Pro se inmate wins deliberate indifference dental treatment appeal

Inmates who bring medical indifference claims against their jailers mostly lose their cases because the legal standards adopted by the courts impose evidentiary hurdles that usually doom their chances of victory. But the courts sometimes find that the inmates have enough evidence for a jury trial. This is one of those (rare) case, all the more remarkable because the inmate won his appeal pro se against the Connecticut Attorney General's office.

The case is Gaffney v. Perelmuter, a summary order issued on April 1. To win these claims under the Eighth Amendment, the inmate has to show that (1) his medical condition was sufficiently serious and (2) the medical defendant acted with deliberate indifference to his medical needs, that is, that the defendant acted or failed to act while actually aware of a substantial risk that serious inmate harm will result.

As an aside, did you notice how detailed that multi-part constitutional standard is? The Eighth Amendment does not articulate this test. Rather, this test is judge-made. Do people realize that most constitutional issues are resolved on the basis of multi-part legal standards that were crafted by appellate judges over the years? I am not saying this is right or wrong, but the point is worth pondering.

We have two issues here: first, whether the dentist's choice to extract the plaintiff's tooth even though putting in crowns may have been the better treatment. But plaintiff loses that claim on summary judgment because he neither alleges the treatment option was foreclosed by prison policy or that based on monetary or other improper incentives. At best, he only argues the extraction choice was incorrect and that other dentists said extraction was unnecessary. That might be enough for a dental malpractice case under state tort law, but it will not work in an Eighth Amendment case brought under Section 1983.

However, plaintiff can win his claim alleging the dentist was deliberately indifferent to his pain during the extraction itself. Plaintiff alleges the dentist began working on his tooth before the Novocain kicked in, and that he ignored plaintiff's cries of pain and instead "digged" and "stabbed" in his mouth.  Folks, this is why people don't like going to the dentist. Here is how the Court of Appeals (Jacobs, Sack and Hall) analyzes the case

Construed liberally, Gaffney argued that Perelmuter was deliberately indifferent during the extraction in two distinct ways: (1) Perelmuter knew or should have known that ten minutes was insufficient time for the Novocain to take effect and for Perelmuter to properly extract the tooth, and (2) Perelmuter evinced conscious disregard of Gaffney’s pain during the extraction by ignoring his cries of pain, failing to provide further pain relief, and continuing to “dig” and “stab” the area. Viewing the evidence in the light most favorable to Gaffney, both arguments succeed.

The following evidence further supports plaintiff's claim (and reinforces why people hate going to the dentist):

First, "That ten minutes was an insufficient time is further supported by the evidence of complications during the extraction: the tooth broke in the gum and Gaffney required several follow-up visits (including two procedures to slice the gum away from the cheek); and

Second, "Gaffney asserted that he yelled out, moaned and groaned, and held his knees to his chest, and a reasonable jury could infer that Perelmuter knew from that reaction that Gaffney was in pain. A reasonable jury could also conclude that the confluence of factors here (proceeding with insufficient time, ignoring yells of pain, breaking the tooth, repeatedly slipping and stabbing the area), even if considered individually would not show deliberate indifference, taken together show that Perelmuter evinced a conscious disregard to Gaffney’s pain and dental health during the extraction."