Petition for Writ of Certiorari — Ronnie Alexander, Petitioner v. Philip R. Taft Psy D and Associates, P.L.L.C., et al.

No. __________

In the Supreme Court of the United States

________________________

RONNIE ALEXANDER,

Petitioner,

v.

PHILIP R. TAFT PSY D AND ASSOCIATES, PLLC., ET AL.,

Respondents.

___________________________________________

ON PETITION FOR WRIT OF CERTIORARI

TO THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

___________________________________________

APPENDIX

___________________________________________

Roger E. Topham

Counsel of Record

13809 Research Blvd

Ste 500

Austin, TX 78750

(512) 987-7818

rt@tophamlaw.com

Jeff Daniel Clark

GREENCLARK LAW FIRM

8350 N. Central Expy.

19th Fl.

Dallas, TX 75206

(817) 953-8567

jeff@greenclark.law

Attorneys for Petitioner

MARCH MMXXVI

United States Commercial Printing Company • www.uscpc.us • (202) 866-8558

App-i

APPENDIX

TABLE OF CONTENTS

Appendix A

Opinion [precedential], United States

Court of Appeals for the Fifth Circuit,

Ronnie Alexander v. Philip R. Taft Psy D

and Associates, P.L.L.C.; Henderson

County Texas; Nathaniel Patterson; Taylor Caldwell; Morgan Fain; Noah Kreie;

William Trussel; Dora Martinez; Melissa

Harmon; Philip Taft,

No. 24-10663 (Jul. 10, 2025) .................... App-1

Dissenting Opinion (DENNIS, J.) ...... App-28

Appendix B

Opinion [precedential, rehearing denied,

previous opinion reported at 143 F. 4th

569 [Appendix A] substituted], United

States Court of Appeals for the Fifth Circuit, Ronnie Alexander v. Philip R. Taft

Psy D and Associates, P.L.L.C.; Henderson County Texas; Nathaniel Patterson;

Taylor Caldwell; Morgan Fain; Noah

Kreie; William Trussel; Dora Martinez;

Melissa Harmon; Philip Taft,

No. 24-10663 (Dec.23, 2025) .................. App-38

Dissenting Opinion (DENNIS, J.) ...... App-65

Appendix to Dissenting Opinion of

DENNIS, J. (brief of prison law scholars as amici curiae supporting [Alexander] and rehearing) ....................... App-77

App-ii

Appendix to brief of prison law

scholars as amici curiae supporting [Alexander] and rehearing .... App-95

Appendix C

Memorandum Opinion and Order Granting In Part and Denying In Part Motions

to Dismiss, United States District Court

for the Northern District of Texas, Ronnie Alexander v. Southern Health Partners, Inc. et al.,

No. 3:22-cv-00395-X (Jun. 28, 2024) ...... App-97

App-1

Appendix A

[Filed: Jul. 10, 2025]

United States Court of Appeals

for the Fifth Circuit

_____________________

No. 24-10663

_____________________

RONNIE ALEXANDER,

Plaintiff—Appellant,

versus

PHILIP R. TAFT PSY D AND ASSOCIATES, P.L.L.C.; HENDERSON COUNTY TEXAS; NATHANIEL PATTERSON; TAYLOR CALDWELL; MORGAN FAIN; NOAH KREIE; WILLIAM

TRUSSEL; DORA MARTINEZ; MELISSA HARMON; PHILIP

TAFT,

Defendants—Appellees.

_____________________

Appeal from the United States District Court

for the Northern District of Texas

USDC No. 3:22-CV-395

_____________________

Before DENNIS, OLDHAM, and DOUGLAS, Circuit

Judges.

DANA M. DOUGLAS, Circuit Judge:

Ronnie Alexander was arrested and detained in

Henderson County Jail while he awaited trial. Hoping

to transfer out of the group holding cell, he falsely informed Jail officials that he was suicidal. The Jail subsequently transferred him to its suicide-prevention

cell, known as the “violent cell.”

The violent cell has no toilet, running water, or bedding, and the lights run at all hours. Alexander was

App-2

housed there for five days, after which he was released

from the Jail. He subsequently filed this lawsuit,

bringing federal-and state-law claims challenging the

conditions of his confinement in the violent cell and

the adequacy of the Jail’s mental health services. The

district court granted the defendants’ motions to dismiss. We AFFIRM.

I

A

On March 8, 2021, Ronnie Alexander was booked at

the Jail. 1 The next day, he underwent a medical intake screening, during which he reported that he was

not suicidal. He showed no signs of intoxication or

withdrawal; nevertheless, he was placed on alcohol

withdrawal protocol under which he received “a suite

of prescriptions.” At all relevant times, Southern

Health Partners provided non-mental health care at

the Jail, while Philip R. Taft, Psy.D & Associates,

P.L.L.C., provided mental health care. One of Taft’s

employees, Jessica Phlips, was assigned to visit inmates.

Shortly after Alexander’s booking, Phlips visited

him and observed no mental health issues, but noted

that he disclosed suffering from post-traumatic stress

disorder (“PTSD”) and depression. After a follow-up

meeting, she identified no concerns regarding his

mental status. Soon thereafter, the Jail designated

Alexander a maximum-security detainee and placed

him in group detention “with some of the most violent

and dangerous men being held at the Jail.” Alexander

1 The

booked.

record does not identify the crime for which he was

App-3

alleges that the other inmates consistently threatened

him, causing him to fear for his safety and his blood

pressure to rise.

Worried by the circumstances, Alexander requested

transfer to another cell several times. The guards refused. Eventually, he falsely informed a correctional

officer that he was suicidal, “believing that would

force the [J]ail to move him out of the group detention

cell for medical or mental health evaluation.” He was

correct. On March 10, officers transferred him to the

violent cell. Along the way, they harassed Alexander,

calling him a “b****” and telling him that he “really

f***** up now, b****.”

Alexander paints a grim picture of the violent cell.

It has “no bed, sink, toilet, shower, or running water

of any kind.” The only place for an inmate to urinate

or defecate is through a small, grated drain in the middle of the floor. He received no toilet paper, so he used

a paper cup to force fecal matter through the drain.

And he had no access to running water or utensils,

forcing him to eat “with hands that were perpetually

contaminated with fecal bacteria.” During his five

days in the violent cell, “he was never once allowed to

leave his cell to use a proper toilet, shower, or wash

his hands.” 2

While Alexander alleges that “[t]he floor had not been

cleaned and was covered in dried urine and fecal matter,” he incorporated a color image of his cell, which is an off-white color.

From review of this image, the cell appears clean—and certainly

devoid of fecal matter—discounting any allegation that the cell

was covered in waste. We need not accept allegations clearly disproven by photographic evidence incorporated in the complaint.

See Kokesh v. Curlee, 14 F.4th 382, 385 n.2 (5th Cir. 2021).

2

App-4

He also had no clothing or sheets, and was provided

only a “suicide blanket” to cover himself. In lieu of a

bed, the violent cell has a concrete slab built into the

wall. The lights ran at all hours, “inhibit[ing]” his ability to sleep. He was provided three eight-ounce cups

of water per day—one with each meal. And during his

time in the violent cell, he received no exercise or recreation time.

To mitigate these deficiencies, Alexander requested

water, toilet paper, and an opportunity to shower or

wash his hands. The officers almost uniformly rejected the requests, taking “no affirmative steps whatsoever, beyond cursory visual checks, to ensure that

[his] physical and mental health were not suffering

from the conditions he was subjected to in the violent

cell.” 3 Instead, the guards often taunted Alexander.

One “loudly discussed taking [him] out to a field and

unleashing [a police] dog on him.” Another threatened

to kill him with a “barbed wire guillotine.” Yet another

stated: “Ronnie Alexander, you are not leaving this facility alive.”

On March 12, two days after Alexander’s transfer to

the violent cell, Phlips visited. Prior to their meeting,

she did not review his medical file or other records and

did not have access to the officers’ suicide screener.

She quickly determined that Alexander was “‘too confused’ to answer her initial questions” and departed,

doing “nothing to alleviate the conditions that were

causing [his] psychological deterioration” and “fail[ing]

3 Over the course of his five days in the violent cell, Alexander

received “only about three small beverages in total” beyond those

he received with his meals.

App-5

to report her observations to any medical or mental

health professionals.” She did not visit again.

Alexander remained in the violent cell until March

15, at which time he was released to the custody of

Dallas County.

B

On February 17, 2022, almost one year after his release, Alexander filed this lawsuit against various individuals and entities, alleging violations of 42 U.S.C.

§ 1983, alongside various state-law claims. He

amended his complaint several times, ultimately filing his Third Amended Complaint, in which he alleged claims against Southern Health Partners, Inc.;

Philip Taft in his individual capacity and Philip R.

Taft, Psy.D & Associates P.L.L.C. (“the Taft defendants”); Henderson County, Texas; and Henderson

County Correctional Officers Nathaniel Patterson,

Taylor Caldwell, Morgan Fain, Noah Kreie, William

Trussell, Dora Martinez, and Melissa Harmon (“the

officers”).

The defendants individually filed motions to dismiss pursuant to Federal Rule of Civil Procedure

12(b)(6). The district court granted the defendants’

motions over Alexander’s opposition, finding that he

failed to state a claim under § 1983 against the Taft

defendants, Henderson County, and the officers. It declined to exercise supplemental jurisdiction over Alexander’s remaining state-law claims against the Taft

defendants and Southern Health Partners and dismissed them without prejudice. Alexander timely appealed the dismissal of his federal claims.

App-6

II

“We review a district court’s dismissal of claims under Federal Rule of Civil Procedure 12(b)(6) de novo.”

Clyce v. Butler, 876 F.3d 145, 148 (5th Cir. 2017). We

“interpret[] the complaint in the light most favorable

to the plaintiff,” United States ex rel. Steury v. Cardinal Health, Inc., 735 F.3d 202, 204 (5th Cir. 2013)

(quoting United States ex rel. Steury v. Cardinal

Health, Inc., 625 F.3d 262, 266 (5th Cir. 2010)), accepting all well-pleaded facts as true, see Cicalese v.

Univ. of Tex. Med. Branch, 924 F.3d 762, 765 (5th Cir.

2019). However, those facts must state “a claim to relief that is plausible on its face.” Bell Atl. Corp. v.

Twombly, 550 U.S. 544, 570 (2007). “A claim has facial

plausibility when the plaintiff pleads factual content

that allows the court to draw the reasonable inference

that the defendant is liable for the misconduct alleged.”

Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).

While complaints do “not need detailed factual allegations,” speculative or conclusory statements of fact

are insufficient. Cicalese, 924 F.3d at 765 (quoting

Twombly, 550 U.S. at 555); Iqbal, 556 U.S. at 678. And

we “are not bound to accept as true a legal conclusion

couched as a factual allegation.” Iqbal, 556 U.S. at 678

(quoting Twombly, 550 U.S. at 555).

III

The Fourteenth Amendment’s Due Process Clause

provides pretrial detainees protections extending beyond those granted to sentenced defendants. See Bell

v. Wolfish, 441 U.S. 520, 535 n.16 (1979). While “[a]

sentenced inmate . . . may be punished” within the

strictures of the Eighth Amendment, “[d]ue process

requires that a pretrial detainee not be punished.” Id.;

App-7

see also Kingsley v. Hendrickson, 576 U.S. 389, 400–

01 (2015) (“[M]ost importantly, pretrial detainees (unlike convicted prisoners) cannot be punished at all,

much less ‘maliciously and sadistically.’” (citations

omitted)); Graham v. Connor, 490 U.S. 386, 395 n.10

(1989) (protecting pretrial detainees “from the use of

excessive force that amounts to punishment”). Such

protection is fundamental to our criminal justice system. “A person lawfully committed to pretrial detention has not been adjudged guilty of any crime.” Bell,

441 U.S. at 536. Since the detainee has “had only a

‘judicial determination of probable cause as a prerequisite to [the] extended restraint of [his] liberty following arrest,’” the Government may only use such conditions necessary “to ensure his presence at trial.” Id.

(alterations in original) (quoting Gerstein v. Pugh, 420

U.S. 103, 114 (1975)).

Due process compels us to ask whether the “restrictions and conditions of the detention facility . . .

amount to punishment, or otherwise violate the Constitution.” Id. at 536–37. “Not every disability imposed during pretrial detention amounts to ‘punishment’ in the constitutional sense . . . .” Id. at 537.

Therefore, traditional “confinement in a facility

which . . . results in restricting the movement of a detainee” is permissible. Id. Often, these restrictions

arise from the Government’s “legitimate interests

that stem from its need to manage the facility in which

the individual is detained.” Id. at 540. This means

that some “administrative measures that go beyond

those that are, strictly speaking, necessary to ensure

that the detainee shows up at trial” may be warranted.

Id. Such is the case “even if they are discomforting and

are restrictions that the detainee would not have

App-8

experienced had he been released while awaiting trial.”

Id.

Pretrial detainees may bring claims of such violations “either by demonstrating an unconstitutional

condition of confinement or by demonstrating an unconstitutional episodic act or omission.” Cadena v. El

Paso County, 946 F.3d 717, 727 (5th Cir. 2020). “For

a conditions of confinement claim, ‘the proper inquiry

is whether those conditions amount to punishment of

the detainee.’” Id. (quoting Bell, 441 U.S. at 535).

These conditions “may take the form of ‘a rule,’ a ‘restriction,’ ‘an identifiable intended condition or practice,’ or ‘acts or omissions’ by a jail official that are

‘sufficiently extended or pervasive.’” Id. (quoting Est.

of Henson v. Wichita County, 795 F.3d 456, 468 (5th

Cir. 2015)). 4

To determine whether conditions are constitutionally permissible, we ask whether the restrictions and

practices “are rationally related to a legitimate nonpunitive governmental purpose and whether they appear excessive in relation to that purpose.” Bell, 441

4 Alexander alleges that the violent cell’s “conditions had no

justifiable purpose and were therefore unlawful punishment,”

and that he “was harmed by intentional acts or omissions, such

as the denial of water and toilet paper.” The district court

acknowledged this duality, but found that Alexander’s “harms . . .

stem from the barren conditions within the violent cell” and were

“best classified as harms relating from his conditions of confinement.” It therefore “proceed[ed] analyzing his Section 1983

claims under the Fifth Circuit’s conditions-of-confinement

framework” in light of the clarity provided by the most recent

amended complaint. On appeal, Alexander discusses, but does

not challenge, this classification. We agree that his claims challenge the conditions of his confinement, and consider them as

such.

App-9

U.S. at 561. If there is a related governmental objective, the conditions, “without more, [do not] amount to

‘punishment.’ Conversely, if a restriction or condition

is not reasonably related to a legitimate purpose—if it

is arbitrary or purposeless—a court may infer that the

purpose of the governmental action is punishment

that may not constitutionally be inflicted upon detainees qua detainees.” Id. at 539 (footnote omitted).

Therefore, Alexander must demonstrate, inter alia,

that the restrictions are not reasonably related to a

legitimate governmental objective. See Cadena, 946

F.3d at 727 (quoting Duvall v. Dallas County, 631 F.3d

203, 207 (5th Cir. 2011)). Because Alexander cannot

make this showing, as described below, we affirm.

IV

On appeal, Alexander raises the following issues:

whether (1) his confinement was an unlawful punishment of a pretrial detainee; (2) the Taft defendants

and the County completely deprived him of qualified

mental health care, creating an unlawful condition of

confinement; (3) Taft is liable in his individual capacity for Alexander’s injuries; and (4) he plausibly alleged that the County maintained a custom or practice

of punishing inmates through the violent cell. Because

we conclude that the violent cell’s conditions are reasonably related to a legitimate government interest

and are thus not punitive, we do not reach the fourth

issue.

A

We begin with Alexander’s claims that Henderson

County and the officers unconstitutionally punished

him through the conditions of his confinement.

App-10

Alexander complains that he was subjected to a “barbaric combination of conditions,” which he asserts

were unjustifiable and therefore punitive. We accept

his well-pleaded allegations that he was deprived of a

toilet, toilet paper, running water, recreation, bedding,

clothing, additional drinking water, or particularly

sanitary or clean conditions, and that he was subjected to a 24/7-lights-on policy. We also accept as fact

that officers threatened him as alleged.

“Absent a showing of an expressed intent to punish

on the part of detention facility officials,” we ask

whether the “particular condition or restriction . . . is

reasonably related to a legitimate nonpunitive governmental objective.” Bell, 441 U.S. at 538–39. We

first consider whether there was an expressed intent

to punish, and then ask whether the conditions were

reasonably related to a legitimate nonpunitive governmental objective.

1

Alexander argues that the district court failed to

credit his well-pleaded allegations that prison officials

were aware that he was not actually suicidal. As Alexander frames it, he informed the guards that he was

suicidal to escape group housing. But when they

moved him to solitary confinement, they did so not to

protect him, but to punish him. 5

5 The district court did not consider these allegations. The dis-

sent says that this “should end the analysis.” Post, at 27. But a

district court need only consider well-pleaded allegations of fact,

not speculation about others’ states of mind. Cicalese, 924 F.3d

at 765 (noting that we need not accept speculative allegations);

Iqbal, 556 U.S. at 678 (requiring factual content that leads to

“reasonable inferences”). Nor does the failure to consider a

App-11

As an initial matter, Alexander was not transferred

until he informed correctional officers that he was suicidal. That alone implies that the officers took his

statement at face value, even if they did not subjectively believe him. But Alexander points to the vulgar

comments the officers made during his transfer, including that he “really f***** up now, b****.” This, he

claims, gives rise to the inference that “the guards did

not care about [his] fear of his cellmates or spiking

blood pressure and wanted to punish him for complaining.” He asserts that “[i]t can be further inferred

that they also knew [he] could expect to suffer while

he was in the violent cell.” Inappropriate as the officials’ statements may be, they do not evince punitive

intent, even if they followed several denied requests

for relocation. The same is true of any threats directed

at Alexander while he was in the violent cell. 6

handful of allegations always warrant reversal. Such is especially so here, considering that Alexander’s framing requires an

inferential leap—from the officers’ alleged subjective disbelief to

an expressed intent to punish—that we need not accept. Nevertheless, as described below, the allegation does not save his complaint. See also Gilbert v. Donahoe, 751 F.3d 303, 311 (5th Cir.

2014) (explaining that we may affirm on any ground supported

by the record).

6 The threats included unleashing a police dog on Alexander

and threatening to kill him with a barbed wire guillotine. Officers also stated that Alexander would not “leav[e] this facility

alive.” We do not endorse such comments. But “[m]ere allegations of verbal abuse do not present actionable claims under §

1983. ‘As a rule, “mere threatening language and gestures of a

custodial officer do not, even if true, amount to a constitutional

violation.”’” Bender v. Brumley, 1 F.3d 271, 274 n.4 (5th Cir. 1993)

(alteration omitted) (quoting McFadden v. Lucas, 713 F.2d 143,

146 (5th Cir. 1983)). Therefore, to the extent that Alexander

App-12

Alexander alleges no facts of the officers’ explicit intent to punish him, or that they outwardly disbelieved

him, or that other suicidal inmates received different

treatment. 7

Moreover, it matters not whether the officers believed he was suicidal. County jails have a constitutional duty to ensure the safety of potentially suicidal

detainees. Rhyne v. Henderson County, 973 F.2d 386,

391 (5th Cir. 1992) (“The failure to provide pre-trial

detainees with adequate protection from their known

suicidal impulses is actionable under § 1983 as a violation of the detainee’s constitutional rights.”). Allowing this allegation to bootstrap Alexander’s complaint

past a motion to dismiss would create a minefield we

decline to enter. Consider the dangers of requiring officers to second-guess every inmate’s report of suicidal

ideation. If they believe and transfer a dishonest detainee, as here, they would be liable for conditions

suggests that these comments created a condition of confinement

that violated the Constitution, we disagree.

7 The dissent argues that we “invert[] Rule 12(b)(6)” by “assum[ing] facts in favor of the moving party.” Post, at 26 n.1. Not

so. The facts alleged, taken as true, do not give rise to the reasonable inference that the officers intended to punish Alexander.

Beyond these insufficient factual allegations, he may claim that

the officers desired to punish him, but any allegation to that effect is speculation that we need not accept. See Cicalese, 924 F.3d

at 765. And, as described later, we do not depend on whether officers believe an individual’s report of suicidal ideation.

Nor do we “fault[] Alexander for not meeting a legal test that

finds no support in precedent” through our discussion of similarly situated detainees. Post, at 28. Where there are insufficient

factual allegations demonstrating punitive intent, a detainee

could presumably make a showing of punitive intent through disparate treatment of similarly situated individuals. Alexander

failed to do so.

App-13

that are designed to protect suicidal inmates. But if

they disbelieve and do not transfer an honest detainee,

they would also be liable, and the detainee would be

in serious danger of self-harm. This standard is unworkable and would result in the denial of constitutional protections, and we therefore reject it.

2

We next consider whether the conditions of the violent cell are reasonably related to a legitimate governmental interest. As discussed above, pretrial detainees have a constitutional right to protection from selfharm. Rhyne, 973 F.2d at 391. As barren as the violent

cell was, each condition was reasonably related to the

legitimate government interest of protecting suicidal

inmates from self-harm.

Alexander alleges that the cell did not have a toilet,

a shower, or running water. But each of these poses a

drowning risk. See, e.g., Elliott v. Cheshire County,

940 F.2d 7, 9 (1st Cir. 1991) (noting that the prisoner

stated that “he wanted to drown himself in the toilet”);

Belcher v. City of Foley, 30 F.3d 1390, 1393 (11th Cir.

1994) (“As the officers attempted to move Mr. Belcher,

he broke away and stuck his head into the toilet in an

attempt to drown himself.”); Cervantez v. Frith, No.

22-150, 2025 WL 1287918, at *1 (N.D. Tex. May 2,

2025) (inmate attempted to drown himself in the toilet

three separate times); Crocco v. Winkler, 659 F. Supp.

3d 204, 207 (D.N.H. 2023) (“Crocco attempted to

drown himself in the cell’s sink . . . .”). He claims that

he was stripped and provided no bedding. But clothes

and sheets carry risks of self-asphyxiation, especially

when combined with showers, sinks, or toilets. See,

e.g., McMahon v. Beard, 583 F.2d 172, 175 (5th Cir.

App-14

1978) (“Removal of all cloth which might offer a means

for suicide would seem prudent.”); Hare v. City of Corinth, 36 F.3d 412, 414 (5th Cir. 1994) (inmate hanged

herself “from the bars of her cell” using “strips of the

blanket”); Lewis v. Stephens, 710 F. App’x 703, 703

(7th Cir. 2018) (“He stood on the sink in his cell with

a bedsheet tied around his neck, threatening to hang

himself.”); Romero v. Donley County, 87 F.3d 1311, at

*1 (5th Cir. 1996) (unpublished) (inmate hanged himself from bar above the toilet); Rangel v. Wellpath,

LLC, No. 23-128, 2024 WL 1160913, at *1 n.3 (N.D.

Tex. Mar. 18, 2024) (inmate “tore the blanket into

strips, tied them to the shower head, and hung himself”). He states that his requests for toilet paper were

denied. But, sadly, even toilet paper could pose a choking hazard. See Nagle v. Gusman, 61 F. Supp. 3d 609,

624 (E.D. La. 2014) (deposition testimony that an inmate “swallowed a roll of toilet paper and killed himself”); Elliott, 940 F.2d at 9 (inmate that had previously threatened suicide asked another “what would

happen if he . . . swallowed paper towels”). 8 Moreover,

8 We note that Alexander complains of other rejected requests

and conditions, including requests for additional drinking water

and to shower or wash his hands, and a lack of recreational time.

All inmates have “a right to adequate food.” Youngberg v. Romeo,

457 U.S. 307, 315 (1982). Inherent in such a right is access to

water. But we hesitate to take Alexander’s suggestion that he

ought to have received the “ideal” amount of drinking water for

an adult male, which he totals to be 124 ounces. Even if Alexander’s drinking water values were lower than what a typical person may aim for, we cannot say that he was provided “inadequate”

water to the point of constitutional deprivation. This determination, of course, is context-dependent. But we decline to create an

express baseline for daily water consumption for prisoners in suicide prevention cells.

App-15

a twenty-four-hour-lights-on policy permits officers to

monitor the inmate’s activity around the clock to prevent them from self-harming. Cf. Anderson v. Dallas

County, 286 F. App’x 850, 852 n.1 (5th Cir. 2008) (noting that “[o]nce an inmate is placed on Suicide Prevention Status, jailers must routinely monitor and observe the inmate”). These conditions, “barbaric” as

they may be, relate to the legitimate government interest of protecting inmates—an interest that is constitutionally imposed upon the State. 9

As for the inability to shower and the loss of recreation time,

such are reasonably related to the legitimate interest in protecting him from self-harm. Officials would have been required to

move him out of the protective cell, provide him access to running

water and a shower head—among the dangers from which he

was isolated—and afford recreational time in open space, possibly with other inmates. These acts could pose a danger to an individual suffering suicidal ideation, and are not “arbitrary or

purposeless.” Bell, 441 U.S. at 539. We expressly limit this holding to Alexander’s circumstances. We do not extend this to instances in which an individual is in such a cell for other periods

of time or subjected to other conditions.

Finally, while we need not credit Alexander’s allegation that

waste covered the floor, see supra n.2, this alleged condition is a

far cry from the horrifying facts presented in Taylor v. Riojas,

which amounted to an Eighth Amendment violation. See 592 U.S.

7, 8–9 (2020) (inmate was confined in two cells, one of which “was

covered, nearly floor to ceiling, in massive amounts of feces” and

the second of which was “frigidly cold” and “equipped with only

a clogged drain in the floor to dispose of bodily wastes”). The photograph in Alexander’s complaint discounts any allegation that

the violent cell was in nearly the state of the cell in Taylor, or

amounted to a punitive condition under the circumstances.

9 The district court found that the violent cell was “reasonably

tailored to the state’s interest in preventing suicides.” But it then

relied on out-of-circuit caselaw to alternatively hold that “the

App-16

To be sure, these conditions are not narrowly tailored. They are overinclusive, painting with a broad

brush to protect those who pose the greatest danger to

themselves. But Bell looks only for a reasonable relationship, not narrow tailoring. So, even if these conditions are overly protective of Alexander, they are sufficiently related to the Jail’s legitimate interest in protecting suicidal inmates and thus pass constitutional

muster. 10

violent cell’s conditions did not deprive Alexander of life’s minimal necessities.” We disagree.

We have previously held that similar conditions violate the

Eighth Amendment where there is punitive intent. See, e.g.,

McCray v. Sullivan, 509 F.2d 1332, 1336 (5th Cir. 1975) (finding

an Eighth Amendment violation where “[a]s many as seven” prisoners were placed in a single cell in punitive isolation measuring

six feet by eight feet, which lacked “bunks, toilets, sinks[,] or

other facilities,” and had only a “hole in the cell floor” as a toilet

that was flushed four times each day and often backed up); Alexander v. Tippah County, 351 F.3d 626, 628–31 (5th Cir. 2003)

(referring to conditions as “deplorable” where inmates punished

for fighting were transferred to a similar cell, sewage littered the

cell, it was freezing, and inmates were unable to wash their

hands before eating). Alexander’s housing was affirmatively not

punitive—it was protective.

Nor do we adopt the district court’s suggestion that, because

Alexander lived through his confinement at Henderson County

Jail, the conditions are per se reasonably related to the Jail’s interest in protecting suicidal inmates. The fact that some conditions protect a detainee does not make all conditions reasonably

related to the Government’s interest in the detainee’s protection.

Nevertheless, here, all conditions bore a reasonable relationship

to a legitimate government interest, and Alexander’s claims

therefore fail. It is solely on that basis that we affirm the district

court’s judgment.

10 In his complaint and the factual background of the opening

brief, Alexander notes that “inmates identified with a potential

for self-harm would sometimes be moved into the much less

App-17

Because the conditions were sufficiently related to

a legitimate governmental interest, Alexander was

not punished in violation of the Due Process Clause. 11

We therefore do not consider whether the officers are

entitled to qualified immunity.

B

Alexander’s remaining claims focus on medical care.

He argues that “the county was well aware that no

qualified mental health care was being provided at the

[J]ail” and that its policies and contract with the Taft

defendants resulted in a “total, intentional

restrictive ‘separation cells’ if the [J]ail decided it needed the violent cell for someone who was genuinely violent.” Those cells

have a toilet, sink, shower, table, and bed. This, he claims, shows

that the Jail did not believe the violent cell’s restrictions were

necessary.

Any argument centering on these alternative cells is forfeited

for failure to brief the issue before this court. See United States

v. Delgado, 672 F.3d 320, 334 (5th Cir. 2012) (en banc). Regardless, as we note above, there is no requirement that the violent

cell be tailored to the individual. Where multiple individuals’ circumstances warrant placement in the violent cell, spillover into

the “separation cells” is required. But where the violent cell is

available, Alexander cannot claim that he should have been

placed in a separation cell instead. The violent cell is the safest

place for the Jail to place a suicidal inmate, and the conditions

are reasonably related to its interest in protection against suicide.

We decline to suggest that officers should weigh the sincerity of

such reports to determine whether a detainee should be housed

in a more relaxed cell, given their potential for self-harm.

11 We do not hold today that the violent cell’s conditions are

permissible in all circumstances. For instance, we express no

view of the various other individuals’ stories that Alexander

raises in both his complaint and opening brief. We hold only that,

as it relates to Alexander, accepting his well-pleaded allegations

as true, the Jail did not violate his constitutional rights.

App-18

deprivation of qualified mental health care.” Specifically, he alleges that Phlips “did not bother to gather

or confirm any information on [him], such as why he

was in the violent cell, how long he had been in there,

whether he was taking any medication, or anything

else.” Instead, she “quickly aborted her visit when she

decided that Alexander was ‘too confused’ to answer

her initial questions.” He also alleges that she took no

action to help him; lacks medical or mental health licensing; has admitted she is not a clinician; is unqualified to make a clinical assessment; and must report

her findings to someone qualified to make such an assessment. But, while Alexander believes that “[a]

qualified mental health professional would have been

alarmed at [his] state and taken steps to address it,”

Phlips “did not notify Taft or any other medical or

mental health professional about Alexander’s obvious

distress.”

Alexander then turns to Taft. He alleges that Taft

assigned “an unlicensed person not legally authorized

to provide psychological services” to handle his contractual responsibilities without providing written

policies or procedures. Because the Jail was aware

“from simple observation that [Phlips] was unsupervised and the only person allegedly providing mental

health care at the [J]ail,” and it knew that she had no

license, Alexander asserts that “it was the [J]ail’s express policy to deny its entire inmate population access to mental health care of any kind.”

We consider first his claims against the County, and

then turn to the Taft defendants. 12

12 The

dissent states that the district court dismissed this

claim sub silentio and we should therefore vacate and remand.

App-19

1

The State must “assume some responsibility for [a

pretrial detainee’s] safety and general well-being.”

DeShaney v. Winnebago Cnty. Dep’t of Soc. Servs., 489

U.S. 189, 200 (1989). These responsibilities include

“food, clothing, shelter, medical care, and reasonable

safety.” Id. Medical care includes “protection from violence or suicide.” Hare v. City of Corinth, 74 F.3d 633,

643 (5th Cir. 1996). The district court did not expressly consider Alexander’s argument that the Jail

failed to provide sufficient mental health care, instead

dismissing the § 1983 claims against the Taft defendants because the violent cell’s conditions did not violate his constitutional rights. Nevertheless, seeing no

cognizable claim under § 1983, we affirm. See Gilbert,

751 F.3d at 311.

Post, at 30. But the district court explained that, although Alexander challenged his medical treatment, administrative segregation and his confinement to a suicide-prevention cell did not

amount to a constitutional violation. True enough, this analysis

did not fully consider one of Alexander’s chief complaints—that

he did not receive sufficient mental health care—but we may consider this issue nonetheless. “Under our precedent, we may ‘affirm on any ground supported by the record, including one not

reached by the district court.’ This is so even if neither the appellant nor the district court addressed the ground, so long as the

argument was raised below.” Gilbert v. Donahoe, 751 F.3d 303,

311 (5th Cir. 2014) (footnotes omitted) (quoting Ballew v. Cont’l

Airlines, Inc., 668 F.3d 777, 781 (5th Cir. 2012)). The dissent provides that this principle “applies only when the district court has

actually considered the claim.” Post, at 30. In our view, the district court did consider Alexander’s § 1983 claim against the Taft

defendants, even if it failed to individually consider every factual

basis supporting that claim.

App-20

First, Alexander argues that the Jail allowed Phlips,

whom he alleges is unlicensed, to provide all mental

health care at the Jail. The Texas Commission on Jail

Standards requires that each facility have a plan that

“provide[s] procedures that shall give inmates the

ability to access a mental health professional at the

jail or through a telemental health service.” 37 TEX.

ADMIN. CODE § 273.2(13). “If a mental health professional is not present at the county jail at the time or

available by telemental health services, then [the plan

must] require the jail to provide the inmate access to,

at a minimum, a qualified mental health professional

(as defined by [26 TEX. ADMIN. CODE § 301.303(48)])

within a reasonable time.” Id. Under 26 TEX. ADMIN.

CODE § 301.303(48), a qualified mental health professional is one with competency in the work to be performed and (1) has a bachelor’s degree from an accredited university with a minimum number of hours dedicated to a major in one of various fields; (2) is a registered nurse; or (3) completes an alternative credentialing process.

The complaint repeatedly calls Phlips unqualified,

at some point asserting that she is “not legally authorized to make suicide or mental health care assessments.” But this legal conclusion, without more, cannot survive a motion to dismiss. See Iqbal, 556 U.S. at

678. Alexander does not allege that Phlips falls short

of the three categories in § 301.303(48).13 13 He therefore cannot rely on her purported lack of qualifications.

13 In other words, his complaint is devoid of factual allegations

that Phlips (1) lacks a bachelor’s degree from an accredited university with a minimum number of hours dedicated to one of the

required majors; (2) is not a registered nurse; and (3) has not

completed an alternative credentialing process. His allegation

App-21

But we cannot assume that there is no constitutional violation just because there is no properly alleged statutory violation under 37 TEX. ADMIN. CODE

§ 273.2(13). In other words, by maintaining a formal

policy, the County may well satisfy its statutory requirements, but it still must provide the constitutional minimum of care. Cf. Murphy v. Collins, 26 F.3d

541, 543 (5th Cir. 1994) (“A state’s failure to follow its

own procedural regulations does not constitute a violation of due process, however, if ‘constitutional minima [have] nevertheless . . . been met.’” (alterations in

original) (quoting Jackson v. Cain, 864 F.2d 1235,

1251 (5th Cir. 1989))).

The County provided the constitutional minimum

for mental health assistance: “protection from violence or suicide.” Hare, 74 F.3d at 643. In addition to

being housed in a solitary confinement unit in which

it was virtually impossible to self-harm, Alexander

spoke with the employed mental health individual

during his five-day confinement. It matters not that

Phlips was not licensed to the extent that Alexander

desired. Nor is it of any moment that he disagreed

with both her determination that he was too confused

to continue to interview and her decision not to recommend his release. While Alexander argues that the

Jail’s policy “was simply to defer completely to the discretion of correctional officers,” he does not allege that

he ever informed Jail officials—or Phlips—that he

was no longer suicidal.

that she received “no formal training period” from Taft is not

enough to demonstrate that she is unqualified under 26 TEX. ADMIN. CODE § 301.303(48).

App-22

Alexander alternatively blames the violent cell for

his severe “psychological deterioration,” and claims

that Phlips did nothing to remove him therefrom. We

cannot charge mental health professionals, contracted

to provide care to pretrial detainees, with releasing inmates from suicide cells or improving the conditions

of their protective confinement. They have no authority to confine individuals or to free them from confinement. Cf. McClure v. Foster, 465 F. App’x 373, 375 (5th

Cir. 2012) (noting that the complainant failed to show

that it was the nurse’s duty to provide toilet paper).

Alexander provides only conclusory allegations

demonstrating that Phlips or the Jail knew—or had

reason to believe—that his mental deterioration was

caused by the violent cell’s conditions, rather than his

self-reported suicidal ideation. This is insufficient to

survive a motion to dismiss.

Alexander cannot demonstrate that the County

“knowingly subject[ed] [him] to inhumane conditions

of confinement or abusive jail practices” through its

mental health treatment plan. Shepherd v. Dallas

County, 591 F.3d 445, 456 (5th Cir. 2009). Because the

plan does not violate the Constitution, we do not consider his municipal liability claim against the County.

See Valle v. City of Houston, 613 F.3d 536, 541-42 (requiring a constitutional violation to impose municipal

liability).

2

This leaves the Taft defendants. The Taft defendants are state actors under § 1983. See West v. Atkins,

487 U.S. 42, 54 (1988) (noting that “a physician employed by [the State] to provide medical services to

state prison inmates[] act[s] under color of state law

App-23

for the purposes of § 1983” when providing medical

care); Rosborough v. Mgmt. & Training Corp., 350

F.3d 459, 461 (5th Cir. 2003) (noting that private companies and employees that manage state prisons “are

subject to § 1983 liability because they are performing

a government function traditionally reserved to the

state”). When determining whether such individuals

have violated the Constitution, the plaintiff must

demonstrate that (1) “the deprivation alleged was sufficiently serious” and (2) “the prison official possessed

a sufficiently culpable state of mind.” Herman v. Holiday, 238 F.3d 660, 664 (5th Cir. 2001). 14 That state of

mind is deliberate indifference. Id.

We begin and end with deliberate indifference. “Deliberate indifference is an extremely high standard to

meet.” Domino v. Tex. Dep’t of Crim. Just., 239 F.3d

752, 756 (5th Cir. 2001). In the context of medical care,

“[m]ere negligence, neglect, or medical malpractice”

does not suffice. Varnado v. Lynaugh, 920 F.2d 320,

321 (5th Cir. 1991) (alteration in original) (quoting

Fielder v. Bosshard, 590 F.2d 105, 107 (5th Cir. 1979)).

Where “medical treatment was provided, even if it

was negligent, disagreed-with, and based on a perfunctory and inadequate evaluation, it was not denied.” Petzold v. Rostollan, 946 F.3d 242, 250 (5th Cir.

2019). Because the Taft defendants provided treatment—even if imperfect—Alexander’s claim fails.

14 To qualify under the first of these two prongs, the “official’s

act or omission must have resulted in the denial of ‘the minimal

civilized measure of life’s necessities.’” Id. (quoting Farmer v.

Brennan, 511 U.S. 825, 834 (1994)). Although we hold that the

Jail did not knowingly provide constitutionally insufficient mental health care, we must also ascertain whether the Taft defendants deprived Alexander of mental health services.

App-24

Alexander points us to another case arising out of

the Henderson County Jail and involving the Taft defendants. See Albritton v. Henderson County, No. 231723, 2024 WL 1776380 (N.D. Tex. Apr. 23, 2024).

There, the court stated that “[t]he system for inmates

to access mental health care at the Henderson County

Jail amounted to a condition that left the inmates

with no avenues to access mental health care and this

dereliction of care cannot be reasonably related to any

legitimate governmental objective.” Id. at *5. With respect to the Taft defendants, it considered allegations

similar to those Alexander makes here: Taft contracted with the County, delegated all duties to an unlicensed professional, did not train or supervise that

individual, provided no mental health care at the Jail,

and did not establish a system through which the individual could contact Taft for assistance. Id. at *6.

The court concluded that Taft knew that no one could

provide mental health assistance and “[t]he substantial risk of harm of Taft flouting his responsibilities to

the individuals in need of mental health services

while at the [J]ail and outsourcing mental health care

to an unqualified individual is so obvious” that it did

not matter if Taft actually knew of the inmate or was

aware of the substantial risk of harm. Id.

Albritton “ha[d] the ‘mental age’ of a six-year-old”

and numerous known disabilities. Id. at *1. He took

“approximately eighteen daily medications to treat his

psychological and physical ailments,” and was prone

to danger when he did not understand his surroundings. Id. While housed in the violent cell—despite

lacking indications of suicidal thoughts—he did not

eat because he believed the food was poisoned, was not

provided water, and “had diarrhea . . . on the sleeping

App-25

bench which no one cleaned up” during the two-day

detention. Id. at *2. It is unclear whether Taft’s aide

at the time, Jeffries, ever visited Albritton. The court

found that the failure to provide any sort of mental

health care to an individual “like [Albritton] experiencing a mental health crisis” could contribute to a finding of deliberate indifference. Id. at *6 (emphasis

added).

The facts here are highly distinguishable. Alexander reported that he was suicidal and was moved to

the violent cell. At that point, he claims he mentally

deteriorated and that Phlips failed to release him.

Putting aside the fact that authority to release him

from the violent cell was left to the Jail—not Taft and

his employees—it is unclear what Phlips (or Taft) was

to make of his mental deterioration. Alexander

seemed healthy during Phlips’s earlier visits, but was

moved to the violent cell after stating that he was suicidal. She then found him unable to answer her questions. She could have drawn the inference that he was

not ready to be released from a suicide protection cell

because he had deteriorated between visits. Such a

conclusion would be logical, given that he had previously reported to her that he struggled with depression and subsequently reported suicidal ideation. 15

Holding the Taft defendants liable would transform

our consideration of deliberate indifference into a

post-hoc scrutiny of each determination of inmates’

mental health statuses. Alexander cannot expose

15 We therefore reject Alexander’s argument that she should

have reported these findings to Taft. The Jail provided Alexander

with necessary protections. In Phlips’s view, his mental health

was being treated.

App-26

them to liability for failing to release him from the violent cell under these circumstances. His § 1983 claim

against the Taft defendants therefore fails. 16

16 Alexander also brings a supervisory liability claim against

Taft. This requires that he identify a constitutional violation that

caused his injury. See Valle, 613 F.3d at 541-42. The same is true

if he chooses to bring such a claim under a failure-to-train or failure-to-supervise theory. See Littell v. Hous. Indep. Sch. Dist., 894

F.3d 616, 624 (5th Cir. 2018) (“[W]hen a municipal entity enacts

a facially valid policy but fails to train its employees to implement it in a constitutional manner, that failure constitutes ‘official policy’ that can support municipal liability if it ‘amounts to

deliberate indifference.’” (quoting City of Canton v. Harris, 489

U.S. 378, 388 (1989))). Since he fails to demonstrate deliberate

indifference, Alexander has pleaded no constitutional violation

and therefore cannot demonstrate supervisory liability against

Taft in his individual capacity under any theory.

The Rule 28(j) material that Alexander filed—the recent opinion in Anderson v. Henderson County, No. 24-cv-2394 (N.D. Tex.

June 23, 2025)—contemplates different circumstances. There,

the detainee “suffer[ed] from muscular dystrophy,” resulting “in

a significant speech impediment and an inability to move or walk

as easily as a healthy person.” Anderson, slip op. at 1. He, too,

suffered from PTSD, but was prescribed medication for its treatment. Id. at 2. Upon arrival at the Jail, he was “immediately

placed in the . . . ‘violent cell’ for seven days.” Id. During that

time, despite informing Jail staff of his medical conditions, “he

was never seen by any medical or mental health staff.” Id. (emphasis added). Moreover, he never received his prescription medication. Id. at 2–3.

As described above, Phlips visited Alexander. While Alexander may plead similar facts to Anderson—including that Taft

provided inadequate training or that his employee was unauthorized to provide psychological services, see id. at 9—he was

visited by a mental health professional affiliated with Taft’s

practice. Moreover, his circumstances were vastly different: He

experienced suicidal ideation. The Taft defendants knew that

when Phlips visited him, and took that into account when responding. Anderson, on the other hand, failed to receive any of

App-27

V

Alexander asks that we require officers and mental

health providers to second-guess inmates’ disclosure

of suicidal ideation. We decline to create such a requirement. We therefore AFFIRM the district court’s

order of dismissal.

his prescription medication, or any treatment at all. The facts in

these cases are inapposite, and Anderson therefore does not

counsel against dismissal.

To be clear, we do not hold that every actionless visit by a mental health professional passes constitutional muster. We hold

that, under Alexander’s specific circumstances, as alleged, Phlips

and the Taft defendants provided the constitutional minimum of

care required.

App-28

[Dissenting Opinion]

JAMES L. DENNIS, Circuit Judge, dissenting:

With respect for my esteemed colleagues, I dissent.

The majority opinion overlooks critical allegations

that, accepted as true, plausibly show jail officials

misused suicide watch protocols to punish a pretrial

detainee.

I

“Due process requires that a pretrial detainee not

be punished.” Hare v. City of Corinth, 74 F.3d 633, 651

(5th Cir. 1996) (DENNIS, J., specially concurring). “In

determining whether particular restrictions and conditions accompanying pretrial detention amount to

punishment in the constitutional sense of that word,

a court must decide whether the disability is imposed

for the purpose of punishment or whether it is but an

incident of some other legitimate governmental purpose.” Id. (citing Bell v. Wolfish, 441 U.S. 520, 538

(1979)). “Absent a showing of an expressed intent to

punish on the part of detention facility officials, that

determination generally will turn on ‘whether an alternative purpose to which [the restriction] may rationally be connected is assignable for it, and whether

it appears excessive in relation to the alternative purpose assigned [to it].’” Id. (first citing Bell, 441 U.S. at

538; and then quoting Kennedy v. Mendoza-Martinez,

372 U.S. 144, 168–69 (1963)). “Thus, if a particular

condition or restriction of pretrial detention is reasonably related to a legitimate governmental objective, it

does not, without more, amount to ‘punishment.’” Id.

By contrast, “if a restriction or condition is not reasonably related to a legitimate goal—if it is arbitrary or

App-29

purposeless—a court permissibly may infer that the

purpose of the governmental action is punishment

that may not constitutionally be inflicted upon detainees qua detainees.” Id. (citing Bell, 441 U.S. at 539).

The district court dismissed Alexander’s conditionsof-confinement claim on only two grounds: (1) that the

conditions in the “violent cell” were justified by the

need to prevent Alexander’s suicide and, thus, were

reasonably related to a legitimate governmental objective; and (2) that even absent such a justification,

the cell conditions and the jail’s denial of water and

toilet paper were per se lawful.

The first rationale badly misapplies Federal Rule of

Civil Procedure 12(b)(6). Alexander alleges that he

falsely claimed to be suicidal as a last resort to escape

placement in a dangerous group cell, where other inmates repeatedly threatened him. He further alleges

that jail officials knew he was not suicidal but used

his plea as a pretext to place him in the violent cell for

punitive purposes. Several key facts, all occurring in

rapid succession, support an inference of retaliatory

motive.

March 8: Alexander was booked into the

jail. A Henderson County mental health

professional conducted an “observation

clearance,” observing no concerns with

his mental health.

March 9 (daytime): The same provider

performed a follow-up and again documented “no concerns” with Alexander’s

mental status.

March 9 (evening): Guards placed Alexander in group detention “with some of

App-30

the most violent and dangerous men being held at the Jail.” These inmates immediately made serious threats against

him. Alexander feared for his life, due to

both the threats by his cellmates and his

spiking blood pressure, which had already required treatment since he had

arrived at the jail.

Later that evening: Alexander informed guards of the threats and requested to be moved “multiple times.”

The guards refused. “Thinking he had no

other option, he told [a] correctional officer . . . that he was suicidal, believing

that would force the jail to move him out

of the group detention cell for medical or

mental health care evaluation.”

Shortly after midnight, March 10:

Officers transferred Alexander to the “violent cell.” 1 During the walk, guards

The majority opinion observes that “Alexander was not

transferred until he informed correctional officers that he was

suicidal,” which “alone implies that the officers took his statement at face value, even if they did not subjectively believe him.”

Ante, at 9. Drawing that inference at the pleading stage risks

inverting Rule 12(b)(6): it assumes facts in favor of the moving

party, not the plaintiff, which is precisely what the Rule forbids.

United States ex rel. Steury v. Cardinal Health, Inc., 735 F.3d

202, 204 (5th Cir. 2013) (quoting United States ex rel. Steury v.

Cardinal Health, Inc., 625 F.3d 262, 266 (5th Cir. 2010)). The

opposite inference—one we are required to credit at this stage—

is that the officers knew Alexander was not suicidal, understood

that he was using the claim as a desperate attempt to escape a

threatening environment, and chose to punish him for it. He had

1

App-31

repeatedly called him a “bitch.” One said,

“You really fucked up now, bitch.”

March 10–15: While Alexander remained in the violent cell, guards

taunted him with repeated insults and

threats. On one occasion, they paraded a

police dog outside his cell and loudly discussed taking Alexander into a field and

unleashing the dog on him. They threatened to kill him using a “barbed wire

guillotine.” Just before he was released

from the cell, one officer said: “Ronnie Alexander, you are not leaving this

facility alive.”

At this early stage, these allegations—combined

with their tight chronology—plausibly support Alexander’s allegation that the officers did not act to protect Alexander, but to punish him for complaining

about his safety in group detention. The mental

health evaluations showing no suicidal concerns, the

guards’ refusal to move him despite his clear fear for

his safety, the retaliatory language during his transfer, and the continuing harassment while in the violent cell together present a coherent narrative of punitive intent. In the context of a pretrial detainee, “an

been in the group cell only a few hours, had repeatedly asked for

protection, and had already been ignored. When he cried suicide,

the officers responded not with concern but with hostility, using

his plea as a convenient excuse to isolate and degrade him. That

response does not reflect protective intent. It reflects retaliation.

And merely saying that the “facts alleged, taken as true, do not

give rise to the reasonable inference that the officers intended to

punish Alexander,” ante, at 10 n.7, does not make it so.

App-32

inference that governmental intent was punitive is

equivalent to an inference that the challenged condition is unconstitutional.” Hamilton v. Lyons, 74 F.3d

99, 106 (5th Cir. 1996).

Critically, none of these alleged facts appear in the

district court’s opinion. The court’s analysis of the government’s interest instead assumes Alexander was a

known suicide risk. That assumption favors the defendants over the plaintiff, which is improper at the

motion-to-dismiss stage. Q Clothier New Orleans,

L.L.C. v. Twin City Fire Ins. Co., 29 F.4th 252, 256

(5th Cir. 2022) (“The court must accept the wellpleaded facts as true and view them in the light most

favorable to the plaintiff,” not the defendant).

The majority opinion acknowledges that “[t]he district court did not consider these allegations.” Ante, at

9 n.5. In other words, we agree the district court gave

no consideration at all to these specific, non-conclusory allegations. 2 That should end the analysis. We

2 The majority opinion seems to suggest the district court was

free to ignore these allegations because they are not “wellpleaded allegations of fact.” Ante, at 9 n.5. It is difficult to see

what, exactly, is not “well-pleaded” about an allegation that a jail

official told Alexander, “You really fucked up now, bitch,” or that

another said, “Ronnie Alexander, you are not leaving this facility

alive.”

In the alternative, the majority dismisses “any threats directed at Alexander while he was in the violent cell” on the

ground that they do “not creat[e] a condition of confinement,” citing the general rule that “[m]ere allegations of verbal abuse do

not present actionable claims under” 42 U.S.C. § 1983. Ante, at

10 & n.6 (quoting Bender v. Brumley, 1 F.3d 271, 274 n.4 (5th Cir.

1993)). Alexander does not make that argument. He cites the

threats not as a standalone claim, but as circumstantial evidence

of the officers’ punitive intent.

App-33

are a “court of review, not first view.” Stringer v. Town

of Jonesboro, 986 F.3d 502, 509 (5th Cir. 2021) (quoting Cruson v. Nat’l Life Ins. Co., 954 F.3d 240, 249 n.7

(5th Cir. 2020)).

Nevertheless, the majority opinion proceeds to reject Alexander’s conditions-of-confinement claim as

speculative, reasoning that he failed to allege an express admission of punitive intent or identify a

“[an]other suicidal inmate[] [that] received different

treatment.” Ante, at 9–11. No authority imposes such

requirements, so faulting Alexander for not meeting a

legal test that finds no support in precedent is unpersuasive. The question is whether his allegations allow

us to plausibly infer retaliatory or punitive conduct

under the guise of suicide prevention. See, e.g., Simons v. Clemons, 752 F.2d 1053, 1056 (5th Cir. 1985)

(analyzing Bell and inquiring whether an “express intent to punish” could be “infer[red] . . . from the pleadings”). As I have outlined, they do.

If Alexander’s allegations are true, then the jail violated the Fourteenth Amendment by using suicide

protocols to punish a pretrial detainee—denying him

a toilet, toilet paper, running water, recreation, bedding, clothing, and sufficient drinking water, while

subjecting him to twenty-four-hour lighting and a cell

contaminated with fecal matter and urine. 3 Ante, at

3 My reading of the record diverges from the majority opinion,

which discounts Alexander’s allegation—“that ‘[t]he [cell’s] floor

had not been cleaned and was covered in dried urine and fecal

matter’”—based on a color image showing an “off-white” cell that

“appears clean” and “certainly devoid of fecal matter.” Ante, at 3

n.2. First, that is not the full allegation. Alexander also alleges

that fecal matter and urine were present in the drain located at

the center of the cell floor, and that he had to manually force the

App-34

13 n.9 (“We have previously held that similar conditions violate the Eighth Amendment where there is

punitive intent.” (first citing McCray v. Sullivan, 509

F.2d 1332, 1336 (5th Cir. 1975); and then citing Alexander v. Tippah Cnty., 351 F.3d 626, 628–31 (5th Cir.

2003))). 4

The majority opinion rejects Alexander’s claim

partly out of a policy concern for placing jailers in an

untenable position: liable whether they act or refrain.

Ante, at 10–11. I do not believe the allegations in the

present case fall within either horn of that dilemma.

Taking Alexander’s allegations as true, the officers

knew he was not suicidal, knew he feared for his

safety in his group housing, and deliberately chose a

punitive response that exposed him to new risks. This

feces through the grates using a paper cup. He further alleges

that the floor was soiled with dried waste left by prior inmates

housed in the toilet-less cell.

Second, although the complaint includes two photos of the cell,

they are blurry. I cannot say they either support or contradict

Alexander’s account. Given the ambiguity, this case does not fall

within the narrow exception recognized in Scott v. Harris, 550

U.S. 372, 380 (2007), which permits a court to disregard a plaintiff’s version of events only when it is “so utterly discredited by

the record that no reasonable jury could have believed him.”

“Scott was an exceptional case with an extremely limited holding,” inapplicable to ambiguous photo evidence. Aguirre v. City

of San Antonio, 995 F.3d 395, 410 (5th Cir. 2021).

4 McCray and Alexander involved convicted individuals and

were analyzed under the Eighth Amendment. By contrast, Alexander was a pretrial detainee, so his claims arise under the Fourteenth Amendment. Still, we may look to those cases for guidance

because a pretrial detainee’s due process rights are said to be “at

least as great as the Eighth Amendment protections available to

a convicted prisoner.” City of Revere v. Mass. Gen. Hosp., 463 U.S.

239, 244 (1983).

App-35

is not a matter of difficult judgment; it is punishment

of a pretrial detainee disguised as suicide watch. The

Constitution forbids that. Bell, 441 U.S. at 535.

The district court’s second basis for dismissal—

raised sua sponte and without notice to Alexander—

fares no better. See Carroll v. Fort James Corp., 470

F.3d 1171, 1176–77 (5th Cir. 2006) (noting the importance of prior notice and an opportunity to respond); cf. Day v. McDonough, 547 U.S. 198, 210 (2006)

(“Of course, before acting on its own initiative, a court

must accord the parties fair notice and an opportunity

to present their positions.”). The defendants never argued that the conditions of the violent cell were per se

lawful. Alexander therefore had no notice of this theory and no chance to respond. Regardless of the procedural infirmity, as the majority opinion rightly

acknowledges, the district court’s alternative ruling

fails as a matter of law. Ante, at 13 n.9.

App-36

II

That leaves the claims focusing on medical care.

The district court never addressed Alexander’s claims

that the jail provided constitutionally deficient mental

health care. Ante, at 16 n.12 (majority opinion agreeing that these particular claims were not “fully considered”). By disposing of the issue without explanation, the court effectively dismissed the claims sub silentio, undermining meaningful appellate review. See,

e.g., McInrow v. Harris Cnty., 878 F.2d 835, 836 (5th

Cir. 1989). While Federal Rule of Civil Procedure 12

does not require findings of fact or conclusions of law,

the parties are still entitled to understand the basis

for final judgment. Hanson v. Aetna Life & Cas., 625

F.2d 573, 575 (5th Cir. 1980). As we have stressed,

“discussion by the trial judge” is often essential to facilitate proper review. Myers v. Gulf Oil Corp., 731

F.2d 281, 283 (5th Cir. 1984). That is especially true

where, as here, the record does not reveal which of

several theories the district court may have relied on.

Mosley v. Ogden Marine, Inc., 480 F.2d 1226 (5th Cir.

1973). When a court’s reasoning is either vague or absent, effective appellate review becomes all but impossible. McInrow, 878 F.2d at 836. In those circumstances, we have consistently remanded to obtain at

least some explanation of the district court’s rationale.

See, e.g., Myers, 731 F.2d at 284.

The majority opinion devotes seven pages to analyzing the medical care claims. Ante, at 15–22. Yet it cites

no analysis from the district court—because none exists. Instead, the majority opinion relies on the principle that we may affirm on any ground supported by

the record, even one not reached by the district court,

App-37

if the argument was raised below. Id. at 16 n.12 (citing

Gilbert v. Donahoe, 751 F.3d 303, 311 (5th Cir. 2014)).

But that principle applies only when the district court

has actually considered the claim. Here, although Alexander’s mental health care claims were raised and

briefed, the district court gave them no consideration.

Vacatur and remand are warranted. Ashley v. Clay

Cnty., 125 F.4th 654, 662 n.5 (5th Cir. 2025) (“It is not

our role to address a question that the district court

left unresolved . . . as both a matter of judicial restraint and sound policy.”).

III

Ultimately, the majority opinion “decline[s] to . . .

require officers and mental health providers to second-guess inmates’ disclosure of suicidal ideation.”

Ante, at 22–23. That is not the rule Alexander seeks.

He does not argue that officials must second-guess

every report of suicidal ideation. Rather, he alleges

that, in his case, the officials knew he was not suicidal

and used suicide protocols as a pretext to punish him.

Accepting those allegations as true, as we must at this

stage, Alexander’s case centers not on a failure to assess risk but on the deliberate misuse of suicide watch

to retaliate against a pretrial detainee. Our precedent

does not permit courts to look away when protective

procedures become tools of punishment.

I respectfully dissent.

App-38

Appendix B

[Filed: Dec. 23, 2025]

United States Court of Appeals

for the Fifth Circuit

_____________________

No. 24-10663

_____________________

RONNIE ALEXANDER,

Plaintiff—Appellant,

versus

PHILIP R. TAFT PSY D AND ASSOCIATES, P.L.L.C.; HENDERSON COUNTY TEXAS; NATHANIEL PATTERSON; TAYLOR CALDWELL; MORGAN FAIN; NOAH KREIE; WILLIAM

TRUSSEL; DORA MARTINEZ; MELISSA HARMON; PHILIP

TAFT,

Defendants—Appellees.

_____________________

Appeal from the United States District Court

for the Northern District of Texas

USDC No. 3:22-CV-395

_____________________

Before DENNIS, OLDHAM, and DOUGLAS, Circuit

Judges.

DANA M. DOUGLAS, Circuit Judge:

The petition for panel rehearing is DENIED. No

member of the panel nor judge in regular active service having requested that the court be polled on rehearing en banc, the petition for rehearing en banc is

also DENIED. FED. R. APP. P. 35; 5TH CIR. R. 40.

JUDGE DENNIS having filed a revised dissent, the prior

opinions, Alexander v. Taft, 143 F.4th 569 (5th Cir.

App-39

2025), are WITHDRAWN, and the following opinions

are SUBSTITUTED.

Ronnie Alexander was arrested and detained in

Henderson County Jail while he awaited trial. Hoping

to transfer out of the group holding cell, he falsely informed Jail officials that he was suicidal. The Jail subsequently transferred him to its suicide-prevention

cell, known as the “violent cell.”

The violent cell has no toilet, running water, or bedding, and the lights run at all hours. Alexander was

housed there for five days, after which he was released

from the Jail. He subsequently filed this lawsuit,

bringing federal-and state-law claims challenging the

conditions of his confinement in the violent cell and

the adequacy of the Jail’s mental health services. The

district court granted the defendants’ motions to dismiss. We AFFIRM.

I

A

On March 8, 2021, Ronnie Alexander was booked at

the Jail. 1 The next day, he underwent a medical intake screening, during which he reported that he was

not suicidal. He showed no signs of intoxication or

withdrawal; nevertheless, he was placed on alcohol

withdrawal protocol under which he received “a suite

of prescriptions.” At all relevant times, Southern

Health Partners provided non-mental health care at

the Jail, while Philip R. Taft, Psy.D & Associates,

P.L.L.C., provided mental health care. One of Taft’s

1 The

booked.

record does not identify the crime for which he was

App-40

employees, Jessica Phlips, was assigned to visit inmates.

Shortly after Alexander’s booking, Phlips visited

him and observed no mental health issues, but noted

that he disclosed suffering from post- traumatic stress

disorder (“PTSD”) and depression. After a follow-up

meeting, she identified no concerns regarding his

mental status. Soon thereafter, the Jail designated

Alexander a maximum-security detainee and placed

him in group detention “with some of the most violent

and dangerous men being held at the Jail.” Alexander

alleges that the other inmates consistently threatened

him, causing him to fear for his safety and his blood

pressure to rise.

Worried by the circumstances, Alexander requested

transfer to another cell several times. The guards refused. Eventually, he falsely informed a correctional

officer that he was suicidal, “believing that would

force the [J]ail to move him out of the group detention

cell for medical or mental health evaluation.” He was

correct. On March 10, officers transferred him to the

violent cell. Along the way, they harassed Alexander,

calling him a “b****” and telling him that he “really

f***** up now, b****.”

Alexander paints a grim picture of the violent cell.

It has “no bed, sink, toilet, shower, or running water

of any kind.” The only place for an inmate to urinate

or defecate is through a small, grated drain in the middle of the floor. He received no toilet paper, so he used

a paper cup to force fecal matter through the drain.

And he had no access to running water or utensils,

forcing him to eat “with hands that were perpetually

contaminated with fecal bacteria.” During his five

days in the violent cell, “he was never once allowed to

App-41

leave his cell to use a proper toilet, shower, or wash

his hands.” 2

He also had no clothing or sheets, and was provided

only a “suicide blanket” to cover himself. In lieu of a

bed, the violent cell has a concrete slab built into the

wall. The lights ran at all hours, “inhibit[ing]” his

ability to sleep. He was provided three eight-ounce

cups of water per day—one with each meal. And during his time in the violent cell, he received no exercise

or recreation time.

To mitigate these deficiencies, Alexander requested

water, toilet paper, and an opportunity to shower or

wash his hands. The officers almost uniformly rejected the requests, taking “no affirmative steps whatsoever, beyond cursory visual checks, to ensure that

[his] physical and mental health were not suffering

from the conditions he was subjected to in the violent

cell.” 3 Instead, the guards often taunted Alexander.

One “loudly discussed taking [him] out to a field and

unleashing [a police] dog on him.” Another threatened to kill him with a “barbed wire guillotine.” Yet

another stated: “Ronnie Alexander, you are not leaving this facility alive.”

While Alexander alleges that “[t]he floor had not been

cleaned and was covered in dried urine and fecal matter,” he incorporated a color image of his cell, which is an off-white color.

From review of this image, the cell appears clean—and certainly

devoid of fecal matter—discounting any allegation that the cell

was covered in waste. We need not accept allegations clearly disproven by photographic evidence incorporated in the complaint.

See Kokesh v. Curlee, 14 F.4th 382, 385 n.2 (5th Cir. 2021).

3 Over the course of his five days in the violent cell, Alexander

received “only about three small beverages in total” beyond those

he received with his meals.

2

App-42

On March 12, two days after Alexander’s transfer to

the violent cell, Phlips visited. Prior to their meeting,

she did not review his medical file or other records and

did not have access to the officers’ suicide screener.

She quickly determined that Alexander was “‘too confused’ to answer her initial questions” and departed,

doing “nothing to alleviate the conditions that were

causing [his] psychological deterioration” and “fail[ing]

to report her observations to any medical or mental

health professionals.” She did not visit again.

Alexander remained in the violent cell until March

15, at which time he was released to the custody of

Dallas County.

B

On February 17, 2022, almost one year after his release, Alexander filed this lawsuit against various individuals and entities, alleging violations of 42 U.S.C.

§ 1983, alongside various state-law claims. He

amended his complaint several times, ultimately filing his Third Amended Complaint, in which he alleged claims against Southern Health Partners, Inc.;

Philip Taft in his individual capacity and Philip R.

Taft, Psy.D & Associates P.L.L.C. (“the Taft defendants”); Henderson County, Texas; and Henderson

County Correctional Officers Nathaniel Patterson,

Taylor Caldwell, Morgan Fain, Noah Kreie, William

Trussell, Dora Martinez, and Melissa Harmon (“the

officers”).

The defendants individually filed motions to dismiss pursuant to Federal Rule of Civil Procedure

12(b)(6). The district court granted the defendants’

motions over Alexander’s opposition, finding that he

failed to state a claim under § 1983 against the Taft

App-43

defendants, Henderson County, and the officers. It

declined to exercise supplemental jurisdiction over Alexander’s remaining state-law claims against the Taft

defendants and Southern Health Partners and dismissed them without prejudice. Alexander timely appealed the dismissal of his federal claims.

II

“We review a district court’s dismissal of claims under Federal Rule of Civil Procedure 12(b)(6) de novo.”

Clyce v. Butler, 876 F.3d 145, 148 (5th Cir. 2017). We

“interpret[] the complaint in the light most favorable

to the plaintiff,” United States ex rel. Steury v. Cardinal Health, Inc., 735 F.3d 202, 204 (5th Cir. 2013)

(quoting United States ex rel. Steury v. Cardinal

Health, Inc., 625 F.3d 262, 266 (5th Cir. 2010)), accepting all well-pleaded facts as true, see Cicalese v.

Univ. of Tex. Med. Branch, 924 F.3d 762, 765 (5th Cir.

2019). However, those facts must state “a claim to relief that is plausible on its face.” Bell Atl. Corp. v.

Twombly, 550 U.S. 544, 570 (2007). “A claim has facial

plausibility when the plaintiff pleads factual content

that allows the court to draw the reasonable inference

that the defendant is liable for the misconduct alleged.”

Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).

While complaints do “not need detailed factual allegations,” speculative or conclusory statements of fact

are insufficient. Cicalese, 924 F.3d at 765 (quoting

Twombly, 550 U.S. at 555); Iqbal, 556 U.S. at 678. And

we “are not bound to accept as true a legal conclusion

couched as a factual allegation.” Iqbal, 556 U.S. at 678

(quoting Twombly, 550 U.S. at 555).

App-44

III

The Fourteenth Amendment’s Due Process Clause

provides pretrial detainees protections extending beyond those granted to sentenced defendants. See Bell

v. Wolfish, 441 U.S. 520, 535 n.16 (1979). While “[a]

sentenced inmate . . . may be punished” within the

strictures of the Eighth Amendment, “[d]ue process

requires that a pretrial detainee not be punished.” Id.;

see also Kingsley v. Hendrickson, 576 U.S. 389, 400–

01 (2015) (“[M]ost importantly, pretrial detainees (unlike convicted prisoners) cannot be punished at all,

much less ‘maliciously and sadistically.’” (citations

omitted)); Graham v. Connor, 490 U.S. 386, 395 n.10

(1989) (protecting pretrial detainees “from the use of

excessive force that amounts to punishment”). Such

protection is fundamental to our criminal justice system. “A person lawfully committed to pretrial detention has not been adjudged guilty of any crime.” Bell,

441 U.S. at 536. Since the detainee has “had only a

‘judicial determination of probable cause as a prerequisite to [the] extended restraint of [his] liberty following arrest,’” the Government may only use such conditions necessary “to ensure his presence at trial.” Id.

(alterations in original) (quoting Gerstein v. Pugh, 420

U.S. 103, 114 (1975)).

Due process compels us to ask whether the “restrictions and conditions of the detention facility . . .

amount to punishment, or otherwise violate the Constitution.” Id. at 536–37. “Not every disability imposed during pretrial detention amounts to ‘punishment’ in the constitutional sense . . . .” Id. at 537.

Therefore, traditional “confinement in a facility

which . . . results in restricting the movement of a

App-45

detainee” is permissible. Id. Often, these restrictions

arise from the Government’s “legitimate interests

that stem from its need to manage the facility in which

the individual is detained.” Id. at 540. This means

that some “administrative measures that go beyond

those that are, strictly speaking, necessary to ensure

that the detainee shows up at trial” may be warranted.

Id. Such is the case “even if they are discomforting and

are restrictions that the detainee would not have experienced had he been released while awaiting trial.”

Id.

Pretrial detainees may bring claims of such violations “either by demonstrating an unconstitutional

condition of confinement or by demonstrating an unconstitutional episodic act or omission.” Cadena v. El

Paso County, 946 F.3d 717, 727 (5th Cir. 2020). “For

a conditions of confinement claim, ‘the proper inquiry

is whether those conditions amount to punishment of

the detainee.’” Id. (quoting Bell, 441 U.S. at 535).

These conditions “may take the form of ‘a rule,’ a ‘restriction,’ ‘an identifiable intended condition or practice,’ or ‘acts or omissions’ by a jail official that are

‘sufficiently extended or pervasive.’” Id. (quoting Est.

of Henson v. Wichita County, 795 F.3d 456, 468 (5th

Cir. 2015)). 4

4 Alexander alleges that the violent cell’s “conditions had no

justifiable purpose and were therefore unlawful punishment,”

and that he “was harmed by intentional acts or omissions, such

as the denial of water and toilet paper.” The district court

acknowledged this duality, but found that Alexander’s “harms . . .

stem from the barren conditions within the violent cell” and were

“best classified as harms relating from his conditions of confinement.” It therefore “proceed[ed] analyzing his Section 1983

claims under the Fifth Circuit’s conditions-of-confinement

App-46

To determine whether conditions are constitutionally permissible, we ask whether the restrictions and

practices “are rationally related to a legitimate nonpunitive governmental purpose and whether they appear excessive in relation to that purpose.” Bell, 441

U.S. at 561. If there is a related governmental objective, the conditions, “without more, [do not] amount to

‘punishment.’ Conversely, if a restriction or condition

is not reasonably related to a legitimate purpose—if it

is arbitrary or purposeless—a court may infer that the

purpose of the governmental action is punishment

that may not constitutionally be inflicted upon detainees qua detainees.” Id. at 539 (footnote omitted).

Therefore, Alexander must demonstrate, inter alia,

that the restrictions are not reasonably related to a

legitimate governmental objective. See Cadena, 946

F.3d at 727 (quoting Duvall v. Dallas County, 631 F.3d

203, 207 (5th Cir. 2011)). Because Alexander cannot

make this showing, as described below, we affirm.

IV

On appeal, Alexander raises the following issues:

whether (1) his confinement was an unlawful punishment of a pretrial detainee; (2) the Taft defendants

and the County completely deprived him of qualified

mental health care, creating an unlawful condition of

confinement; (3) Taft is liable in his individual capacity for Alexander’s injuries; and (4) he plausibly alleged that the County maintained a custom or practice

framework” in light of the clarity provided by the most recent

amended complaint. On appeal, Alexander discusses, but does

not challenge, this classification. We agree that his claims challenge the conditions of his confinement, and consider them as

such.

App-47

of punishing inmates through the violent cell. Because we conclude that the violent cell’s conditions are

reasonably related to a legitimate government interest and are thus not punitive, we do not reach the

fourth issue.

A

We begin with Alexander’s claims that Henderson

County and the officers unconstitutionally punished

him through the conditions of his confinement. Alexander complains that he was subjected to a “barbaric

combination of conditions,” which he asserts were unjustifiable and therefore punitive. We accept his wellpleaded allegations that he was deprived of a toilet,

toilet paper, running water, recreation, bedding,

clothing, additional drinking water, or particularly

sanitary or clean conditions, and that he was subjected to a 24/7-lights-on policy. We also accept as fact

that officers threatened him as alleged.

“Absent a showing of an expressed intent to punish

on the part of detention facility officials,” we ask

whether the “particular condition or restriction . . . is

reasonably related to a legitimate nonpunitive governmental objective.” Bell, 441 U.S. at 538–39. We

first consider whether there was an expressed intent

to punish, and then ask whether the conditions were

reasonably related to a legitimate nonpunitive governmental objective.

1

Alexander argues that the district court failed to

credit his well-pleaded allegations that prison officials

were aware that he was not actually suicidal. As Alexander frames it, he informed the guards that he was

App-48

suicidal to escape group housing. But when they

moved him to solitary confinement, they did so not to

protect him, but to punish him. 5

As an initial matter, Alexander was not transferred

until he informed correctional officers that he was suicidal. That alone implies that the officers took his

statement at face value, even if they did not subjectively believe him. But Alexander points to the vulgar

comments the officers made during his transfer, including that he “really f***** up now, b****.” This, he

claims, gives rise to the inference that “the guards did

not care about [his] fear of his cellmates or spiking

blood pressure and wanted to punish him for complaining.” He asserts that “[i]t can be further inferred

that they also knew [he] could expect to suffer while

he was in the violent cell.” Inappropriate as the officials’ statements may be, they do not evince punitive

intent, even if they followed several denied requests

for relocation. The same is true of any threats directed

5 The district court did not consider these allegations. The dis-

sent says that this “should end the analysis.” Post, at 27. But a

district court need only consider well-pleaded allegations of fact,

not speculation about others’ states of mind. Cicalese, 924 F.3d

at 765 (noting that we need not accept speculative allegations);

Iqbal, 556 U.S. at 678 (requiring factual content that leads to

“reasonable inferences”). Nor does the failure to consider a handful of allegations always warrant reversal. Such is especially so

here, considering that Alexander’s framing requires an inferential leap—from the officers’ alleged subjective disbelief to an expressed intent to punish—that we need not accept. Nevertheless,

as described below, the allegation does not save his complaint.

See also Gilbert v. Donahoe, 751 F.3d 303, 311 (5th Cir. 2014)

(explaining that we may affirm on any ground supported by the

record).

App-49

at Alexander while he was in the violent cell. 6 Alexander alleges no facts of the officers’ explicit intent to

punish him, or that they outwardly disbelieved him,

or that other suicidal inmates received different treatment. 7

Moreover, it matters not whether the officers believed he was suicidal. County jails have a constitutional duty to ensure the safety of potentially suicidal

detainees. Rhyne v. Henderson County, 973 F.2d 386,

6 The threats included unleashing a police dog on Alexander

and threatening to kill him with a barbed wire guillotine. Officers also stated that Alexander would not “leav[e] this facility

alive.” We do not endorse such comments. But “[m]ere allegations of verbal abuse do not present actionable claims under §

1983. ‘As a rule, “mere threatening language and gestures of a

custodial officer do not, even if true, amount to a constitutional

violation.”’” Bender v. Brumley, 1 F.3d 271, 274 n.4 (5th Cir. 1993)

(alteration omitted) (quoting McFadden v. Lucas, 713 F.2d 143,

146 (5th Cir. 1983)). Therefore, to the extent that Alexander suggests that these comments created a condition of confinement

that violated the Constitution, we disagree.

7 The dissent argues that we “invert[] Rule 12(b)(6)” by “assum[ing] facts in favor of the moving party.” Post, at 26 n.1. Not

so. The facts alleged, taken as true, do not give rise to the reasonable inference that the officers intended to punish Alexander.

Beyond these insufficient factual allegations, he may claim that

the officers desired to punish him, but any allegation to that effect is speculation that we need not accept. See Cicalese, 924 F.3d

at 765. And, as described later, we do not depend on whether officers believe an individual’s report of suicidal ideation.

Nor do we “fault[] Alexander for not meeting a legal test that

finds no support in precedent” through our discussion of similarly situated detainees. Post, at 28. Where there are insufficient

factual allegations demonstrating punitive intent, a detainee

could presumably make a showing of punitive intent through disparate treatment of similarly situated individuals. Alexander

failed to do so.

App-50

391 (5th Cir. 1992) (“The failure to provide pre-trial

detainees with adequate protection from their known

suicidal impulses is actionable under § 1983 as a violation of the detainee’s constitutional rights.”). Allowing this allegation to bootstrap Alexander’s complaint

past a motion to dismiss would create a minefield we

decline to enter. Consider the dangers of requiring officers to second-guess every inmate’s report of suicidal

ideation. If they believe and transfer a dishonest detainee, as here, they would be liable for conditions

that are designed to protect suicidal inmates. But if

they disbelieve and do not transfer an honest detainee,

they would also be liable, and the detainee would be

in serious danger of self-harm. This standard is unworkable and would result in the denial of constitutional protections, and we therefore reject it.

2

We next consider whether the conditions of the violent cell are reasonably related to a legitimate governmental interest. As discussed above, pretrial detainees have a constitutional right to protection from selfharm. Rhyne, 973 F.2d at 391. As barren as the violent

cell was, each condition was reasonably related to the

legitimate government interest of protecting suicidal

inmates from self-harm.

Alexander alleges that the cell did not have a toilet,

a shower, or running water. But each of these poses a

drowning risk. See, e.g., Elliott v. Cheshire County,

940 F.2d 7, 9 (1st Cir. 1991) (noting that the prisoner

stated that “he wanted to drown himself in the toilet”);

Belcher v. City of Foley, 30 F.3d 1390, 1393 (11th Cir.

1994) (“As the officers attempted to move Mr. Belcher,

he broke away and stuck his head into the toilet in an

App-51

attempt to drown himself.”); Cervantez v. Frith, No.

22-150, 2025 WL 1287918, at *1 (N.D. Tex. May 2,

2025) (inmate attempted to drown himself in the toilet

three separate times); Crocco v. Winkler, 659 F. Supp.

3d 204, 207 (D.N.H. 2023) (“Crocco attempted to

drown himself in the cell’s sink . . . .”). He claims that

he was stripped and provided no bedding. But clothes

and sheets carry risks of self-asphyxiation, especially

when combined with showers, sinks, or toilets. See,

e.g., McMahon v. Beard, 583 F.2d 172, 175 (5th Cir.

1978) (“Removal of all cloth which might offer a means

for suicide would seem prudent.”); Hare v. City of Corinth, 36 F.3d 412, 414 (5th Cir. 1994) (inmate hanged

herself “from the bars of her cell” using “strips of the

blanket”); Lewis v. Stephens, 710 F. App’x 703, 703

(7th Cir. 2018) (“He stood on the sink in his cell with

a bedsheet tied around his neck, threatening to hang

himself.”); Romero v. Donley County, 87 F.3d 1311, at

*1 (5th Cir. 1996) (unpublished) (inmate hanged himself from bar above the toilet); Rangel v. Wellpath,

LLC, No. 23-128, 2024 WL 1160913, at *1 n.3 (N.D.

Tex. Mar. 18, 2024) (inmate “tore the blanket into

strips, tied them to the shower head, and hung himself”). He states that his requests for toilet paper were

denied. But, sadly, even toilet paper could pose a choking hazard. See Nagle v. Gusman, 61 F. Supp. 3d 609,

624 (E.D. La. 2014) (deposition testimony that an inmate “swallowed a roll of toilet paper and killed himself”); Elliott, 940 F.2d at 9 (inmate that had previously threatened suicide asked another “what would

happen if he . . . swallowed paper towels”). 8 Moreover,

8 We note that Alexander complains of other rejected requests

and conditions, including requests for additional drinking water

App-52

a twenty-four-hour-lights-on policy permits officers to

monitor the inmate’s activity around the clock to prevent them from self-harming. Cf. Anderson v. Dallas

County, 286 F. App’x 850, 852 n.1 (5th Cir. 2008)

and to shower or wash his hands, and a lack of recreational time.

All inmates have “a right to adequate food.” Youngberg v. Romeo,

457 U.S. 307, 315 (1982). Inherent in such a right is access to

water. But we hesitate to take Alexander’s suggestion that he

ought to have received the “ideal” amount of drinking water for

an adult male, which he totals to be 124 ounces. Even if Alexander’s drinking water values were lower than what a typical person may aim for, we cannot say that he was provided “inadequate”

water to the point of constitutional deprivation. This determination, of course, is context-dependent. But we decline to create an

express baseline for daily water consumption for prisoners in suicide prevention cells.

As for the inability to shower and the loss of recreation time,

such are reasonably related to the legitimate interest in protecting him from self-harm. Officials would have been required to

move him out of the protective cell, provide him access to running

water and a shower head—among the dangers from which he

was isolated—and afford recreational time in open space, possibly with other inmates. These acts could pose a danger to an individual suffering suicidal ideation, and are not “arbitrary or

purposeless.” Bell, 441 U.S. at 539. We expressly limit this holding to Alexander’s circumstances. We do not extend this to instances in which an individual is in such a cell for other periods

of time or subjected to other conditions.

Finally, while we need not credit Alexander’s allegation that

waste covered the floor, see supra n.2, this alleged condition is a

far cry from the horrifying facts presented in Taylor v. Riojas,

which amounted to an Eighth Amendment violation. See 592 U.S.

7, 8–9 (2020) (inmate was confined in two cells, one of which “was

covered, nearly floor to ceiling, in massive amounts of feces” and

the second of which was “frigidly cold” and “equipped with only

a clogged drain in the floor to dispose of bodily wastes”). The photograph in Alexander’s complaint discounts any allegation that

the violent cell was in nearly the state of the cell in Taylor, or

amounted to a punitive condition under the circumstances.

App-53

(noting that “[o]nce an inmate is placed on Suicide

Prevention Status, jailers must routinely monitor and

observe the inmate”). These conditions, “barbaric” as

they may be, relate to the legitimate government interest of protecting inmates—an interest that is constitutionally imposed upon the State. 9

To be sure, these conditions are not narrowly tailored. They are overinclusive, painting with a broad

brush to protect those who pose the greatest danger to

9 The district court found that the violent cell was “reasonably

tailored to the state’s interest in preventing suicides.” But it then

relied on out-of-circuit caselaw to alternatively hold that “the violent cell’s conditions did not deprive Alexander of life’s minimal

necessities.” We disagree.

We have previously held that similar conditions violate the

Eighth Amendment where there is punitive intent. See, e.g.,

McCray v. Sullivan, 509 F.2d 1332, 1336 (5th Cir. 1975) (finding

an Eighth Amendment violation where “[a]s many as seven” prisoners were placed in a single cell in punitive isolation measuring

six feet by eight feet, which lacked “bunks, toilets, sinks[,] or

other facilities,” and had only a “hole in the cell floor” as a toilet

that was flushed four times each day and often backed up); Alexander v. Tippah County, 351 F.3d 626, 628–31 (5th Cir. 2003)

(referring to conditions as “deplorable” where inmates punished

for fighting were transferred to a similar cell, sewage littered the

cell, it was freezing, and inmates were unable to wash their

hands before eating). Alexander’s housing was affirmatively not

punitive—it was protective.

Nor do we adopt the district court’s suggestion that, because

Alexander lived through his confinement at Henderson County

Jail, the conditions are per se reasonably related to the Jail’s interest in protecting suicidal inmates. The fact that some conditions protect a detainee does not make all conditions reasonably

related to the Government’s interest in the detainee’s protection.

Nevertheless, here, all conditions bore a reasonable relationship

to a legitimate government interest, and Alexander’s claims

therefore fail. It is solely on that basis that we affirm the district

court’s judgment.

App-54

themselves. But Bell looks only for a reasonable relationship, not narrow tailoring. So, even if these conditions are overly protective of Alexander, they are sufficiently related to the Jail’s legitimate interest in protecting suicidal inmates and thus pass constitutional

muster. 10

Because the conditions were sufficiently related to

a legitimate governmental interest, Alexander was

not punished in violation of the Due Process Clause. 11

10 In his complaint and the factual background of the opening

brief, Alexander notes that “inmates identified with a potential

for self-harm would sometimes be moved into the much less restrictive ‘separation cells’ if the [J]ail decided it needed the violent cell for someone who was genuinely violent.” Those cells

have a toilet, sink, shower, table, and bed. This, he claims, shows

that the Jail did not believe the violent cell’s restrictions were

necessary.

Any argument centering on these alternative cells is forfeited

for failure to brief the issue before this court. See United States

v. Delgado, 672 F.3d 320, 334 (5th Cir. 2012) (en banc). Regardless, as we note above, there is no requirement that the violent

cell be tailored to the individual. Where multiple individuals’ circumstances warrant placement in the violent cell, spillover into

the “separation cells” is required. But where the violent cell is

available, Alexander cannot claim that he should have been

placed in a separation cell instead. The violent cell is the safest

place for the Jail to place a suicidal inmate, and the conditions

are reasonably related to its interest in protection against suicide.

We decline to suggest that officers should weigh the sincerity of

such reports to determine whether a detainee should be housed

in a more relaxed cell, given their potential for self-harm.

11 We do not hold today that the violent cell’s conditions are

permissible in all circumstances. For instance, we express no

view of the various other individuals’ stories that Alexander

raises in both his complaint and opening brief. We hold only that,

as it relates to Alexander, accepting his well-pleaded allegations

as true, the Jail did not violate his constitutional rights.

App-55

We therefore do not consider whether the officers are

entitled to qualified immunity.

B

Alexander’s remaining claims focus on medical care.

He argues that “the county was well aware that no

qualified mental health care was being provided at the

[J]ail” and that its policies and contract with the Taft

defendants resulted in a “total, intentional deprivation of qualified mental health care.” Specifically, he

alleges that Phlips “did not bother to gather or confirm

any information on [him], such as why he was in the

violent cell, how long he had been in there, whether

he was taking any medication, or anything else.” Instead, she “quickly aborted her visit when she decided

that Alexander was ‘too confused’ to answer her initial

questions.” He also alleges that she took no action to

help him; lacks medical or mental health licensing;

has admitted she is not a clinician; is unqualified to

make a clinical assessment; and must report her findings to someone qualified to make such an assessment.

But, while Alexander believes that “[a] qualified mental health professional would have been alarmed at

[his] state and taken steps to address it,” Phlips “did

not notify Taft or any other medical or mental health

professional about Alexander’s obvious distress.”

Alexander then turns to Taft. He alleges that Taft

assigned “an unlicensed person not legally authorized

to provide psychological services” to handle his contractual responsibilities without providing written

policies or procedures. Because the Jail was aware

“from simple observation that [Phlips] was unsupervised and the only person allegedly providing mental

health care at the [J]ail,” and it knew that she had no

App-56

license, Alexander asserts that “it was the [J]ail’s express policy to deny its entire inmate population access to mental health care of any kind.”

We consider first his claims against the County, and

then turn to the Taft defendants. 12

1

The State must “assume some responsibility for [a

pretrial detainee’s] safety and general well-being.”

DeShaney v. Winnebago Cnty. Dep’t of Soc. Servs., 489

U.S. 189, 200 (1989). These responsibilities include

“food, clothing, shelter, medical care, and reasonable

safety.” Id. Medical care includes “protection from violence or suicide.” Hare v. City of Corinth, 74 F.3d 633,

643 (5th Cir. 1996). The district court did not expressly consider Alexander’s argument that the Jail

12 The

dissent states that the district court dismissed this

claim sub silentio and we should therefore vacate and remand.

Post, at 30. But the district court explained that, although Alexander challenged his medical treatment, administrative segregation and his confinement to a suicide-prevention cell did not

amount to a constitutional violation. True enough, this analysis

did not fully consider one of Alexander’s chief complaints—that

he did not receive sufficient mental health care—but we may consider this issue nonetheless. “Under our precedent, we may ‘affirm on any ground supported by the record, including one not

reached by the district court.’ This is so even if neither the appellant nor the district court addressed the ground, so long as the

argument was raised below.” Gilbert v. Donahoe, 751 F.3d 303,

311 (5th Cir. 2014) (footnotes omitted) (quoting Ballew v. Cont’l

Airlines, Inc., 668 F.3d 777, 781 (5th Cir. 2012)). The dissent provides that this principle “applies only when the district court has

actually considered the claim.” Post, at 30. In our view, the district court did consider Alexander’s § 1983 claim against the Taft

defendants, even if it failed to individually consider every factual

basis supporting that claim.

App-57

failed to provide sufficient mental health care, instead

dismissing the § 1983 claims against the Taft defendants because the violent cell’s conditions did not violate his constitutional rights. Nevertheless, seeing no

cognizable claim under § 1983, we affirm. See Gilbert,

751 F.3d at 311.

First, Alexander argues that the Jail allowed Phlips,

whom he alleges is unlicensed, to provide all mental

health care at the Jail. The Texas Commission on Jail

Standards requires that each facility have a plan that

“provide[s] procedures that shall give inmates the

ability to access a mental health professional at the

jail or through a telemental health service.” 37 TEX.

ADMIN. CODE § 273.2(13). “If a mental health professional is not present at the county jail at the time or

available by telemental health services, then [the plan

must] require the jail to provide the inmate access to,

at a minimum, a qualified mental health professional

(as defined by [26 TEX. ADMIN. CODE § 301.303(48)])

within a reasonable time.” Id. Under 26 TEX. ADMIN.

CODE § 301.303(48), a qualified mental health professional is one with competency in the work to be performed and (1) has a bachelor’s degree from an accredited university with a minimum number of hours dedicated to a major in one of various fields; (2) is a registered nurse; or (3) completes an alternative credentialing process.

The complaint repeatedly calls Phlips unqualified,

at some point asserting that she is “not legally authorized to make suicide or mental health care assessments.” But this legal conclusion, without more, cannot survive a motion to dismiss. See Iqbal, 556 U.S. at

678. Alexander does not allege that Phlips falls short

App-58

of the three categories in § 301.303(48). 13 He therefore

cannot rely on her purported lack of qualifications.

But we cannot assume that there is no constitutional violation just because there is no properly alleged statutory violation under 37 Tex. Admin. Code §

273.2(13). In other words, by maintaining a formal

policy, the County may well satisfy its statutory requirements, but it still must provide the constitutional minimum of care. Cf. Murphy v. Collins, 26 F.3d

541, 543 (5th Cir. 1994) (“A state’s failure to follow its

own procedural regulations does not constitute a violation of due process, however, if ‘constitutional minima [have] nevertheless . . . been met.’” (alterations in

original) (quoting Jackson v. Cain, 864 F.2d 1235,

1251 (5th Cir. 1989))).

The County provided the constitutional minimum

for mental health assistance: “protection from violence or suicide.” Hare, 74 F.3d at 643. In addition to

being housed in a solitary confinement unit in which

it was virtually impossible to self-harm, Alexander

spoke with the employed mental health individual

during his five-day confinement. It matters not that

Phlips was not licensed to the extent that Alexander

desired. Nor is it of any moment that he disagreed

with both her determination that he was too confused

to continue to interview and her decision not to

13 In other words, his complaint is devoid of factual allegations

that Phlips (1) lacks a bachelor’s degree from an accredited university with a minimum number of hours dedicated to one of the

required majors; (2) is not a registered nurse; and (3) has not

completed an alternative credentialing process. His allegation

that she received “no formal training period” from Taft is not

enough to demonstrate that she is unqualified under 26 TEX. ADMIN. CODE § 301.303(48).

App-59

recommend his release. While Alexander argues that

the Jail’s policy “was simply to defer completely to the

discretion of correctional officers,” he does not allege

that he ever informed Jail officials—or Phlips—that

he was no longer suicidal.

Alexander alternatively blames the violent cell for

his severe “psychological deterioration,” and claims

that Phlips did nothing to remove him therefrom. We

cannot charge mental health professionals, contracted

to provide care to pretrial detainees, with releasing inmates from suicide cells or improving the conditions

of their protective confinement. They have no authority to confine individuals or to free them from confinement. Cf. McClure v. Foster, 465 F. App’x 373, 375 (5th

Cir. 2012) (noting that the complainant failed to show

that it was the nurse’s duty to provide toilet paper).

Alexander provides only conclusory allegations

demonstrating that Phlips or the Jail knew—or had

reason to believe—that his mental deterioration was

caused by the violent cell’s conditions, rather than his

self-reported suicidal ideation. This is insufficient to

survive a motion to dismiss.

Alexander cannot demonstrate that the County

“knowingly subject[ed] [him] to inhumane conditions

of confinement or abusive jail practices” through its

mental health treatment plan. Shepherd v. Dallas

County, 591 F.3d 445, 456 (5th Cir. 2009). Because the

plan does not violate the Constitution, we do not consider his municipal liability claim against the County.

See Valle v. City of Houston, 613 F.3d 536, 541-42 (requiring a constitutional violation to impose municipal

liability).

2

App-60

This leaves the Taft defendants. The Taft defendants are state actors under § 1983. See West v. Atkins,

487 U.S. 42, 54 (1988) (noting that “a physician employed by [the State] to provide medical services to

state prison inmates[] act[s] under color of state law

for the purposes of § 1983” when providing medical

care); Rosborough v. Mgmt. & Training Corp., 350

F.3d 459, 461 (5th Cir. 2003) (noting that private companies and employees that manage state prisons “are

subject to § 1983 liability because they are performing

a government function traditionally reserved to the

state”). When determining whether such individuals

have violated the Constitution, the plaintiff must

demonstrate that (1) “the deprivation alleged was sufficiently serious” and (2) “the prison official possessed

a sufficiently culpable state of mind.” Herman v. Holiday, 238 F.3d 660, 664 (5th Cir. 2001). 14 That state of

mind is deliberate indifference. Id.

We begin and end with deliberate indifference. “Deliberate indifference is an extremely high standard to

meet.” Domino v. Tex. Dep’t of Crim. Just., 239 F.3d

752, 756 (5th Cir. 2001). In the context of medical care,

“[m]ere negligence, neglect, or medical malpractice”

does not suffice. Varnado v. Lynaugh, 920 F.2d 320,

321 (5th Cir. 1991) (alteration in original) (quoting

Fielder v. Bosshard, 590 F.2d 105, 107 (5th Cir. 1979)).

Where “medical treatment was provided, even if it

14 To qualify under the first of these two prongs, the “official’s

act or omission must have resulted in the denial of ‘the minimal

civilized measure of life’s necessities.’” Id. (quoting Farmer v.

Brennan, 511 U.S. 825, 834 (1994)). Although we hold that the

Jail did not knowingly provide constitutionally insufficient mental health care, we must also ascertain whether the Taft defendants deprived Alexander of mental health services.

App-61

was negligent, disagreed-with, and based on a perfunctory and inadequate evaluation, it was not denied.” Petzold v. Rostollan, 946 F.3d 242, 250 (5th Cir.

2019). Because the Taft defendants provided treatment—even if imperfect—Alexander’s claim fails.

Alexander points us to another case arising out of

the Henderson County Jail and involving the Taft defendants. See Albritton v. Henderson County, No. 231723, 2024 WL 1776380 (N.D. Tex. Apr. 23, 2024).

There, the court stated that “[t]he system for inmates

to access mental health care at the Henderson County

Jail amounted to a condition that left the inmates

with no avenues to access mental health care and this

dereliction of care cannot be reasonably related to any

legitimate governmental objective.” Id. at *5. With respect to the Taft defendants, it considered allegations

similar to those Alexander makes here: Taft contracted with the County, delegated all duties to an unlicensed professional, did not train or supervise that

individual, provided no mental health care at the Jail,

and did not establish a system through which the individual could contact Taft for assistance. Id. at

*6. The court concluded that Taft knew that no one

could provide mental health assistance and “[t]he substantial risk of harm of Taft flouting his responsibilities to the individuals in need of mental health services while at the [J]ail and outsourcing mental health

care to an unqualified individual is so obvious” that it

did not matter if Taft actually knew of the inmate or

was aware of the substantial risk of harm. Id.

Albritton “ha[d] the ‘mental age’ of a six-year-old”

and numerous known disabilities. Id. at *1. He took

“approximately eighteen daily medications to treat his

psychological and physical ailments,” and was prone

App-62

to danger when he did not understand his surroundings. Id. While housed in the violent cell—despite

lacking indications of suicidal thoughts—he did not

eat because he believed the food was poisoned, was not

provided water, and “had diarrhea . . . on the sleeping

bench which no one cleaned up” during the two-day

detention. Id. at *2. It is unclear whether Taft’s aide

at the time, Jeffries, ever visited Albritton. The court

found that the failure to provide any sort of mental

health care to an individual “like [Albritton] experiencing a mental health crisis” could contribute to a finding of deliberate indifference. Id. at *6 (emphasis

added).

The facts here are highly distinguishable. Alexander reported that he was suicidal and was moved to

the violent cell. At that point, he claims he mentally

deteriorated and that Phlips failed to release him.

Putting aside the fact that authority to release him

from the violent cell was left to the Jail—not Taft and

his employees—it is unclear what Phlips (or Taft) was

to make of his mental deterioration. Alexander

seemed healthy during Phlips’s earlier visits, but was

moved to the violent cell after stating that he was suicidal. She then found him unable to answer her questions. She could have drawn the inference that he was

not ready to be released from a suicide protection cell

because he had deteriorated between visits. Such a

conclusion would be logical, given that he had previously reported to her that he struggled with depression and subsequently reported suicidal ideation. 15

15 We therefore reject Alexander’s argument that she should

have reported these findings to Taft. The Jail provided Alexander

App-63

Holding the Taft defendants liable would transform

our consideration of deliberate indifference into a

post-hoc scrutiny of each determination of inmates’

mental health statuses. Alexander cannot expose

them to liability for failing to release him from the violent cell under these circumstances. His § 1983 claim

against the Taft defendants therefore fails. 16

with necessary protections. In Phlips’s view, his mental health

was being treated.

16 Alexander also brings a supervisory liability claim against

Taft. This requires that he identify a constitutional violation that

caused his injury. See Valle, 613 F.3d at 541-42. The same is true

if he chooses to bring such a claim under a failure-to-train or failure-to-supervise theory. See Littell v. Hous. Indep. Sch. Dist., 894

F.3d 616, 624 (5th Cir. 2018) (“[W]hen a municipal entity enacts

a facially valid policy but fails to train its employees to implement it in a constitutional manner, that failure constitutes ‘official policy’ that can support municipal liability if it ‘amounts to

deliberate indifference.’” (quoting City of Canton v. Harris, 489

U.S. 378, 388 (1989))). Since he fails to demonstrate deliberate

indifference, Alexander has pleaded no constitutional violation

and therefore cannot demonstrate supervisory liability against

Taft in his individual capacity under any theory.

The Rule 28(j) material that Alexander filed—the recent opinion in Anderson v. Henderson County, No. 24-cv-2394 (N.D. Tex.

June 23, 2025)—contemplates different circumstances. There,

the detainee “suffer[ed] from muscular dystrophy,” resulting “in

a significant speech impediment and an inability to move or walk

as easily as a healthy person.” Anderson, slip op. at 1. He, too,

suffered from PTSD, but was prescribed medication for its treatment. Id. at 2. Upon arrival at the Jail, he was “immediately

placed in the . . . ‘violent cell’ for seven days.” Id. During that

time, despite informing Jail staff of his medical conditions, “he

was never seen by any medical or mental health staff.” Id. (emphasis added). Moreover, he never received his prescription medication. Id. at 2–3.

As described above, Phlips visited Alexander. While Alexander may plead similar facts to Anderson—including that Taft

App-64

V

Alexander asks that we require officers and mental

health providers to second-guess inmates’ disclosure

of suicidal ideation. We decline to create such a requirement. We therefore AFFIRM the district court’s

order of dismissal.

provided inadequate training or that his employee was unauthorized to provide psychological services, see id. at 9—he was

visited by a mental health professional affiliated with Taft’s

practice. Moreover, his circumstances were vastly different: He

experienced suicidal ideation. The Taft defendants knew that

when Phlips visited him, and took that into account when responding. Anderson, on the other hand, failed to receive any of

his prescription medication, or any treatment at all. The facts in

these cases are inapposite, and Anderson therefore does not

counsel against dismissal.

To be clear, we do not hold that every actionless visit by a mental health professional passes constitutional muster. We hold

that, under Alexander’s specific circumstances, as alleged, Phlips

and the Taft defendants provided the constitutional minimum of

care required.

App-65

[Dissenting Opinion]

JAMES L. DENNIS, Circuit Judge, dissenting:

After we issued our opinions in this case, seven

leading prison-law scholars filed an amicus brief

warning that the majority opinion “makes basic errors

of prison law,” “misdescribes the Fourteenth Amendment’s due process inquiry,” “misstates the constitutional inquiry for deliberate indifference to a serious

medical need,” “addresses hypothetical concerns that

simply do not exist,” and “ignores the impossible burdens the opinion imposes on incarcerated litigants.” 1

These are serious charges.

* * *

How did we get here? Jail officials punished pretrial

detainee Ronnie Alexander by denying him a toilet,

toilet paper, running water, recreation, bedding,

clothing, and sufficient drinking water, all while subjecting him to twenty-four-hour lighting and a cell

contaminated with human waste. Alexander not only

lived in that filth for five days, but he also developed

infections in his feet from exposure to urine and fecal

matter—allegations the majority ignores entirely.

That type of error pervades the majority opinion.

Correctly applying Federal Rule of Civil Procedure

12(b)(6), Alexander has plausibly shown that jail officials misused suicide-watch protocols to punish a pretrial detainee.

With respect for my esteemed colleagues, I dissent.

1 The amicus brief is appended to this dissent.

App-66

I

“Due process requires that a pretrial detainee not

be punished.” Hare v. City of Corinth, 74 F.3d 633, 651

(5th Cir. 1996) (DENNIS, J., specially concurring). “In

determining whether particular restrictions and conditions accompanying pretrial detention amount to

punishment in the constitutional sense of that word,

a court must decide whether the disability is imposed

for the purpose of punishment or whether it is but an

incident of some other legitimate governmental purpose.” Id. (citing Bell v. Wolfish, 441 U.S. 520, 538

(1979)). “Absent a showing of an expressed intent to

punish on the part of detention facility officials, that

determination generally will turn on ‘whether an alternative purpose to which [the restriction] may rationally be connected is assignable for it, and whether

it appears excessive in relation to the alternative purpose assigned [to it].’” Id. (first citing Bell, 441 U.S. at

538; and then quoting Kennedy v. Mendoza-Martinez,

372 U.S. 144, 168–69 (1963)).

Put simply, conditions must advance a legitimate

governmental goal and cannot be excessively harsh in

doing so. The district court, however, dismissed Alexander’s conditions-of-confinement claim solely on the

ground that the conditions in the “violent cell” were

justified by the need to prevent Alexander’s suicide

and, thus, were reasonably related to a legitimate governmental objective. The majority opinion initially describes Bell’s test correctly but repeats the same error:

it omits the proportionality requirement in its analysis, addressing only whether the jail’s actions purportedly advanced a legitimate objective. Yet, as the amicus brief explains, a great weight of authority holds

App-67

that exposing a detainee to the conditions Alexander

alleges is excessive in relation to any legitimate penological purpose. App. at 3–4. The majority offers no

answer, instead opting to tacitly and fundamentally

alter the Bell test.

At any rate, the majority opinion’s governmental

goal rationale itself badly misapplies Rule 12(b)(6).

Alexander alleges that he falsely claimed to be suicidal as a last resort to escape placement in a dangerous group cell, where other inmates repeatedly threatened him. He further alleges that jail officials knew

he was not suicidal but used his plea as a pretext to

place him in the violent cell for punitive purposes.

Several key facts, all occurring in rapid succession,

support an inference of retaliatory motive.

March 8: Alexander was booked into the

jail. A Henderson County mental health

professional conducted an “observation

clearance,” observing no concerns with

his mental health.

March 9 (daytime): The same provider

performed a follow-up and again documented “no concerns” with Alexander’s

mental status.

March 9 (evening): Guards placed Alexander in group detention “with some of

the most violent and dangerous men being held at the Jail.” These inmates immediately made serious threats against

him. Alexander feared for his life, due to

both the threats by his cellmates and his

spiking blood pressure, which had

App-68

already required treatment since he had

arrived at the jail.

Later that evening: Alexander informed guards of the threats and requested to be moved “multiple times.”

The guards refused. “Thinking he had no

other option, he told [a] correctional officer . . . that he was suicidal, believing

that would force the jail to move him out

of the group detention cell for medical or

mental health care evaluation.”

Shortly after midnight, March 10:

Officers transferred Alexander to the “violent cell.” 2 During the walk, guards repeatedly called him a “bitch.” One said,

“You really fucked up now, bitch.”

The majority opinion observes that “Alexander was not

transferred until he informed correctional officers that he was

suicidal,” which “alone implies that the officers took his statement at face value, even if they did not subjectively believe him.”

Ante, at 9. Drawing that inference at the pleading stage inverts

Rule 12(b)(6): it assumes facts in favor of the moving party, not

the plaintiff, which is precisely what the Rule forbids. United

States ex rel. Steury v. Cardinal Health, Inc., 735 F.3d 202, 204

(5th Cir. 2013) (quoting United States ex rel. Steury v. Cardinal

Health, Inc., 625 F.3d 262, 266 (5th Cir. 2010)). The opposite inference—one we are required to credit at this stage—is that the

officers knew Alexander was not suicidal, understood that he was

using the claim as a desperate attempt to escape a threatening

environment, and chose to punish him for it. He had been in the

group cell only a few hours, had repeatedly asked for protection,

and had already been ignored. When he cried suicide, the officers

responded not with concern but with hostility, using his plea as

a convenient excuse to isolate and degrade him. That response

does not reflect protective intent. It reflects retaliation.

2

App-69

March 10–15: While Alexander remained in the violent cell, guards

taunted him with repeated insults and

threats. On one occasion, they paraded a

police dog outside his cell and loudly discussed taking Alexander into a field and

unleashing the dog on him. They threatened to kill him using a “barbed wire

guillotine.” Just before he was released

from the cell, one officer said: “Ronnie Alexander, you are not leaving this facility

alive.”

At this early stage, these allegations combined with

their tight chronology plausibly support Alexander’s

allegation that the officers did not act to protect Alexander, but to punish him for complaining about his

safety in group detention. The mental health evaluations showing no suicidal concerns, the guards’ refusal

to move him despite his clear fear for his safety, the

retaliatory language during his transfer, and the continuing harassment while in the violent cell together

present a coherent narrative of punitive intent. In the

context of a pretrial detainee, “an inference that governmental intent was punitive is equivalent to an inference that the challenged condition is unconstitutional.” Hamilton v. Lyons, 74 F.3d 99, 106 (5th Cir.

1996).

Critically, none of these alleged facts appear in the

district court’s opinion. The court’s analysis of the government’s interest instead assumes Alexander was a

known suicide risk. That assumption favors the defendants over the plaintiff, which is improper at the

motion-to-dismiss stage. Q Clothier New Orleans,

App-70

L.L.C. v. Twin City Fire Ins. Co., 29 F.4th 252, 256

(5th Cir. 2022) (“The court must accept the wellpleaded facts as true and view them in the light most

favorable to the plaintiff,” not the defendant).

The majority opinion concedes that “[t]he district

court did not consider these allegations.” Ante, at 9 n.5.

In other words, we agree the district court gave no

consideration at all to these specific, non-conclusory

allegations. 3 That should end the analysis. We are a

“court of review, not first view.” Stringer v. Town of

Jonesboro, 986 F.3d 502, 509 (5th Cir. 2021) (quoting

Cruson v. Nat’l Life Ins. Co., 954 F.3d 240, 249 n.7 (5th

Cir. 2020)).

Undeterred, the majority opinion proceeds to reject

Alexander’s conditions-of-confinement claim as speculative, reasoning that he failed to allege an express

admission of punitive intent or identify “other suicidal

inmates [that] received different treatment.” Ante, at

9–11. I do not follow. The question here is whether his

3 The majority opinion seems to suggest the district court was

free to ignore these allegations because they are not “wellpleaded allegations of fact.” Ante, at 9 n.5. It is difficult to see

what, exactly, is not “well-pleaded” about an allegation that a jail

official told Alexander, “You really fucked up now, bitch,” or that

another said, “Ronnie Alexander, you are not leaving this facility

alive.”

In the alternative, the majority dismisses “any threats directed at Alexander while he was in the violent cell” on the

ground that they do “not creat[e] a condition of confinement,” citing the general rule that “[m]ere allegations of verbal abuse do

not present actionable claims under” 42 U.S.C. § 1983. Ante, at

10 & n.6 (quoting Bender v. Brumley, 1 F.3d 271, 274 n.4 (5th Cir.

1993)). Alexander does not make that argument. He cites the

threats not as a standalone claim, but as circumstantial evidence

of the officers’ punitive intent.

App-71

allegations allow us to plausibly infer retaliatory or

punitive conduct under the guise of suicide prevention.

See, e.g., Simons v. Clemons, 752 F.2d 1053, 1056 (5th

Cir. 1985) (analyzing Bell and inquiring whether an

“express intent to punish” could be “infer[red] . . . from

the pleadings”); Bell, 441 U.S. at 538–39 (permitting

courts to infer an intent to punish). As outlined above,

they do. The majority’s refusal to infer anything about

state of mind despite numerous explicit comments, defendants’ associated conduct, and context (all at the

motion to dismiss stage), if applied widely, would immunize numerous constitutional violations committed

by all but the most proudly malicious defendants.

This case exemplifies that risk. If Alexander’s allegations are true, then the jail violated the Fourteenth

Amendment by using suicide protocols to punish a

pretrial detainee—denying him a toilet, toilet paper,

running water, recreation, bedding, clothing, and sufficient drinking water, while subjecting him to

twenty-four-hour lighting and a cell contaminated

with fecal matter and urine. 4 Ante, at 13 n.9 (“We

4 My reading of the record diverges from the majority opinion,

which discounts Alexander’s allegation—“that ‘[t]he [cell’s] floor

had not been cleaned and was covered in dried urine and fecal

matter’”—based on a color image showing an “off-white” cell that

“appears clean” and “certainly devoid of fecal matter.” Ante, at 3

n.2. First, that is not the full allegation. Alexander also alleges

that fecal matter and urine were present in the drain located at

the center of the cell floor, and that he had to manually force the

feces through the grates using a paper cup. He further alleges

that the floor was soiled with dried waste left by prior inmates

housed in the toilet-less cell.

Second, although the complaint includes two photos of the cell,

they are blurry. I cannot say they either support or contradict

Alexander’s account. Given the ambiguity, this case does not fall

App-72

have previously held that similar conditions violate

the Eighth Amendment where there is punitive intent.” (first citing McCray v. Sullivan, 509 F.2d 1332,

1336 (5th Cir. 1975); and then citing Alexander v. Tippah County, 351 F.3d 626, 628–31 (5th Cir. 2003))). 5

The majority opinion rejects Alexander’s claim

partly out of a policy concern for placing jailers in an

untenable position: liable whether they act or refrain.

Ante, at 10–11. The allegations in the present case fall

within neither horn of that dilemma. Taking Alexander’s allegations as true, the officers knew he was not

suicidal, knew he feared for his safety in his group

housing, and deliberately chose a punitive response

that exposed him to new risks. This is not a matter of

difficult judgment; it is punishment of a pretrial detainee disguised as suicide watch. The Constitution

forbids that. Bell, 441 U.S. at 535.

within the narrow exception recognized in Scott v. Harris, 550

U.S. 372, 380 (2007), which permits a court to disregard a plaintiff’s version of events only when it is “so utterly discredited by

the record that no reasonable jury could have believed him.”

“Scott was an exceptional case with an extremely limited holding,” inapplicable to ambiguous photo evidence. Aguirre v. City

of San Antonio, 995 F.3d 395, 410 (5th Cir. 2021).

5 McCray and Alexander involved convicted individuals and

were analyzed under the Eighth Amendment. By contrast, Alexander was a pretrial detainee, so his claims arise under the Fourteenth Amendment. Still, we may look to those cases for guidance

because a pretrial detainee’s due process rights are said to be “at

least as great as the Eighth Amendment protections available to

a convicted prisoner.” City of Revere v. Mass. Gen. Hosp., 463 U.S.

239, 244 (1983).

App-73

II

That leaves the claims focusing on medical care.

The district court never addressed Alexander’s claims

that the jail provided constitutionally deficient mental

health care. Ante, at 16 n.12 (majority opinion agreeing that these particular claims were not “fully considered”). By disposing of the issue without explanation, the court effectively dismissed the claims sub silentio, undermining meaningful appellate review. See,

e.g., McInrow v. Harris County, 878 F.2d 835, 836 (5th

Cir. 1989). While Federal Rule of Civil Procedure 12

does not require findings of fact or conclusions of law,

the parties are still entitled to understand the basis

for final judgment. Hanson v. Aetna Life & Cas., 625

F.2d 573, 575 (5th Cir. 1980). As we have stressed,

“discussion by the trial judge” is often essential to facilitate proper review. Myers v. Gulf Oil Corp., 731

F.2d 281, 283 (5th Cir. 1984). That is especially true

where, as here, the record does not reveal which of

several theories the district court may have relied on.

Mosley v. Ogden Marine, Inc., 480 F.2d 1226 (5th Cir.

1973). When a court’s reasoning is either vague or absent, effective appellate review becomes all but impossible. McInrow, 878 F.2d at 836. In those circumstances, we have consistently remanded to obtain at

least some explanation of the district court’s rationale.

See, e.g., Myers, 731 F.2d at 284.

The majority opinion devotes seven pages to analyzing the medical care claims. Ante, at 15–22. Yet it cites

no analysis from the district court. None exists. Instead, the majority opinion relies on the principle that

we may affirm on any ground supported by the record,

even one not reached by the district court, if the

App-74

argument was raised below. Id. at 16 n.12 (citing Gilbert v. Donahoe, 751 F.3d 303, 311 (5th Cir. 2014)).

But that principle applies only when the district court

has actually considered the claim. Although Alexander’s mental health care claims were raised and

briefed, the district court gave them no consideration.

Vacatur and remand are warranted. Ashley v. Clay

County, 125 F.4th 654, 662 n.5 (5th Cir. 2025) (“It is

not our role to address a question that the district

court left unresolved . . . as both a matter of judicial

restraint and sound policy.”).

As the prison-law scholars well explain, the majority opinion is incorrect in any event:

Pretrial detainees are entitled to adequate medical care. Estelle v. Gamble,

429 U.S. 97, 104 (1976); Hare v. City of

Corinth, Miss., 74 F.3d 633, 642 (5th Cir.

1996). A jail official violates this constitutional protection when deliberately indifferent to a pretrial detainee’s serious

medical needs. Id. The test applies

equally to mental health issues as to

physical ones. Id. Deliberate indifference

requires that a jail official subjectively

“knows of and disregards an excessive

risk” to health or safety. Farmer v. Brennan, 511 U.S. 825, 838 (1994); see, e.g.,

Easter v. Powell, 467 F.3d 459, 464–65

(5th Cir. 2006) (holding that there was

an Eighth Amendment liability where

the prison nurse offered non treatment

options to a patient with a history of cardiac problems who was experiencing

App-75

chest pains). A jail official’s knowledge of

a substantial risk of harm can be inferred if the health risk is obvious.

Farmer, 511 U.S. at 842 n.8.

The panel majority fails to state or apply

this black letter standard to the County.

Instead, the majority simply holds that

the County provided mental health assistance through “protection from violence or suicide” without considering

whether Alexander had a serious medical need or whether the County was deliberately indifferent to it by failing to

have any qualified mental health staff

present. Ante, at 18. The majority says

that Alexander failed to demonstrate

that the County’s “mental health treatment plan” was constitutionally inadequate, id. at 19, yet acknowledges that

Alexander plausibly alleged a “total, intentional deprivation of qualified mental

health care,” id. at 15. An entirely unqualified person conducting a fleeting interview with Alexander more than two

days after Alexander was placed in isolation cannot constitute a treatment plan.

See Gates v. Cook, 376 F.3d 323, 336 (5th

Cir. 2004). The majority errs too in applying this standard to Phlips herself by

considering only what she did not do—

move Alexander out of the suicide cell—

rather than on what she did do: nothing.

Ante, at 18; see Gates, 376 F.3d at 336.

App-76

App. at 86-87 (citation modified).

Alexander’s allegations establish a plausible claim

that the jail provided constitutionally deficient mental

health care, and I would therefore vacate the district

court’s dismissal and remand for further proceedings.

III

Ultimately, the majority opinion “decline[s] to . . .

require officers and mental health providers to second-guess inmates’ disclosure of suicidal ideation.”

Ante, at 22–23. That is not the rule Alexander seeks.

He does not argue that officials must second-guess

every report of suicidal ideation. Rather, he alleges

that, in his case, the officials knew he was not suicidal

and used suicide protocols as a method of punishment.

I am deeply concerned that the majority’s decision creates an untenable exception to Bell, permitting jailers

to punish detainees under the guise of suicide prevention, so long as they offer even the thinnest pretext,

despite substantial evidence of punitive intent.

I respectfully dissent.

App-77

[Appendix to Dissenting Opinion of DENNIS, J.]

No. 24-10663

________________________________________________________________________

IN THE UNITED STATES

COURT OF APPEALS

FOR THE FIFTH CIRCUIT

________________________________________________________________________

RONNIE ALEXANDER,

Plaintiff–Appellant,

v.

PHILIP R. TAFT PSY D AND ASSOCIATES, P.L.L.C.; HENDERSON COUNTY TEXAS; NATHANIEL PATTERSON; TAYLOR CALDWELL; MORGAN FAIN; NOAH KREIE; WILLIAM

TRUSSEL; DORA MARTINEZ; MELISSA HARMON; PHILIP

TAFT,

Defendants–Appellees.

________________________________________________________________________

On Appeal from a Final Judgment of the

United States District Court

for the Northern District of Texas

Case No. 3:22-cv-395, Hon. Brantley Starr

________________________________________________________________________

BRIEF OF PRISON LAW SCHOLARS AS AMICI

CURIAE SUPPORTING APPELLANT AND REHEARING

________________________________________________________________________

Samuel Weiss

RIGHTS BEHIND BARS

1800 M Street NW Front 1

#33821

Washington, DC 20033

(202) 455-4399

sam@rightsbehindbars.org

August 14, 2025

Jim Davy

ALL RISE TRIAL & APPELLATE

P.O. Box 15216

Philadelphia, PA 19125

(215) 792-3579

jimdavy@allriselaw.org

Counsel for Amici

App-78

CERTIFICATE OF INTERESTED PERSONS

In addition to the persons described in the Parties’

certificates of interested persons, the following listed

persons have an interest in the outcome of this case

within the meaning of Rule 28.2.1:

Bakhshay, Shirin, Amicus

Dangaran, D, Amicus

Davy, Jim, Amici’s counsel

Fenster, Mark, Amicus

Godfrey, Nicole, Amicus

Godsoe, Cynthia, Amicus

Jefferis, Danielle, Amicus

Weiss, Samuel, Amici’s counsel and Amicus.

App-79

TABLE OF CONTENTS

[page numbers updated]

Certificate of Interested Persons ...................... App-78

Table of Authorities ........................................... App-80

Introduction ....................................................... App-83

Argument ........................................................... App-83

I.

The panel opinion makes basic errors

of prison law. ........................................... App-83

A.

The Court misdescribes the

Fourteenth Amendment’s due

process inquiry. ............................... App-83

B.

The opinion misstates the

constitutional inquiry for

deliberate indifference to a serious

medical need. ................................... App-86

II. In the context of prison law, the

majority’s concerns are unfounded,

and the opinion will have considerable

unintended consequences. ...................... App-87

A.

The majority addresses hypothetical

concerns that simply do not exist. .. App-88

B.

The majority ignores the impossible

burdens the opinion imposes on

incarcerated litigants. ..................... App-90

Conclusion .......................................................... App-93

Appendix of Amici Curiae ................................. App-96

App-80

TABLE OF AUTHORITIES

[formatting modified and page numbers updated]

Cases

Bell v. Wolfish,

441 U.S. 520 (1979) .................................. App-81–83

Billman v. Ind. Dep't of Corr.,

56 F.3d 785 (7th Cir. 1995)............................ App-89

Brooks v. Warden,

800 F.3d 1295 (11th Cir. 2015)...................... App-82

Crandel v. Hall,

75 F.4th 537 (5th Cir. 2023) .......................... App-87

DeShaney v. Winnebago Cnty. Dep't of Soc. Servs.,

489 U.S. 189 (1989) ........................................ App-87

DeSpain v. Uphoff,

264 F.3d 965 (10th Cir. 2001)........................ App-82

Easter v. Powell,

467 F.3d 459 (5th Cir. 2006).......................... App-83

Edwards v. Arocho,

125 F.4th 336 (2d Cir. 2024).......................... App-82

Estelle v. Gamble,

429 U.S. 97 (1976) .......................................... App-83

Farmer v. Brennan,

511 U.S. 825 (1994) ...... App-83–84, App-87, App-90

Gates v. Cook,

376 F.3d 323 (5th Cir. 2004)............ App-82, App-84

Hare v. City of Corinth, Miss.,

74 F.3d 633 (5th Cir. 1996)............................ App-83

App-81

Horvath v. City of Leander,

946 F.3d 787 (5th Cir. 2020).......................... App-88

J.H. v. Williamson County,

951 F.3d 709 (6th Cir. 2020).......................... App-82

Johnson v. Johnson,

385 F.3d 503 (5th Cir. 2004).......................... App-89

Jones v. Bock,

549 U.S. 199 (2007) ........................................ App-89

LaReau v. MacDougall,

473 F.2d 974 (2d Cir. 1972) ........................... App-82

Littlefield v. Deland,

641 F.2d 729 (10th Cir. 1981)........................ App-82

May v. Sheahan,

226 F.3d 876 (7th Cir. 2000).......................... App-82

McKeithan v. Jones,

212 F. App'x 129 (3d Cir. 2007)

(per curiam) .................................................... App-90

Morris v. Zefferi,

601 F.3d 805 (8th Cir. 2010).......................... App-82

Naranjo v. Thompson,

809 F.3d 793 (5th Cir. 2015).......................... App-89

Sims v. Griffin,

35 F.4th 945 (5th Cir. 2022) .......................... App-90

Stevenson v. Tocé,

113 F.4th 494 (5th Cir. 2024) ........................ App-90

Taylor v. Riojas,

592 U.S. 7 (2020) ...................................... App-83–84

App-82

Whitley v. Albers,

475 U.S. 312 (1986) ........................................ App-87

Williamson v. Stirling,

912 F.3d 154 (4th Cir. 2018).......................... App-82

Young v. Quinlan,

960 F.2d 351 (3d Cir. 1992) ........................... App-82

Zadeh v. Robinson,

928 F. 3d 457 (5th Cir. 2019)......................... App-88

Ziglar v. Abassi,

137 S. Ct. 1843 (2017) .................................... App-88

Other Authorities

Institute for Justice, Results: Who wins qualified immunity cases, and how often do courts grant or

deny qualified immunity? .............................. App-88

Rules

Fed. R. Civ. P. 26(a)(1)(B)(iv) ............................ App-89

App-83

INTERESTS OF THE AMICI CURIAE

Amici are professors of law who study, teach, and

write about prison and jail litigation. They submit this

brief to share their views on the substance of prison

law and the practical realities of prisoner litigation. A

full list of signatories appears as an appendix.

INTRODUCTION

Amici urge the panel to rehear this opinion, or at

minimum reissue it as unpublished. It makes basic errors of prison law—both doctrinal and in assessing the

context and incentives of prison civil rights litigation.

If applied widely, it would immunize unconstitutional

conduct across the Circuit.

ARGUMENT

I.

The panel opinion makes basic errors of

prison law.

A. The Court misdescribes the

Fourteenth Amendment’s due process

inquiry.

Pretrial detainees cannot be “punished.” Bell v.

Wolfish, 441 U.S. 520, 535 (1979). In Bell, the Court

explained that a pretrial detainee’s conditions of confinement can constitute punishment either because of

a jail’s “expressed intent to punish” or an inferred one.

441 U.S. at 538–39. The latter inquiry examines (1)

“whether an alternative purpose to which the restriction may rationally be connected is assignable for

it, and [(2)] whether it appears excessive in relation to

the alternative purpose assigned to it.” Id. at 538

(cleaned up). In short, conditions must advance a

App-84

legitimate goal and cannot be excessively harsh in doing so. Id. at 548.

In Bell, the Court described the importance of step

two of this test by giving an outlandish example:

“loading a detainee with chains and shackles and

throwing him in a dungeon.” Id. Doing so “may ensure

his presence at trial and preserve the security of the

institution” but would nonetheless “support a conclusion that the purpose for which they were imposed

was to punish.” Id. The Court thus warned that absent

a proportionality requirement, jails would have undue

leeway to impose harsh conditions of confinement for

purposes of punishment but escape liability because

the conditions had some connection to a legitimate

goal of pretrial detention. Id.

Circuit courts regularly apply Bell’s proportionality

test to infer a purpose to punish in violation of the

Fourteenth Amendment. Morris v. Zefferi, 601 F.3d

805, 811 (8th Cir. 2010) (holding that transporting a

pretrial detainee “in a small, unsanitary dog cage for

the ninety-minute drive … with no compelling urgency and other options available, was excessive in relation to the goal of preventing escape, and thus, an

inference may reasonably be made” that the conditions constituted punishment); see also Williamson v.

Stirling, 912 F.3d 154, 179 (4th Cir. 2018); Edwards

v. Arocho, 125 F.4th 336, 352–53 (2d Cir. 2024); J.H.

v. Williamson County, 951 F.3d 709, 718 (6th Cir.

2020); May v. Sheahan, 226 F.3d 876, 884 (7th Cir.

2000); Littlefield v. Deland, 641 F.2d 729, 731 (10th

Cir. 1981). In a case like Morris, the jail had a legitimate objective in maintaining security during transportation, and placing the detainee in a urine-soaked

dog cage advanced that objective—only Bell’s

App-85

proportionality test supports the obvious conclusion

that doing so nonetheless constituted punishment.

Here, the panel majority initially described Bell’s

test correctly but then simply omitted the proportionality requirement in its analysis. Slip Op. at 6, 7-8.

The majority explained that Alexander must demonstrate the jail’s restrictions were “not reasonably related to a legitimate governmental objective,” and

then provided examples of legitimate objectives related to preventing self-harm. Id. at 8, 11-12. This

analysis, however, only addressed the first prong of

Bell. 441 U.S. at 538. The Court failed to address

whether these restrictions were excessive in relation

to that purpose. Slip Op. at 6; see 441 U.S. at 538.

In abandoning Bell’s proportionality analysis, the

majority failed to engage with the specific harsh conditions that form the basis for a Fourteenth Amendment claim under Bell. Slip Op. at 6; see 441 U.S. at

538. A great weight of caselaw holds that it is excessive in relation to any penological purpose to expose

prisoners to feces. See, e.g., Gates v. Cook, 376 F.3d

323, 334 (5th Cir. 2004); Brooks v. Warden, 800 F.3d

1295, 1303–04 (11th Cir. 2015); DeSpain v. Uphoff,

264 F.3d 965, 974 (10th Cir. 2001); Young v. Quinlan,

960 F.2d 351, 365 (3d Cir. 1992); LaReau v. MacDougall, 473 F.2d 974, 978 (2d Cir. 1972). Here, Alexander

not only lived in his waste for five days, but developed

infections in his feet from exposure to urine and fecal

matter—allegations that the Court not only failed to

apply in step two of the Bell analysis but ignored entirely. Slip Op. at 6; ROA.114 ¶40.

Similarly, while the majority insisted that Alexander’s case was “a far cry from the horrifying facts” of

Taylor v. Riojas, in which the U.S. Supreme Court

App-86

summarily reversed this Court for failing to find a

clearly established Eighth Amendment violation,

much of the case is strikingly similar. Slip Op. at 12

n.8. Both cases involve a man who was thrown naked

into a filthy cell by taunting guards for five or six days

because of a purported suicide threat. Id. at 1; see Taylor v. Riojas, 592 U.S. 7, 8–9 (2020). Some of the facts

from Taylor may indeed have been more “horrifying”

than here, Slip Op. at 12 n.8, but whatever factual distinctions exist only even matter in step two of the Bell

inquiry the majority skipped, because defendants in

both cases had identical rationales for their similar

behavior.

B. The opinion misstates the

constitutional inquiry for deliberate

indifference to a serious medical need.

Pretrial detainees are entitled to adequate medical

care. Estelle v. Gamble, 429 U.S. 97, 104 (1976); Hare

v. City of Corinth, Miss., 74 F.3d 633, 642 (5th Cir.

1996). A jail official violates this constitutional protection when deliberately indifferent to a pretrial detainee’s serious medical needs. Id. The test applies

equally to mental health issues as to physical ones.

Hare, 74 F.3d at 642. Deliberate indifference requires

that a jail official subjectively “knows of and disregards an excessive risk” to health or safety. Farmer v.

Brennan, 511 U.S. 825, 838 (1994); see e.g., Easter v.

Powell, 467 F.3d 459, 464–65 (5th Cir. 2006) (holding

that there was an Eighth Amendment liability where

the prison nurse offered non treatment options to a

patient with a history of cardiac problems who was experiencing chest pains). A jail official’s knowledge of a

App-87

substantial risk of harm can be inferred if the health

risk is obvious. Farmer, 511 U.S. at 842 n.8.

The panel majority failed to state or apply this black

letter standard to the County. Instead, the majority

simply held that the County provided mental health

assistance through “protection from violence or suicide” without considering whether Alexander had a

serious medical need or whether the County was deliberately indifferent to it by failing to have any qualified mental health staff present. Slip Op. at 15. The

majority held that Alexander failed to demonstrate

that the County’s “mental health treatment plan” was

constitutionally inadequate, but Alexander plausibly

alleged a “total, intentional deprivation of qualified

mental health care.” Slip Op. at 19, 15. An entirely

unqualified person conducting a fleeting interview

with Alexander more than two days after Alexander

was placed in isolation cannot constitute a treatment

plan. ROA.114 ¶¶ 4, 99, 104, 107, 122–23; see Gates,

376 F.3d at 336. The Court erred too in applying this

standard to Phlips herself when it considered only on

what she did not do—move Alexander out of the suicide cell—rather than on what she did do: nothing.

Slip Op. at 15; see Gates, 376 F.3d at 336.

II.

In the context of prison law, the

majority’s concerns are unfounded, and

the opinion will have considerable

unintended consequences.

The panel majority expresses concern that allowing

Mr. Alexander’s claim to proceed would create a

“minefield” for correctional defendants. Slip Op. at 11.

That concern is misplaced. The structures of prison

law and the PLRA, including high substantive

App-88

standards that pro se incarcerated litigants cannot

marshal evidence to meet and the judge-made doctrine of qualified immunity, already prevent prisoners

from redressing many constitutional violations. Additionally, those difficult substantive standards incorporating the subjective state-of-mind of correctional defendants means that prisoners rely even

more than other litigants on inferences from allegations and record evidence. Officers rarely state their

sadistic or malicious intent explicitly—courts must infer it from context. The majority’s misplaced concern

about prison defendants’ hypothetical liability overrides incarcerated peoples’ entitlement to reasonable

inferences, and unfairly bars them from proving already-difficult claims.

A. The majority addresses hypothetical

concerns that simply do not exist.

The majority fears reading too much into “vulgar

comments,” Slip Op. at 9, “inappropriate” statements,

Slip Op. at 10, or even “threats directed at Alexander,”

id. It worries that inferring malicious intent on the

part of officers who, for example, “threaten[ed] to kill

[Alexander] with a barbed wire guillotine” and told

him not to expect to “leave this facility alive,” id. at 10

n.6, would actually “result in the denial of constitutional protections” to incarcerated people. Id. at 11.

That worry is backwards. Prison civil rights law already provides more-than-sufficient protection to officers, obviating any need to undercut Rule 12(b)(6)

inferential standards.

First, the substantive standards in prison civil

rights cases are already often very high. Substantive

claims under the Eighth Amendment include a

App-89

“subjective” prong that requires plaintiffs to show

high mens rea on the part of correctional defendants. 1

As noted, claims for inadequate medical care require

deliberate indifference, meaning that a defendant

knew—not should have known, but actually knew—of

a substantial risk of serious harm and intentionally

disregarded it. Farmer, 511 U.S. at 842-43. Eighth

Amendment claims for excessive force similarly require subjective intent to cause harm on the part of an

officer—so even objectively unreasonable and seriously injurious uses of force may not trigger liability

without “wanton infliction of pain.” Whitley v. Albers,

475 U.S. 312, 319 (1986). Because of the duty that the

constitution imposes upon the State to “assume some

responsibility for [the] safety and general well-being”

of someone in its custody, DeShaney v. Winnebago

Cnty. Dep’t of Soc. Servs., 489 U.S. 189, 199-200 (1989),

corrections officials cannot disregard a risk of substantial harm to an incarcerated person. Farmer, 511

U.S. at 842-43. But an incarcerated plaintiff must

show not only that the defendant had knowledge “of

the facts from which the inference could be drawn that

a substantial risk of harm exists,” but that the official

did in fact “draw the inference” and consciously disregard the risk. Id. at 837, 842. Other common prison

civil rights claims, like First Amendment retaliation,

look to the state of mind of the defendant also. As

claims brought by prisoners require demanding proof

of a defendant’s state of mind, the standards

1 Pretrial detention claims arise under the Fourteenth Amend-

ment but this Court has held that Eighth Amendment standards

apply in most contexts. See Crandel v. Hall, 75 F.4th 537, 544

(5th Cir. 2023).

App-90

themselves already shield all but the most malicious

defendants.

Second, prison officials benefit from the atextual,

judge-made doctrine of qualified immunity. Several

judges of this court have explained that, “Nothing in

the text of § 1983—either as originally enacted in 1871

or as it is codified today—supports the imposition of

the ‘clearly established’ requirement.” Horvath v. City

of Leander, 946 F.3d 787, 801 (5th Cir. 2020) (Ho, J.,

concurring the judgment and dissenting in part); Zadeh v. Robinson, 928 F.3d 457, 480 (5th Cir. 2019)

(Willet, J., concurring in part and dissenting in part)

(discussing growing calls to reform qualified immunity). And the Supreme Court might well reform it. See

Ziglar v. Abassi, 137 S.Ct. 1843, 1872 (2017) (Thomas,

J., concurring in part and concurring the judgment)

(“In an appropriate case, we should reconsider our

qualified immunity jurisprudence.”). Until the Court

does, however, qualified immunity protects officers

who violate rights every day. See Institute for Justice,

Results: Who wins qualified immunity cases, and how

often do courts grant or deny qualified immunity? (listing 5th Circuit as denying qualified immunity in only

16% of appeals). Correctly applying Rule 12 to Alexander’s allegations will not put jail officials between a

rock and a hard place with liability, as all of prison

law is structured to only create liability for significant

misconduct.

B. The majority ignores the impossible

burdens the opinion imposes on

incarcerated litigants.

Prisoners, more than most litigants, depend on

fairly-construed inferences at the motion to dismiss

App-91

and summary judgment stages because of the difficult

substantive standards with subjective elements that

they must prove to win their claims. The PLRA, court

procedures, and other features of litigation specific to

pro se incarcerated litigants—including limits on the

sorts of discovery that would allow them to obtain

state-of-mind information from defendants—pose obstacles independent of and exacerbating the onerous

substantive standards. Declining to give incarcerated

litigants reasonable inferences risks immunizing entire categories of unconstitutional conduct in prisons

and jails across the Circuit.

Aside from the difficult substantive standards, the

PLRA prevents many meritorious cases outright.

Many never make it to court at all because prisons set

their own exhaustion rules, Jones v. Bock, 549 U.S.

199, 218 (2007), and often design onerous exhaustion

regimes, see, e.g., Johnson v. Johnson, 385 F.3d 503,

519 (5th Cir. 2004) (holding that a prisoner could sue

about only some sexual assaults among many, based

on the grievance time limit). Prisoners cannot easily

investigate their claims prior to filing because their

facility has a monopoly on information about defendants’ identities and most relevant facts. See, e.g., Billman v. Ind. Dep’t of Corr., 56 F.3d 785, 789 (7th Cir.

1995) (“Billman is a prison inmate. His opportunities

for conducting a precomplaint inquiry are, we assume,

virtually nil.”). When prisoners do file, they cannot get

those facts in discovery, either. They are not entitled

to initial disclosures, Fed. R. Civ. P. 26(a)(1)(B)(iv),

are often barred from receiving information because

of security concerns, Naranjo v. Thompson, 809 F.3d

793, 798 (5th Cir. 2015) (explaining that plaintiff “was

barred from viewing and responding to discovery that

App-92

defendants had filed under seal”), and typically do not

get to take depositions of correctional defendants

without court intervention. See, e.g., McKeithan v.

Jones, 212 F. App’x 129, 131 (3d Cir. 2007) (per curiam)

(rejecting plaintiff’s request for an oral deposition,

calling it “unorthodox”). And not getting discovery—

particularly not getting to question defendants—imposes a unique burden on pro se incarcerated litigants

who must show defendants’ subjective state of mind

as part of their claims.

Absent robust discovery, proving correctional defendants’ subjective state-of-mind depends on reasonable inferences. The Supreme Court itself has

acknowledged this in its seminal cases addressing the

difficult substantive standards. Farmer, for example,

noted that plaintiffs could provide knowledge of a substantial risk of harm through either direct or circumstantial evidence—i.e. evidence from which one can

draw inferences about state of mind. Farmer, 511 U.S.

837, 842. Most circuits, including this one, draw inferences about subjective knowledge of a substantial risk

of harm based upon the obviousness of a serious medical need—because most defendants deny having

knowledge. Sims v. Griffin, 35 F.4th 945, 949-50 (5th

Cir. 2022) (denying summary judgment because of

fact dispute over inference about clarity of need for

treatment); see also Stevenson v. Tocé, 113 F.4th 494

(5th Cir. 2024). The majority’s refusal to infer anything about state of mind despite numerous explicit

comments, defendants’ associated conduct, and context—all at the motion to dismiss stage—if applied

widely, would immunize numerous constitutional violations committed by all but the most proudly malicious defendants.

App-93

CONCLUSION

The panel should rehear this case, or, at least, withdraw it and issue it as an unpublished decision.

Respectfully submitted.

/s/ Samuel Weiss

Jim Davy

Samuel Weiss

ALL RISE TRIAL & APPEL- RIGHTS BEHIND BARS

LATE

1800 M Street NW Front 1

P.O. Box 15216

#33821

Philadelphia, PA 19125 Washington, DC 20033

(215) 792-3579

(202) 455-4399

jimdavy@allriselaw.org sam@rightsbehindbars.org

Counsel for Amici Curiae

August 14, 2025

CERTIFICATE OF COMPLIANCE

In accordance with Federal Rule of Appellate Procedure 32(a)(7)(C), I certify that this brief:

(i) complies with the type-volume limitation of

Rule 32(a)(7)(B) because it contains fewer than 2,600

words, including footnotes and excluding the parts of

the brief exempted by Rule 32(a)(7)(B)(iii); and

(ii) complies with the typeface requirements of

Rule 32(a)(5) and the type-style requirements of Rule

32(a)(6) because it has been prepared using Microsoft

Office Word 16.99, set in Century Schoolbook font in

12-point; and

(iii) that this brief was scanned for viruses prior to

submission.

/s/ Samuel Weiss

Samuel Weiss

App-94

CERTIFICATE OF SERVICE

I certify that on August 14, 2025 this brief was filed

using the Court’s CM/ECF system. All participants in

the case are registered CM/ECF users and will be

served electronically via that system. I further certify

that this brief complies with Fifth Circuit Rule 25.2.13

regarding redactions.

/s/ Samuel Weiss

Samuel Weiss

App-95

APPENDIX

App-96

APPENDIX OF AMICI CURIAE

Name of Amicus Curiae. The below sign in their

personal capacities. Their affiliations are listed

for purposes of identification only.

-

Bakhshay, Shirin. Assistant Professor of

Law, UCLA School of Law.

-

Dangaran, D. Assistant Professor of Law

at the University of Hawai‘i at Mānoa

William S. Richardson School of Law.

-

Fenster, Mark. Marshall M. Criser Eminent Scholar Chair in Electronic Communications and Administrative Law, Levin

College of Law, University of Florida.

-

Godfrey, Nicole. Assistant Professor of

Law, Sturm College of Law, University of

Denver.

-

Godsoe, Cynthia. Professor of Law and

Associate Dean for Research and Scholarship, Brooklyn Law School.

-

Jefferis, Danielle. Schmid Professor for

Excellence in Research, Assistant Professor of Law, University of Nebraska College of Law.

-

Weiss, Samuel. Lecturer on Law at Harvard Law School where he teaches the

course “Prison Law.”

App-97

Appendix C

[Filed: Jun. 28, 2024]

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF TEXAS

DALLAS DIVISION

RONNIE ALEXANDER,

Plaintiff,

v.

§

§

§

§ Civil Action No. 3:22-CV§ 0395-X

SOUTHERN HEALTH §

PARTNERS,

§

INC., et al.,

§

§

Defendants.

§

MEMORANDUM OPINION AND ORDER

GRANTING IN PART AND DENYING IN PART

MOTIONS TO DISMISS

Pending before the Court are four motions to dismiss: Defendant Southern Health Partners Inc.’s

(“SHP”) motion to dismiss, Defendants Philip R. Taft,

Psy. D. & Associates PLLC and Philip Taft’s (“Taft Defendants”) motion to dismiss, Henderson County’s motion to dismiss, and correctional officers Nathaniel

Patterson, Taylor Caldwell, Morgan Fain, Noah Kreie,

William Trussell, Dora Martinez, and Melissa Harmon’s (“Officers”) motion to dismiss. (Docs. 122–125).

After reviewing the motions, responses, replies, and

applicable law, the Court GRANTS IN PART AND

DENIES IN PART Defendants’ motions and DISMISSES all claims in this action. Plaintiff Ronnie Alexander’s Section 1983 claims against the Taft

App-98

Defendants, Henderson County, and the Officers are

DISMISSED WITH PREJUDICE for failure to

state a claim, and Alexander’s state-law, medical-negligence claims against the Taft Defendants and SHP

are DISMISSED WITHOUT PREJUDICE for lack

of subject-matter jurisdiction. This is a final judgment

dismissing all parties and claims. The Clerk of the

Court is INSTRUCTED to close this case.

I. Background

This case relates to a prison’s conditions of confinement. Police arrested Ronnie Alexander for an unknown crime that is not at issue in this case. After his

arrest, Alexander spent two “uneventful” days in Henderson County Jail’s holding cell. After those two days,

prison officials transferred Alexander to a group pod

where “his new podmates repeatedly threatened

him.” 1 Because of this, he wanted out. So he asked the

prison guards to move him. They didn’t. Still wanting

out, Alexander hatched a plan to lie to the prison official that he was suicidal to get out of his group pod.

Well . . . it worked. Alexander cried out to prison

officials that he was suicidal. Accordingly, he was then

transferred from his group pod to a suicide-prevention

cell known in the Henderson County Jail as the “violent cell.”

For the purpose of preventing suicides, the violent

cell is barren. There is no toilet. There is no toilet paper. There is no bedding apart from a suicide blanket.

The lights remain on throughout the day. And detainees in the violent cell are not allowed outside of their

1 Doc. 114 at 3 (Third Amended Compl.).

App-99

cells. Alexander was subjected to those conditions for

five days.

Alexander now sues in this

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