Full opinion text
OPINION OF THE COURT FISHER, Circuit Judge. In this appeal, we consider whether two prison administrators are entitled to qualified immunity from an Eighth Amendment claim that serious deficiencies in the provision of medical care by a private, third-party provider resulted in an inmate’s suicide. We agree with the District Court that they are not. For reasons to be discussed, we will affirm. I. A. Plaintiff-Appellees Karen Barkes, Alexandra Barkes, and Brittany Barkes (collectively, “Appellees”) are the widow and children, respectively, of decedent Christopher Barkes (“Barkes”). Barkes committed suicide on November 14, 2004, while being held at the Howard R. Young Correctional Institution (“HRYCI”) in Wilmington, Delaware, awaiting transportation to the Violation of Probation Center in Sussex County, Delaware. He had been arrested the previous day on an administrative warrant. Barkes was on probation for a March 2004 domestic abuse conviction, and had been arrested for loitering while waiting to purchase drugs. Appellees filed suit against then-Delaware Commissioner of Correction Stanley Taylor, then-Warden of HRY-CI Raphael Williams, the Delaware Department of Corrections (“DOC”), and the third-party vendor providing medical services in HRYCI, First Correctional Medical, Inc. (“FCM”). Appellants here are Taylor and Williams. Barkes was a troubled man with a long history of mental health and substance abuse problems. On March 15, 1997, Barkes killed two people in a car accident while driving drunk. He pleaded guilty to two counts of second-degree vehicular homicide. Seven months after the accident, on October 31,1997, Barkes attempted suicide while incarcerated by ingesting an overdose of pills that he had apparently stockpiled. He was incarcerated at HRY-CI (also known as Gander Hill Prison), the same facility at which he would eventually commit suicide in 2004. Barkes served two and a half years in prison, during which time he completed a substance abuse program. He stayed sober for approximately four years before relapsing in December 2003. He entered the Recovery Center for Delaware on December 15, 2003, but could stay for only one week because of limited funding from his insurance provider. On December 21, 2003, police responded to a reported domestic altercation at Barkes’s home. After police placed him in handcuffs, he became unconscious and unresponsive. Paramedics were called, who opened Barkes’s airways, provided oxygen, and administered drugs to counteract a suspected heroin overdose. Barkes admitted — and the toxicology report in his medical records confirms — that he consumed one and a half pints of vodka and a “bag” of heroin, quantity unspecified. He later characterized this overdose as a suicide attempt. Shortly before the December 2008 relapse, Barkes checked himself into the Rockford Center in Wilmington, Delaware, where he was diagnosed with post-traumatic stress disorder. David Becker, Barkes’s probation officer at the time, opined that Barkes was “[n]ot only ... a threat to the community, he is also a threat to himself,” in a “violation report” dated February 8, 2004. JA at 296. On September 10, 2004, sixty-five days before his death, Barkes attempted to kill himself twice in one day. During an afternoon house visit by a probation officer, Barkes was found asleep on top of a bottle of gin. He appeared to be extremely intoxicated — he apparently could not recall who he was — and the officer arrested Barkes. Two hours after his arrest, Barkes had a blood alcohol content (“BAC”) of .222. Because of his high BAC the officers took Barkes to a hospital, where he admitted to a nurse that he had also consumed forty Tylenol tablets. While being treated, Barkes attempted to kill himself by wrapping an IV cord around his neck. Both incidents were recorded in his probation file. Barkes received a new probation officer shortly before his death. In notes dated November 9, 2004 — five days before he died — the officer indicated her awareness that Barkes suffered from bipolar disorder, attended one therapy session and six Alcoholics Anonymous meetings each week, and took four medications for his bipolar condition and other mental health problems. The notes also acknowledged three individuals — the record suggests that they were therapists, counselors, and/or social workers — whom Barkes was currently seeing. Barkes was arrested on November 13, 2004 for violating his probation. At approximately 3:00 p.m. that day, he underwent a medical intake/screening procedure at HRYCI conducted by a licensed practical nurse (“LPN”) who was employed by FCM, a private contractor hired to provide medical services in the prison. The intake procedure included a form containing questions about Barkes’s mental health, including questions about suicidal ideation. Barkes indicated on the form that he had attempted suicide in 2003 but did not include the 1997 attempt or the two attempts in September 2004. He stated that he had no current suicidal ideation. The intake procedure also screened for seventeen suicide risk factors. If the inmate checked eight or more factors on a form, or if certain other serious risk factors were present (for example, the arresting officer expressed concern that the inmate was a suicide, risk), the on-call physician was to be notified and suicide prevention measures initiated. Barkes answered yes to two of the questions: (1) that he had a psychiatric history; and (2) that he had previously attempted suicide. The LPN completed a standard medical intake form, which included questions as to whether Barkes showed signs of “altered mental status ... or abnormal conduct.” JA at 71. The LPN indicated “no” to both. Barkes also denied having a history of drug abuse. The LPN referred Barkes to mental health services on a “routine” urgency level, based on his psychiatric history and the 2003 suicide attempt. Barkes was placed alone in a cell in the booking and receiving area. At some point during the evening of November 13, Barkes called his wife Karen. According to Karen, Barkes told her that he “can’t live this way anymore,” and said that he was going to kill himself. JA at 2, 72. It is undisputed that Karen did not inform the DOC of Barkes’s stated intent. Shortly before 4:00 a.m. on November 14th, in an unrelated incident, another inmate at HRYCI was transferred to the infirmary from his cell and placed on Psychiatric Close Observation, Level II (“PCO II”). Patients placed on PCO II are given a “suicide gown” and are checked every 15 minutes by staff. Appellants’ Br. at 10 (citing Lamb v. Taylor, No. 08-324, 2011 WL 4006586, at *2 n. 1 (D.Del. Sept. 8, 2011) (describing medical care at HRYCI in the context of another lawsuit arising out of a prison suicide)). At 8:00 a.m. on the 14th, Barkes ate breakfast alone in his cell. Correctional officers observed him lying awake on his bed at 10:45, 10:50, and 11:00 a.m., and none recalled anything unusual about him or any indication that he was suicidal. At 11:35 a.m., when an officer arrived at his cell to deliver his lunch, Barkes was hanging by a sheet from a steel partition. Medical staff responded and Barkes was taken to a hospital, but attempts to resuscitate him were unsuccessful. B. FCM entered into a Health Care Services Contract with DOC on June 17, 2002, and was the contracted medical provider at HRYCI at the time of Barkes’s suicide. In that role it was responsible for inmate intake and medical screening. The DOC reviewed FCM’s performance in monthly Medical Review Committee (“MRC”) meetings, overseen by DOC Bureau Chief of Management Services Joyce Talley. Talley was the DOC’s appointed representative for administering the contract with FCM. See DeLCode Ann. tit. 11, § 6517(13) (currently codified at Del-Code Ann. tit. 11, § 6517(12)) (requiring that the Commissioner of Correction “[a]dminis-ter[] the medical/treatment services contract, or appoint! ] a designee to administer the medical/treatment contract”). As Chief of the DOC Bureau of Management Services, Talley had many responsibilities. She testified that her areas of oversight responsibility included “fiscal, payroll, budgeting, food services for the inmates, health care for the inmates, substance abuse for the inmates, management information systems, purchasing and warehousing, facilities maintenance and construction.” JA at 364-65. She further testified that, in each of these areas except for health care, she relied on a “key manager [to do] the day-to-day” oversight. JA at 366. The “key manager” was an official within the DOC, but with respect to health care services Talley relied on FCM and the MRC, testifying that she did not make any assessments regarding FCM’s job performance and that no individual working within the DOC “had the knowledge or the background ... [to] go out to see if the medical care was provided.” JA at 367. The contract outlined standards of care to which FCM must adhere. To the extent that the health care standards of the American Correctional Association and the National Commission on Correctional Health Care (“NCCHC”) differed, FCM was to adhere to the higher standard. Taylor testified that he believed that ensuring FCM “delivered] health care in accordance with NCCHC standards” was sufficient to meet his responsibility to deliver health care to the inmate population. JA at 51. Williams testified that he had a responsibility to ensure that HRYCI was in compliance with NCCHC standards, but that he believed he had no personal responsibility to ensure FCM’s compliance. JA at 55. Talley also testified that she did not believe it to be her responsibility to ensure FCM’s compliance with NCCHC standards. JA at 368 (“Q: Did you believe that it was your responsibility when you served in that role as bureau chief that you reviewed the compliance with the standards set forth by NCCHC? A: No.”). In 1997, NCCHC published standards for use by correctional facilities to screen inmates for physical and mental health problems during the intake process. These standards included a variety of forms to be completed by medical intake staff. The NCCHC altered its standards in 2003, doing away with the forms and instead instituting a narrative recommendation of various mental health warning signs of which all prison staff should be aware and vigilant. Though FCM appears to have been relying on the outdated 1997 forms in 2004 when Barkes was incarcerated, NCCHC accredited HRYCI approximately one year before Barkes’s suicide. However, part of Appellees’ theory of liability is that not only did FCM fail to implement the newer guidelines as required by its contract, it failed to properly implement the 1997 NCCHC standards. Therefore, it is necessary to discuss the 1997 NCCHC standards for suicide assessment in some detail. The 1997 NCCHC guidelines provided a number of sample intake forms covering general physical and mental health questions. These included a suicide-specific assessment form that asked questions regarding past and current suicidal ideation, mental health treatment, and recent emotional trauma. JA at 310. There was also a mental health screening form that was to be filled out by the intake staff member. The mental health form instructed the screener to ask the inmate, in pertinent part: “Have you ever felt so bad, so depressed, that you tried to take your own life?”; and “Have you ever taken medication for emotional problems, for mental illness, or for ‘nerves?’ ” JA at 313. The following page of the standards provided criteria for referring an inmate to a mental health professional based on answers given in the mental health screening form, which stated: Refer an inmate to mental health staff for assessment if the inmate gives a ‘Yes” response to ANY question. There are no exceptions to this procedure. If the inmate gives an affirmative response to question 9,[] make an immediate referral to mental health staff and make sure continuous “eyes on” supervision is provided until seen by the mental health staff. Remember, this screening inventory IS NOT your only guide for referral to mental health services. Even if there are all “no” answers, you may still refer the inmate: • if you suspect that, in spite of the answers, this inmate is experiencing some emotional difficulties; • if you need additional mental health information on an inmate prior to classification; • or for reasons not listed here JA at 314 (emphasis in original). The 1997 guidelines provided sample protocols to be administered by a qualified mental health professional if the inmate’s intake screening triggered referral. JA at 322. The guidelines explicitly required the protocols to be administered by a mental health professional. Appellees claim, however, that FCM failed to comply with the 1997 NCCHC standards. They argue that the suicide screening form that FCM administered corresponded to the screening form to be used by a mental health professional, but that FCM allowed the form to be administered by an unqualified LPN rather than a qualified mental health professional, as required under NCCHC guidelines. To put it simply, Appellees claim that, if FCM had been in compliance with NCCHC standards, Barkes’s “yes” answer to the question “Have you ever attempted suicide?” and his identification of his psychiatric medication would have triggered a referral to a mental health professional. The professional in turn would have instituted increased suicide prevention procedures, thus preventing Barkes’s death. In deposition testimony, Appellants acknowledged that they were aware of the deteriorating quality of FCM’s provision of medical services. Williams admitted that FCM’s performance had degraded significantly and that he was aware FCM may not have been fulfilling its contractual obligations. JA at 792. He was aware of significant backlogs, that FCM may have been intentionally short-staffing to save money, and that inmate complaints had increased. JA at 792-93. Taylor testified that his responsibility as Commissioner of Correction was to “provide health care delivery to the offender population comparable to that available in the community.” JA at 799. He acknowledged that in the period of 2003-2007 audits conducted by the NCCHC had identified deficiencies in healthcare provision in the Delaware prison system. He also suspected that FCM was intentionally leaving positions vacant in order to save money rather than simply having difficulty recruiting and retaining staff. Minutes from a meeting of the MRC on June 17, 2004, at which Williams was present, indicate ongoing problems with the DOC’s document management computer system, called “DACS,” including that the medical unit at HRYCI was “not putting information into DACS consistently for medical grievances.” JA at 809. Talley indicated that FCM was “beyond the borderline of not being in compliance with the contract” and that the MRC would issue a letter of non-compliance at the next meeting if problems with the computer system were not resolved by then. Id. Minutes from the MRC’s August 26, 2004 meeting indicate that FCM remained non-compliant with respect to implementing the DACS system, and that this issue was to be brought to Taylor’s attention. In May 2005, Taylor wrote a letter to FCM indicating that the DOC would be terminating the contract, citing among his reasons “the serious deficiencies in the delivery of health care outlined in the National Commission on Correctional Health Care (NCCHC) audit report dated February 28, 2005.” JA at 788. C. On February 16, 2006, Appellees filed a complaint pursuant to 42 U.S.C. § 1983 in the United States District Court for the District of Delaware. Appellees asserted against Taylor and Williams an Eighth Amendment claim based on deliberate indifference to Barkes’s serious medical needs, an Eighth Amendment claim based on a failure to train/wrongful customs, practices, and policies, and a state law wrongful death claim. On February 27, 2008, the District Court granted summary judgment to Appellants. Appellees filed an appeal, see Barkes v. First Correctional Medical, Inc., No. 08-2280 (docketed May 7, 2008), which we dismissed per stipulation of the parties on July 9, 2008. On May 21, 2008, while the first appeal was pending, the District Court held a show cause hearing on Appellees’ motion for default judgment against FCM. At that hearing, the Court granted the motion and granted Appellees leave to amend. They filed a first amended complaint on June 13, 2008, which Appellants moved to strike on the basis that it reasserted claims upon which they had already prevailed on summary judgment. The Court granted the motion to strike on March 30, 2009, but permitted Appellees to file a second amended complaint against Appellants provided that it did not assert any claims from the previous complaint. Appellees filed a second amended complaint on April 9, 2009, which was eventually dismissed. Appellees were permitted to file a third amended complaint only to add an Eighth Amendment failure-to-supervise claim, which was filed on April 22, 2010. Appellants moved to dismiss the third amended complaint on May 6, 2010, and the District Court denied the motion. On February 27, 2012, the parties filed cross-motions for summary judgment. It was then that Appellants asserted qualified immunity in a motion for the first time. The District Court denied both motions for summary judgment, and Appellants filed this appeal pursuant to the collateral order doctrine. II. The district court had jurisdiction pursuant to 28 U.S.C. §§ 1331 and 1343. We have jurisdiction pursuant to 28 U.S.C. § 1291 and the collateral order doctrine. The collateral order doctrine allows us to review an interlocutory order “as a ‘final decision’ if it: ‘(1) conclusively determine[s] the disputed question, (2) re-solvéis] an important issue completely separate from the merits of the action, and (3) [is] effectively unreviewable on appeal from a final judgment.’ ” Blaylock v. City of Phila., 504 F.3d 405, 408 (3d Cir.2007) (alterations in original) (quoting Johnson v. Jones, 515 U.S. 304, 310, 115 S.Ct. 2151, 132 L.Ed.2d 238 (1995)). It is well-established that orders denying qualified immunity at summary judgment are reviewable under the collateral order doctrine “to the extent that denial turns on questions of law.” Bayer v. Monroe Cnty. Children and Youth Serv., 577 F.3d 186, 191 (3d Cir.2009); see also Wright v. City of Phila., 409 F.3d 595, 599 (3d Cir.2005) (“Despite the interlocutory nature of qualified immunity rulings, they are reviewable on appeal where the dispute does not turn upon which facts the parties might be able to prove, but, rather, whether or not certain facts showed a violation of ‘clearly established’ law.” (internal quotation marks and citation omitted)). “On an appeal from a grant or denial of summary judgment, our review is plenary and we apply the same test the district court should have utilized initially.” Giles v. Kearney, 571 F.3d 318, 322 (3d Cir.2009). A court may grant summary judgment only when the record “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). The issue of qualified immunity is generally a question of law, but a genuine dispute of material fact will preclude summary judgment on qualified immunity. Giles, 571 F.3d at 326. III. A. 1. Before discussing the District Court’s qualified immunity analysis, it is necessary first to consider whether and to what extent our precedent on supervisory liability in the Eighth Amendment context was altered by the Supreme Court’s decision in Ashcroft v. Iqbal, 556 U.S. 662, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). Though we have in the past declined “to wade into the muddied waters of post-Iqbal ‘supervisory liability,’ ” Bistrian v. Levi, 696 F.3d 352, 366 n. 5 (3d Cir.2012); see also Argueta v. U.S. Immigration and Customs Enforcement, 643 F.3d 60, 69-70 (3d Cir.2011), we find it appropriate to do so now. Section 1983 provides a cause of action against “every person who,” under color of state law, “subjects, or causes to be subjected,” another person to a deprivation of a federally protected right. 42 U.S.C. § 1983. It is well-recognized that “[g]ov-ernment officials may not be held hable for the unconstitutional conduct of their subordinates under a theory of respondeat superior.” Bistrian, 696 F.3d at 366 (alteration in original) (quoting Iqbal, 556 U.S. at 676, 129 S.Ct. 1937). Rather, state actors are liable only for their own unconstitutional conduct. Id. With this principle in mind, we have previously identified two general ways in which a supervisor-defendant may be liable for unconstitutional acts undertaken by subordinates. First, liability may attach if they, “with deliberate indifference to the consequences, established and maintained a policy, practice or custom which directly caused [the] constitutional harm.” A.M. ex rel. J.M.K. v. Luzerne Cnty. Juvenile Det. Ctr., 372 F.3d 572, 586 (3d Cir.2004) (alteration in original) (quoting Stoneking v. Bradford Area Sch. Dist., 882 F.2d 720, 725 (3d Cir.1989)). Second, “a supervisor may be personally liable under § 1983 if he or she participated in violating the plaintiffs rights, directed others to violate them, or, as the person in charge, had knowledge of and acquiesced” in the subordinate’s unconstitutional conduct. Id. (citing Baker v. Monroe Twp., 50 F.3d 1186, 1190-91 (3d Cir.1995)). “Failure to” claims — failure to train, failure to discipline, or, as is the case here, failure to supervise — are generally considered a subcategory of policy or practice liability. See Rosalie Berger Levinson, Who Will Supervise the Supervisors? Establishing Liability for Failure to Train, Supervise, or Discipline Subor dinates in a Post-Iqbal/Connick World, 47 Harv. C.R.-C.L. L.Rev. 273, 280 (2012). In Sample v. Diecks, we recognized that “ ‘supervision’ entails, among other things, training, defining expected performance by promulgating rules or otherwise, monitoring adherence to performance standards, and responding to unacceptable performance whether through individualized discipline or further rulemaking.” 885 F.2d 1099, 1116 (3d Cir.1989). Sample involved an Eighth Amendment claim against a supervisor for implementing deficient policies and being deliberately indifferent to the risk that the policies would result in the deprivation of a constitutional right. Id.; see also Beers-Capitol v. Whetzel, 256 F.3d 120, 133-34 (3d Cir.2001) (discussing Sample). We developed a four-part test for determining whether an official may be held liable on a claim for a failure to supervise. The plaintiff must identify a supervisory policy or practice that the supervisor failed to employ, and then prove that: (1) the policy or procedures in effect at the time of the alleged injury created an unreasonable risk of a constitutional violation; (2) the defendant-official was aware that the policy created an unreasonable risk; (3) the defendant was indifferent to that risk; and (4) the constitutional injury was caused by the failure to implement the supervisory practice or procedure. Sample, 885 F.2d at 1118; Brown v. Muhlenberg Twp., 269 F.3d 205 (3d Cir.2001). In this Circuit, when a plaintiff seeks to hold a defendant liable under the Eighth Amendment in his or her role as a supervisor, “Sample’s four-part test provides the analytical structure ..., it being simply the deliberate indifference test applied to the specific situation of a policymaker.” Whetzel, 256 F.3d at 135. Which brings us to Iqbal. Javaid Iqbal sued United States Attorney General John Ashcroft and FBI Director Robert Mueller, high-level Executive Branch officials, under Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388, 91 S.Ct. 1999, 29 L.Ed.2d 619 (1971). In Bivens, the Court “ ‘recognized for the first time an implied private action for damages against federal officers alleged to have violated a citizen’s constitutional rights.’ ” Iqbal, 556 U.S. at 675, 129 S.Ct. 1937 (quoting Corr. Serv. Corp. v. Malesko, 534 U.S. 61, 66, 122 S.Ct. 515, 151 L.Ed.2d 456 (2001)). Iqbal alleged that he was unlawfully detained and subjected to harsh conditions of confinement on the basis of his race, religion, or national origin, as part of a purposefully discriminatory policy of which Ashcroft was the “principal architect” and Mueller was “instrumental” in executing. Id. at 669, 129 S.Ct. 1937. Iqbal’s theory of supervisory liability was that Ashcroft and Mueller could be liable if they had “knowledge [of] and [had] acquiesce[ed] in their subordinates’ use of discriminatory criteria to make classification decisions among detainees.” Id. at 677, 129 S.Ct. 1937 (internal citation and quotation marks omitted). In rejecting Iqbal’s claim, the Supreme Court first recognized that “[t]he factors necessary to establish a Bivens violation will vary with the constitutional provision at issue.” Id. at 676, 129 S.Ct. 1937. The claim presented in Iqbal — discrimination in violation of the First and Fifth Amendments — requires that the plaintiff prove that the defendant acted with a discriminatory purpose, and “purposeful discrimination requires more than ‘intent as volition or intent as awareness of consequences.’ ” Id. (quoting Personnel Adm’r of Mass. v. Feeney, 442 U.S. 256, 279, 99 S.Ct. 2282, 60 L.Ed.2d 870 (1979), and citing Church of Lukumi Babalu Aye, Inc. v. Hialeah, 508 U.S. 520, 540-41, 113 S.Ct. 2217, 124 L.Ed.2d 472 (1993); Washington v. Davis, 426 U.S. 229, 240, 96 S.Ct. 2040, 48 L.Ed.2d 597 (1976)). The Court reasoned that, because such a claim requires that the defendant have acted “ ‘because of,’ not merely ‘in spite of,’ [the action’s] adverse effects upon an identifiable group,’ ” id. at 676-77, 129 S.Ct. 1937 (some internal quotation marks omitted) (quoting Feeney, 442 U.S. at 279, 99 S.Ct. 2282), it necessarily followed that Ashcroft and Mueller could be held liable only if they had “adopted and implemented the detention policies at issue ... for the purpose of discriminating on account of race, religion, or national origin,” id. (emphasis added). The Court rejected Iqbal’s argument that supervisory liability could attach based on Ashcroft and Mueller’s knowledge of and acquiescence in their subordinates’ unconstitutional discrimination, stating: “In a § 1983 suit or a Bivens action — where masters do not answer for the torts of their servants — the term ‘supervisory liability’ is a misnomer. Absent vicarious liability, each Government official, his or her title notwithstanding, is only liable for his or her own misconduct.” Id. at 677, 129 S.Ct. 1937. In reaching this conclusion, the Court expressly tied the level of intent necessary for superintendent liability to the underlying constitutional tort. See id. at 678, 129 S.Ct. 1937 (“In the context of determining whether there is a violation of clearly established law to overcome qualified immunity, purpose rather than knowledge is required to impose Bivens liability on the subordinate for unconstitutional discrimination; the same holds true for an official charged with violations arising from his or her superintendent responsibilities.”). This aspect of Iqbal has bedeviled the Courts of Appeals to have considered it, producing varied interpretations of its effect on supervisory liability. The dissenters in Iqbal believed the majority to be abolishing supervisory liability in its entirety, 556 U.S. at 692-93, 129 S.Ct. 1937 (Souter, J., dissenting), and at least one Court of Appeals impliedly confirmed this view, albeit without much in the way of discussion, see Carnaby v. City of Houston, 636 F.3d 183, 189 (5th Cir.2011). The Ninth Circuit, on the other hand, has suggested that under Iqbal the United States Attorney General could be liable for knowingly “failpng] to act in the light of even unauthorized abuses” of the federal material witness statute, insofar as that statute was used as a pretext to detain terrorism suspects despite a lack of probable cause of a criminal violation. See al-Kidd v. Ashcroft, 580 F.3d 949, 976 (9th Cir.2009), overruled on other grounds, — U.S. —, 131 S.Ct. 2074, 179 L.Ed.2d 1149 (2011) (overruling the Ninth Circuit on the basis of qualified immunity, finding no Fourth Amendment violation, and not reaching the supervisory liability question). Most courts have gravitated to the center, recognizing that because the state of mind necessary to establish a § 1983 or Bivens claim varies with the constitutional provision at issue, so too does the state of mind necessary to trigger liability in a supervisory capacity. The Tenth Circuit, for example, held that, after Iqbal, § 1983 liability may attach to “a defendant-supervisor who creates, promulgates, implements, or in some other way possesses responsibility for the continued operation of a policy the enforcement (by the defendant-supervisor or her subordinates) of which ‘subjects, or causes to be subjected,’ ” the plaintiff to a constitutional deprivation, if the supervisor “acted with the state of mind required to establish the alleged constitutional deprivation.” Dodds v. Richardson, 614 F.3d 1185, 1199 (10th Cir.2010) (emphasis added). The Court of Appeals in Dodds reasoned that such a standard “complies with Iqbal’s requirement that § 1988 liability only be imposed upon those defendants whose own individual actions cause a constitutional deprivation because it requires plaintiffs [to] prove each defendant took some act with the constitutionally applicable state of mind that caused the alleged constitutional violation.” Id. at 1200. The Ninth Circuit agreed with this view in Starr v. Baca, seeing “nothing in Iqbal indicating that the Supreme Court intended to overturn longstanding case law on deliberate indifference claims against supervisors in conditions of confinement cases.” 652 F.3d 1202, 1207 (2011). See also Whitson v. Stone County Jail, 602 F.3d 920, 922, 927-28 (8th Cir.2010) (holding that prison supervisors could be liable on an Eighth Amendment claim “only if they personally displayed deliberate indifference to the risk” of a constitutional deprivation); Sanchez v. Pereira-Castillo, 590 F.3d 31, 49 (1st Cir.2009) (holding, post-Iqbal, that prison administrators could be liable in a supervisory capacity for a Fourth Amendment violation if their “actions displayed deliberate indifference toward the rights of third parties and had some causal connection to the subsequent tort”) (quoting Camilo-Robles v. Zapata, 175 F.3d 41, 44 (1st Cir.1999)). The Seventh Circuit has also indicated that the mental state required to impose supervisory liability will vary with the underlying constitutional tort. In T.E. v. Grindle, the Seventh Circuit held that a school principal could be liable under § 1983 for allowing a subordinate teacher to continue working despite numerous allegations that the teacher was sexually abusing his female students. 599 F.3d 583, 585-87 (7th Cir.2010). The plaintiff alleged supervisory liability that derived from both substantive due process and equal protection violations. The Court recognized that Iqbal had abrogated its prior precedent allowing plaintiffs to recover from a supervisor who was deliberately indifferent toward a subordinate’s purposeful discrimination, because in a discrimination claim Iqbal requires that “a plaintiff must show that the supervisor possessed ... discriminatory intent.” Id. But this was not so with respect to the substantive due process claim, for which the Court held that “[w]hen a state actor’s deliberate indifference deprives someone of his or her protected liberty interest ..., that actor violates the Constitution, regardless of whether the actor is a supervisor or subordinate.” Id. at 591. The Court thus recognized that the mental state necessary for supervisory liability tracks with the mental state required for the underlying tort. See also Vance v. Rumsfeld, 701 F.3d 193, 204 (7th Cir.2012) (en banc). We do not read Iqbal to have abolished supervisory liability in its entirety. Rather, we agree with those courts that have held that, under Iqbal, the level of intent necessary to establish supervisory liability will vary with the underlying constitutional tort alleged. In this case, the underlying tort is the denial of adequate medical care in violation of the Eighth Amendment’s prohibition on cruel and unusual punishment, and the accompanying mental state is subjective deliberate indifference. See Farmer v. Brennan, 511 U.S. 825, 847, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). Iqbal held that state officials are liable only for their own unconstitutional actions. The essence of the type of claim we approved in Sample is that a state official, by virtue of his or her own deliberate indifference to known deficiencies in a government policy or procedure, has allowed to develop an environment in which there is an unreasonable risk that a constitutional injury will occur, and that such an injury does occur. Liability in such a situation is, as Iqbal requires, imposed not vicariously but based on the supervisor’s own misconduct, because to exhibit deliberate indifference to such a situation is a culpable mental state under the Eighth Amendment. See Starr, 652 F.3d at 1207 (“[W]hen a supervisor is found liable based on deliberate indifference, the supervisor is being held liable for his or her own culpable action or inaction, not held vicariously liable for the culpable action or inaction of his or her subordinates.”). Accordingly, we hold that the standard we announced in Sample for imposing supervisory liability based on an Eighth Amendment violation is consistent with Iqbal. We leave for another day the question whether and under what circumstances a claim for supervisory liability derived from a violation of a different constitutional provision remains valid. 2. Our dissenting colleague disagrees with our conclusion that Sample has survived Iqbal. In his view, a supervisor can be held liable under the Eighth Amendment only if he committed an affirmative “action! ],” was “personally] involve[d] in his subordinates’ misfeasance,” and acted with “intentional ... deliberate indifference.” Dis. Op. at 336, 340 (internal quotation marks omitted). Our colleague claims that his position recognizes that “there’s no special rule of liability for supervisors” and that “the test for them is the same as the test for everyone else.” Id. at 342 (internal quotation marks omitted) (quoting Porro v. Barnes, 624 F.3d 1322, 1327-28 (10th Cir.2010)). But in fact the opposite is true: his test would immunize from liability prison officials who were deliberately indifferent to a substantial risk that inmates’ serious medical conditions were being mistreated or not treated at all. This would subvert the Supreme Court’s command that any prison official who, “acting with deliberate indifference, expose[s] a prisoner to a sufficiently substantial risk of serious damage to his future health,” violates the Eighth Amendment. Farmer, 511 U.S. at 844, 114 S.Ct. 1970 (internal quotation marks and citations omitted). Simply because an official may have a senior position in the DOC does not make him free to ignore substantial dangers to inmate health and safety. Id. at 842, 114 S.Ct. 1970; Grindle, 599 F.3d at 590 (‘When a state actor’s deliberate indifference deprives someone of his or her protected liberty interest in bodily integrity, that actor violates the Constitution, regardless of whether the actor is a supervisor or subordinate, and the actor may be held liable for the resulting harm.”). Treating supervisors and subordinates equally under the Eighth Amendment does not mean ignoring the different ways in which each type of officer can, with deliberate indifference, expose inmates to constitutional injury. We think our dissenting colleague fails to recognize this fact, and in doing so makes three significant analytical errors. We address each below. i. First, the Dissent claims that for a supervisor to be liable under § 1983, he must have taken a “deliberate, intentional act ... to violate the plaintiffs legal rights.” Dis. Op. at 338 (quoting Porro, 624 F.3d at 1327-28). The Dissent draws this principle primarily from the Tenth Circuit’s opinion in Porro, which we have cited with approval for its discussion of the mental state required to make out a claim of supervisory liability. But on this particular point the Dissent’s reliance is off-base. Porro involved an allegation of excessive force by an officer, for which the plaintiff also sued the Sheriff (and his successor) as supervisor. 624 F.3d at 1324-25. In affirming the district court’s grant of summary judgment to the Sheriff, the Tenth Circuit began by identifying the precise constitutional tort at issue: the use of excessive force in violation of the due process clause. Id. at 1326. The court stated that for a supervisor to be liable, he must have committed a “deliberate, intentional act.” Id. at 1327-28. Importantly, it made this statement in the context of an excessive force claim, which meant that “the focus [was] on the force the supervisor used or caused to be used, the resulting injury attributable to his conduct, and the mens rea required of him to be held liable, which can be no less than the mens rea required of anyone else.” Id. at 1328 (emphasis omitted). But excessive force claims are different than conditions of confinement claims: instead of deliberate indifference, they require a plaintiff to show that “officials applied force ‘maliciously and sadistically for the very purpose of causing harm,’ or ... with ‘a knowing willingness that [harm] occur.’ ” Farmer, 511 U.S. at 835-36, 114 S.Ct. 1970 (quoting Hudson v. McMillian, 503 U.S. 1, 6-7, 112 S.Ct. 995, 117 L.Ed.2d 156 (1992)). Under the rule we derive from Iqbal — that the mental state necessary for supervisory liability will vary with the substance of the underlying constitutional tort — it makes sense that the Tenth Circuit would require deliberate action in that case. The Dissent’s position neglects the black-letter principle that the type of Eighth Amendment claim alleged here can be shown by an act or an omission. See Farmer, 511 U.S. at 835, 114 S.Ct. 1970 (“[T]he cases are ... clear that [the deliberate indifference standard] is satisfied by something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result” (emphasis added)); Estelle v. Gamble, 429 U.S. 97, 106, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976) (“In order to state a cognizable claim [under the Eighth Amendment], a prisoner must allege acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs.” (emphasis added)). What the Dissent attempts to do is shoehorn into the Eighth Amendment the deliberate-act requirement adopted in our state-created-danger jurisprudence. In that context, we have held that “[liability ... [must be] predicated upon the states’ affirmative acts which work to the plaintiffs detriment in terms of exposure to danger. It is the misuse of state authority, rather than a failure to use it, that can violate the Due Process Clause.” Phillips v. Cnty. of Allegheny, 515 F.3d 224, 235 (3d Cir.2008) (third alteration added; emphasis in original) (quoting Bright v. Westmoreland Cnty., 443 F.3d 276, 282 (3d Cir.2006)). The reason for this requirement is that the Government is not generally required to “guarantee [a] certain minimal level[] of safety and security” to its citizens. Bright, 443 F.3d at 280 (quoting DeShaney v. Winnebago Cnty. Soc. Servs. Dep’t, 489 U.S. 189, 195-96, 109 S.Ct. 998, 103 L.Ed.2d 249 (1989)). But this principle does not apply once the Government takes custody of the citizen and deprives him of his liberty. [Our cases] stand only for the proposition that when the State takes a person into its custody and holds him there against his will, the Constitution imposes upon it a corresponding duty to assume some responsibility for his safety and general well-being.... The affirmative duty to protect arises not from the State’s knowledge of the individual’s predicament or from its expressions of intent to help him, but from the limitation which it has imposed on his freedom to act on his own behalf. Id. at 280-81 (alteration in original) (quoting DeShaney, 489 U.S. at 199-200, 109 S.Ct. 998). The Dissent cites Grindle, in support of its claim that an affirmative act is required, and he is correct that this case upheld a supervisory liability claim for substantive due process deliberate indifference that was predicated upon an official’s attempt to “coneeal[ ] reports of abuse and creat[e] an atmosphere that allowed abuse to flourish.” 599 F.3d at 590. Certainly, an affirmative act such as concealment of wrongdoing could satisfy the deliberate indifference standard, but it is not necessary. Under the Eighth Amendment, prison officials, from the bottom up, may be liable if by act or omission they display a deliberate indifference to a known risk of substantial harm to an inmate’s health or safety. Farmer, 511 U.S. at 843, 114 S.Ct. 1970. The omission alleged here is the deliberately indifferent failure to enforce FCM’s compliance with proper suicide-prevention protocols, as required under FCM’s contract with the DOC. As we will discuss, there is a material factual dispute on this point. a The Dissent would require both that the supervisor “personally displayed] deliberate indifference,” Dis. Op. at 340 (internal citation and quotation marks omitted), and that the supervisor was “personally] involved in his subordinates’ misfeasance,” id. at 336. With respect to the former observation, we agree, which is why our decision requires subjective deliberate indifference on the part of the offending officer. See Part III.A.1, supra. With respect to the latter, the Dissent misinterprets the rules for Eighth Amendment liability under Farmer. The Dissent asserts that, by affirming Sample’s vitality post-Iqbal, our decision wrongly applies an objective, rather than a subjective, test for evaluating deliberate indifference, in contravention of Farmer. This criticism is unpersuasive for two reasons. First, the premise upon which the Dissent’s argument rests — that “Sample’s objective quality is patent,” see Dis. Op. at 341 — is far from clear. Sample expressly constructed its test for deliberate indifference around what the officer knew and how the officer reacted to that knowledge. Sample, 885 F.2d at 1118 (asking whether the officer “was aware that this unreasonable risk existed” and whether that officer “was indifferent to that risk” (emphasis added)). This is clearly a subjective test as required by Farmer, a conclusion bolstered by our recitation of the Sample test in Brown, a case that post-dates Farmer and yet approves Sample. See Brown, 269 F.3d at 216. Far from being patently objective, Sample’s test is explicitly concerned with the officer’s subjective knowledge. The origin of the Dissent’s discontent may be Sample’s reference to City of Canton v. Harris, 489 U.S. 378, 109 S.Ct. 1197, 103 L.Ed.2d 412 (1989). In City of Canton, the Supreme Court held that a municipality “can be liable for failure to train its employees when the municipality’s failure shows ‘a deliberate indifference to the rights of its inhabitants.’ ” Farmer, 511 U.S. at 840, 114 S.Ct. 1970 (quoting City of Canton, 489 U.S. at 389, 109 S.Ct. 1197). In Farmer, the Court stated that City of Canton, which allowed liability to attach based on “obviousness or constructive notice,” created an objective test for deliberate indifference that was inappropriate in the Eighth Amendment context. Farmer, 511 U.S. at 841, 114 S.Ct. 1970. To be sure, Sample stated that it derived its test “[biased on City of Canton,” 885 F.2d at 1118, but the actual test that it articulated clearly sounds in subjectivity. The Dissent cites a passage of Sample in which we said that “there are situations in which the risk of constitutionally cognizable harm is so great and so obvious that the risk and the failure of supervisory officials to respond will alone support findings of the existence of an unreasonable risk, of knowledge of that unreasonable risk, and of indifference to it.” 885 F.2d at 1118; Dis. Op. at 342. In fairness to our colleague, one could read this as suggesting that an objective test might be applicable in situations where evidence of the officer’s knowledge and intent was absent. But one could also read this statement as recognizing that the requisite mental state can be proved by circumstantial evidence. Cf. Farmer, 511 U.S. at 842, 114 S.Ct. 1970 (“Whether a prison official had the requisite knowledge of a substantial risk is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence, and a factfinder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious.” (emphasis added)). At any rate, this brings us to the second reason that the Dissent’s objection fails: the test that we derive from Sample and apply in this case cannot be described as anything but subjective, and is thus entirely consistent with Farmer. Moreover, the Dissent’s statement that the District Court has already determined that “ ‘a reasonable factfinder could not determine that Defendants were deliberately indifferent to the risk of suicide,’” Dis. Op. at 341 (quoting JA at 15), is a red herring because that determination was made in reference to Count I of the third amended complaint, which alleged that Appellants were deliberately indifferent to Barkes’s serious medical needs as an individual. That is a very different claim than the supervisory liability claim contained in Count V and that we are allowing to proceed. To the extent that Sample approved, in some circumstances, an objective test for determining a prison official’s Eighth Amendment deliberate indifference, that portion of Sample has been abrogated by Farmer and it is not the test we apply today. Recognizing that our test does, in fact, require an official’s subjective deliberate indifference, the Dissent pivots and claims that the plaintiff must nonetheless plead that the supervisor was “personally] involve[d] in his subordinates’ misfeasance.” Dis. Op. at 336. The Dissent’s rule would have the practical effect of requiring that a supervisor have personal knowledge of an individual inmate, that inmate’s particular serious medical need, and of the prison staffs failure to treat that need, before the supervisor could ever be held liable for deliberate indifference. But Farmer itself recognized that a prison official cannot avoid liability under the Eighth Amendment simply “by showing that, while he was aware of an obvious, substantial risk to inmate safety, he did not know that the complainant was especially likely to” suffer a constitutional injury. 511 U.S. at 843, 114 S.Ct. 1970. The question under the Eighth Amendment is whether prison officials, acting with deliberate indifference, exposed a prisoner to a sufficiently substantial “risk of serious damage to his future health,” and it does not matter whether the risk comes from a single source or multiple sources, any more than it matters whether a prisoner faces an excessive risk of attack for reasons personal to him or because all prisoners in his situation face such a risk. If, for example, prison officials were aware that inmate “rape was so common and uncontrolled that some potential victims dared not sleep [but] instead ... would leave their beds and spend the night clinging to the bars nearest the guards’ station,” it would obviously be irrelevant to liability that the officials could not guess beforehand precisely who would attack whom. Id. at 843-44, 114 S.Ct. 1970 (internal citations omitted) (quoting Helling v. McKinney, 509 U.S. 25, 33, 35,113 S.Ct. 2475, 125 L.Ed.2d 22 (1993); Hutto v. Finney, 437 U.S. 678, 681-82 n. 3, 98 S.Ct. 2565, 57 L.Ed.2d 522 (1978)). A high-ranking prison official can expose an inmate to danger by failing to correct serious known deficiencies in the provision of medical care to the inmate population. That the official had no specific knowledge of any particular inmate or the failure of subordinate officials to treat that inmate’s serious medical condition is irrelevant. The Dissent suggests that Nelson v. Correctional Medical Services, 583 F.3d 522 (8th Cir.2009) (en banc), contradicts our analysis, but in fact that case supports our position. There, an inmate sued a guard and a prison director under the Eighth Amendment because her legs had been shackled during labor, causing her injury. Id. at 525-27. She alleged that the prison director had violated her rights “by failing to ensure that proper policies and customs were implemented with respect to the restraint of female inmates in labor.” Id. at 534-35. The Eighth Circuit stated that the director could be liable “if he personally displayed deliberate indifference to the hazards and pain resulting from shackling an inmate such as [the plaintiff ] during the final stages of labor.” Id. (emphasis added) (citing Farmer, 511 U.S. at 842, 114 S.Ct. 1970). The court then engaged in a lengthy analysis of the policies and procedures in place at the time, and concluded that they “suggested] administrative concern for the health and safety of pregnant inmates.” Id. at 536. Under the Eighth Circuit’s analysis, the outcome would have been different had the policies and procedures in place been constitutionally inadequate and had there been evidence of the prison director’s deliberate indifference to that fact. Nelson’s analysis also suggests that the director could have been held liable if, notwithstanding the adequacy of the policies, he had been deliberately indifferent to a widespread failure to properly implement the policies. See id. at 536 (recognizing the adequacy of the policies and stating that “[w]ithout further allegation or evidence of deliberate indifference,” the Eighth Amendment claim must fail (emphasis added)). The latter situation is analogous to that before us today. What the Dissent fundamentally fails to recognize is that there are different ways that prison officials can be responsible for causing an inmate harm. Dissenting in Vance, Judge Hamilton adroitly provided the following hypothetical: “[S]uppose ... that a local police chief or even the FBI director issued a policy that authorized the use of deadly force against any fleeing subject. The policy itself would be unconstitutional under Tennessee v. Garner[, 471 U.S. 1, 105 S.Ct. 1694, 85 L.Ed.2d 1 (1985)]. The chief or director who authorized that unconstitutional use of force could certainly be held personally responsible under section 1988 or Bivens to a person shot by an officer following the policy. Vance, 701 F.3d at 223 (Hamilton, J., dissenting). No less here, where there is evidence of serious inadequacies in the provision of adequate medical care for inmates, and there is evidence that prison officials were aware of the problem and yet indifferent to the risk that an inmate would suffer a constitutional injury, they can be held liable under § 1983 for violating the Eighth Amendment Hi. Our final point of disagreement with the Dissent is in his articulation of the deliberate indifference standard itself. The Dissent claims that we err in failing to apply an “intentional version of deliberate indifference.” Dis. Op. at 340. But his formulation of deliberate indifference is entirely inconsistent with Supreme Court precedent. We derive the test for establishing Eighth Amendment deliberate indifference from Sample and from the Supreme Court’s decision in Farmer. While the Dissent is correct that Appellees do not allege that Appellants took an intentional act to cause inadequate medical care for inmates, this is a straw-man argument because under Farmer they are not required to make that allegation. Farmer stated that although “deliberate indifference entails something more than mere negligence, the cases are also clear that it is satisfied by something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result.” 511 U.S. at 835, 114 S.Ct. 1970. Deliberate indifference falls “somewhere between the poles of negligence at one end and purpose or knowledge at the other.” Id. at 836, 114 S.Ct. 1970. “[A]n Eighth Amendment claimant need not show that a prison official acted or failed to act believing that harm actually would befall an inmate; it is enough that the official acted or failed to act despite his knowledge of a substantial risk of serious harm.” As we will discuss infra, there remains a genuine dispute of material fact over whether Appellants displayed deliberate indifference under this standard. B. “Qualified immunity shields government officials from civil damages liability unless the official violated a statutory or constitutional right that was clearly established at the time of the challenged conduct.” Reichle v. Howards, — U.S. —, 132 S.Ct. 2088, 2093, 182 L.Ed.2d 985 (2012). The qualified immunity analysis is thus composed of two constituent questions: first, whether the plaintiff suffered a deprivation of a constitutional or statutory right; and second, if so, whether that right was “clearly established” at the time of the alleged misconduct. If the answer to either question is “no,” qualified immunity applies. Id. Deciding which question to address first is within the Court’s sound discretion. Pearson v. Callahan, 555 U.S. 228, 236, 129 S.Ct. 808, 172 L.Ed.2d 565 (2009). 1. A right is “clearly established” if, at the time of the alleged deprivation, “ ‘[t]he contours of [the] right [are] sufficiently clear’ that every ‘reasonable official would have understood that what he is doing violates that right.’ ” al-Kidd, 131 S.Ct. at 2083 (second alteration in original) (quoting Anderson v. Creighton, 483 U.S. 635, 640, 107 S.Ct. 3034, 97 L.Ed.2d 523 (1987)). Crucial to the “clearly established” inquiry is the level of generality at which the right is defined. A constitutional right is not “clearly established simply because of the existence of a broad imperative like the one against ‘unreasonable ... seizures,’ ” Schneyder v. Smith, 653 F.3d 313, 329 (3d Cir.2011), but nor must there be “a case directly on point [if] existing precedent ... [has] placed the statutory or constitutional question beyond debate,” al-Kidd, 131 S.Ct. at 2083 (citing Anderson, 483 U.S. at 640, 107 S.Ct. 3034). Rather, the asserted right must be sufficiently bounded that it gives “practical guidance” to officials on the ground. See John C. Jeffries, Jr., What’s Wrong with Qualified Immunity?, 62 Fla. L.Rev. 851, 854 (2010). Put another way, the right asserted cannot be so abstract that any transgression violates a clearly established right, thereby evaporating “the balance ... between the interests in vindication of citizens’ constitutional rights and in public officials’ effective performance of their duties.” Anderson, 483 U.S. at 639, 107 S.Ct. 3034 (internal quotation marks omitted) (quoting Davis v. Scherer, 468 U.S. 183, 195, 104 S.Ct. 3012, 82 L.Ed.2d 139 (1984)). The “ultimate question” in the qualified immunity analysis “is whether the defendant had ‘“fair warning” that his conduct deprived his victim of a constitutional right.’ ” Schneyder, 653 F.3d at 329 (quoting Hope v. Pelzer, 536 U.S. 730, 740, 122 S.Ct. 2508, 153 L.Ed.2d 666 (2002)). The “clearly established” game is won or lost on how broadly or narrowly one defines the right at issue. Appellants attempt to atomize the asserted right into oblivion by defining it narrowly as an inmate’s right to “supervision of the medical vendor by the prison administrators,” for which they assert that “[t]here is no case law establishing that a government entity is responsible for monitoring a medical provider under Section 1983.” Appellants’ Br. at 19. There are two problems with this characterization. First, its myopia runs directly contrary to the Supreme Court’s oft-repeated admonition that “a case directly on point” is not required for a right to be clearly established. See al-Kidd, 131 S.Ct. at 2083. Second, this argument hinges entirely on the outsourcing of prison medical care to a private, third-party provider. Appellants do not argue that they have no responsibility to supervise state-employed correctional staff such as guards, or that they would have no responsibility to supervise the medical staff were it composed of state employees rather than private contractors. Rather, their argument depends entirely on the Court finding that there is a difference of constitutional import between the two. No reasonable prison administrator could believe that hiring a private contractor to provide a constitutionally required service would allow them to abdicate their constitutional supervisory duties. Yet, culled to its essence, that is Appellants’ argument. Even if we were to accept the manner in which Appellants would particularize the asserted right, they have nonetheless failed to show a lack of clarity in the law. They rely on our decision in Spruill v. Gillis, in which an inmate in a Pennsylvania prison brought a § 1983 claim against, among other individuals, the Unit Manager of the Restricted Housing Unit, alleging that as a result of his deliberate indifference the plaintiff was injured by an untreated or inadequately treated back problem. 372 F.3d 218, 222 (3d Cir.2004). In affirming dismissal of the complaint against the non-medical official for failure to state a claim, we held: If a prisoner is under the care of medical experts ..., a non-medical prison official will generally be justified in believing that the prisoner is in capable hands. This follows naturally from the division of labor within a prison. Inmate health and safety is promoted by dividing responsibility for various aspects of inmate life among guards, administrators, physicians, and so on. Holding a non-medical prison official liable in a case where a prisoner was under a physician’s care would strain this division of labor. Moreover, under such a regime, nonmedical officials could even have a perverse incentive not to delegate treatment responsibility to the very physicians most likely to be able to help prisoners, for fear of vicarious liability. Id. at 236. Appellants rely on this language to argue that, at the time of Barkes’s suicide, it was not clearly established that they, as non-medical prison administrators, had a constitutional supervisory duty over the medical staff. But in the very next line of Spruill we stated that “absent a reason to believe (or actual knowledge) that prison doctors or their assistants are mistreating (or not treating) a prisoner, a non-medical prison official ... will not be chargeable with the Eighth Amendment scienter requirement of deliberate indifference.” Id. Dismissal was proper in Spruill because the plaintiff had failed to plead facts suggesting that the official was aware of the alleged inadequacies in medical care, not because prison administrators are categorically exempt from a supervisory role over medical personnel. Id. at 236-37 & n. 12. And moreover, there is nothing in Spruill supporting Appellants’ contention that there is a difference of constitutional import between state-employed and privately contracted medical staff. Appellants’ argument that the law was hazy with respect to their supervisory duty over prison medical staff is thus belied by the very case upon which they rely. See Appellants’ Br. at 20 (conceding that Spruill was “[t]he clearly established” law at the pertinent time). With that said, we think that the right Appellees assert, properly defined, is this: an inc