Margherita Cunningham v. Centurion of Florida LLC

USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 1 of 8

NOT FOR PUBLICATION

In the United States Court of Appeals For the Eleventh Circuit ____________________ No. 26-10205 Non-Argument Calendar ____________________ RAY EDWARD CUNNINGHAM, JR, Plaintiff, MARGHERITA CUNNINGHAM, In her official capacity as Personal Representative of the Estate of Ray Cunninham Jr, Plaintiff-Appellant, versus DEPARTMENT OF CORRECTIONS, Defendant, CENTURION OF FLORIDA, LLC, STATE OF FLORIDA DEPARTMENT OF CORRECTIONS, Defendants-Appellees.

USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 2 of 8

2 Opinion of the Court 26-10205 ____________________ Appeal from the United States District Court for the Northern District of Florida D.C. Docket No. 4:21-cv-00414-AW-MAF ____________________ Before GRANT, LUCK, and WILSON, Circuit Judges.

PER CURIAM: Ray Cunningham’s estate appeals the district court’s dismis- sal of its second amended complaint, which alleged that Centurion of Florida, LLC was deliberately indifferent toward Cunningham’s serious medical needs while he was in Florida state prison. After careful review, we affirm.

FACTUAL BACKGROUND AND PROCEDURAL HISTORY Cunningham filed this 42 U.S.C. section 1983 action in Sep- tember 2021, alleging that Centurion, the medical provider at his prison, violated the Eighth Amendment because it was deliberately indifferent to his serious medical needs. Centurion, he alleged, ig- nored his repeated complaints about “breathing issues” and “re- fused to refer [him] out for diagnostic services or to refer him out for interventional treatment.” After he was discharged from cus- tody, “he was diagnosed with pneumonia,” which caused him to “suffer[] great physical and emotional harm.”

Shortly after filing the lawsuit, Cunningham passed away, causing the district court to stay the case until Cunningham’s estate could appoint a personal representative. After a lengthy delay, USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 3 of 8

26-10205 Opinion of the Court 3 Margherita Cunningham was named as the estate’s personal repre- sentative in June 2024, and she continued to pursue this lawsuit on the estate’s behalf.

The estate filed an amended complaint in September 2024, again alleging that Centurion was deliberately indifferent to Cun- ningham’s serious medical need by failing to treat his “various ras- patory [sic] symptoms.” On Centurion’s motion, the district court dismissed the amended complaint without prejudice for failure to state a claim.

In May 2025, the estate filed a second amended complaint (mislabeled as the third amended complaint). This time, the estate dropped the previous allegations about Cunningham’s breathing problems and pneumonia, and instead alleged that Centurion was deliberately indifferent in treating his hepatitis C infection.

According to the second amended complaint, Cunningham was diagnosed with hepatitis C when he first arrived at prison on February 16, 2016. Despite knowing that he had developed ad- vanced liver disease and that his condition “could very likely de- velop into liver cancer,” Centurion did not provide Cunningham with medication to treat his hepatitis C until January 3, 2018.

Shortly after Cunningham was released in September 2018, he was diagnosed with advanced liver cancer, which caused his death three years later. Thus, the estate alleged, despite “Centu- rion’s awareness of the gravity of [his] medical condition, it delayed treatment for 687 days,” a “decision . . . heavily influenced by Cen- USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 4 of 8

4 Opinion of the Court 26-10205 turion’s unofficial policy and practice of delaying and denying treat- ment to save the company money” that “permitted Cunningham’s [h]epatitis C, 1b to progress to liver cancer.”

Centurion filed a motion to dismiss the second amended complaint, which the district court granted “for three independent reasons.” First, the district court explained, the second amended complaint’s deliberate-indifference claim was barred by Florida’s four-year statute of limitations for section 1983 claims. The latest the claim could have accrued was January 2018, when Cunning- ham received medication to treat his hepatitis C. But the estate didn’t file the second amended complaint until May 2025, over seven years later, and this new claim did not relate back to the orig- inal claim because it was based on different conduct.

Second, the estate failed to state a claim for deliberate indif- ference because he did not “allege facts showing Centurion was subjectively aware that its conduct could put Cunningham at sub- stantial risk of serious harm.” And third, the estate failed to state a claim that Centurion’s policy or custom caused his injuries, as re- quired to establish Centurion’s liability under Monell v. Department of Social Services of New York, 436 U.S. 658 (1978).

STANDARD OF REVIEW We review de novo an order dismissing a complaint, “ac- cepting the allegations in the complaint as true and construing them in the light most favorable to the plaintiff.” Butler v. Sheriff of Palm Beach Cnty., 685 F.3d 1261, 1265 (11th Cir. 2012). We also re- view de novo a district court’s application of a statute of limitations USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 5 of 8

26-10205 Opinion of the Court 5 and its determination about whether an amendment relates back to the original complaint. Harrison v. Digit. Health Plan, 183 F.3d 1235, 1238 (11th Cir. 1999); Mungin v. Sec’y, Fla. Dep’t of Corr., 89 F.4th 1308, 1321–22 (11th Cir. 2024).

DISCUSSION The estate challenges the district court’s conclusion that the second amended complaint’s deliberate-indifference claim was time barred and that the estate did not adequately plead Centu- rion’s liability under Monell. But the estate does not argue that the district court erred in dismissing the second amended complaint for failing to state a deliberate-indifference claim. This is fatal to the estate’s appeal.

By failing to make any argument challenging the district court’s determination that the second amended complaint failed to state a claim for deliberate indifference, the estate has forfeited the issue, which was an independent ground for the district court to dismiss the second amended complaint. See United States v. Camp- bell, 26 F.4th 860, 873 (11th Cir. 2022) (en banc) (“[F]ailure to raise an issue in an initial brief on direct appeal should be treated as a forfeiture of the issue[.]”). And because it “fails to challenge properly on appeal one of the grounds on which the district court based its judgment, . . . it follows that the judgment is due to be affirmed.” Sapuppo v. Allstate Floridian Ins. Co., 739 F.3d 678, 680 (11th Cir. 2014).

But even if the estate had properly challenged the district court’s dismissal, the appeal would not succeed because the second USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 6 of 8

6 Opinion of the Court 26-10205 amended complaint’s deliberate-indifference claim was time barred. “Section 1983 claims are governed by the forum state’s re- sidual personal injury statute of limitations, which in Florida is four years.” Chappell v. Rich, 340 F.3d 1279, 1283 (11th Cir. 2003). The estate does not dispute that the second amended complaint was filed more than four years after Cunningham’s deliberate-indiffer- ence claim accrued. Instead, it argues that the second amended complaint related back to the original complaint under Florida’s re- lation-back doctrine. We disagree.

“Relation back is a legal fiction employed to salvage claims that would otherwise be unjustly barred by a limitations provi- sion.” Caron v. NCL (Bah.), Ltd., 910 F.3d 1359, 1368 (11th Cir. 2018) (citing McCurdy v. United States, 264 U.S. 484, 487 (1924)). Federal Rule of Civil Procedure 15(c)(1)(A) permits relation back when “the law that provides the applicable statute of limitations allows relation back.” Fed. R. Civ. P. 15(c)(1)(A). Thus, “if an amendment relates back under the law that provides the applicable statute of limitations, that amendment relates back under [r]ule 15(c)(1) even if the amendment would not relate back under the federal law rules.” Saxton v. ACF Indus., Inc., 254 F.3d 959, 963 (11th Cir. 2001) (en banc).

Here, the law that provides the applicable statute of limita- tions—Florida law—allows relation back “[w]hen the claim or de- fense asserted in the amended pleading arose out of the conduct, transaction, or occurrence set forth or attempted to be set forth in the original pleading.” Fla. R. Civ. P. 1.190(c). This rule “is to be USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 7 of 8

26-10205 Opinion of the Court 7 liberally construed” and will permit relation back of an amended complaint “where the legal theory of recovery has changed or where the original and amended claims require the assertion of dif- ferent elements” so long as “the initial complaint gives the defend- ant fair notice of the general factual scenario or factual underpin- ning of the claim.” Kopel v. Kopel, 229 So. 3d 812, 816, 817 (Fla. 2017) (citation modified). This liberal policy, however, does not allow relation back when an amended pleading is “so factually distinct that it does not arise out of the same conduct, transaction, or oc- currence as the original.” Id. at 816.

Here, the second amended complaint’s deliberate-indiffer- ence claim did not relate back because it did not “ar[i]se out of the conduct, transaction, or occurrence set forth or attempted to be set forth in the original [complaint].” See Fla. R. Civ. P. 1.190(c). The original complaint alleged that Centurion repeatedly ignored Cun- ningham’s grievances about “breathing difficulty” and that he was diagnosed with pneumonia after he was released from custody.

The second amended complaint alleged that Centurion diagnosed Cunningham with hepatitis C but provided improper treatment for the condition, causing Cunningham to die from liver cancer.

The second amended complaint’s deliberate-indifference claim was therefore based on an entirely different set of facts (hep- atitis C, not breathing problems) and an entirely different injury (liver cancer, not pneumonia) than the deliberate-indifference claim in the original complaint. The second amended complaint’s deliberate-indifference claim did not relate back to the original USCA11 Case: 26-10205 Document: 21-1 Date Filed: 09/09/2026 Page: 8 of 8

8 Opinion of the Court 26-10205 complaint because the original complaint did not give Centurion “fair notice of the . . . factual underpinning of” the second amended complaint’s deliberate-indifference claim. See Kopel, 229 So. 3d at 817; cf. Fabbiano v. Demings, 91 So. 3d 893, 894 (Fla. Dist. Ct. App. 2012) (finding “no doubt” that an amended pleading alleged “a claim that arose out of the same occurrence as the original plead- ing” when it was “based upon [an] identical act, resulting in [an] identical injury”). Accordingly, the district court did not err in de- termining that the second amended complaint’s deliberate-indiffer- ence claim was time barred.

AFFIRMED.