author: DIANA GRIBBON MOTZ, Circuit Judge:

text:
    PALMETTO PRINCE GEORGE OPERATING, LLC, d/b/a Prince George Healthcare Center, Petitioner, v. NATIONAL LABOR RELATIONS BOARD, Respondent. National Labor Relations Board, Petitioner, v. Palmetto Prince George Operating, LLC, d/b/a Prince George Healthcare Center, Respondent.
    No. 15-2143, No. 15-2221
    United States Court of Appeals, Fourth Circuit.
    Argued: September 21, 2016
    Decided: November 1, 2016

      ARGUED: Jennifer Marie Fowler-Hermes, Williams, Parker, Harrison, Dietz & Getzen, Sarasota, Florida, for Petitioner/Cross-Respondent. Meghan Brooke Phillips, National Labor Relations Board, Washington, D.C., for RespondenVCross-Petitioner. ON BRIEF: John M. Hament, Kunkel Miller & Hament, Sarasota, Florida, for Petitioner/Cross-Respondent. Richard Griffin, Jr., General Counsel, Jennifer Abruzzo, Deputy General Counsel, John H. Ferguson, Associate General Counsel, Linda Dreeben, Deputy Associate General Counsel, Robert J. Englehart, Supervisory Attorney, National Labor Relations Board, Washington, D.C., for Respondent/Cross-Petitioner.
    Before MOTZ, TRAXLER, and AGEE, Circuit Judges.
   Petition for review denied; cross-petition for enforcement granted by published opinion. Judge MOTZ wrote the opinion, in which Judge TRAXLER and Judge AGEE joined.

DIANA GRIBBON MOTZ, Circuit Judge:

In this case, nurses sought to join a union and engage in collective bargaining with their employer. The National Labor Relations. Board found that the nurses could unionize, rejecting the employer’s contention that they were ineligible supervisors within the meaning of the National Labor Relations Act, 29 U.S.C. § 152(11). When the employer refused to bargain with the nurses’ union, the Board ordered the employer to do so. The employer then filed this petition for review, and the Board cross-petitioned to enforce its order. Substantial evidence supports the Board’s finding that the nurses are not supervisors because their duties do not require the exercise of independent judgment. Therefore, we deny the employer’s petition and grant the Board’s cross-petition.

I.

A.

Palmetto Prince George Operating, LLC, operates a nursing home in Georgetown, South Carolina. The nursing home provides care twenty-four hours, a day, seven days a week.

Palmetto’s management team consists of a Director of Nursing, an Assistant Director of Nursing, and three Unit Managers (collectively the “Managers”). The Managers monitor and evaluate the quality of nursing care, supervise and discipline nursing staff, and arrange the schedules and assignments of the nursing staff.

The Center employs twenty-three nurses to staff its units: six registered nurses (RNs) and seventeen licensed practical nurses (LPNs) (collectively, the “Nurses”). All assess patients, answer call lights, administer medications,' and perform géneral patient care duties. In addition to the Nurses, the Center employs forty certified nursing assistants (CNAs). The CNAs assist residents with daily tasks, such as helping them bathe, repositioning them in bed, and aiding them in using the restroom. Palmetto’s handbook describes the Nurses as the CNAs’ “first line of authority,” and it places the Nurses above the CNAs on its organizational chart.

B.

In 2015, the United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied Industrial and Service Workers Union sought to represent the Nurses as their exclusive bargaining representative. On January 12, 2015, the Union filed an election petition with the Board. At the pre-election hearing before the Regional Director, Palmetto argued that the Nurses are supervisors and therefore have no collective bargaining rights under the National Labor Relations Act. See 29 U.S.C. § 152(3) (2012).

Section 152(11) of the Act defines “supervisor” as: . , .

[A]ny individual having authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or responsibly to direct them, or to adjust their grievances, or effectively to recommend such action, if in connection with the foregoing the exercise of such authority is not of a merely routine or clerical nature, but requires the use of independent judgment.

Palmetto contends that the Nurses are supervisors because they have the authority to discipline and responsibly direct the CNAs and must use independent judgment in' exercising those two authorities. The parties have stipulated that the' Nurses lack authority to perform any of the other ten functions listed in § 152(11).

The Regional Director concluded that Palmetto failed to prove the Nurses are supervisors. Accordingly, the Regional Director ordered an election, and the Nurses voted in favor of having the Union represent them. After the election, the Union requested that Palmetto recognize it as the Nurses’ representative and begin bargaining with it. Palmetto refused, and the Union filed a refusal-to-bargain charge with the Board.

The Board’s General Counsel then filed a complaint against Palmetto alleging that it had committed unfair labor practices -in violation of §§ 158(a)(1) and (5) of the National Labor Relations Act. The Board granted the General Counsel summary-judgment, adopting the Regional Director’s findings and concluding that Palmetto had indeed violated §§ 168(a)(1) and (5) of the Act. Palmetto filed a petition for review with us, and the Board filed a cross-petition to enforce its order.

II.

A.

We review the Board’s factual findings regarding supervisory status for substantial evidence. Glenmark Assoc., Inc, v. NLRB, 147 F.3d 333, 338 (4th Cir. 1998). We affirm if the record contains enough evidence that “a reasonable mind might accept [it] as adequate to support a conclusion.” Gestamp South Carolina, LLC v. NLRB, 769 F.3d 254, 263 (4th Cir. 2014) (internal quotation marks omitted). We defer to the Board’s factual findings even if we might have resolved factual disputes differently. Id.

The Supreme Court has’ held that § 152(11) establishes a three-prong test for supervisory status. See, e.g., NLRB v. Kentucky River Cmty. Care, Inc., 532 U.S. 706, 712-13, 121 S.Ct. 1861, 149 L.Ed.2d 939 (2001). Employees are supervisors if they (1) have the authority to perform any one of the twelve functions listed in § 152(11) or effectively recommend such action, (2) exercise that authority in a manner that is not merely clerical or routine but requires the use of independent judgment, and (3) hold that authority in the interest of the employer. Id. The employer bears the burden of proving all three prongs. Id. at 711-12, 121 S.Ct. 1861. And it must do so by a preponderance of the evidence. Pac Tell Group, Inc, v. NLRB, 817 F.3d 85, 91 (4th Cir. 2016).

In this case, the parties dispute only the first and second prongs of this test; We need only address the second—whether the Nurses exercise authority requiring independent judgment.

The Act leaves the term “independent judgment” undefined. Moreover, the Supreme Court has recognized that the term “is ambiguous with respect to the degree of discretion required for supervisory status.” Kentucky River, 532 U.S. at 713, 121 S.Ct. 1861 (emphasis in original). The Court explained that it is “undoubtedly true that the degree of judgment that might ordinarily be required to conduct a particular task may be reduced below the statutory threshold by detailed orders and regulations issued by the employer.” Id. at 713-14, 121 S.Ct, 1861. The Supreme Court concluded that “[i]t falls clearly within the . Board’s discretion to determine, within reason, what scope of discretion qualifies.” Id Accordingly, a court defers to the Board’s interpretation of “independent judgment” so long as it is “reasonable and consistent with the Act.” Id at 711-12, 121 S.Ct. 1861. .

After the Supreme Court decided Kentucky River, the Board explained that to exercise independent judgment, “an individual must at a minimum act, or effectively recommend action, free of the control of others and form an opinion or evaluation by discerning and comparing data.” In re Oakwood Healthcare, Inc., 348 NLRB 686, 693 (2006). Crucially, the Board concluded in Oakwood that “a judgment is not independent if it is dictated or controlled by detailed instructions, whether set forth in company policies or rules, the verbal instructions- of a higher authority, or in the provisions of a collective bargaining agreement.” Id.

B.

Palmetto does not challenge the reasonableness of the Board’s current, post-Kentucky River interpretation of “independent judgment.” Nor does Palmetto contend that this interpretation is inconsistent with the Act. Indeed, Palmetto conceded at oral argument that the Board’s interpretation of “independent judgment” in Oakwood controls. Palmetto maintains, however, that our analysis of “independent judgment” in cases involving nurses issued pri- or to Kentucky River and Oakwood is in all respects “consistent” with those cases, and so governs the case at hand. Reply Br. 2.

Our pre-Oakwood cases responded to the Board’s perplexing application of § 152(11) to nurses. Before Kentucky River, the Board took the position that nurses do not exercise “independent judgment” any time they exercise “ordinary professional or technical judgment in directing less-skilled employees to deliver services.” Kentucky River, 532 U.S. at 713, 121 S.Ct. 1861 (quoting the Board’s brief).

In a series of cases, we rejected that interpretation of “independent judgment” as unreasonable and held that the nursés at issue in those cases were supervisors. See, e.g., Beverly Enterprises, Virginia, Inc. v. NLRB, 165 F.3d 290, 298 (4th Cir. 1999) (en banc) (holding that nurses were supervisors because they exercised ,§ 152(11) authorities “by and large without any guidelines or established criteria”); Glenmark, 147 F.3d at 341-45, (holding that nurses were supervisors given their authority to schedule and discipline nursing assistants without management approval).

After we decided these nurse/supervisor cases, the Supreme Court in Kentucky River similarly rejected the Board’s sharp distinction between professional and independent judgment, holding that it was unreasonable to conclude that professional judgment can never be “independent” for the purposes of the Act. 532 U.S. at 714, 721, 121 S.Ct. 1861 (citation omitted). In Oakwood, the Board adopted its current interpretation of “independent judgment” to comport with Kentucky River.

This is the first case requiring us to address the precedential value of our pre-Oakwood nurse/supervisor cases. It is settled law that an agency construction entitled to deference supersedes a prior judicial construction of an ambiguous statute. Nat’l Cable & Telecomm. Ass’n v. Brand X Internet Servs., 545 U.S. 967, 982 (2005). The phrase “independent judgment” is ambiguous, and we have always understood that the Board’s reasonable and consistent interpretations of it are entitled to deference. See, e.g., Beverly, 165 F.3d at 296; Glenmark, 147 F.3d at 338.

In Oakwood, the Board adopted a reasonable interpretation of “independent judgment.” As we recently noted, there is no conflict between the Board’s interpretation and the text of § 152(11) or Congress’s intent to distinguish “true supervisors” from employees whom the Act protects “even though they perform ‘minor supervisory duties.’” Pac Tell, 817 F.3d at 91 (quoting Oakwood, 348 NLRB at 686); see also NLRB v. Health Care & Retirement Corp. of America, 511 U.S. 571, 586-88, 114 S.Ct. 1778, 128 L.Ed.2d 586 (1994) (recounting the legislative history of § 152(11)). Indeed, in Oakwood the Board did nothing more than implement guidance offered directly by the Supreme Court. See Kentucky River, 532 U.S. at 713-14, 121 S.Ct. 1861 (noting the significance when determining “independent judgment” of an employer’s “detailed orders and regulations”).

. We therefore defer to the Board’s interpretation of “independent judgment” and apply its standards here. To the extent our pre-Oakwood cases accord with those standards, they remain instructive. However, the Board’s current standards supersede our prior cases to the extent the two conflict. Thus, for example, before Oakwood, we considered it highly probative of independent judgment if nurses served as the most senior staff on site for significant portions of the work week. See Beverly, 165 F.3d at 297-98; Glenmark, 147 F.3d at 341-42; NLRB v. St. Mary’s Home, Inc., 690 F.2d 1062, 1066 (4th Cir. 1982). In accordance with Kentucky River, when detailed employer' rules severely constrain the nurses’ discretion, Oakwood indicates that this fact is not as probative as we had held. Moreover, in Golden Crest Healthcare Center, a case decided the same day as Oakwood, the Board expressly applied Oakwood to hold that the nurses at issue there, although serving for significant periods of time as the most senior staff on site, were not supervisors, particularly given that managers remained on-call after hours. 348 NLRB 727, 727, 730 n.10 (2006).

With these legal principles in mind, we turn to the case at hand.

in.

Palmetto argues that the Nurses here are supervisors because they have the authority to discipline and responsibly direct the work of CNAs in a manner requiring the use of independent judgment. Both arguments fail for the same reason: Palmetto simply has not shown that the Nurses must use any independent judgment when performing these functions.

A.

We first consider the evidence Palmetto offered in support of its contention that the Nurses must exercise independent judgment when disciplining CNAs,

Palmetto uses a progressive discipline policy that classifies violations into three categories. Category I includes minor infractions, such as failing to comply with the dress code or departmental procedures. Category II includes violations such as threatening other employees and ignoring protocols for lifting and moving residents. Category III includes the most serious violations, such as sleeping on the job, insubordination, and neglecting or abusing residents. Palmetto’s current handbook lists the following disciplinary steps: documented oral counseling, reprimands, written warnings, suspension, and discharge.

Any employee can report a disciplinary violation, and in some cases, employees must report them. In particular, failure to report a Category II or Category III violation is itself a Category II violation. The Managers conduct separate investigations of misconduct and make all final disciplinary decisions.

Nevertheless, Palmetto insists that the Nurses must use independent judgment in disciplining CNAs. The record before us contains very scant evidence of oral counseling and only three instances in more than three years—2011 through 2014—of Nurses filing written reports of CNA misconduct. In one, it is unclear under which category the violation fell. The other two involved Category II and Category III violations, which the Nurses had no choice but to report. In the Category III case, a Nurse sent a CNÁ home for sleeping on the job. Palmetto relies heavily on this incident. However, one instance of a Nurse reacting to such an egregious violation, by itself, does not demonstrate independent judgment. See Phelps Cmty. Med. Ctr., 295 NLRB 486, 492 (1989). Moreover, Palmetto’s argument ignores its written rule that sleeping on the job is punishable only by discharge. The Nurse involved in this incident did not discharge or even suspend the CNA. She made no final disciplinary decision. Rather, she called Director of Nursing Jennifer Lambert to report the incident, who then investigated the matter and ultimately fired the CNA. The record before us indicates that Palmetto has given its Nurses only the disciplinary power provided to every other employee (including CNAs themselves): the power to report rule violations to the Managers.

On this record, a reasonable mind could certainly conclude that Palmetto did not offer evidence sufficient to establish that the Nurses use independent judgment when disciplining CNAs.

B.

We next consider the evidence Palmetto offered in support of its contention that the Nurses must use independent judgment when they responsibly direct the work of CNAs.

Palmetto argues that Director Lambert’s testimony establishes as much. But at most, that testimony establishes that the Nurses exercise not independent, but heavily constrained, judgment. Director Lambert testified that the Nurses are responsible for making sure CNAs:

(1) follow various laws, rules, and regulations, including the OSH [sic], (2) comply with infection control procedures, (3) stay within the scope of their certification, (4) adhere to proper protocols for resident hygiene, (5) treat residents in a non-abusive or neglectful [sic] manner, (6) follow the proper feeding and hydration rules and regulations, (7) document treatment, and (8) comply with fire alarm, disaster evacuation, and resident elopement procedures.

Pet. Br. 31.

Palmetto has extensive policies on all these matters and on virtually all CNA duties. It has training, instructions, and policies on everything from handwashing and bathing residents to dealing with patient abuse. During mandatory in-service meetings, the Managers regulaiiy give specific instructions to Nurses and CNAs on such topics as repositioning residents, properly clothing residents, taking breaks, clocking in and out, attending to residents’ hygiene, and providing meal service. Palmetto also conducts fire, evacuation, and resident elopement drills. State law and OSHA regulations provide, additional protocols for infection control, patient hygiene, and emergency preparedness. In every case, the Nurses’ responsibility seems to amount to the same thing: making sure the CNAs follow the written instructions. This suggests that the Nurses serve merely as conduits for these instructions.

It is true, of course, that “the mere existence of company policies does not eliminate independent judgment from decision-making if the policies allow for discretionary choices.” Oakwood, 348 NLRB at 693 (citing Glenmark, 147 F.3d at 341). However, Palmetto has not offered even one instance in which the Nurses could (let alone did) direct CNAs largely without guidance from Palmetto’s instructions.

Palmetto leans heavily on the Managers’ absence at night and on weekends, leaving the Nurses as the most senior staff on site during those times. But, under the Oak-wood standard, which Palmetto agrees controls, these facts do not themselves establish independent judgment. See Golden Crest, 348 NLRB at 730 n.10 (applying Oakwood and holding that charge nurses were not statutory supervisors despite this arrangement). Here, substantial record evidence establishes that Palmetto’s instructions continue to control nurses’ discretion even after hours and on weekends. When the Managers go home at night or for the weekend, they do not take their instructions with them.

Moreover, the record evidence establishes that both the Director and Assistant Director of Nursing rotate “on-call” duties on nights and weekends, and the three Unit Managers have other limited on-call duties. The Unit Managers have instructed the Nurses to call them after hours for assistance, and Director Lambert testified that the Nurses may call her for assistance as well. As the Board explained in Golden Crest, the fact that nurses are the most senior staff on site after hours “is even less probative where management is available after hours.” Id.

Given these facts, the Board reasonably concluded that the Nurses do not exercise independent judgment when directing CNAs.

IV.

The record offers abundant evidence supporting the Board’s finding that Palmetto failed to establish that the Nurses use independent judgment in disciplining and directing the work of CNAs. Accordingly, we must deny Palmetto’s petition for review and grant the Board’s cross-petition for enforcement of its order.

PETITION FOR REVIEW DENIED; CROSS-PETITION FOR ENFORCEMENT GRANTED

      . RNs and LPNs share the same duties, with the exception that LPNs cannot sign assessments or administer small doses of intravenous medications. These differences do not bear on the question of whether they are supervisors.

      . In Oakwood, the Board also adopted a new interpretation of the term “responsibly to direct.” Oakwood, 348 NLRB at 690-92. Here, we need not address the extent to which this new interpretation displaces our prior cases.

      . Palmetto’s reliance on our decision in Beverly is misplaced. In addition to predating Kentucky River and Oakwood, in Beverly the Board conceded that the employer "provides no list of criteria by which assignments, direction of nursing assistants, or emergency dismissals are to be made.” 165 F.3d at 298, Here, Palmetto has utterly failed to rebut evidence that its instructions provided detailed "criteria” on these issues.


source: Caselaw Access Project

author: WYNN, Circuit Judge:

license: Public Domain

text:
    Paul SCINTO, Sr., Plaintiff-Appellant, v. Warden Patricia STANSBERRY, FCI—Butner-Low; Susan McClintock, Camp Administrator, FPC-Butner; R. Holt, Senior Officer Specialist; Dr. Phillips; Officer Coors, Defendants-Appellees, and Federal Bureau of Prisons, a division of the U.S. Department of Justice; Harley G. Lappin, Director, Bureau of Prisons; Kim White, Mid Atlantic Regional Director, Defendants.
    No. 15-1587
    United States Court of Appeals, Fourth Circuit.
    Argued: September 23, 2016
    Decided: November 4, 2016

      ARGUED: Adam H. Farra, COHEN MILSTEIN SELLERS & TOLL PLLC, Washington, D.C., for Appellant. Robert J. Dodson, OFFICE OF THE UNITED STATES ATTORNEY, Raleigh, North Carolina, for Appellees. ON BRIEF: Paul J. Zidlicky, SIDLEY AUSTIN LLP, Washington, D.C., for Appellant. John Stuart Bruce, Acting United States Attorney, G. Norman Acker, III, Assistant United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Raleigh, North Carolina, for Appellees.
    Before NIEMEYER, MOTZ, and WYNN, Circuit Judges.
   Affirmed in part and reversed in part by published opinion. Judge WYNN wrote the opinion, in which Judge NIEMEYER and Judge MOTZ joined.

WYNN, Circuit Judge:

Plaintiff Paul Scinto, Sr. (“Plaintiff’), a former federal prisoner, sued several federal prison officials pursuant to Bivens v. Six Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S. 388, 91 S.Ct. 1999, 29 L.Ed.2d 619 (1971), alleging a number of violations under the Fourth, Fifth, Eighth, and Fourteenth Amendments. Defendants are Dr. Derick Phillip (“Dr. Phillip”); Patricia Stansberry, former Federal Prison Camp Butner Warden (“Warden Stansberry”); and Susan McClintock, former Butner Camp Administrator (“Administrator McClintock”). Collectively, these Defendants successfully moved for summary judgment on all of Plaintiffs claims.

On appeal, Plaintiff limits his arguments to the district court’s dismissal of three claims that Defendants were deliberately indifferent to his medical needs, in violar tion of the Eighth Amendment. Plaintiff argues that, in dismissing these claims, the district court made credibility determinations and weighed the parties’ evidence, thus violating the summary judgment standard.

For the reasons that follow, we reverse the district court’s disposition of the two Eighth Amendment claims against Dr. Phillip and Administrator McClintock but affirm its resolution of the claim against Warden Stansberry.

I.

The Eighth Amendment prohibits the infliction of “cruel and unusual punishments.” U.S. Const, amend. VIII. This prohibition “proscribes more than physically barbarous punishments.” Estelle v. Gamble, 429 U.S. 97, 102, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). It also encompasses “the treatment a prisoner receives in prison and the conditions under which he is confined.” Helling v. McKinney, 509 U.S. 25, 31, 113 S.Ct. 2475, 125 L.Ed.2d 22 (1993). In particular, the Eighth Amendment imposes a duty on prison officials to “provide humane conditions of confinement ... [and] ensure that inmates receive adequate food, clothing, shelter, and medical care.” Farmer v. Brennan, 511 U.S. 825, 832, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). To that end, a prison official’s “deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction' of pain proscribed by the Eighth Amendment.” Estelle, 429 U.S. at 104, 97 S.Ct. 285 (internal quotation marks and citation omitted). Prisoners alleging that they have been subjected to unconstitutional conditions of confinement must satisfy the Supreme Court’s two-pronged test set forth in Farmer v. Brennan, 511 U.S. 825, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994).

First, Farmer’s “objective” prong requires plaintiffs to demonstrate that “the deprivation alleged [was], objectively, ‘sufficiently serious.’ ” Farmer, 511 U.S. at 834, 114 S.Ct. 1970 (quoting Wilson v. Seiter, 501 U.S. 294, 298, 111 S.Ct. 2321, 115 L.Ed.2d 271 (1991)). To be “sufficiently serious,” the deprivation must be “extreme”—meaning that it poses “a serious or significant physical or emotional injury resulting from the challenged conditions,” or “a substantial risk of such serious harm resulting from ... exposure to the challenged conditions.” De’Lonta v. Angelone, 330 F.3d 630, 634 (4th Cir. 2003) (internal quotation marks and citation omitted). In medical needs cases, like the case at bar, the Farmer test requires plaintiffs to demonstrate officials’ deliberate indifference to a “serious” medical need that has either “been diagnosed by a physician as mandating treatment or ... is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.” Iko v. Shreve, 535 F.3d 225, 241 (4th Cir. 2008).

Second, under Farmer’s “subjective” prong, plaintiffs must show that prison officials acted with a “sufficiently culpable state of mind.” Farmer, 511 U.S. at 834, 114 S.Ct. 1970 (internal quotation marks omitted) (quoting Wilson, 501 U.S. at 297, 111 S.Ct. 2321). In conditions of confinement cases, the requisite state of mind is deliberate indifference. Id. To prove deliberate indifference, plaintiffs must show that “the official kn[ew] of and disregarded] an excessive risk to inmate health or safety.” Id. at 837, 114 S.Ct. 1970. Put differently, the plaintiff must show that the official was "aware of facts from which the inference could be drawn that a substantial risk of serious harm exist[ed], and .. dr[ew] th[at] inference.” Id. (emphasis added). Deliberate indifference is “more than mere negligence,” but “less than acts or omissions [done] for the very purpose of causing harm or with knowledge that harm will result.” Id. at 835, 114 S.Ct. 1970. It “lies somewhere between negligence and purpose or knowledge: namely, recklessness of the subjective type used in criminal law.” Brice v. Va. Beach Corr. Ctr., 58 F.3d 101, 105 (4th Cir. 1995) (citing Farmer, 511 U.S. at 835, 114 S.Ct. 1970). Under this standard, mere “[disagreements between an inmate and a physician over the inmate’s proper medical care” are not actionable absent exceptional circumstances. Wright v. Collins, 766 F.2d 841, 849 (4th Cir. 1985) (citing Gittlemacker v. Prasse, 428 F.2d 1, 6 (3d Cir. 1970)).

In deliberate indifference to medical needs cases, Farmer’s subjective prong requires proof of the official’s “actual subjective knowledge of both the inmate’s serious medical condition and the excessive risk posed by [the official’s] action or inaction.” Jackson v, Lightsey, 775 F.3d 170, 178 (4th Cir. 2014) (citing Farmer, 511 U.S. at 837-39, 114 S.Ct. 1970). A plaintiff can meet the subjective knowledge requirement through direct evidence of a prison official’s actual knowledge or circumstantial evidence tending to establish such knowledge, including evidence “that a prison official knew of a substantial risk from the very fact that the risk was obvious.” Makdessi v. Fields, 789 F.3d 126, 133 (4th Cir. 2015) (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970).’

A plaintiff also makes out a prima facie case of deliberate indifference when he demonstrates “that a substantial risk of [serious harm] was longstanding, pervasive, well-documented, or expressly noted by prison officials in the past, and the circumstances suggest that the defendant-official ... had been exposed to information concerning the risk and thus must have known about it—” Parrish ex rel. Lee v. Cleveland, 372 F.3d 294, 303 (4th Cir. 2004) (first alteration in original) (internal quotation marks omitted) (quoting Farmer, 511 U.S. at 842, 114 S.Ct. 1970). Similarly, a prison official’s “[fjailure to respond to an inmate’s known medical needs raises an inference [of] deliberate indifference to those needs,” Miltier v. Beorn, 896 F.2d 848, 853 (4th Cir. 1990), overruled in part on other grounds by Farmer, 511 U.S. at 837, 114 S.Ct. 1970. However, even officials who acted with deliberate indifference may be “free from liability if they responded reasonably to the risk.” Farmer, 511 U.S. at 844, 114 S.Ct. 1970.

II.

Plaintiff entered federal custody at Federal Prison Camp Seymour Johnson in October 2002, At that time, he suffered from myriad medical conditions, including hepatitis C, a knee infection, insulin-dependent diabetes, and high blood pressure. In the years that followed, Plaintiff was confined in various federal prison facilities. In particular, from June 2005 to March 2006, Plaintiff was incarcerated at Federal Prison Camp Butner in Butner, North Carolina. During that time, several incidents purportedly occurred and gave rise to a number of constitutional claims. Following a circuitous journey through the federal judicial system, the present appeal addresses only a subset of these claims.

On February 28, 2008, Plaintiff filed a Bivens action pro se' in the United States District Court for the District of Columbia. Plaintiffs original complaint sought relief for alleged violations of his rights under the Fourth* Fifth, Eighth, and Fourteenth Amendments, naming as defendants various federal officials, including the Bureau of Prisons, then-Bureau Director Harley Lappin, Regional Director Kim White, Warden Stansberry, Administrator McClintock, and Butner Correctional Officer Richard Holt (“Officer Holt”). After dismissing a number of these claims on jurisdictional and sovereign immunity grounds, the district court transferred Plaintiffs remaining claims against Warden Stansberry, Administrator McClin-tock, and Officer Holt to the United States District Court for the Eastern District of North Carolina. Scinto v. Fed. Bureau of Prisons, 608 F.Supp.2d 4, 10 (D.D.C.), aff'd, 352 Fed.Appx. 448 (D.C. Cir. 2009). Following a second appeal in this Circuit, Plaintiff successfully amended his complaint to include additional Eighth Amendment claims against defendants Dr. Phillip and Butner Correctional Officer Lawrence Coor (“Officer Coor”). Scinto v. Stansberry, 507 Fed.Appx. 311 (4th Cir. 2013) (per curiam). Cross-motions for summary judgment followed and, on September 9, 2014, the district court denied Plaintiffs motion for summary judgment and granted summary judgment to the defendants on each of Plaintiffs claims.

Plaintiff appeals only three of the claims dismissed on summary judgment, each arising under the Eighth Amendment. These include: (1) Plaintiffs claim against Dr. Phillip for allegedly denying Plaintiff insulin to treat his diabetes; (2) Plaintiffs claims against Dr. Phillip and Administrator McClintock for allegedly failing to provide aid in a medical emergency; and (3) Plaintiffs claim against Warden Stansber-ry for her alleged failure to provide Plaintiff with a diabetic diet during Plaintiffs incarceration in administrative segregation (the “Special Housing Unit”). We address the facts relevant to each claim below.

III.

“We review the district court’s grant of summary judgment dé novo, viewing the facts and the reasonable inferences therefrom in the light most favorable to the nonmoving party.” Bonds v. Leavitt, 629 F.3d 369, 380 (4th Cir. 2011). Summary judgment must be granted “if the movant shows that there is no 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). To survive summary judgment, “there must be evidence on which the jury could reasonably find for the [nonmovant].” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

A.

1.

Plaintiffs first claim alleges that Dr. Phillip violated Plaintiffs Eighth Amendment rights by denying Plaintiff insulin to treat his diabetes. Dr. Phillip was Plaintiffs prison doctor at Federal Prison Camp Butner and treated several of Plaintiffs medical conditions, including' his diabetes. On June 5, 2005, shortly after Plaintiffs arrival at Butner, Dr. Phillip prescribed Plaintiff morning and evening insulin injections, as well as supplemental insulin injections based upon a “sliding scale” keyed to his blood sugar. According to that sliding scale, Plaintiff was prescribed two units of insulin when his blood sugar was between 141 and 150 milligrams (“mg”) per deciliter (“dL”), four units when his blood sugar was between 151 and 200mg/dL, and so on.

On June 14, 2005, Plaintiff requested from Dr. Phillip and other medical personnel at Federal Medical Camp Butner a supplemental insulin injection because his blood sugar was 200mg/dL. Based on the sliding scale Dr. Phillip prescribed, Plaintiff should have received four units of insulin. At the time pf his request, Plaintiff admits that he was “angry”—at least in part because his blood sugar was high. The parties agree that, rather than providing four units of insulin as dictated by Plaintiffs prescription, Dr. Phillip terminated Plaintiffs visit to the medical clinic and declined to provide him with insulin. Instead, Dr. Phillip developed an alternative plan to monitor Plaintiffs blood sugar levels at mealtimes and to “cover each meal with short acting insulin” if Plaintiff desired. J.A. 521.

According to Plaintiffs evidence, the June 14 incident was not the first time Dr. Phillip denied Plaintiff prescribed insulin injections. Nor, according to Plaintiff, was it the last. Although medical records reflect Dr. Phillip’s plan to monitor Plaintiffs blood sugar and provide supplemental insulin at mealtimes, Plaintiff filed two Inmate Request to Staff forms (“cop-outs”) that suggest this plan was never followed. First, on June 22, 2005, Plaintiff directed a cop-out to Dr. Phillip “requesting] insulin coverage whenever my blood glucose levels rise above 200mg/dl.” J.A. 88. And on July 27, 2005, Plaintiff addressed another cop-out to Dr. Phillip referencing his June 22 request for supplemental insulin (along with several other, unrelated requests for medical attention) and stating that his conditions “remain untreated [and] uncured.” J.A. 82. Dr. Phillip admits that he did not provide Plaintiff with insulin during the June 14 appointment, but asserts that the denial was justified based on Plaintiffs threatening behavior and that his treatment of Plaintiffs diabetes before and after this incident was appropriate.

Plaintiff claims that Dr. Phillip’s alleged repeated denials of supplemental insulin resulted in an unhealthy increase in Plaintiffs blood sugar and his hemoglobin A1C levels, which rose from approximately 7 (within the normal range for diabetics) to 9.8 (an unhealthy level for diabetics) from January to September 2005. More generally, Plaintiff claims that the inadequate treatment of his diabetes resulted in “unnecessary exacerbation of his serious diabetic ... condition[ ], causing serious harm to the Plaintiff [that] resulted in damage to the Plaintiffs kidney’s [sic], eyesight, nervous system, ... and psychological well being.” J.A. 165.

2.

Contrary to the district court’s holding, Plaintiff adduced sufficient evidence to establish a genuine dispute of fact as to both Farmer’s objective and subjective prongs.

Regarding the objective prong, Plaintiffs evidence established that he suffers from a serious medical condition: insulin-dependent diabetes. This medical condition was diagnosed by a medical professional, and Dr. Phillip provided treatment for the condition by prescribing Plaintiffs insulin regimen. Moreover, Plaintiff has created a genuine issue of material fact regarding whether Dr. Phillip’s failure to provide him with insulin was an “extreme deprivation” resulting in “a serious or significant physical or emotional injury” or “a substantial risk” thereof actionable under the Eighth Amendment. See De’Lonta, 330 F.3d at 634. Dr. Phillip admits that he denied Plaintiff a supplemental dose of insulin on June 14, 2005, at a time when Plaintiffs blood sugar was 200mg/dL. This may be sufficient alone to meet the objective test set forth in Farmer. See, e.g., Lolli v. Cty. of Orange, 351 F.3d 410, 420 (9th Cir. 2003) (“Leaving a diabetic ... without proper food or insulin when it is needed creates an objectively, sufficiently serious risk of harm.” (internal quotation marks omitted)).

Even without drawing this conclusion, however, Plaintiff raises a genuine dispute of material fact as to whether the deprivation of his prescribed insulin caused serious injury or a substantial risk of serious injury as required by the objective prong. He does so by pointing to his deposition testimony and medical records showing an increase in his blood sugar and hemoglobin A1C values from January to September 2005, which encompasses the period from June to August 2005 during which Dr. Phillip was assigned to treat Plaintiffs diabetes. Viewing these facts in the light most favorable to Plaintiff,. there are genuine disputes of material fact as to whether (1) this increase is itself a serious injury and (2) the act of withholding insulin from an insulin-dependent diabetic alone creates a serious injury or a substantial risk of such injury.

Plaintiffs evidence also created a genuine dispute of material fact 'as to Farmer’s subjective prong. As Plaintiffs prison doctor, Dr. Phillip knew of Plaintiffs serious medical condition. Indeed, Dr. Phillip prescribed the insulin regimen under which Plaintiff was to receive supplemental insulin injections when his blood sugar was above 140mg/dL. This evidence establishes that Dr. Phillip was aware of facts-Plaintiffs diabetes and his blood sugar value at the time of his request for insulin—giving rise to an inference that failing to provide insulin could result, at least, in a substantial risk of serious harm.

Moreover, viewed in the light most favorable to Plaintiff, Plaintiffs lengthy prison medical records show that his diabetes diagnosis was “longstanding, pervasive, well-documented, [and] expressly noted by prison officials,” Parrish, 372 F.3d at 303— including by Dr. Phillip himself.' This is sufficient to prove a prima facie case of deliberate indifference. Id. Furthermore, as in Miltier, Dr. Phillip knew of Plaintiffs medical need for insulin at the time of the request and failed to respond to that known need, raising an inference of deliberate indifference. 896 F.2d at 853, overruled in part on other grounds by Farmer, 511 U.S. at 837, 114 S.Ct. 1970. The district court erred in failing to apply the Parrish presumption and infer deliberate indifference from Dr. Phillip’s knowledge of Plaintiffs diabetes and disregard of .his own prescription designed to manage that condition.

Notwithstanding the factual disputes outlined above, the district court granted Dr. Phillip’s motion for summary judgment for two principal reasons. First, the court found fault with Plaintiffs failure to offer medical expert testimony (a) that his blood sugar level during the June 14 appointment “created a substantial harm” under the objective prong of Farmer and (b) that Dr. Phillip’s failure to provide insulin during the appointment “resulted in some substantial harm” sufficient to satisfy the objective prong. J.A. 956. Second, the district court concluded that Dr. Phillip had no obligation under the Eighth Amendment to provide Plaintiff, “an angry and hostile patient,” with the requested insulin. J.A. 956. Accordingly, the district court held, Dr. Phillip satisfied his constitutional burden by ordering staff to monitor Plaintiffs condition and provide supplemental insulin at mealtimes. We disagree with both conclusions.

Regarding the absence of expert medical testimony, plaintiffs alleging deliberate indifference must, “[a]t a minimum, ... specifically describe not only the injury but also its relation to the allegedly unconstitutional condition.” Strickler v. Waters, 989 F.2d 1375, 1381 n.9 (4th Cir. 1993). There is no requirement, however, that a plaintiff alleging deliberate indifference present expert testimony to support his allegations of serious injury or substantial risk of serious injury. Rather, the Federal Rules of Evidence apply, and expert testimony is necessary—indeed, permissible—only when it will “help the trier of fact to understand the evidence or to determine a fact in issue.” Fed. R. Evid. 702(a). When laypersons are just “as capable of comprehending the primary facts and of drawing correct conclusions from them” as are experts, expert testimony may properly be excluded. Salem v. U.S. Lines Co., 370 U.S. 31, 35, 82 S.Ct. 1119, 8 L.Ed.2d 313 (1962). As a result, when the seriousness of an injury or illness and the risk of leaving that injury or illness untreated would be apparent to a layperson, expert testimony is not necessary to establish a deliberate indifference claim. See, e.g., Blackmore v. Kalamazoo Cty., 390 F.3d 890, 899-900 (6th Cir. 2004); Boring v. Kozakiewicz, 833 F.2d 468, 473 (3d Cir. 1987).

Recognizing that it is a “[w]ell-known” fact that diabetes is a “common yet serious illness that can produce harmful consequences if left untreated for even a short period of time,” several of our Sister Circuits have denied defendants summary judgment on Eighth Amendment claims alleging that prison officials deprived diabetic inmates of insulin, even when those claims were not supported by expert testimony. Lolli, 351 F.3d at 419-20 (concluding, based on the plaintiffs testimony, that a diabetic person who is “unable to take insulin ... regularly” suffers a sufficiently serious risk of harm); Natale v. Camden Cty. Corr. Facility, 318 F.3d 575, 582-83 (3d Cir. 2003) (holding, in the absence of expert testimony, that a reasonable jury could conclude that prison officials who knew the inmate was diabetic and needed insulin regularly were deliberately indiffei'ent in denying insulin for non-medical reasons). We' agree: a jury is capable of understanding, unaided, the risks of failing to provide insulin to a diabetic and of a trained doctor’s denial of a diabetic’s known need for insulin. Accordingly, we reject the district court’s contention that Plaintiff was required to adduce expert testimony to demonstrate an objectively serious deprivation giving rise to a claim under the Eighth Amendment,

. Regarding Dr, Phillip’s response to Plaintiffs request for insulin, we agree that—even when both Farmer prongs are satisfied—a prison official who responds reasonably in the face of a known, serious risk of harm to an inmate may be “free from liability” under the Eighth Amendment even if harm is not avoided. Farmer, 511 U.S. at 844, 114 S.Ct. 1970. But even assuming arguendo that it was reasonable for Dr. Phillip to decline to provide Plaintiff insulin in the face of his “angry” demands and, instead, to plan to monitor Plaintiffs blood sugar and provide supplemental insulin at mealtimes, Plaintiff nonetheless has established a genuine dispute of fact as to whether Dr. Phillip followed through with that plan. In particular, Plaintiffs June 22 and July 27, 2005, cop-outs raise a reasonable inference that Dr. Phillip failed to provide supplemental insulin as proposed by his alternative plan. Therefore, the district court erred in concluding that there was no genuine dispute of fact as to whether Dr. Phillip reasonably responded to Plaintiffs medical needs.

B.

1.

We now turn to Plaintiffs second Eighth Amendment claim, which arises out of Dr. Phillip’s and Administrator McClintock’s alleged failure to provide aid to Plaintiff during a medical emergency. Oh August 24,2005, Plaintiff was locked in his housing unit while prison officials conducted a “census count.” During that time, the flow of water to Plaintiffs unit was discontinued because maintenance workers were repairing the unit’s showers. While locked down and unable to access water,. Plaintiff began experiencing “extreme [stomach] pain ... was throwing up vomit and blood ... [and] became incontinent.” J.A. 846. In this state, Plaintiff used an emergency phone in the unit to call for help by dialing a “deuces alarm” (2-2-2).

The parties dispute Plaintiffs reason for using the emergency phone. Plaintiff claims that he used the phone to report his illness, saying “I’m sick. The water is off. I can’t get anything to drink. I can’t wash up. I’ve got blood all over me,” J.A. 848-49. By contrast, in a now-expunged incident report arising from the phone use, prison officials recorded that Plaintiff used the phone to complain about the lack of water. According to prison officials, Plaintiff complained that he “ha[d] to get a shower” before reporting to his work shift that afternoon. J.A. 327. Plaintiff asserts that the officials’ explanation is unfounded since prisoft records show that he worked only the morning shift on the day in question.

When prison officials responded to Plaintiffs emergency call, they offered no assistance even though Plaintiff points to several “outward signs” of his need for medical attention, including that his cell “reeked to high heaven” and that his face was covered with partially wiped-up vomit and blood. J.A.' 867-68. Despite his distressed state, Plaintiff claims that Dr. Phillip simply “looked at [Plaintiff] in disgust and turned his head and started to walk away,” providing no medical aid. J.A. 858. According to Plaintiffs evidence, Administrator McClintock also failed to provide Plaintiff with treatment or call for medical assistance, instead ordering prison guards to “lock him up” in the Special Housing Unit. J.A. 858-59. Thereafter, prison officials removed Plaintiff to the Special Housing Unit, where he was confined for six months.

Plaintiffs evidence indicates he did not receive medical attention until at least two days after the August 24 incident, with the only related entry in- his medical record appearing on August 29, 2005—five days after the purported emergency. In court documents, Plaintiff attributes his emergency to acute cholelithiasis (gallstones), signs of which were first documented in his medical record on July 20, 2005, over one month prior to the incident.

2.

Again, Plaintiffs evidence establishes genuine disputes of material fact as to both Farmer prongs. First, there is a genuine dispute regarding whether Dr. Phillip’s and Administrator McClintock’s failure to provide aid to Plaintiff after he used the emergency phone constituted an “objectively, sufficiently serious” deprivation. Viewing the facts in the light most favorable to Plaintiff, as we must, Plaintiff was suffering from a serious, visible medical need at the time Dr. Phillip and Administrator McClintock responded to his emergency call. In particular, Plaintiff was experiencing “extreme pain in [his] stomach, ... throwing up vomit and blood[, and] became incontinent.” J.A. 846. This is the sort of serious medical condition “so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.” Iko, 535 F.3d at 241 (internal quotation marks omitted) (quoting Henderson v. Sheahan, 196 F.3d 839, 846 (7th Cir. 1999)).

Further, Plaintiffs evidence creates a genuine dispute of fact as to whether the denial of medical attention during this emergency resulted in serious injury or a substantial risk of serious injury. A juror could reasonably infer that failing to treat, for two to five days, an inmate who is vomiting blood and experiencing evident physical distress creates a substantial risk that serious bodily injury will result or has already occurred. This conclusion is supported by Plaintiffs medical records, which indicate that, at the time of the alleged emergency, he may have been experiencing complications arising from an earlier gallstone diagnosis.

Plaintiff also has raised a genuine issue of material fact on the subjective prong of Farmer—whether Dr. Phillip and Administrator McClintock acted with deliberate indifference in failing to provide assistance in the face of Plaintiffs alleged medical emergency. In particular, there is sufficient circumstantial evidence to suggest that Defendants were aware of facts giving rise to an inference that their decision to send Plaintiff to the Special Housing Unit without providing medical aid created a substantial risk of serious injury.

Plaintiffs testimony that his cell “reeked” and his face exhibited visible signs of illness, as well as his contemporaneous account of his symptoms create a genuine factual dispute about whether his need for medical attention was so obvious that an official observing the scene would have both known of the facts giving rise to a risk of serious harm resulting from failure to provide medical attention and inferred that such a substantial risk was present. In addition, these outward signs of Plaintiffs need for medical attention and Defendants’ contemporaneous failure to offer aid give rise to an inference of deliberate indifference sufficient for Plaintiffs claim to survive summary judgment. See Miltier, 896 F.2d at 853 (“Failure to respond to an inmate’s known medical needs raises an inference [of] deliberate indifference to those needs.”).

C.

1.

Plaintiffs final Eighth Amendment claim is against Warden Stansberry and alleges a denial of a proper diabetic diet during his six-month confinement in the Special Housing Unit. According to Plaintiffs evidence, the only meals available to Plaintiff in the Special Housing Unit were those served to every other inmate in the unit—meals high in sugar and accompanied by a sugary drink.

Plaintiff used several channels of communication to complain to Warden Stans-berry about the unavailability of a diabetic diet. First, Plaintiff complained to the Warden during her weekly rounds in the unit. Second, Plaintiff submitted cop-outs to Warden Stansberry seeking redress for his complaints. Third, Plaintiff wrote to his congressman, asking him to inquire with prison officials about the deficiencies in his diet. After the congressman forwarded this correspondence to the Bureau of Prisons, Warden Stansberry addressed the allegations in a reply letter. She acknowledged that inmates in the Special Housing Unit did not receive special diets but maintained that inmates were educated about how to select foods appropriate for their medical conditions.

Because of the alleged deficiencies in the diet offered in the Special Housing Unit, Plaintiff claims to have suffered an increase in his blood sugar and A1C levels. Prison medical officials sought to combat these symptoms by increasing his insulin dosage. This treatment purportedly “resulted in the loss of ... diabetic control ... and severe painful and destructive episodes of diabetic hypoglycemia and ... hyperglycemia.” J.A. 626.

The district court assumed without deciding that Plaintiff raised a genuine issue of material fact on Farmer’s objective prong: that the lack of a diabetic diet constituted a sufficiently serious deprivation. The court went on to. conclude, however, that there was no genuine dispute regarding whether Warden Stansberry knew of and disregarded Plaintiffs need for a special diet. The court based its conclusion on Plaintiffs log of interactions with prison officials, which revealed that Plaintiff was “mainly focused on pursuing a collateral attack on his criminal conviction and on defending against his disciplinary charge, rather than on informing Stansberry of the conditions” he considered unconstitutional. J.A. 964. The court went on to note that even if there were a genuine dispute of material fact on this subjective prong, Plaintiffs acknowledgement that he otherwise received adequate medical treatment for his diabetes while confined in the Special Housing Unit rendered a finding of deliberate indifference untenable.

2.

We affirm the district court’s award of summary judgment' in favor of Warden Stansberry on this claim, but for a different reason. Viewing the record in the light most favorable to Plaintiff, we conclude that Plaintiff failed to raise a genuine dispute of material fact regarding whether, in this case, the lack of a diabetic diet was a sufficiently serious deprivation to be actionable under the Eighth Amendment. Warden Stansberry conceded in her deposition and in her letter to Plaintiffs congressman that there was no diabetic diet provided to inmates in the Special Housing Unit. Even so, Warden Stansber-ry stated on at least two occasions that all inmates were educated about how to select from the available, meals foods appropriate for their medical conditions.

In Farmer, the Supreme Court stated that the Eighth Amendment imposes a duty on prison officials to provide inmates with “adequate food.” Farmer, 511 U.S. at 832, 114 S.Ct. 1970. Several of our Sister Circuits have reasoned, albeit in unpublished decisions, that this duty includes an obligation to provide a medically appropriate diet when necessary. For instance, the Tenth Circuit has stated that the Eighth Amendment “requires officials to provide inmates with a special diet if such an accommodation is medically necessary.” Frazier v. Dep’t of Corr., 125 F.3d 861, at *1 (10th Cir.1997) (citing Byrd v. Wilson, 701 F.2d 592, 595 (6th Cir. 1983)). Similarly, the Seventh Circuit has noted that the Amendment “assures prisoners a medically and nutritionally sound diet.” Jackson v. Hanlon, 923 F.2d 856, at *1 (7th Cir.1991). Likewise, the Sixth Circuit has concluded that “officials must provide inmates with a special diet if such an accommodation is obviously medically necessary.” Miller v. Cleek, 198 F.3d 246, at *2 (6th Cir.1999) (citing Byrd, 701 F.2d at 594-95). We agree.

Yet the Eighth Amendment’s requirement that prisoners receive special diets when medically appropriate is not without limit. Courts have consistently held that prison officials comply with this mandate when they provide some food that the complaining prisoner is able to eat without compromising his health. For instance, in Frazier, the Tenth Circuit rejected a prisoner’s deliberate indifference claim when he “d[id] not contend that he [wa]s unable to eat any of the food provided by the correctional facility” and conceded that he was “able to eat certain items on the facility’s menu.” Frazier, 125 F.3d 861, at. *1. The same was true in Miller, • where the Sixth Circuit affirmed dismissal of an inmate’s inadequate diet claim based in part on the lack of “evidence that [he] could not maintain his health based on the diet provided and [the fact that he] d[id] not contend that he was unable to eat any of the food provided by the jail.” Miller, 198 F.3d 246, at *2.

Likewise, courts have found that inmates who are denied special diets suffer no constitutional harm so long as they are instead given instruction on how to eat the available meals in a way that satisfies their medical needs. For example, the Tenth Circuit has found that an inmate who was served a universal, cafeteria-style diet but could use “nutritional break down cards” to determine what foods were amenable to his medical condition could not claim deliberate indifference based on the lack of a special diet. Moore v. Perrill, 51 F.3d 286, at *1 (10th Cir.1995); see also Williams v. Hartz, 43 Fed.Appx. 964, 966 (7th Cir. 2002) (affirming the district court’s award of summary judgment when the complaining prisoner was not given a special diet, but was “instructed” on medically appropriate food choices and given “snacks” when necessary to raise his blood sugar).

And a California district court held that a prisoner who received the “Heart Healthy” diet provided to all inmates in the state prison system and failed to present evidence that he could not eat certain menu items or that the “overall percentage” of such items in each meal was significant could not survive summary judgment on his deliberate indifference claim. Baird v. Alameida, 407 F.Supp.2d 1134, 1140-41 (C.D. Cal. 2005).

We find these decisions persuasive. Only an “extreme deprivation” is actionable under the Eighth Amendment. According to Plaintiff, the meals in the Special Housing Unit included “a bread, a meat product!,] a vegetable!,] and a sweet dessert.” J.A. 279. Plaintiff has not offered evidence that there was no combination of foods in each meal that would have provided him with adequate sustenance without causing adverse medical consequences, instead asserting only that the meals were high in sugar and accompanied by a sugary drink. Plaintiff also does not contradict prison officials’ claims that he was educated on how to eat the available meals (which were from the “national diet” “approved for all” inmates, J.A. 462, 539) in a way that would not exacerbate his diabetic condition. Accordingly, the district court properly awarded Warden Stansberry summary judgment on Plaintiffs diet and nutrition claim.

IV.

Having determined that Plaintiffs claims against Dr. Phillip and Administrator McClintoek should go forward, we must address Defendants’ argument that they are entitled to qualified immunity. Defendants raised qualified immunity before the district court, but because the court ruled for Defendants on the merits, it did not reach the question of Defendants’ entitlement to qualified immunity. Qualified immunity may provide a basis for affirming the district court. R.R. ex rel. R. v. Fairfax Cty. Sch. Bd., 338 F.3d 325, 332 (4th Cir. 2003) (“[W]e may affirm the district court’s judgment on any ground properly raised below.”) (citing Nw.. Airlines, Inc. v. Cty. of Kent, 510 U.S. 355, 364, 114 S.Ct. 855, 127 L.Ed.2d 183 (1994)).

Qualified immunity shields “government' officials performing discretionary functions .,. fi’om liability for civil damages insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818, 102 S.Ct. 2727, 73 L.Ed.2d 396 (1982). In determining whether defendant government officials are protected by qualified immunity, the court considers both “whether a constitutional right [was] violated on the facts alleged” and “whether the right was clearly established” at the time of the conduct in question. Saucier v. Katz, 533 U.S. 194, 200, 121 S.Ct. 2151, 150 L.Ed.2d 272 (2001), overruled in part by Pearson v. Callahan, 555 U.S. 223, 129 S.Ct. 808, 172 L.Ed.2d 565 (2009).

As explained previously, Plaintiff has alleged facts sufficient for a reasonable jury to conclude that his constitutional rights were violated when Dr. Phillip denied Plaintiff his prescribed insulin and when Dr. Phillip and Administrator McClintoek failed to aid Plaintiff during a medical emergency. See supra Parts III.A, B. Although a jury may ultimately decide that Defendants’ version of events is more credible, we are barred from making such a determination when deciding whether to grant summary judgment based on qualified immunity. See Meyers v. Balt. Cty., 713 F.3d 723, 733 (4th Cir. 2013).

To determine whether the right was clearly established, we first must define the right at issue. Occupy Columbia v. Haley, 738 F.3d 107, 118 (4th Cir. 2013). Dr. Phillip maintains that we should frame our analysis of qualified immunity as to Plaintiffs insulin claim as whether it is “clearly established that a prison medical provider runs afoul of the Eighth Amendment when he does not give one single dose of insulin to a federal inmate, after the inmate becomes angry and hostile .,, and the doctor implements a plan to monitor the inmate thereafter.” Appellees’ Br. at 44. Similarly, Dr. Phillip and Administrator McClintoek assert that we should consider their qualified immunity as to Plaintiffs medical emergency claim based on whether a reasonable official would have known it violated a clearly established constitutional right to follow protocol by placing an inmate in administrative detention after he receives an incident report.

But “[f]or a constitutional right to be clearly established, its contours ‘must be sufficiently clear that a reasonable official . would understand that what he is doing violates-that right.’” Hope v. Pelzer, 536 U.S. 730, 739, 122 S.Ct. 2508, 153 L.Ed.2d 666 (2002) (quoting Anderson v. Creighton, 483 U.S. 635, 640, 107 S.Ct. 3034, 97 L.Ed.2d 523 (1987)). There is no requirement that the “very action in question [must have] previously been held unlawful” for a reasonable official to have notice that his conduct violated that right. Id. Accordingly, we reject Dr. Phillip’s and Administrator McClintock’s invitations to define the rights at issue in accordance with the “very aetion[s] in question.”

Rather, we define the right in question as the right of prisoners to receive adequate medical care and to be free from officials’ deliberate indifference to their known medical needs. This definition is consistent with previous deliberate indifference cases from this Circuit. For example, in Iko v. Shreve—a case in which a prisoner alleged government officials failed to conduct a medical evaluation after pepper-spraying him to compel compliance during a cell removal—this Court defined the right at issue as “the right to adequate medical care.” 535 F.3d at 243 n.12. This definition also accords with Supreme Court jurisprudence, which has long dictated that the Eighth Amendment confers a duty upon prison officials to ensure that prisoners “receive adequate ... medical care.” Farmer, 511 U.S. at 832, 114 S.Ct. 1970.

A prisoner’s right to adequate medical care and freedom from deliberate indifference to medical needs has been clearly established by the Supreme Court and this Circuit since at least 1976 and, thus, was clearly established at the time of the events in question. See, e.g., Estelle, 429 U.S. at 104-05, 97 S.Ct. 285 (“We therefore conclude that deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain’ proscribed by the Eighth Amendment.” (citation omitted) (quoting Gregg v. Georgia, 428 U.S. 153, 182-83, 96 S.Ct. 2909, 49 L.Ed.2d 859 (1976))); Farmer, 511 U.S. at 832, 114 S.Ct. 1970 (“[P]ris-on officials must ensure that inmates receive adequate food, clothihg, shelter, and medical care.”); Bowring v. Godwin, 551 F.2d 44, 47 (4th Cir. 1977) (“This circuit has consistently adhered to the prevailing view in requiring reasonable medical treatment [for inmates].”) (citing authorities).

Because we conclude that there is sufficient evidence that Plaintiffs Eighth Amendment right to adequate medical care and freedom from officials’ deliberate indifference to his medical needs was violated and that the right was clearly established, Dr. Phillip and Administrator McClintock are not entitled to qualified immunity.

V.

For the foregoing reasons, we affirm the district court’s disposition of Plaintiffs deliberate indifference claim against Warden Stansberry, reverse its resolution of the claims against Dr. Phillip and Administrator McClintock, and reject Dr. Phillip’s and Administrator McClintock’s invocations of qualified immunity.

AFFIRMED IN PART AND REVERSED IN PART

      . After pleading guilty to maintaining a place for the purpose of manufacturing, distributing, or using phencyclidine, Plaintiff was sentenced to 78 months' imprisonment. The nature of his conviction and sentence are irrelevant to this appeal.

      . Citations to “J.A._’’ refer to the Joint Appendix filed by the parties in this appeal.

      . We emphasize that the correct standard to apply when considering the objective prong of deliberate indifference claims is whether there is an "extreme deprivation” and "a serious or significant physical or emotional injury resulting from the challenged conditions or ... a substantial risk of such serious harm resulting from ... exposure to the challenged conditions.” De’Lonta, 330 F.3d at 634. The district court’s reference to a "substantial harm” requirement does not change this analysis substantively, but does alter unnecessarily the language set forth in Fourth Circuit precedent. We caution that the “serious or significant” injury or "substantial risk” standard, not the district court’s "substantial harm" standard, should be used when instructing the jury on the objective prong of the Farmer test.

      . During a census count, inmates must'remain in place while prison officials conduct a count to ensure that all inmates are in their assigned locations.

      . In recounting their version of events, prison ■officials make no mention of Plaintiffs physical appearance or medical condition.

      . Because Plaintiff has not raised a genuine issue of material fact as to whether there was a sufficiently serious deprivation, we need not consider whether he has sufficiently established the subjective, deliberate indifference prong. See Celotex Corp. v. Catrett, 477 U.S. 317, 322-23, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (requiring the nonmovant to "make a sufficient showing on” every essential element to survive summary judgment).

      . Though we affirm the district court's award of summary judgment on Plaintiffs diet and nutrition claim, we reject the district court's reasoning that because Plaintiff received some adequate treatment for his diabetes while in the Special Housing Unit he cannot complain about other aspects of that treatment. To the contrary, this court has held that "just because [prison officials] have provided [an inmate] with some treatment .,. it does not follow that they have necessarily provided h[im] with constitutionally adequate treatment.” See De’lonta v. Johnson, 708 F.3d 520, 526 (4th Cir. 2013).

      . We reject Dr. Phillip’s and Administrator McCiintock’s framing of the right at issue in Plaintiffs medical emergency claim for the additional reason that it would require us to make a credibility determination inappropriate at the summary judgment stage of litigation.

      . Although we need not reach the issue here, we note once again the “special problem” of " ‘applying an objective qualified immunity standard in the context of an Eighth Amendment claim that is satisfied only by a showing of deliberate indifference’—that is, a knowing violation of the law.” Cox v. Quinn, 828 F.3d 227, 238 n.4 (4th Cir. 2016) (quoting Rish v. Johnson, 131 F.3d 1092, 1098 n.6 (4th Cir. 1997)).
      Some Circuits have resolved this problem by concluding that qualified immunity is unavailable when the plaintiff presents a genuine dispute of material fact regarding the defendant's deliberate indifference, The Seventh Circuit, for example, has held that the subjective prong of the Farmer test and the objective, clearly established prong of the qualified immunity test "effectively collapse into one” when the plaintiff raises genuine factual disputes regarding the defendant’s deliberate indifference. Walker v. Benjamin, 293 F.3d 1030, 1037 (7th Cir. 2002). That court explained that when a plaintiff raises genuine disputes of fact on Farmer's subjective prong, "a defendant may not avoid trial on the grounds of qualified immunity” even though qualified immunity protects covered govern-

        ment officials from suit, not merely from liability. Icl; see also, e.g., Beers-Capitol v. Whetzel, 256 F.3d 120, 142 n.15 (3d Cir. 2001) ("[T]o the extent that the plaintiffs have made a showing sufficient to overcome summary judgment on the merits [of their deliberate indifference claim], they have also made a showing sufficient to overcome any claim to qualified immunity.”). But see Estate of Ford v. Ramirez-Palmer, 301 F.3d 1043, 1049-50 (9th Cir. 2002) (rejecting the view that the deliberate indifference and clearly established inquiries merge).


author: NIEMEYER, Circuit Judge:

text:
    WELLS FARGO EQUIPMENT FINANCE, INCORPORATED, Plaintiff-Appellee, v. Nabil J. ASTERBADI, Defendant-Appellant.
    No. 15-2182
    United States Court of Appeals, Fourth Circuit.
    Argued: September 20, 2016
    Decided: November 4, 2016

      ARGUED: David B. Lamb, Washington, D.C., for Appellant. Steven Neal Leitess, Leitess Friedberg PC, Baltimore, Maryland, for Appellee. ON BRIEF: David A. Donohoe, Potomac, Maryland, for Appellant. Gordon S. Young, Pierce C. Murphy, Leitess Friedberg PC, Baltimore, Maryland, for Appellee.
    Before NIEMEYER and DIAZ, Circuit Judges, and IRENE M. KEELEY, United States District Judge for the Northern District of West Virginia, sitting by designation.
   Affirmed by published opinion. Judge ■ NIEMEYER wrote the opinion, in which Judge DIAZ and Judge KEELEY joined.

NIEMEYER, Circuit Judge:

In this appeal, we address the enforceability of a judgment originally entered in the Eastern District of Virginia but registered for enforcement in the District of Maryland under 28 U.S.C. § 1963. Particularly, we consider the time period during which the judgment remains enforceable in Maryland.

Collecting on a financing debt incurred by Dr. Nabil J. Asterbadi, CIT/Equipment Financing, Inc. (“CIT”) obtained a $2.63 million judgment against Asterbadi in 1993, in the Eastern District of Virginia. Under Virginia law, that judgment remained viable for 20 years. Roughly 10 years after the judgment had been entered, on August 27, 2003, CIT registered the judgment in the District of Maryland pursuant to § 1963. Under Maryland law, made relevant by Federal Rule of Civil Procedure 69(a), judgments expire 12 years after entry.

CIT sold the judgment to Wells Fargo Equipment Finance, Inc., and Wells Fargo thereafter, in April 2015, began collection efforts in Maryland. Asterbadi filed a motion for a protective order, contending that the judgment was unenforceable because the efforts began more than 12 years after the judgment had originally been entered in Virginia. Wells Fargo responded that the registration of the Virginia judgment in Maryland before it had expired under Virginia law became, in effect, a new judgment that was subject to Maryland law for enforcement. Thus, it argued, Maryland’s 12-year limitations period began on the date that the judgment was registered in Maryland, not on the date that the original judgment was entered in Virginia, and therefore the judgment was still enforceable.

The district court agreed with Wells Fargo, concluding that the time limitation for enforcement of the judgment began with the date of its registration in Maryland, on August 27, 2003, and that therefore it was still enforceable against Aster-badi.

For the reasons that follow, we affirm.

I

The judgment was entered on October 4, 1993, against Asterbadi in the Eastern District of Virginia and arose from a defaulted debt that Asterbadi incurred to invest in an airplane. It was entered in the amount of “$2,286,009.97, plus interest from May 31, 1993 on the sum of $2,184,950 at the rate of 1.5% per month, and attorney’s fees of $347,742.50.” Under Virginia law, the judgment remained enforceable for 20 years, or until October 4, 2013. See Va. Code Ann. § 8.01-251(A).

While Asterbadi made a number of payments on the judgment during the period shortly after it was entered, the judgment has, in substantial part, remained unsatisfied. In furtherance of its collection efforts, CIT registered the judgment in the District of Maryland on August 27, 2003, pursuant to 28 U.S.C. § 1963. It also recorded the judgment in state courts in Fairfax County, Virginia; Prince George’s County, Maryland; Montgomery County, Maryland; and the District of Columbia, under the law of those jurisdictions. At the time that CIT registered its judgment in the District of Maryland, Asterbadi still owed some $1.75 million, much of which represented interest.

Several months later, on October 31, 2003, CIT undertook collection efforts in Maryland to execute on stock that Aster-badi held in Zachair, Ltd. To this end, it filed a motion in the district court for an injunction prohibiting Asterbadi “from transferring the [stock] Certificates and ordering him to turn over the Certificates to CIT.” In response, Asterbadi, who explained that he was a physician who had made “an ill-fated investment in an airplane over 15 years ago,” claimed that CIT had overstated the amount owed on the judgment. He also asserted that his stock in Zachair was owned with his wife as tenants by the entireties and therefore was not subject to execution on the judgment. Nonetheless, he stated that he “ha[d] no intention, and will not transfer, any shares of stock in which he has any interest” and that he had no objection to the entry of an order “which would preclude any such transfers.” He did not, however, agree to an order transferring the stock certificates to CIT. No further action was taken on the motion for more than 10 years.

Effective June 29, 2007, CIT sold and assigned its judgment against Asterbadi to Wells Fargo as part of an asset purchase agreement. Some years later, Wells Fargo renewed collection efforts. In preparation for collection in Maryland, Wells Fargo filed a notice of the assignment, as well as a copy of the assignment, in the Circuit Court for Montgomery County on April 1, 2015. And on April 7, 2015, it filed a “Notice of Assignment” in the district court, although without including a copy of the assignment. After Wells Fargo filed the notice of the assignment, it noticed the deposition of Zachair, whose stock Aster-badi held. ’ ■

Asterbadi filed a motion for protective order on May 8, 2015, contending that the Virginia judgment was not enforceable, as Wells Fargo was seeking to enforce a judgment “entered more than 21 years ago in Virginia,” which was beyond both Virginia’s and Maryland’s statute of limitations for enforcing judgments. He concluded that if the judgment was' unenforceable, “there can be no post-judgment discovery.” He acknowledged that, if the limitations period began on the date of registration, a judgment registered in the District in Maryland might still be enforceable under Maryland Rule 2-625, which provides that a money judgment expires 12 years from the date of entry. But he argued that the registration of the judgment in Maryland was “nothing more” than “ministerial” and that it “does not have the effect of entering a ‘new judgment’ ” with a new enforceability period. Thus, he reasoned that any applicable limitations period began at the time of the judgment’s entry in 1993 and therefore that the judgment was unenforceable.

In view of Asterbadi’s arguments, the district court entered an order requiring Wells Fargo to show cause “why this matter is not subject to dismissal” for the reasons given by Asterbadi. Wells Fargo responded, arguing that “once* a [viable] foreign judgment is recorded in the [District of Maryland], that judgment remains effective and enforceable for the time period provided by Maryland law—12 years unless earlier renewed for another 12 year period”—from the date registered. Therefore, it claimed,' the judgment was enforceable to August 27, 2015.

Asterbadi filed a reply and shortly thereafter a supplement to his reply, asserting in his supplement the additional argument that Wells Fargo did not have standing to enforce the judgment because, while it filed a notice of the assignment of the judgment in the district court, it did not file a copy of the assignment itself, as required by Maryland Rule 2-624. He attached to his supplement an actual copy of the assignment that Wells Fargo had filed in Montgomery County, Maryland.

While the proceedings were pending, Wells Fargo filed a renewal of its registered judgment in the district court on August 26, 2015, which, it contends, extended the enforceability of its judgment under Maryland law to 2027.

By order dated September 16, 2015, the district court rejected Asterbadi’s argument that Wells Fargo lacked standing to enforce the judgment, noting that Asterba-di himself had provided the court with a copy of the assignment that had been filed in the Circuit Cóurt for Montgomery County and therefore that “Wells Fargo ha[d] standing [to] respond to my show cause order regarding the enforceability of the 1993 Judgment.” The district court also rejected Asterbadi’s argument that when discovery was commenced in 2015, the judgment was unenforceable because the Maryland limitation of 12 years had run. Relying on Home Port Rentals, Inc. v. International Yachting Group, Inc., 252 F.3d 399 (5th Cir. 2001), the court held that “the [Maryland] statute of limitations in this case started to run on the date that the judgment was registered in this Court, August 27, 2003, and is currently enforceable against the Defendant.” (Emphasis added). With respect to the motion for injunction that had' -been pending since 2003, the court enjoined Asterbadi from transferring his stock certificates in Za-chair—relief to which Asterbadi had earlier consented—but denied, without prejudice, Wells Fargo’s request that Asterbadi be required to turn those certificates over to it.

Asterbadi noticed this appeal from the district court’s September 16, 2015 order. After Asterbadi noticed his appeal from that order, the district court entered a separate order on October 14, 2015, denying, without prejudice, Asterbadi’s motion for a protective order against discovery, pending this appeal.

II

Both parties raise jurisdictional issues. Wells Fargo contends that Asterbadi appealed only the September 16, 2015 order, which entered an injunction to which As-terbadi had earlier consented, and not the court’s denial of the motion for a protective order, entered on October 14, 2015. And Asterbadi contends that Wells Fargo lacks standing to enforce its judgment against him because Wells Fargo filed only a notice of assignment in the district court, not a copy of the assignment itself, and therefore failed to comply with Maryland Rule 2-624, which entitles parties filing an assignment to pursue enforcement in their own name. We address these issues in order.

A

In its September 16, 2015 order, the district court granted in part and denied in part CIT’s original motion for an injunction, a result to which Asterbadi had consented in his original response to the motion for an injunction. After Asterbadi filed an appeal from that order, the district court entered a separate order dated October 14, 2015, denying Asterbadi’s motion for a protective order to halt Wells Fargo’s discovery efforts. Wells Fargo now argues that Asterbadi should have appealed the second order and' that, because he never did so, his appeal should be dismissed.

The filing of a proper notice of appeal is indeed “jurisdictional in nature and ... is a prerequisite to appellate review.” Smith v. Barry, 502 U.S. 244, 248, 112 S.Ct. 678, 116 L.Ed.2d 678. (1992). Federal Rule of Appellate Procedure 3 requires that the notice of appeal “designate,” among other information, “the judgment, order, or part thereof being appealed.” Fed. R. App. P. 3(c)(1)(B). And even though “[cjourts will liberally construe the requirements of Rule 3,” Barry, 502 U.S. at 248, 112 S.Ct. 678, we generally confine our review to the order designated in the notice of appeal, cf. Bogart v. Chapell, 396 F.3d 548, 554 (4th Cir. 2008) (“[W]e are obliged to identify those particular matters over which we possess jurisdiction”).

In this case, however, Asterbadi was justified in presenting his issues in connection with his appeal from the district court’s September 16, 2015 order. While he had not objected to the form of the injunc-tive relief entered, he maintained that the court lacked the ability to grant any in-junctive relief because, as he argued, the judgment against him was unenforceable. In the September 16, 2015 order, the district court explicitly rejected two of Aster-badi’s arguments—that Wells Fargo lacked standing to enforce the judgment and that limitations for enforcement of the judgment had run. Those rulings were necessary conditions precedent if the district court were to grant any injunctive relief, as it did in the September 16, 2015 order. Accordingly, we conclude that Asterbadi’s appeal of that order allows him to challenge the district court’s rulings on these two conditions that were necessary for granting injunctive relief.

B

Asterbadi contends that because Wells Fargo did not comply with Maryland Rule 2-624, it was not entitled to step into the shoes of CIT, which had obtained the judgment against Asterbadi in the first place. That Rule provides that the assignee of a judgment may enforce the judgment in its own name when it files “the assignment ... in the court where the judgment was entered.” Md. Rule 2-624 (emphasis added). Accordingly, he maintains, Wells Fargo has no standing to enforce CIT’s judgment in its own name.

It is important to .note that, while Aster-badi’s argument raises a question of federal law, Federal Rule of Civil Procedure 69(a)(1) incorporates the state law of the jurisdiction where enforcement is sought for the procedure to be followed in enforcing money judgments. Cf. 28 U.S.C. § 1962 (incorporating state law for determining judgment liens on property located in the State). Accordingly, because federal law so requires, it is appropriate that we look to Maryland Rule 2-624.

Whether a “notice” of assignment is sufficient to satisfy the filing of “the assignment,” as provided in Rule 2-624, is not a question that we need to resolve here. As the district court observed, while Wells Fargo filed only a notice of assignment in the district court, Asterbadi filed the actual assignment, which had previously been filed in state court, so that the district court had before it both the notice of assignment and the assignment itself. While the procedure by which the district court received the assignment might have been awkward, that awkwardness did not deprive Wells Fargo of standing to enforce the judgment that it had purchased.

Ill

On the merits, the parties agree on several threshold issues. First, the original $2.63 million judgment in this case was entered on October 4, 1993, in the Eastern District of Virginia, and, under Virginia law, it remained enforceable for 20 years from the date of entry. Va. Code. Ann. § 8.01-251. Second, roughly 10 years later, on August 27, 2003, CIT, the judgment holder, at the time, registered the judgment in the District of Maryland pursuant to 28 U.S.C. § 1963. Third, Maryland law provides that a money judgment expires 12 years from the date of entry or from the date of renewal, if it is renewed before its expiration. Md. Rule 2-625. Finally, Maryland’s 12-year limitation governs the enforcement of this judgment in the District of Maryland.

Against these undisputed propositions, Asterbadi argues that even though the Virginia judgment, when registered in Maryland, was governed by Maryland’s 12-year limitation, the 12-year limitation period began to run at the time when the original judgment was entered in Virginia, i.e„ on October 4, 1993. Under his argument, the enforceability of the registered judgment in Maryland expired 12 years after 1993, or on October 4, 2005.

Wells Fargo contends that when the Virginia judgment was registered in Maryland, it became, in effect, a new judgment governed by Maryland’s 12-year limitations period, which began running on the date of registration, August 27, 2003.

To resolve the dispute, we begin with § 1963 itself, under which the Virginia district court judgment was registered in the Maryland district court. Section 1963 provides in relevant part:

A judgment in an action for the recovery of money ... entered in any ... district court ,.. may be registered by filing a certified copy of the judgment in any other district_A judgment so registered shall have the same effect as a judgment of the district court of the district where registered and may be enforced in like manner.

28 U.S.C. § 1963. The statute was enacted in 1948 as a device to streamline the more awkward prior practice of bringing suit on a foreign judgment and thereby obtaining a new judgment on the foreign judgment. As' then-Circuit Judge Harry Blackmun observed:

It seems to be conceded that the purposes of § 1963 were to simply facilitate the enforcement of federal judgments, at least those for money, to eliminate the necessity and expense of a second lawsuit, and to avoid the impediments, such as diversity of citizenship, which new and distinct federal litigation might otherwise encounter.

Stanford v. Utley, 341 F.2d 266, 270 (8th Cir. 1965); see also Home Port Rentals, 252 F.3d at 404 (noting that Congress explicitly enacted § 1963 to spare litigants the inefficiencies of obtaining a judgment on a judgment); Stiller v. Hardman, 324 F.2d 626, 628 (2d Cir. 1963) (noting that § 1963 provides “a speedier and more efficient mechanism for the enforcement of federal judgments” than the practice of obtaining a judgment on a judgment); S. Rep. No. 83-1917 (1954), as reprinted in 1954 U.S.C.C.A.N. 3142, 3142 (explaining that § 1963 was enacted to spare creditors and debtors alike “the additional cost and harassment of further litigation which would otherwise be required by way of an action on the judgment in a district other than that where the judgment was originally obtained”).

Thus, instead of requiring the holder of a Virginia judgment to file a complaint in the Maryland district court on the basis of the Virginia judgment, thereby engaging the federal process to obtain a new judgment enforceable in the District of Maryland, § 1963 allows the judgment holder simply to register the Virginia judgment in Maryland but to retain the benefits of obtaining a judgment under the former practice of suing on a judgment to obtain a new judgment. Indeed, § 1963 explicitly so provides, stating that a district court judgment registered in another district court “shall have the same effect as a judgment of the district court ... and may be enforced in like manner.” 28 U.S.C. § 1963 (emphasis added).

We thus construe § 1963 to provide for a new judgment in the district court where the judgment is registered, as if the new judgment had been entered in the district after filing an action for a judgment on a judgment. Accordingly, just as a new judgment obtained in an action on a previous judgment from another district would be enforceable as any judgment entered in the district court, so too is a registered judgment. The other courts of appeals that have construed § 1963 have reached the same conclusion. See, e.g., In re Estate of Ferdinand E. Marcos Human Rights Litig., 536 F.3d 980, 989 (9th Cir. 2008) (“[Registering a judgment under § 1963 is the functional equivalent- of obtaining a new judgment of the registration court” (emphasis added)); Home Port Rentals, 252 F.3d at 405 (“[Registration truly is the equivalent of a new judgment of the registration court” (emphasis added)); Stanford, 341 F.2d at 268 (“We feel that registration provides, as far as enforcement is concerned, the equivalent of a new judgment of the registration court” (emphasis added)).

With this understanding of § 1963,. we apply the principles applicable to any money judgment entered in a district court. Under Rule 69(a), the judgment is enforceable in accordance with state law, and in this case Maryland law provides that “a money judgment expires 12 years from the date of entry or most recent renewal.” Md. Rule 2-625. Accordingly, the registered judgment in this case would have expired 12 years from August 27, 2003, or on August 27, 2015. And because Wells Fargo renewed the judgment for another 12 years on August 26, 2015, the registered judgment remains enforceable in Maryland to August 26, 2027.

Asterbadi argues that registration is merely a “ministerial act” that is carried out as a matter of procedure to enforce the Virginia district court judgment, and therefore the original Virginia judgment is actually the judgment Wells Fargo seeks to enforce, even if that judgment is admittedly subject to the Maryland 12-year limitation. Thus, he argues, the 12 years began running when the Virginia judgment was entered, as stated in Maryland Rule 2-625 (providing that a “judgment expires 12 years from the date of entry” (emphasis added)). This argument, however, overlooks the effect of registration under § 1963. If registration were merely a ministerial act to enforce the Virginia judgment in Maryland, there would be no need for the statute to have added the language that the registered judgment functions the same as a judgment entered in the registration court. With that language, § 1963 elevates the registered Virginia judgment to the status of a new Maryland judgment, and it is accordingly enforced as a new judgment entered in the first instance in Maryland.

The Stanford court likewise expressly rejected Asterbadi’s “ministerial act” characterization of § 1963:

We have concluded that § 1963 is more than “ministerial” and is more than a mere procedural device for the collection of the foreign judgment. We feel that registration provides, so -far as enforcement is concerned, the equivalent of a new judgment of the registration court.

341 F.2d at 268. And the Stanford court gave the same reasons that we do in reaching this conclusion:

To restrict registration to a procedural and collection device for the foreign judgment itself, and to have it expire with the foreign judgment, would give the words of the statute a lesser status than their plain meaning and to make registration something far inferior to a judgment on a judgment.

Id. at 270 (emphasis added). Again, as all the courts of appeals have noted, the purpose of § 1963 was to give the same effect achieved by a judgment on a judgment but without the excessive process.

Asterbadi also argues that we should construe § 1963 in the same manner as courts have construed the Uniform Enforcement of Foreign Judgments Act, which facilitates the enforcement of one State’s judgment in the courts of another State. See, e.g., Md. Code Ann., Cts. & Jud. Proc. §§ 11-801 to 11-807. He claims that some courts have construed the Uniform Act or similar state statutes in a manner that distinguishes between registering a judgment and suing on a judgment, with the former subject to the limitations of the state where the judgment was originally entered and the latter subject to the limitations of the state where the new judgment was obtained. While we do not assume that this construction is an accurate one, see, e.g., Revised Unif. Enforcement of Foreign Judgments Act prefatory note (Unif. Law Comm’n 1964), we are nonetheless not construing the Uniform Act, but rather § 1963. And we construe § 1963 to elevate a registered money judgment such that it functions in every way as a new judgment. It follows that with the registered judgment functioning as a new judgment, the limitations period for enforcement runs from the date of registration. This is the conclusion that every court of appeals that has construed § 1963 has reached. See, e.g., Home Port Rentals, 252 F.3d at 407 (holding that “the applicable limitation law for purposes of enforcement of the registered judgment in the registration district is that of the registration state ... and it starts to run on the date of registration”); see also In re Estate of Marcos Human Rights Litig., 536 F.3d at 989; Stanford, 341 F.2d at 268.

Finally, Asterbadi proposed during oral argument numerous horribles that he envisions will result from the fact that creditors will be able repeatedly to restart a statute of limitations through the simple act of registration, defeating any purpose for the limitation. The posited consequences, however, are no different than have always existed under the more burdensome process of suing on an original judgment to obtain a new judgment in the enforcement jurisdiction. When the new judgment was entered, it carried with it the limitations period then applicable to judgments in the State of entry. Moreover, creditors in many States—including in Maryland—are also able to renew existing judgments indefinitely and thus extend enforcement with new limitations periods without any adversarial process. See, e.g., Md. Rule 2-625 (requiring only that the “judgment holder ... file a notice of renewal” at any time before expiration of the judgment or a previous renewal, without any limit on the number of renewals that might be filed).

In sum, we hold that the registration of the Virginia district court judgment in the District of Maryland at a time when the judgment was not time-barred by Virginia law functions as a new judgment in the District of Maryland, and Maryland’s 12-year limitations period for enforcement on the judgment begins running from the date of registration.

Accordingly, the district court’s September 16, 2015 order is

AFFIRMED.