.

            Lech's   claims in this case    focus on the period of

December 22, 2013, to January 1, 2014, when Lech was about two to

three weeks away from her scheduled C-section.      Lech testified at

trial that, during this time period, she sought near-daily medical

attention for her pregnancy and became extremely concerned that

something was wrong.    She stated that she reported to WCC medical

staff increasing signs of serious problems with her pregnancy,

including decreased fetal movement, vaginal discharge, cramping,

a "dropping feeling" in her abdomen, a "bulging sensation" on her

right side, and, later, vaginal bleeding.      Lech also stated that,

because of these symptoms, she repeatedly requested to go to the

hospital.     And yet, she maintained, WCC medical staff either

belittled or ignored her symptoms.     WCC medical staff, by contrast,

                                 -5-
denied that Lech reported any pregnancy-related symptoms other

than those contained in the medical notes for each of Lech's

visits -- which report either no pregnancy-related symptoms at all

or only a small subset of them.2            The staff further denied that

Lech ever asked them to send her to the hospital.

            Eventually, on January 1, 2014, Lech was transported to

the    hospital.      That   night,   she    had   told   Natalie      Cruz,   a

correctional officer at WCC, and a nurse on staff that she was

experiencing vaginal bleeding; Lech testified that she had also

told them she believed she was going into labor.                    The nurse

contacted the on-call certified nurse midwife, who directed that

Lech should be sent to the hospital.

            Lech arrived at the hospital on the morning of January

2, 2014.     There, she was told that her baby had passed away.

Physicians diagnosed her with a suspected placental abruption, a

condition   in     which   the   placenta    separates    from   the   uterus,

depriving the fetus of oxygen.          Lech had a C-section later that

day.

       Specifically, defendants agree that Lech reported decreased
       2

fetal movement once, on December 23, 2013, vaginal discharge once,
on December 30, 2013, and some vaginal bleeding and cramping on
January 1, 2014, as the providers' medical records document, but
they deny that Lech reported any other pregnancy-related symptoms.

                                      -6-
                                B. Legal Proceedings

             Lech filed this action in 2017, naming as defendants

several healthcare providers and correctional personnel at WCC

with whom she interacted in the days before she learned of her

stillbirth, as well as their employers.                 The defendants included

six     nurses,     two    correctional         officers,   and    the    assistant

superintendent at WCC; the Hampden County Sheriff's Department,

which     employs       those    staff;   and    the   Hampden    County    Sheriff

(collectively,          "the    Hampden   County    defendants").        They     also

included Dr. Dorothea von Goeler, an internal medicine physician

who provides medical care at WCC as an independent contractor, and

her employer, Baystate Medical Practices, Inc. (collectively, "von

Goeler").         In     her    complaint,   Lech      alleged    that   defendants

disregarded       her    concerns    about   her    pregnancy     and    denied   her

repeated requests to go to the hospital, which resulted in her

baby's death.            She brought      Eighth Amendment claims          based on

defendants' deliberate indifference to her serious medical needs

and Massachusetts state-law claims of deliberate indifference,

negligence, medical malpractice, and intentional infliction of

emotional distress (IIED).           The parties agreed to have a magistrate

judge conduct all proceedings.3

      We refer to the magistrate judge as the district court
      3

throughout this opinion.

                                          -7-
               The district court resolved some of Lech's claims at the

summary-judgment stage.          As relevant here, it found that Natalie

Cruz, whom Lech told that she needed medical care on January 1,

2014,    was    entitled    to   summary   judgment   on    Lech's   deliberate

indifference and IIED claims against her.

               Most of Lech's other claims proceeded to a jury trial,

which was held over 17 days.           The fact witnesses included Lech,

members of the medical and correctional staff at WCC, Lech's

mother, and Lech's close friend, Alfred Zygmont, who had visited

her at the facility twice during the critical time period.                     Both

parties also offered expert testimony, which primarily focused on

the timing and cause of Lech's stillbirth and whether the medical

staff's treatment as documented in their medical notes complied

with the standard of care.

               Throughout   trial,   the     defendants    all   agreed   on    one

central theory of the case:          that Lech never told the facility's

medical staff about most of the pregnancy-related concerns she

claimed to have reported and that the medical providers' version

of events, not Lech's, was credible.4            Defendants focused on this

theory in their opening statement, asserting that the jury would

"hear two stories," the first of which was alleged in Lech's

     4In addition, von Goeler offered a causation theory, claiming
that Lech's stillbirth occurred before she saw von Goeler on
December 30, 2013, and was caused in part by Lech's underlying
risk factors.

                                       -8-
complaint and in her testimony, and the second of which was told

by medical providers, their medical records, and "Lech's own

recorded phone calls."           As the defense framed the case, the true

story of what transpired "is told not by what [Lech] says but what

she doesn't say."

              Recorded phone calls that Lech made to her family and

then-boyfriend while at WCC took center stage in the defense.5

Defendants used the contents of the calls in two key ways.                      First,

they argued that Lech's calls undercut her own testimony because

"what [the jury] w[ould not] hear" in those calls was Lech stating

that she "th[ought] she need[ed] to go to the hospital" or "that

[she] ha[d] asked the medical providers to send her to the hospital

and they ha[d] refused."             Thus, defendants maintained, Lech's

failure to mention her symptoms or appointments with WCC medical

staff during the calls "contradict[ed] the story . . . Lech [was]

trying   to    tell   [the       jury]   through   this    lawsuit."            Second,

defendants used other portions of Lech's calls to demonstrate

specific   occasions        on   which   she   allegedly    lied        about   topics

unrelated to her health or medical care, contending that those

lies showed her general character for untruthfulness.

              At   trial,    the    district   court     made     two    evidentiary

rulings that Lech challenges on appeal, both of which implicate

     5 It appears that WCC records                 all    phone    calls    made     by
individuals incarcerated there.

                                         -9-
defendants'    attacks      on   her     credibility.        During     Lech's

cross-examination, the district court allowed defendants to play

recordings    of   Lech's   phone      calls   to   prove   her    purportedly

untruthful character.       It then excluded testimony from Zygmont

about statements Lech made to him when he visited her at WCC on

December 26 and 28, 2013.           Based on Lech's proffer at trial,

Zygmont would have corroborated her version of events by testifying

that, during those visits, Lech told him that she was concerned

about her pregnancy, that she thought she needed to go to the

hospital, and that WCC staff were not paying attention to her.

          The jury ultimately found in favor of defendants on all

claims. This timely appeal followed.

                         II. STANDARD OF REVIEW

          We review preserved objections to the district court's

evidentiary rulings for abuse of discretion.                United States v.

Kilmartin, 944 F.3d 315, 335 (1st Cir. 2019).                     An abuse of

discretion occurs "when a material factor deserving significant

weight is ignored, when an improper factor is relied upon, or when

all proper and no improper factors are assessed, but the court

makes a serious mistake in weighing them."            Ruiz-Troche v. Pepsi

Cola of P.R. Bottling Co., 161 F.3d 77, 83 (1st Cir. 1998) (quoting

Foster v. Mydas Assocs., Inc., 943 F.2d 139, 143 (1st Cir. 1991)).

An error of law qualifies as an abuse of discretion.              Torres-Rivera

v. O'Neill-Cancel, 524 F.3d 331, 336 (1st Cir. 2008).

                                    -10-
             If we determine that the district court erroneously

admitted or excluded evidence, we then review that ruling for

harmless error. Duval v. Dep't of Veterans Affs., 69 F.4th 37, 42

(1st Cir. 2023) (quoting Gay v. Stonebridge Life Ins. Co., 660

F.3d 58, 62 (1st Cir. 2011)).       An error is harmless if it is

"highly probable that [it] did not affect the outcome of the case."

McDonough v. City of Quincy, 452 F.3d 8, 19-20 (1st Cir. 2006);

see also Nieves-Villanueva v. Soto-Rivera, 133 F.3d 92, 102 (1st

Cir. 1997) (explaining that in a civil case, the party claiming

error has the burden of demonstrating that the error was not

harmless).    To determine the probable impact of improperly admitted

or excluded evidence on the jury verdict, we consider factors such

as "[t]he centrality of the evidence, its prejudicial effect,

whether it is cumulative, the use of the evidence by counsel, and

the closeness of the case."    Kowalski v. Gagne, 914 F.2d 299, 308

(1st Cir. 1990) (quoting Lataille v. Ponte, 754 F.2d 33, 37 (1st

Cir. 1985)); accord Nieves-Villanueva, 133 F.3d at 102.      We weigh

these factors "in the context of the case," as drawn "from the

record as a whole."    Nieves-Villanueva, 133 F.3d at 102 (citation

omitted).

             A different standard applies to the district court's

grant of summary judgment to Cruz.      We review that ruling de novo,

drawing all reasonable inferences in favor of Lech, the nonmoving

party.   Fincher v. Town of Brookline, 26 F.4th 479, 485 (1st Cir.

                                 -11-
2022).   "Summary judgment is proper if the movant," here Cruz,

"shows that there is no genuine dispute as to any material fact

and [she] is entitled to judgment as a matter of law."   Id. (quoting

Fed. R. Civ. P. 56(a)).

                          III. DISCUSSION

          We begin by discussing Lech's challenge to the district

court's evidentiary rulings.     We ultimately determine that the

district court abused its discretion both by permitting defendants

to use Lech's recorded phone calls to attack her character for

truthfulness and by excluding Zygmont's proffered testimony.      At

least one of these errors was not harmless as to the Hampden County

defendants, whose defense hinged on the jury finding that Lech's

version of events was not believable, and thus requires a new trial

as to those defendants.   We cannot say that the evidentiary rulings

affected the outcome of the trial as to von Goeler, however,

because she offered a causation defense that did not implicate

Lech's credibility and instead relied on a concession by Lech's

own expert: that it was possible Lech's stillbirth occurred before

her appointment with von Goeler.   After addressing the evidentiary

rulings, we turn to the grant of summary judgment to Cruz on the

deliberate indifference and IIED claims, which we affirm.

                                -12-
                           A. Evidentiary Rulings

                   1. Use of Lech's Recorded Phone Calls

             In    her   first    challenge     to   the   district   court's

evidentiary rulings, Lech argues that the district court erred

when it allowed defendants to play portions of recorded calls she

made at WCC to prove her purportedly untruthful character.                She

asserts that this use of the recordings violated Federal Rule of

Evidence 608(b).

             We address the standard of review before turning to the

substance of Lech's argument.             The Hampden County defendants

contend that we must review Lech's claim for plain error because

she did not object to the admission of the phone calls, which

occurred during Lech's direct examination, but only to defendants'

inquiry into whether certain statements she made on the phone calls

were false.       But Lech did specifically object below on Rule 608(b)

grounds to defendants' use of the recorded calls for the purpose

of proving her purportedly untruthful character, which is the exact

issue she now raises.            Lech thereby preserved her evidentiary

objection, and we review her 608(b) claim for abuse of discretion.

             Rule 608(b) "bars the credibility-related use of some

extrinsic evidence."       United States v. Winchenbach, 197 F.3d 548,

557 (1st Cir. 1999).          Under the rule, "extrinsic evidence is not

admissible to prove specific instances of a witness's conduct in

order   to    attack     or     support   the    witness's   character   for

                                      -13-
truthfulness."      Fed. R. Evid. 608(b).        But the district court "may,

on   cross-examination,          allow   [such   specific    instances]       to    be

inquired into if they are probative of [the witness's] character

for truthfulness or untruthfulness."             Id.; see also United States

v. Abel, 469 U.S. 45, 55 (1984).

            At trial, defendants played portions of recorded phone

calls Lech made to her family while she was at WCC.                       They then

asked her whether specific statements she made in those recordings

unrelated   to     her   medical     care -- such    as     the   basis      for   her

probation violation, whether her then-boyfriend was living in a

sober    house,    and     her    boyfriend's    employment       history -- were

untruthful.       Similarly, defendants played portions of recorded

calls Lech made to her then-boyfriend.             They asked her to confirm

that, in those recordings, she discussed participating in or

planning deceitful conduct unrelated to her medical care, such as

lying to her family for her boyfriend, telling her boyfriend not

to appear for an upcoming court date, and discussing how her

boyfriend could obtain a false negative on a drug test.

            The district court initially ruled that such use of the

recorded calls violated Rule 608(b), but it invited defendants to

file a motion on the issue.              Defendants did so, arguing in part

that the phone calls were not extrinsic because they already had

been    admitted    into    evidence,      and   that,    even    if   the    rule's

prohibition on the use of extrinsic evidence applied, defendants

                                         -14-
were    permitted   on   cross-examination     to     inquire    into   Lech's

untruthful statements on the calls.            The district court then

reversed its earlier ruling and determined that "the specific

instances of untruthfulness reflected in the phone calls" were

admissible, although it did not explain its reasoning.

            We conclude that the district court ran afoul of Rule

608(b) when it allowed defendants to play the recordings before

the jury.    Defendants recognize on appeal, as they did below, that

Lech's allegedly untruthful statements on the recordings were

specific instances of her conduct and that they sought to use the

recordings     to   attack    Lech's      character     for     truthfulness.

Defendants argue, however, that the recordings were not extrinsic

evidence because they were admitted and used during Lech's direct

testimony and so are not covered by Rule 608(b).

            But we have stated that "extrinsic evidence includes any

evidence other than trial testimony."          United States v. Balsam,

203 F.3d 72, 87 n.18 (1st Cir. 2000); see also 4 Jack B. Weinstein

& Margaret A. Berger, Weinstein's Federal Evidence § 608.20[1]

(2023) ("Evidence is 'extrinsic' if offered through documents or

other witnesses, rather than through cross-examination of the

witness himself or herself.").         Indeed, in Balsam, we held that

taped    recordings      of   jailhouse     phone      conversations      were

inadmissible under Rule 608(b) because "the tapes were just such

nontestimonial evidence."      203 F.3d at 87 n.18; see also United

                                  -15-
States v. Sabean, 885 F.3d 27, 39 (1st Cir. 2018) (holding that

the district court properly excluded an audio recording of a

witness's testimony in a previous case when the recording was

offered to impeach the witness's truthful character, given that

such use would "ru[n] headlong into Federal Rule of Evidence

608(b)").6        Here, Lech's statements on the recordings were not

developed in her trial testimony and therefore were extrinsic.

And the fact that Lech's counsel used portions of the calls for

one purpose -- to bolster her testimony on direct examination --

does       not   answer   the   question   of   whether   defendants'   use   of

      The Hampden County defendants offer different definitions
       6

of extrinsic evidence and contend that the recordings do not
qualify. But their arguments do not stand up to scrutiny. First,
relying on United States v. Ofray-Campos, 534 F.3d 1, 18 (1st Cir.
2008), defendants contend that extrinsic evidence is evidence
other than that developed or introduced at trial. Ofray-Campos,
however, did not involve Rule 608(b) and examined only whether a
judge's   response   to   a   jury   note   during   deliberations
inappropriately exposed the jury to "extrinsic information,"
meaning "any outside influence," in violation of the defendant's
Sixth Amendment rights. Ofray-Campos, 534 F.3d at 18-19 (quoting
Patterson v. Colorado, 205 U.S. 454, 462 (1907)).
     Second, defendants assert that the recordings were highly
relevant to the litigation and that extrinsic evidence is evidence
that is "'not relevant in the litigation to establish a fact of
consequence,' i.e., evidence of a 'collateral matter.'" United
States v. Boulerice, 325 F.3d 75, 82 n.5 (1st Cir. 2003) (quoting
United States v. Andújar, 49 F.3d 16, 26 (1st Cir. 1995)). But
whether the recordings were "highly relevant" has no bearing on
whether they are extrinsic. The recordings went beyond Lech's own
testimony during her      cross-examination   and are therefore
extrinsic.     See id. (contrasting evidence offered through
documents or another witness, which is extrinsic, and testimony
elicited on the witness's own cross-examination, which is not).

                                       -16-
different portions of the calls for a different purpose violated

Rule 608(b).     See Fed. R. Evid. 105 (explaining that evidence may

be admissible for one purpose but not another).

              Defendants     offer    several      reasons    for      why    it     was

permissible for them to play the recordings, but we find none

persuasive.      First, the Hampden County defendants contend that

Lech's calls were admissible as statements of a party opponent.

See Fed. R. Evid. 801(d)(2)(A).             But that rule provides only that

an opposing party's statements are not hearsay.                     Fed. R. Evid.

801(d).   It does not establish that the statements are admissible

in violation of another rule.            See Fed. R. Evid. 105.

              Next,   the   Hampden      County    defendants   argue        that,    on

cross-examination,         they   were     permitted   to    inquire    into       false

statements Lech made on the recorded calls to demonstrate her

allegedly untruthful character.             Defendants are correct that Rule

608(b) allows a party to ask a witness about a specific instance

of past conduct if it is probative of the witness's character for

truthfulness, with the understanding that the party is then "stuck"

with the witness's answer.            See United States v. A.S., 939 F.3d

1063, 1072 (10th Cir. 2019) (quoting Seifert v. Unified Gov't, 779

F.3d 1141, 1154 (10th Cir. 2015)); see also Fed. R. Evid. 608(b);

Abel,   469    U.S.   at    55.      So,    when   defendants    asked       Lech    on

cross-examination whether she lied during the phone calls, the

rule did not render Lech's answers inadmissible.                But the rule did

                                         -17-
prohibit     defendants    from     playing     the   recordings    to    introduce

specific instances of her past conduct for the purpose of showing

her alleged penchant for untruthfulness.                   See United States v.

Mateos-Sanchez, 864 F.2d 232, 237 (1st Cir. 1988) (distinguishing

between inquiry on cross-examination to demonstrate untruthful

character, which is permissible, and presentation of physical

evidence, which is not); Sabean, 885 F.3d at 39 (determining that

the district court properly permitted the defendant to cross-

examine a witness about testimony she had given in a prior case to

impeach her general truthfulness while excluding an audiotape of

that testimony).      And that is what defendants did here.               They told

the district court they sought to play the calls because specific

statements on the recordings were either false on their face or

demonstrated that Lech lied on other occasions, all of which was

"highly probative of her character for untruthfulness."

             As   their    last   line    of    defense,    the   Hampden   County

defendants contend that, even if the phone calls were extrinsic

evidence, they were admissible because Rule 608(b) does not bar

extrinsic evidence unless "the sole purpose" for offering the

evidence was to prove a witness's character for untruthfulness.

See   Fed.   R.    Evid.   608(b)    advisory     committee's      note    to   2003

amendment.        They note that both parties used Lech's calls for

different purposes throughout trial.             But defendants fail to offer

important context for the authority upon which they rely.                         A

                                         -18-
previous version of Rule 608(b) stated that extrinsic evidence

could not be used to prove specific instances of conduct for the

purpose of "attacking or supporting the witness' credibility."

United States v. Epstein, 426 F.3d 431, 439 n.4 (1st Cir. 2005).

The   rule    was   later   amended   to   substitute   "character   for

truthfulness" for "credibility."         Id.   The advisory committee's

note explains that the amendment intended to "clarify that the

absolute prohibition on extrinsic evidence applies only when the

sole reason for proffering that evidence is to attack or support

the witness' character for truthfulness," thereby "leav[ing] the

admissibility of extrinsic evidence offered for other grounds of

impeachment (such as contradiction, prior inconsistent statement,

bias and mental capacity)" to other rules.         Fed. R. Evid. 608(b)

advisory committee's note to 2003 amendment; see also United States

v. Delgado-Marrero, 744 F.3d 167, 179 (1st Cir. 2014) (explaining

that the amendment sought to make clear that the rule "exclude[d]

extrinsic evidence of a witness's general propensity for honesty

and truth, rather than . . . for other non-propensity purposes").

Critically, in defendants' own words, they sought to use the

recordings in the manner challenged here to demonstrate Lech's

"character for untruthfulness."       Accordingly, Rule 608(b) applies.

             Finally, von Goeler recognizes that Rule 608(b), "read

narrowly," would prohibit a party from using previously admitted

exhibits when cross-examining a witness about allegedly untruthful

                                  -19-
conduct.       But she states that a narrow construction would have

been inefficient here.            She asserts that, because the recorded

calls    were    already    in    evidence,       it   was    more    efficient     for

defendants to use the recordings to establish that Lech made the

statements, rather than proceed through the more extended process

of using the recording to refresh Lech's recollection or impeach

her.     But the issue here is not that defendants played the

recordings simply to confirm that Lech made certain statements in

her    phone    calls.     Rather,      it   is   that   defendants      played     the

recordings to prove that Lech had lied in the calls, with the

ultimate aim of depicting her as habitually untruthful.

               To summarize, we conclude that the district court abused

its discretion when it allowed defendants to play the recordings

of Lech's calls to prove she had lied in the past and impugn her

truthful character, in violation of Rule 608(b).                     We next turn to

Lech's second evidentiary argument.

                      2. Exclusion of Zygmont's Testimony

               Lech   argues    that   the   district        court   erred   when    it

excluded       testimony       from    her   friend      Alfred      Zygmont   about

corroborating statements she made to him when he visited her at

WCC.    The parties agree that she preserved this objection, and

that the abuse of discretion standard applies.

               Below, Lech proffered that Zygmont would testify that,

during his visits with her on December 26 and 28, 2013, "Lech

                                         -20-
complained WCC medical staff were not paying attention to her, she

was experiencing decreased fetal movement, felt that something was

wrong, and that she thought she needed to go to the hospital."

Lech contends that those statements were admissible as prior

consistent    statements     under    Federal     Rule     of   Evidence

801(d)(1)(B)(i).

          We have explained that under Federal Rule of Evidence

801(d)(1)(B)(i), "a witness's prior statement is excluded from the

rule against hearsay -- and thus may be admissible -- 'when (1)

the   declarant     testifies    at   trial     and   is    subject   to

cross-examination; (2) the prior statement is consistent with the

declarant's trial testimony; and (3) the prior statement is offered

to rebut an express or implied charge against the declarant of

recent fabrication or improper influence or motive.'"             United

States v. Chiu, 36 F.4th 294, 300 (1st Cir. 2022) (quoting United

States v. Jahagirdar, 466 F.3d 149, 155 (1st Cir. 2006)); see also

Fed. R. Evid. 801(d)(1)(B)(i).

          In rejecting the proffer, the district court focused on

the third element -- that Zygmont's testimony must be offered to

rebut an express or implied charge of recent fabrication levied

against Lech.      It concluded that there was no such charge of

fabrication   because   on   cross-examination,   defendants    did   not

challenge Lech on whether she told the medical providers about all

of her pregnancy-related symptoms or whether she asked those

                                  -21-
providers to go to the hospital but was ignored.         In the district

court's   view,   therefore,   Lech    was    offering     impermissible

bolstering testimony.   On appeal, the parties also focus primarily

on this third element.7      Accordingly, we turn to whether that

element is satisfied here.

           For this inquiry, we consider whether there is "some

degree of fit between the alleged fabrication and the prior

statement."   Chiu, 36 F.4th at 301.         To meet this standard, a

charge of recent fabrication does not have to be "expressly made."

United States v. Lozada-Rivera, 177 F.3d 98, 104 (1st Cir. 1999).

But the person who seeks to introduce prior consistent statements,

here Lech, must "point to specific questions" during the opposing

party's examination "that suggest recent fabrication or bias."

Id.   "Merely appealing to credibility as a live issue will not do

the trick."   Id.; see also Chiu, 36 F.4th at 300–01 (examining

whether the government challenged the defendant on the "specific

subject of the rehabilitative, prior consistent statement" or

launched only a generalized attack on his credibility); United

States v. Wilkerson, 411 F.3d 1, 5 (1st Cir. 2005) (explaining

      The Hampden County defendants concede that the first two
      7

elements set forth in Chiu are satisfied, although von Goeler
briefly suggests that Zygmont's testimony would not have been
consistent with Lech's.    She contends that Zygmont would have
testified as to broad, generalized statements that Lech made to
him, but that Lech's testimony was about specific medical issues
she experienced. We reject this argument based on our review of
the proffer and the record.

                                -22-
that prior consistent statements "must at least have some rebutting

force beyond the mere fact that the witness has repeated on a prior

occasion a statement consistent with [their] trial testimony"

(internal   quotation   marks   omitted)   (quoting   United   States   v.

Simonelli, 237 F.3d 19, 27 (1st Cir. 2001))).

            Lech easily satisfies that standard here.          The trial

record makes abundantly clear that defendants accused Lech of

fabrication and that there is at least "some degree of fit" between

Zygmont's testimony and the charge of fabrication it was offered

to rebut.    Chiu, 36 F.4th at 301.        One of the central theories

pursued by all defendants at trial was that the jury should believe

the medical providers and their medical records, not Lech.              As

defendants recognized at oral argument before us, that theory

required the jury to reject Lech's contrary testimony that she

raised all her pregnancy-related concerns to the medical staff,

who ignored her.    Indeed, throughout trial, defendants compared

(i) what Lech stated she told medical providers with (ii) what she

discussed on her recorded calls with family members and her

then-boyfriend to imply that her testimony about experiencing

symptoms, reporting all those symptoms to medical staff, and

requesting to go to the hospital was all fabricated.

            For instance, during their cross-examination of Lech,

defendants confirmed that she had just testified that she reported

pregnancy-related symptoms to medical staff.          They then played

                                  -23-
recorded      calls      Lech   had   with   her    mother,   brother,      and

then-boyfriend on the same day as those appointments and asked her

to confirm that during those calls she did not mention anything

about her pregnancy, the appointments, or the health of her baby,

or that she needed to go to the hospital and medical staff refused

to send her.

              The implication of defendants' cross-examination was

that Lech fabricated her testimony that she communicated concerns

about her pregnancy to WCC medical staff.            Defendants argued that

the omissions in Lech's calls to family members made it unlikely

that Lech experienced her symptoms at all or shared her symptoms

with anyone, providers included, and more likely that she never

told providers what she claimed.

              In their opening statement, defendants confirmed that

the purpose of using the recorded calls was to undermine Lech's

testimony that she told providers her concerns about her pregnancy.

So, too, in their closing argument, when defendants contended that

Lech's pleas to the medical providers "are not supported by the

medical records, and . . . are not supported by the recorded phone

calls for a simple reason: Because they did not happen."            In fact,

at closing, defendants implored the jury, "[i]f [they were] having

any   doubt    as   to    the   v[e]racity   of   [defendants']   story,"   to

"[d]ecide . . . whether [Lech's] phone conversations, the topics,

the tone . . . are consistent with a woman who feels that her baby

                                      -24-
is dying within her, who has been repeatedly begging to be sent to

the hospital, and who has repeatedly been refused by every single

medical provider she encountered over that 10-day period."             To

believe Lech, defendants asserted, the jury had to believe that,

"in spite of [her] pressing concerns that she told [the jury]

about, it is entirely reasonable that [she] made almost no mention

of them" in her recorded conversations.

           Zygmont's   testimony    would   have   rebutted   defendants'

theory that Lech fabricated either experiencing certain symptoms

or sharing them with others (or both).          As to Lech's symptoms,

Zygmont would have testified that, when he visited Lech at WCC

twice during the critical time period, Lech told him that she "was

experiencing decreased fetal movement, felt that something was

wrong, and that she thought she needed to go to the hospital."         As

to her communications with the providers, he would have testified

that "Lech complained WCC medical staff were not paying attention

to her."   Lech contended that his testimony would have helped to

establish that she was concerned about her pregnancy, communicated

those concerns to her close friend, and felt that medical staff

were dismissive of her.      It also would have shown that Lech

specifically   mentioned   experiencing      decreased   fetal   movement

multiple times and not just once.           Further, a jury could have

viewed Zygmont's testimony that Lech told him about her symptoms

and thought she needed to go to the hospital as making it more

                                   -25-
likely that Lech reported those symptoms to WCC staff and asked

them to send her to the hospital.         Accordingly, Zygmont's testimony

would   not        have   rebutted    merely   a    broad   attack     on     Lech's

credibility.        See Lozada-Rivera, 177 F.3d at 104; Chiu, 36 F.4th

at 300–01.         Rather, it would have rebutted the specific charge

that she fabricated either her symptoms or her communication of

those symptoms to providers.           Chiu, 36 F.4th at 301.

           Moreover, Zygmont's proposed testimony would not have

been impermissible bolstering testimony.              See Wilkerson, 411 F.3d

at 5; Simonelli, 237 F.3d at 28.           Its "rebutting force" was that,

although Lech did not mention to some people in her life the

concerns she said she raised to the providers, Lech told the one

person who visited her while she was incarcerated at WCC that she

was   worried       about   her   pregnancy.       Wilkerson,   411   F.3d     at   5

(citation omitted).

           For these reasons, Zygmont's testimony was admissible as

evidence      of     Lech's   prior    consistent     statements      under     Rule

801(d)(1)(B)(i).          See United States v. Washington, 434 F.3d 7, 15

(1st Cir. 2006) (finding that a prior consistent statement was

properly admitted when the opposing party "had suggested that the

entirety of [the declarant's] testimony on direct examination had

been false," including testimony about the specific subject of the

prior consistent statement (emphasis omitted)).                    The district

court abused its discretion when it excluded his testimony.                     Its

                                        -26-
determination that there was no charge of fabrication for that

testimony to rebut simply does not reflect what occurred at trial.

              Having    found     that    the    district    court    abused   its

discretion by allowing defendants to play recordings of Lech's

calls to assail her character for truthfulness and by excluding

Zygmont's testimony, we proceed to a harmless-error analysis.

                          3. Harmless-Error Inquiry

              The district court's erroneous exclusion of Zygmont's

testimony was not harmless as to the Hampden County defendants.

The theme that they revisited at opening, at closing, in their

cross-examination of Lech, and with virtually every fact witness

was    that    the     medical    providers'      account,    not    Lech's,   was

believable.      In pursuit of that strategy, defendants emphasized

that Lech's alleged silence about her pregnancy-related concerns

on her recorded calls and her lack of corroborating evidence backed

up    their   version     of     events   and    disproved   Lech's.      Indeed,

defendants ended their closing argument by stating that "[t]he

conflicts between . . . [Lech's] story and virtually all of the

other evidence in this case" was "why such an important part" of

the jury's job "is deciding who is telling the truth, whom do you

believe is credible."          In a similar manner, they contrasted Lech's

testimony with that of the medical providers, which was "entirely

corroborated" by the medical records and "all of the percipient

witnesses."

                                          -27-
            Given that the case centered on a credibility battle

between Lech and the medical providers, it cannot be harmless error

to exclude corroborating testimony from the sole person who visited

Lech at WCC during the relevant time period.        Zygmont's testimony

would have buttressed Lech's account, rebutted the argument that

she never told anyone about all her symptoms, and made it more

likely that she either discussed her concerns with providers or

requested to be sent to the hospital.8 See United States v. Awon,

135 F.3d 96, 101 (1st Cir. 1998), abrogated on other grounds by

United States v. Piper, 298 F.3d 47 (1st Cir. 2002) (explaining

that the impact of prior consistent statements is that they

corroborate other evidence).

            The district court's ruling excluded exactly the type of

evidence that defendants emphasized was missing from Lech's case.

It also excluded the only corroborating account from another

witness that Lech sought to introduce.           And because Zygmont's

testimony     was   her   sole   corroborating   account,   it   was   not

cumulative.    Its value is precisely that it came from someone other

than Lech.

     8 We note that the district court characterized Zygmont's
testimony differently than the way that testimony was described in
the proffer.   The district court understood that Zygmont would
testify that Lech told him she had relayed to medical staff her
various pregnancy-related symptoms and asked medical staff to go
to the hospital but was ignored. Zygmont's testimony would have
had even more rebutting force -- and its exclusion would therefore
have been more harmful -- when characterized in such a way.

                                    -28-
             Moreover, as Lech notes, the district court permitted

Zygmont to testify about his visits but only as to what he observed

about Lech, not what she stated to him.           The exclusion of Lech's

statements to Zygmont could have implied to the jury that Lech did

not mention any issues with her pregnancy to him either.            The jury

therefore could have been misled into thinking that what was

actually corroborating evidence undermined Lech's account.

             To be sure, the accounts of seven medical providers and

their notes conflicted with Lech's version of events.         In addition,

Lech   had   to    contend   with   defendants'   argument   that    it   was

inherently unlikely that providers ignored and failed to document

some of Lech's pregnancy-related symptoms, while simultaneously

responding to and documenting other symptoms that Lech agreed she

reported.     However, that backdrop only reinforces that the case

hinged on competing credibility assessments.          Lech's inability to

offset defendants' account with evidence of her own is, in part,

what helped defendants argue her account was false.          And although

Zygmont's testimony would not have changed Lech's omissions on the

recorded calls, Lech explained at trial that she did not speak to

her then-boyfriend or family members about her health because her

boyfriend was not sympathetic and her family was dismissive of her

concerns.    Zygmont, by contrast, was the only person who visited

her at WCC.       The jury, if it had Zygmont's testimony, could have

found that Lech was more likely to have confided in Zygmont about

                                     -29-
her medical issues than the people she spoke with on the phone.

Accordingly, his testimony was particularly important to rebutting

the attacks on Lech's credibility.

            Indeed,     the    exclusion    of   Zygmont's     testimony   is

especially harmful when we consider it alongside defendants' use

of   the   recorded    calls   to   show    Lech's   alleged   penchant    for

untruthfulness.       We agree with Lech that, as a practical matter,

it is necessary to evaluate the evidentiary rulings in combination.

The jury would have reviewed the trial evidence holistically and

could have weighed together -- and was encouraged by defendants to

weigh together --       the evidence of Lech's alleged untruthfulness

and the presence or absence of corroborating evidence for each

side's version of events.           The district court rejected Lech's

proffer after defendants had spent part of their cross-examination

attempting to show that Lech had a propensity to lie.              With that

ruling, Lech was deprived of the opportunity to introduce Zygmont's

testimony to bolster her credibility, rebut the claim that she

fabricated her account, and challenge defendants' account.            At the

same time, defendants were allowed to use statements unrelated to

her medical care to show her alleged character for untruthfulness

and to shore up their version of events.               The two errors are

mutually reinforcing.

            Finally, Zygmont's testimony would have been relevant to

Lech's contention that defendants unjustifiably delayed her access

                                     -30-
to medical care.      A jury could have found that his testimony helped

show that Lech consistently noted decreased fetal movement over a

period of days and that, as of December 26 and 28, she believed

she needed to go to the hospital, but WCC medical staff did not

send her there until the morning of January 2.

              In considering the centrality of Zygmont's testimony to

the   trial    and   the   prejudicial   effect     of   its    exclusion,   see

Nieves-Villanueva, 133 F.3d at 102, we conclude that it is not

"highly probable that the error did not affect the outcome of the

case" against the Hampden County defendants.             McDonough, 452 F.3d

at 19-20.9     Because we determine that the exclusion of Zygmont's

testimony was not harmless as to the Hampden County defendants and

vacate the jury verdict as to those defendants on that ground, we

need not determine whether the use of the recorded phone calls in

violation of Rule 608(b) was also harmful.

          4. Effect of the Evidentiary Rulings as to von Goeler

              We reach a different conclusion about the impact of the

evidentiary errors on the verdict as to von Goeler.                   Like the

Hampden     County   defendants,   von     Goeler    also      attacked   Lech's

credibility.      However, she offered an additional defense theory:

      Because we resolve Lech's claim on the ground that Zygmont's
      9

testimony was admissible as evidence of prior consistent
statements and its exclusion was harmful, we need not address
Lech's additional argument that the testimony was also admissible
as evidence of her then-existing condition under Rule 803(3).

                                    -31-
that Lech's stillbirth had already happened by the time von Goeler

saw Lech on December 30, 2013.        She presented that theory at

opening, in closing, and through expert testimony.       This theory

relied on von Goeler's own expert, who estimated that Lech's

placental abruption occurred one week before Lech's C-section on

January 2, 2014, or on approximately December 26, 2013.           But it

also relied on a concession by Lech's expert, who testified that

it was "not likely" but "possible" that the placental abruption

occurred 72 hours before the C-section.        Under that timeline,

Lech's stillbirth would have occurred before Lech's December 30

appointment with von Goeler that formed the basis of her claims.

Thus, if the jury credited Lech's own expert, it could have found

that, even under Lech's version of events, von Goeler's actions

did not cause Lech to lose her baby.   That lack of causation would

have been fatal to Lech's claims against von Goeler.              As the

district court's jury instructions made clear, each claim --

deliberate indifference, medical malpractice, and IIED -- required

Lech to prove by a preponderance of the evidence that von Goeler's

conduct   was   a   but-for   cause    of   Lech's   harm.   10      See

Nieves-Villanueva, 133 F.3d at 102 (considering jury instructions

     10Although the loss of Lech's baby may not be the only
relevant harm as to Lech's IIED claim against von Goeler, Lech
offers no argument on appeal that von Goeler's actions caused her
some type of other, independent emotional distress that is
sufficient to sustain an IIED claim.

                               -32-
in assessing the centrality of the evidence and any prejudicial

effect on the jury's decision).

            Although   the    parties   did   not   discuss   von   Goeler's

causation theory as part of their harmless-error arguments on

appeal, we may affirm the judgment on any ground apparent in the

record.   United States v. George, 886 F.3d 31, 39 (1st Cir. 2018).

Given the evidence supporting von Goeler's theory, which was the

only defense theory that did not implicate Lech's credibility, the

exclusion of Zygmont's testimony "cannot reasonably be understood

as the pivotal evidence that tipped the verdict in favor of [von

Goeler]."   Gay, 660 F.3d at 64.        Because we "cannot say that the

[district court's evidentiary ruling] affected the outcome of the

trial" as to von Goeler, we find that error harmless as to her.

Nieves-Villanueva, 133 F.3d at 102.

                             B. Summary Judgment

            Next, we address Lech's argument that the district court

should not have granted summary judgment to correctional officer

Natalie Cruz on the deliberate indifference and IIED claims against

her.   We first address a threshold issue before turning to the

relevant facts and legal standard.

            Defendants argue that, even if the district court erred

by granting summary judgment to Cruz on the deliberate indifference

and IIED claims, any error was harmless given that the jury found

that Cruz was not liable for negligence.             We have declined to

                                    -33-
"reenter the morass" of summary judgment when it is "perfectly

clear that, even if a plaintiff's claim should not have been

dismissed[,] . . . any such mistake was harmless, given the jury's

verdict in the defendant's favor on other claims addressed to the

very same factual circumstances."      In re Nexium (Esomeprazole)

Antitrust Litig., 842 F.3d 34, 62 (1st Cir. 2016) (cleaned up)

(quoting Fite v. Dig. Equip. Corp., 232 F.3d 3, 6 (1st Cir. 2000)).

Because we have determined that one of the evidentiary rulings

discussed above affected the jury verdict, it is not "perfectly

clear" that the verdict on the negligence claim renders the grant

of summary judgment to Cruz on the deliberate indifference and

IIED claims harmless.   Id. Accordingly, we proceed to evaluate de

novo the merits of the district court's entry of summary judgment.

We begin by setting forth the facts related to the motion in the

light most favorable to Lech consistent with record support.

Johnson v. Johnson, 23 F.4th 136, 139 (1st Cir. 2022).

          Lech interacted with Cruz the night before she was

eventually transported to the hospital, where she was told her

baby had passed away.   At around 10 p.m. on January 1, 2014, Lech

stood up to have her identification bracelet scanned as part of

the facility's evening count.   Lech felt a "gushing sensation" and

a "wetness," in addition to abdominal cramping and bulging.    She

noticed that she was having vaginal bleeding and that her clothes

were stained and wet.   Lech used the intercom in her cell to call

                                -34-
the correctional officers' station, and Cruz answered.   Cruz, who

had received first-responder training as part of her job as a

correctional officer, knew that Lech was pregnant both because it

was clear to Cruz from Lech's appearance and because a list of

prisoner information that Cruz possessed noted Lech's pregnancy.

When she called Cruz, Lech told Cruz that her water had broken,

that she believed she was in labor, and that she "need[ed] to go

to medical or [she] need[ed] to go to the hospital."

          WCC correctional officers like Cruz have two options for

responding to inmates' medical needs: (1) they can "call medical

[staff] and let them know the inmate is requesting medical," in

which case the individual will be sent from their cell to the

medical unit if the medical staff deems it necessary, or (2) they

can "call a medical emergency via the radio," in which case medical

staff will go to the individual's cell immediately to assess the

individual.   In responding to Lech, Cruz used the first option.

Cruz told Lech that everything was fine, and that she would contact

medical staff after finishing her count.   After Cruz finished the

count, which takes between two-and-a-half and three minutes to

complete, and at some point between 10 p.m. and 10:19 p.m., Cruz

called WCC medical staff.   After speaking with medical staff, Cruz

called Lech on the intercom and told her that medical staff wanted

to know how serious her symptoms were and if she could wait until

the morning to be seen.     Lech told Cruz "why" she needed to see

                                -35-
medical, and her roommate shouted through the intercom that Lech

"need[ed] to go [to] medical" and that "[Lech's] water broke."

Cruz then spoke with the medical staff again, and they directed

Cruz to send Lech to the medical unit.                 Cruz did so, and Lech was

scanned out of the housing unit on her way to medical at 10:19

p.m. -- about twenty minutes after she first called Cruz.                        Lech

walked to the medical unit with another WCC staff member.

            In granting summary judgment to Cruz, the district court

determined that "[t]he twenty−minute delay in transferring [Lech]

from her cell to the medical unit while she was bleeding may have

been   negligence      on    Cruz's   part,      but    it   was    not   deliberate

indifference."      It also held that "[b]ecause the bar for IIED

liability   may   be    as    high    as   the   standard     for    a    finding   of

deliberate indifference," Lech failed to show that Cruz's delay

rose to the level of intentional infliction of emotional distress

under Massachusetts law.         We address the deliberate indifference

and the IIED claim in turn.

                    1. Deliberate Indifference Claim

            Prison officials violate the Eighth Amendment when they

act with deliberate indifference to a prisoner's serious medical

needs.   Estelle v. Gamble, 429 U.S. 97, 104 (1976).                     To establish

an Eighth Amendment violation, a prisoner must satisfy both an

objective element, which requires proof of a serious medical need,

and a subjective element, which requires a showing that a prison

                                       -36-
official had a "sufficiently culpable state of mind" such that

they   were    deliberately   indifferent   to   that   need.   Leite   v.

Bergeron, 911 F.3d 47, 52 (1st Cir. 2018) (quoting Farmer v.

Brennan, 511 U.S. 825, 834 (1994)).

              The district court concluded that Lech had a serious

medical need, and defendants do not contest that conclusion.            We

agree that Lech's medical needs were sufficiently serious at the

time she interacted with Cruz to satisfy the objective element.

"A medical need is sufficiently serious if it 'has been diagnosed

by a physician as mandating treatment,' or is 'so obvious that

even a lay person would easily recognize the necessity for a

doctor's attention.'"     Sosa v. Mass. Dep't of Corr., 80 F.4th 15,

27 (1st Cir. 2023) (quoting Zingg v. Groblewski, 907 F.3d 630, 635

(1st Cir. 2018)).      On the evening of January 1, 2014, Lech had

vaginal bleeding and had reported that her water broke and that

she was in labor.        Those symptoms are obvious enough that a

layperson presented with them would recognize that Lech needed

medical attention.      Accordingly, the open issue is whether Lech

has produced enough evidence for a jury to conclude that Cruz was

deliberately indifferent.

              Prison officials are deliberately indifferent when they

"know[] of and disregard[] an excessive risk to inmate health or

safety."      Farmer, 511 U.S. at 836–37.        To meet this standard,

"prison officials must either deny needed medical treatment in

                                   -37-
order   to   punish   the   inmate,   or    display    wanton    or   criminal

recklessness in the treatment afforded."              Sosa, 80 F.4th at 27

(internal quotation marks omitted) (quoting Zingg, 907 F.3d at

635).    That is, deliberate indifference may take the form of

"'wanton' decisions to deny or delay care where the action is

recklessness, 'not in the tort law sense but in the appreciably

stricter     criminal-law   sense,    requiring       actual    knowledge   of

impending harm, easily preventable.'"          Watson v. Caton, 984 F.2d

537, 540 (1st Cir. 1993) (citations omitted).            It is that form of

deliberate indifference that Lech argues a jury could find here.

Thus, to survive summary judgment, she must present enough evidence

for a factfinder to conclude that, in taking about twenty minutes

to transfer Lech to the medical unit, Cruz acted with "wanton

disregard" for Lech's serious medical needs -- that is, Cruz knew

Lech faced a substantial risk of serious harm and yet failed to

take reasonable measures to prevent it.         Zingg, 907 F.3d at 635.

             On the particular facts here, given Lech's own framing

of her request, what Cruz knew at the time, and Cruz's multiple

calls to Lech and medical staff within the twenty-minute period,

we conclude that the district court did not err in granting summary

judgment to Cruz.      Lech herself asked Cruz to send her to the

medical unit or to the hospital.        After finishing her count, Cruz

responded to Lech's request by calling the medical unit and went

back and forth with the medical unit and Lech.                 Critically, no

                                     -38-
evidence indicates that Cruz knew Lech had a high-risk pregnancy.

See Burnette v. Taylor, 533 F.3d 1325, 1331 (11th Cir. 2008)

(explaining that each defendant's subjective awareness of a risk

of harm must be assessed individually).            The evidence shows only

that Cruz knew Lech's water had broken and Lech believed she was

in labor.     Within that context, neither Cruz's completion of all

the steps needed to send Lech to the medical unit within twenty

minutes of Lech's request nor Cruz's decision to call the medical

unit,   as   opposed   to   using   the    radio   to   announce   a   medical

emergency, is sufficient to support a finding that Cruz wantonly

delayed care.

             To be sure, "short[] delays" in providing medical care

"may . . . constitute a constitutional violation if injuries are

sufficiently serious."       Youmans v. Gagnon, 626 F.3d 557, 564 (11th

Cir. 2010). As Lech points out, in other cases, courts have found

sufficient evidence to permit a finding of deliberate indifference

by prison officials when medical care was delayed for fewer than

twenty minutes.        But cases with shorter or comparable delays

involved prison officials' knowledge of readily apparent life-

threatening injuries.       See Beauford v. Mesa County, 35 F.4th 1248,

1267 (10th Cir. 2022) (finding that waiting ten minutes to seek

medical assistance when prison official was not sure if prisoner

was breathing may constitute deliberate indifference); Bradich ex

rel. Est. of Bradich v. City of Chicago, 413 F.3d 688, 691-92 (7th

                                    -39-
Cir. 2005) (same when three prison officials waited ten minutes to

seek help after prisoner's attempted hanging and in that time

provided unhelpful assistance); Bozeman v. Orum, 422 F.3d 1265,

1273 (11th Cir. 2005), abrogated on other grounds by Kingsley v.

Hendrickson, 576 U.S. 389 (2015) (same when officers knew prisoner

was either unconscious or not breathing (or both) and failed to

summon help for fourteen minutes); Tlamka v. Serrell, 244 F.3d

628, 632–35 (8th Cir. 2001) (same when correctional officers forced

prisoners who were providing CPR to another prisoner who had

suffered a heart attack to stop and then failed to approach the

prisoner or provide CPR for a period of up to ten minutes). As we

noted above, because Lech did not dispute that Cruz was unaware of

her high-risk pregnancy, no such readily apparent life-threatening

injury was presented here.

           Relying on Giroux v. Somerset County, 178 F.3d 28 (1st

Cir. 1999) and Goebert v. Lee County, 510 F.3d 1312 (11th Cir.

2007), Lech also argues that Cruz's failure to enter her cell and

investigate her condition is enough to support her deliberate

indifference claim.       But, again, the defendants' conduct in those

cases is different than Cruz's conduct.           In Giroux, we explained

that the evidence showed a correctional-officer defendant was

"aware of a high probability that [a prisoner] was vulnerable to

attack   from   another    inmate   but    took   no   action   despite   that

awareness."     178 F.3d at 33.       And in Goebert, a jail official

                                    -40-
failed to act in response to a pregnant woman's complaint that she

had been leaking fluid for more than nine days for no reason other

than that he "automatically disbelieve[d] all inmate statements

about medical care."          510 F.3d at 1316–19, 1327–29.                 Here, by

contrast,    Cruz    completed     the     steps      to    arrange   for    medical

assistance for Lech within twenty minutes of Lech's request.

            We    therefore     affirm    the   district       court's      grant   of

summary judgment to Cruz on the deliberate indifference claim.

                                 2. IIED Claim

            We    must   next   determine       whether      the   district    court

correctly ruled that Cruz's conduct failed to rise to the level

required for an IIED claim.            "The standard for making a claim of

intentional infliction of emotional distress is very high."                    Polay

v. McMahon, 10 N.E.3d 1122, 1128 (Mass. 2014) (citation omitted).

To sustain an IIED claim under Massachusetts law, a plaintiff must

show "(1) that [the defendant] intended, knew, or should have known

that [their] conduct would cause emotional distress; (2) that the

conduct was extreme and outrageous; (3) that the conduct caused

emotional   distress;     and    (4)     that   the    emotional      distress      was

severe."    Id.   Massachusetts courts have interpreted "extreme and

outrageous conduct" to mean behavior that is "so outrageous in

character, and so extreme in degree, as to go beyond all possible

bounds of decency, and to be regarded as atrocious, and utterly

intolerable in a civilized community."                     Roman v. Tr. of Tufts

                                        -41-
Coll., 964 N.E.2d 331, 341 (Mass. 2012) (quoting Foley v. Polaroid

Corp., 508 N.E.2d 72, 82 (Mass. 1987)).        In determining whether

conduct rises to that level, a factfinder is entitled to "put as

harsh a face on the actions of the [defendant] as the basic facts

would reasonably allow."     Richey v. Am. Auto. Ass'n, 406 N.E.2d

675, 678 (Mass. 1980).

          We determine that it was not error for the district court

to conclude that Cruz's conduct fails to rise to the level of

extreme or outrageous.     The fact that Cruz, who did not know that

Lech had a high-risk pregnancy, engaged in all the steps to send

Lech to medical within twenty minutes of Lech's request and did so

rather than call a medical emergency via radio is insufficient to

permit a jury to find that she engaged in conduct that exceeds

"all possible bounds of decency" and is "utterly intolerable in a

civilized community."    Polay, 10 N.E.3d at 1128 (citation omitted).

          We   therefore   affirm   the   district   court's   grant   of

summary judgment to Cruz on the IIED claim.

                            IV. CONCLUSION

          For these reasons, we affirm in part and vacate and

remand in part. The parties shall bear their own costs.

                                 -42-