The opinion
RECOMMENDED FOR PUBLICATION
Pursuant to Sixth Circuit I.O.P. 32.1(b)
File Name: 25a0167p.06
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
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DENNIS WIERTELLA, as father and administrator of the
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estate of Randy Wiertella, deceased,
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Plaintiff-Appellee, │
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v. > No. 24-3311
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LAKE COUNTY, OHIO, │
Defendant, │
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DIANA SNOW, RN and CHRISTINA WATSON, RN, in │
their individual and official capacities, │
Defendants-Appellants. │
┘
Appeal from the United States District Court for the Northern District of Ohio at Cleveland.
No. 1:20-cv-02739—Bridget Meehan Brennan, District Judge.
Decided and Filed: June 24, 2025
Before: GILMAN, READLER, and BLOOMEKATZ, Circuit Judges.
_________________
COUNSEL
ON BRIEF: Kathleen M. Minahan, MEYERS, ROMAN, FRIEDBERG, & LEWIS, Cleveland,
Ohio, for Appellants. Daniel P. Petrov, Sarah E. Wyss, THORMAN PETROV GROUP CO.,
LPA, Shaker Heights, Ohio, for Appellee.
GILMAN, J., delivered the opinion of the court in which BLOOMEKATZ, J., concurred.
READLER, J. (pp. 10–28), delivered a separate dissenting opinion.
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 2
_________________
OPINION
_________________
RONALD LEE GILMAN, Circuit Judge. Randy Wiertella died in the Lake County
Adult Detention Facility (the Jail) on the morning of December 10, 2018. Dennis Wiertella, as
the Administrator of the Estate of Randy Wiertella (the Estate), filed suit on behalf of the Estate.
The Estate brought several claims, including a 42 U.S.C. § 1983 claim that Wiertella’s
constitutional rights under the Eighth and Fourteenth Amendments were violated by Jail staff
Diane Snow, RN, and Christina Watson, LPN.
Snow and Watson filed a motion for summary judgment, seeking dismissal on the basis
of qualified immunity. The district court denied their motion. For the reasons set forth below,
we AFFIRM the decision of the district court and REMAND the case for further proceedings on
the Estate’s § 1983 claim.
I. BACKGROUND
Wiertella was charged in Willoughby Municipal Court with the illegal possession of
drugs and the improper transport of a firearm. He was sentenced to 27 days in the Jail. Wiertella
was booked at the Jail on December 2, 2018 and underwent a medical screening as part of the
booking process. He entered the Jail without any of his medications, but a corrections officer
recorded that Wiertella was taking medications for heart disease, diabetes, high blood pressure,
and a psychiatric disorder. These were “essential medications” under the Jail’s policies and
procedures. The medical-screening form states that Wiertella’s medications needed to be
continuously administered. Snow was the medical coordinator responsible for making sure that
all inmate medical screens were reviewed.
Watson reviewed and signed Wiertella’s medical-screening form on December 2, 2018.
She was aware that Wiertella was booked without any medications and that Wiertella had been
taking “essential medications” that needed to be continuously administered. She initially
testified that she was “sure” that she would have ordered diabetes medication and a diabetic diet
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 3
immediately after reviewing the medical-screening form. But she did not in fact order any
medications on that date.
On December 3, Wiertella sent in an inmate-request form that asked for “diabetic, and
other meds.” Watson received this request. She wrote down that “Inmate states he is diabetic
and takes Metformin 1000 mg BID.” Watson testified that she had likely asked a booking
officer to ask Wiertella how many milligrams of Metformin he took and how often. She said that
Wiertella “had to have probably stated that he was on a thousand milligrams twice a day in order
for me to order it such as that.” The Jail doctor then signed off on Watson’s order for diabetes
medication and a diabetic diet.
Later that same day, Wiertella submitted another inmate-request form for five other
medications, including blood-pressure medication. Wiertella made yet another request for
blood-pressure medications two days after that. He also reminded the medical staff to call the
Veterans Administration (VA) pharmacy in Wasau, Wisconsin to get his medication records.
Watson testified that she did not recall receiving any inmate-request forms from
Wiertella. No one contacted the VA pharmacy or ordered any blood-pressure medication.
Watson also testified that she prioritized Wiertella’s “most important” medical condition, which
was “him being a diabetic,” and did not treat his other medical conditions. She said that this is
what she was trained to do by Snow. But Watson conceded that there was nothing that prevented
her from addressing Wiertella’s other medical conditions. She testified that the Jail, however,
preferred for inmates to get a friend or family member to bring in their medications because
medications could be expensive for the Jail to order through the pharmacy.
Wiertella was eventually scheduled to have a sick call on December 10, 2018. But the
record does not indicate when Wiertella was added to the sick-call log or which nurse added him.
The sick-call log states that Wiertella needed to be seen for “BP check, no meds.” Snow testified
that this meant that Wiertella “need[ed] his blood pressure checked because he’s got some sort of
history of high blood pressure and he brought no meds in with him.” There was also a
scheduling book for sick calls that was set up by whichever nurse was working the evening
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 4
before. In the scheduling book, Watson wrote Wiertella’s name and “BP check and sign
release.”
There is no explanation in the record for why Wiertella was not scheduled for a sick call
until December 10. Nurse sick call was available every day of the week, including weekends,
and doctor sick call was available on Mondays through Fridays. The medical-release form could
be signed by an inmate during a nurse sick call, and nurses could usually verify medications with
a pharmacy in less than ten minutes. Nurses were also able to “check anybody’s blood pressure
at any time” to determine if they had high blood pressure and needed medication.
Watson testified that if an inmate said he was on blood-pressure medication, she could
decide that she did not need to verify the prescription with his pharmacy and could order the
medication herself. She chose to do this with Wiertella’s diabetes medication, but not with any
of his other medications.
If an inmate was unable to provide his own medications, nurses could also put that inmate
on the sick-call log to be evaluated by the doctor. Wiertella was never scheduled for a physical
exam or for a review of his medical history. Nor was he ever seen by anyone who could
prescribe medications.
Wiertella was found in his cell nonresponsive and pronounced dead at 3:12 a.m. on
December 10, 2018. The Estate’s expert, Dr. Jonathan Arden, concluded that Wiertella’s cause
of death was hypertensive cardiovascular disease. Dr. Arden testified that “the discontinuance
and failure to provide medications contributed to [Wiertella’s] blood pressure spiking and his
risk of sudden death.” He concluded in his report that “[b]ut for the failure to provide those
medications and a CPAP machine, in my opinion, Mr. Wiertella would not have died how and
when he did.”
On appeal, Snow and Watson argue that the district court erred by denying their motion
for summary judgment. They contend that they are entitled to qualified immunity because the
caselaw has not “clearly established” that a medical employee at a jail violates an inmate’s
constitutional rights if she becomes aware that an inmate is on medication for a serious medical
condition and then fails to ensure that the medication is timely obtained. In addition, Snow and
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 5
Watson argue that the court erred in finding that they subjectively appreciated a substantial risk
of harm to Wiertella and that they failed to reasonably respond.
II. ANALYSIS
A. Standard of review
“We review de novo a district court’s denial of a defendant’s motion for summary
judgment on qualified immunity grounds.” Raimey v. City of Niles, 77 F.4th 441, 446–47 (6th
Cir. 2023) (quoting Stoudemire v. Mich. Dep’t of Corr., 705 F.3d 560, 565 (6th Cir. 2013)).
“Qualified immunity shields government officials performing discretionary functions from civil
liability unless their conduct violates clearly established rights.” Id. at 447 (quoting Quigley v.
Tuong Vinh Thai, 707 F.3d 675, 680 (6th Cir. 2013)). “At summary judgment, a government
official is entitled to qualified immunity unless the evidence, viewed in the light most favorable
to the plaintiff, would permit a reasonable juror to find that ‘(1) the defendant violated a
constitutional right; and (2) the right was clearly established.’” Id. (quoting Quigley, 707 F.3d at
680–81). “We view the evidence in the light most favorable to the nonmovant and draw all
reasonable inferences in his favor.” Id.
B. Jurisdiction
We have jurisdiction over appeals from final decisions of the district courts.
28 U.S.C. § 1291. Interlocutory appeals from the denial of qualified immunity at the
summary-judgment stage are considered “final decision[s]” within the meaning of
28 U.S.C. § 1291. Mitchell v. Forsyth, 472 U.S. 511, 530 (1985). “This jurisdiction, however, is
limited: circuit courts can review a denial of qualified immunity only ‘to the extent that it turns
on an issue of law’—the appeal cannot be from a district court’s determination that there is a
genuine dispute of material fact.” Brown v. Chapman, 814 F.3d 436, 444 (6th Cir. 2016)
(quoting Mitchell, 472 U.S. at 530). “The effect of this limitation is that the defendant appealing
a denial of qualified immunity must concede the plaintiff’s facts.” Id. We may “decide the legal
question of whether qualified immunity is warranted based on the facts as found by the district
court, taken in the light most favorable to [the Estate].” Raimey, 77 F.4th at 448.
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 6
C. Qualified immunity
To overcome Snow’s and Watson’s qualified-immunity defense, the Estate must establish
(1) that Snow and Watson violated Wiertella’s constitutional rights, and (2) that the governing
caselaw “clearly established” the violation. See Lawler ex rel. Lawler v. Hardeman County, 93
F.4th 919, 925 (6th Cir. 2024).
In Lawler, this court recognized that an Eighth Amendment failure-to-protect claim
arising from conduct occurring before 2021 is governed by Farmer v. Brennan, 511 U.S. 825
(1994). Id. at 927–28. Farmer’s first element is satisfied if the plaintiff proves that the inmate
had an objectively “serious medical need[].” Id. at 928 (quoting Estelle v. Gamble, 429 U.S. 97,
104 (1976)). Snow and Watson do not dispute that the Estate satisfied this element. Wiertella
had several conditions that had been “diagnosed by a physician as mandating treatment.” See
Harrison v. Ash, 539 F.3d 510, 518 (6th Cir. 2008) (quoting Blackmore v. Kalamazoo County,
390 F.3d 890, 897 (6th Cir. 2004)). The first requirement of Farmer has therefore been met.
Farmer next requires the plaintiff to prove that “[the] officer knew of the facts creating
the substantial risk of serious harm,” that “the officer believed that this substantial risk existed,”
and that “the officer ‘responded’ to the risk in an unreasonable way.” See Lawler, 93 F.4th at
929 (quoting Farmer, 511 U.S. at 844).
Watson testified that she was aware that Wiertella had been booked without his
medications, that he was on medications that needed to be continuously administered, and that
these medications were classified as “essential” under the Jail’s policies. She stated that heart
disease, high blood pressure, diabetes, severe sleep apnea, and depression are all serious medical
conditions. Watson also considered medications for diabetes, heart disease, high blood pressure,
and psychiatric disorders to all be essential medications. She further acknowledged the
importance of taking medications for serious medical conditions because the failure to take
those medications could lead to serious harm or even death.
Finally, Watson recognized the general principle that the medical staff should intervene
sooner rather than later. She expressly said that she had sometimes been concerned that inmates
at the Jail were not getting their blood-pressure medicine in a timely manner.
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 7
In light of the above testimony, the district court properly concluded that Watson was
aware of a substantial risk to Wiertella if he did not timely receive his essential medications. Yet
Watson did nothing to ensure that Wiertella received his blood-pressure medications—or any
medication other than for his diabetes—in a timely manner. This was unreasonable.
With regard to Snow, she was responsible as the medical coordinator for making sure that
every inmate’s medical-screening form was reviewed. She was also responsible for making sure
that all the sick calls were set up correctly. Snow was not merely an administrator; she also
performed the same duties as the other nurses, such as addressing the daily medical needs of
inmates. Further, Watson testified that she believed that Snow had seen Wiertella. Snow
disputed this fact, but we must view the evidence in the light most favorable to the Estate.
A jury could thus find that Snow was aware that Wiertella had been booked without
“essential medications” that needed to be continuously administered. Snow testified that
untreated high blood pressure can cause a substantial risk of harm to patients and that, if an
inmate identified a need for high-blood-pressure medication, “it would be something that would
need to be addressed as soon as possible.” Based on the above evidence, a jury could find that
Snow was aware of the substantial risk that Wiertella faced, and that she unreasonably failed to
ensure that Wiertella timely received all his essential medications.
To prove that Wiertella faced a “substantial risk of serious harm,” the Estate does not
have to establish that Wiertella faced a substantial risk of dying within one week. The dissent
argues that, since “less than 0.5% of those with high blood pressure suffer an associated death
. . .[, i]t follows that even a three-week deprivation of blood-pressure medication does not pose
an objectively serious risk of harm, absent further evidence of another serious underlying
medical condition.” Dissenting Op. at 14–15. But Wiertella informed the prison staff that he
had several serious underlying medical conditions besides high blood pressure, including heart
disease, diabetes, sleep apnea, and depression.
Moreover, a plaintiff can suffer serious harm without dying. For example, if the medical
staff refuses to clean a prisoner’s wound, this can constitute serious harm even if the wound later
heals. See Boretti v. Wiscomb, 930 F.2d 1150, 1154 (6th Cir. 1991). If an inmate experiences
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 8
symptoms of depression because he is not timely receiving his psychiatric medication, this can
constitute serious harm. See Richmond v. Huq, 885 F.3d 928, 942–43 (6th Cir. 2018). An
inmate who “suffers pain needlessly” has suffered serious harm. Boretti, 930 F.2d at 1154–55.
And the “interruption of a prescribed plan of treatment could constitute a constitutional
violation.” Id. at 1154. Wiertella suffered the symptoms of untreated high blood pressure, heart
disease, sleep apnea, and depression because his prescribed plan of treatment for all these
conditions was unnecessarily interrupted.
In establishing its § 1983 claim, the Estate concedes that it is required to “identify a case
with a similar fact pattern that would have given ‘fair and clear warning to officers’ about what
the law requires.” See Arrington-Bey v. City of Bedford Heights, 858 F.3d 988, 993 (6th Cir.
2017) (quoting White v. Pauly, 580 U.S. 73, 79 (2017) (per curiam)). The Estate cited, and the
district court extensively analyzed, similarities between this case and Richmond. Richmond’s
medical records indicated that she had been taking psychiatric medications before she arrived at
the Wayne County Jail. Richmond, 858 F.3d at 935–36. This court held that her treating doctor
at the jail had an obligation to take reasonable steps to ensure that Richmond timely received her
medications. Id. at 942. These steps could have included the doctor prescribing the medications
herself or requesting that a nurse verify Richmond’s prior prescriptions. Id. Waiting for
Richmond to have her psychiatric conditions addressed at an upcoming psychiatrist appointment
scheduled 14 days later was not deemed sufficient to address her serious medical needs. See id.
at 935, 941–43.
The dissent argues that Watson‘s conduct was not “so cursory as to amount to no medical
treatment at all” because she scheduled Wiertella for a sick call. Dissenting Op. at 15 (citing
Helphenstine v. Lewis County, 60 F.4th 305, 322 (6th Cir. 2023)). But there is no evidence that
Watson was the nurse who initially added Wiertella to the sick-call log. And even if she was,
having Wiertella wait a full week to have several serious medical conditions addressed was
unreasonable.
This case is distinguishable from cases like Jones v. Martin, 9 F. App’x 360 (6th Cir.
2001) (order), relied on by the dissent. Dissenting Op. at 18. Jones suffered blackouts after
running out of his blood-pressure medication, but he was unable to establish that the prison
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 9
doctor intentionally denied him the medication or unreasonably delayed treatment. Id. at 362.
Snow and Watson, in contrast, were aware that Wiertella had been taking several essential
medications for serious medical conditions, and they knew that he did not have access to these
medications in the Jail. Yet they intentionally chose not to provide those medications in a timely
manner.
This court in Richmond, moreover, held that prior caselaw had clearly established that
“neglecting to provide a prisoner with needed medication” could “constitute a constitutional
violation.” Id. at 948. Richmond thus presents a “similar fact pattern” that gave Snow and
Watson a “fair and clear warning” that failing to ensure that Wiertella timely received his
essential medications was a violation of his constitutional rights under the Eighth and Fourteenth
Amendments. See Arrington-Bey, 858 F.3d at 993. The district court therefore did not err in
concluding that Snow and Watson were not entitled to qualified immunity as a matter of law.
III. CONCLUSION
For all of the reasons set forth above, we AFFIRM the decision of the district court and
REMAND the case for further proceedings on the Estate’s § 1983 claim.
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 10
_________________
DISSENT
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CHAD A. READLER, Circuit Judge, dissenting. Treating incarcerated patients presents
unique challenges for medical professionals. Especially so in the jail setting, where rapid
turnover of detainees further complicates the effort to address medical needs. See Zhen Zeng &
Todd D. Minton, Bureau of Just. Stats., Census of Jails 2015–2019 – Statistical Tables 31 (Oct.
2021) (noting that the average detainee spends just 23 days in jail). As a legal matter, the
Constitution’s due process guarantee is a poor fit for setting appropriate boundaries for treating
these detainees. See Brawner v. Scott County, 14 F.4th 585, 610 (6th Cir. 2021) (Readler, J.,
concurring in part and dissenting in part); Helphenstine v. Lewis County, 65 F.4th 794, 801 (6th
Cir. 2023) (order) (Readler, J., statement respecting denial of rehearing en banc). But if we must
deploy due process notions here, we owe it to medical professionals to articulate clear guideposts
governing their conduct.
Congress has signaled as much by implicitly incorporating the common law defense of
qualified immunity into 42 U.S.C. § 1983. Wyatt v. Cole, 504 U.S. 158, 163–64 (1992); Scott
Keller¸ Qualified and Absolute Immunity at Common Law, 73 Stan. L. Rev. 1337, 1342 & n.19,
1358 (2021). At common law, history suggests, that defense required “clear evidence of
subjective improper purpose.” Keller, supra, at 1377; cf. Baxter v. Bracey, 140 S. Ct. 1862,
1864 (2020) (Thomas, J., dissenting from the denial of certiorari) (advocating return to common
law basis for qualified immunity). Our modern qualified immunity test, although perhaps less
rigorous in comparison, still adheres to similar notice principles. Before a plaintiff may
overcome an assertion of qualified immunity, he must show that a defendant violated “clearly
established” constitutional law. Wyatt, 504 U.S. at 166; see also Rivas-Villegas v. Cortesluna,
595 U.S. 1, 5 (2021) (per curiam) (explaining that liability arises only where “existing
precedent” places the “constitutional question beyond debate”) (citation omitted)). By requiring
that the rule at issue be clearly established, we ensure that a defendant may be sued only for
conduct that “every reasonable official would have understood” to violate legal boundaries, thus
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 11
limiting liability to the “plainly incompetent or those who knowingly violate the law.” Ashcroft
v. al-Kidd, 563 U.S. 731, 741, 743 (2011) (citations omitted).
Yet all too often, we define “clearly established” rights in such broad fashion that notions
of predictability become little more than an afterthought. See Colson v. City of Alcoa, No. 20-
6084, 2021 WL 3913040, at *8, *10 (6th Cir. Sept. 1, 2021) (Readler, J., dissenting). This case
is a good example. After unearthing a constitutional violation from a factual record that supports
none, the majority opinion finds a clearly established right in precedent that supplies little more
than debate. Employing such loose legal standards is problematic enough for defendants
Christina Watson and Diane Snow. But it is especially worrisome when viewed across the
medical profession. In 2019, ten million detainees (like Randy Wiertella) were housed in
jails. Zeng & Minton, supra, at 41. As roughly one-fifth of those jails provide on-site medical
treatment, id. at 43, jail-based medical personnel likely encounter about two million detainees
annually. With each interaction giving rise to the risk of constitutional liability, it becomes all
the more critical that judges articulate concrete standards for those medical professionals to
follow. Nor may we impose liability when those clear markers have not been crossed. Today,
we fall well short of honoring those settled obligations.
I.
The facts tell an admittedly tragic tale. At the start of what was scheduled to be a nearly
month-long period of detention in jail, Randy Wiertella completed a medical screening form
indicating that he was “on medication which should be continuously administered,” and that his
conditions requiring medication included diabetes, heart disease, high blood pressure, and
psychiatric disorders. The form, however, did not identify Wiertella’s specific prescriptions.
Nurse Christina Watson reviewed and signed the form.
The next day, following Wiertella’s request for “diabetic, and other meds,” Watson
ordered a diabetes medication called metformin, which Wiertella received. At some point, she
also made Wiertella an appointment with another nurse (dubbed “sick call”) in about a week’s
time for the purposes of checking blood pressure, discussing his lack of “meds,” and “sign[ing a]
release.” R. 64, PageID 2835, 2873–74. Regarding the last notation, Wiertella’s pharmacy
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 12
would not verify his prescription information without a release form signed by Wiertella.
Wiertella made two subsequent written requests through the jail’s administrative channels. In
those materials, he for the first time listed the names of his other medications. Watson, all agree,
never received those requests. Nor did she ever examine Wiertella or receive any other
information indicating a risk of a looming hypertensive crisis.
The morning Wiertella was supposed to be seen for his sick call, he was found dead,
having died from a heart attack caused in part by his lack of medication. His estate sued Watson
and nurse Diane Snow, Watson’s supervisor, for deliberate indifference under the Eighth and
Fourteenth Amendments. The district court denied the two qualified immunity, a decision they
now appeal.
II.
To overcome the nurses’ assertion of qualified immunity, Wiertella must show both that
the two violated the Constitution and that the violation was clearly established. Fisher v. Jordan,
91 F.4th 419, 424 (6th Cir. 2024). At step one, this case is governed by Farmer v. Brennan, 511
U.S. 825 (1994). Thus, Wiertella must demonstrate that he suffered from an objectively serious
risk of harm which the nurses, at the very least, consciously disregarded. Lawler ex rel. Lawler
v. Hardeman County, 93 F.4th 919, 928–30 (6th Cir. 2024). At step two, he must provide
existing precedent showing “beyond debate” that each nurse violated the law. Kisela v. Hughes,
584 U.S. 100, 104 (2018) (per curiam). Doing so demands that he cite “a case with facts similar
enough that it squarely governs this one, what amounts to on-point caselaw that would bind a
panel of this court.” Moore v. Oakland County, 126 F.4th 1163, 1167 (6th Cir. 2025) (citation
modified). Wiertella has met neither burden.
The interlocutory posture of this appeal, I recognize, typically limits us from reaching
purely fact-bound issues the nurses might raise in an ordinary summary judgment appeal. Id.
But “legal questions”—such as what conduct violates the Eighth and Fourteenth Amendments
and which violations have been clearly established—are fair game. Id. So is the question
“whether a reasonable jury could believe an assertion of fact blatantly contradicted by the
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 13
record.” Id. (cleaned up). Wiertella’s failure to satisfy each qualified immunity hurdle falls
easily within these categories.
A. Take first the absence of any constitutional violation. This case, like so many in this
setting, hinges on the nurses’ state of mind. See Lawler, 93 F.4th at 929. Even accepting the
facts in his favor, Wiertella fails to show that either nurse consciously disregarded any risk he
faced. See Farmer, 511 U.S. at 839. The overarching question of “conscious disregard” breaks
down into three smaller ones: (1) Did the nurses know the facts that created the risk to
Wiertella? (2) If so, did they also interpret those facts to conclude for themselves that the risk
existed? And (3) if so, was their response to this known risk reasonable? Lawler, 93 F.4th at
929–30. We must be careful not to dilute this standard. That warning bears emphasis, as our
Court has all too often premised liability on what an official should have known rather than what
she did know. See Brawner v. Scott County, 18 F.4th 551, 554 (6th Cir. 2021) (order) (Readler,
J., dissenting from the denial of rehearing en banc) (canvassing cases). Farmer, however, was
unequivocal: Wiertella needs evidence that the nurses had “actual knowledge of [his] risk[]” and
still proceeded to disregard it. 511 U.S. at 842. He has no such evidence.
1. Begin with Watson. To the majority opinion’s eye, “Watson was aware of a
substantial risk to Wiertella if he did not timely receive his essential medications.” Maj. Op. 7.
But what does “timely” mean to those in the majority? In other words, did Watson fail to
respond to a risk of immediate harm during the week between when she reviewed Wiertella’s
information and when he was scheduled for sick call? Or was it instead a risk of harm at some
later point? The majority opinion does not say. Either way, Watson did not consciously
disregard any risk to Wiertella.
a. There is no evidence that Watson was aware of the risk of immediate harm to
Wiertella. The district court, for its part, made no findings to that end. See DiLuzio v. Village of
Yorkville, 796 F.3d 604, 609 (6th Cir. 2015). The majority opinion’s circumstantial evidence of
Watson’s knowledge fares no better, especially when measured against Farmer’s yardstick for
when circumstantial evidence “could be sufficient” to prove actual knowledge—namely, when
the risks were “longstanding, pervasive, well-documented, or expressly noted by prison officials
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 14
in the past” and the defendant “had been exposed to information concerning the risk” such that
she “must have known of it.” 511 U.S. at 842.
The majority opinion first emphasizes that Watson knew Wiertella was on medication
that needed to be continuously administered, yet was booked without all of his medications.
Maj. Op. 6–7. But knowing Wiertella needed some medication to be continuously administered
does not show that Watson thought any medications besides metformin (his diabetes drug) fit in
this category. The screening form does not state which medications were needed continuously.
And according to Watson, she interpreted this entry to refer only to metformin. R. 59, PageID
1268 (Watson identifying diabetes medication as the only concern needing to be taken care of “at
that time”). None of this indicates that Watson “must have known” Wiertella might suffer harm
within the week if other medications were not administered immediately. Farmer, 511 U.S. at
842.
True, as the majority opinion notes, see Maj. Op. 6, Watson acknowledged that it is
“important to be compliant with [essential] medications” because “there can be serious medical
consequences” otherwise, sometimes including serious harm or death. R. 59, PageID 1252–53.
Those points are unassailable. But so is the fact that a general awareness of risk “[i]n some
situations,” id., falls far short of showing Watson subjectively concluded that an immediate,
within-the-week risk existed here with respect to Wiertella’s heart condition. See Buetenmiller v.
Macomb Cnty. Jail, 53 F.4th 939, 944 (6th Cir. 2022) (noting that general “knowledge of
something ‘suspicious’ is not akin to demonstrating awareness of a specific risk”).
That high blood pressure, Wiertella’s primary non-diabetes complaint, is both highly
prevalent and relatively benign in most cases only bolsters the point. Roughly half of adults in
America—120 million—suffer from high blood pressure, and about half of them treat it with
medication. Cheryl D. Fryar et al., U.S. Ctrs. for Disease Control & Prevention, Hypertension
Prevalence, Awareness, Treatment, and Control Among Adults Age 18 and Older: United States
August 2021–August 2023, at 1, 3 (2024). Yet on an annual basis, less than 0.5% of those with
high blood pressure suffer an associated death. High Blood Pressure, CDC (Jan. 3, 2025),
https://perma.cc/5QGA-FLPD. It follows that even a three-week deprivation of blood-pressure
medication does not pose an objectively serious risk of harm, absent further evidence of another
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 15
serious underlying medical condition. See Jackson v. Pollion, 733 F.3d 786, 787–90 (7th Cir.
2013) (Posner, J.) (surveying a large amount of medical research). While the nurses do not
contest the objective element, what is true there applies with greater force in determining what
risk they could have perceived from reviewing the skeletal information on Wiertella’s screening
form. In doing so, Watson had little reason to conclude that Wiertella would be the rare
hypertensive patient to suffer serious harm. And, more to the point, she had absolutely no basis
to conclude he might suffer such harm within a week.
The majority opinion responds that “a plaintiff can suffer serious harm without dying.”
Maj. Op. 7. Very true. Perhaps, as the majority opinion suggests, “the symptoms of untreated
high blood pressure, heart disease, sleep apnea, and depression” qualify as “serious harm.” Id.
And perhaps “Wiertella suffered the[se] symptoms” prior to the fatal event, although the
majority opinion’s conclusion to that effect includes no record citation, and thus is pure
speculation. Id. Even so, the question on the subjective prong is not what we know happened to
Wiertella in hindsight but whether Watson concluded that he faced these “specific risk[s]” within
a week. As just explained, she did not.
b. As to whether Wiertella might suffer serious harm at a future point if he did not
receive his medication, all agree that Watson was aware of this risk. And she responded
reasonably by scheduling Wiertella for sick call. In evaluating Watson’s response, we may not
“second guess medical judgments” she made regarding Wiertella’s “treatment,” even if that
treatment was “inadequate.” Richmond v. Huq, 885 F.3d 928, 939 (6th Cir. 2018) (citation
omitted). It follows that in cases that do not involve “a complete denial of medical care,” id., we
will not hold a medical professional liable unless she acted in a way “so grossly incompetent . . .
as to shock the conscience,” or offered treatment “so cursory as to amount to no medical
treatment at all.” Helphenstine v. Lewis County, 60 F.4th 305, 322 (6th Cir. 2023) (citations
omitted).
That does not describe Watson’s actions. Again, she scheduled Wiertella for sick call.
The majority opinion, I note, concludes that “there is no evidence” of Watson taking that step.
Maj. Op. 8. But Snow testified that the “writing” in the sick-call log “is Christina [Watson]’s,”
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 16
R. 64, PageID 2860, a fact Wiertella concedes, Appellee Br. 22 (“Watson . . . scheduled a sick
visit eight days after Wiertella was booked.”).
Watson’s handwritten notes identified three purposes for the appointment: check “BP”
(that is, blood pressure), “[no] meds,” and “sign [pharmacy] release.” R. 64, PageID 2835,
2873–74. These notations show that Watson scheduled the sick call specifically in response to
Wiertella’s lack of medication—especially blood pressure medication. Doing so neither
“shock[s] the conscience” nor “amount[s] to no medical treatment at all.” Helphenstine, 60 F.4th
at 322 (citations omitted).
That is especially true when one considers that Watson, like all medical personnel, is
subject to “the unhappy truth that, when vital resources are limited, some will not get what they
need, at least not right away.” Ken Kipnis, Triage and Ethics, 4 Am. Med. Ass’n J. Ethics 19, 19
(2002). That well describes the jail setting, where detainees come and go, often in unpredictable
ways. See generally Zeng & Minton, supra. As a result, when faced with a patient who, like
Wiertella, presents a constellation of potential issues, Watson had to “perform a preliminary
assessment . . . to determine the nature and degree of urgency of treatment required,” a process
otherwise known as “triage.” Triage, Oxford English Dictionary, https://perma.cc/MX6L-C8EJ.
Doing so involves balancing the urgency of intervention with the resources needed to treat
relevant conditions. See Emergency Nurses Ass’n, Emergency Severity Index Handbook 5 (5th
ed. 2023); Rhonda Gay Hartman, Tripartite Triage Concerns: Issues for Law and Ethics, 31
Critical Care Med. S358, S358 (Supp. 2003) (noting that triage decisions necessarily require
“human judgment”).
As lay people, we judges may not “second guess [these] medical judgments,” even if we
believe they led to “inadequate . . . treatment.” Richmond, 885 F.3d at 939 (citation omitted).
That includes Watson’s medical judgments underlying her triage decisions. After reviewing
Wiertella’s screening form and related requests, she determined a course of action. She began by
doing “what [she] was trained to do,” namely “to pull out the . . . most important” condition.
R. 70-8, PageID 4025. For Wiertella, that was his “diabet[es].” Id. With respect to other
conditions noted on the screening form, Watson “personally ma[d]e [the] decision[]” to “have
[Wiertella] come for sick call.” See id., PageID 3995. In doing so, she relied on her medical
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 17
training, which taught her to “mak[e] the judgment calls [regarding] who needs to be seen” in
“sick call.” Id., PageID 3986.
Given the circumstances, what more could Watson have done? Wiertella’s screening
form did not provide medicine names or doses. Watson never received the forms that did
identify that information. And calling Wiertella’s pharmacy would have been met with a request
for his signed release form, which Watson did not possess. As a result, her lone option for
addressing those omissions was to schedule Wiertella for sick call, where he could give needed
information to a nurse or sign the release allowing his pharmacy to do so. Cf. Mullins v. Kalns,
234 F.3d 1269, 2000 WL 1679511 (6th Cir. 2000) (unpublished table decision) (order) (nurses
responded reasonably to risk from one-weekend-long lack of blood pressure medication when
they took all steps possible to obtain it). Perhaps Watson could have scheduled that appointment
sooner, although limited jail resources may have dictated otherwise. Either way, that fact alone
does not make Watson’s decision grossly incompetent, or so cursory as to amount to no
treatment at all. Helphenstine, 60 F.4th at 322. Especially so, again, when Watson perceived no
risk of immediate harm to Wiertella. At worst, Watson acted “carelessly or inefficaciously” by
not scheduling Wiertella sooner, a “degree of incompetence which does not rise to the level of a
constitutional violation.” Comstock v. McCrary, 273 F.3d 693, 703 (6th Cir. 2001).
Our precedent bears this out. We consistently refuse to hold medical personnel liable for
triage decisions regarding treatment even if a different decision would have prevented some ill
effect. Consider, for example, Griffith v. Franklin County. There, two nurses received urinalysis
results indicating that an inmate had an acute kidney injury, which typically dictates
hospitalization. 975 F.3d 554, 563 (6th Cir. 2020). Deploying their independent medical
judgment, however, the nurses “weren’t that alarmed” by the data but “did want it reviewed.” Id.
As a result, they forewent hospitalization and instead scheduled the inmate to be seen by another
nurse during her next weekly visit. Before being seen, the inmate suffered multiple seizures tied
to acute renal failure. Id. at 564–65. In awarding the nurses qualified immunity, we honored
their “independent evaluation as to whether to place the inmate on medical observation” or take
other action—in other words, their triage judgment. Id. at 572. So too here, where Watson
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 18
determined that Wiertella’s need for medication besides metformin could wait for consultation
days later.
Griffith does not stand alone. Circuit decisions refusing to second-guess a medical
professional choosing one treatment over an earlier or different treatment abound. See Rouster v.
County of Saginaw, 749 F.3d 437, 443–44, 449 (6th Cir. 2014) (decision not to notify on-call
physician of vomiting and bizarre behavior by inmate and instead to place the inmate under
medical observation); Jackson v. Gibson, 779 F. App’x 343, 344, 348 (6th Cir. 2019) (decision
not to treat or medicate inmate’s foot injury and instead to schedule for an appointment with a
prison doctor); VanNortwick v. Stewart, No. 21-2739, 2022 WL 1494538, at *2–3 (6th Cir. May
12, 2022) (decision not to hospitalize inmate and instead to arrange for further testing and later
follow up by a colleague); Britt v. Hamilton County, No. 21-3424, 2022 WL 405847, at * 4 (6th
Cir. Feb. 10, 2022) (decision not to take inmate’s vital signs and instead to await physician’s
instructions); Bowles v. Bourbon County, No. 21-5012, 2021 WL 3028128, at *9 (6th Cir. July
19, 2021) (decision not to hospitalize inmate who was “in obvious pain, beating his head with his
fists, and throwing up in a bucket” and instead to await superior’s instructions). Like each of
these medical professionals, Watson used her medical judgment to make a reasonable treatment
decision, leaving us little basis to conclude that she wholly disregarded Wiertella’s risk of harm
from not having his medications.
On a more granular level, allegations that jail staff “failed to provide [an inmate] with
. . . blood pressure medicine during the first few days of his stay in the county jail” are by no
means novel in our circuit. Reed v. Gill, 205 F.3d 1341, 2000 WL 194146, at *1 (6th Cir. 2000)
(unpublished table decision) (order). Yet we routinely refuse to hold medical providers liable for
that delay, even if it results in harm. Id.; Jones v. Martin, 9 F. App’x 360, 362 (6th Cir. 2001)
(order) (holding that “lapse in [blood pressure] medication” through failure to refill prescriptions
twice was not deliberate indifference, even though inmate suffered black-outs as a result);
Carpenter v. Wilkinson, 205 F.3d 1339, 2000 WL 190054, at *1 (6th Cir. 2000) (unpublished
table decision) (describing the allegation that prison officials “violated [the inmate’s] Eighth
Amendment rights by not timely providing him with medication for high blood pressure” as
mere “difference of opinion regarding treatment”).
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 19
Ours is not a minority view. When our sister circuits face similar lack-of-blood-pressure-
medicine claims, they too bless treatment decisions like Watson’s, to say nothing of treatment
decisions that are even less comprehensive. See, e.g., Jackson, 733 F.3d at 787 (no liability for
three-week delay); Lindwurm v. Wexford Health Sources, Inc., 84 F. App’x 46, 48 (10th Cir.
2003) (order) (no liability for “isolated and brief” “lapses in [providing blood pressure]
medication”); Pandey v. Freedman, 66 F.3d 306, 1995 WL 568490, at *2 (5th Cir. 1995)
(unpublished table decision) (per curiam) (no liability for providing wrong blood pressure
medication four days late); see also Duncan v. Corr. Med. Servs., 451 F. App’x 901, 905 (11th
Cir. 2012) (per curiam) (noting that “an isolated instance where [the inmate] had not received
proper [blood pressure] medication and then suffered a medical emergency” would “clearly”
support “no showing of deliberate indifference”). Reflective of this seemingly uniform approach
is the Eighth Circuit’s decision in Fourte v. Faulkner County. There, an inmate “submitted a
medical form complaining of high blood pressure and asking jail staff to call two family
members who could get his ‘meds,’” yet did not receive any treatment (besides monitoring of his
ever-increasing blood pressure) until his blood pressure reached the “emergency level” of
“180/121” 27 days later. 746 F.3d 384, 386–87 (8th Cir. 2014). Even then, the jail nurse who
provided the emergency medication waited another week to schedule the inmate for an
appointment—despite the fact he now also complained of vision loss and would eventually go
blind—at which point he finally received a blood pressure prescription. Id. In evaluating these
treatment decisions, the Eighth Circuit concluded that the providers at most “should have known
they were committing malpractice,” but were not deliberately indifferent. Id. at 389. Watson’s
conduct pales in comparison.
Eschewing this long line of authority, the majority opinion instead creates a circuit split.
Indeed, deeming Watson’s purported mistreatment as anything more than mere negligence is out
of step with circuits across the land. At most, those courts find liability only when the
deprivation of blood pressure medication is, unlike here, repeated, prolonged, intentional, or
accompanied by overt signs of an impending and serious hypertensive crisis. See Duncan, 451
F. App’x at 903–05 (liability for depriving inmate of three different heart medications for periods
totaling 22 days, 210 days, and 46 days respectively, despite his repeated requests and trips to the
emergency room with chest pain); Carter v. Broward Cnty. Sheriff’s Off., 710 F. App’x 387, 392
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 20
(11th Cir. 2017) (per curiam) (liability for “regularly” denying medication for five months,
despite inmate complaints and symptoms); King v. Busby, 162 F. App’x 669, 671 (8th Cir. 2006)
(per curiam) (liability for depriving inmate of medication “half the time,” including at least 26
identified occasions, over seven months); Haltiwanger v. Mobley, 230 F.3d 1363, 2000 WL
1371098, at *1 (8th Cir. 2000) (unpublished table decision) (per curiam) (liability for
“periodically” refusing to give inmate blood pressure medication in retaliation for spurning
nurse’s sexual advance).
The majority opinion, regrettably, stands alone. As we have held in Reed, Jones, and
Carpenter, and as other circuits agree, Watson did not consciously disregard any risk to
Wiertella.
2.a. As for Snow, she never perceived any risk to Wiertella whatsoever, similarly
absolving her of liability. All that Wiertella has mustered on this point is the possibility,
identified by the district court, that his screening form was placed on a shelf for Snow to review.
But the district court’s assumption “blatantly contradict[s] . . . the record, so that no reasonable
jury could believe it.” DiLuzio, 796 F.3d at 609 (citation omitted).
We “are able to fix obvious factual errors” as part of our interlocutory review. Bey v.
Falk, 946 F.3d 304, 322 (6th Cir. 2019). That is the case here, where the district court blatantly
erred in concluding that Wiertella’s screening form could have been presented to Snow. See id.
As an initial flaw, the district court appeared to invert the burden of production at summary
judgment. It faulted Snow for “not provid[ing] any evidence that Mr. W[ie]rtella’s file was not
placed on [her] shelf for review.” Wiertella v. Lake County, No. 20-CV-2739, 2024 WL
1282715, at *13 (N.D. Ohio Mar. 26, 2024). But it was Wiertella’s duty to provide evidence
demonstrating Snow did review the form. See Burwell v. City of Lansing, 7 F.4th 456, 467–69
(6th Cir. 2021) (affirming summary judgment for nurse who “did nothing to assess” inmate she
saw “lying motionless on the ground” because “the record [wa]s insufficient” to show she “had
[any] reason to suspect” the inmate was suffering from a drug overdose).
In any event, on that issue, the record says otherwise. Watson testified that standard
protocol dictated that a screening nurse (like Watson) would review the form to look for
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 21
“issue[s] that the medical . . . department needs to deal with,” including “diabetics need[ing] to
have their insulin or their medication.” R. 59, PageID 1205–07. Only if this nurse “determined
that there were not medical issues” would the form be placed “into a bin” or “wooden shelf.”
Id., PageID 1206–07. Snow then “reviewed [the] med screens that” the screening nurses “put
into the wooden folder” to determine whether the inmate needed his once-yearly physical. Id.,
PageID 1208–09. But if a form was not placed there, it customarily was not reviewed by
Snow. One jail lieutenant, I recognize, described Snow as “responsible [for] mak[ing] sure that
all of the inmate medical screens are reviewed.” R. 60, PageID 2100. As Watson explained,
however, that responsibility was fulfilled by Snow assigning a screening nurse to “look over and
sign” each form. R. 59, PageID 1204.
Read together, this testimony confirms that a screening nurse would not place a form like
Wiertella’s—which indicated that he had significant medical issues like diabetes—on Snow’s
shelf. The district court’s conclusion to the contrary is an “obvious factual error” that deserves
correction. Bey, 946 F.3d at 322.
b. Even if Snow did see Wiertella’s form, she would not have perceived any risk to him.
Once again, any attempt to charge Snow with actual knowledge of Wiertella’s risk of a cardiac
event relies on circumstantial evidence that she “must have known” about the risk. Farmer, 511
U.S. at 842. With respect to the risk of harm in the near term, the majority opinion cites Snow’s
testimony that “there are medical situations in which untreated high blood pressure can cause
substantial risk of harm to a patient,” and that an inmate’s need for blood pressure medication
“would need to be addressed as soon as possible” seemingly to conclude that Snow was aware of
an immediate risk to Wiertella. R. 63, PageID 2730, 2764. A risk, perhaps. But an immediate
one? Snow’s statement conspicuously lacks any timeframe as to when a “medical situation[]”
could pose a risk. Id., PageID 2730. What is more, Snow prefaced her statement by clarifying
that she “wouldn’t call [the lack of blood pressure medication] emergent,” and added that it
should be addressed by “[s]peaking to the individual again, to find out what medication he’s on
and, if at all possible, a pharmacy we can contact[,] . . . the quickest way to find out what the[]
[medications] are.” Id., PageID 2764. In other words, Snow saw no risk in waiting to provide
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 22
blood pressure medicine until medical staff verified the prescription by seeing the inmate in sick
call or contacting his pharmacy with a signed release.
Nor is there evidence that Snow knew Wiertella might suffer harm in the future. Again,
assuming (contrary to the record) that Wiertella’s screening form was placed on her shelf, Snow
reviewed those forms only to determine whether the inmate needed a “history and physical”
exam—not to determine a course of treatment. R. 59, PageID 1208. Nothing in the record
indicates that the shelf had any other purpose or that Snow ever had a role in making treatment
decisions based on the forms on her shelf. The screening nurses, not Snow, were responsible for
identifying any “issue[s] that the medical . . . department needs to deal with.” Id., PageID 1205–
07. In short, Snow had no reason to believe that a medical condition listed on a screening form
was not being addressed by the screening nurse. Nor was she aware of the fact that Watson had
not obtained Wiertella’s medications. So Snow never “knew of the facts creating the substantial
risk” to Wiertella, and thus could not have subjectively “believed” the “risk existed.” Lawler, 93
F.4th at 929; cf. Jackson, 733 F.3d at 787 (summary judgment on deliberate indifference claim
was “so clearly correct as not to require elaboration” where a “nurse practitioner didn’t know the
plaintiff wasn’t receiving his [blood pressure] medication” for a period of three weeks).
Snow’s reliance on screening nurses places her in good company. We routinely allow
providers to rely on colleagues to provide inmate care without risking liability if the other
provider falls short in some respect. See Rouster, 749 F.3d at 449 (nurse’s reliance on others to
observe and supervise inmate); Griffith, 975 F.3d at 576 (nurses’ reliance on jailers to submit
sick slip if inmate needed further attention); Burwell, 7 F.4th at 467–69 (nurse’s reliance on
jailers to perform “cell checks” that would have discovered overdosing inmate); Est. of Majors v.
Gerlach, 821 F. App’x 533, 547 (6th Cir. 2020) (nurses’ reliance on physician orders in lieu of
“exercis[ing] their own independent medical judgment”); VanNortwick, 2022 WL 1494538, at *3
(doctor’s reliance on colleague to check lab results); cf. Graham ex rel. Est. of Graham v. County
of Washtenaw, 358 F.3d 377, 384 (6th Cir. 2004) (county’s reliance on medical professionals to
whom it delegated inmate care); Dudley v. Streeval, No. 20-5291, 2021 WL 1054390, at *2 (6th
Cir. Feb. 8, 2021) (order) (reliance by administrator with no active role in patient care on
medical colleagues). Like each of these medical professionals, Snow was not at fault for relying
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 23
on other staff to address the conditions listed in the screening forms later placed on her shelf,
forms that she reviewed merely for scheduling physicals. All things considered, Snow fairly
perceived no risk to Wiertella.
B.1. Assuming the nurses did violate Wiertella’s constitutional rights, he fails to show
that those acts transgressed clearly established constitutional markers. Kisela, 584 U.S. at 104.
His effort to do so is tied entirely to our Richmond opinion. Yet its value is deeply suspect.
Let’s consider the source. Richmond authorized a pretrial detainee to sue a doctor, social
worker, and two nurses for failing to obtain the detainee’s prescribed medication for a period of
17 days. 885 F.3d at 935–36, 940–47. To overcome those defendants’ assertion of qualified
immunity, Richmond had to show that their actions violated her clearly established rights.
Regrettably, our opinion failed to honor that command. Id. at 947–48. We began by observing
that the right to be free from “deliberate indifference to a prisoner’s medical needs” has existed
since 1976. Id. (citation omitted). This surface-level observation comes nowhere close to
resolving all debate over the illegality of the defendants’ actions there. Cf. City & County of San
Francisco v. Sheehan, 575 U.S. 600, 613 (2015) (“Qualified immunity is no immunity at all if
‘clearly established’ law can simply be defined as the right to be free from unreasonable searches
and seizures.”). Nor, for many of the same reasons, does our spacious observation “that [this]
right . . . extends to psychological needs.” Richmond, 885 F.3d at 947. That leaves one final
instruction, that “neglecting a . . . medical need” and “interrupting a prescribed plan of treatment
can constitute a constitutional violation.” Id. at 948. This statement is problematic too. In
particular, it offers no “specific context” for when a violation in fact occurs, and thus falls short
of extinguishing all “debate” over the constitutional question. See Rivas-Villegas, 595 U.S. at 5.
After all, merely because something “can” violate the Constitution does not mean that it does so
in a given scenario. Richmond, 885 F.3d at 948.
Nor do the cases cited by Richmond end that debate. Fairly read, the facts of those cases
never pass within Richmond’s orbit. See Estelle v. Gamble, 429 U.S. 97, 99–100 (1976)
(discipline of inmate with severe back pain for not joining prison workforce); Comstock, 273
F.3d at 704–05 (release of inmate from suicide watch with knowledge he was still at risk of self-
harm); Terrance v. Northville Reg’l Psychiatric Hosp., 286 F.3d 834, 844 (6th Cir. 2002)
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 24
(prescription of heat-stroke-inducing medication to obese-hypertensive inmate during severe
heatwave); Boretti v. Wiscomb, 930 F.2d 1150, 1151–52 (6th Cir. 1991) (refusal to follow
instructions to change inmate’s bandage daily). True, Richmond did not have to identify a case
that was “directly on point.” Kisela, 584 U.S. at 104 (emphasis added). But it did need to cite
case law “squarely govern[ing]” the facts, Moore, 126 F.4th at 1167, such that it was “beyond
debate” that waiting two weeks to verify a prescription runs afoul of the Constitution, Kisela,
584 U.S. at 104. It failed to do so.
Adding all of this together, Richmond’s deep flaws give it little precedential value.
Especially so when “intervening Supreme Court decision[s]” provide contrary “legal reasoning”
that is “directly applicable” to those shortcomings—a situation that “gives us the right to revisit
[the] question” Richmond decided. Ne. Ohio Coal. for the Homeless v. Husted, 831 F.3d 686,
720 (6th Cir. 2016); see, e.g., Kisela, 584 U.S. at 104–05 (rebuking court of appeals for
“defin[ing] clearly established law at a high level of generality” without making “the right’s
contours . . . sufficiently definite” in a case decided one month after Richmond); see also Colson
v. City of Alcoa, 37 F.4th 1182, 1190 (6th Cir. 2022) (granting qualified immunity because
previous, flawed “clearly established” analysis was supplanted by subsequent Supreme Court
decisions).
2. Even accepting Richmond as controlling, the decision does not “place[] the
. . . constitutional question” here—whether the nurses consciously disregarded Wiertella’s risk of
serious harm—“beyond debate . . . in light of [Richmond’s] specific context.” Rivas-Villegas,
595 U.S. at 5. Back to today’s majority opinion. It draws on Richmond’s holding that
“neglecting to provide a prisoner with needed medication” could amount to a constitutional
violation. Maj. Op. 9 (quoting Richmond, 885 F.3d at 948). Yet this “broad general proposition”
leaves medical personnel with little guidance as to what specific actions violate the law, and thus
serves as a poor guide here in assessing what right was clearly established. It likewise ignores
Richmond’s “specific context,” as neither nurse’s actions align with anything deemed illegal
there. Rivas-Villegas, 595 U.S. at 5.
a. Turn first to Watson. Scheduling Wiertella for sick call is unlike any unlawful act in
Richmond, which, as our Court has noted, “involved allegations that medical professionals
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 25
deliberately provided no treatment in the face of a known medical issue.” Whyde v. Sigsworth,
No. 22-3581, 2024 WL 4719649, at *5 (6th Cir. Nov. 8, 2024). In Richmond, a doctor took no
“steps to ensure that Richmond received her medication,” thereby violating the doctor’s
“obligation to offer medical care.” 885 F.3d at 942. Nor did the nurses in that case make “any
attempt” to get Richmond medication, whether by contacting Richmond’s pharmacy or
psychiatrist or by “request[ing] that another nurse attempt to do so.” Id. at 946. The social
worker likewise did not act even though he perceived an immediate risk of harm to Richmond, as
he knew bipolar, depressed patients like Richmond could “expect the symptoms to return within
ten days” of stopping medication. Id. at 943. Yet he merely scheduled Richmond to see a
psychiatrist 17 days later, failing to address the inherent risk that Richmond’s symptoms could
return much sooner. Id. None of these treaters is like Watson, who responded to the risk she
perceived by scheduling Wiertella for sick call within a week.
Any analogy to Richmond wanes even further when we consider what Watson knew
about Wiertella’s medications. Take, for comparison’s sake, the social worker. Richmond
highlighted that the social worker knew the exact medications Richmond was taking (even down
to the date of her last dose) and could have obtained those medications immediately after
evaluating her. Id. at 942. Watson, again, knew none of this, as the forms she received did not
indicate the names or doses of Wiertella’s other medications. As a result, her delay in the face of
this obstacle, especially when she had no reason to fear imminent harm to Wiertella, was not
indisputably prohibited by Richmond’s censure of a professional who, while alert to the
oncoming danger to the inmate and armed with both knowledge of her medications and the
ability to acquire them at any time, still failed to act. Put differently, accepting that it is
unconstitutional to take no action when an official knows an inmate is missing a specific
prescribed medication nonetheless leaves it open for debate whether a nurse can fairly address an
inmate’s lack of unknown medications by setting an appointment to discuss those medications in
a week’s time.
b. As to Snow, even if we assume that she reviewed the screening form and perceived a
risk to Wiertella after doing so, her non-treating role with respect to those forms negates any
comparison to Richmond, where each defendant provided Richmond with medical care. See id.
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 26
at 941 (“Dr. Huq treated Richmond . . . .”); id. at 942 (“Myftari diagnosed Richmond . . . .”); id.
at 946 (“Nurse Fowler examined Richmond . . . .”); id. (“Nurse Hawk also had extensive
interactions with Richmond . . . .”). Each, in short, was a “medical professional[] responsible for
prisoner care.” Graham, 358 F.3d at 384. But not Snow, who was not responsible for providing
day-to-day treatment tied to the forms on her shelf, other than reviewing those forms to assess
whether an inmate like Wiertella was due for his yearly physical. In that narrow role, Snow was
effectively “an administrator who worked with [Wiertella’s] medical providers” but was “not
personally involved in making decisions about [his] medical care.” Dudley, 2021 WL 1054390,
at *2. Given this key difference from the Richmond defendants, that case does not clearly
establish Snow’s liability for “rely[ing] on medical judgments made by [the] medical
professionals [who were] responsible for prisoner care.” Graham, 358 F.3d at 384.
If anything, Richmond squarely confirms the absence of liability here. In finding no
constitutional violation by a second social worker, Richmond honored the social worker’s
“medically reasonable” decision to rely on another provider instead of “personally mak[ing] an
effort to verify or secure Richmond’s medications.” 885 F.3d at 943–44. Like this social
worker, Snow was allowed to rely on other medical professionals—including a screening nurse
like Watson—to provide Wiertella with appropriate treatment.
Seeing things otherwise, the majority opinion discerns a jury issue as to whether Snow
personally provided Wiertella with medical treatment. Maj. Op. 7. That is an unusual point to
emphasize when Wiertella himself has never done so. Before the district court, it bears
reminding, Wiertella argued that Snow was liable based on (1) reviewing his screening form, (2)
playing an “oversight” role “over the sick call process,” and (3) serving “as Watson’s
supervisor.” R. 71, PageID 4946–47. And he abandoned all but the first theory on appeal.
Appellee Br. 24–25. Nor did he ever cite the evidence the majority opinion relies on here. See
generally R. 71 (never citing R. 59, PageID 1243); Appellee Br. (same).
Even if we tread where Wiertella did not ask us to go, this evidence creates no jury
“disput[e].” Maj. Op. 7. The majority opinion asks us to believe that Watson “testified that she
believed Snow had seen Wiertella.” Id. Not so. Look to the record. In answering whether she
No. 24-3311 Wiertella v. Lake Cnty., Ohio, et al. Page 27
had any conversations about Wiertella after his death, Watson gave a rambling answer she
summed up by saying, “I honestly don’t know”:
No. I mean, there wasn’t—no. I mean, I, I can’t, I mean, I don’t, I don’t really
believe so, nothing that would jog my memory. So no, I don’t, no, I don’t think
so. It was, I mean, it just was, I remember Diane [Snow], I think, I think she had
seen him, but that was about it. I mean, I don’t know if I was on, I don’t
remember what shift I was on at that point in time, so I don’t, I honestly don’t
know.
It is difficult to draw any conclusion from that testimony, let alone the one forcefully
drawn by the majority opinion. In the end, no reasonable jury could find that Snow treated
Wiertella, and thus knew about his lack of medication, based solely on such “inconclusive”
testimony. See Wooler v. Hickman County, 377 F. App’x 502, 507 (6th Cir. 2010).
And, even were that not the case, Wiertella is still no closer to showing that Snow
transgressed clearly established constitutional limits. If Snow did treat Wiertella, then she would
have learned from his chart that he was scheduled for sick call at the end of the week to check his
blood pressure and obtain prescription information. This keeps her squarely in line with the
second social worker from Richmond, who “saw Richmond” in person but still “responded
reasonably” by “referring” her to another professional for evaluation. 885 F.3d at 943–44.
* * * * *
Wiertella’s tragic death inevitably tends to color any after-the-fact assessment of the
underlying events. But whether a circumstance is tragic is a far different question from whether
the facts give rise to a constitutional violation. The rule invented here—that a brief deprivation
of a commonplace medication unnecessary to staving off any apparently imminent patient risk
runs afoul of the Constitution—diverges wildly from the document’s original public meaning,
from circuit precedent, and from Supreme Court precedent as well. And the ramifications will
be widespread. Consider treatment involving blood pressure medication alone. With one-
quarter of adults in the United States taking blood pressure medication, approximately 500,000
such patients are seen by local jail medical staff each year. See Fryar et al., supra, at 1, 3; Zeng
& Minton, supra, at 41, 43. Now, in our circuit at least, each of those jailed patients has at his
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disposal a § 1983 claim if the jail delays in supplying his medication. Bad facts make bad law,
indeed.
More to the point, we do not judge medical treaters with the benefit of hindsight. Watson
and Snow made their treatment decisions with limited information and resources, a reality faced
by many jail medical professionals. Qualified immunity demands that we assess their actions in
light of what they knew then, not what we know after the relevant events played out. In a case
like this, that means Wiertella needs a record reflecting conscious disregard of a risk to his health
and a precedent that stamps out any debate on the question. With both elements absent here,
Watson and Snow are entitled to judgment in their favor.