Thus, under either legal standard—professional judgment or deliberate indifference—the record could not support a finding that the nurses acted unlawfully in managing the cystoscopy scheduling.

D. Claim Two: Conditions of Confinement — Disposal of Used Catheters

1. Hall’s Allegations

Hall alleged that:

• He used catheters that became filled with blood.
• The “biohazard team” did not pick up his used catheters.
• He was denied the ability to dispose of them in the medical office.
• As a result, he had to store them under his bed, where they allegedly overflowed with blood.

He argued that this created unsafe, unsanitary, and degrading conditions, violating his Fourteenth Amendment right to reasonably safe and humane conditions.

2. Eighth Amendment Analogy and Bilal

The Eleventh Circuit’s analysis of this claim closely tracks its approach in Bilal. In Bilal, the court found that a civil detainee stated a claim where he allegedly had to sit in his own excrement for hundreds of miles during transport—drawing heavily on Eighth Amendment conditions-of-confinement cases such as Brooks v. Warden, 800 F.3d 1295 (11th Cir. 2015).

The Eighth Amendment conditions-of-confinement test, summarized in Thomas v. Bryant, 614 F.3d 1288 (11th Cir. 2010), asks:

1. Objectively: Was the deprivation sufficiently serious to deny “the minimal civilized measure of life’s necessities,” considering evolving standards of decency and security needs?
2. Subjectively: Did officials know of and disregard a substantial risk of serious harm, engaging in conduct more culpable than negligence?

For civil committees, if such conditions would violate the Eighth Amendment for prisoners, they “undoubtedly” violate due process rights under the more protective Fourteenth Amendment standard (Bilal, 981 F.3d at 915).

3. Professional Judgment Analysis

Under the professional judgment standard, the panel’s reasoning has two steps:

1. Legitimate institutional interest: The nurses claimed a need to keep the medical office secure and orderly, implying that limiting resident access to the office after hours (e.g., after 5:00 p.m.) or without proper permission was justified.
2. Departure from professional judgment: The key question was whether the nurses’ handling of catheter disposal substantially departed from accepted medical or institutional standards.

The court acknowledged a factual dispute on the first point:

• Hall’s sworn affidavit stated that:
  • He did not visit the medical office after 5:00 p.m.;
  • He always obtained some form of staff permission to go to the office; and
  • The biohazard team did not pick up his used catheters.
• The nurses, in contrast, submitted evidence suggesting that:
  • The medical supervisor (Herbert) did not authorize Hall’s entry into the office; and
  • There may have been policies limiting resident access.

Nevertheless, even accepting Hall’s version, the court held he failed at the second step. Why?

• The nurses evidenced that Hall could:
  • Request catheter supplies to be picked up and dropped off without personally entering the office.
• Hall’s own affidavit and records showed that:
  • He successfully used a sick call request to obtain additional catheter supplies, demonstrating the system functioned at least once.

In short, the court concluded:

Hall failed to demonstrate that there was a genuine dispute about whether the nurses' actions departed from accepted professional judgment because the nurses told him that he could request for catheter supplies to be picked up and dropped off.

That is, while the conditions Hall described were troubling, he did not show that no reasonable professional would have handled catheter disposal as the nurses did, given the available procedures.

4. Deliberate Indifference Analysis

The panel took a more nuanced path under the Eighth Amendment framework:

• Objective prong: The court explicitly held that the district court erred in finding no serious risk. Hall’s affidavit—that:
  • biohazard staff did not pick up his catheters,
  • he had to store them under his bed, and
  • they overflowed with blood—
  was sufficient to create a factual dispute about whether the conditions created a substantial risk of harm.
• The nurses had no evidence that “blatantly contradicted” this account; thus, under Reeves, Scott, and Stein, the court had to accept Hall’s version at summary judgment.

However, the claim still failed on the subjective prong:

• Even if the conditions posed a serious risk, the nurses:
  • Explicitly told Hall he could request pick-up/drop-off of catheter supplies.
  • Responded to at least one request by providing additional supplies.
• These actions constitute a reasonable response to the risk; thus, under Wade and Farmer, there is no deliberate indifference.

Importantly, the court’s approach illustrates two doctrinal points:

1. Error on one element can be harmless: The panel corrected the district court’s objective-prong analysis but affirmed on the alternative ground that the subjective element was not met.
2. Civil detainee claims are robust but not absolute: Even for serious hygienic or biohazard concerns, if staff provide a reasonable remedial mechanism that the detainee can use, liability is unlikely absent evidence of ignoring known risks.

E. Claim Three: First Amendment Retaliation — Gardiner’s Incident Report

1. Legal Standard

First Amendment retaliation doctrine, as applied to incarcerated individuals and adopted here in the civil commitment context, was drawn from:

• Farrow v. West, 320 F.3d 1235 (11th Cir. 2003);
• Bennett v. Hendrix, 423 F.3d 1247 (11th Cir. 2005);
• Smith v. Mosley, 532 F.3d 1270 (11th Cir. 2008); and
• O’Bryant v. Finch, 637 F.3d 1207 (11th Cir. 2011).

To prevail on a retaliation claim, a detainee must show:

1. He engaged in constitutionally protected speech (e.g., filing grievances).
2. He suffered an adverse action that would likely deter a person of ordinary firmness from exercising such speech (e.g., a disciplinary report, transfer, or sanction).
3. A causal connection between the protected speech and the adverse action.

The Eleventh Circuit has recognized that filing institutional grievances is protected speech. However, O’Bryant adds a crucial limitation:

A prisoner cannot maintain a retaliation claim when he is convicted of the actual behavioral violation underlying the alleged retaliatory false disciplinary report and there is evidence to sustain the conviction.

If the institution would have taken the same action regardless of the protected conduct because the detainee in fact violated a rule, there is no actionable retaliation.

2. Application to Hall

Hall contended that Nurse Gardiner filed an incident report in retaliation for his prior grievances. The report charged him with going to the medical office without permission.

The court’s analysis proceeded as follows:

• Hall does not lose on the first two elements:
  • Filing grievances is protected speech (Smith).
  • An incident report and resulting discipline can constitute an adverse action.
• However, Hall was:
  • Afforded due process in an institutional hearing; and
  • Found guilty of the violation.
• The record, including both Hall’s and the nurses’ evidence, showed that:
  • He did not have the level of permission required to enter the medical office; and
  • There was factual support for the disciplinary finding.

On that basis, the court applied O’Bryant directly:

Accordingly, Hall's retaliation claim is foreclosed.

In other words, because the institution had an independent, non-speech-related justification supported by evidence—his actual rule violation—the causal link between his grievances and the incident report could not sustain a First Amendment retaliation claim.

F. Precedents Cited and Their Influence

1. Summary Judgment & Evidence

• Brown v. Crawford, 906 F.2d 667 (11th Cir. 1990): Established that pro se litigants must still meet the evidentiary burdens at summary judgment.
• Reeves v. Sanderson Plumbing, 530 U.S. 133 (2000): No weighing of evidence; view inferences in favor of non-movant.
• Scott v. Harris, 550 U.S. 372 (2007): Court may disregard non-movant’s version if video or record “blatantly contradicts” it.
• United States v. Stein, 881 F.3d 853 (11th Cir. 2018); Sears v. Roberts, 922 F.3d 1199 (11th Cir. 2019); Feliciano: Clarified that self-serving but non-conclusory affidavits can create fact disputes.
• Cuddeback: Court can affirm for any reason supported by the record, which the panel did when correcting the catheter claim’s objective-prong analysis but affirming on subjective prong.

2. Fourteenth Amendment & Civil Commitment

• Youngberg v. Romeo, 457 U.S. 307 (1982): The cornerstone of the professional judgment standard.
• Bilal v. Geo Care LLC, 981 F.3d 903 (11th Cir. 2020): Applied Youngberg to FCCC; used Eighth Amendment cases like Brooks to define minimum conditions; emphasized that civil committees are entitled to more considerate conditions than prisoners.
• Rodgers v. Horsley, 39 F.3d 308 (11th Cir. 1994): Confirmed that the professional judgment standard governs civil commitment claims, not deliberate indifference.

3. Eighth Amendment Analogy & Deliberate Indifference

• Estelle v. Gamble, 429 U.S. 97 (1976): Non-response to serious medical needs constitutes cruel and unusual punishment.
• Farmer v. Brennan, 511 U.S. 825 (1994): Defined deliberate indifference as subjective recklessness.
• Wade v. McDade, 106 F.4th 1251 (11th Cir. 2024) (en banc): Modern restatement of deliberate indifference, emphasizing criminal-law-type recklessness and reasonable response defeating liability.
• Swain v. Junior, 961 F.3d 1276 (11th Cir. 2020): Applied the Farmer/Estelle framework to pretrial detainees’ Fourteenth Amendment claims; later used by analogy here.
• Brooks v. Warden, 800 F.3d 1295 (11th Cir. 2015); Thomas v. Bryant, 614 F.3d 1288 (11th Cir. 2010): Eighth Amendment conditions-of-confinement cases showing when degrading, unsanitary conditions violate the Constitution.

4. Retaliation and Protected Activity

• Farrow v. West: Foundational for prisoner retaliation claims under the First Amendment.
• Bennett v. Hendrix: Clarified the “ordinary firmness” standard for adverse action.
• Smith v. Mosley: Recognized grievances as protected speech and set out the causation analysis for institutional discipline.
• O’Bryant v. Finch: Established that a supported disciplinary conviction bars a retaliation claim based on that same conduct.

The Hall panel did not innovate new doctrine so much as reaffirm and integrate these existing strands, particularly emphasizing:

• The primacy of professional judgment for civilly committed persons;
• The continued relevance of Eighth Amendment benchmarks for defining adequate conditions and medical care;
• The stringent requirement of actual, supported misconduct defeating retaliation claims under O’Bryant.

G. Complex Concepts Simplified

1. Civil Commitment vs. Imprisonment

A civilly committed person (like Hall) is confined not as punishment for a crime, but because the State has determined he is dangerous (e.g., a sexually violent predator). A prisoner is confined as a criminal punishment. Civil detainees:

• Cannot be punished; their confinement is supposed to be treatment-oriented.
• Are protected primarily by the Fourteenth Amendment’s Due Process Clause, not the Eighth Amendment directly.

2. Professional Judgment Standard (Fourteenth Amendment)

Under Youngberg, courts ask:

• Was there a professional decision (e.g., by a doctor, nurse, or trained administrator)?
• If so, was that decision a substantial departure from how similarly trained professionals would act?

Only if the decision is far outside normal professional standards can the institution be liable. Mere disagreement with the professional’s judgment is not enough.

3. Deliberate Indifference (Eighth Amendment Analogy)

“Deliberate indifference” is a two-part test:

1. Serious risk: The condition or medical issue must be objectively serious or dangerous (e.g., a serious illness, severe pain, or unsanitary, dangerous conditions).
2. Knowing disregard: Officials must actually know of the risk and still do essentially nothing (or act unreasonably) to address it.

If staff take reasonable steps—such as providing treatment, responding to complaints, or offering a workable disposal system—they are typically not liable, even if the detainee thinks more should have been done.

4. Summary Judgment

Summary judgment is a way to resolve a case without a trial where:

• All the evidence is in;
• There are no real disputes about important facts; and
• One side is entitled to win under the law.

A plaintiff cannot rely only on allegations in the complaint; he must present admissible evidence (like sworn affidavits, documents, or deposition testimony) showing an actual factual dispute requiring a trial.

5. Retaliation

Retaliation claims protect inmates and detainees from punishment for exercising constitutional rights (like free speech or filing grievances). But:

• If the institution has a valid reason for the action (e.g., a real rule violation), and
• The violation is confirmed after due process and supported by evidence,

then the claim of retaliation usually fails. The theory is that the sanction was motivated by the misconduct, not by the protected speech.

H. Impact and Future Implications

1. For Civilly Committed Detainees (Especially at FCCC)

Even though this opinion is unpublished and technically not binding precedent, it will likely be cited by defendants and district courts as persuasive authority, especially in FCCC litigation. Its practical messages for civilly committed plaintiffs are:

• Medical-care claims will be scrutinized for:
  • Whether staff actually responded (via sick call, medications, follow-up);
  • Whether delays were caused by legitimate factors (e.g., outside specialist scheduling); and
  • Whether the plaintiff can point to concrete facts—beyond conclusions—showing that staff ignored serious needs.
• Conditions claims must address:
  • Not only the severity of the condition (e.g., blood-filled catheters under a bed), but also
  • What staff actually did once notified (e.g., offered disposal options).
• In retaliation claims, if the detainee is found guilty of an underlying rules violation and there is evidence for it, O’Bryant will be a major obstacle.

2. For Counsel and Pro Se Litigants

The opinion underscores several strategic points:

• Affidavits must go beyond conclusory statements; they should describe:
  • specific dates,
  • particular interactions,
  • what staff knew and when, and
  • how staff’s conduct deviated from accepted medical or institutional practice.
• Where the institution has created a reasonable mechanism (like a request system for supplies/disposal), plaintiffs must show either:
  • that the mechanism was nonfunctional in practice, or
  • that staff knew it was failing and still did nothing.
• Retaliation claims should be brought with caution if there is a disciplinary conviction supported by record evidence; otherwise, O’Bryant is likely dispositive.

3. Doctrinal Clarification

Doctrinally, Hall does the following:

• Reaffirms that the professional judgment standard—not deliberate indifference—is the formal standard for Fourteenth Amendment civil commitment claims, while still treating Eighth Amendment law as a “floor” for conditions.
• Demonstrates the Eleventh Circuit’s increasing reliance on Wade for articulating the subjective prong of deliberate indifference, even in non-prisoner contexts by analogy.
• Applies O’Bryant to civilly committed individuals, effectively extending prisoner retaliation doctrine to the civil commitment setting.

IV. Conclusion

Hall v. Valere is an unpublished but instructive decision that illustrates how the Eleventh Circuit currently approaches constitutional claims by civilly committed individuals at FCCC. The panel:

• Reaffirms the professional judgment standard for Fourteenth Amendment claims, while using Eighth Amendment doctrine as a benchmark for minimum conditions and care.
• Clarifies the importance of the subjective element (actual, knowing disregard) in deliberate indifference and conditions-of-confinement claims.
• Demonstrates that even serious or unsanitary conditions will not result in liability if staff provide a reasonable, functioning response mechanism.
• Applies the O’Bryant rule to foreclose retaliation claims where a supported disciplinary conviction exists on the underlying conduct.

In the broader legal landscape, the decision underscores that civilly committed detainees enjoy rights at least as protective as those of prisoners, but that liability under § 1983 remains tied to proof of concrete departures from professional standards or actual, reckless disregard of serious risks. Future litigants and courts are likely to rely on this opinion as a concise blueprint for how the Eleventh Circuit harmonizes Youngberg, Bilal, Eighth Amendment precedent, and First Amendment retaliation doctrine in the civil commitment context.