Failure to Warn of Medication Side Effects During a Competency Evaluation Does Not Plead Fourteenth Amendment Deliberate Indifference (and Mislabeling “Frivolous” Dismissals Matters for Review and PLRA Strikes)

1. Introduction

In Watson v. DeQuardo (10th Cir. Aug. 11, 2026) (nonprecedential “Order and Judgment”), the Tenth Circuit addressed whether a pretrial detainee stated a viable 42 U.S.C. § 1983 claim for unconstitutional medical care against two physicians at the Colorado Mental Health Institute at Pueblo (“CMHIP”) who conducted a competency evaluation. The plaintiff, Warren D. Watson, alleged the doctors failed to recognize and warn him that Depakote could cause long-term, irreversible physical and mental harm. He also asserted state-law theories (including negligence/medical malpractice).

Key issues included: (i) whether the complaint plausibly alleged the subjective knowledge and disregard required for “deliberate indifference” under the Fourteenth Amendment (applying Eighth Amendment standards); (ii) how to properly characterize a dismissal under 28 U.S.C. § 1915(e)(2)(B) when the district court labels it “frivolous” but the defect is pleading insufficiency; (iii) whether the district court properly declined supplemental jurisdiction over state claims; and (iv) the PLRA strike consequences and the standard for proceeding in forma pauperis (“ifp”) on appeal.

2. Summary of the Opinion

  • The Tenth Circuit agreed the amended complaint did not plead facts showing either doctor was deliberately indifferent to a serious medical need.
  • Although the district court had dismissed the federal claim as “frivolous” under § 1915(e)(2)(B)(i), the panel explained the dismissal was more properly treated as a failure to state a claim under § 1915(e)(2)(B)(ii), triggering de novo appellate review.
  • The court held that an alleged failure to warn about potential medication side effects—without facts showing defendants knew of a substantial risk and disregarded it—amounts at most to negligence, not a constitutional violation.
  • With the federal claim dismissed, the court approved the district court’s decision to decline supplemental jurisdiction over the state-law claims.
  • The panel dismissed the appeal as frivolous (because the appellate briefing did not present an arguable legal/factual basis to overturn the rulings), denied ifp, and assessed two PLRA strikes: one for the district court’s failure-to-state-a-claim dismissal and one for the frivolous appeal.

3. Analysis

3.1 Precedents Cited

IFP on appeal and “good faith”

  • Rolland v. Primesource Staffing, L.L.C., 497 F.3d 1077 (10th Cir. 2007): Cited for the proposition that a litigant may seek ifp in the court of appeals even after a district-court “not in good faith” certification, but must show inability to pay and a reasoned, nonfrivolous argument. The panel used this framework to deny ifp because Watson’s appeal did not engage the dispositive rulings.

Screening dismissals: “frivolous” vs. “failure to state a claim” and standard of review

  • Milligan v. Archuleta, 659 F.3d 1294 (10th Cir. 2011) and Fogle v. Pierson, 435 F.3d 1252 (10th Cir. 2006): Used for the general rule that § 1915(e)(2)(B)(i) “frivolous” dismissals are typically reviewed for abuse of discretion.
  • Fratus v. DeLand, 49 F.3d 673 (10th Cir. 1995): Supplies the definition that a claim is frivolous when it “lacks an arguable basis either in law or in fact.”
  • Pittman v. Holcomb, 838 F. App'x 344 (10th Cir. 2020) (unpublished): Central to the panel’s recharacterization move: when a district court labels a dismissal “frivolous” but the real defect is inadequate pleading, the correct lens is § 1915(e)(2)(B)(ii) (failure to state a claim).
  • Neitzke v. Williams, 490 U.S. 319 (1989): Anchors the distinction between “frivolous” claims (e.g., indisputably meritless legal theories or “fantastic or delusional” facts) and merely insufficient pleadings. The court relied on Neitzke to explain why Watson’s claim was not “automatically frivolous,” even though it failed under Rule 12(b)(6)-type standards.
  • Gaines v. Stenseng, 292 F.3d 1222 (10th Cir. 2002), Perkins v. Kan. Dep't of Corr., 165 F.3d 803 (10th Cir.1999), and Cummings v. Evans, 161 F.3d 610 (10th Cir.1998): Provide that failure-to-state-a-claim dismissals are reviewed de novo and that pro se pleadings are construed liberally.
  • Hall v. Bellmon, 935 F.2d 1106 (10th Cir. 1991): Limits liberal construction: courts do not act as the pro se litigant’s advocate by supplying missing facts or legal theories.

Deliberate indifference standard (Eighth Amendment applied via Fourteenth Amendment)

  • Burke v. Regalado, 935 F.3d 960 (10th Cir. 2019): Reaffirms that pretrial detainee medical-care claims arise under the Fourteenth Amendment but are analyzed identically to Eighth Amendment deliberate-indifference claims.
  • Farmer v. Brennan, 511 U.S. 825 (1994): Provides the subjective standard—official must know of and disregard an excessive risk.
  • Estelle v. Gamble, 429 U.S. 97 (1976): The foundational case: deliberate indifference violates the Constitution, but medical malpractice/negligence does not.
  • Lopez v. LeMaster, 172 F.3d 756 (10th Cir. 1999): Supports using the same analysis for Fourteenth Amendment detainee claims as Eighth Amendment claims.
  • Strain v. Regalado, 977 F.3d 984 (10th Cir. 2020) and Clark v. Colbert, 895 F.3d 1258 (10th Cir. 2018): Cited for the two-part framework (objective seriousness + subjective culpability).
  • Sealock v. Colorado, 218 F.3d 1205 (10th Cir. 2000): Quoted for the subjective element (“knows of and disregards” an excessive risk).
  • Self v. Crum, 439 F.3d 1227 (10th Cir. 2006): Reinforces that allegations consistent with negligence, without more, are insufficient for deliberate indifference.

Failure-to-warn about side effects as (at most) negligence

  • Bryant v. Kaskie, 744 F. App'x 39 (3d Cir. 2018) (unpublished) and Burgess v. Mar, 395 F. App'x 368 (9th Cir. 2010) (unpublished): Persuasive authority that an alleged failure to inform a prisoner about medication side effects, standing alone, does not demonstrate deliberate indifference.
  • Phillips v. Wexford Health Sources, Inc., 522 F. App'x 364 (7th Cir. 2013) (unpublished): Emphasizes the missing link in Watson’s pleadings: absent allegations that side-effect risks were significant and that defendants knew they were significant, the subjective prong fails.

Supplemental jurisdiction after federal claims are dismissed

  • Foxfield Villa Assocs., LLC v. Robben, 967 F.3d 1082 (10th Cir. 2020) and United States v. Botefuhr, 309 F.3d 1263 (10th Cir. 2002): Support the general practice that state claims should be dismissed once federal claims are gone, particularly pretrial.

Frivolous appeals, and PLRA strikes

  • Jennings v. Natrona Cnty. Det. Ctr. Med. Facility, 175 F.3d 775 (10th Cir. 1999), overruled in part on other grounds, Coleman v. Tollefson, 575 U.S. 532 (2015): Cited for the strike consequence: when a district court dismisses under § 1915(e)(2)(B) and the appeal is dismissed as frivolous, both can count as strikes.
  • Thomas v. Muskogee Sheriff's Dep't, 160 F. App'x 714 (10th Cir. 2005) (unpublished) and Ford v. Pryor, 552 F.3d 1174 (10th Cir. 2008): Provide standards for deeming an appeal frivolous (no arguable basis; outcome obvious).
  • Hafed v. Fed. Bureau of Prisons, 635 F.3d 1172 (10th Cir. 2011), overruled in part on other grounds, Coleman v. Tollefson, 575 U.S. 532 (2015): Cited to define when a prisoner earns a strike under 28 U.S.C. § 1915(g).

3.2 Legal Reasoning

  1. Proper characterization of the screening dismissal drives the appellate lens. The panel carefully separated “frivolousness” under § 1915(e)(2)(B)(i) (reserved for claims that are indisputably meritless or delusional) from mere pleading insufficiency under § 1915(e)(2)(B)(ii). Because the district court dismissed for lack of factual allegations showing deliberate indifference, the Tenth Circuit treated it as a failure-to-state-a-claim dismissal and applied de novo review.
  2. Fourteenth Amendment detainee claim requires the same deliberate-indifference proof as Eighth Amendment. Citing Burke v. Regalado and Lopez v. LeMaster, the court applied the familiar two-part test: objective seriousness and subjective culpability.
  3. The subjective prong was the pleading failure. Watson alleged the doctors did not warn him about Depakote’s long-term side effects and that one doctor’s report led him to believe Depakote was not a “psychotic drug.” But he did not plead facts that either doctor knew Depakote posed a substantial risk of the specific long-term harms alleged, nor that they disregarded such a risk. Under Farmer v. Brennan and Sealock v. Colorado, that omission is fatal.
  4. Failure to warn is treated as negligence, not a constitutional tort, on these allegations. The panel relied on Estelle v. Gamble (malpractice ≠ constitutional violation) and cited persuasive, unpublished authority (Bryant v. Kaskie, Burgess v. Mar, Phillips v. Wexford Health Sources, Inc.) to reinforce that a bare “failure to inform of side effects” theory, without subjective-risk awareness, does not state deliberate indifference.
  5. State-law claims properly fell away with the federal claim. Consistent with Foxfield Villa Assocs., LLC v. Robben and United States v. Botefuhr, once the federal claim was dismissed at the outset, the district court’s choice to decline supplemental jurisdiction was the expected course.
  6. The appeal was frivolous because it did not attack the dispositive rulings. The panel emphasized that Watson mostly argued the merits of state-law negligence (which the district court did not reach) and failed to explain why declining supplemental jurisdiction was incorrect. Under Thomas v. Muskogee Sheriff's Dep't and Ford v. Pryor, that absence of an arguable basis justified dismissal of the appeal as frivolous, denial of ifp, and assessment of strikes.

3.3 Impact

  • Clarifies (in persuasive form) the boundary between “frivolous” and “fails to state a claim” at screening. Even when the outcome is dismissal, the categorization matters for the standard of review and for keeping § 1915(e)(2)(B)(i) reserved for truly baseless or delusional cases.
  • Reinforces the subjective-knowledge requirement in medication-harm theories. Plaintiffs alleging constitutional injury from medication effects must plead facts supporting that each defendant actually knew of a substantial risk and disregarded it—particularly when the defendant did not prescribe the medication and served in an evaluative role.
  • Signals appellate pleading discipline under the PLRA regime. The decision underscores that appeals that do not engage the district court’s actual reasons—especially on supplemental jurisdiction—risk being labeled frivolous, denied ifp, and generating a second strike.
  • Practical consequence: accelerated “three strikes” exposure. By assessing two strikes here (district court + appeal), the case illustrates how quickly repeated screening dismissals and meritless appeals can restrict a prisoner’s future access to ifp status under § 1915(g).

4. Complex Concepts Simplified

Deliberate indifference
A constitutional standard requiring more than careless medical treatment. The plaintiff must show: (1) a serious medical need (objective), and (2) the defendant actually knew of a substantial risk and ignored it (subjective). Negligence or malpractice alone is not enough.
§ 1915(e)(2)(B)(i) “frivolous” vs. § 1915(e)(2)(B)(ii) “failure to state a claim”
“Frivolous” is reserved for claims with no arguable legal/factual basis (including delusional allegations). “Failure to state a claim” means the facts alleged—assumed true—still do not satisfy the legal elements. The distinction affects appellate review (often abuse-of-discretion vs. de novo) and how courts describe the defect.
Supplemental jurisdiction
A federal court’s power to hear related state-law claims. When the federal claims drop out early, courts usually dismiss the state claims without deciding their merits, leaving them for state court.
IFP and “good faith” on appeal
Proceeding without prepaying fees requires both financial eligibility and a nonfrivolous appellate argument. If the appeal lacks an arguable basis, ifp is denied even if the appellant cannot afford fees.
PLRA “strike”
Under 28 U.S.C. § 1915(g), dismissals for frivolousness, maliciousness, or failure to state a claim can count as “strikes.” After three strikes, a prisoner generally cannot proceed ifp in future civil actions absent imminent danger.

5. Conclusion

Watson v. DeQuardo underscores two intertwined lessons. Substantively, a detainee’s claim that evaluators failed to warn about medication side effects—without pled facts showing defendants’ subjective awareness of a substantial risk—sounds in negligence, not Fourteenth Amendment deliberate indifference. Procedurally, the opinion highlights the importance of correctly distinguishing “frivolous” claims from complaints that merely fail to state a claim, while also illustrating the steep consequences for prisoners who pursue appeals without addressing the dispositive legal rulings: denial of ifp and accumulation of PLRA strikes.