OPINION

WILLIAMS, Circuit Judge:

Early in the evening of May 22, 2001, Fairfax County police officers arrested Tony Marcel Lee on suspicion of being drunk in public. After processing Lee at a substation and placing a "spit mask" over his head, the officers placed the handcuffed Lee in the back of a police van to transport him to an adult detention center, where medical care was available for intoxicated detainees. En route, Lee vomited and later died. An autopsy revealed the cause of death to be aspiration of gastric content and positional asphyxia, with Lee's 0.35 percent blood alcohol content being a contributing cause. Appellee Joseph R. Parrish, acting as personal representative for Lee, brought suit against the five individual officers who handled Lee while he was in custody (the "officers" or "individual defendants"), raising a variety of state and federal claims, including claims that each of the officers violated Lee's Fourteenth Amendment Due Process rights in that each was deliberately indifferent to a serious risk of physical harm to Lee. The district court denied summary judgment to the officers, summarily rejecting their assertions of qualified immunity. The officers appeal the denial of qualified immunity, and we reverse.

I. A.

Viewed in the light most favorable to the plaintiff, Winfield v. Bass, 106 F.3d 525, 535 (4th Cir. 1997) (en banc), the relevant facts are as follows. On the evening of May 22, 2001, Officer Paul Cleveland of the Fairfax County Police Department, one of the defendants below, responded to a reported larceny at a convenience store. After taking a description of the alleged perpetrators from the convenience store attendant, Cleveland searched the area nearby and discovered a man, later identified as Lee, in a wooded area adjacent to the store who matched one of the descriptions provided by the attendant. Lee was shirtless, appeared to be intoxicated, was drooling from his mouth, and had several cuts and abrasions across his body. Cleveland placed Lee under arrest on suspicion of being drunk in public, handcuffed him in accordance with standard practice, placed him in the back of his cruiser, and drove him to the Mount Vernon Satellite Intake Facility (the police station) for processing. Lee vomited several times along the way to the station. Upon his arrival at the police station, Cleveland was met in the sally port area by Officer Paul Thompson and Deputy Sheriffs Brian Wancik and Kevin Garlow, all of whom are co-defendants in this case. When Thompson arrived at the scene, Lee was lying prone in the back of the cruiser, with his feet in the floorboard area behind the driver's seat and his head on the back seat behind the passenger seat. On the floorboard behind the passenger seat and beneath Lee's head was a quantity of liquid that appeared to be a combination of vomit and mucous. Lee also had some of this substance on his shoulder. After some effort, Cleveland, Thompson, Wancik and Garlow were able to get Lee to sit upright in the back seat of the cruiser with his feet on the pavement outside the cruiser. At this point, the officers observed that Lee had a large quantity of fluid inside his mouth and asked him to spit it out. Lee refused to do so and rolled the contents around in his mouth. Second Lieutenant John L. Dooley, also a defendant in this case, overheard this exchange and recommended that one of the officers get a large garbage can for Lee to spit in. When Lee spat into the garbage can, Deputy Wancik noticed that the substance that Lee expectorated contained "red specks." (J.A. at 684-85.)

Although Lee had not attempted to spit at anyone, Lee was drooling heavily and was intoxicated. Given that intoxicated individuals tend to behave unpredictably and knowing that the officers would be handling Lee, Wancik decided that, based on the red specks he had seen, a "spit mask" should be used on Lee to prevent the spread of any bloodborne pathogens that Lee might be carrying. Wancik retrieved a "TranZport Hood" spit mask from a filing cabinet, removed it from its packaging, and returned to the sally port area where the other officers were attending to Lee. Wancik had no experience with the TranZport Hood specifically and never previously had used any type of spit mask on a detainee.

Upon returning to Cleveland's cruiser, Wancik asked the other officers if they thought that the spit mask should be used. Like Wancik, the other officers had neither any formal training on the use of the TranZport Hood or any other type of spit mask, nor any direct experience in the use of spit masks. Cleveland, Dooley, and Garlow nonetheless agreed with Wancik that the use of the mask was warranted under the circumstances. Wancik placed the mask over Lee's head while Lee was seated in the backseat of the cruiser, applying the spit mask so that Lee's nose was not covered by the filtering fabric. According to Wancik, the mask fit loosely around Lee's neck, so that if any liquid were to flow into the mask from Lee's mouth, it "easily" would flow out of the bottom. (J.A. at 439.) During the forty-five minutes to one hour from the time that Wancik placed the mask over Lee's head until the time Lee left in the police van, Lee was conscious and able to communicate. During this time period, Lee did not vomit or indicate that he needed to vomit, although he did spit into the mask several times. No one observed any fluid flow out of the bottom of the mask.

After Wancik placed the mask over Lee's head, Cleveland and Thompson escorted Lee into the station. Shortly thereafter, Thompson left the station and had no further contact with Lee. Inside the station, Cleveland conducted a records check on Lee (which revealed that Lee been arrested twenty-one times for being drunk in public between 1987 and 2001) and obtained an arrest warrant charging Lee with being drunk in public, while the other officers monitored Lee. During this time period, the officers noticed a small abrasion on Lee's forehead and decided to call the Fairfax County Fire and Rescue Department to assess this injury as well as Lee's level of intoxication. EMT Kathleen Earl and Firefighter Roosevelt Carson, both of whom were trained emergency medical technicians (EMTs), responded and examined Lee in the station. EMT Earl saw the abrasion through the net portion of the mask, and, given the officers' concern about the possibility that Lee might spit, EMT Earl decided to conduct the examination of Lee without removing the mask. The mask did not hinder EMT Earl's evaluation, and she concluded that Lee's head injury did not require treatment. EMT Earl was told that Lee was intoxicated, and she herself noticed that his demeanor was consistent with a person who was intoxicated — he appeared "sleepy," (J.A. at 1472), and had become "agitated" with a sheriff's deputy who was assisting Earl with the examination, (J.A. at 1470). At some point during her examination, EMT Earl asked the officers about the use of the mask and specifically inquired about what might happen should Lee vomit with the mask over his head. One of the officers (in all likelihood Wancik, although EMT Earl later could not recall which one) explained that the vomit would flow out the bottom of the mask. There is no evidence in the record that EMT Earl, or any other person then present, questioned this assessment of the mask's fit or cautioned the officers about any risk to Lee associated with the spit mask.

After the EMTs had examined Lee and Cleveland had obtained the warrant, the officers determined that, although he was conscious, Lee was too intoxicated to be held at the station, and they decided that Cleveland should transport Lee to the adult detention center where better medical care was available should Lee need it. Dooley directed that, in accordance with "accepted practice and procedure," Cleveland use a police van that had been specially modified to transport prisoners. (J.A. at 1332.) The front seat of the van was separated from the back area by a metal divider with a small window in the middle. The back of the van was separated into a left chamber and a right chamber by another metal divider that was solid at the bottom and open mesh at the top. The right chamber was sixty-seven inches long and approximately thirty-four inches wide. A thirteen-inch high bench occupied fourteen inches of the width of the chamber, thus leaving a floor space approximately twenty inches wide. The right chamber was slightly narrower than the left and was not visible to the driver of the van through the window. The van had an intercom but, as Cleveland discovered while checking the van, the intercom system was not working.

Once the van was in position, Cleveland, Dooley, Wancik and Garlow carried Lee out to the van. They were accompanied by EMT Earl. In deciding how to place Lee in the van, a number of factors concerned the officers. First, the officers determined that Lee should not be placed on the bench because of the risk he would roll off of it and injure himself. Next, Dooley expressed concern about the possibility of positional asphyxiation, which can occur when an intoxicated person is placed on his stomach with his hands restrained behind his back, and determined that Lee should not be placed on his stomach. Most importantly, Dooley and EMT Earl expressed concern that Lee might vomit while in the van and thus determined that he should not be placed on his back either. Dooley accordingly directed that Lee be placed on his side on the floor of the van so that his airway would remain open. The officers, in the presence of EMT Earl, complied with Dooley's instruction, placing Lee on his left side on the floor of the van, on the narrower passenger side of the partition. The officers then tilted Lee's head so that his airway would remain free were he to vomit and positioned Lee's legs so that he would remain on his side during the transport. The officers did not remove the spit mask and, in accordance with standard police practice, left Lee's hands cuffed behind his back. No one rode with Lee in the rear of the van.

Cleveland then drove to the adult detention center, a trip that took approximately 30 minutes. Because the van's intercom was not working, Cleveland's ability to hear Lee was impaired.

When Cleveland arrived at the adult detention center and attempted to rouse Lee, Lee did not respond. A sheriff's deputy who was assisting Cleveland then called for medical assistance. Cleveland remained with Lee and continued to attempt to rouse him until the medic arrived. The medic removed Lee's mask and noted that it contained vomit. The medic attempted CPR but was unsuccessful. Lee was then transported to the Inova Fairfax Hospital, where he was pronounced dead at 11:06 p.m. A subsequent autopsy revealed the cause of death to be "aspiration and positional asphyxia" with a contributing cause being "ethanol intoxication." (J.A. at 280.) Lee's blood alcohol content was 0.35 percent.

B.

Parrish, acting as Lee's personal representative, filed suit against a number of individual officers in their individual capacities, including the five mentioned above, as well as the municipal defendants, alleging violations of federal constitutional law and state tort law. On April 24, 2002, the officers removed the action to the United States District Court for the Eastern District of Virginia, and on August 5, 2002, Parrish filed a second amended complaint (the complaint), which remains Parrish's operative pleading. Relevant to this appeal, Parrish alleged in his complaint that the individual defendants violated Lee's Fourteenth Amendment rights in that they acted with deliberate indifference both to a substantial risk of serious harm (Count 1) and to Lee's serious medical need (Count 2), violated Lee's Fourth Amendment right to be free from unreasonable restraint (Count 3), and violated Lee's Fourth and Fourteenth Amendment rights by failing to remedy their colleagues' deprivations of constitutional rights (Count 4). Parrish also asserted claims against the individual defendants under state law for wrongful death (Counts 6 and 7).

After discovery, each individual defendant filed a motion for summary judgment based on the defense of qualified immunity. In an order issued without opinion or any explanation on the record, the district court denied the individual defendants' requests for qualified immunity as to Counts 1 through 4. The individual defendants timely appealed.

II.

Under 28 U.S.C.A. § 1291 (West 1993), we have jurisdiction to review final orders of district courts. Under the collateral order doctrine, a district court order is final, "even if it does not terminate proceedings in the district court, so long as it conclusively determines the disputed question, resolves an important issue completely separate from the merits of the action, and would be effectively unreviewable on appeal from a final judgment." Gray Hopkins v. Prince George's County, 309 F.3d 224, 229 (4th Cir. 2002) (citing Cohen v. Beneficial Indus. Loan Corp., 337 U.S. 541, 69 S.Ct. 1221, 93 L.Ed. 1528 (1949)). Because qualified immunity is an immunity from suit, and not merely an immunity from liability, "it is effectively lost if a case is erroneously permitted to go to trial." Mitchell v. Forsyth, 472 U.S. 511, 526, 105 S.Ct. 2806, 86 L.Ed.2d 411 (1985). Accordingly, a district court's order denying a defendant's claim of qualified immunity is a qualifying order under the collateral order doctrine and thus is reviewable immediately. Gray Hopkins, 309 F.3d at 229. We review the denial of qualified immunity de novo, using our full knowledge of relevant precedent and limiting our review to the district court's legal conclusions. Winfield, 106 F.3d at 529, 535.

A.

To determine whether the individual defendants here are entitled to qualified immunity, we must make a two-step inquiry "in proper sequence." Saucier v. Katz, 533 U.S. 194, 200, 121 S.Ct. 2151, 150 L.Ed.2d 272 (2001). As a threshold matter, we must determine whether, "[t]aken in the light most favorable to the party asserting the injury, . . . the facts alleged show [that] the officer's conduct violated a constitutional right." Id. at 201, 121 S.Ct. 2151. If the facts, so viewed, do not establish a violation of a constitutional right, the inquiry ends, and the plaintiff cannot prevail. Id. If the facts do establish such a violation, the next step is to determine whether the right violated was "clearly established" at the time of the alleged offense. Id. In determining whether the right violated was "clearly established," we define the right "in light of the specific context of the case, not as a broad general proposition[.]" Id. "If the right was not `clearly established' in the `specific context of the case' — that is, if it was not `clear to a reasonable officer' that the conduct in which he allegedly engaged `was unlawful in the situation he confronted' — then the law affords immunity from suit." Clem v. Corbeau, 284 F.3d 543, 549 (4th Cir. 2002) (quoting Saucier, 533 U.S. at 201, 121 S.Ct. 2151). With this framework in mind, we turn to the specific claim of immunity here.

B.

Although Parrish asserts four independent constitutional claims in the complaint, his claims boil down to one relevant question: whether the individual defendants violated Lee's Fourteenth Amendment rights as a pre-trial detainee through their deliberate indifference to a substantial risk of physical harm to Lee.

As a general matter, "[o]nly governmental conduct that `shocks the conscience' is actionable as a violation of the Fourteenth Amendment." Young v. City of Mount Ranier, 238 F.3d 567, 574 (4th Cir. 2001) (quoting County of Sacramento v. Lewis, 523 U.S. 833, 845-46, 118 S.Ct. 1708, 140 L.Ed.2d 1043 (1998)). The degree of culpability on the part of a governmental actor that is sufficient to shock the conscience will depend on the circumstances of any given case. Id. In cases where the government is accused of failing to attend to a detainee's serious medical needs, and in cases where the government is accused of failing to protect a detainee from a substantial risk of physical harm, "conduct that amounts to `deliberate indifference' . . . is viewed as sufficiently shocking to the conscience that it can support a Fourteenth Amendment claim." Id. at 575.

"Deliberate indifference is a very high standard — a showing of mere negligence will not meet it." Grayson v. Peed, 195 F.3d 692, 695 (4th Cir. 1999). An officer is deliberately indifferent to a substantial risk of harm to a detainee when that officer "knows of and disregards" the risk. Farmer v. Brennan, 511 U.S. 825, 837, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994). In order to be liable under this standard, "the official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference." Id. Stated somewhat differently, "[d]eliberate indifference requires a showing that the defendants actually knew of and disregarded a substantial risk of serious injury to the detainee or that they actually knew of and ignored a detainee's serious need for medical care." Young, 238 F.3d at 575-76 (emphases added).

Liability under this standard thus requires two showings. First, the evidence must show that the official in question subjectively recognized a substantial risk of harm. It is not enough that the officers should have recognized it; they actually must have perceived the risk. Rich v. Bruce, 129 F.3d 336, 340 n. 2 (4th Cir. 1997). Second, the evidence must show that the official in question subjectively recognized that his actions were "inappropriate in light of that risk." Id. As with the subjective awareness element, it is not enough that the official should have recognized that his actions were inappropriate; the official actually must have recognized that his actions were insufficient. See Brown v. Harris, 240 F.3d 383, 390-91 (4th Cir. 2001).

Although the deliberate indifference standard requires a showing of actual knowledge as to both elements, it "is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence." Farmer, 511 U.S. at 842, 114 S.Ct. 1970. Thus, "a factfinder may conclude that [an officer] knew of a substantial risk from the very fact that the risk was obvious." Id. But, it is not enough that a reasonable officer would have found the risk to be obvious. Rich, 129 F.3d at 339-40. Rather, the risk of injury must be "so obvious that the fact-finder could conclude that the [officer] did know of it because he could not have failed to know of it." Brice v. Va. Beach Corr. Ctr., 58 F.3d 101, 105 (4th Cir. 1995). As the Supreme Court explained in Farmer, a plaintiff can make a prima facie case under this standard by showing "that a substantial risk of [serious harm] was longstanding, pervasive, well-documented, or expressly noted by prison officials in the past, and the circumstances suggest that the defendant-official being sued had been exposed to information concerning the risk and thus must have known about it . . ." 511 U.S. at 842, 114 S.Ct. 1970. See, e.g., Odom v. S.C. Dept. of Corr., 349 F.3d 765, 771 (4th Cir. 2003) (noting, in finding that the prison guards were aware of the risk to the plaintiff, that the guards previously and contemporaneously had been warned that the plaintiff's assailants would attack him if given the chance and had been instructed to remove plaintiff from his recreation cage in light of this risk). Similarly, a factfinder may conclude that the official's response to a perceived risk was so patently inadequate as to justify an inference that the official actually recognized that his response to the risk was inappropriate under the circumstances.

Having set forth the two general requirements for liability under the deliberate indifference standard, we assess the evidence in the record as to each.

1.

As to the subjective awareness prong, we must assess the extent to which the officers recognized the risk factors attending the detention of Lee, including the indisputably substantial risk that Lee, due to the level of his intoxication, would aspirate his vomit if he were to vomit during his transport to the adult detention center and that he would die as a result. In making this assessment, it is important to remember that to cross the threshold from mere negligence to conscience-shocking deliberate indifference, the officers not only must recognize the facts giving rise to the risk, but they also must draw the additional causal inference. Rich, 129 F.3d at 338. Thus, to the extent the officers recognized any risk at all, we are concerned with the risk as they perceived it, not as a reasonable officer under the circumstances should have perceived it, id. at 339-40, Brown, 240 F.3d at 390-91, and not as it now may be perceived enlightened by the benefit of hindsight, Grayson, 195 F.3d at 695.

Our decision in Rich is instructive in this regard. Rich, a prison inmate, sued his prison guard, Bruce, on a theory of Eighth Amendment deliberate indifference, because another inmate, Higgins, attacked Rich while Rich was in Bruce's custody. Id. at 336-38. On the date of the events giving rise to the suit, Bruce had removed Rich from his cell and placed him in an outdoor recreation area. Id. at 337. While Rich was in this recreational area, Bruce removed Higgins from his cell and placed him in an indoor recreation area, despite the fact that prison regulations prohibited the removal of more than one inmate at a time from his cell for recreation. Id. While Bruce was returning Rich to his cell, Higgins escaped from the indoor recreation area and attacked Rich. Id. The evidence showed (1) that Bruce was aware that Higgins posed a substantial risk to every inmate in the prison and especially to Rich, who previously had stabbed Higgins; (2) that Bruce recognized the general risk that inmates posed to one another in that particular prison; and (3) that Bruce deliberately violated regulations intended to prevent exactly the kind of inmate-on-inmate violence that actually occurred. We held that these facts were insufficient to justify a finding of deliberate indifference, because the evidence did not show that Bruce recognized the unique risks created by his actions in the case:

These findings establish that Bruce knew, as a general matter, that Rich was at risk from other inmates, and from Higgins in particular, and that Bruce knew that his actions were in violation of [prison] regulations. They do not establish, however, that Bruce had actual knowledge that his actions uniquely increased these general risks to which Rich was exposed each and every day he was incarcerated in disciplinary segregation at [the prison]. That is, the findings do not establish that Bruce knew that his actions exposed Rich to a specific risk distinct from the general risks of violence from other inmates and Higgins to which Rich was always exposed, and of which Bruce was most certainly aware.

Id. at 339. Rich thus makes clear that officials can be liable under the deliberate indifference standard only to the extent that they actually appreciate the risk factors in a given case, and only to the extent they make the causal inference that the circumstances as they perceived them created a substantial risk of serious harm. Holding officials accountable for risk factors that they did not actually recognize, while permissible if negligence were the standard of culpability, is not permissible when deliberate indifference is the standard.

Here, there is no dispute that the officers recognized substantial risks associated with their detention and transportation of Lee. They recognized that Lee was highly intoxicated and would need to be held at a facility where medical care was available. They likewise recognized that Lee had suffered an injury to his head, and even though the injury appeared to be minor, they brought in EMTs to evaluate him. In determining how to place Lee inside the van, the officers recognized that placing Lee on the bench was not an option because he might fall off. Importantly, they recognized that, with his hands cuffed behind his back, Lee was at greater risk of positional asphyxiation and thus concluded that he should not be placed on his stomach. They also recognized that, given Lee's level of intoxication, Lee was at risk of aspirating his vomit were he to vomit and thus concluded that he should not be placed on his back. In short, the officers recognized a host of general risks associated with detaining and transporting intoxicated, handcuffed individuals.

Although it is clear that the officers recognized these more general risks, the evidence does not show that they appreciated the incremental risk that they themselves created by leaving the spit mask over Lee's head during the ride to the adult detention center — i.e., the risk that, should Lee vomit, the spit mask would trap Lee's vomit around his face and effectively defeat the purpose of specially placing him on the van floor on his side with his head tilted.

No direct evidence in the record indicates that the officers were aware of the distinct risk created by leaving the spit mask on Lee. None of the officers have stated that they viewed the mask as increasing the risk to Lee, and there is no evidence that EMT Earl (or anyone else who may have been present from the time the spit mask was placed over Lee's head until the time Lee left the station) warned the officers of any such risk. Cf. Odom, 349 F.3d at 771 (noting that the guards themselves demonstrated their recognition of the risk through their own contemporaneous statements).

Nor, after setting aside 20/20 hindsight, as we must in conducting this assessment, Grayson, 195 F.3d at 695, does the evidence support a conclusion that officers here "had been exposed to information concerning the [incremental] risk [associated with the spit mask] and thus must have known about it." Farmer, 511 U.S. at 842, 114 S.Ct. 1970. Cf. Odom, 349 F.3d at 771 (noting that the officers had been warned explicitly about the risk to the plaintiff). That is, the evidence does not show that the incremental risk associated with the spit mask was so obvious as to justify an inference of actual knowledge. First, at least one officer, Deputy Wancik, when viewing the manner in which the mask fit around Lee's neck, came away with the impression that it fit loosely enough such that, in the event Lee vomited, there was "plenty of room for a lot of liquid to kind of exit out." (J.A. at 1272.) That one officer came away with this (perhaps erroneous) impression of the mask's fit suggests that, at that time, the risk was not so obvious to the officers that they could not have failed to know of it. Second, none of the officers had any prior direct experience with this type of mask or any formal training on its use, thus diminishing the plausibility of the inference that the officers actually recognized the risk associated with its use. In the absence of particularized evidence showing that the officers actually had training or experience with the TranZport Hood and therefore were familiar with the manner in which it fit and the uses for which it was designed, it is difficult to conclude that this particular risk was obvious to the officers.

Finally, and most importantly, EMT Earl, a trained medical professional, observed the placement of Lee in the van with the spit mask over his head and expressed no concern. EMT Earl had ample opportunity to assess the spit mask, having earlier conducted an examination of Lee's head, during which she evaluated for herself the spit mask's fit and function in light of the risk he might vomit. At the time Lee was loaded into the van, EMT Earl raised again the concern that Lee might vomit and recommended that he be placed on his side. Notably though, she expressed no concern at that time about the spit mask specifically and effectively agreed with the officers that placing Lee on his side was sufficient to mitigate any risk to Lee. And, EMT Earl since has stated that had she perceived any problem with the mask, she would have stated it to the officers at that time. While the EMT's presence by no means immunizes the officers from liability, the fact that a trained medical technician did not recognize the risk associated with transporting a handcuffed inebriated person wearing a spit mask strongly suggests that the risk was something less than obvious.

In sum, the evidence in the record, viewed in the light most favorable to Parrish, shows, at most, that the officers were subjectively aware of the general risks attending the detention and transport of intoxicated, handcuffed individuals. The evidence, however, does not establish that the officers knew the spit mask exposed Lee to a specific risk distinct from the general risks of which the officers were aware. Lest the deliberate indifference standard be transformed into negligence, we can assess the officers' response only in light of the general risks that they actually recognized.

2.

Having ascertained the risk as the officers perceived it, we next must determine whether the evidence supports a finding that the officers' response thereto was deliberately indifferent. In Farmer, the Supreme Court noted that officials "may be found free from liability if they responded reasonably" to a perceived risk. 511 U.S. at 844, 114 S.Ct. 1970. This observation, of course, must be true because if the official's response was reasonable — i.e., not negligent — then a fortiori he was not deliberately indifferent. It does not follow, however, that when an officer's response is unreasonable — i.e., negligent — that he is liable for deliberate indifference. Indeed, we have noted that an officer's response to a perceived risk must be more than merely negligent or simply unreasonable. See Brown, 240 F.3d at 390-91 ("At most, [the officer's] failure to take additional precautions was negligent [ i.e., unreasonable under the circumstances], and not deliberately indifferent."). If a negligent response were sufficient to show deliberate indifference, the Supreme Court's explicit decision in Farmer to incorporate the subjective recklessness standard of culpability from the criminal law would be effectively negated. See Rich, 129 F.3d at 340 n. 2 (explaining this aspect of Farmer and noting that "[t]rue subjective recklessness requires knowledge both of the general risk, and also that the conduct is inappropriate in light of that risk"). As one of our sister courts has explained:

The response demanded of jail officials with actual knowledge of such risk of serious injury is that [they] not act with deliberate indifference. We share the concern . . . that the Farmer standard not be transmuted into a negligence inquiry. Deliberate indifference, i.e., the subjective intent to cause harm, cannot be inferred from a prison guard's failure to act reasonably. If it could, the standard applied would be more akin to negligence than deliberate indifference.

We reject the suggestion that the proper measure of the duty to respond of persons with the requisite knowledge ought to revisit negligence. Under that view negligence tossed out the front door re-enters through the back.

Hare v. City of Corinth, 74 F.3d 633, 649 (5th Cir. 1996) (en banc) (internal quotation marks omitted). Accordingly, where the evidence shows, at most, that an officer's response to a perceived substantial risk was unreasonable under the circumstances, a claim of deliberate indifference cannot succeed.

In contrast, we recently have found deliberate indifference where the evidence — uncontradicted at the time the qualified immunity determination was made — showed that the officials in question responded to a perceived risk with subjective awareness that their response was inappropriate. See Odom, 349 F.3d 765. Odom, a prison inmate, alleged that prison guards had been deliberately indifferent to the substantial risk that Odom's fellow inmates would attempt to kill him. Id. at 767. The evidence presented in that case, viewed in the light most favorable to Odom, showed that Odom's fellow inmates started a fire to create an opportunity to attack Odom. Id. Because of the fire, inmates were moved from their cells to outdoor chain-link recreation cages. Id. Odom explained to prison guards that certain other inmates would attempt to attack him, and the guards placed those inmates in the cage adjacent to Odom. Shortly thereafter, the guards overheard the inmates verbally threatening Odom and observed the inmates tearing down the fence that separated them from Odom. Id. at 767-68. In response to this developing situation, other correctional officers directed the defendants to remove Odom from his cage, but the defendants did not do so, and Odom's assailants were able to enter his cage and assault him. Id. at 768. Instead, the defendants openly mocked Odom and, through their alleged contemporaneous statements, indicated both that they recognized the risk to Odom and that they believed that he somehow deserved to be beaten. One of the officers flippantly observed that the assailants "got th[ei]r snitch;" another scolded Odom, stating, "you should not have snitched on them guys[,] you stupid [expletive]." Id. at 771 (alterations in original). In light of this direct evidence that the officers actually welcomed the harm that befell Odom and subjectively realized that the precautions they had taken were inadequate, the panel majority concluded that the evidence, in the absence of any rebuttal from the defendants, sufficiently supported a claim of deliberate indifference and thus justified reversing the district court's grant of summary judgment for the defendants and remanding the matter for further proceedings. Id. at 772.

In contrast, the record before us here contains no evidence suggesting that these officers recognized that their actions were inappropriate under the circumstances. To the contrary, the evidence shows that the officers believed that their actions were sufficient to mitigate the risks created by Lee's intoxicated condition. The officers decided to transport Lee to the adult detention center where medical help would be available if he needed it and they called in the paramedics to ensure that Lee's head injury did not require treatment. In making the critical decision respecting how Lee should be placed in the van, the officers consulted with a trained medical professional. Recognizing the risks of aspiration and positional asphyxiation, the officers and EMT Earl decided to place Lee on his side and the officers did so. The officers then positioned Lee's legs so that he would remain on his side, and then tilted his head so that his airway would remain free should he need to vomit. Neither EMT Earl nor anyone else then present expressed any concern that these precautions would not be sufficient. In short, the evidence shows that the officers took precautions that they believed (albeit erroneously) were sufficient to prevent the harm that befell Lee. There simply is no evidence in the record, in the form of contemporaneous statements or otherwise, to justify an inference that the officers subjectively recognized that their precautions would prove to be inadequate.

Notwithstanding the lack of evidence of subjective awareness of the inappropriateness of the response, the dissent suggests that, because the officers could have taken additional precautionary measures, their conduct is more indicative of deliberate indifference than that which occurred in Odom, and thus that a finding of deliberate indifference is mandated here. Post at 315-317. Under our precedent, however, the feasibility of additional precautionary measures is rarely probative in a deliberate indifference inquiry. See Brown, 240 F.3d at 390-91 (citing Liebe v. Norton, 157 F.3d 574, 578 (8th Cir. 1998)) ("Appellant points to all of the actions which [the official] should have taken. Unfortunately, [the official] did not have the benefit of twenty-twenty hindsight, as we do now. Thus, we must examine those precautionary actions which [actually] were undertaken."). As we often have made clear, the question in deliberate indifference cases is not whether the officials could have taken additional precautions — almost invariably, with the benefit of 20/20 hindsight, there are additional precautions that could have been taken — but whether they " disregard[ed] an excessive risk to . . . health or safety." Brown, 240 F.3d at 390-91 (noting that failure to take additional precautions showed, at most, negligence and not deliberate indifference); Grayson, 195 F.3d at 695 (rejecting as "impermissible 20/20 hindsight" the contention that officers should have taken detainee to a medical facility). Moreover, the rule the dissent seems to believe that Odom requires "would thrust federal courts into the daily practices of local police departments." Grayson, 195 F.3d at 696. As my concurring colleague correctly recognizes, we ought to avoid such "precipitous interfere[nce]" in "the difficult decisions faced regularly by law enforcement officers." Post at 312.

In conclusion, the evidence does not show that the officers here responded with deliberate indifference to the substantial risk of harm to Lee. Accordingly, the district court should have granted the officers' request for qualified immunity. Because Parrish fails the first prong of the qualified immunity inquiry, we need not consider whether the right alleged to have been violated was clearly established under the specific circumstances of this case. Saucier, 533 U.S. at 201, 121 S.Ct. 2151.

III.

Before closing, I feel obliged to comment briefly on this chapter in my dissenting colleague's on-going disquisition over the state of our court's qualified immunity jurisprudence. According to the dissent, our decision today is only the latest in a growing line of cases that are "individually indefensible and collectively irreconcilable," and we as a court are "in need of instruction in the critical areas of our jurisprudence" represented by various of our decisions. Post at 31. I, of course, do not agree.

As a preliminary matter, despite the dissent's impassioned but unsubstantiated claim that we have turned the doctrines of qualified immunity and deliberate indifference on their respective heads, the legal analysis conducted here is in lockstep with the precedent of the Supreme Court as well as that of this circuit. Not one of the cases setting forth the doctrine upon which this opinion is based has been reheard en banc, nor has the Supreme Court granted certiorari in any of these cases to correct any errors. To the contrary, the precedent articulated and relied upon here is well-settled and not in serious dispute. (I also recognize that this opinion has no particular precedential value as it represents only my analysis of the case, and only the judgment it represents has been joined by Judge King.)

The more important observation about the dissent's critique is the extent to which it is based on a selective recitation of the facts of our cases. If one were blindly to accept as true the dissent's characterizations of our precedent, his view of our qualified immunity jurisprudence might well be justified. A careful reading of each precedent, however, reveals that, although the dissent begins with a generally accurate assessment of the facts of the cases he pillories, he invariably fails to include factual detail that was highly relevant to the respective panels that decided each of those cases. When one considers all of the facts of these cases, as we are required to do under Supreme Court precedent, an entirely different picture emerges.

For example, the dissent omits facts from his discussion of Odom that were highly relevant to the majority's disposition of the case ( e.g., the fact that the guards never rebutted the evidence of deliberate indifference; the fact that the prison guards made contemporaneous statements that strongly indicated that they were subjectively aware of the risk to Odom and of the inappropriateness of their response to that risk).

The dissent's discussion of Bailey v. Kennedy, 349 F.3d 731, 739-41 (4th Cir. 2003) likewise is incomplete. According to the dissent, the officers in Bailey "merely took a suicidal person into custody for psychological evaluation after having been summoned to the scene by an emergency caller who reported that a suicide was imminent." Post at 314. The dissent omits, however, that the officers' investigation contradicted the emergency call's report of a suicide risk. Rather than finding a depressed person on the verge of suicide, the first responding officer discovered a man sitting in his own home calmly eating his lunch. During a five-minute conversation with the officer, the man denied any suicidal intentions, and the officer discovered no evidence of preparations for suicide. Id. at 740-41. This officer then left the house voluntarily. Because the officers' personal investigation revealed that Bailey was not an imminent suicide risk, we found that the officers' subsequent forceful seizure of Bailey, which resulted in substantial physical injuries to the man, was objectively unreasonable and a violation of clearly established law. Id. at 741.

My dissenting colleague's treatment of Robles v. Prince George's County, 302 F.3d 262 (4th Cir. 2002), is in accord with his oft-repeated view of that case, but nonetheless suffers from the same defect. Members of the panel that decided Robles have responded to my dissenting colleague's criticisms of that decision, and I see no reason to add to that discussion in this case. See Robles, 308 F.3d 437, 437-41 (4th Cir. 2002) (Wilkinson, C.J., concurring in the denial of rehearing en banc); Jones v. Buchanan, 325 F.3d 520, 535 n. 8 (4th Cir. 2003) (Motz, J.).

Finally, I note that the dissent resorts to characterization in attacking my holding as being irreconcilable with existing precedent. In comparing this case to his characterization of Odom, the dissent asserts that the only thing the officers did in response to the perceived risk was "lay Lee on his side and send him on his way." Post at 314. He omits, however, the fact that is most relevant to the analysis in this opinion — that the officers placed Lee on his side with his head tilted and feet positioned so that he would remain on his side, all in the presence of, and in consultation with, a trained medical professional who had examined Lee with the spit mask on, who herself recognized the possibility that handcuffed Lee might vomit while being transported to the adult detention center. The dissent disputes the significance of EMT Earl's presence when Lee was loaded into the van, post at 324-326, but that fact is significant to both of the judges voting to reverse today. Any discussion of this case as precedent that omits this fact is simply misleading.

Supreme Court precedent dictates that, in reviewing claims of qualified immunity, we must pay careful attention to the peculiar facts and circumstances of the case. Anderson v. Creighton, 483 U.S. 635, 639-40, 107 S.Ct. 3034, 97 L.Ed.2d 523 (1987). Ironically, in excoriating this court for its alleged faithlessness to the dictates of precedent, the dissent itself is unfaithful to this most salient feature of the Supreme Court's modern qualified immunity jurisprudence.

IV.

Lee's death in this case was unquestionably tragic, and as my separately concurring colleague rightly has noted, the officers here "skirted the precipice of deliberate indifference." Post at 312. Nevertheless, while the evidence supports the conclusion that the officers here may have acted negligently, their culpability falls short of the conscience-shocking deliberate indifference necessary to sustain Parrish's Fourteenth Amendment claims. For this reason, we reverse the district court's denial of qualified immunity and remand with instructions to grant qualified immunity to each of the five officers.

REVERSED AND REMANDED WITH INSTRUCTIONS