Friday, March 7, 2014
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En Banc Court Upholds Ruling Against Inmate Over Dental Care
By KENNETH OFGANG, Staff Writer
A prison dentist accused of deliberate indifference to the needs of a prisoner may assert lack of resources as a defense, the Ninth U.S. Circuit Court of Appeals ruled yesterday.
In a 6-5 decision, the limited en banc panel upheld a jury verdict in favor of a dentist, identified only as Dr. Brooks, who saw Cion Adonis Peralta at California State Prison in Lancaster. Peralta claimed that Brooks was responsible for a months-long delay in treatment that caused him unnecessary pain and damage to his teeth.
The dentist claimed he did the best he could, given the circumstances existing when Peralta came to Lancaster. There were only three or four dentists, three or four dental assistants, and no office technicians or dental hygienists, according to testimony.
The dentist-to-inmate ratio was about one for every 1,500, instead of the one for every 950 called for by state policy. In addition, the dentists there had to treat about 1,800 inmates at smaller institutions.
Peralta sued Brooks, along with the chief medical officer and chief dental officer of the prison. The case was assigned to U.S. District Judge James V. Selna of the Central District of California.
Judgment MOL
During trial, Selna granted judgment as a matter of law to the CMO and CDO, leaving Brooks as the lone defendant. He instructed the jury that “[w]hether a dentist or doctor met his duties to Plaintiff Peralta under the Eighth Amendment must be considered in the context of the personnel, financial, and other resources available to him or her or which he or she could reasonably obtain.”
The judge also told the jury that “[a] doctor or dentist is not responsible for services which he or she could not render or cause to be rendered because the necessary personnel, financial, and other resources were not available . . . or which he or she could not reasonably obtain.”
The jury rendered a verdict for the defendant. On appeal, the plaintiff argued that the “cost defense” instruction should not have been given and that the jury should have been allowed to determine whether the supervisory doctors were liable.
Chief Judge Alex Kozinski, joined in full by Judges Barry Silverman, Susan Graber, Richard Tallman, Richard Clifton and Jacqueline Nguyen, agreed that the judgment should be affirmed in its entirety. Judge Jay Bybee joined as to the supervisors only.
‘Care on Demand’
Kozinski said it was unreasonable to hold Brooks responsible for an inability “to provide every prisoner with dental care on demand.” The dentist cannot be “personally liable for failing to give Peralta care that Brooks would have found impossible to provide,” the chief judge said.
Nor can liability be predicated on the expectation that the state, whose officials made the staffing and budgetary decisions that led to the delay in treatment, will actually pay the damages, he said. This would legally shift responsibility from the individual state actors to the sovereign itself, contrary to the Eleventh Amendment, Kozinski wrote.
Congress, he noted can abrogate the state’s immunity from §1983 claims, but has never done so.
As for the supervisors, the chief judge went on to say, they were not liable as a matter of law because there was no evidence they were personally aware of Peralta’s difficulties.
Judge Morgan Christen, in an opinion joined in full by Judges Johnnie Rawlinson, Milan Smith, and Andrew Hurwitz and in part by Bybee, dissented with respect to the claims against Brooks and the chief dental officer.
“Today,” Christen argued, “our court overturns more than thirty years of circuit precedent by holding that lack of resources is a defense to a damages claim that a prisoner was denied the constitutionally-required minimum threshold for adequate care.”
Christen also argued that the chief dental officer’s delegation to a physician of the responsibility to review Peralta’s case when he sought internal review of Brooks’ decision not to expedite his dental visit raised a jury question as to whether he was deliberately indifferent to the prisoner’s needs.
The case is Peralta v. Dillard, 09-55907.
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