Court: District Court, D. Nevada; February 24, 2012; Federal District Court
Defendants’ Motion for Summary Judgment was filed on June 20, 2011, regarding Plaintiff Fredric Dixon, an inmate at Southern Desert Correctional Center. Defendants include Bruce Bannister (Medical Director), Howard Skolnik (Director), and Paul Bitar (Senior Institutional Dentist). Prior to incarceration, Dixon had cosmetic dental work, including crowns and veneers. After three veneers broke or were removed, he sought dental care and was seen by Bitar on June 12, 2009, complaining of pain due to gingival inflammation. Bitar recommended the removal of a remaining crown for better hygiene access, which Dixon consented to despite claiming he was not fully informed of potential risks or NDOC regulations against cosmetic dental services. Dixon asserted he would not have consented had he been adequately advised. Following the removal, Dixon reported further dental pain and subsequently filed a grievance. During a January 2010 appointment, Bitar advised extraction of four teeth but suggested waiting for approval from the NDOC’s Utilization Review Panel (URP) regarding off-site dental services, which are subject to NDOC regulations prohibiting cosmetic procedures unless medically necessary.
Plaintiff's outside dentist offered to replace his crowns and veneers without cost to the Nevada Department of Corrections (NDOC) or Plaintiff, with Plaintiff agreeing to cover transportation costs. The Utilization Review Panel (URP) denied this request. Following this, Plaintiff filed a second-level grievance, leading NDOC to refer him to the dentist at Southern Desert Correctional Center (SDCC). According to Dr. Bitar, the removal of the crown and denial of veneers do not increase Plaintiff's risk for health issues as claimed. Bitar also suggested tooth extraction and a partial denture as a viable treatment option available at NDOC.
Plaintiff filed suit in Nevada state court against Bannister, Skolnik, and Bitar, which was removed to federal court. Count one of his First Amended Complaint alleges Bitar violated the Eighth and Fourteenth Amendments, as well as Nevada's constitutional provisions and state statutes, by denying necessary dental care. Count two asserts that Bannister, Skolnik, and Bitar violated the same laws by maintaining a policy that denies needed dental care and does not allow offsite treatment.
Defendants seek summary judgment, arguing that Plaintiff's claims are based on a disagreement between his opinion and Bitar's professional judgment, which does not constitute deliberate indifference. They also claim Bannister and Skolnik did not personally participate in any violations and assert qualified immunity, stating that there is no clearly established right to cosmetic dental services. Additionally, they argue that punitive damages are unwarranted as there is no evidence of reckless or callous behavior.
In response, Plaintiff contends that Bitar indicated the primary treatment should have been the replacement of crowns and veneers, suggesting Plaintiff wait for URP approval instead of proceeding with extraction. He argues that tooth extraction is unreasonable given the availability of cost-free dental services from a private dentist. Plaintiff compares the situation to an unreasonable limb severance when a less invasive option exists. Regarding personal involvement, he asserts Bannister and Skolnik were part of the URP that denied his referral and are responsible for NDOC's policies prohibiting cosmetic dentistry. Plaintiff maintains he has a clearly established right to adequate dental treatment that prevents unnecessary extractions and protects against associated health risks.
Plaintiff argues that the facts indicate recklessness or callous disregard by Defendants in denying him access to outside dental services. Summary judgment is warranted when there are no genuine disputes over material facts, as defined by Federal Rule of Civil Procedure 56(a). A fact is material if it could influence the case's outcome, while an issue is genuine if a reasonable fact-finder could favor the non-moving party. The burden initially lies with the moving party to demonstrate the absence of a genuine issue of material fact, after which the non-moving party must provide evidence to the contrary, with all evidence viewed favorably to the non-moving party.
Under 42 U.S.C. § 1983, a plaintiff must show a constitutional right violation by someone acting under state law to establish liability. Government officials performing discretionary functions may be granted qualified immunity to protect them from undue litigation risks, shielding them unless they are "plainly incompetent" or knowingly violate the law. Courts assessing qualified immunity must first determine if the alleged facts indicate a constitutional right violation and then if that right was clearly established. A right is deemed clearly established if it would be evident to a reasonable officer that their conduct was unlawful in the circumstances. This evaluation should be context-specific rather than generalized. An officer can still claim qualified immunity even if mistaken in believing their actions were lawful, provided that belief was reasonable. The burden is on the plaintiff to demonstrate that the right in question was clearly established, though prior court declarations of unconstitutionality are not strictly necessary if prior precedent clearly indicates the conduct was unlawful.
Plaintiff claims Defendants violated his Eighth Amendment rights, which protect against "cruel and unusual" punishment. To establish a violation, Plaintiff must demonstrate two key elements: (1) the alleged deprivation was "sufficiently serious" to constitute an Eighth Amendment violation, and (2) Defendants acted with "deliberate indifference." Prisoners are entitled to basic necessities including adequate shelter, food, clothing, sanitation, medical care, and personal safety, with dental care recognized as a significant medical need. However, a prisoner is not entitled to outside medical care beyond what is provided by prison staff.
Deliberate indifference requires that a prison official be aware of and disregard a substantial risk to inmate health or safety. Simple negligence or differing medical opinions do not meet this standard; instead, the plaintiff must prove the chosen treatment was unreasonably inadequate and that officials acted with conscious disregard for an excessive risk to health. In this case, there is no genuine issue of material fact indicating Defendants denied Plaintiff adequate dental treatment, as the evidence shows that the extraction of teeth and provision of a partial denture were not medically unacceptable under the circumstances.
Plaintiff's preference for veneers or crowns does not create a factual dispute regarding the medical acceptability of extraction as an alternative treatment. Bitar's affidavit confirms that extracting four teeth and fitting a partial denture is a viable option, and Plaintiff has not provided evidence to dispute this. Additionally, Plaintiff has not shown that Defendants acted with conscious disregard for his health, as they attended to him whenever he filed a dental kite and recommended appropriate treatments. Bitar's affidavit indicates that the removal of the crown or refusal to allow veneers does not increase Plaintiff's risk for health issues like gingivitis, diabetes, or heart disease, while Plaintiff's claims are based only on his unsubstantiated opinions. Even if Defendants’ actions could be deemed deliberately indifferent, they are entitled to qualified immunity because Plaintiff failed to prove that a reasonable official would recognize the treatment provided as a violation of his Eighth Amendment rights. Consequently, the court grants Defendants’ Motion for Summary Judgment concerning Plaintiff's Eighth Amendment claims, rendering his request for punitive damages moot. However, claims based on Nevada state constitutional and statutory provisions remain pending, as Defendants did not seek summary judgment on these grounds. The court has ordered the correction of the case caption to accurately reflect the name of Defendant Bruce Bannister and overruled objections to Dixon's affidavit as moot since they do not affect the outcome. Additionally, the court noted that the procedural approach to qualified immunity has shifted, allowing for flexibility in addressing constitutional violations and clearly established rights. Plaintiff's First Amended Complaint also references the Fourteenth Amendment, which incorporates the Eighth Amendment's protections against the states.
