Macias v. Perry: Reaffirming the “Extremely High” Bar for Pretrial Detainee Mental‑Health Deliberate‑Indifference Claims at the Pleading Stage

Macias v. Perry: Reaffirming the “Extremely High” Bar for Pretrial Detainee Mental‑Health Deliberate‑Indifference Claims at the Pleading Stage

I. Introduction

In Macias v. Perry, No. 25‑40028 (5th Cir. Dec. 22, 2025) (per curiam) (unpublished), the United States Court of Appeals for the Fifth Circuit affirmed the dismissal of § 1983 claims brought by the parents and estate of Jason John Perez, a mentally ill pretrial detainee who was later killed when he walked into oncoming traffic. Although the district court had focused on causation under Texas law, the Fifth Circuit affirmed on a different ground: the complaint did not plausibly allege “deliberate indifference” to serious medical needs as required for a Fourteenth Amendment claim.

The panel’s opinion does not create new doctrine; it is expressly unpublished and thus non‑precedential under 5th Cir. R. 47.5. Nonetheless, it is a clear, practical application of existing Fifth Circuit standards that:

  • Re‑emphasizes that deliberate indifference is an “extremely high” standard, especially in the mental‑health context;
  • Holds that incomplete or arguably erroneous mental‑health screening, documentation, and release decisions at a jail amount at most to negligence or gross negligence—not a constitutional violation—absent specific facts showing wanton disregard;
  • Illustrates how claims couched in terms of “failure to document,” “incorrect forms,” or “failure to refer for inpatient care” will routinely be dismissed at the Rule 12(b)(6) stage if they sound in medical judgment or negligence rather than purposeful disregard of risk;
  • Clarifies, in practice, that where § 1983 wrongful‑death and survival claims derive from the same alleged constitutional violation, a failure to plausibly plead that violation will dispose of both, without any need to reach complex causation issues.

The decision will be instructive for practitioners litigating detainee mental‑health cases in the Fifth Circuit, particularly at the pleading stage, and for jail and mental‑health providers seeking to understand the boundary between medical negligence and constitutional liability.

II. Case Overview

A. Parties

  • Plaintiffs–Appellants:
    • Manuel Macias and Diana Perez, individually and as representatives of the Estate of their son, Jason John Perez, and
    • The Estate of Jason Perez.
  • Defendants–Appellees (the only parties on appeal):
    • Corporal Analicia Perry, a Live Oak County Jail corporal;
    • Officer Analicia Vasquez, a Live Oak County Jail officer (Appellees asserted below that Perry and Vasquez are the same person; the court, following the complaint, treated them as distinct);
    • Patricia Carabajal, a mental‑health provider employed by Coastal Plains Community Center, which provided services to the jail.

Other counties and entities were named below, including county defendants subject to Monell claims, but those parties were not included in the notices of appeal, and the Fifth Circuit therefore did not review any rulings as to them.

B. Factual Background

The court recites the facts as alleged in the “operative complaint,” taking well‑pleaded facts as true for purposes of Rule 12(b)(6). The key allegations are:

  • Jason Perez suffered from serious mental illnesses, including bipolar disorder, paranoid schizophrenia, and depression.
  • After moving to Live Oak County, Texas, his mother, Diana Perez, called the police multiple times because of his threatening or unsafe behavior. In the week leading up to his death, Jason had been arrested in a separate incident and police had been called again over concerns for his safety and threats.
  • On the morning of his death, Diana again called police due to Jason’s behavior, including threats toward her. Officers located Jason and transported him to the Live Oak County Jail.
  • Police allegedly documented manifestations of his mental illness, including in a “Notice of Emergency Detention” form, noting paranoid and delusional behavior and risk of harm.

At the jail:

  • Intake by Perry and Vasquez:
    • Perry (corporal) and Vasquez (officer) completed “intake documentation,” including a form titled “Screening for Suicide and Medical/Mental/Dev. Impairments.”
    • They allegedly failed to include the most relevant symptoms and answered “NO” to questions about whether Jason was worried someone was trying to hurt him and whether he was showing signs of mental illness.
    • Perry completed an “Inmate Mental Condition Report to Magistrate” but allegedly left unchecked the box for “Subject is violent and appears to be a danger to themselves or others.” Plaintiffs assert the form may never have reached the magistrate (though the record is unclear).
    • Perry also “signed off” on another piece of documentation—apparently prepared by a police officer—indicating Jason was paranoid, delusional, and at risk of harm.
    • Plaintiffs characterize Perry and Vasquez’s documentation as “inaccurate” and “indifferent,” allegedly forwarded to magistrates and health providers so Jason would not receive medical care.
  • Telephone screening by Carabajal:
    • Carabajal, a health‑care provider for Coastal Plains Community Center, conducted a telephone screening of Jason and completed an MHMR (mental health/mental retardation) assessment.
    • Plaintiffs allege she knew Jason was in a mental‑health crisis and that an officer wanted to share additional information about his mental status, but she ignored that information.
    • She documented “mania” and “mood swings” as Jason’s symptoms but failed to document other alleged symptoms (bizarre behavior, hallucinations, paranoia, delusions, anxiety), even though others overheard him repeating delusional thoughts during the screening.
    • She concluded that Jason did not need further inpatient treatment, which Plaintiffs characterize as “indifferent” and contradictory of her own findings.
    • Plaintiffs at one point say she “failed to medically treat Jason at all,” despite also alleging that she performed an assessment.

Jason was released from Live Oak County Jail the same day. That evening, a patrol officer unrelated to the case misidentified him as someone else and drove him to a restaurant. Afterward, Jason—allegedly still in a delusional state—walked into oncoming traffic on a highway and was struck and killed by a vehicle.

C. Procedural History

  1. State‑court filing and removal:
    • Plaintiffs filed suit in November 2022 in the 24th Judicial District Court of DeWitt County, Texas.
    • Defendants removed to federal court (Southern District of Texas) based on federal‑question jurisdiction under 28 U.S.C. § 1331.
  2. Claims in the operative complaint:
    • Claims under 42 U.S.C. § 1983 for violations of Jason’s Fourth and Fourteenth Amendment rights (though only Fourteenth Amendment medical‑care claims were pursued on appeal).
    • Monell claims under § 1983 against county defendants and entities.
    • Wrongful death and survival claims under 42 U.S.C. § 1988, premised on the same alleged constitutional violations.
  3. Motions to dismiss:
    • Appellees moved to dismiss under:
      • Rule 12(b)(1) (subject‑matter jurisdiction),
      • Rule 12(b)(5) and Rule 4(m) (service issues, largely as to other defendants), and
      • Rule 12(b)(6) (failure to state a claim), arguing no constitutional violation and entitlement to qualified immunity.
  4. Magistrate judge’s recommendations:
    • Recommended dismissing all claims except Plaintiffs’ § 1983 claims against Perry, Vasquez, and Carabajal.
    • As to Appellees, the magistrate believed Plaintiffs had adequately alleged knowledge of Jason’s serious mental illness and failure to provide appropriate care.
  5. District court’s ruling on the merits:
    • In March 2024, the district court modified and adopted the magistrate’s R&R, but it also dismissed the § 1983 claims against Appellees.
    • The court focused on Texas causation law and held that Appellees’ alleged failures in intake, screening, and referral did not cause Jason to be on the highway where he was killed.
    • On that basis, the court dismissed the § 1983 claims and the related § 1988 wrongful death and survival claims with prejudice.
  6. Post‑judgment motions:
    • Plaintiffs moved under Rule 59(e) to alter or amend the judgment, or alternatively under Rule 60(b) for relief from judgment.
    • The magistrate recommended denying the motion; no party objected.
    • The district court adopted the recommendation and denied post‑judgment relief.
  7. Appeal:
    • Plaintiffs filed a notice and supplemental notice of appeal, both expressly limited to “Defendants, Analicia Perry, Analicia Vasquez, and Patricia Carabajal.”
    • Although the notice named only the order denying post‑judgment relief, the Fifth Circuit, citing Norsworthy v. Houston ISD, 70 F.4th 332 (5th Cir. 2023), exercised jurisdiction over the underlying final judgment under 28 U.S.C. § 1291.
    • The panel reviewed the Rule 12(b)(6) dismissal de novo, drawing reasonable inferences in Plaintiffs’ favor but disregarding conclusory allegations.

III. Summary of the Fifth Circuit’s Opinion

On appeal, Plaintiffs effectively pursued one type of federal claim: that the Appellees violated Jason Perez’s Fourteenth Amendment right to adequate medical care by acting with deliberate indifference to his serious mental‑health needs while he was a pretrial detainee. Their § 1983 wrongful‑death and survival claims were derivative of that alleged constitutional violation.

The panel:

  • Confirmed that pretrial detainees have a Due Process right not to have their serious medical needs met with deliberate indifference, citing Thompson v. Upshur County, 245 F.3d 447 (5th Cir. 2001), and Hare v. City of Corinth, 74 F.3d 633 (5th Cir. 1996) (en banc);
  • Applied the deliberate‑indifference framework from Dyer v. Houston, 964 F.3d 374 (5th Cir. 2020), and Domino v. Texas Dep’t of Criminal Justice, 239 F.3d 752 (5th Cir. 2001);
  • Held that Plaintiffs’ factual allegations, taken as true, showed at most negligence or gross negligence in screening, documentation, and treatment decisions—not deliberate indifference;
  • Thus held that Plaintiffs failed to plausibly state a constitutional violation, and therefore their § 1983 medical‑care, wrongful‑death, and survival claims failed;
  • Affirmed the district court’s judgment on that ground, without needing to reach the district court’s alternative causation analysis under Texas law (although the panel signaled agreement in a footnote that the causal link to Jason’s highway death was “very obvious[ly]” lacking).

The bottom line: the Fifth Circuit reaffirmed that allegations of inaccurate mental‑health documentation, incomplete symptom recording, and arguably mistaken release decisions—even where tragic harm follows—do not meet the “extremely high” deliberate‑indifference standard absent specific facts showing that officials subjectively perceived a substantial risk of serious harm and consciously disregarded it.

IV. Detailed Analysis

A. Scope of Appeal and Notice Requirements

Before turning to the merits, the panel addressed a threshold procedural issue: Plaintiffs’ notices of appeal.

  • The notices explicitly confined the appeal to portions of the judgment “against Defendants, Analicia Perry, Analicia Vasquez, and Patricia Carabajal.”
  • Yet Plaintiffs’ appellate briefing asked the Fifth Circuit to revive their Monell claims against multiple county defendants.
  • Under Fed. R. App. P. 3(c)(6), a notice of appeal must “designate the judgment—or the appealable order—from which the appeal is taken.” While the court interprets notices liberally, it will not rewrite them to encompass parties or issues clearly excluded.

Citing Trust Co. Bank v. U.S. Gypsum Co., 950 F.2d 1144 (5th Cir. 1992), the panel observed that liberal construction is appropriate where it is clear the appellant intended to appeal the entire case. Here, the opposite was true: Plaintiffs twice filed notices expressly limited to three individuals. The court therefore refused to consider arguments relating to other defendants or to Monell liability.

Practical impact: Litigants must draft notices of appeal carefully; explicit limitation to certain defendants can irrevocably narrow the scope of appellate review, no matter how broadly the opening brief is written.

B. Standard of Review and Effect of Non‑Objection to the Magistrate

Although Plaintiffs did not object to the magistrate judge’s recommendation denying their Rule 59(e)/60(b) motion, the Fifth Circuit still applied de novo review to the Rule 12(b)(6) dismissal. Relying on Alexander v. Verizon Wireless Services, L.L.C., 875 F.3d 243 (5th Cir. 2017), the panel explained:

  • Ordinarily, failure to object to a magistrate judge’s report can limit appellate review.
  • But if the district court undertakes its own “independent review of the record” and expressly adopts the magistrate’s reasoning as consistent with the law and the record, then the court of appeals conducts de novo review notwithstanding the lack of objections.

Here, the district court indicated it had independently reviewed the magistrate judge’s findings and the record. That sufficed to preserve full appellate review of the dismissal.

C. The Deliberate‑Indifference Framework

1. Pretrial detainee’s right to medical care

The panel restated the basic rule:

“[P]retrial detainees have a constitutional right, under the Due Process Clause of the Fourteenth Amendment, not to have their serious medical needs met with deliberate indifference on the part of the confining officials.”

(citing Thompson v. Upshur Cnty., 245 F.3d 447, 457 (5th Cir. 2001) (relying on Estelle v. Gamble, 429 U.S. 97 (1976)), and Hare v. City of Corinth, 74 F.3d 633 (5th Cir. 1996) (en banc)).

In the Fifth Circuit, episodic acts or omissions (e.g., intake decisions, response to a particular medical crisis) are evaluated using the same subjective deliberate‑indifference standard applied under the Eighth Amendment to convicted prisoners, even though the source of the right is the Fourteenth Amendment’s Due Process Clause.

2. Elements of deliberate indifference

The court quoted Dyer v. Houston, 964 F.3d 374 (5th Cir. 2020), for the two‑part test:

  1. The official was aware of facts from which the inference could be drawn that a substantial risk of serious harm existed; and
  2. The official actually drew that inference—i.e., subjectively appreciated the risk—and then disregarded it.

This formulation comes from the Supreme Court’s decision in Farmer v. Brennan, 511 U.S. 825 (1994), and has been repeatedly applied by the Fifth Circuit in detainee and prisoner medical‑care cases.

3. High bar: negligence vs. deliberate indifference

The panel emphasized established Fifth Circuit law:

  • “Deliberate indifference is an extremely high standard to meet.” Domino v. TDCJ, 239 F.3d 752, 756 (5th Cir. 2001).
  • It cannot be inferred “merely from a negligent or even a grossly negligent response to a substantial risk of serious harm.” Dyer, 964 F.3d at 381.
  • “An incorrect diagnosis by prison medical personnel does not suffice.” Domino, 239 F.3d at 756.
  • The plaintiff must show refusal to treat, ignoring complaints, intentional incorrect treatment, or similar conduct that “clearly evince[s] a wanton disregard for any serious medical needs.” Id.
  • Decisions about “whether to provide additional treatment” are “a classic example of a matter for medical judgment” and thus, absent more, do not establish deliberate indifference. Id. (quoting Estelle, 429 U.S. at 107).
  • “Failure to alleviate a significant risk that [the official] should have perceived, but did not” is insufficient. Dyer, 964 F.3d at 381 (quoting Farmer, 511 U.S. at 838).

The panel also relied on Gobert v. Caldwell, 463 F.3d 339, 346 (5th Cir. 2006), reiterating that “unsuccessful medical treatment, acts of negligence, or medical malpractice do not constitute deliberate indifference,” nor does a prisoner’s disagreement with the treatment he received.

D. Application to the Allegations Against Appellees

The heart of the opinion lies in how the panel applies the above framework to Plaintiffs’ specific allegations about jail intake officers and a mental‑health provider in a psychiatric‑crisis context.

1. Comparison to Dyer v. Houston

The court explicitly relied on and analogized to Dyer. In Dyer:

  • Paramedics evaluated an arrestee exhibiting erratic behavior, incoherence, screaming, and signs of a serious head injury, and who had consumed LSD.
  • The complaint alleged they should have taken additional steps—transport to a hospital, sedation, further monitoring—but they did not.
  • On a Rule 12(b)(6) motion, the Fifth Circuit held those allegations at most described negligence or gross negligence, not deliberate indifference.

Here, the “thrust” of the complaint against Appellees is similar:

  • Perry and Vasquez allegedly failed to document all of Jason’s symptoms or accurately complete suicide/mental‑health screening forms, giving the impression he was “not in crisis mode” and thereby decreasing the likelihood of a thorough evaluation or specialized treatment.
  • Carabajal performed a telephonic assessment, documented some symptoms but not others, allegedly ignored offered information, and concluded Jason did not need inpatient care.

The Fifth Circuit viewed this, as in Dyer, as an assertion that officials “should have provided additional care,” not that they consciously chose to leave a known, substantial risk unaddressed. The panel again characterized the decisions challenged by Plaintiffs—how to complete intake forms, how to weigh symptoms, whether to refer for inpatient treatment—as “classic example[s] of [matters] for medical judgment” that do not, without more, support a deliberate‑indifference claim.

2. Allegations against Perry and Vasquez (jail staff)

The complaint alleged that Perry and Vasquez:

  • Had observations and knowledge of Jason’s serious mental‑health issues;
  • Nonetheless answered “NO” on screening forms to key questions about paranoia and signs of mental illness;
  • Left boxes unchecked on a magistrate mental‑condition report (specifically, whether Jason was violent and dangerous to himself or others);
  • Thereby created inaccurate documentation that, when forwarded to other actors, downplayed Jason’s risk and reduced the chance he would receive more robust care.

Even accepting these facts as true, the panel concluded they did not plausibly allege deliberate indifference:

  • The alleged conduct shows, at most, negligent intake and documentation, perhaps even grossly negligent under Plaintiffs’ characterizations.
  • But the complaint lacks concrete factual allegations that Perry or Vasquez:
    • Subjectively recognized a substantial risk that Jason would seriously harm himself or others if released that day, and
    • Consciously decided to disregard that risk (for instance, by refusing to initiate clearly available and obviously necessary interventions).
  • Instead, the allegations concern how they answered form questions and what they did or did not record—a classic “documentation and triage” critique that falls into the realm of negligence and professional judgment, not constitutional wrongdoing.

Under Domino, Dyer, and Gobert, this is exactly the category of cases the Fifth Circuit has consistently held do not satisfy the “extremely high” deliberate‑indifference standard.

3. Allegations against Carabajal (mental‑health provider)

As to Carabajal, Plaintiffs alleged that she:

  • Was aware Jason was in a mental‑health crisis and that a police officer had additional information;
  • Ignored offered information and conducted only a telephone screening;
  • Documented “mania” and “mood swings” but not other symptoms (bizarre behavior, hallucinations, paranoia, delusions, anxiety), even though others overheard Jason repeating delusional thoughts;
  • Concluded that he did not meet criteria for inpatient treatment, allegedly contradicting her own findings and “fail[ing] to medically treat Jason at all.”

The Fifth Circuit again concluded these allegations sounded in negligence or diagnostic error:

  • Plaintiffs’ own pleading acknowledged that Carabajal had only “a mixture of thorough and indifferent reporting” and “incomplete data,” undermining any inference that she knowingly understated a clear and overwhelming risk.
  • The complaint simultaneously alleges that she conducted an assessment (documenting mania and mood swings) and that she “failed to medically treat Jason at all.” The court reads this as disagreement with the level and nature of treatment—precisely the type of dispute Estelle and Gobert identify as insufficient.
  • Nothing in the complaint alleges that Jason explicitly requested or obviously needed a particular intervention that she then intentionally denied despite knowing it was necessary to prevent serious harm.

Thus, “[a]t most,” Plaintiffs alleged that Appellees “acted with negligence in not taking further steps to treat Jason Perez while he was in Live Oak County Jail.” That is not enough to cross the “extremely high” deliberate‑indifference threshold.

E. Wrongful‑Death and Survival Claims Under § 1983

1. Distinct causation frameworks

The panel acknowledged that:

  • § 1983 survival and wrongful‑death claims can differ in their causation analysis, as recognized in Moore v. LaSalle Mgmt. Co., L.L.C., 41 F.4th 493, 504 (5th Cir. 2022); and
  • Under Phillips ex rel. Phillips v. Monroe County, 311 F.3d 369, 374 (5th Cir. 2002), a § 1983 wrongful‑death action requires plaintiffs to prove both:
    • the underlying constitutional deprivation, and
    • the requisite causal link (often incorporating state tort causation principles via § 1988).

The district court had focused on causation, concluding that Appellees’ alleged misconduct did not cause Jason to be on the highway later that evening and thus did not cause his death under Texas law. The panel, in footnote 11, opined that “it is very obvious that the death was not caused by Appellees’ conduct, even their alleged negligence,” signaling broad agreement with the district court’s proximate‑cause analysis.

2. Disposition based on lack of constitutional violation

However, the Fifth Circuit ultimately chose not to decide the appeal on causation grounds. Instead, it relied on a more fundamental defect:

  • Plaintiffs failed to plausibly allege a constitutional deprivation—i.e., deliberate indifference to serious medical needs—by Appellees.
  • Without a constitutional violation, neither § 1983 survival claims nor § 1983‑based wrongful‑death claims can proceed.

The court underscored:

“Claims brought as part of a survival action . . . redress any constitutional injuries suffered by the Decedent before his death.”
Moore, 41 F.4th at 504.

and:

“[A] plaintiff seeking to recover on a wrongful death claim under § 1983 must prove both the alleged constitutional deprivation required by § 1983 and the causal link . . . .”
Phillips, 311 F.3d at 374 (emphasis added).

Because the court concluded that the complaint did not clear the deliberate‑indifference bar, it held that both the survival and wrongful‑death components necessarily failed, regardless of the nuances of Texas causation law.

V. Clarifying Complex Concepts

A. Deliberate Indifference vs. Negligence (and Gross Negligence)

A recurring confusion in detainee medical‑care cases is the difference between:

  • Negligence: failure to exercise reasonable care; a mistake in judgment or treatment; misdiagnosis; sloppy or incomplete documentation.
  • Gross negligence: very serious carelessness; a marked departure from professional standards.
  • Deliberate indifference: a constitutional standard, requiring:
    • Subjective awareness of a substantial risk of serious harm, and
    • Conscious disregard of that risk.

Under Farmer, Estelle, Domino, Dyer, and Gobert, even conduct that would qualify as medical malpractice—or even gross negligence—does not automatically equal deliberate indifference. There must be “wanton disregard” for a known, serious risk, not merely poor judgment or incomplete care.

In Macias, the alleged incomplete mental‑health forms, imperfect symptom documentation, and arguably wrong decision not to send Jason to inpatient care fall squarely into the disfavored category of “negligence in the adequacy of treatment,” not the prohibited category of “intentional disregard of known danger.”

B. Pretrial Detainee Medical‑Care Rights in the Fifth Circuit

Pretrial detainees are not yet convicted and therefore cannot be “punished” without due process. Their right to adequate medical care arises from the Fourteenth Amendment’s Due Process Clause rather than directly from the Eighth Amendment. However, under Hare and its progeny, the Fifth Circuit:

  • Uses the same substantive standard—deliberate indifference—as applied to convicted prisoners, at least for episodic acts or omissions (like individual intake decisions or responses to a crisis);
  • Has not replaced the subjective deliberate‑indifference test with a purely objective “reasonableness” test for medical‑care claims, even after the Supreme Court’s decision in Kingsley v. Hendrickson, 576 U.S. 389 (2015), which altered the standard for pretrial detainee excessive‑force claims.

Macias thus reflects the continued vitality of the subjective deliberate‑indifference standard in the Fifth Circuit’s detainee medical‑care jurisprudence.

C. § 1983 Survival vs. Wrongful‑Death Claims and § 1988

Plaintiffs brought “wrongful death and survival” claims “under 42 U.S.C. § 1988.” Understanding this framework requires unpacking three components:

  1. Section 1983 creates a federal cause of action for deprivation of constitutional rights under color of state law, but it does not itself provide:
    • a federal survival statute (allowing decedent’s claims to outlive him), or
    • a federal wrongful‑death statute (providing recovery to survivors for their own losses).
  2. Section 1988 is a “gap‑filling” statute. It allows courts to borrow state survival and wrongful‑death law where doing so is consistent with federal law and policies. In Texas, for example:
    • The survival statute allows a decedent’s estate to pursue claims the decedent could have asserted had he lived.
    • The wrongful‑death statute allows certain relatives to seek damages for their own losses resulting from the death.
  3. In a § 1983 context:
    • Survival actions focus on the decedent’s own constitutional injuries before death (e.g., inadequate medical care while incarcerated).
    • Wrongful‑death actions focus on a constitutional violation that caused the death itself, with damages flowing to survivors.
    • Both, however, require proof of an underlying constitutional violation.

Macias underscores this last point: absent a plausible allegation that Appellees committed a constitutional violation, both survival and wrongful‑death claims fail, regardless of how causation is framed under state law.

D. Qualified Immunity (in the Background)

Although Appellees invoked qualified immunity in their motions to dismiss, the panel did not explicitly conduct a step‑by‑step qualified‑immunity analysis. Instead, it effectively resolved the first prong of the inquiry—whether Plaintiffs alleged a violation of a constitutional right—against Plaintiffs. Once the court found no plausible deliberate‑indifference claim, there was no need to reach:

  • whether the right was “clearly established” in a particularized way; or
  • any dispute about whether existing case law put the unconstitutionality of Appellees’ conduct “beyond debate.”

In practice, many Fifth Circuit detainee medical‑care cases are resolved at the pleading stage for failure to allege facts that state a constitutional violation with the requisite level of culpability—long before the court engages in a detailed “clearly established law” analysis.

VI. Likely Impact and Practical Implications

A. For Plaintiffs’ Attorneys in Detainee Mental‑Health Cases

Macias offers several cautionary lessons about pleading deliberate‑indifference claims in the Fifth Circuit:

  • Generic allegations of “indifferent” or “incorrect” documentation are not enough. Plaintiffs must plead specific facts showing that officials:
    • Recognized a substantial risk of serious harm, and
    • Chose to do substantially less than even minimally adequate care in conscious disregard of that risk.
  • Disagreement with mental‑health judgments is insufficient. Allegations that officers or clinicians should have documented more symptoms, considered different information, or made a different triage or referral decision will almost always be cast as “issues of medical judgment” or negligence, not constitutional violations.
  • Connect the dots factually. To survive Rule 12(b)(6), complaints must show more than “he was very ill, they didn’t do enough, and something terrible later happened.” They should allege:
    • Clear manifestations of suicide or self‑harm risk (if present);
    • Requests for help or explicit warnings to staff that were ignored or overridden for non‑medical reasons;
    • Policies or practices that in effect encouraged staff to disregard known risks.

B. For Jail Officials and Contract Mental‑Health Providers

While Macias is favorable to individual defendants, it is not an endorsement of minimal care. Rather, it highlights what typically shields jail staff and clinicians from § 1983 liability:

  • Documented assessment and some form of treatment or triage, even if later criticized, tends to be viewed as medical judgment, not deliberate indifference.
  • Errors in documentation or missed symptoms are generally treated as negligence, not constitutional wrongdoing, unless there is evidence that staff knew of a grave risk and consciously chose not to act.
  • Nevertheless, such errors may still produce:
    • State‑law negligence or malpractice exposure (if properly pleaded and not immunity‑barred);
    • Administrative or professional consequences; and
    • Serious human consequences, as this case tragically demonstrates.

From a risk‑management standpoint, Macias underscores the importance of:

  • Robust, accurate intake procedures for mentally ill detainees;
  • Clear communication among law enforcement, jail staff, and mental‑health providers;
  • Policies that encourage, rather than discourage, referral to specialized care when faced with ambiguous or incomplete information.

C. On Causation and Intervening Acts

Although not formally decided, the panel’s footnote that it was “very obvious” Appellees’ conduct did not cause Jason’s death suggests how Texas‑law proximate cause might be applied in similar § 1983 wrongful‑death cases:

  • Significant temporal and factual gaps (e.g., release from custody; later misidentification by another officer; independent decision to walk onto a highway) can break the causal chain.
  • Injuries occurring after an individual leaves custody may be especially difficult to causally link to in‑custody medical‑care decisions, absent exceptional facts (e.g., release of an acutely suicidal detainee directly onto a bridge, with explicit threats and warnings ignored).

Future plaintiffs asserting wrongful‑death claims based on in‑custody medical care should expect rigorous scrutiny of both:

  • the existence of a constitutional violation, and
  • whether that violation proximately caused the death under applicable state‑law principles borrowed via § 1988.

VII. Conclusion

Macias v. Perry reinforces, in a detailed factual context, several core features of Fifth Circuit detainee medical‑care jurisprudence:

  • The deliberate‑indifference standard is “extremely high” and requires proof of subjective awareness and wanton disregard—not merely negligent or even grossly negligent medical judgment.
  • Intake documentation errors, incomplete mental‑health screening, and arguably mistaken triage or referral decisions remain firmly within the realm of negligence absent additional facts showing purposeful disregard of known risk.
  • § 1983 survival and wrongful‑death claims rise or fall with the underlying constitutional violation; if the complaint fails to plausibly allege that violation, both types of claims fail without the need to reach complex causation questions.
  • Procedurally, narrowly drafted notices of appeal will limit the issues and parties before the court of appeals, and failure to object to a magistrate’s report does not preclude de novo review when the district court conducts its own independent review.

Although unpublished and therefore non‑precedential, Macias is a clear and instructive application of existing law. It signals that, in mental‑health cases involving pretrial detainees, plaintiffs must do more than allege tragic outcomes and flawed judgment; they must plead concrete facts showing that officials subjectively recognized and deliberately disregarded a substantial risk of serious harm. Without such allegations, federal constitutional claims will not survive past the Rule 12(b)(6) stage, even in the face of severe mental illness and heartbreaking consequences.

Case Details

Year: 2025
Court: Court of Appeals for the Fifth Circuit

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