Abernathy v. Anderson ( 2020 )


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  •             United States Court of Appeals
    For the First Circuit
    No. 19-1880
    FRANKLIN B. ABERNATHY,
    Plaintiff, Appellant,
    v.
    KRYSTAL ANDERSON,
    Defendant, Appellee,
    CAPTAIN SHAUN DEWEY; SERGEANT MICHAEL RUMERY;
    THOMAS GROBLEWSKI, MD, Medical Director for UMass Correctional
    Health Inc.; OFFICER GERARD BREAU, a/k/a John Doe II;
    LIEUTENANT DAVID DARLING, a/k/a John Doe I;
    OFFICER KYLE SHELDON, a/k/a John Doe III; OFFICER SHAWN GYLES,
    a/k/a John Doe IV; BRUCE GELB; LUIS SPENCER;
    JOHN DOE V, Officer for the D.O.C.,
    Defendants.
    APPEAL FROM THE UNITED STATES DISTRICT COURT
    FOR THE DISTRICT OF MASSACHUSETTS
    [Hon. F. Dennis Saylor IV, U.S. District Judge]
    Before
    Howard, Chief Judge,
    and Barron, Circuit Judge.*
    *  Judge Torruella heard oral argument in this matter and
    participated in the semble, but he did not participate in the
    issuance of the panel's opinion in this case. The remaining two
    panelists therefore issued the opinion pursuant to 
    28 U.S.C. § 46
    (d)
    Ezekiel L. Hill, Diana E. Coleman, and Goodwin Procter LLP on
    brief, for appellant.
    Tory A. Weigand and Morrison Mahoney LLP on brief, for
    appellee.
    December 18, 2020
    Per curiam. Plaintiff-Appellant Franklin B. Abernathy
    ("Abernathy"), an inmate at Souza-Baranowski Correctional Center
    ("SBCC"), appeals the district court's order granting summary
    judgment on his deliberate indifference claim brought under 
    42 U.S.C. § 1983
       against      Defendant-Appellee         Krystal    Anderson
    ("Anderson"), a nurse at SBCC.          Because we agree with the district
    court that Abernathy has failed to establish a triable issue that
    he had a serious medical need to which Anderson was indifferent,
    we affirm.
    I. Background
    A. Factual Background
    On April 3, 2013, Abernathy was incarcerated at SBCC in
    the J-Unit tier of the Special Management Unit.                      At the time,
    Anderson worked as a nurse at SBCC.            In the morning, Correctional
    Officer    Kyle    Sheldon    ("C.O.    Sheldon")       instructed     Abernathy's
    cellmate, Leon Shelby ("Shelby"), to remove a blanket that was
    covering the rear window of the cell, which Shelby refused to do.
    Later that morning, Sergeant Michael Rumery ("Sergeant Rumery")
    accompanied      Anderson    for    medication    rounds       in   J-Unit.     Upon
    reaching       Abernathy    and    Shelby's      cell    for    distribution      of
    medication,      Sergeant    Rumery    noticed    the    blanket     covering   the
    window and instructed Abernathy to remove it.                   Abernathy refused
    to remove the blanket because it belonged to Shelby.                      Sergeant
    Rumery then instructed Shelby to remove the blanket, which Shelby
    - 3 -
    once again refused to do.             As a result of Shelby's refusal,
    Sergeant Rumery instructed Anderson not to dispense the medication
    and told Abernathy that he would not receive his medications until
    the blanket was removed from the window.1
    Around noontime, C.O. Sheldon went to Abernathy and
    Shelby's cell and attempted to hand a tray of food to Shelby.
    Shelby, who refused to take the tray, stated that he believed his
    food had been tampered with, and then threw a cup of liquid at
    C.O. Sheldon, hitting him in the face.                As a result of the
    altercation, it was ordered that Shelby be placed in restraints.
    Sergeant Rumery told Abernathy that he also needed to be placed in
    restraints because the correctional officers were going to open
    the cell to remove Shelby from it.            Abernathy stuck his hands out
    of   the   cell   door   in   order   to   be   handcuffed.   According   to
    Abernathy, the officers "slammed" or "squeezed" the handcuffs on
    1   Anderson contends that Sergeant Rumery's decision to not
    dispense the medication was due to safety concerns because the
    cell was dark due to the blanket covering the window, making it
    unsafe to reach into the cell.   Abernathy disputes that the cell
    was dark and asserts that he turned the light on in the cell when
    the interaction with Anderson and Sergeant Rumery began. Also,
    according to Anderson, Abernathy received his medication once
    "everything calmed down." Abernathy, however, claims he did not
    receive his medication until the following day when "[e]verything
    went back to normal" and that the delay caused him to experience
    muscle spasms ("off and on"), chest pain, and pain in his left
    shoulder for twenty-four hours. These discrepancies, however, do
    not create an issue of material fact preventing the entry of
    summary judgment. See infra.
    - 4 -
    his wrists so tightly that it affected his blood circulation, and
    they then pulled on the handcuffs, twisting his fingers and hands,
    causing bleeding and pain in the process.
    Correctional officers escorted Abernathy over to the
    Special Management Unit medical triage room, where Anderson was
    the nurse on duty.     According to Abernathy, even though he had
    blood on his body and "visible cuts, bruises, and swelling on [his]
    hands, wrists, and arms," Anderson refused to assess his medical
    needs and refused to provide him with any medication or treatment.2
    The next day, Abernathy submitted a sick-call request,
    stating that he had bruises and lacerations on both arms, as well
    as a strained or broken wrist.      In the morning, he received his
    medications   for    pre-existing    conditions,   including   pain
    medication, but was not medically assessed for his alleged injuries
    from the day before.    On April 5, 2013, the SBCC medical staff
    assessed Abernathy and determined that he had no bruising or
    2  Anderson disputes this fact, though her account has not always
    been consistent. In 2013, she stated to OIS investigators that on
    April 3, 2013 she assessed Abernathy and that he seemed to be fine
    and had no complaints. In 2018, however, Anderson testified in
    her deposition that Abernathy did not show up at the triage room
    for examination on April 3, and that she was never told that he
    wanted to be examined.    Regardless, because we are reviewing a
    grant of summary judgment, we construe the record in the light
    most favorable to Abernathy, the nonmovant. See Ocasio-Hernández
    v. Fortuño-Burset, 
    777 F.3d 1
    , 4 (1st Cir. 2015).
    - 5 -
    swelling, although he did have old, already healed scars.                  The
    medical staff provided Abernathy Motrin 200mg and ordered x-rays.
    On April 8, 2013, Abernathy reported the April 3 incident
    to Feltus Bradford, a mental health professional at SBCC.                  The
    next day, on April 9, 2013, Abernathy submitted another sick call
    request, this time reporting that he was suffering from a numb
    wrist, pain in the area near his thumb, soreness from the handcuff
    cutting into the flesh of his wrist, and what he thought could be
    "nerve damage."    Medical progress notes prepared on April 10, 2013
    reveal that Abernathy claimed a numb thumb, "scabbing" of the right
    thumb joint, tenderness on his wrist, and "ecchymosis" (i.e.
    bruising) on "both arms from wrist to elbow."
    On April 15, 2013, x-rays were taken of Abernathy's right
    wrist and right thumb, showing no fractures, dislocations or other
    abnormalities.        Progress notes from May 7, 2013, state that
    Abernathy   complained       of   "hand   pain,"   but   had   "no   functional
    impairment."     The medical examiner noted that Abernathy's hands
    had no "gross deformity" or "pain on palpation."
    B. Procedural Background
    In February 2015, Abernathy filed his original complaint
    pro se, alleging claims under 
    42 U.S.C. § 1983
     and state tort law
    against Anderson and several other defendants.                 Abernathy later
    retained    counsel    and    amended     his   complaint      several   times.
    Abernathy contends that Anderson's failure to assess and treat his
    - 6 -
    alleged medical needs on April 3, as well as her refusal to
    administer his medication, caused him physical pain, fear, and
    anxiety arising from not knowing the extent of his wounds.
    The court dismissed the claims against all defendants,
    save for those against Anderson.      Anderson, the sole remaining
    defendant, then moved for summary judgment on all claims against
    her: a § 1983 deliberate indifference claim for the alleged denial
    of medical care and treatment to Abernathy on April 3, 2013; a
    claim for negligence due to Anderson's alleged failure to provide
    medical assessment and/or treatment to Abernathy on April 3, 2013;
    and a claim for negligent infliction of emotional distress related
    to Anderson's alleged actions and/or omissions on that same day.
    Abernathy opposed.   On July 31, 2019, the district court granted
    summary judgment for Anderson on all claims.     Abernathy appeals
    only the disposition of his § 1983 claim.       We thus limit our
    discussion accordingly.
    II. Discussion
    We review a district court's grant of summary judgment
    de novo, construing the record in the light most favorable to the
    nonmovant and resolving all reasonable inferences in that party's
    favor.    Ocasio-Hernández v. Fortuño-Burset, 
    777 F.3d 1
    , 4 (1st
    Cir. 2015); Mesnick v. Gen. Elec. Co., 
    950 F.2d 816
    , 822 (1st Cir.
    1991) (quoting Griggs-Ryan v. Smith, 
    904 F.2d 112
    , 115 (1st Cir.
    1990)).   Summary judgment may be granted only when "there is no
    - 7 -
    genuine dispute as to any material fact and the movant is entitled
    to judgment as a matter of law."             Fed. R. Civ. P.56(a).        A fact is
    considered material when it has the "potential to affect the
    outcome   of   the    suit    under    the     applicable      law."    Sánchez    v.
    Alvarado, 
    101 F.3d 223
    , 227 (1st Cir. 1996) (quoting One Nat'l
    Bank v. Antonellis, 
    80 F.3d 606
    , 608 (1st Cir. 1996)).                   "A dispute
    is 'genuine' if 'the evidence about the fact is such that a
    reasonable jury could resolve the point in the favor of the non-
    moving party.'"        
    Id.
     (quoting Rivera–Muriente v. Agosto–Alicea,
    
    959 F.2d 349
    , 351-52 (1st Cir. 1992)).               The party opposing summary
    judgment "bears 'the burden of producing specific facts sufficient
    to deflect the swing of the summary judgment scythe.'"                   Theidon v.
    Harvard Univ., 
    948 F.3d 477
    , 494 (1st Cir. 2020) (quoting Mulvihill
    v. Top-Flite Golf Co., 
    335 F.3d 15
    , 19 (1st Cir. 2003)).                         "For
    this    purpose,     [it]     cannot    rely    on     'conclusory     allegations,
    improbable      inferences,           acrimonious        invective,      or      rank
    speculation.'"       
    Id.
     (quoting Ahern v. Shinseki, 
    629 F.3d 49
    , 54
    (1st Cir. 2010)).
    Abernathy's § 1983 claim alleges that Anderson violated
    his Eighth Amendment rights. The Eighth Amendment prohibits "cruel
    and unusual punishments."           U.S. Const. amend. VIII.           Although the
    Eighth Amendment "does not mandate comfortable prisons," Rhodes v.
    Chapman, 
    452 U.S. 337
    , 349 (1981), it does not "permit inhumane
    ones"   either,      Farmer    v.   Brennan,     
    511 U.S. 825
    ,   832    (1994).
    - 8 -
    Accordingly, "the treatment a prisoner receives in prison and the
    conditions under which he is confined are subject to scrutiny under
    the Eighth Amendment."       
    Id.
     (quoting Helling v. McKinney, 
    509 U.S. 25
    , 31 (1993)).
    It is well established that "deliberate indifference to
    serious medical needs of prisoners constitutes the 'unnecessary
    and wanton infliction of pain' proscribed by the Eighth Amendment,"
    Estelle v. Gamble, 
    429 U.S. 97
    , 104 (1976) (citation omitted)
    (quoting Gregg v. Georgia, 
    428 U.S. 153
    , 173 (1976)), and is
    actionable under 
    42 U.S.C. § 1983
    , 
    id. at 105
    .             To succeed on a
    deliberate indifference claim under § 1983, a plaintiff must
    satisfy a two-prong standard. Leavitt v. Corr. Med. Servs., Inc.,
    
    645 F.3d. 484
    , 497 (1st Cir. 2011).        First, a plaintiff must show,
    as an objective matter, that he has a "serious medical need[]"
    that received inadequate care.           
    Id.
       A serious medical need is
    that   which   "has   been   diagnosed    by   a   physician   as   mandating
    treatment, or one that is so obvious that even a lay person would
    easily recognize the necessity for a doctor's attention."                 
    Id.
    (quoting Gaudreault v. Municipality of Salem, 
    923 F.2d 203
    , 208
    (1st Cir. 1990)).      "The 'seriousness' of an inmate's needs may
    also be determined by reference to the effect of the delay of
    treatment."    Id. at 497-98 (quoting Gaudreault, 
    923 F.2d at 208
    ).
    The serious medical need inquiry is fact-specific and must be
    - 9 -
    tailored to the specific circumstances of the case. See id. at 500
    (quoting Smith v. Carpenter, 
    316 F.3d 178
    , 185 (2d Cir. 2003)).
    Second, even if the plaintiff satisfies the objective
    prong,    "the    Eighth    Amendment     is    not    violated    unless     prison
    administrators      also     exhibit      deliberate      indifference       to    the
    prisoner's needs."         Kosilek v. Spencer, 
    774 F.3d 63
    , 83 (1st Cir.
    2014).        Deliberate    indifference       under    this    subjective        prong
    requires evidence that the failure in providing treatment to the
    plaintiff was purposeful.           
    Id.
        Thus, an "inadvertent failure to
    provide       adequate    medical    care"      does    not    give   rise    to      a
    constitutional claim. Estelle, 
    429 U.S. at 105-06
    ; see also Watson
    v. Caton, 
    984 F.2d 537
    , 540 (1st Cir. 1993).                  This prong can also
    be met by showing a "wanton disregard to a prisoner's needs . . .
    akin     to    criminal     recklessness,       requiring      consciousness         of
    impending harm, easily preventable."                   Kosilek, 774 F.3d at 83
    (quotations omitted).
    Here, the district court concluded that Abernathy's
    § 1983 deliberate indifference claim failed because he could not
    show a triable issue of fact as to whether his alleged injuries
    constituted a serious medical need.             Abernathy v. Anderson, 
    395 F. Supp. 3d 123
    , 126 (D. Mass. 2019).                 First, the district court
    determined that evidence of mere bruises, cuts, swelling, and
    superficial lacerations that did not require treatment and did not
    lead to infection or complications did not constitute a serious
    - 10 -
    medical need under our precedent.            
    Id. at 133-34
    .   Second, the
    court noted that the evidence in the record did not show that the
    alleged delay in examining Abernathy's injuries exacerbated any
    medical condition or resulted in permanent damage.            Thus, it was
    insufficient as a matter of law to show that Abernathy had a
    serious medical need.       
    Id. at 134
    .      Finally, the court held that
    "[e]ven assuming [that Abernathy's] bruises and cuts were visible
    to Anderson on April 3," the record did not contain sufficient
    evidence from which a rational jury could conclude that his need
    for treatment was so obvious "that even a lay person would easily
    recognize the necessity for [medical] attention."             
    Id.
     (quoting
    Gaudreault, 923 F.3d at 208).
    On appeal, Abernathy argues that the district court
    erred in granting summary judgment on his § 1983 deliberate
    indifference claim because there is a genuine issue of material
    fact as to whether he had a serious medical need within the meaning
    of the Eighth Amendment.       He offers three theories in support of
    his position.
    First, Abernathy posits that there is a material factual
    dispute over whether he faced a significant risk of future harm
    given that a correctional officer presented him to Anderson for
    medical   attention   and     she   refused    to   perform   any   medical
    assessment. Relying on Leavitt, 
    645 F.3d 484
    , 500 (1st Cir. 2011),
    Abernathy argues that the mere fact that Anderson refused to assess
    - 11 -
    his injuries "subjected [him] to a substantial risk of harm,"
    thereby constituting a "serious medical need" for Eighth Amendment
    purposes,     regardless    of   whether    his   injuries   were    actually
    serious.
    "[S]ubjecting individuals to a risk of future harm . . .
    can qualify as cruel and unusual punishment."            Kosilek, 774 F.3d
    at 85-86 (alterations in original) (quoting Baze v. Rees, 
    553 U.S. 35
    , 50 (2008)).       It is "the particular risk of harm faced by a
    prisoner due to the challenged deprivation of care, rather than
    the   severity   of   the   prisoner's     underlying   medical     condition,
    considered in the abstract, that is relevant for Eighth Amendment
    purposes."     Leavitt, 
    645 F.3d at 500
     (quoting Smith, 
    316 F.3d at 186
    ).   However, the particular risk of harm which can rise to the
    level of a serious medical need cannot be a purely hypothetical or
    abstract risk.    Instead, it refers to an actual risk of harm faced
    by the plaintiff-inmate who does not receive the medical attention
    that he requests and genuinely needs.         See Helling, 
    509 U.S. at 33
    (holding that prospective harm, defined as that which is "sure or
    very likely to cause serious illness and needless suffering" to an
    inmate in the future, can be the basis for an Eighth Amendment
    claim even if the inmate has "no serious current symptoms"); Smith,
    
    316 F.3d at 188
     (holding that although "an Eighth Amendment claim
    may be based on a defendant's conduct in exposing an inmate to an
    unreasonable risk of future harm and that actual physical injury
    - 12 -
    is not necessary in order to demonstrate an Eighth Amendment
    violation,"      the   absence      of   present   physical        injury     will
    nonetheless "often be probative in assessing the risk of future
    harm").
    In   Leavitt,     the    plaintiff-inmate        was   deprived    of
    medication needed to treat his HIV, causing him to suffer severe
    withdrawal symptoms, such as "nightsweats, chills, fever, fatigue,
    gastrointestinal problems, including vomiting and constipation,
    and psoriasis."        
    645 F.3d at 501
    .        Further, the deprivation of
    care created long-term risks by exacerbating his underlying HIV
    condition and making him statistically more likely to develop
    cancer in the future.         
    Id.
        We reversed the granting of summary
    judgment for the defendant because a reasonable factfinder could
    have found that the defendant's deprivation of care subjected the
    plaintiff-inmate to serious harm, both short-term and long-term.
    
    Id.
    Here, Abernathy claims to have suffered cuts, bruises,
    swelling, and some bleeding as a result of the altercation he had
    with SBCC's correctional officers on April 3, 2013.                    Although
    taking the facts in the light most favorable to Abernathy, Anderson
    refused to assess Abernathy's injuries that day, Abernathy was
    medically   assessed     by   SBCC   medical    staff   on    April   5,    2013.
    Moreover, on April 15, 2013, x-rays were taken of his right wrist
    and thumb, showing "[n]o acute fracture, dislocation, or other
    - 13 -
    acute bony abnormality."            Even though Abernathy alleges that
    Anderson's refusal to assess his injuries on April 3 created a
    "risk of harm" to his health, there is no evidence in the summary
    judgment record showing what that future harm could have consisted
    of, much less that it would "sure[ly] or very likely [] cause
    serious illness and needless suffering" to him in the future.
    Helling, 
    509 U.S. at 33
    .         Accordingly, as opposed to the plaintiff
    in Leavitt, for whom the deprivation of HIV medication created a
    real and concrete risk of future harm, we conclude that, based on
    the evidence in the record, the risk of future harm claimed by
    Abernathy is purely hypothetical and that no reasonable jury could
    find that Anderson's refusal to assess Abernathy's medical needs
    on April 3, 2013 created an objective risk of future harm grave
    enough to constitute a serious medical need.
    Abernathy next argues that even if he is not entitled to
    go to trial on his theory that Anderson's denial of medical care
    subjected    him     to    a   "substantial     risk   of    harm,"    there   is
    nevertheless a triable factual issue as to whether he had a serious
    medical need because his injuries were so obvious that even a lay
    person -- a correctional officer -- recognized the need for
    treatment and escorted him to Anderson.
    At     the    outset,   Abernathy    has   not    put     forth    any
    affirmative evidence establishing that the correctional officer
    brought him to Anderson because he "recognized" the severity of
    - 14 -
    Abernathy's need for medical attention.             Instead, Abernathy has
    merely alleged that he was escorted to the triage room, which is
    insufficient to create a genuine dispute of material fact as to
    either his contention that the officers took him of their own
    accord or that they did so because medical care was necessary.               In
    any event, even if the correctional officer himself thought that
    Abernathy needed medical attention, that alone is not sufficient
    for Abernathy's claim to survive.
    The serious medical need inquiry for an Eighth Amendment
    claim of this nature is an objective test, which cannot be met
    merely by pointing to any one lay person's subjective impression
    of the seriousness of Abernathy's injuries.              The injuries suffered
    by Abernathy, to wit, cuts, bruises, swelling, and some bleeding,
    absent,    for     example,    any     underlying   conditions     or     future
    complications, are not the type of wounds that have been typically
    viewed    as    constituting   a     serious   medical    need.    See,   e.g.,
    Montes v. Ponce Municipality, 
    79 Fed. Appx. 448
     (1st Cir. 2003)
    (holding no serious medical need where detainee was active in cell
    after beating and had only swelling and bruising); Chance v.
    Armstrong, 
    143 F.3d 698
    , 702 (2d Cir. 1998) (holding that "[t]he
    standard for Eighth Amendment violations contemplates 'a condition
    of urgency' that may result in 'degeneration' or 'extreme pain'")
    (quoting Hathaway v. Coughlin, 
    37 F.3d 63
    , 66 (2d Cir. 1994)).
    - 15 -
    Relying       on    this   Court's      statements       in   Gaudreault
    defining a serious medical need as "one that has been diagnosed by
    a physician as mandating treatment, or one that is so obvious that
    even a lay person would easily recognize the necessity for a
    doctor's attention," 
    923 F.2d at 208
     (emphasis added), Abernathy
    argues that "a medical need may be proven serious based solely on
    how   a   lay    person   would    perceive       it,"   regardless       of   whether
    treatment is required or if a delay in medical assessment or
    treatment had an adverse effect.             However, such an interpretation
    is inconsistent with our decision in Gaudreault.
    In Gaudreault we affirmed the district court's grant of
    summary judgment in favor of the defendants on the basis that the
    plaintiff had failed to display any serious medical needs during
    the hours following his arrest, even though he was beaten by
    correctional      officers,      causing    him    "multiple    bruises,       to   the
    forehead, left and right orbits of his eyes, nasal area, left ribs,
    right flank and left shoulder, and . . . a corneal abrasion and an
    abrasion    on    the   upper    back."      Gaudreault,       
    923 F.2d at 207
    .
    Recognizing that the plaintiff's injuries "may have been 'obvious'
    in the sense that his bruises and abrasions were visible," we
    concluded       that,   "the    medical    record   demonstrate[d]         that     [the
    plaintiff] did not display any needs so patent as to make lay
    persons" such as the defendant officers "remiss in failing to
    arrange for immediate medical attention."                    
    Id. at 208
    .             The
    - 16 -
    plaintiff's injuries failed to constitute a serious medical need
    because the doctors and nurses who did examine him ten hours after
    his arrest "found him bruised but unbroken, requiring no more
    medical care than a sling, an eye-patch and the application of
    some   disinfectant."         
    Id.
          Although        Abernathy    criticizes
    Gaudreault, arguing that how a prisoner's injuries turn out, i.e.
    whether    the    injuries   ultimately      require    stitches    or    become
    infected, does not "determine whether [a prisoner's] injuries were
    so obvious that even a lay person would easily recognize the
    necessity   for    a   doctor's   attention,"    the     extent    to    which   a
    prisoner's injuries are ultimately assessed as insignificant may
    reflect that an objective lay person would not found the injuries
    so obvious as to mandate immediate attention in the moment.
    Here, there is no evidence in the summary judgment record
    showing that Abernathy's injuries were significant enough to give
    rise to a serious medical need.       Like the plaintiff in Gaudreault,
    Abernathy remained "bruised but unbroken," 
    923 F.2d at 208
    , after
    he was allegedly assaulted by the correctional officers on April
    3, 2013.     Nor is there any evidence in the record that the
    approximately      48-hour   delay    in     medical    treatment       had   any
    detrimental effect on Abernathy's injuries.               See 
    id. at 208-09
    (noting that, although the plaintiff complained that his injuries
    would cause his "imminent demise," the medical record -- which
    indicated the plaintiff had suffered a deviated septum, a cyst in
    - 17 -
    his sinus, and some transient nerve damages -- showed no evidence
    that the plaintiff's injuries were exacerbated by a delay in
    treatment); see also Hernández v. Ashe, 
    745 F. Supp. 2d 15
    , 24 (D.
    Mass. 2010) (explaining how "[a] primary factor in determining
    whether a medical need is serious [in the Eighth Amendment context]
    is the effect of denial of treatment").               Indeed, x-rays taken of
    his right thumb and wrist revealed no issues and thus, no need for
    treatment.     Consequently, there is no evidence in the record from
    which a reasonable jury could find that the injuries sustained by
    Abernathy could have been so obviously serious that a lay person
    would   have    recognized      the    need     for   a   doctor's     attention,
    constituting     an   objective       serious    medical     need    for   Eighth
    Amendment purposes.
    We do note, however, that this case is different from
    Gaudreault.      There,   the    claim    was    that     several    correctional
    officers failed to arrange for medical attention for a detainee
    whose injuries they did not find to be overly serious.                 Here, the
    claim is that Abernathy reported to Nurse Anderson and she refused
    to carry out even a simple assessment of his injuries.                      That
    distinction does not bear, however, on whether Abernathy has
    established a genuine dispute of material fact as to whether he
    had a "serious medical need" -- as we explain, he has failed to do
    so, although we emphasize it could have been relevant to the
    deliberate indifference portion of the Eighth Amendment analysis.
    - 18 -
    Finally, Abernathy argues that there is a triable issue
    of fact as to whether the delay in treating his injuries created
    a   serious    medical       need    by   subjecting   him   to   "severe   pain."
    According to Abernathy, he was in "significant pain" when he was
    taken to Anderson and it is for the jury to determine whether her
    refusal to assess his medical needs "resulted in continued pain"
    constituting a serious medical need.
    Abernathy did not raise this argument below, and, thus
    the district court did not consider it.                Abernathy's argument in
    the district court about there being a triable issue of fact as to
    whether he had a serious medical need relied exclusively on
    "physical trauma." He did not develop an argument that pain itself
    could   constitute       a    serious      medical   need.     Although     in   his
    opposition     to   summary         judgment   Abernathy     mentioned    that   he
    experienced "severe pain," this fleeting reference to pain was not
    made in connection to the argument he now makes that the pain he
    experienced constituted a serious medical need.                   See Pl.'s Opp'n
    to Def. Krystal Anderson's Mot. for Summ. J. at 7 (noting that
    "[w]hen he was presented to Nurse Anderson for treatment on April
    3, 2013 . . . his wrists were lacerated, bruised, and swollen, .
    . . and he was bloody and in severe pain," and arguing that,
    contrary to Anderson's contentions, there is "a genuine issue of
    material fact as to whether" "this physical trauma" qualifies as
    a serious medical need).            Our case law is clear that, "absent the
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    most extraordinary circumstances" -- none discernable here -- such
    a situation calls for finding Abernathy's newly unveiled argument
    waived.    Teamsters Union, Loc. No. 59 v. Superline Transp. Co.,
    
    953 F.2d 17
    , 21 (1st Cir. 1992) ("If any principle is settled in
    this   circuit,   it    is   that,    absent   the   most   extraordinary
    circumstances, legal theories not raised squarely in the lower
    court cannot be broached for the first time on appeal."); see also
    Gray v. Cummings, 
    917 F.3d 1
    , 13 (1st Cir. 2019) (noting that
    arguments not raised in the district court cannot be advanced on
    appeal).
    III.    Conclusion
    In sum, to defeat Anderson's summary judgment motion,
    Abernathy had to produce evidence sufficient to allow a reasonable
    jury to determine that he had a serious medical need under the
    Eighth Amendment.      Because the evidence in the record would not
    allow a reasonable jury to conclude that the injuries he allegedly
    sustained from the handcuffing incident posed a substantial risk
    of future harm or were so obvious that even a lay person would
    recognize the need for a doctor's attention, we affirm the district
    court's entry of summary judgment for Anderson.             No costs are
    awarded.
    Affirmed.
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