Peralta v. Dillard

Decision Date06 March 2014
Docket NumberNo. 09–55907.,09–55907.
Citation744 F.3d 1076
PartiesCion Adonis PERALTA, Plaintiff–Appellant, v. T.C. DILLARD, Chief Dental Officer; S. Brooks, D.D.S. Staff Dentist; J. Fitter, Chief Medical Officer, Defendants–Appellees.
CourtU.S. Court of Appeals — Ninth Circuit

OPINION TEXT STARTS HERE

Derek Milosavljevic (argued), Kirkland & Ellis LLP, Los Angeles, CA, for PlaintiffAppellant.

Janine K. Jeffery (argued) and Oren Rosenthal, Reily & Jeffery, Northridge, CA, for DefendantsAppellees.

Melinda Bird and Monisha Coelho, Disability Rights California, Los Angeles, CA, Donald Specter and Kelly Knapp, Prison Law Office, Berkeley, CA, Ernest Galvan and Lisa Ells, Rosen Bien Galvan & Grunfeld, LLP, San Francisco, CA, Paula D. Pearlman and Michelle Uzeta, Disability Rights Legal Center, Los Angeles, CA, for Amicus Curiae Disability Rights California, Disability Rights Legal Center, Prison Law Office, and Rosen Bien Galvan & Grunfeld, LLP.

Appeal from the United States District Court for the Central District of California, James V. Selna, District Judge, Presiding. D.C. No. 2:05–cv–01937–JVS–PLA.

Before: ALEX KOZINSKI, Chief Judge, BARRY G. SILVERMAN, SUSAN P. GRABER, RICHARD C. TALLMAN, JOHNNIE B. RAWLINSON, RICHARD R. CLIFTON, JAY S. BYBEE, MILAN D. SMITH, JR., MORGAN CHRISTEN, JACQUELINE H. NGUYEN and ANDREW D. HURWITZ, Circuit Judges.

Chief Judge KOZINSKI delivered the opinion of the court, which is joined in full by Judges SILVERMAN, GRABER, TALLMAN, CLIFTON and NGUYEN. Judge BYBEE joins Part II.B.

OPINION

KOZINSKI, Chief Judge:

We consider whether prison officials sued for money damages under 42 U.S.C. § 1983 may raise a lack of available resources as a defense.

I. Background

At the time Cion Adonis Peralta arrived at California State Prison, Los Angeles County (Lancaster), the prison had only three or four dentists and three or four dental assistants. It had no office technicians or dental hygienists. State policy calls for one dentist for every 950 prisoners, but the ratio at Lancaster was closer to one to 1,500. In addition, the dentists there were responsible for roughly 1,800 inmates at other facilities, bringing the ratio to around one to 2,000.

Peralta requested dental care almost immediately. He complained that his teeth hurt, he had cavities and his gums were bleeding. When he hadn't received care a few weeks after his initial request, Peralta filed a written appeal, in which he again claimed that he had cavities and severe pain. In the informal response to that appeal, Peralta was put on a waiting list, which was generally nine to twelve months long.

Peralta then pursued a formal appeal. He was subsequently interviewed by Dr. Brooks, a staff dentist. Brooks asked Peralta which tooth hurt most, took X-rays and scheduled Peralta for an extraction of that tooth. Brooks also gave Peralta a few days' supply of Ibuprofen. Dissatisfied, Peralta filed a second-level appeal a few days later, and was told that “further treatment [would] be provided based on the waiting list.”

About three months after his initial interview, Peralta had his second visit with Brooks. During that visit, Peralta was supposed to have the scheduled extraction, but he declined to go through with it after Brooks told him removal was unnecessary. Brooks gave Peralta more Ibuprofen and medication for an infection. Eleven months after that, Brooks saw Peralta again and took X-rays, reviewed Peralta's history and cleaned his teeth.

After Peralta declined to have his tooth extracted, but before his cleaning, he filed this section 1983 lawsuit for money damages against Brooks; the prison's Chief Dental Officer, Dr. Dillard; and the Chief Medical Officer, Dr. Fitter. He claimed that their deliberate indifference to his serious medical needs violated his Eighth Amendment rights. See42 U.S.C. § 1983. In the end, his claims amounted to a several-month delay in getting his teeth cleaned and an alleged failure to treat his pain. These claims went to trial, but after Peralta presented his case, the district court granted directed verdicts to Dillard and Fitter. The jury found for Brooks. Peralta challenges the jury instruction, as well as the judgment in favor of Dillard and Fitter.

II. Discussion

Prison officials violate the Eighth Amendment if they are “deliberate[ly] indifferen[t] to [a prisoner's] serious medical needs.” Estelle v. Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976). A medical need is serious if failure to treat it will result in ‘significant injury or the unnecessary and wanton infliction of pain.’ Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir.2006) (quoting McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir.1992), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir.1997) (en banc)). A prison official is deliberately indifferent to that need if he “knows of and disregards an excessive risk to inmate health.” Farmer v. Brennan, 511 U.S. 825, 837, 114 S.Ct. 1970, 128 L.Ed.2d 811 (1994).

A. “Cost Defense” Jury Instruction

The court 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 court 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.”

We review a district court's formulation of civil jury instructions for abuse of discretion, Dang v. Cross, 422 F.3d 800, 804 (9th Cir.2005), but we review de novo whether an instruction states the law correctly, Clem v. Lomeli, 566 F.3d 1177, 1180–81 (9th Cir.2009). Jury instructions must be supported by the evidence, fairly and adequately cover the issues presented, correctly state the law, and not be misleading. Id. at 1181.

1. The Instruction's Statement of the Law

The Supreme Court has not said whether juries and judges may consider a lack of resources as a defense in section 1983 actions. See Wilson v. Seiter, 501 U.S. 294, 302, 111 S.Ct. 2321, 115 L.Ed.2d 271 (1991) ([T]he validity of a ‘cost’ defense as negating the requisite intent is not at issue in this case....”); see also Harris v. Angelina Cnty., 31 F.3d 331, 336 (5th Cir.1994). But the Court has told us that prison officials aren't deliberately indifferent to a prisoner's medical needs unless they act wantonly, see Estelle, 429 U.S. at 104, 97 S.Ct. 285, and whether an official's conduct “can be characterized as ‘wanton’ depends upon the constraints facing [him],” Wilson, 501 U.S. at 303, 111 S.Ct. 2321. The Court has also told us that, even if an official knows of a substantial risk, he's not liable “if [he] responded reasonably.” Farmer, 511 U.S. at 844, 114 S.Ct. 1970.

What is reasonable depends on the circumstances, which normally constrain what actions a state official can take. 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. Security concerns dictate that only one prisoner be in the examination room at a time, even if there's more than one chair, and that no prisoner be left alone, lest he try to use dental tools as weapons. Further exacerbating the problem, only emergency cases can be seen when the prison is in lockdown, and dentists can't accept prisoners' complaints at face value, as inmates often try to jump the line by exaggerating their symptoms.

These challenges aside, there simply weren't enough dentists at Lancaster to provide every prisoner with dental care on demand. The ratio of dentists to prisoners was less than half what the state said it should be, there were no office technicians or dental hygienists and, on many occasions, Brooks had no dental assistant. Peralta doesn't argue that Brooks was responsible for these constraints. Nor could he, since Brooks had no control over the budget.

Peralta would have had the jury ignore that there was no money or staff available to treat him immediately, and hold Brooks personally liable for failing to give Peralta care that Brooks would have found impossible to provide. Peralta claims that this approach is compelled by our decisions in Jones v. Johnson, 781 F.2d 769 (9th Cir.1986), and Snow v. McDaniel, 681 F.3d 978 (9th Cir.2012). In Jones, we reversed a district court's dismissal of a pretrial detainee's deliberate indifference claims because we found “no other explanation in the record than the budget concerns” for denying treatment, and [b]udgetary constraints ... do not justify cruel and unusual punishment.” 781 F.2d at 771. In Snow, we reversed a district court's grant of summary judgment in favor of prison officials who delayed an inmate's surgery, partially due to a lack of resources, because the desire to avoid paying for a surgery is an “improper motive[ ] for delaying it. 681 F.3d at 987.

As an en banc court, we're not bound by either decision. Even if we were, it wouldn't help Peralta. In Jones and Snow, plaintiffs sought both money damages and injunctions. Neither case dealt with jury instructions; the question in both was whether the case could proceed at all.

Lack of resources is not a defense to a claim for prospective relief because prison officials may be compelled to expand the pool of existing resources in order to remedy continuing Eighth Amendment violations. See LaMarca v. Turner, 995 F.2d 1526, 1536–39, 1542 (11th Cir.1993) (prison official wouldn't be personally liable if he did everything he could, but prisoner could get an injunction against official in his official capacity); see also Watson v. City of Memphis, 373 U.S. 526, 537, 83 S.Ct. 1314, 10 L.Ed.2d 529 (1963) (rejecting argument that city couldn't desegregate parks because of...

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