Francisco Estrada v. D. Montalvo, 703 F. App'x 755

Francisco Estrada, a federal inmate at FCC Coleman, alleged Eighth Amendment deliberate indifference to serious medical needs (gout, hepatitis C, post-biopsy complications) by prison medical staff and administrators.
Following a botched liver biopsy, Estrada experienced internal bleeding, jaundice, and severe pain; hospital ordered follow-up care that he alleges was not followed when returned to Coleman.
For about a year he repeatedly sought care; defendants primarily prescribed ineffective generic colchicine and provided only three days of pain medication after the biopsy; an ultrasound a year later found a gallstone and probenecid relieved symptoms.
Estrada alleged fabricated medical records and that Warden Drew promised but failed to investigate; he sued multiple staff and administrators under Bivens and state tort theories.
After multiple amendments, the district court required a fifth amended complaint and dismissed it with prejudice under Rule 12(b)(6); Estrada appealed pro se.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether care alleged rises to Eighth Amendment deliberate indifference by medical staff	Estrada: defendants ignored severe pain, delayed/failed effective treatment for ~1 year, provided only minimal medication after serious diagnosis	Defendants: provided medical care; at most negligent diagnosis/treatment, not constitutional violation	Reversed as to Drs. Carver and Chipi: allegations plausibly show deliberate indifference; affirmed as to Michel and Flagg (medical negligence only)
Supervisory liability for medical supervisor Montalvo	Estrada: Montalvo knew of prolonged ineffective treatment and failed to act	Defendants: no personal participation or causal connection alleged	Reversed as to Montalvo: pleading sufficiently alleges personal knowledge and failure to act
Supervisory liability for Warden Drew regarding alleged fabrication of records	Estrada: Drew promised investigation and failed to act	Defendants: fabrication claim not tied to denial/delay of medical care	Affirmed dismissal as to Drew: no causal link to denial of medical care alleged
Denial of leave to amend further and appointment of counsel	Estrada: should have been allowed another amendment and counsel appointed	Defendants: plaintiff had multiple opportunities; case not exceptional or complex	Affirmed: further amendment would be futile; denial of counsel not abuse of discretion

Bivens v. Six Unknown Named Agents of Fed. Bureau of Narcotics, 403 U.S. 388 (establishing Bivens remedy for certain constitutional violations)
McElligott v. Foley, 182 F.3d 1248 (11th Cir. 1999) (deliberate indifference standard and when cursory care can constitute Eighth Amendment violation)
Waldrop v. Evans, 871 F.2d 1030 (11th Cir. 1989) (court reluctance to find Eighth Amendment violation where medical care was provided)
Hamm v. DeKalb County, 774 F.2d 1567 (11th Cir. 1985) (disagreement over treatment choice not Eighth Amendment violation)
Farrow v. West, 320 F.3d 1235 (11th Cir. 2003) (some delay in finding effective treatment not per se constitutional violation)
Gonzalez v. Reno, 325 F.3d 1228 (11th Cir. 2003) (standards for supervisory liability in Bivens context)
Aldana v. Del Monte Fresh Produce N.A., Inc., 578 F.3d 1283 (11th Cir. 2009) (court may reconsider earlier interlocutory rulings before final judgment)
Cockrell v. Sparks, 510 F.3d 1307 (11th Cir. 2007) (denial of leave to amend reviewed for abuse of discretion; futility doctrine)
Fowler v. Jones, 899 F.2d 1088 (11th Cir. 1990) (appointment of counsel in civil cases is discretionary; reserved for exceptional circumstances)
Chudasama v. Mazda Motor Corp., 123 F.3d 1353 (11th Cir. 1997) (Rule 12(b)(6) ruling based solely on pleadings unaffected by discovery)