No Money for Prison Dental Care, No Problem

A federal appeals court split 7-4 to reject an inmate civil rights claim that prison officials made him wait 18 months to treat severe dental pain and infection, then blamed that deficiency on a lack of resources to excuse the poor care.

In two strongly-worded,  dissents, four judges said Thursday the majority of the 9th U.S. Circuit Court of Appeals has “overturned more than thirty years of circuit precedent by holding that lack of resources is a defense to providing constitutionally inadequate care for prisoners.”

The majority upheld a jury verdict in favor of dentists at the California state prison at Lancaster in Los AngelesCounty, where just three or four dentists were responsible for roughly 2,000 inmates each at Lancaster and surrounding facilities.

The state policy calls for one dentist for each 950 prisoners, according to the court.

Cion Peralta requested dental care almost immediately after arriving because his teeth had cavities and his gums were bleeding.  Despite severe pain he was placed on a waiting list that was nearly one year long.

He appealed and was given an X-ray by a dentist who asked which tooth hurt most.  The dentist then scheduled time to pull the tooth.  It was three months before he saw the dentist again and Peralta declined the extraction after being told it was unnecessary.  Another 11 months after that Peralta was again given X-rays and his teeth were cleaned.

Prior to that visit, Peralta filed a civil rights lawsuit seeking money damages against the prison and the medical authorities for deliberate indifference to his serious medical needs, according to the court.

The trial judge told the jury that a doctor or dentist cannot be held responsible for failure to render services because necessary personnel or financial resources are unavailable.

The trial judge directed a verdict in favor of two physicians and jurors found in favor of two others.

“What is reasonable depends on the circumstances,” wrote Chief Judge Alex Kozinski.  “This case is a fine example.  Peralta rests his claim on having to wait for dental care, but prisons are a particularly difficult place to provide such care,” he wrote.

“There just were not enough dentists at Lancaster to provide every prisoner with dental care on demand,” he said.

Peralta wanted money damages but the state is protected from that by the 11th Amendment immunity, according to the majority.

Kozinski was joined by Judges Barry Silverman, Susan Graber, Richard Tallman, Richard Clifton and Jacqueline Nguyen.  Judge Jay Bybee joined only on the decision to side with the chief medical officer and chief dental officer as a matter of law.

In dissent, Judge Morgan Christen wrote, “Twenty years ago, the United States Supreme Court observed: ‘The Constitution does not mandate comfortable prisons, but neither does it permit inhumane ones.’”

Peralta’s claim was not for his wait for services, but rather for the dentist’s failure to put him on the prison’s emergency dental care list for condition’s the dentist admitted qualified.  Peralta waited 18 months and developed periodontitis and severe bone lose, the court said.

“Because it will deny any remedy for prisoners who have suffered injuries due to prison officials’ deliberate indifference and eliminates an important incentive for improving prison conditions, I respectfully dissent,” Christen wrote.

She was joined by Judges Johnnie Rawlinson, Milan Smith, Andrew Hurwitz and Bybee.

In a second, partial dissent, Judge Hurwitz said the majority opinion “has something of a seductive quality.  It pits Peralta, a jailhouse lawyer, against Dr. Brooks, an overworked dentist.”

But, he said, the case is not about the inmate and the dentist, the question is “whether a state can shield itself from the consequences of denying constitutionally required medical treatment to those it incarcerates by deliberately choosing not to appropriate sufficient funds for that treatment.”

The majority holds that the state can first choose to underfund the medical treatment of its wards, and then excuse the Eighth Amendment violations caused by the underfunding, he said.

Hurwitz said it will only encourage future constitutional violations.

He was joined by Judges Christen, Rawlinson, Smith and Bybee.

Case:  Peralta v. Dillard, No. 09-55907





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