by Chuck Sharman

In a ruling on August 15, 2025, the U.S. Court of Appeals for the Fourth Circuit offered important guidance for prisoners relying on expert medical testimony, affirming dismissal of claims by North Carolina prisoner Manuel Moreno for neglect he suffered while incarcerated. The U.S. District Court for the Middle District of North Carolina had earlier entered default judgment against several Defendant medical providers at Scotland Correctional Institution (SCI), where Moreno and 18 other prisoners were sickened in February 2016 in an outbreak of what was later determined to be avian flu.

All 19 prisoners reported to the SCI medical unit on February 26, 2016, complaining of flu-­like symptoms. Staffers forwarded their charts to supervising Dr. Carol Bosholm, who had the prisoners quarantined. She also ordered them treated with anti-­bacterial medication, even though she thought the contagion was probably a viral flu. 

But Moreno had a documented allergy to the medication, amoxycillin. Predictably, he got even sicker after taking it. Other than monitoring his vital signs, however, medical unit staffers did nothing, ignoring his worsening symptoms even as the other quarantined prisoners recovered. 

After three days without seeing a doctor, Moreno was finally examined by Dr. Bosholm on February 29, 2016. By then “he was in acute respiratory failure, in acute renal failure, had hypoxia, and had acidosis,” as the complaint he later filed recalled. “His O2 saturation levels were at 80%, his lips were blue, he was vomiting, his creatinine levels were severely elevated to 5.9, and his LFTs were elevated.”

Moreno was transferred to a hospital, where he was finally tested and diagnosed with H1N1 influenza, commonly known as avian flu. But before hospital staff could arrest his decline, he slipped into a “months-­long” coma, the complaint continued, which left him with severe and permanent injuries. Moreno then filed suit in 2019 under 42 U.S.C. § 1983, accusing Bosholm and fellow Defendants of deliberate indifference to his serious medical need, in violation of his Eighth Amendment rights. 

Defendant medical providers Japeth Bett, Jose Cruz, Jeremy Edwards, Tiffany Locklear, Yahaira Martinez, and Michael Morse never replied to the complaint. The district court entered default judgment against them in October 2023, awarding Moreno $350,000 in compensatory damages and $700,000 in punitive damages; an additional award of $17,801 was made the next month in fees and costs for Moreno’s court-­appointed pro bono counsel, provided by attorneys with Brooks, Pierce, Mclendon, Humphrey & Leonard, LLP in Raleigh and Greensboro.

Meanwhile, Moreno’s remaining claims against Dr. Bosholm proceeded to trial in July 2023. At its conclusion, she moved for judgment as a matter of law (JNOV). That motion was granted, and judgment was entered for Defendant. Moreno timely appealed the JNOV ruling, while Bosholm appealed the earlier Report and Recommendation from a magistrate that denied her motion for summary judgment and forced her to trial. 

The Fourth Circuit consolidated the appeals before hearing the case and issuing its ruling. Of particular importance to other prisoners is the Court’s explanation of the mechanics of presenting expert medical testimony in federal court. Simply put, Fed. R. of Ev. (FRE) 601 requires the federal judge to apply local state rules governing the competency of witnesses, while FRE 702 governs the admissibility of the witnesses’ testimony. 

In North Carolina, the former is governed by the state’s Rule of Evidence (NCRE) 702(b). The district court found that Moreno’s medical expert, Dr. Bilbro, didn’t meet the requirements of NCRE 702(b), so it didn’t allow his testimony about the standard of care owed to the Plaintiff. On appeal, Moreno argued that this was error because FRE 702 governed the admissibility of the testimony, and Dr. Bilbro met its requirements. But the Fourth Circuit found no error, holding that exclusion of a witness under FRE 601 and NCRE 702(b) is materially different from exclusion of the witness’ testimony under FRE 702. The former acts as a threshold test that must be passed before the latter can be considered, the Court said, which is all that the district court did.

If Moreno had called a state-­qualified expert whose testimony was accepted, might the district court have reached a different decision? We’ll never know. But consider the facts: A mass infection of unknown origin sickened a group of prisoners, whose treatment was directed by a doctor who never saw them in person for three crucial days, prescribing one a medication to which he had a documented adverse reaction. Given that, the absence of expert testimony may well have been fatal to Moreno’s case. See: Moreno v. Bosholm, 151 F.4th 543 (4th Cir. 2025).

It is also unknown if Moreno was able to collect the default judgment from the other defendants, since they apparently were not indemnified by the state. The envelopes containing the default order copies addressed to Morse and Edwards were docketed returned to the district court in December 2023, with insufficient address information to forward them.

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