Divided Court rejects inmate's medical treatment claim

You don't see too many claims alleging that prison officials were deliberately indifferent to the medical needs of inmates. These cases are hard to win. To bring a constitutional claim, the inmate needs to show the officials were deliberately indifferent, and not merely negligent, in their treatment. As I have learned from handling these cases, it is difficult to survive a motion to dismiss under Rule 12 because the inmates do not have medical information or expertise to prove it was deliberate indifference and not negligence. This is one of these cases, and plaintiff loses.

The case is Darby v. Greenman, issued on September 16. The plaintiff was an inmate at Rikers Island. He began to experience inflammation and pain in his right cheek area, and dental clinicians fond a 3x3 centimeter bulge in his gums. Two dentists saw plaintiff. The first, Greenman, recommended a tooth extraction, which plaintiff said was unnecessary. The pain persisted, and plaintiff continued to request dental treatment. He says no one responded to his requests. Another dentist, Hamilton, later treated plaintiff and performed a dental cleaning, even as plaintiff continued to complain about the significant pain in his mouth. Those complaints were ignored. 

This case was dismissed under Rule 12, which is pre-discovery, on the basis that plaintiff did not plead that the dentists were deliberately indifferent. The Supreme Court devised that standard for inmate medical treatment claims and, in doing so, said that mere negligence does not violate the constitution. But the difference between deliberate indifference and negligence is a fine one, and it is tough to allege the latter when the inmate may not have the medical records or the expertise to properly allege deliberate indifference and not just negligence. Hence the few cases in the Second Circuit where the inmate prevails.

Plaintiff loses against Greenman. The Court of Appeals (Cabranes and Park) says:

Darby  does  not  claim  that  Greenman  denied  him  treatment  but instead disagrees with Greenman’s assessment of the severity of his condition and recommendation for treatment. This constitutes, at most, a difference of opinion about the proper course of treatment; it does not demonstrate deliberate indifference to a substantial risk of harm to Darby’s health. Even assuming that Greenman’s proposed treatment was inadequate, “mere medical  malpractice  is  not  tantamount  to  deliberate  indifference”  absent  a showing of “conscious disregard of a substantial risk of serious harm.”Thus,  Darby  has  not  alleged  that  Greenman  acted  with  deliberate indifference under the Fourteenth Amendment.

We have a similar analysis as to Hamilton, who gave plaintiff a dental cleaning over his objections about the pain in  his gums. The Court sees this as an allegation that Hamilton were merely negligent.

Judge Carney dissents, noting that inmates in the U.S. often receive lousy dental treatment, citing studies and other lawsuits to that effect. She thinks plaintiff has sufficient plead a deliberate indifference claim. She sums up this way:

For over four months while incarcerated at Rikers Island, Darby experienced severe gum pain from an almost golf-ball sized abscess in his mouth. He had trouble sleeping, eating, and talking, and lost twenty pounds as a result. As we have commented before, “Any person who has spent a night tossing and turning in suffering from an abscessed tooth knows that dental pain can be excru[c]iatingly severe.” Although he saw two prison dentists and filed over 15 sick call requests that described his symptoms in detail, Darby received no real care for a condition that was eminently treatable by gum surgery. Instead, one dentist offered a tooth extraction; the other, a dental cleaning.

I am concerned that the Majority’s decision affirming the district court’s dismissal of Darby’s complaint may work to immunize the relevant prison officials from liability in Darby’s and in other cases. In my view, the course of events specifically alleged by Darby could—if borne out by evidence—reasonably support a determination that the officials and dentists were deliberately indifferent to his serious medical needs.