Background
Jessica McKee, a pretrial detainee at Minnesota’s Steele County Detention Center, had a history of Crohn’s disease. During her detention, she sent nurse Jessica Brady several kiosk messages concerning seizures she attributed to malnutrition, gastrointestinal bleeding and light-headedness, dietary changes, a low-bunk request, and access to sulfasalazine. Brady changed McKee’s diet as requested, sought records from her outside provider, forwarded those records to the jail’s prescribing physician, and advised McKee that she could request a sick call for evaluation of her bunk request.
After McKee later reported that her Crohn’s disease was worsening and asked how to stay hydrated, Brady evaluated her the next morning and referred her to an emergency room. McKee received a blood transfusion, developed sepsis, remained hospitalized for approximately 11 days, and alleged permanent injuries. She sued Brady under 42 U.S.C. § 1983, claiming deliberate indifference to her serious medical needs in violation of the Fourteenth Amendment. The district court denied Brady’s summary-judgment motion based on qualified immunity.
The Court’s Holding
The Eighth Circuit reversed, holding that Brady was entitled to qualified immunity. The court explained that McKee bore the burden of showing both a constitutional violation and that Brady’s conduct violated clearly established law. To establish deliberate indifference, McKee had to show that Brady actually knew of an objectively serious medical need and deliberately disregarded it with a mental state akin to criminal recklessness.
The court concluded that Brady responded to each request, reasonably required documentation or an evaluation for a low bunk, and took permissible steps concerning medication that she lacked authority to prescribe. No clearly established law required Brady to monitor or challenge the prescribing physician’s treatment decisions or proactively provide care that McKee had not requested. Even if Brady negligently relied on McKee’s assessment of what care she needed or could have acted more aggressively, negligence or gross negligence did not establish deliberate indifference.
Key Takeaways
- A plaintiff opposing qualified immunity bears the burden of showing that the official’s conduct violated a clearly established constitutional right.
- A jail nurse who lacks prescribing authority does not violate clearly established law merely by forwarding an inmate’s medical records and medication request to an authorized physician.
- Failure to act more aggressively on reported symptoms may amount to negligence, but deliberate indifference requires evidence of knowing disregard akin to criminal recklessness.
Why It Matters
The decision reinforces the Eighth Circuit’s demanding subjective standard for pretrial-detainee medical-care claims. Serious symptoms and a poor medical outcome are not enough by themselves; a plaintiff must produce evidence that the defendant actually knew of and deliberately disregarded the medical risk.
The ruling also limits a nurse’s clearly established constitutional duties when prescribing and treatment decisions fall outside the nurse’s authority, particularly where the nurse responds to requests, obtains records, and refers matters to an authorized physician.