Unnecessary Pain Suffices: Eleventh Circuit Clarifies Causation and Deems Repeated “Submit Another Sick Call” Amid Known Futility Potentially Unreasonable in Eighth Amendment Medical-Indifference Claims

Case: Marlon Brown v. Maureen Ricewick, et al.

Court: United States Court of Appeals for the Eleventh Circuit (Non-Argument Calendar; Not for Publication)

Date: October 14, 2025

Panel: Jordan, Rosenbaum, and Luck, Circuit Judges (per curiam)

Disposition: Vacated and remanded in part; affirmed in part; dismissed in part.

Introduction

This appeal arises from a pro se § 1983 action by Marlon Brown, a state prisoner, who alleged that several nurses at Desoto Correctional Institution–Annex were deliberately indifferent to his serious medical needs in violation of the Eighth Amendment. Brown injured the ring and little fingers of his dominant right hand when a locker lid slammed onto them on September 26, 2020. He consistently reported significant swelling, visible deformity, and severe pain over the next three months, submitted multiple sick-call requests, and complained to several nurses during unrelated encounters. Although x-rays later confirmed fractures of both fingers, Brown maintains he received no timely care, was told repeatedly to “submit another sick-call request,” and needlessly suffered pain that culminated in tendon injuries diagnosed as mallet fingers and trigger finger.

The district court granted summary judgment to all defendants, reasoning principally that Brown had not shown the three-month delay in treatment worsened his condition. The Eleventh Circuit vacated that judgment as to three nurses (Maureen Ricewick, Michaela Beard, and Jenice Jackson), concluding that a jury could find deliberate indifference and causation based on unnecessary and wanton infliction of pain alone. The court affirmed as to one nurse (Aniece Thermidor), finding her response reasonable in context. The court also dismissed Brown’s appeal of two magistrate-judge orders (denying leave to amend and appointment of counsel) for lack of jurisdiction and waiver due to his failure to object to the district court.

Summary of the Opinion

Serious Medical Need: The court held that Brown’s swollen, deformed, and painful fractured fingers constituted an objectively serious medical need. Broken bones accompanied by substantial pain plainly require prompt attention.
Deliberate Indifference:
- Vacated as to Ricewick, Beard, and Jackson: A reasonable jury could find that each had subjective awareness of Brown’s serious condition yet provided no care, and, despite knowing the sick-call process had been ineffective for weeks, continued to direct him to “submit another sick-call request” without interim treatment or escalation.
- Affirmed as to Thermidor: On an early, unrelated visit, she told Brown to submit a sick-call request. The record did not show she knew the fingers were broken or that the sick-call process would be inadequate at that time. Her response was not unreasonable.
Causation: The district court erred by demanding evidence that the delay worsened Brown’s medical condition. The Eleventh Circuit clarified that causation may be satisfied by showing that officials’ failure to provide care caused unnecessary pain—the constitutional injury—irrespective of proof that the underlying condition worsened.
Procedural/Jurisdictional Rulings: Because Brown did not object to the magistrate judge’s orders (denying leave to amend and to appoint counsel) before the district judge under Rule 72(a) and 28 U.S.C. § 636(b)(1)(A), the Eleventh Circuit lacked jurisdiction, and the issues were waived. Brown may, however, renew his request for counsel on remand.

Analysis

Precedents Cited and Their Influence

Harris v. Thigpen, 941 F.2d 1495 (11th Cir. 1991): Establishes the constitutional obligation to provide minimally adequate medical care to incarcerated persons. Anchors the basic Eighth Amendment duty.
McElligott v. Foley, 182 F.3d 1248 (11th Cir. 1999): A cornerstone for the principle that failing to provide, delaying, or grossly inadequately providing care can amount to deliberate indifference, particularly when it causes needless pain.
Mann v. TASER Int’l, Inc., 588 F.3d 1291 (11th Cir. 2009): Defines “serious medical need” as one diagnosed as mandating treatment or so obvious even a layperson recognizes the necessity of care; also notes that delay worsening a condition can render a need serious.
Melton v. Abston, 841 F.3d 1207 (11th Cir. 2016): Confirms broken bones and untreated severe pain are serious medical needs; supports that delays in treating serious injuries (requiring attention within hours) may be unconstitutional and that months-long failure to provide any treatment can be causative of constitutional injury.
Brown v. Hughes, 894 F.2d 1533 (11th Cir. 1990): Recognizes that delay in treatment for a broken bone and associated pain—even hours—can state an Eighth Amendment claim.
Aldridge v. Montgomery, 753 F.2d 970 (11th Cir. 1985): Reverses a directed verdict where officers failed to supply basic pain relief for a bleeding cut—underscoring pain-related injury.
Hill v. DeKalb Reg’l Youth Det. Ctr., 40 F.3d 1176 (11th Cir. 1994): Explains that delayed access can violate the Eighth Amendment when amounting to wanton infliction of pain; broken bones are circumstances where delay is especially harmful.
Harris v. Coweta County, 21 F.3d 388 (11th Cir. 1994): States that a few hours’ delay for emergencies like broken bones can violate the Constitution and that several weeks of inaction is too long for such injuries.
Wade v. McDade, 106 F.4th 1251 (11th Cir. 2024) (en banc): Clarifies the subjective recklessness standard: the official must actually know their conduct poses a substantial risk of serious harm, and a reasonable response negates liability. The opinion applies Wade to assess whether repeatedly routing a prisoner back to a demonstrably ineffective process is reasonable.
Hoffer v. Sec’y, Fla. Dep’t of Corr., 973 F.3d 1263 (11th Cir. 2020) and Harris v. Thigpen: Emphasize that the Constitution does not entitle prisoners to the best care; mere differences of medical opinion do not constitute deliberate indifference.
Waldrop v. Evans, 871 F.2d 1030 (11th Cir. 1989): Officials with knowledge of a need must act or inform competent authorities; failure to escalate can be deliberate indifference.
Burnette v. Taylor, 533 F.3d 1325 (11th Cir. 2008): Each defendant must be evaluated individually based on what they knew subjectively.
Jurisdiction/Waiver Authorities: United States v. Renfro, 620 F.2d 497 (5th Cir. 1980) (no direct appeal from magistrate judges); United States v. Brown, 441 F.3d 1330 (11th Cir. 2006); United States v. Schultz, 565 F.3d 1353 (11th Cir. 2009); Smith v. Marcus & Millichap, Inc., 106 F.4th 1091 (11th Cir. 2024); Smith v. School Board of Orange County, 487 F.3d 1361 (11th Cir. 2007). These cases, along with Fed. R. Civ. P. 72(a) and 28 U.S.C. § 636(b)(1)(A), explain why the appellate court lacked jurisdiction to review the magistrate orders and why the issues were waived.

Legal Reasoning

1) Serious Medical Need

The court found the evidence sufficient for a jury to conclude Brown’s fractured fingers constituted an obvious serious medical need. Key facts included persistent swelling, visible deformity, severe pain (reported up to 8/10), and x-rays confirming acute dorsal plate fractures of the distal phalanx in two fingers, followed by later tendon injuries and surgical planning. Broken bones and severe untreated pain fit comfortably within established Eleventh Circuit doctrine on serious medical needs.

2) Deliberate Indifference: Subjective Knowledge and Reasonableness

Under Wade v. McDade’s subjective recklessness standard, the court assessed each nurse’s knowledge and response separately:

Thermidor (October 1 encounter): Though Brown complained of pain soon after the injury, the record did not show she knew the fingers were broken or that sick call would be inadequate at that point. Advising a routine sick-call request once, early, is not inherently unreasonable. Summary judgment affirmed.
Ricewick (October 19, November 2, December 18–24): Brown showed her swollen, deformed fingers; she said they looked broken, yet did not provide interim care (analgesics, splinting) nor escalate for weeks, and x-rays were not ordered until December 24. On November 2, she told him to submit “another” sick-call request, indicating awareness that prior requests had failed. A jury could find that, with knowledge of an urgent need and the futility of the process, the repeated direction to “submit another sick call” without any care was an unreasonable response and deliberate indifference.
Beard (October 30): When Brown showed visibly swollen, painful fingers a month after injury and reported prior unanswered sick-call requests, Beard advised another sick call and became argumentative. A jury could infer subjective awareness of a substantial risk and an unreasonable failure to provide or escalate care.
Jackson (October 30 and November 24): Present with Beard on October 30 and later told Brown on November 24 she was “tired of hearing about [his] fingers.” As with Beard, a jury could find Jackson knew of the serious need and responded unreasonably by neither treating nor escalating the matter despite obvious, prolonged injury and prior sick-call failures.

Collectively, the court emphasized that an official cannot escape liability merely by invoking a standard triage process where it is known to be ineffective for the particular patient, especially where the condition (broken bones) requires prompt intervention and the patient’s pain is severe. Conversely, an initial referral to sick call may be reasonable when the provider lacks knowledge that the condition is severe or that the process is failing—hence the different outcome for Thermidor.

3) Causation: Pain as the Constitutional Injury

The district court required proof that delayed treatment worsened Brown’s condition (e.g., caused tendon tears or mallet/trigger finger). The Eleventh Circuit corrected that approach. It reiterated that causation may be established where officials’ conduct causes a prisoner to needlessly suffer pain—the Eighth Amendment injury—even if the delay cannot be linked to a worsened anatomic outcome. That distinction is critical: proof of medical worsening may affect damages, but it is not an element required to show the constitutional harm in a denial-of-care claim premised on pain.

Impact

Clarified Causation Standard: Plaintiffs alleging Eighth Amendment medical-indifference claims need not prove that an official’s delay worsened the underlying medical condition if they can show the official’s response caused unnecessary pain. District courts should not grant summary judgment solely because a plaintiff lacks medical-expert evidence tying delay to a permanent or worsened injury.
Operational Implications for Correctional Healthcare:
- Broken bones and similar “obvious” injuries demand prompt action; a “sick call only” response may be reasonable once, but not repeatedly after it is clear the process has failed.
- Frontline nurses must either provide interim measures (e.g., pain relief, splinting) or escalate to competent authorities when they recognize a potentially serious injury, particularly where pain is severe and ongoing.
- Documenting efforts to triage, treat, and escalate is critical; “submit another sick call” cannot be a default response when prior sick calls have produced no care over weeks in the face of obvious injury.
Individualized Liability: The opinion reinforces that each defendant’s subjective knowledge and response will be assessed separately, which may yield mixed outcomes for co-defendants based on differing encounters and knowledge.
Procedural Preservation: The court’s jurisdictional/waiver analysis is a reminder that parties must timely object to magistrate-judge non-dispositive orders to preserve appellate review. Pro se litigants are not excused from Rule 72(a)’s requirements.
Counsel on Remand: Although the appellate court lacked jurisdiction to review the earlier denial of appointed counsel, its invitation to renew on remand suggests that, where triable deliberate-indifference claims survive, courts may consider appointing counsel to aid in further proceedings.

Complex Concepts Simplified

Deliberate Indifference: More than negligence. A defendant must actually know their conduct poses a substantial risk of serious harm and disregard that risk. If the response is reasonable under the circumstances, there is no liability—even if the outcome is imperfect.
Serious Medical Need: A condition diagnosed as needing treatment, or one so obvious a layperson would recognize the need for medical attention. Broken bones and severe untreated pain are classic examples.
Causation in Eighth Amendment Medical Claims: The injury can be the unnecessary and wanton infliction of pain from failure to provide care, not only a worsened medical condition. Evidence of worsening may increase damages but is not always required to prove a constitutional violation.
Sick-Call Procedure: A routine process for non-emergency medical requests in prisons. It may be appropriate initial triage, but continued reliance on it can be unreasonable when officials know it has not yielded care for a serious, obvious condition.
“Subjective Recklessness” (Wade v. McDade): A mental state akin to criminal recklessness—actual, subjective awareness of the risk and disregard of it. Objective negligence is not enough.
Rule 72(a) and 28 U.S.C. § 636(b)(1)(A): Non-dispositive orders by magistrate judges (e.g., discovery, denial of leave to amend, appointment of counsel) must be objected to in the district court within 14 days. Failure to object means the order generally cannot be appealed later.
Mallet Finger and Trigger Finger: Tendon-related injuries in the fingers. Mallet finger is a disruption of the tendon that straightens the fingertip, leading to a droop; trigger finger involves a tendon that catches or locks during movement, causing pain and stiffness. Untreated fractures and delayed care can complicate these conditions.
Splinting and Interim Care: In the context of fractures, splinting stabilizes the injury and can reduce pain and further harm. Failure to provide basic interim measures may be evidence of deliberate indifference when the need is obvious.

Conclusion

This unpublished Eleventh Circuit decision delivers two practical and doctrinal clarifications in the prison medical-care context. First, causation for an Eighth Amendment medical-indifference claim may rest on the unnecessary pain caused by the failure to treat; plaintiffs need not prove that delay worsened the underlying medical condition at summary judgment. Second, while initial recourse to a prison’s routine sick-call process may be reasonable, persisting in “submit another sick-call request” in the face of an obvious, serious injury and knowledge that prior requests have not yielded care can be an unreasonable response evidencing deliberate indifference.

Applying these principles, the court affirmed summary judgment for one nurse whose early, singular direction to use sick call was not unreasonable, but revived claims against three others who allegedly observed obvious fractures and severe pain for weeks yet neither treated nor escalated the problem. It also reminded litigants that failure to object to magistrate-judge rulings waives appellate review under Rule 72(a) and § 636(b)(1)(A). On remand, Brown may renew his request for counsel, and the case will proceed against the three defendants for conduct prior to late December 2020.

The opinion reinforces a core Eighth Amendment principle: prison officials with knowledge of a prisoner’s need for care may not, by inaction or unreasonable delay, cause the prisoner to needlessly suffer pain. In settings where obvious injuries meet bureaucratic inertia, the Constitution requires more than repeated instructions to “try sick call again.”