Professional Judgment, Deliberate Indifference, and Harmless Error in Civil Detainee Medical-Care Claims: Commentary on Nealy v. Masters (11th Cir. 2025)

Professional Judgment, Deliberate Indifference, and Harmless Error in Civil Detainee Medical-Care Claims:
Commentary on Nealy v. Masters, No. 24‑13002 (11th Cir. Nov. 26, 2025)

I. Introduction

This commentary analyzes the Eleventh Circuit’s unpublished per curiam decision in Tonnie Nealy v. Melinda Masters, No. 24‑13002 (11th Cir. Nov. 26, 2025), arising from the Florida Civil Commitment Center (FCCC). The case sits at the intersection of:

  • the constitutional standards governing medical care for civilly committed detainees under the Fourteenth Amendment, and
  • traditional Eighth Amendment “deliberate indifference” jurisprudence applied to prisoners.

Although labeled “NOT FOR PUBLICATION” and therefore non-precedential under Eleventh Circuit rules, Nealy is a useful illustration of several important doctrinal points:

  • the distinct but related standards for civil detainees (professional judgment / Fourteenth Amendment) versus prisoners (deliberate indifference / Eighth Amendment);
  • the burden on a civil detainee at summary judgment to produce specific, admissible evidence, even when proceeding pro se; and
  • how an appellate court handles a district court’s use of the “wrong” doctrinal framework under a harmless-error analysis.

The immediate dispute involved a civil detainee, Tonnie Nealy, who alleged that FCCC officials were deliberately indifferent to his serious medical needs—specifically chronic knee pain (including delayed knee surgery), shoulder pain, and ear pain. The district court granted summary judgment to the FCCC defendants. On appeal, Nealy, proceeding without counsel, challenged both the factual evaluation and the legal standard applied.

The Eleventh Circuit affirmed. It recognized that the district court applied the “deliberate indifference” framework typically used for prisoners rather than the “professional judgment” standard applicable to civilly committed individuals, but held that this error was harmless on the record presented.

II. Summary of the Opinion

The Court of Appeals, reviewing de novo the grant of summary judgment, concluded that:

  1. The district court should have evaluated Nealy’s medical-care claims under the Fourteenth Amendment’s “professional judgment” standard (applicable to civil detainees) rather than purely under the Eighth Amendment’s “deliberate indifference” standard (applicable to convicted prisoners).
  2. Nevertheless, the misapplication of the doctrinal label was harmless error. Even under the more protective Fourteenth Amendment regime, the record did not support a finding of a constitutional violation.
  3. The undisputed medical records showed that:
    • Nealy was seen at least 14 times by outside specialists between April 2022 and January 2024;
    • his knee surgery was postponed only because physicians wanted his cardiac issues resolved first;
    • he received multiple visits and treatments for his shoulder pain; and
    • he similarly received care for his chronic ear pain.
  4. Nealy failed to:
    • specifically rebut the affidavits and records submitted by the defendants, and
    • offer “verifying medical evidence” that any alleged delay in treatment exacerbated his conditions, as required for a constitutional delay-of-treatment claim.
  5. His opposition consisted primarily of conclusory and self-serving assertions, which are insufficient to create a “genuine issue of material fact” at summary judgment.

As a result, the Eleventh Circuit affirmed the grant of summary judgment in favor of the FCCC Facility Director (Masters), Assistant Director (Carner), and the treating physician (Dr. Le).

III. Detailed Analysis

A. Procedural Posture and Standard of Review

The case reached the Eleventh Circuit on appeal from an order granting summary judgment. The governing standard is well-settled:

  • The appellate court reviews the grant of summary judgment de novo, i.e., it gives no deference to the district court’s legal conclusions.
  • All evidence is viewed in the light most favorable to the nonmoving party (here, Nealy). See Ellis v. England, 432 F.3d 1321, 1325 (11th Cir. 2005).
  • Summary judgment is appropriate when there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a).

The panel underscores that even pro se litigants must satisfy Rule 56:

  • While a pro se party’s filings are “liberally construed,” the litigant still bears the burden of showing a genuine issue of material fact to avoid summary judgment. See Brown v. Crawford, 906 F.2d 667, 670 (11th Cir. 1990).
  • Mere conclusions, unsupported factual allegations, or affidavits based on “information and belief” rather than personal knowledge are insufficient. Ellis, 432 F.3d at 1327.

This framework is critical to the outcome: once the FCCC defendants submitted detailed affidavits and medical records, the burden shifted to Nealy to provide specific, admissible, contrary evidence. He did not.

B. Precedents Cited and Their Role in the Decision

1. Bilal v. Geo Care, LLC, 981 F.3d 903 (11th Cir. 2020)

Bilal is the central precedent guiding constitutional claims by civilly committed detainees. The court in Bilal held that:

  • Civilly committed individuals proceed under the Fourteenth Amendment’s Due Process Clause, not the Eighth Amendment.
  • Civil detainees are entitled to a higher standard of care than criminally incarcerated prisoners because:
    • prison conditions are designed in part to punish, whereas
    • civil commitment is not punishment but is generally framed as treatment and public safety.
  • Decisions by professionals in a civil commitment facility are judged under a “professional judgment” standard, which deems such decisions “presumptively valid” and imposes liability only where there is a substantial departure from accepted professional norms, indicating that the decision was not actually based on professional judgment.
  • Importantly, Bilal explains that Fourteenth Amendment substantive due process rights are at least equivalent to comparable Eighth Amendment rights, such that a violation of the Eighth Amendment standard would undoubtedly be a violation of the more protective Fourteenth Amendment standard.

In Nealy, the panel uses Bilal both to:

  • acknowledge the error in the district court’s using the Eighth Amendment “deliberate indifference” language, and
  • conclude that the error is harmless because, if there is no violation even under the more demanding Eighth Amendment framework, there is necessarily no violation under the Fourteenth Amendment professional judgment standard in this case.

2. Pesci v. Budz, 730 F.3d 1291 (11th Cir. 2013)

Pesci is an earlier Eleventh Circuit decision dealing specifically with the FCCC. There, the court held that:

  • The FCCC is a secure facility that also has a rehabilitative purpose under Florida law.
  • FCCC staff are “best equipped” to make difficult decisions regarding the administration of the facility, given its dual public safety and treatment obligations.

In Nealy, the panel invokes Pesci to:

  • reinforce the deference owed to FCCC staff as “professionals,” and
  • support the presumption that their decisions—about how, when, and where Nealy receives medical care—are valid exercises of professional judgment absent evidence of a substantial departure from accepted standards.

3. Youmans v. Gagnon, 626 F.3d 557 (11th Cir. 2010)

Youmans supplies the basic three-part test for a deliberate-indifference claim to serious medical needs:

  1. a serious medical need;
  2. the defendant’s deliberate indifference to that need; and
  3. causation between that indifference and the injury.

Although Youmans is an Eighth Amendment case, the Eleventh Circuit regularly uses the same structure when analyzing Fourteenth Amendment medical-care claims, overlaying it with the special “professional judgment” standard for civil detainees as needed.

4. Gilmore v. Hodges, 738 F.3d 266 (11th Cir. 2013)

Gilmore is cited for the definition of a “serious medical need”:

  • one diagnosed by a physician as mandating treatment, or
  • so obvious that even a layperson would recognize the necessity for a doctor’s attention.

The panel implicitly assumes Nealy’s knee, shoulder, and ear problems qualify as “serious medical needs,” and focuses its analysis on whether defendants were deliberately indifferent / deviated from professional judgment.

5. Wade v. McDade, 106 F.4th 1251 (11th Cir. 2024) (en banc)

Wade is a recent en banc decision refining the mental-state component of deliberate indifference. It holds that a plaintiff must show that the official:

  1. had subjective knowledge of a risk of serious harm,
  2. disregarded that risk, and
  3. acted with subjective recklessness, as that term is used in criminal law.

The en banc court in Wade clarifies that negligence—even gross negligence—is not enough; the conduct must approach criminal recklessness in terms of conscious disregard of a substantial risk.

In Nealy, the citation to Wade ensures that the mental-standard for deliberate indifference is read in this stricter sense, further underscoring why Nealy’s evidence fell short.

6. Melton v. Abston, 841 F.3d 1207 (11th Cir. 2016)

Though partially abrogated by Wade on other grounds, Melton is cited for the types of conduct that can amount to deliberate indifference:

  • grossly inadequate care;
  • choosing an easier but less effective course of treatment; or
  • medical care so cursory that it amounts to no care at all.

The panel contrasts this framework with the record, which shows repeated consultations, diagnostic work, and concern for Nealy’s cardiac condition before proceeding with knee surgery.

7. Waldrop v. Evans, 871 F.2d 1030 (11th Cir. 1989)

Waldrop is cited to emphasize:

  • Courts are “hesitant” to find deliberate indifference where the plaintiff received medical care; and
  • a mere difference in medical opinion—as between provider and patient or between two physicians—does not constitute deliberate indifference.

This is critical in Nealy: his disagreement with the timing of his surgery and the adequacy of pain treatment, without more, is framed as a non-constitutional medical disagreement.

8. Hill v. DeKalb Reg’l Youth Det. Ctr., 40 F.3d 1176 (11th Cir. 1994)

Hill, later abrogated in part by Hope v. Pelzer, 536 U.S. 730 (2002), is cited for its delay-of-treatment doctrine:

  • deliberate indifference may be established by an unreasonable delay in medical care, not only for emergencies but also where delay is likely to exacerbate the condition;
  • however, a plaintiff alleging unconstitutional delay must place “verifying medical evidence” in the record to show the detrimental effect of the delay; and
  • the significance of delay depends on the nature of the condition and the reason for the delay.

The panel holds Nealy to this requirement: lacking medical evidence that delay worsened his knee, shoulder, or ear conditions, he cannot transform delay into a constitutional claim.

9. Ellis v. England, 432 F.3d 1321 (11th Cir. 2005)

Beyond articulating the standard of review, Ellis is used to reaffirm that:

  • conclusory, self-serving, or unsupported allegations cannot defeat summary judgment;
  • affidavits must be based on personal knowledge, not “information and belief.”

The panel cites Ellis when characterizing Nealy’s filings as insufficient to create a genuine factual dispute.

C. The Court’s Legal Reasoning

1. The Constitutional Framework for Civil Detainees

The opinion begins by drawing a familiar but important distinction:

  • Convicted prisoners raise medical-care claims under the Eighth Amendment’s Cruel and Unusual Punishment Clause.
  • Civilly committed detainees—such as those at FCCC, often committed under Florida’s sexually violent predator laws—raise such claims under the Fourteenth Amendment’s Due Process Clause.

Under Bilal, civil detainees are entitled to at least the level of protection prisoners receive, and often more. Their claims are measured against a professional judgment standard:

  • decisions of qualified professionals are presumed valid;
  • liability arises only if there is a substantial departure from accepted professional standards, suggesting the decision was not truly based on professional judgment.

At the same time, the Eleventh Circuit continues to use the deliberate-indifference framework (serious medical need, deliberate indifference, causation) as a structural template in Fourteenth Amendment medical cases, with the professional-judgment overlay providing the standard against which the defendants’ actions are measured.

2. The District Court’s Use of the “Wrong” Standard and Harmless Error

The panel explicitly recognizes that the district court applied the “deliberate indifference” standard “when it should have applied the professional judgment standard.” Normally, this would be a significant doctrinal error. However, the court declares the error harmless because:

  • The district court found that the defendants were not deliberately indifferent even under the stricter Eighth Amendment-type standard.
  • Under Bilal, if there is no Eighth Amendment violation, there is “no doubt” that civil detainee rights—at least equivalent, if not broader—also have not been violated on the facts presented.

In other words, the panel reasons:

If Nealy cannot establish deliberate indifference under the prisoner standard, he certainly cannot show the more extreme kind of professional departure needed to violate his Fourteenth Amendment rights in this setting.

This is the core “harmless error” holding: mislabeling the standard did not affect the outcome, given the record.

3. Evaluation of the Evidence: Knee, Shoulder, and Ear Care

The crucial analytic step is the court’s evaluation of the actual medical record, which the FCCC defendants introduced via exhibits and affidavits. The panel emphasizes several points:

a. Knee Pain and Delayed Surgery
  • Nealy complained of chronic knee pain and asserted that FCCC officials unreasonably delayed his knee surgery.
  • The medical records showed at least 14 visits to outside specialists between April 2022 and January 2024.
  • The postponement of surgery was tied to legitimate medical reasons: unresolved cardiac issues that the surgeon wanted addressed first.

The panel concludes that this is not an “unreasonable delay” but a medically justified decision. Nothing in the record shows a non-medical motive (e.g., punishment, cost-saving at the expense of medical need) or a substantial departure from professional standards.

b. Shoulder Pain
  • Nealy contended that treatment of his chronic shoulder pain was unreasonably delayed or inadequate.
  • Defendants produced unrefuted documentation of multiple visits and treatments for his shoulder pain.

The panel finds that these records directly contradict Nealy’s allegations of neglect, and Nealy provided no medical evidence or specific factual account that would transform his dissatisfaction into a constitutional claim.

c. Ear Pain
  • Nealy similarly alleged unreasonable delays in treatment of his chronic ear pain.
  • The medical records again document treatment, undermining his claim of inattention.

Across all three conditions, the panel treats the medical documentation as dispositive in the absence of credible contradictory evidence.

4. The Plaintiff’s Evidentiary Failures

Once the FCCC defendants introduced copious medical records, the burden shifted to Nealy under Rule 56. The court highlights three related failures:

  1. No specific rebuttal of the defendants’ affidavits and records.
    Nealy did not point to particular entries, inconsistencies, or omissions in the medical records that would call the defendants’ narrative into question.
  2. Reliance on conclusory assertions and self-serving allegations.
    The court characterizes his submissions as conclusory and self-serving, which, under Ellis, cannot create a genuine factual dispute.
  3. Absence of “verifying medical evidence” for any alleged harmful delay.
    Under Hill, a plaintiff claiming unconstitutional delay must produce medical evidence that the delay worsened the condition. Nealy provided none—no expert opinion, no treating physician statement, no diagnostic comparison.

Given these deficiencies, the panel concludes that no reasonable jury could find deliberate indifference, much less a substantial departure from professional judgment, on this record.

5. Deference to Professional Judgment and the FCCC Context

Drawing on Bilal and Pesci, the court underscores that:

  • FCCC is both secure and rehabilitative;
  • its staff are professionals presumed to act within accepted standards; and
  • courts must be cautious about substituting their judgment for that of medical professionals or facility administrators on treatment details, particularly where:
    • the record shows ongoing care, and
    • the dispute sounds primarily in dissatisfaction with timing or choice of treatment modality.

Against that institutional backdrop, Nealy’s showing is too weak to overcome the presumption that the FCCC staff acted within the bounds of professional judgment.

D. Impact and Future Significance

1. For Civil Detainee Litigation in the Eleventh Circuit

Although unpublished, Nealy illustrates how the Eleventh Circuit will likely approach civil detainee medical-care claims:

  • Courts will be quick to correct doctrinal misstatements (e.g., conflating Eighth and Fourteenth Amendment standards) but will also apply a robust harmless-error analysis where the factual record overwhelmingly favors the defendants.
  • The existence of multiple medical visits and documented care will strongly undercut a claim of deliberate indifference or breach of professional judgment, especially in the absence of expert or medical evidence from the plaintiff.
  • Civil detainees at the FCCC and similar facilities should not assume that their Fourteenth Amendment status by itself makes it easier to prevail; they still must overcome strong deference to professional judgment and meet exacting evidentiary burdens at summary judgment.

2. Reinforcement of Summary Judgment Burdens for Pro Se Plaintiffs

Nealy reinforces an important practical lesson: being pro se does not relax the evidentiary threshold at summary judgment. Civil detainees and prisoners must:

  • submit admissible evidence (e.g., sworn declarations based on personal knowledge, medical records, expert statements);
  • specifically address and, where possible, undermine the defendant’s evidence; and
  • avoid reliance on broad, conclusory statements unanchored to the record.

Failing this, courts will treat the defendant’s record-based account as effectively undisputed.

3. Delay-of-Treatment Claims After Hill and Wade

The decision also underscores a stringent combination of doctrines:

  • From Hill: the need for verifying medical evidence showing that delay caused a detrimental effect.
  • From Wade: the mental-state requirement of subjective recklessness.

In practice, this means:

  • A plaintiff alleging delay cannot rely on pain alone; there must be some medical evidence (e.g., worsened degeneration, lost surgical options) traceable to the delay.
  • Even then, the plaintiff must show that officials knew of and disregarded a substantial risk that such harm would occur.

This combination makes successful constitutional delay-of-treatment claims more demanding, especially without expert support.

4. The “Harmless Error” Template for Misapplied Standards

Finally, Nealy functions as an example of how appellate courts can address a district court’s application of the wrong legal test:

  • acknowledge the error (here, failure to use the explicit “professional judgment” standard);
  • reframe the legal inquiry under the correct standard; and
  • hold the error harmless where the outcome is the same under either framework, based on undisputed facts.

Future litigants arguing on appeal that the district court applied the “wrong standard” should note that this argument will succeed only if the standard matters to the outcome; where the factual record is one-sided, appellate courts may affirm on harmless-error grounds.

IV. Complex Concepts Simplified

To make the opinion more accessible, the following key concepts are explained in plain language.

1. Civil Detainee vs. Prisoner

  • Prisoner: Someone convicted of a crime and serving a criminal sentence.
  • Civil detainee: Someone confined not as punishment for a crime but for other reasons (e.g., mental health commitments, sexually violent predator commitments). Civil commitment is officially for treatment and public safety, not punishment.

2. Eighth Amendment vs. Fourteenth Amendment

  • Eighth Amendment: Protects convicted prisoners from cruel and unusual punishment, including deliberate indifference to serious medical needs.
  • Fourteenth Amendment (Due Process): Protects civil detainees; courts have said their rights are at least as strong as, and often stronger than, those of prisoners because they are not supposed to be punished at all.

3. “Professional Judgment” Standard

For civil detainees, courts ask whether facility professionals (doctors, administrators) made decisions based on accepted professional norms. The decisions are presumed valid unless:

  • they substantially depart from accepted practice, suggesting they were not really professional decisions at all (e.g., done for punishment, spite, or ignorance of basic standards).

4. “Deliberate Indifference” and Subjective Recklessness

In both prisoner and civil detainee medical cases, courts often use a three-part structure:

  1. Serious medical need: A condition that obviously needs treatment or has been diagnosed as requiring treatment.
  2. Deliberate indifference: Officials knew about a serious risk to the person’s health and consciously disregarded it.
  3. Causation: The indifference actually caused or worsened the injury.

“Subjective recklessness” means:

  • the official was aware of the risk,
  • understood its seriousness, and
  • chose to ignore it anyway.

It is more than a mistake or carelessness; it resembles criminal recklessness.

5. “Genuine Issue of Material Fact” and Summary Judgment

At summary judgment, the question is whether a case must go to trial or can be decided based on undisputed facts. A “genuine issue of material fact” exists if:

  • the evidence is such that a reasonable jury could decide in favor of either side, and
  • the disputed fact matters to the outcome under the governing law.

If the party opposing summary judgment (here, Nealy) offers only unsupported or conclusory allegations, and the other side provides detailed records and sworn statements, the court may conclude there is no genuine factual dispute requiring a trial.

6. “Verifying Medical Evidence” for Delay Claims

When a detainee claims that delay in treatment violated the Constitution, the law generally requires medical proof that the delay caused harm, such as:

  • a doctor stating the delay worsened the condition;
  • test results showing measurable deterioration over the delay period;
  • evidence that the window for an effective treatment was missed because of the delay.

Pain alone, without such evidence of worsening due to delay, often will not satisfy this requirement.

7. Harmless Error

“Harmless error” is an appellate doctrine. It means:

  • The lower court made a mistake (for example, used the wrong legal label), but
  • Correcting that mistake would not change the result because, even under the right standard, the losing party would still lose based on the undisputed facts.

In Nealy, the wrong standard label (Eighth vs. Fourteenth Amendment) was deemed harmless because the evidence could not support a constitutional violation under either.

V. Conclusion

Nealy v. Masters offers a compact but instructive example of how the Eleventh Circuit approaches medical-care claims by civil detainees at the Florida Civil Commitment Center. The opinion:

  • Reaffirms that civil detainees’ claims arise under the Fourteenth Amendment and are evaluated using a professional-judgment standard, though structured through the deliberate-indifference framework.
  • Demonstrates that applying the prisoner-focused Eighth Amendment standard instead can be harmless error where the factual record overwhelmingly refutes the claim of inadequate care.
  • Shows the decisive role of detailed medical records and the plaintiff’s obligation—pro se or not—to produce specific, admissible, and preferably medical evidence to survive summary judgment.
  • Reinforces the combined effect of Bilal, Pesci, Hill, and Wade in making constitutional medical-care and delay-of-treatment claims demanding, particularly where the record shows extensive treatment and legitimate medical reasons for any delay.

In the broader legal context, Nealy underscores a recurring theme in constitutional medical-care jurisprudence: the distinction between suboptimal or disputed care, which is generally a matter for malpractice or professional discipline, and the much narrower category of care so deficient or recklessly withheld that it violates the Constitution. For civil detainees at institutions like FCCC, the presumption of professional judgment and the stringent evidentiary requirements at summary judgment remain formidable hurdles that must be met with specific, corroborated, and medically grounded proof.

Case Details

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

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