Fourth Circuit Upholds Denial of Qualified Immunity to Jail Supervisors Who Ignored Detainee’s Cranial Abscesses
by Matt Clarke
On July 2, 2026, the United States Court of Appeals for the Fourth Circuit upheld a district court’s denial of qualified immunity to two supervisors at the Aiken County Detention Center (ACDC) in South Carolina.
While Cassiopeia Rhoads was a pretrial detainee at ACDC, she developed an abscess on the side of her head but was not taken to a hospital for medical intervention for three weeks. She was being seen regularly by Southern Health Partners (SHP) medical personnel because she was detoxing from heroin and was on the withdrawal monitoring schedule. SHP had contracted to provide health care at the jail.
Four days after arriving at the jail, Rhoads began complaining of pain related to the developing abscess. Although she saw medical personnel multiple times daily for detox monitoring, she was not seen by a nurse for her abscess for four days when she was given antibiotics, prescribed ibuprofen for a week and put on the “dentist list.”
Rhoads continued to complain of pain, fever, dizziness, vomiting and other symptoms due to a “fluid like sack” above the right ear and swelling of the right side of the face. Finally, 16 days after her initial complaint, she was seen by Dr. Robert Williams. However, Williams merely recommended three days of Tylenol and warm compresses for what he called a “small hematoma to [right] parietal scalp” and “tenderness.” That day, Rhoads “partook in a peaceful protest” by refusing to return to her cell until she was taken to the hospital. In response, she was issued a disciplinary citation and transferred to solitary confinement. Detainees in solitary had no access to the kiosk that allowed them to request medical assistance and file grievances.
Four days later, Rhoads was found unconscious on the floor of her cell. She was revived but was vomiting and feverish three hours later, so medical staff finally relented and allowed her to be transported to a hospital.
Rhoads was diagnosed with severe sepsis caused by a bone infection complicated by abscesses under her tongue and inside the skull near her spine. She had to undergo “a right partial craniectomy,” removal of part of the skull to access the brain skull base.
Rhoads filed a federal civil rights lawsuit alleging jail and medical staff violated her Fourteenth Amendment substantive due process rights by being deliberately indifferent to her serious medical needs. Defendants moved for summary judgment, which was granted for all but jail Lieutenants Erik Riddle and Jessica Whitaker, who filed an interlocutory appeal. Rhoads was represented on appeal by attorneys William Camden Lewis, Francis M. Vinson, IV, and Patrick L. McLaughlin.
The Fourth Circuit noted that Deputy Kimberly Kelly had repeatedly voiced her concerns about Rhoads’s medical condition to Riddle and Whitaker only to be told that they could not send her to the hospital if “Medical” did not want to send her there. Deputy Carla Hill told Whitaker that Rhoads had a swollen area the size of a grapefruit on her head but Whitaker accepted “Medical’s” opinion that this was self-inflected, despite Hill telling her that she had kept a close watch on Rhoads and had never seen her attempt self-harm. Both lieutenants testified they could not recall having been told about the swelling.
The Fourth Circuit began its analysis by determining whether a clearly established right existed. It held that “a pretrial detainee’s right to receive adequate medical care and to be free from deliberate indifference to their known medical needs” was the appropriate definition of the right, per Tarashuk v. Givens, 53 F.4th 122 (4th Cir. 2022), and it was clearly established “since at least 1976,” citing Scinto v. Stansberry, 841 F.3d 219 (4th Cir. 2016).
The Court held that the requirement for a guard to take action to respond to information about a detainee’s serious medical needs was also established in 2019, per Gordon v. Kidd, 971 F.2d 1087 (4th Cir. 1992) (suicidal intentions). This holds true even if medical personnel have already seen the detainee. See: Iko v. Shreve, 535 F.3d 225 (4th Cir. 2008).
The Court concluded that its 2023 revamping of pretrial detainee deliberate indifference claims to adopt an objective test did not change the result in this case as the change came after the events that gave rise to the lawsuit and thus did not apply to this case and Rhoads would prevail under either standard.
The Court also concluded that the lieutenants could not rely on the fact the medical personnel did not want to send Rhoads to the hospital because “government officials who ignore indications that a prisoner’s or pretrial detainee’s initial medical treatment was inadequate [could] be held liable for deliberate indifference to medical needs.” See: Stevens v. Holler, 68 F.4th 921 (4th Cir. 2023).
This is especially true when “continued complaints … or … manifest symptoms … would have put defendants on notice that additional care was required.” Further, “there is no indication in the record that [Rhoads] was seen by any medical personnel after she was placed in solitary confinement,” eliminating any reliance on medical personnel’s opinion for that time period.
The district court’s judgment was affirmed. See: Rhoads v. Riddell, 180 F.4th 171 (4th Cir. 2026).
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Related legal case
Rhoads v. Riddell
| Year | 2026 |
|---|---|
| Cite | 180 F.4th 171 (4th Cir. 2026) |
| Level | District Court |