Preservation on Appeal and the “High Bar” for Pretrial Detainee Deliberate-Indifference Claims Under Short v. Hartman

1. Introduction

Beatrice V. Johnson v. Tanya Adams (4th Cir. Mar. 4, 2026) is an unpublished per curiam decision arising from the death of Paul Antione Johnson, a pretrial detainee at the Colleton County Detention Center (CCDC). After Johnson was booked on July 11, 2019, he suffered a medical emergency on July 17, was hospitalized, and died on July 19.

Johnson’s mother, Beatrice V. Johnson, sued under 42 U.S.C. § 1983, alleging deliberate indifference to Johnson’s medical needs (with emphasis on diabetes management) in violation of the Fourteenth Amendment. Defendants included: (i) CCDC employees Tanya Adams, Joyce Rice, and Janet White (the “CCDC Defendants”); and (ii) Henry Williams, LPN, a nurse employed by a private medical contractor serving CCDC.

The central appellate issues were whether summary judgment was properly granted because (1) the record did not support deliberate indifference under governing Fourth Circuit standards, and (2) several appellate theories were waived (not adequately preserved in the district court).

2. Summary of the Opinion

The Fourth Circuit affirmed summary judgment for all defendants. As to Henry Williams, the court held that the plaintiff failed to create a genuine dispute of material fact on the third element of the deliberate-indifference test (that Williams “knew or should have known” both of the condition and that his action/inaction posed an unjustifiably high risk of harm). The court also found one key appellate theory (a claimed “physician’s order” for thrice-daily blood sugar checks) to be waived.

As to the CCDC Defendants, the court affirmed because the plaintiff’s appellate theory—failure to communicate Johnson’s deterioration to medical staff—was not raised before the magistrate judge or district court and was therefore procedurally barred on appeal.

Because the court found no constitutional violation on the merits as to Williams, it “need not reach” qualified immunity.

3. Analysis

3.1 Precedents Cited

  • United States v. 8.929 Acres of Land in Arlington Cnty., 36 F.4th 240 (4th Cir. 2022)
    Used for the appellate standard of review and summary-judgment framing: de novo review and the requirement that a genuine factual dispute be supported by enough evidence for a reasonable jury to find for the nonmovant.
  • Short v. Hartman, 87 F.4th 593 (4th Cir. 2023)
    Supplies the four-part deliberate-indifference test for pretrial detainees under the Fourteenth Amendment, including the key objective phrasing that the defendant “knew or should have known” of the condition and the unjustifiably high risk created by action/inaction.
  • CoreTel Va., LLC v. Verizon Va., LLC, 808 F.3d 978 (4th Cir. 2015) and United States v. Bennett, 698 F.3d 194 (4th Cir. 2012)
    These cases drive the opinion’s waiver/forfeiture analysis: arguments must be pressed with sufficient specificity to alert the district court to the “specific reason” relief is sought; a party may not rely on “fleeting references” and then expand into a new appellate theory.
  • Jackson v. Lightsey, 775 F.3d 170 (4th Cir. 2014) and Wright v. Collins, 766 F.2d 841 (4th Cir. 1985)
    Stand for the recurring boundary line: deviation from the standard of care, negligence, or malpractice—without more—does not meet the “high bar” of a constitutional deliberate-indifference claim under § 1983.
  • Sedar v. Reston Town Ctr. Prop., LLC, 988 F.3d 756 (4th Cir. 2021)
    Cited for the proposition that “speculation” cannot support a reasonable inference necessary to survive summary judgment; the plaintiff’s characterization of the detainee’s “different look” and lethargy was treated as insufficiently concrete to show the requisite knowledge/risk.
  • United States v. Clawson, 650 F.3d 530 (4th Cir. 2011) and Mays v. Sprinkle, 992 F.3d 295 (4th Cir. 2021)
    Used to reinforce that a “mere difference of opinion” with medical staff’s professional judgment does not establish deliberate indifference, and that Fourteenth Amendment pretrial-detainee medical claims are evaluated using precedent developed in the Eighth Amendment deliberate-indifference context.

3.2 Legal Reasoning

A. The summary-judgment lens (Rule 56) and the “genuine dispute” requirement

Applying Fed. R. Civ. P. 56(a) through United States v. 8.929 Acres of Land in Arlington Cnty., the court required evidence that would allow a reasonable jury to find deliberate indifference—not merely that Johnson’s outcome was tragic or that different medical steps might have been preferable.

B. The deliberate-indifference framework (and why the third element mattered most)

Under Short v. Hartman, the plaintiff had to show (among other elements) that Williams “knew or should have known” of Johnson’s serious condition and that Williams’ response posed an unjustifiably high risk of harm. The opinion resolved the Williams claim largely by concluding the record did not support that knowledge/risk component on the proffered facts.

C. Preservation/waiver: a case-dispositive procedural holding

The court treated as waived the argument that Williams ignored a “physician’s order” for thrice-daily blood sugar testing, relying on CoreTel Va., LLC v. Verizon Va., LLC and United States v. Bennett. The plaintiff’s brief references in the district court were deemed insufficient to preserve the narrower, more pointed appellate claim that a doctor’s order was ignored.

This is more than a technicality: by removing the “ignored order” theory, the court evaluated Williams’ conduct primarily through what the record showed he observed and did, not through a presumed noncompliance with a specific medical directive.

D. Merits as to Williams: negligence and disagreement are not deliberate indifference

The plaintiff pointed to three categories of evidence: (1) the thrice-daily testing notation; (2) alleged deterioration from July 11–17; and (3) Williams’ response to symptoms on July 17. The court held none created a triable issue of deliberate indifference:

  • (1) Thrice-daily testing notation: the “physician’s order” framing was waived; and to the extent the dispute was about the standard of care, Jackson v. Lightsey and Wright v. Collins foreclosed converting standard-of-care deviation into a constitutional claim absent evidence of the requisite mental state (at least recklessness) and unjustifiably high risk.
  • (2) July 11–17 deterioration: the court emphasized the absence of complaints by Johnson, the existence of frequent observation, and Williams’ lack of presence on July 15–16. Assertions like a “different look” and lethargy were treated as insufficiently concrete and too speculative under Sedar v. Reston Town Ctr. Prop., LLC.
  • (3) July 17 response: Williams monitored breathing issues and ordered breathing treatment; he followed directions from a supervising physician and a mental health provider after a blood sugar reading of 245 and odd behavior. The court characterized the plaintiff’s challenge as a “mere difference of opinion” with professional judgment, which United States v. Clawson says cannot establish a constitutional violation (as applied to pretrial detainees via Mays v. Sprinkle).

E. Claims against the CCDC Defendants: forfeiture of the communication theory

The court affirmed summary judgment for the CCDC Defendants on a distinct procedural basis: the plaintiff’s appellate contention that CCDC staff failed to communicate deterioration to medical personnel was not raised before the magistrate judge or district court. The result was an appellate procedural bar, leaving no preserved argument to reverse summary judgment as to those defendants.

3.3 Impact

Although unpublished and “not binding precedent,” the decision illustrates several practice-shaping lessons that are likely to influence litigants and district court litigation strategy in detainee medical-care cases:

  • Issue preservation can be outcome-determinative: the court’s reliance on waiver doctrine (for both Williams and the CCDC Defendants) signals that plaintiffs must identify and press precise theories—especially “ignored order” or “failure to communicate” theories—squarely and with record support at the district court level.
  • Post-Short scrutiny remains demanding: even with the “knew or should have known” formulation in Short v. Hartman, plaintiffs still must connect observable facts to an unjustifiably high risk, not just to an adverse outcome or arguable negligence.
  • Standard-of-care evidence is not enough without constitutional-grade culpability: the opinion reinforces the line separating malpractice from § 1983 deliberate indifference, relying on Jackson v. Lightsey and Wright v. Collins.
  • Summary judgment will turn on evidentiary specificity: generalized descriptions (e.g., “different look,” “lethargy”) may be deemed speculative under Sedar unless anchored to concrete, documented observations that reasonably convey a serious risk.

4. Complex Concepts Simplified

  • Deliberate indifference: more than a mistake. It requires proof that a defendant acted (or failed to act) in a way that was at least reckless in the face of a serious medical risk—under Short v. Hartman, including situations where the defendant “should have known” of the risk.
  • “High bar” vs. negligence: medical negligence/malpractice concerns substandard care; deliberate indifference concerns constitutionally blameworthy disregard of serious risk. Jackson v. Lightsey and Wright v. Collins are cited to keep that boundary firm.
  • Qualified immunity: a defense that can shield officials from damages if the law was not clearly established. The court did not reach it as to Williams because it found no constitutional violation on the merits.
  • Waiver/forfeiture on appeal: an appellate court generally will not consider arguments not clearly presented to the district court. CoreTel Va., LLC v. Verizon Va., LLC and United States v. Bennett are used to enforce that rule.
  • Summary judgment: a pretrial ruling where the court decides there is no genuine dispute of material fact for a jury. The nonmovant must produce evidence, not speculation, sufficient for a reasonable jury verdict (United States v. 8.929 Acres of Land in Arlington Cnty.; Sedar).

5. Conclusion

Beatrice V. Johnson v. Tanya Adams affirms summary judgment in a detainee-death case by pairing a strict application of deliberate-indifference doctrine with equally strict enforcement of appellate issue-preservation rules. The opinion underscores that (1) plaintiffs must preserve precise theories in the district court, (2) evidence of negligence or a disputable standard of care will not, without more, satisfy the constitutional “high bar,” and (3) disagreements with medical judgment—absent evidence of recklessness toward a serious risk—do not amount to deliberate indifference under the Fourteenth Amendment framework articulated in Short v. Hartman.