Introduction

In Robert DiPietro v. Doctor Laretha Urett Lockhart, the United States Court of Appeals for the Eleventh Circuit addressed two recurring issues in prisoner civil rights litigation under 42 U.S.C. § 1983: (1) pleading the personal involvement necessary to hold a supervisory official liable, and (2) the evidentiary showing required to survive summary judgment on an Eighth Amendment deliberate indifference claim arising from delay in medical/dental care.

Plaintiff-appellant Robert DiPietro, incarcerated at Rutledge State Prison, alleged that prison dentist Dr. Laretha Lockhart was deliberately indifferent to his serious dental needs by failing to treat a fractured filling for thirteen months while he endured severe, worsening pain. He also pursued a supervisory liability claim against Sharon Lewis, the statewide medical director, contending that her grievance-related actions caused or perpetuated the constitutional violation.

The district court dismissed the supervisory claim at the screening stage and later granted summary judgment to Dr. Lockhart on the deliberate indifference claim. On appeal, the Eleventh Circuit affirmed the dismissal of the supervisory claim against Lewis, but vacated the grant of summary judgment to Dr. Lockhart and remanded for further proceedings. The court’s opinion clarifies how affidavits and grievance evidence can create genuine disputes of material fact regarding pain and delay, and underscores that a medical provider’s failure to escalate treatment—when she has authority to do so—can support a finding of deliberate indifference even amid systemic constraints like equipment failures and backlogs.

Summary of the Opinion

The Eleventh Circuit held:

• Supervisory Liability: The complaint failed to state a claim against Sharon Lewis. It did not plead facts showing her personal participation or the “extremely rigorous” causal connection required for supervisory liability (such as directing unlawful acts, maintaining a policy of deliberate indifference, or knowledge of and failure to stop widespread abuse). Bare references to denial of a grievance appeal and an unspecified letter did not suffice.
• Deliberate Indifference: The district court erred in granting summary judgment to Dr. Lockhart. When the record is viewed in the light most favorable to DiPietro, a reasonable jury could find that Dr. Lockhart knew of and disregarded a substantial risk of serious harm by keeping him on a routine list for thirteen months despite his repeated reports of severe, worsening pain, the ineffectiveness of over-the-counter medication, and her conceded authority to classify the condition as “urgent” and expedite treatment within seven days at another facility.

The panel emphasized that a prisoner’s sworn affidavit, corroborated by grievance materials and consistent medical diagnoses (here, a fractured filling needing restoration), can create genuine disputes of material fact that preclude summary judgment—despite contrary inferences from medical records or a provider’s affidavit.

Factual Background and Procedural Posture

DiPietro arrived at Rutledge State Prison in August 2016. The facility’s dental triage categorizes conditions as emergent, urgent, or routine. Emergent conditions require immediate care; urgent conditions involve severe pain or infection requiring treatment within seven days (including transfer to Augusta State Medical Prison); and routine conditions are treated locally in order received.

Key timeline:

• June 2017: DiPietro grieved ignored sick-call requests for a toothache. Dr. Lockhart examined him; she found no infection or fracture, offered over-the-counter (OTC) pain medication (declined as duplicative), and recommended no further treatment.
• Late June 2017: DiPietro believed the same tooth fractured; pain became severe and constant, causing headaches. He filed another grievance.
• August 16, 2017: Dr. Lockhart diagnosed a fractured filling and recommended a routine restoration; she did not prescribe pain medication. DiPietro reported severe pain unrelieved by OTC medication.
• February 2018: At follow-up, DiPietro reported worsening pain radiating to head/neck, affecting eating and sleep. Dr. Lockhart offered OTC medication again; he declined as ineffective. She did not alter the treatment plan and noted the prison’s autoclave was inoperable, delaying procedures.
• May 2018: DiPietro again reported severe pain; Dr. Lockhart prescribed OTC medication and said the autoclave had been replaced but the routine list was backlogged.
• June–August 2018: DiPietro submitted weekly sick-call requests (per his affidavit) and enlisted his brother to advocate by calling prison officials. His brother was documented as “very stressed” by DiPietro’s constant pain.
• September 20, 2018: Dr. Lockhart restored the filling. DiPietro made no further complaints about the tooth thereafter.

Litigation history:

• February 2020: DiPietro filed § 1983 claims against Dr. Lockhart (Eighth Amendment deliberate indifference) and Sharon Lewis (supervisory liability), among others.
• Screening: The district court dismissed the supervisory claim against Lewis under 28 U.S.C. § 1915A for failure to state a claim but allowed the deliberate indifference claim to proceed.
• Summary judgment: After discovery, the district court granted summary judgment to Dr. Lockhart, finding no objective medical evidence of worsening pain and attributing delays to factors outside her control.
• Appeal: DiPietro challenged both the screening dismissal and the summary judgment ruling.

Analysis

Precedents Cited and Their Role

• Estelle v. Gamble, 429 U.S. 97 (1976): The foundational Supreme Court case establishing that deliberate indifference to serious medical needs violates the Eighth Amendment. The panel relies on this framework, as filtered through Eleventh Circuit precedent.
• Farmer v. Brennan, 511 U.S. 825 (1994): Articulates the subjective recklessness standard—official must actually know of and disregard an excessive risk. The panel applies Farmer’s subjective standard via Wade v. McDade.
• Wade v. McDade, 106 F.4th 1251 (11th Cir. 2024) (en banc): Clarifies that the deliberate indifference inquiry hinges on subjective awareness, disregard of risk, and criminal-law-style subjective recklessness; officials are not liable if they reasonably responded. The panel uses Wade’s articulation to assess Dr. Lockhart’s state of mind and response.
• Farrow v. West, 320 F.3d 1235 (11th Cir. 2003): A pivotal Eleventh Circuit case on delayed dental care. There, a 15-month delay in providing dentures despite repeated pain complaints supported deliberate indifference. The panel treats this case as closely analogous: a 13-month delay in restoring a fractured filling, despite knowledge of severe, worsening pain and ineffective OTC analgesics, can support a jury finding of deliberate indifference. Crucially, Farrow also instructs that a prisoner’s affidavit can create a triable fact issue even if medical records are silent (Farrow n.20).
• Goebert v. Lee County, 510 F.3d 1312 (11th Cir. 2007): Provides the general deliberate indifference framework and clarifies causation can be shown by personal participation. The panel uses it for the causation element—DiPietro’s pain ceased after the restoration.
• Taylor v. Hughes, 920 F.3d 729 (11th Cir. 2019): Restates the three elements of deliberate indifference: (1) serious medical need, (2) deliberate indifference, and (3) causation. The panel structures its analysis around this triad.
• Mann v. Taser Int’l, Inc., 588 F.3d 1291 (11th Cir. 2009): Defines “serious medical need,” either diagnosed as requiring treatment or obvious to a layperson. The panel accepts that a fractured filling plus severe pain satisfies this element.
• Roy v. Ivy, 53 F.4th 1338 (11th Cir. 2022); Keith v. DeKalb County, 749 F.3d 1034 (11th Cir. 2014); Myrick v. Fulton County, 69 F.4th 1277 (11th Cir. 2023): These cases set the “extremely rigorous” standards for § 1983 supervisory liability, requiring personal participation or a tight causal nexus via policy, widespread abuse, or direction-to-act-unlawfully. The panel leans on these authorities to affirm dismissal of the supervisory claim.
• Douglas v. Yates, 535 F.3d 1316 (11th Cir. 2008): A comparator case where detailed allegations about a supervisor’s knowledge of ongoing retaliation sufficed at the pleading stage. The panel distinguishes Yates because DiPietro’s complaint lacked comparable detail about what Lewis knew and when.
• Waldman v. Conway, 871 F.3d 1283 (11th Cir. 2017): Governs screening standards under § 1915A and the liberal construction of pro se pleadings, while requiring some factual content. Supports the dismissal of the Lewis claim.
• Alcocer v. Mills, 906 F.3d 944 (11th Cir. 2018) and Fed. R. Civ. P. 56(a): Provide the de novo standard for summary judgment and the requirement to resolve all factual disputes and inferences in the non-movant’s favor. The panel invokes these to fault the district court’s weighing of competing affidavits and insistence on “objective medical evidence” of worsening pain.

Legal Reasoning

1) Supervisory Liability against Sharon Lewis

The court affirmed dismissal under § 1915A because the complaint lacked factual content tying Lewis to the alleged violation. Merely alleging that Lewis denied a grievance appeal and received a letter was insufficient. No facts described the content of the appeal or letter, when Lewis received them, or how they provided notice that Dr. Lockhart was denying necessary dental care. Nor were there allegations of a policy or custom, a history of widespread abuse, or direction to act unlawfully—all pathways recognized as “extremely rigorous” prerequisites for supervisory liability in the Eleventh Circuit.

The panel distinguished Douglas v. Yates, where the complaint contained detailed, temporal allegations that the supervisor knew about ongoing retaliatory abuse and declined to act. By contrast, DiPietro’s pleading did not specify what knowledge Lewis had at any particular time, or how her actions caused the delay in treatment.

2) Deliberate Indifference by Dr. Lockhart

The court accepted that DiPietro had a serious medical need: a fractured filling accompanied by severe, worsening pain. The dispositive issues were (a) Dr. Lockhart’s subjective awareness and disregard of risk, and (b) causation.

On awareness and disregard, the panel reasoned a jury could find that:

• By August 2017, Dr. Lockhart knew DiPietro had severe pain not relieved by OTC medication, diagnosed a fractured filling, and recommended restoration.
• By February 2018, she knew his pain was worsening, radiating to his head and neck, disturbing sleep and eating.
• Despite this knowledge, she kept him on the routine list for another seven months, offering only OTC medications she knew to be ineffective for him, and did not invoke her authority under prison procedures to classify the condition as “urgent” and enable treatment within seven days at the Augusta State Medical Prison.

The district court misstepped in two ways. First, it discounted DiPietro’s “self-serving” affidavit given the medical and dental records, and demanded “objective medical evidence” of worsening pain. The Eleventh Circuit held that approach was incompatible with summary judgment standards and Farrow: a sworn affidavit based on personal knowledge, corroborated by grievance materials and consistent with a diagnosis (fractured filling needing restoration), can create a triable issue even if records are silent or the provider disputes the account. Second, the district court treated systemic delays (an inoperable autoclave and backlog) as absolving Dr. Lockhart. But the panel emphasized that Dr. Lockhart controlled the treatment plan and had the authority to reclassify as urgent and transfer the patient for timely care. Failure to use available tools to mitigate a known, substantial risk can demonstrate deliberate indifference under Farmer and Wade.

On causation, the court noted that DiPietro’s injury was prolonged severe pain; his pain resolved after the restoration. Given Dr. Lockhart’s role in persisting with a routine classification despite knowledge of ineffective pain control and worsening symptoms, a jury could find her omissions caused the constitutional injury.

Impact

Although designated “DO NOT PUBLISH” and therefore non-binding within the Eleventh Circuit, this opinion is nonetheless instructive for several reasons:

• Escalation Duties in Medical/Dental Triage: Medical professionals in correctional settings cannot rely on systemic impediments (equipment failures, backlogs) as a complete defense if they possess authority to reclassify a condition and expedite treatment. Where severe, worsening pain is known and conservative measures are ineffective, failure to escalate can support a deliberate indifference finding.
• Evidence at Summary Judgment: The court reinforces that a prisoner’s sworn affidavit, corroborated by grievances and consistent diagnoses, can defeat summary judgment even where medical charts do not document pain complaints. District courts may not insist on “objective medical evidence” of pain or resolve credibility disputes at summary judgment.
• Supervisory Liability Pleading: Plaintiffs must plead specific facts about what the supervisor knew, when, and how the supervisor’s actions or policies caused the violation. A supervisory defendant’s involvement in grievance processing, without more, rarely suffices.
• Training and Policy Implications: Correctional health systems should ensure clear protocols for reclassifying dental and medical conditions as urgent/emergent based on pain severity and functional impact, and train clinicians to use transfer options when local capacity is compromised. Documentation of pain complaints and responses is critical.
• Litigation Strategy: Defendants should address not only systemic causes of delay but also the reasonableness of their individualized responses to known risks—particularly whether escalation paths were considered or attempted. Plaintiffs should preserve contemporaneous grievance records and witness corroboration to support pain narratives.

Complex Concepts Simplified

• Serious Medical Need: A condition either diagnosed as requiring treatment or so obvious a layperson would recognize the need for care. Severe dental pain and a fractured filling qualify.
• Deliberate Indifference: Not mere negligence or malpractice. The official must actually know of a substantial risk of serious harm, disregard it, and act (or fail to act) with subjective recklessness—akin to criminal recklessness. If the official responded reasonably to the risk, there is no liability.
• Summary Judgment: A case can be resolved without trial only if there is no genuine dispute of material fact. Courts must view evidence in the non-movant’s favor and cannot weigh credibility. A party’s own sworn affidavit, based on personal knowledge, is competent evidence and can create a triable issue.
• Supervisory Liability under § 1983: There is no vicarious liability. Plaintiffs must show the supervisor personally participated, or that a policy/custom, widespread abuse, or a directive/knowledge-and-failure-to-stop caused the violation. The standard is “extremely rigorous.”
• Causation: In this context, causation can be shown if the defendant’s actions or omissions prolonged or exacerbated the inmate’s suffering. Here, pain abated after the delayed restoration, supporting causation.
• Triage Categories (Emergent/Urgent/Routine): These categories affect timing and location of care. A provider’s decision to classify or reclassify a condition—especially with authority to trigger transfer for urgent care—can be central to deliberate indifference analysis when severe pain is known.

Conclusion

The Eleventh Circuit’s decision in DiPietro v. Lockhart underscores two key principles. First, supervisory liability under § 1983 requires specific factual allegations of personal involvement or an exacting causal nexus; denial of a grievance appeal, without more, is insufficient. Second, in deliberate indifference cases predicated on delayed care, courts must credit competent sworn testimony and related grievance evidence at summary judgment. Where a clinician knows of severe, worsening pain and has authority to expedite care but does not do so, a jury may reasonably find deliberate indifference—even if systemic factors contribute to delay.

For correctional health providers and administrators, the opinion highlights the importance of responsive triage, willingness to reclassify and transfer when indicated, and thorough documentation of both complaints and clinical decision-making. For litigants, it clarifies evidentiary sufficiency at summary judgment and the stringent pleading burden for supervisory liability. Although unpublished, the ruling aligns with and reinforces established Eleventh Circuit doctrine, particularly Farrow and Wade, and will likely serve as persuasive authority in analogous prison medical and dental care delay cases.