United States Court of Appeals
                        For the First Circuit


No. 23-1021

 YVONNE MARTIN, as personal representative of the Estate of Paul
                            McDonald,

                        Plaintiff, Appellant,

                                  v.

                       SOMERSET COUNTY ET AL.,
                        Defendants, Appellees.


          APPEAL FROM THE UNITED STATES DISTRICT COURT
                    FOR THE DISTRICT OF MAINE

              [Hon. Nancy Torresen, U.S. District Judge]


                                Before

                      Kayatta, Selya, and Gelpí,
                           Circuit Judges.


     Kristine C. Hanly, with whom Garmey Law was on brief, for
appellant.
     Peter T. Marchesi, with whom Michael D. Lichtenstein and
Wheeler & Arey, P.A., were on brief, for appellees Somerset County
and related parties.
     John J. Wall, III, with whom Monaghan Leahy, LLP was on brief,
for appellees Craig Meunier and Gerard Madore.
     Benjamin J. Wahrer, with whom Thompson Bowie & Hatch LLC was
on brief, for appellees MedPro Associates and Cheryll Needham.
November 21, 2023
           SELYA, Circuit Judge.         On the six-year anniversary of

her son's death, plaintiff-appellant Yvonne Martin invoked 

 and sued on behalf of his estate.           She alleged a

deprivation of her late son's rights at the hands of jail staff

and a medical contractor.      Specifically, she claimed that while

her son was detained in the Somerset County Jail, the defendants

failed to recognize his serious mental illness, leading to his

death after a suicide attempt.            The district court — in two

separate orders — ruled that the suit was time-barred as to all

defendants.   After careful consideration, we affirm.

                                     I

           We briefly rehearse the relevant facts and travel of the

case.   Two dispositive orders are involved:      one granting a motion

to dismiss and the other granting a pair of motions for judgment

on the pleadings.     In reviewing both the grant of a motion to

dismiss and the grant of a motion for judgment on the pleadings,

we take as true the well-pleaded facts. See Álamo-Hornedo v. Puig,

 (1st Cir. 2014); A.G. ex rel. Maddox v. Elsevier,

Inc., 

 (1st Cir. 2013).

                                     A

           Paul   McDonald,   whom   we    sometimes   shall   call   "the

decedent," was arrested in Somerset County, Maine on July 2, 2015.

The arrest was for possession of drug paraphernalia in violation

of the conditions of his probation. After arresting officers found


                                 - 3 -
McDonald in an unresponsive state, they transported him to a local

hospital, where he was cleared medically and discharged later that

day.       He was then taken to the Somerset County Jail.

                 During the booking procedure, jail staff identified

McDonald as a high suicide risk individual with over a dozen

recorded suicide attempts.            McDonald rated his own suicide risk as

a ten out of ten.             Jail staff ordered a suicide-risk assessment,

which      was    conducted     by   Cheryll   Needham   of   MedPro     Associates

(MedPro), a contract health-professional firm, on July 6, 2015.1

Based on the results of that assessment, McDonald was placed in a

smock and given special oversight while incarcerated.

                 The   next   day,   Needham   reexamined     McDonald    and   made

another suicide-risk assessment.               This time, Needham recommended

that McDonald wear regular clothing.               A day later — on July 8 —

Needham cleared McDonald for release into the jail's general

population and recommended no further follow-up risk assessments.

                 Less than twenty-four hours later — on July 9 — McDonald

attempted suicide by hanging himself in his cell. For some unknown

reason, a corrections officer had failed to conduct a security

check of the area in which McDonald was housed.                This failure left




       For the most part, record references to Needham spell her
       1

first name as "Cheryll." Even so, there are indications in the
record, including a facsimile of her signature that the correct
spelling of her name uses a single "l."      In the interest of
uniformity, we use the spelling that predominates in the record.


                                         - 4 -
McDonald unsupervised in his cell for roughly ten minutes, during

which time he tied one end of a sheet to a window beam and the

other end to his neck.    When jail staff approached McDonald's cell

for a medical check-in, they found him unconscious. The jail staff

performed chest compressions and rescue breaths, but to no avail.

          Emergency medical personnel then returned McDonald to

the hospital.     McDonald remained in a coma and never regained

consciousness. Medical scans confirmed that he had suffered severe

brain damage due to oxygen deprivation.           On July 16 — ten days

after receiving his initial suicide-risk assessment and seven days

after his suicide attempt — McDonald died.

          The plaintiff alleged that County officials conducted an

internal investigation into the circumstances of McDonald's death,

but the pleadings offer no further insight into either the scope

or the outcome of the investigation.

                                     B

          Six years later to the day — on July 16, 2021 — the

plaintiff,   in   her    capacity     as    personal   representative   of

McDonald's estate, filed suit in the United States District Court

for the District of Maine.    The complaint, which was premised upon

, alleged infringement of McDonald's Eighth and

Fourteenth Amendment rights.

          MedPro and Needham were among the named defendants, and

they moved to dismiss the suit against them.           See Fed. R. Civ. P.


                                    - 5 -
12(b)(6).    They argued that the plaintiff's cause of action was

time barred and that, alternatively, the plaintiff failed to state

plausible claims against them.              The district court granted the

motion to dismiss, concluding that the cause of action against

MedPro and Needham was time barred.

            The plaintiff's suit also named as defendants Somerset

County, the County's sheriff, and a number of members of the jail

staff.    Following the grant of MedPro's and Needham's motion to

dismiss, those defendants — who already had answered the complaint

— moved for judgment on the pleadings.           See Fed. R. Civ. P. 12(c).

Because     two    of   the   County    defendants      were   independently

represented,      two   separate   motions     were   filed.   Both   motions

asserted that the plaintiff's suit was untimely.               The district

court agreed and granted their motions.2

            This timely appeal ensued.

                                       II

            We review the grant of a motion to dismiss for failure

to state a claim de novo.          See SEC v. Tambone, 

(1st Cir. 2010) (en banc); Garita Hotel Ltd. P'ship v. Ponce Fed.


     2 Although the plaintiff filed an opposition to the motion to
dismiss, she did not file oppositions to the motions for judgment
on the pleadings.    The district court nonetheless treated the
motions for judgment on the pleadings as opposed. Treating the
motions as opposed was within the district court's discretion.
See Delgado v. Pawtucket Police Dep't, 

 (1st Cir.
2012) (explaining that "[d]istrict courts enjoy broad discretion
in managing their dockets").


                                     - 6 -
Bank, F.S.B., 

 (1st Cir. 1992).     We take the well-

pleaded facts contained in the complaint as true and draw all

reasonable inferences in favor of the plaintiff's cause.          See

Tambone, 

.

           Reviewing a motion for judgment on the pleadings "bears

a strong family resemblance to [reviewing] a motion to dismiss."

   Once again, our review is de novo.    Shay v. Walters, 

 (1st Cir. 2012).   We take as true all well-pleaded facts in

the plaintiff's complaint, and we draw all reasonable inferences

to the plaintiff's behoof.      Kando v. R.I. State Bd. of Elections,

 (1st Cir. 2018).     In addition to the well-pleaded

facts, we may also consider facts drawn from any documents that

were "fairly incorporated" in the complaint.       

 (quoting R.G.

Fin. Corp. v. Vergara-Nuñez, 

 (1st Cir. 2006)).

In the end, a judgment on the pleadings should be upheld as long

as the "facts conclusively establish that the movant is entitled

to the relief sought."    

     Entering a judgment on a motion to

dismiss or on a motion for judgment on the pleadings "based on a

limitations defense is entirely appropriate when the pleader's

allegations leave no doubt that an asserted claim is time-barred."

LaChapelle v. Berkshire Life Ins. Co., 

 (1st Cir.

1998).




                                 - 7 -
                                     III

            In the court below, the plaintiff offered two theories

as to why her suit was timely.        First, she argued that the cause

of action could not have accrued until she had standing, that is,

until the date of the decedent's death.           Second, she argued that

the running of the statute of limitations should be equitably

tolled. She rested this latter argument — without much elaboration

— mainly upon the "unique" facts of the case together with an

assertion    that   the   causal   connection    between   the    defendants'

wrongful     acts   and   the   decedent's      injury   was     not   readily

ascertainable until the decedent's records were furnished to the

plaintiff.

            The district court found neither ground sufficient to

warrant a finding of timeliness.            Instead, the court concluded

that the suit was time-barred.       The court proceeded to dismiss the

case as to some defendants and later entered judgment on the

pleadings in favor of all the remaining defendants.

                                     IV

            The plaintiff challenges the district court's rulings —

both on the motion to dismiss and on the motions for judgment on

the pleadings — that her claims were time-barred. We first examine

the anatomy of her challenge and then resolve it.




                                    - 8 -
                                  A

            Federal law creates a cause of action under 

, which allows a plaintiff to sue persons acting under color

of state law for constitutional transgressions or other violations

of federal law.    See Evans v. Avery, 

 (1st Cir.

1996).    Even so, the limitations period for such an action is

borrowed from state law.     See Wallace v. Kato, 

(2007).

            Here, the parties agree that the appropriate limitations

period for the plaintiff's section 1983 action is that specified

in 

, which prescribes that "[a]ll civil

actions shall be commenced within 6 years after the cause of action

accrues."    Thus, if the plaintiff's cause of action accrued on the

date of the decedent's death (as she urges), her suit is not time-

barred:     the plaintiff filed suit on July 16, 2021, which comes,

though barely, within six years of McDonald's death on July 16,

2015.    But if the cause of action accrued on an earlier date when

the decedent first became aware or should have become aware of the

injury (as the defendants urge), the plaintiff's suit is time-

barred.   And that is true regardless of whether the "earlier date"

is deemed to be July 8, 2015 (the date when Needham made the

negative suicide-risk assessment) or July 9, 2015 (the date when

McDonald hanged himself in his cell).         We turn, then, to a

determination of the date of accrual.


                                - 9 -
            We start with the plaintiff's assertion that her section

1983 claim accrued when the decedent died.         In support, the

plaintiff notes that under Maine's wrongful death statute, she had

standing to sue on McDonald's behalf only after he died and she

became the personal representative of his estate.        Her cause of

action, she says, could not have accrued before she had standing

to bring it.

            The plaintiff's view of the accrual date flies in the

teeth of existing precedent.    "[T]he accrual date of a [section]

1983 cause of action is a question of federal law that is not

resolved by reference to state law."      Wallace, 

(emphasis in original).    Any aspect of a section 1983 claim that

is not governed by reference to a specific state law instead is

governed by federal common law principles.    See 

    "Under those

principles, . . . 'the standard rule [is] that [accrual occurs]

when the [injured party] has a complete and present cause of

action.'"    

 (second alteration in original) (quoting Bay Area

Laundry & Dry Cleaning Pension Tr. Fund v. Ferbar Corp. of Cal.,

 (1997)).   A cause of action becomes complete and

present on the date of knowledge of the injury.         See Nieves v.

McSweeney, 

 (1st Cir. 2001). ("[A] section 1983

claim accrues at the moment the plaintiff knows, or has reason to

know, of the injury that is the basis for the claim.").




                               - 10 -
           To be sure, the parties disagree as to the date on which

the decedent had knowledge of the injury.     On the one hand, the

plaintiff contends that this date should be when the effects of

the decedent's injury were fully felt, that is, the date that he

died.    On the other hand, the defendants contend that this date

should be the date when the act that caused the injury occurred

(that is, either the date on which the decedent received an overly

optimistic suicide-risk assessment or the date on which McDonald's

suicide attempt occurred).

           Precedent teaches that, in section 1983 cases, "[the]

plaintiff is deemed to know or have reason to know [of the injury]

at the time of the act itself and not at the point that the harmful

consequences are felt."    Morán Vega v. Cruz Burgos, 

,

20 (1st Cir. 2008) (quoting Guzman-Rivera v. Rivera-Cruz, 

 (1st Cir. 1994)).   This means, of course, that the plaintiff's

position in this case is untenable.     At the latest, knowledge of

the injury took place at the time of the decedent's suicide

attempt,3 not at the later time that the harmful consequences came




     3 It is arguable whether the date of knowledge and, thus, the
accrual date was the date that the negative suicide-risk assessment
was made or the date of the suicide attempt. Cf. Brockman v. Tex.
Dep't of Crim. Just., 

 (5th Cir. 2010)
(evaluating these alternatives and concluding that decedent
"should have known the quality of the [mental health] treatment he
was receiving [before his suicide]"). Here, however, that debate
is academic: whichever of these dates obtains, the plaintiff's
suit is time-barred.


                               - 11 -
to full fruition, that is, the time of the decedent's demise.       Even

assuming that the decedent was not — nor should have been — aware

of his injuries until that time, the plaintiff's filing date of

July 16, 2021, was beyond the six-year limitations period.

                                   B

                                   1

          In the district court, the plaintiff made a cursory

argument that the limitations period should be equitably tolled.

She mentioned equitable tolling — a doctrine that empowers a court,

in appropriate circumstances, to extend the limitations period for

a particular action — and suggested that it should apply based on

the "unique fact pattern" of the case.

          Although     equitable   tolling   may   be   available    in

"exceptional circumstances," Vistamar, Inc. v. Fagundo-Fagundo,

 (1st Cir. 2005) (quoting Neverson v. Farquharson,

 (1st Cir. 2004)), it is "the exception rather than

the rule," Delaney v. Matesanz, 

 (1st Cir. 2001).

To gain the assistance of the doctrine, a plaintiff must show "that

[s]he has been pursuing [her] rights diligently, and [] that some

extraordinary circumstance stood in [her] way and prevented [her]

timely filing."      Holland v. Florida, 

 (2010)

(quoting Pace v. DeGuglielmo, 

 (2005)).            And

equitable tolling may also be available if a plaintiff can show

that a defendant has prevented or discouraged her from uncovering


                               - 12 -
the facts required to bring a cause of action.         See Vistamar, 

.

                                    2

           We have "left open the question of whether the equitable

tolling of § 1983 actions is governed by state or federal law."

Id. at 71-72.      This case does not require us to visit that

unanswered    question.    Under    either   regime,   the   plaintiff's

argument founders.

           Federal law "pauses the running of . . . a statute of

limitations when a litigant has pursued [her] rights diligently

but some extraordinary circumstance prevents [her] from bringing

a timely action."     Arellano v. McDonough, 

 (2023)

(quoting Lozano v. Montoya Alvarez, 

 (2014)).          When

a plaintiff is mentally incapacitated, there is no "absolute rule

of   tolling,"      and   instead       "[r]elief   from     limitations

periods . . . remains subject to careful case-by-case scrutiny."

Nunnally v. MacCausland, 

 (1st Cir. 1993) (emphasis

in original); see Gyamfi v. Whitaker, 

 (1st Cir.

2019) ("[T]he decision to apply equitable tolling is a judgment

call.").

           Maine law points in the same direction.         Under it, "the

statute of limitations is tolled when strict application of the

statute of limitations would be inequitable," Dasha v. Me. Med.




                               - 13 -
Ctr., 

, 995 n.2 (Me. 1995), an essentially case-

sensitive inquiry.

                                     3

          Below, the plaintiff made only glancing references to

equitable tolling.    To flesh out her "unique fact pattern" theory,

she first mused that she experienced a period of delay in obtaining

the decedent's medical records because they were unavailable until

the decedent's death.     In this regard, she suggested that the

records were under the control of one or more of the defendants

prior to the internal investigation (which started and ended at

times she did not specify).        Next — in a single sentence in her

opposition to the motion to dismiss — the plaintiff wrote:         "[T]he

combination of the injury immediately resulting in a period of

unconsciousness preceding death, with the necessity of the records

under control of the actor to show the causal connection warrant

such an application of the tolling doctrine."

          The district court rejected these arguments, and we

discern no error.      As we have said, "[t]he 'heavy burden' of

establishing    entitlement   to    equitable   tolling   rests   on   the

plaintiff,"    Vázquez-Rivera v. Figueroa, 

 (1st Cir.

2014) (quoting Farris v. Shinseki, 

 (1st Cir.

2011)), and the plaintiff did not hoist that burden here.

          To begin, the plaintiff did not cite any statute or case

that might enable equitable tolling based on the defendants'


                                   - 14 -
actions with respect to the decedent's medical records.   Moreover,

she did not describe any conduct on the part of the defendants

that either hampered her efforts to obtain the decedent's records

or hindered her recourse to suit.      Nor did she explain how the

alleged unavailability of the records impacted her ability to

enforce her rights.    A plaintiff who seeks to invoke equitable

tolling must effectively argue for its application, not merely

mention its name and refer cryptically to scattered facts that

populate the record.   In other words, the plaintiff must not only

have identified the legal theory on which she stakes her claim but

also must have given that theory sufficient shape to alert the

court to its proposed application.     See Iverson v. City of Bos.,

 (1st Cir. 2006).

          To cinch the matter, the plaintiff provided nothing to

indicate that she had been diligently pursuing her rights.      Her

argument rested almost exclusively on the unelaborated assertion

that a "unique fact pattern" furnished a sufficient basis for the

application of equitable tolling.      On this barebones record, we

cannot say that the district court erred in refusing to attach

decretory significance to the status of the medical records and

declining — on that basis — to salvage the plaintiff's time-barred

suit through the medium of equitable tolling.       See Clauson v.

Smith, 

 (1st Cir. 1987); cf. United States v.

Zannino, 

 (1st Cir. 1990) (holding, in waiver-of-


                              - 15 -
argument context, that "[i]t is not enough merely to mention a

possible argument in the most skeletal way, leaving the court to

do counsel's work, create the ossature for the argument, and put

flesh on its bones").

                                    C

          On   appeal,   the    plaintiff    advances   a    more   refined

equitable tolling argument.       With a stronger gust filling her

sails, she insists that the fact that the decedent was in a coma

should itself give rise to equitable tolling.               If one becomes

incapacitated as a result of a defendant's alleged negligence, her

thesis runs, it would be inequitable to expect the incapacitated

person to know of the harm.       Thus — she argues — equity demands

the exclusion from the limitations period of the interval of

incapacitation (here, the time during which the decedent was

comatose).

          Assuming,   without    deciding,    that   this    argument   was

preserved for appeal,4 it is nonetheless futile:            the decedent's


     4 Although we do not resolve the issue, we note that the
equitable tolling argument made by the plaintiff on appeal bears
only a modest resemblance to the equitable tolling argument that
she made below. An argument not advanced in the district cannot
be broached for the first time in the court of appeals.         See
Teamsters Union, Local No. 59 v. Superline Transp. Co., 

 (1st Cir. 1992) ("[A]bsent the most extraordinary
circumstances, legal theories not raised squarely in the lower
court cannot be broached for the first time on appeal.). An
appellant must have done more than use the same labels in both the
district court and the court of appeals in order to avoid waiver.
See McCoy v. Mass. Inst. of Tech., 

 (1st Cir. 1991).


                                 - 16 -
five-day period of unconsciousness is not enough to bring equitable

tolling into play.      Even if we were to set aside the five days

that the decedent spent in a coma, the plaintiff still had more

than five years and eleven months within which to bring a timely

suit.   Nowhere does she explain why, had she exercised ordinary

diligence,    she   would   not   have   been    able   to   conform   to   this

deadline.     She does not allege that she was "prevented from

complying with [the statutory deadline] through no fault . . . of

[her] own."     Gyamfi, 

.           Nor does she allege any

facts suggesting that she was assured that she had as much time as

she now claims was available to her.

            That ends this aspect of the matter.             "[T]he equitable

tolling doctrine is not available as a means of rescuing a party

who has failed to exercise due diligence."              Pineda v. Whitaker,

 (1st Cir. 2018).              And so — even if we assume

that the plaintiff has preserved this equitable tolling argument

on appeal — she has not shown that application of the statute of

limitations to her claim would result in an unjust outcome.

            The result might be different if a mental incapacitation

had occurred near the end of the limitations period and a plaintiff

could show that she had otherwise been prepared to file her



"[I]f a claim is 'merely insinuated' rather than 'actually
articulated,' that claim is ordinarily deemed unpreserved for the
purposes of appellate review." Iverson, 

 (quoting
McCoy, 

).


                                   - 17 -
complaint on time.       In such circumstances, it might well be

inequitable to hold a plaintiff to the strict statutory deadline,

where — but for the extraordinary circumstance of the plaintiff's

incapacity — she would have been within the limitations period.

Suffice it to say that those are not the facts before us today.

                                       D

           The plaintiff has two more shots in her sling.            First,

she points to a Maine tolling statute, 

,

and suggests that it operates to rescue her suit.             The statute

permits persons who are "mentally ill" to bring action "after the

disability is removed."        

           Second, the plaintiff notes that survivorship actions

brought under    the   Federal Tort Claims Act (FTCA),            

(b), 2671-2680, entail a different accrual date.           See Rakes

v. United States, 

 (1st Cir. 2006) ("[A] claim does

not accrue under the FTCA until a person in the plaintiff's

position, that is, one who knew or should have known as much as

the plaintiff knew or should have known, would believe that he had

been   injured   and   would    know   'sufficient   facts   to   permit   a

reasonable person to believe that there is a causal connection

between the government and [the] injury.'" (second alteration in

original) (quoting Skwira v. United States, 

 (1st

Cir. 2003))).    She strives to persuade us that the accrual date




                                     - 18 -
for a survivorship action under section 1983 should be determined

in the same manner.

            These shots are wide of the mark.   The plaintiff did not

raise either argument below and, thus, she cannot pursue them for

the first time on appeal.    See Superline Transp. Co., 

.

                                  V

            We need go no further. For the reasons elucidated above,

the judgment of the district court is



Affirmed.




                               - 19 -