Blank v. Bell, 634 F. App'x 445

Plaintiff Travis Hunter Blank, a pretrial detainee, sued Nurse Linda Bell under 42 U.S.C. § 1983 alleging deliberate indifference to serious medical needs (Crohn’s disease and neck injury) while in Rockwall County Jail.
The district court granted summary judgment for Nurse Bell based on qualified immunity; Blank appealed pro se and challenged four deliberate‑indifference theories.
Blank’s four asserted claims on appeal: (1) denial/delay of access to jail physician Dr. Sandknop; (2) refusal to follow hospital discharge instruction to refer him to an outside specialist; (3) failure to provide a special diet for Crohn’s disease; and (4) withholding narcotic pain medication for a neck injury.
The court applied the deliberate‑indifference standard for pretrial detainees and the altered summary‑judgment burden when qualified immunity is invoked: plaintiff must show genuine disputes of material fact as to the reasonableness of the officer’s conduct.
The Fifth Circuit affirmed: Blank failed to produce evidence creating genuine disputes on each claim; disagreements about treatment, negligence, or unsupported assertions do not meet the extremely high deliberate‑indifference standard.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Delay/denial of access to Dr. Sandknop	Bell failed to contact or otherwise prevented access to Dr. Sandknop during Crohn’s deterioration	Bell did not interfere; Dr. Sandknop attested he was unaware of any interference and Bell lacked evidence of blocking access	Affirmed — Blank produced no evidence; disagreement about frequency of visits is not deliberate indifference
Failure to refer to outside specialist	Hospital discharge instructed seeing a specialist; Bell intentionally ignored those instructions	Referrals to outside specialists were Dr. Sandknop’s decision; Bell did not control referrals	Affirmed — Decision not to refer is at physician’s discretion; disagreement/negligence insufficient
Failure to provide special diet	Bell disregarded Dr. Sandknop’s alleged order to avoid spicy/fried foods for Crohn’s	No written special‑diet order in records; Dr. Sandknop stated no medically specialized Crohn’s diets; Bell attempted alternatives when Blank rejected food	Affirmed — Blank’s belief unsupported; no evidence of deliberate withholding of nutrition
Withholding narcotic pain medication	Bell refused to provide narcotic pain meds for neck injury	Bell lacked authority to prescribe; prescribing decisions were for Dr. Sandknop to follow from discharge orders	Affirmed — Bell did not act with the requisite subjective deliberate indifference

Malley v. Briggs, 475 U.S. 335 (qualified immunity protects all but plainly incompetent or those who knowingly violate the law)
Tamez v. Manthey, 589 F.3d 764 (subjective‑knowledge deliberate‑indifference test)
Domino v. Texas Dep’t of Criminal Justice, 239 F.3d 752 (deliberate indifference standard; extremely high threshold)
Gobert v. Caldwell, 463 F.3d 339 (disagreement with treatment, malpractice, or negligence not deliberate indifference)
Michalik v. Hermann, 422 F.3d 252 (altered summary‑judgment burden when qualified immunity is asserted)
Hernandez v. Yellow Transp., 670 F.3d 644 (standard of review for summary judgment)
Mendoza v. Lynaugh, 989 F.2d 191 (delay actionable only if deliberate indifference causes substantial harm)
Stewart v. Murphy, 174 F.3d 530 (decision not to follow outside physician’s recommendation does not necessarily constitute deliberate indifference)