Clarifying “Availability” Under the PLRA: Fourth Circuit Tightens Rules on Exhaustion After Medical Incapacity

Introduction

In Patrick McGraw v. Theresa Gore, the United States Court of Appeals for the Fourth Circuit addressed whether a prisoner’s severe illness can excuse his failure to file an administrative grievance before suing under 42 U.S.C. § 1983. Patrick Ryan McGraw alleged that two prison nurses—Theresa C. Gore and Nancy J. Wargas—were deliberately indifferent to his serious medical needs during the early stages of an infection that ultimately required brain and lung surgery. The district court granted summary judgment for the nurses, holding that McGraw had not exhausted North Carolina’s Administrative Remedy Procedure (“ARP”) as required by the Prison Litigation Reform Act (“PLRA”), 42 U.S.C. § 1997e(a). McGraw appealed, arguing that his hospitalization rendered the grievance process “unavailable” and that the ARP’s emergency-grievance provision or equitable tolling should excuse non-exhaustion. The Fourth Circuit rejected those arguments and affirmed.

Summary of the Judgment

Holding: An inmate’s temporary medical incapacity does not permanently render administrative remedies “unavailable.” Once the inmate regains the functional ability to file a grievance, the ordinary PLRA exhaustion requirement applies.
Disposition: Affirmed. Summary judgment for the defendants was proper because McGraw never filed a grievance during the two-month period after his hospital discharge or during his later reincarceration.
Key Clarifications:
- The ARP’s emergency-grievance pathway is for imminent threats and cannot substitute for standard exhaustion when an inmate seeks only retrospective damages.
- Equitable tolling cannot cure the complete absence of a grievance; it can only excuse lateness where a grievance was in fact filed.

Analysis

Precedents Cited and Their Influence

Woodford v. Ngo, 548 U.S. 81 (2006) – Established that “proper exhaustion” requires full compliance with procedural rules. The court relied on Woodford to stress that McGraw failed to initiate the ARP at all.
Ross v. Blake, 578 U.S. 632 (2016) – Introduced the concept that remedies must be “available” to trigger the PLRA. The Fourth Circuit applied Ross to examine whether McGraw’s illness made the ARP unavailable.
Moss v. Harwood, 19 F.4th 614 (4th Cir. 2021) – Provided Fourth Circuit guidance on “availability.” Cited for the proposition that a remedy must be “capable of use” to obtain relief.
Rucker v. Giffen, 997 F.3d 88 (2d Cir. 2021) & Smallwood v. Williams, 59 F.4th 306 (7th Cir. 2023) – Both recognize that medical emergencies can render procedures unavailable. The court distinguished McGraw’s circumstances from these cases.
Porter v. Nussle, 534 U.S. 516 (2002) and Booth v. Churner, 532 U.S. 731 (2001) – Confirmed that exhaustion is mandatory even if damages are the only relief sought. Used to reject McGraw’s futility claim.
Battle v. Ledford, 912 F.3d 708 (4th Cir. 2019) – Discussed equitable tolling standards under the PLRA. The panel found tolling inapplicable because no grievance was ever filed.

Legal Reasoning

Statutory Framework: The PLRA forbids lawsuits “until such administrative remedies as are available are exhausted.” The court began with this mandatory language.
Existence of a Remedy: North Carolina’s ARP is a structured, 3-step process. McGraw concededly never started it.
Emergency-Grievance Argument Rejected:
- ARP § .0308 allows an inmate in imminent danger to bypass paperwork and “present himself” to medical staff for immediate relief.
- At suit-filing (2019), McGraw sought damages, not urgent care; therefore § .0308 did not apply.
Availability Analysis:
- From April 28 to June 10, 2016, McGraw’s hospitalization may have made the ARP functionally unavailable.
- After June 10, 2016—and during reincarceration in 2018–2019—record evidence (medical notes, functional assessments) showed McGraw was cognitively and physically able to access the grievance procedure.
- Thus, even if unavailable during hospitalization, remedies became available once he was discharged, triggering the exhaustion requirement.
Equitable Tolling Denied: Tolling addresses late filings, not total failure to file. Because McGraw never filed, tolling could not apply.

Impact of the Judgment

Narrowing “Unavailability” in the Fourth Circuit: The decision clarifies that temporary incapacity does not extend indefinitely. Once an inmate is objectively capable of filing a grievance, the duty to exhaust returns.
Guidance for Practitioners: Counsel must evaluate whether and when a client regained the ability to grieve. Medical records immediately after hospital discharge will now be central evidence.
Institutional Implications: Prisons may cite this ruling to defend against § 1983 claims where plaintiffs missed grievance windows after recovery.
Potential for Supreme Court Review: The Court referenced, but did not fully embrace, approaches from the Second and Seventh Circuits. Litigants may seek further clarity on the contours of “availability.”

Complex Concepts Simplified

Prison Litigation Reform Act (PLRA): A 1996 statute requiring prisoners to complete prison grievance procedures before suing in federal court.
Administrative Remedy Procedure (ARP): North Carolina’s internal system for inmate complaints; involves a written grievance within 90 days and two levels of administrative review.
“Availability”: Under Ross v. Blake, remedies must be “capable of use” to qualify. If a process is inaccessible—e.g., due to intimidation or incapacity—it is deemed unavailable.
Emergency Grievance: A fast-track for imminent dangers allowing immediate presentation to staff, bypassing standard paperwork. It is not a substitute for ordinary grievances in non-emergency contexts.
Equitable Tolling: A doctrine that pauses a limitations period when extraordinary circumstances prevent timely filing and the litigant has been diligent.
Summary Judgment: A procedural device where the court decides a case without trial because no genuine dispute of material fact exists.

Conclusion

McGraw v. Gore strengthens the Fourth Circuit’s strict approach to PLRA exhaustion by holding that temporary medical incapacity does not excuse a prisoner from later complying with grievance procedures once he is able. The panel’s meticulous application of Woodford and Ross underscores that the question is not whether remedies were ever unavailable, but whether they were available at any time before suit. Practitioners representing incarcerated clients must now pay careful attention to periods of regained capacity and ensure that grievances are filed promptly, even if the alleged constitutional violation occurred years earlier. The decision promotes administrative autonomy within prison systems while signaling that courts will require clear, objective evidence before exempting inmates from the PLRA’s exhaustion mandate.