Failure to Object to a Magistrate Judge’s R&R Waives Appellate Review; Disagreement with Medical Judgment Does Not Plead Eighth Amendment Deliberate Indifference

Introduction

In James Bailey v. Luis A. Lopez-Rivera, the Eleventh Circuit affirmed the dismissal of a prisoner’s 42 U.S.C. § 1983 claims alleging Eighth Amendment deliberate indifference to medical needs, as well as the denial of leave to amend as futile. The plaintiff, James Bailey, sued (among others) Dr. Luis A. Lopez-Rivera, medical contractor Centurion, LLC, and the Florida Department of Corrections (FDOC).

The appeal presented three recurring issues in prisoner civil-rights litigation: (1) the consequence of not objecting to a magistrate judge’s report and recommendation (R&R); (2) the pleading threshold for deliberate indifference where medical care was provided but allegedly “the wrong type”; and (3) whether proposed amendments targeting a state official (the FDOC Secretary) avoid sovereign immunity and plausibly plead liability.

Summary of the Opinion

Centurion claim (procedural waiver): Bailey waived appellate review because he did not object to the R&R recommending dismissal, despite notice of the objection deadline and consequences under 11th Cir. R. 3-1. The court declined to apply the “interests of justice” exception because Bailey did not argue for it.
Dr. Lopez-Rivera claim (Rule 12(b)(6)): The complaint failed to plausibly allege the required mental state—subjective recklessness. Allegations described extensive treatment (visits, X-rays, pain medication, physical therapy), and Bailey’s theory amounted to a disagreement over medical judgment rather than deliberate indifference.
Motion to amend (futility): Denial of leave to amend was affirmed because the proposed amended complaint still failed to state a claim: it did not plausibly allege subjective recklessness for official-capacity injunctive relief, and it alleged no personal involvement by the Secretary for individual-capacity liability. Official-capacity damages remain barred by the Eleventh Amendment.

Analysis

Precedents Cited

1) Objections to Magistrate Judge R&Rs and Appellate Waiver

11th Cir. R. 3-1: The court applied the circuit rule that failing to object to an R&R—after proper notice—waives the right to challenge on appeal the district court’s order adopting the unobjected-to factual and legal conclusions.
Smith v. Marcus & Millichap, Inc., 106 F.4th 1091 (11th Cir. 2024): The opinion relied on Smith to emphasize two constraints on rescue review: (i) plain-error review “rarely applies in civil cases,” and (ii) the exception generally will not be used when the appellant does not argue in the opening brief that review is “necessary and in the interests of justice.” This made Bailey’s Centurion arguments (which focused on the merits) legally misdirected once waiver attached.

2) Pleading Standards and Rule 12(b)(6)

Roy v. Ivy, 53 F.4th 1338 (11th Cir. 2022): Provided the de novo standard for reviewing Rule 12(b)(6) dismissals and the requirement to accept well-pleaded facts as true and view them favorably to the plaintiff.
Ashcroft v. Iqbal, 556 U.S. 662 (2009): Supplied the plausibility framework and the key limitation that courts do not credit legal conclusions or “threadbare recitals” of elements. The panel used Iqbal to reject Bailey’s conclusory assertions of subjective recklessness.

3) Substantive Eighth Amendment Medical-Care Law

Estelle v. Gamble, 429 U.S. 97 (1976): The foundational rule: deliberate indifference to serious medical needs violates the Eighth Amendment, but mere negligence or disagreements over medical judgment do not. The panel treated Bailey’s allegations (seeking different testing/treatment) as falling on the “medical judgment” side of Estelle.
Wade v. McDade, 106 F.4th 1251 (11th Cir. 2024) (en banc): The controlling articulation of the two-part requirement as framed by the opinion: an objectively serious deprivation plus subjective recklessness—meaning the defendant was “actually aware” that his own conduct created a substantial risk of serious harm. The panel’s dismissal turned on the Wade mental-state requirement.
Hamm v. DeKalb Cnty., 774 F.2d 1567 (11th Cir. 1985): Reinforced that “significant medical care” undermines deliberate-indifference claims premised on a desire for different treatment. The panel analogized Bailey’s acknowledged treatment history to Hamm.
Adams v. Poag, 61 F.3d 1537 (11th Cir. 1995): Confirmed that a “dispute over treatment type” is not deliberate indifference under Estelle. The opinion used Adams to characterize Bailey’s pleading as a treatment-disagreement claim.

4) Amendments, Futility, and Sovereign Immunity

Burger King Corp. v. Weaver, 169 F.3d 1310 (11th Cir. 1999): Set the abuse-of-discretion standard for denying leave to amend.
Marrache v. Bacardi U.S.A., Inc., 17 F.4th 1084 (11th Cir. 2021): Provided the futility principle: amendment may be denied where the complaint “as amended” would still be dismissed. The panel found futility because the proposed allegations still did not plead subjective recklessness or personal involvement.
Jackson v. Ga. Dep't of Transp., 16 F.3d 1573 (11th Cir. 1994): Stated the rule that state officials sued for damages in their official capacity are immune in federal court under the Eleventh Amendment.
Nat'l Ass'n of Bds. of Pharmacy v. Bd. of Regents, 633 F.3d 1297 (11th Cir. 2011): Recognized that the Eleventh Amendment does not bar prospective injunctive relief to stop a continuing violation of federal law. Even so, the panel held Bailey still had to plausibly plead the substantive constitutional violation—something his amended allegations did not do.

Legal Reasoning

Procedural gatekeeping (Centurion): The court treated the failure to object to the Centurion R&R as dispositive. Under 11th Cir. R. 3-1, waiver attaches when proper notice is given. The court’s additional reliance on Smith v. Marcus & Millichap, Inc. underscores that appellants must do more than reargue the merits; they must specifically justify “interests of justice” review to unlock any plain-error consideration.
Substantive plausibility (Lopez-Rivera): Applying Ashcroft v. Iqbal and the deliberate-indifference framework grounded in Estelle v. Gamble and refined by Wade v. McDade, the panel focused on the missing mental state: factual allegations showing the doctor was actually aware that his own treatment decisions posed a substantial risk of serious harm. The opinion treated extensive care allegations as incompatible with an inference of subjective recklessness, and it classified the complaint as a dispute over medical judgment in line with Hamm v. DeKalb Cnty. and Adams v. Poag.
Amendment and sovereign immunity (Secretary Dixon): Even assuming Bailey sought only injunctive relief (which can be allowed despite the Eleventh Amendment under Nat'l Ass'n of Bds. of Pharmacy v. Bd. of Regents), the proposed amendment still needed plausible allegations of deliberate indifference—again failing at subjective recklessness. For individual-capacity liability, the amendment failed because it alleged neither personal involvement in medical care nor facts tying the Secretary to promulgation of the challenged “90-day pill policy.” Under Marrache v. Bacardi U.S.A., Inc., these deficiencies made the amendment futile, justifying denial under Burger King Corp. v. Weaver.

Impact

Reinforces strict R&R objection practice: The opinion is a reminder that merits arguments can be unreachable on appeal if a party fails to object to an R&R and then fails to request “interests of justice” review in the opening brief. This is especially consequential for pro se prisoner litigants, for whom missed objection deadlines frequently end claims.
Raises the pleading bar for “wrong treatment” medical claims: By tying dismissal to the absence of Wade’s “actually aware” facts—and by treating extensive treatment history as signaling medical judgment—the case discourages complaints that do not explain why the provider knew the chosen course created a substantial risk of serious harm.
Limits amendment strategies against agency defendants: Substituting a state official for a state agency may avoid some sovereign-immunity obstacles for prospective relief, but it does not cure pleading defects. The decision highlights the dual hurdle: (i) identify a viable form of relief under the Eleventh Amendment framework, and (ii) still plead a plausible constitutional violation and the correct defendant’s connection to it.

Complex Concepts Simplified

Rule 12(b)(6) dismissal: A case can be dismissed early if the complaint’s facts, even assumed true, do not plausibly show legal liability. Conclusory statements (“the defendant was deliberately indifferent”) do not count as facts.
Plausibility (Ashcroft v. Iqbal): The complaint must contain enough specific factual content to make liability a reasonable inference, not a speculation.
Deliberate indifference vs. negligence: Negligence is a mistake or poor care. Deliberate indifference requires something closer to knowing disregard of a substantial risk. Disagreement about which test or treatment should have been used is usually treated as medical judgment, not a constitutional violation.
Subjective recklessness (Wade v. McDade): The plaintiff must plead facts showing the defendant was actually aware that his own actions created a substantial risk of serious harm—an internal, knowing state of mind, not merely that the care later proved insufficient.
Eleventh Amendment / official-capacity vs. individual-capacity: Suing an official in an official capacity is effectively suing the State; damages are generally barred. Prospective injunctive relief may be possible to stop an ongoing federal-law violation. Individual-capacity claims seek damages from the official personally, but require allegations of personal involvement (or legally sufficient responsibility for the challenged policy).

Conclusion

The opinion’s core lessons are procedural and substantive: (1) failure to object to an R&R can forfeit appellate review, and civil plain-error review will not be entertained without an “interests of justice” argument; (2) Eighth Amendment deliberate-indifference claims require nonconclusory facts showing subjective recklessness, not simply allegations that a different treatment would have been better; and (3) amendment is properly denied as futile when the revised pleading still fails to allege the required mental state and the defendant’s personal involvement, even if the plaintiff repackages the defendant as a state official to seek injunctive relief.