Davenport v. Pata – When a Mere “Referral Note” Is Not Enough:
The Tenth Circuit Holds that Failure to Follow Internal Referral Procedures Can Constitute Deliberate Indifference to Serious Medical Needs

Introduction

Davenport v. Pata, No. 24-6117 (10th Cir. June 20, 2025), is a significant appellate decision concerning the constitutional duty to provide medical care to pre-trial detainees. The Tenth Circuit reversed summary judgment for a nurse practitioner who, for eleven months, failed to initiate HIV treatment or secure an off-site consultation for detainee Bryan Wayne Davenport. The court ruled that:

• Non-compliance with the jail contractor’s own referral policy may support a finding of deliberate indifference; and
• Placing a vague note in the file does not automatically discharge a provider’s “gatekeeper” obligation when the policy requires formal steps to secure specialist care.

By emphasizing the procedural component of a gatekeeper’s duty, Davenport clarifies that an incomplete referral process—especially one the provider knows is essential for scheduling—creates a triable issue of fact on deliberate indifference. The decision also stresses the distinction between a delay in care and an outright denial, rejecting a rigid “substantial harm” requirement where treatment is wholly absent for an extended period.

Summary of the Judgment

The district court had granted summary judgment to Nurse Practitioner Becky Pata, concluding that she reasonably referred Davenport to an infectious disease specialist and that any lapse in treatment caused no substantial harm. The Tenth Circuit reversed, holding:

1. Objective Prong – HIV is a sufficiently serious medical condition; Ms. Pata did not contest this finding on appeal.
2. Subjective Prong – A reasonable jury could find deliberate indifference because:
   • Pata allegedly told Davenport she “didn’t want to start treatment.”
   • She failed to order blood work or antiretroviral medication.
   • She ignored mandatory steps (a “Specialty Service/Consultation Request” form) required under Policy J-18 to secure an outside appointment.
3. Gatekeeper Liability – Merely writing a notation in the chart does not fulfill the duty to expedite necessary specialist care where internal procedures demand more.
4. Substantial Harm Analysis Unnecessary – Because the claim is one of denial rather than mere delay, and objective seriousness was already satisfied, the “substantial harm” discussion was superfluous.

The case was remanded for trial on Davenport’s Fourteenth Amendment claim; all other rulings (dismissal of other defendants) were affirmed.

Analysis

3.1 Precedents Cited and Their Influence

• Crowson v. Washington Cnty., 983 F.3d 1166 (10th Cir. 2020)
  Established the “gatekeeper” doctrine: medical personnel may not impede access to specialists. Davenport extends Crowson by requiring adherence to written referral procedures, not loose informalities.
• Paugh v. Uintah Cnty., 47 F.4th 1139 (10th Cir. 2022)
  Clarified deliberate-indifference standards and “substantial harm” in delay-of-care cases. The panel used Paugh to show that evidence of pain or worsened condition can satisfy harm, but then distinguished Davenport as a denial case.
• Lucas v. Turn Key Health Clinics, 58 F.4th 1127 (10th Cir. 2023)
  Reiterated that a provider must both know and disregard a substantial risk. Davenport cites Lucas to emphasize that failure to verify a “strongly suspected” risk is actionable.
• Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000)
  Defines a “serious medical need” as one diagnosed or obvious. HIV qualifies under this standard, removing doubt about the objective prong.
• Leavitt v. Corr. Med. Servs., 645 F.3d 484 (1st Cir. 2011)
  Persuasive authority stressing the need for lab work and medication in HIV cases; the Tenth Circuit analogized Leavitt to show that omission of testing can be deliberate indifference.

3.2 Legal Reasoning

The court divided its reasoning along the classic objective / subjective framework for deliberate-indifference claims:

1. Objective Seriousness – HIV, by medical consensus and prior caselaw, is inherently serious. Past prescriptions and Pata’s own recognition cemented this prong.
2. Subjective Deliberate Indifference
   • Provider Capacity – Jurors could deem it reckless for Pata to forgo tests or ART medication for 11 months, especially after verbalizing disinterest in treating the disease.
   • Gatekeeper Capacity – Because Policy J-18 required a completed referral form and CMO approval, a chart note was insufficient. Failure to follow mandatory steps can show conscious disregard of risk.
3. Denial vs. Delay – Eleven months without any HIV-specific care transforms the claim from a “delay” to an effective “denial,” obviating the need for separate proof of “substantial harm.”

3.3 Potential Impact on Future Litigation

• Internal Policies Gain Constitutional Salience – Where an institution’s procedures are designed to secure timely specialty care, non-compliance may itself evidence deliberate indifference.
• Re-Defining Gatekeeper Duties – Providers can no longer rely on informal actions (e.g., “I made a note”) if the policy prescribes formal steps. This reduces the likelihood of early summary judgment for defendants who partially initiate but fail to complete referral chains.
• Denial vs. Delay Doctrine Clarified – Courts must analyze whether care was totally absent, not merely postponed. The “substantial harm” element is unnecessary in true denial cases.
• HIV Treatment in Carceral Settings – The decision underscores the judiciary’s vigilance over HIV-related care, likely prompting jails and contractors to audit adherence to testing and ART guidelines.

Complex Concepts Simplified

• Deliberate Indifference – More culpable than negligence (carelessness) but less than intentional harm. Think of it as “reckless disregard” for a known, serious risk.
• Objective vs. Subjective Prongs
  • Objective – Was the medical need serious?
  • Subjective – Did the official actually understand the risk and ignore it?
• Gatekeeper Liability – Medical staff act as “gatekeepers” to outside care. Blocking, stalling, or passively failing to complete referral steps breaches this duty.
• ART (Antiretroviral Therapy) – The medication regimen that suppresses HIV. Standard of care calls for initiation “as soon as possible” after diagnosis.
• CD4 Count / Viral Load – Laboratory markers showing immune status and quantity of HIV in the blood. Falling CD4 and rising viral load signal worsening disease.

Conclusion

Davenport v. Pata reinforces the constitutional principle that carceral medical providers must finish what they start. A perfunctory referral note, absent the required paperwork to trigger scheduling, will not shield a provider from liability. The decision’s core contributions are two-fold:

1. It intertwines institutional policy compliance with the deliberate-indifference analysis, giving plaintiffs a concrete evidentiary hook when providers bypass mandatory procedures.
2. It clarifies the analytical boundary between a delay and a denial of treatment, particularly in chronic-disease contexts where inaction itself endangers the patient.

Going forward, detention facilities and their contractors in the Tenth Circuit—and plausibly beyond—face amplified exposure to jury trials where they overlook procedural safeguards designed to protect inmates’ health. Davenport signals that courts will probe not only what a medical professional did, but how completely they executed the processes necessary to deliver care.