Garza v. Tewalt et al
MEMORANDUM DECISION AND ORDER - Garzas Motion for Summary Judgment Against Dr. Cammann, Corizon, Brewer, Tillemans and Siegert (Dkt. 27 ) is DENIED; The Corizon Defendants Motion for Summary Judgment (Dkt. 28 ) is GRANTED; Garzas Request to Grant Summary Judgment Against Defendant Rona Siegert (Dkt. 32 ) is DENIED; Garzas Motion to Strike (Dkt. 34 ) is DENIED; Siegerts Motion for Summary Judgment (Dkt. 37 ) is GRANTED; The Court will enter a separate judgment in accordance with Fed. R. Civ. P. 58. Signed by Judge David C. Nye. (caused to be mailed to non Registered Participants at the addresses listed on the Notice of Electronic Filing (NEF) by (jd)
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF IDAHO
Case No. 1:19-cv-00275-DCN
MEMORANDUM DECISION AND
CORIZON; SUSANNA CAMMANN,
DDS; GEN BREWER; AMANDA
TILLEMANS; and RONA SIEGERT,
This case involves Eighth Amendment claims brought by inmate Erineo Garza
against Defendants Corizon, LLC (“Corizon”), Dr. Susanna Cammann, Amanda
Tillemans, Gen Brewer, and Rona Siegert.1
Pending before the Court are Garza’s Motion for Summary Judgment (Dkt. 27)
against all Defendants; Corizon, Dr. Cammann, Tillemans, and Brewer’s (collectively the
“Corizon Defendants”) Motion for Summary Judgment (Dkt. 28); Garza’s “Request to
Grant Summary Judgment Against Defendant Rona Siegert” (Dkt. 32); Garza’s Motion to
Strike (Dkt. 34); and Siegert’s Motion for Summary Judgment (Dkt. 37). The parties have
filed their responsive briefing on the motions and/or the time for doing so has passed
Additional named defendants were dismissed in the Court’s Initial Review Order. Dkt. 5.
MEMORANDUM DECISION AND ORDER - 1
Having reviewed the record, the Court finds the parties have adequately presented
the facts and legal arguments in the briefs. Accordingly, in the interest of avoiding further
delay, and because the Court finds the decisional process would not be significantly aided
by oral argument, the Court decides the pending motions on the record and without oral
argument. Dist. Idaho Loc. Civ. R. 7.1(d)(1)(B).
For the reasons stated herein, the Court will DENY Garza’s Motion for Summary
Judgment against the Corizon Defendants (Dkt. 27); GRANT the Corizon Defendants’
Motion for Summary Judgment (Dkt. 28); DENY Garza’s Request to Grant Summary
Judgment Against Rona Siegert (Dkt. 32); DENY Garza’s Motion to Strike (Dkt. 34) and
GRANT Siegert’s Motion for Summary Judgment (Dkt. 37).
Garza is an Idaho Department of Corrections (“IDOC”) inmate incarcerated in the
Idaho State Correctional Institution (“ISCI”). Garza is missing nearly all of his teeth and
requires the use of full upper dentures and partial lower dentures. Under IDOC’s standard
operating procedure for oral care (“Dental SOP”), inmates may be provided dentures at the
discretion of the attending dentist. Inmates are eligible to receive replacement dentures or
new dentures every five years. The Dental SOP classifies denture-related dental treatment
as non-emergency dental treatment. To receive access to non-emergency dental treatment,
inmates must submit a Health Services Request (“HSR”).
Garza’s dental history shows he had full upper and lower partial dentures made in
Unless otherwise noted, the following facts are undisputed.
MEMORANDUM DECISION AND ORDER - 2
approximately November of 2014, before he was incarcerated.3 After Garza was
incarcerated and filed an HSR for dentures, Dr. Cammann provided him with a new set of
full upper dentures and partial lower dentures on May 11, 2017.4 Dr. Cammann gave Garza
written and verbal instructions for care of his new dentures.5 She also advised Garza that
the new dentures should not be worn at night, that sore spots were expected to develop as
his mouth adjusted to the new dentures, and how to clean and chew with the new dentures.
On September 13, 2017, Garza knocked a tooth out of his partial lower dentures.
Dr. Cammann sent the lower dentures to the lab for repair and delivered the repaired
dentures to Garza on October 2, 2017. On March 1, 2018, Garza submitted an HSR stating
his lower partial denture was again broken. Dr. Cammann saw Garza the next day and
noted both his upper and lower dentures were broken. Garza told Dr. Cammann he had
broken his dentures by sneezing. Although she was suspicious of this explanation given
her understanding that it was highly unusual for a sneeze to dislodge—much less damage—
dentures, Dr. Cammann again sent Garza’s dentures to the lab to be repaired.
On March 27, 2018, Dr. Cammann gave Garza his repaired upper and lower
dentures and adjusted them to make sure they fit correctly in his mouth. Dr. Cammann told
Garza’s medical records suggest he had full upper and lower partial dentures made and fitted for him in
Caldwell, Idaho, in November of 2014. Dkt. 28-6, ¶ 9. On summary judgment, Garza disputes that his 2014
dentures were made in Caldwell. Dkt. 33, at 2. Although immaterial, the Court notes the dispute and has
omitted reference to where Garza’s 2014 dentures were purportedly made.
Dr. Cammann is a dentist who, from September 30, 2016, to March 9, 2020, was employed full-time by
Corizon to provide general dental care for inmates at ISCI.
Garza also suggests “Dr. Cammann never gave [him] an instruction sheet but read [the instructions] to
him as he has a hard time understanding things, can barely read and being Spanish the English language is
hard for him to comprehend.” Dkt. 33, at 2–3. The dispute is immaterial because Garza concedes Dr.
Cammann verbally went over the instructions with him.
MEMORANDUM DECISION AND ORDER - 3
Garza to submit an HSR if the dentures started to bother him or if he believed they needed
to be adjusted. On August 17, 2018, Garza submitted an HSR complaining that his upper
dentures were causing him to bite his cheek. On September 9, 2018, Dr. Cammann adjusted
Garza’s upper dentures.
On October 8, 2018, Dr. Cammann removed one of Garza’s remaining four lower
teeth due to a periapical abscess. This left Garza with three remaining teeth. During the
appointment, Dr. Cammann noted both Garza’s upper and lower dentures—which had been
adjusted less than a month earlier—were already showing signs of aesthetic damage. When
Dr. Cammann advised Garza that he needed to take better care of his dentures, he informed
her the damage was caused when he dropped his dentures and stepped on them.
On December 13, 2018, Garza submitted an HSR to seek repairs for damage to his
lower partial dentures. On January 4, 2019, Dr. Cammann examined Garza’s dentures and
found one tooth was missing. Dr. Cammann concluded the missing tooth did not interfere
with Garza’s ability to chew food, the damage was merely aesthetic, and that sending the
dentures to the lab for another repair was not medically necessary. Dr. Cammann noted
this was the third instance where Garza had negligently damaged his dentures and informed
Garza she would no longer send his dentures to the lab to repair aesthetic damage that
lacked medical necessity. During the January 4, 2019 appointment, Dr. Cammann did
smooth the corners of two of Garza’s natural teeth, which Garza complained were sharp.
On March 5, 2019, Garza again submitted an HSR requesting repair of his dentures.
During an appointment with him on March 14, 2019, Dr. Cammann asked Garza if he was
wearing his dentures overnight because the wear pattern appeared consistent with such
MEMORANDUM DECISION AND ORDER - 4
practice. When Garza indicated he was not, Dr. Cammann instructed Garza not to wear his
dentures overnight and reminded him his dentures would no longer be repaired for aesthetic
reasons because it was apparent he was not taking care of them and because they had
already been repaired several times in the last year. Garza complained he was unable to eat
tortillas due to the damage to his dentures, but Dr. Cammann found Garza had an even bite
and concluded it was realistic for him to bite tortillas with the posterior teeth of his
dentures. On summary judgment, Garza disputes that he could eat properly, and notes Dr.
Cammann did not observe him during meals and could not see how hard it was for him to
chew his food or to digest unchewed food as a result of the damage to his dentures.
On April 29, 2019, Garza received a routine annual dental checkup. During the visit,
Dr. Cammann found Garza’s overall oral hygiene was extremely poor. Garza’s remaining
three teeth had heavy plaque and tartar buildup, which suggested he was either not brushing
his teeth properly or was not brushing his teeth at all. During the appointment, a dental
hygienist reminded Garza he was not yet eligible for new dentures pursuant to the Dental
On May 1, 2019, Garza submitted a formal request for new dentures. Dr. Cammann
denied the request on May 7, 2019, stating replacement dentures were not medically
indicated because Garza’s existing dentures were still functional. On May 10, 2019, Garza
submitted an HSR complaining that his dentures were broken and sharp wires were poking
his gums. On May 14, 2019, Garza submitted a grievance stating his upper dentures were
missing teeth, his lower dentures were broken with protruding wires digging into his gums,
and that he suffered a lot of pain and couldn’t chew his food as a result. Garza then
MEMORANDUM DECISION AND ORDER - 5
requested repair of his dentures so he could eat properly.
On May 17, 2019, Dr. Cammann met with Garza to address his complaints. Dr.
Cammann did not find any protruding wires near the #28 junction, where Garza
complained wires were poking his gums. Dr. Cammann noted the wires near the #28
juncture were still coated with acrylic and were unexposed. Although he also complained
of mouth sores, Dr. Cammann could not find any sores in Garza’s mouth. Dr. Cammann
smoothed and polished around the #28 juncture, adjusted and reinforced the lingual cusp
of Garza’s dentures, and ultimately concluded the issues of which Garza complained were
likely due to his poor oral hygiene, and not to any problem with the dentures. For instance,
although Garza had just had a cleaning less than a month earlier, his natural teeth were
already built up with heavy plaque and debris. When Dr. Cammann asked Garza whether
he was intentionally failing to brush his teeth so his remaining teeth would be pulled, Garza
responded, “yes.” Dkt. 28-13, at 6. Dr. Cammann determined there was no clinical reason
to remove Garza’s three remaining teeth because they were non-mobile and served as good
anchors for Garza’s partial lower dentures. Dr. Cammann also again concluded there was
no medical indication Garza’s dentures needed to be repaired because they were
On summary judgment, the Corizon Defendants highlight Garza’s commissary
records from 2018 and 2019 undermine his allegations that he was unable to eat properly
due to his dentures. For instance, in the days after Dr. Cammann’s May 17, 2019
appointment with him, Garza continued to purchase, and presumably eat, many items he
would be unable to consume without functioning dentures, including Whoppers, Milk
MEMORANDUM DECISION AND ORDER - 6
Duds, chips, tortillas, nuts, cookies, crackers, cereal, and popcorn. Dkt. 28-6, at ¶ 25. Dr.
Cammann also notes Garza is morbidly obese, and that this would not be possible if he was
unable to eat. Id. Garza responds that his commissary purchases and weight are irrelevant
and have nothing to do with his dentures. Dkt. 33, at 5.
On May 21, 2019, Gen Brewer, a Registered Nurse and Director of Nursing at ISCI,
responded to Garza’s May 14, 2019 grievance. In her response, Brewer stated: “You were
seen by the dentist on 5/17/19. She looked at and evaluated your partial. I hope your
concerns were addressed. Please brush your teeth and take care of the partial you have.”
Dkt. 28-5, at 2. On May 23, 2019, Amanda Tillemans, the then-Health Service
Administrator at ISCI, reviewed Garza’s grievance and Brewer’s response. Tillemans
denied Garza’s request for new dentures, noting Dr. Cammann performed a thorough
evaluation of Garza’s teeth, gums, and dentures on May 17, 2019, and made sure there was
nothing to cause him significant pain or discomfort. Garza appealed Tillemans’ denial.
On June 18, 2019, Rona Siegert, the Healthcare Services Director for IDOC,
affirmed the denial of Garza’s grievance. Siegert noted Dr. Cammann’s examination of
Garza’s dentures on May 17, 2019, did not reveal any exposed wires and that Dr. Cammann
smoothed out Garza’s lower partial dentures to ensure he would not feel anything sharp.
Siegert encouraged Garza to take care of his dentures and remaining natural teeth. Siegert
also reminded Garza he was not yet eligible for replacement dentures under IDOC’s Dental
Garza filed the instant suit on July 11, 2019. Garza brings Eighth Amendment
claims pursuant to 42 U.S.C. § 1983, and alleges Defendants were deliberately indifferent
MEMORANDUM DECISION AND ORDER - 7
to his serious dental needs by failing to replace his dentures. Garza claims Defendants’
failure to replace his damaged dentures caused him needless pain and suffering, loss of
sleep, loss of appetite, and severe stomach problems due to not being able to properly chew
and digest his food.
In addition to his Motion for Summary Judgment, Garza filed two motions which
essentially seek to strike the Corizon Defendants’ and Siegert’s respective Responses to
his Motion for Summary Judgment. The Corizon Defendants and Siegert have also filed
cross-Motions for Summary Judgment. Because resolution of Garza’s procedural motions
will determine what evidence and briefing the Court considers on summary judgment, the
Court addresses the procedural motions first, and then turns to the various motions for
A. Request to Grant Summary Judgment against Siegert (Dkt. 32) and
Motion to Strike (Dkt. 34) the Corizon Defendants’ Response6
Garza filed a Motion for Summary Judgment—against the Corizon Defendants and
Siegert—on July 10, 2020. Dkt. 27. The Corizon Defendants and Siegert both responded
to Garza’s Motion for Summary Judgment on July 31, 2020. Dkt. 29; Dkt. 30. In his
procedural motions, Garza first suggests summary judgment should be entered against
Defendants because their Responses were untimely filed.
Garza apparently filed his Request to Grant Summary Judgment against Siegert, and Motion to Strike the
Corizon Defendants’ Response, in lieu of a Reply in support of his Motion for Summary Judgment, as he
did not file a Reply to either Siegert’s or the Corizon Defendants’ Responses to his Motion for Summary
Judgment. Similarly, Siegert filed a Reply to Garza’s Request to Grant Summary Judgment against her but
did not file a Reply in support of her cross-Motion for Summary Judgment.
MEMORANDUM DECISION AND ORDER - 8
Garza argues both Federal Rule of Civil Procedure 56 and Local Civil Rule 7.1(c)(1)
for the District of Idaho require a party to respond to a motion for summary judgment
within twenty-one days after the motion is filed. Although the Corizon Defendants and
Siegert filed their Responses to Garza’s Motion for Summary Judgment on July 31, 2020—
twenty-one days after Garza’s July 10, 2020 Motion for Summary Judgment was filed and
served—Garza contends his Motion for Summary Judgment was instead filed on July 8,
2020. Garza argues Defendants’ Responses are purportedly two days late and, as such,
cannot be considered by the Court on summary judgment. Garza is mistaken.
Garza appears to believe that because he signed his Motion for Summary Judgment
and supporting documents on July 8, 2020, the documents were also filed and served on
Defendants on that date. Dkt. 32, at 1; Dkt. 34, at 1. However, as the Mailing Authorization
submitted with Garza’s Motion for Summary Judgment illustrates, ISCI could not file
Garza’s Motion for Summary Judgment electronically on June 8, 2020, due to a network
issue. Dkt. 27-4. The paralegal for ISCI accordingly approved filing by mail. Id. The Clerk
of the Court’s date stamp on Garza’s Motion for Summary Judgment—as well as the Clerk
of the Court’s date stamp on each of Garza’s supporting documents (including the envelope
they arrived in)—illustrates the Court did not receive Garza’s Motion for Summary
Judgment and supporting documents until July 10, 2020. See, Dkt. 27, 27-1–27-11. The
Court electronically filed Garza’s Motion and supporting documents on July 10, 2020, and
the Corizon Defendants and Siegert were served, by virtue of the ECF filing, on the same
date. The Corizon Defendants and Siegert then timely filed their responses on July 31,
2020, exactly twenty-one days after the July 10, 2020 filing. Garza’s argument regarding
MEMORANDUM DECISION AND ORDER - 9
the timing of Defendants’ Responses is accordingly baseless.
Garza also argues summary judgment should be entered against the Corizon
Defendants and Siegert pursuant to Federal Rule of Civil Procedure 56(c) and Local Civil
Rule 7.1(c) because they did not file an affidavit or statement of disputed facts with their
Responses to his Motion for Summary Judgment. Garza suggests the Corizon Defendants
and Siegert have accordingly consented to entry of summary judgment against them.
Again, Garza misunderstands the record.
In addition to responding to Garza’s Motion for Summary Judgment on July 31,
2020, the Corizon Defendants also filed a cross-Motion for Summary Judgment the same
day. Dkt. 28. When a cross-movant’s filing in support of its own motion for summary
judgment contains specific facts that answer the movant’s motion for summary judgment,
there is no need to file the same materials both in opposition to the movant’s motion and
with the cross-motion. William W. Schwarz, et al., The Analysis and Decision of Summary
Judgment Motions, 139 F.R.D. 441, 499 (Feb. 1992); Fair Housing Council of Riverside
Cty., Inc. v. Riverside Two, 249 F.3d 1132, 1137 (9th Cir. 2001) (rejecting party’s position
that the court need not consider evidence submitted in support of a cross-movant’s motion
for summary judgment if that evidence was not also specifically filed with the crossmovant’s response to the movant’s motion).7
As explained below, here the Corizon Defendants’ cross-Motion for Summary
Of course, if a party’s cross-motion and evidentiary support do not adequately respond to the other party’s
motion, the cross-movant must file an opposition or risk a judgment against it for failure to oppose a
properly supported motion. Schwarz, 139 F.R.D. at 500.
MEMORANDUM DECISION AND ORDER - 10
Judgment contains specific facts to answer those raised in Garza’s Motion. Rather than
submitting the same facts with their Response to Garza’s Motion for Summary Judgment,
the Corizon Defendants filed a statement of undisputed facts and supporting evidence with
their cross-Motion for Summary Judgment (Dkt. 28-2), which they explicitly incorporated
by reference in their Response to Garza’s Motion for Summary Judgment. Dkt. 29, at 1–2.
In an attempt to avoid duplicative filing, Siegert also incorporated the Corizon Defendants’
statement of undisputed facts by reference in her Response to Garza’s Motion for Summary
Judgment (Dkt. 30, at 3)8, as well as in her subsequent cross-Motion for Summary
Judgment (Dkt. 37-1, at 3).
Defendants’ attempt to avoid duplicative filing and to preserve judicial economy by
filing one statement of facts (rather than three duplicative versions of the same facts), as
well as one declaration for each defendant (instead of three duplicate declarations for each
defendant) not only complies with Federal Rule of Civil Procedure 56(c) and District of
Idaho Local Rule 7.1(c), but is encouraged by the Court. See Judge Nye’s Motion Practice
Guidelines, available at https://id.uscourts.gov/district/judges/nye/Motion_Practice.cfm.9
In short, Garza’s Request to Grant Summary Judgment against Rona Siegert (Dkt.
32) and Motion to Strike the Corizon Defendants’ Response (Dkt. 34) are meritless and are
Siegert also incorporated the Declarations of Cammann, Brewer, and Tillemans (and supporting evidence,
including Garza’s medical records) by reference in her Response to Garza’s Motion for Summary
Judgment. Dkt. 30, at 8–11.
In fact, the Court would have preferred for Defendants to avoid even further duplication by filing their
respective responses to Garza’s Motion for Summary Judgment combined in the same brief with their
respective cross-Motions for Summary Judgment. Id. Although they were not required to do so, such
practice could have avoided Garza’s misplaced procedural argument, as well as the panoply of briefs on
summary judgment filed in this case.
MEMORANDUM DECISION AND ORDER - 11
B. Cross-Motions for Summary Judgment
1. Summary Judgment Standard
Summary judgment is appropriate where the moving party can show that, as to any
claim or defense, “there is no genuine dispute as to any material fact and the movant is
entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The Court must enter
summary judgment if, after adequate time for discovery and upon motion, a party “fails to
make a showing sufficient to establish the existence of an element essential to that party’s
case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v.
Catrett, 477 U.S. 317, 322 (1986). One of the principal purposes of the summary judgment
rule “is to isolate and dispose of factually unsupported claims or defenses[.]” Id. at 323. It
is not “a disfavored procedural shortcut,” but is instead the “principal tool by which
factually insufficient claims or defenses [can] be isolated and prevented from going to trial
with the attendant unwarranted consumption of public and private resources.” Id. at 327.
“The mere existence of some alleged factual dispute between the parties will not
defeat an otherwise properly supported motion for summary judgment; the requirement is
that there be no genuine issue of material fact.” Anderson v. Liberty Lobby, Inc., 477 U.S.
242, 247–48 (1986) (emphasis in original). Material facts are those “that might affect the
outcome of the suit under the governing law[.]” Id. at 248. Summary judgment is not
appropriate if the dispute about a material fact is “genuine,” that is, “if the evidence is such
that a reasonable jury could return a verdict for the nonmoving party.” Id.
The Court’s role at summary judgment is not “to weigh the evidence and determine
MEMORANDUM DECISION AND ORDER - 12
the truth of the matter but to determine whether there is a genuine issue for trial.” Anderson,
477 U.S. at 249. The Court does not make credibility determinations at this stage of the
litigation, as such determinations are reserved for the trier of fact. Hanon v. Dataproducts
Corp., 976 F.2d 497, 507 (9th Cir. 1992). In considering a motion for summary judgment,
the Court must also “view the facts in the non-moving party’s favor[.]” Zetwick v. Cty. of
Yolo, 850 F.3d 436, 441 (9th Cir. 2017).
However, the Court need not accept allegations by the non-moving party if such
allegations are not supported by sufficient evidence. Anderson, 477 U.S. at 249. Instead,
once the moving party demonstrates the absence of a genuine issue of material fact, the
nonmoving party must go beyond the pleadings and by its own evidence “set forth specific
facts showing that there is a genuine issue for trial.’” Far Out Productions, Inc. v. Oskar,
247 F.3d 986, 997 (9th Cir. 2001) (quoting Fed. R. Civ. P. 56(e)); Keenan v. Allan, 91 F.3d
1275, 1279 (9th Cir. 1996) (noting the nonmoving party must “identify with particularity
the evidence that precludes summary judgment.”). “If the evidence is merely colorable, or
is not significantly probative, summary judgment may be granted.” Anderson, 477 U.S. at
249–50 (cleaned up).
Finally, when cross-motions for summary judgment on the same claim are before
the court, “the court has an independent duty to review each cross-motion and its
supporting evidence.” Fair Housing Council, 249 F.3d at 1137. “The filing of crossmotions does not ensure that summary judgment is in order. Each motion must be
considered on its own merits, and both may be denied.” Schwarz, 139 F.R.D. at 499. Thus,
even in cases in which both parties believe there are no material factual issues, the court
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has a responsibility to analyze whether the record on cross-motions for summary judgment
demonstrates the existence of material fact precluding summary judgment. Chevron USA,
Inc. v. Cayetano, 224 F.3d 1030, 1037 & n.5 (9th Cir. 2000).
2. Deliberate Indifference Standard
Garza contends the Defendants have subjected him to inadequate medical treatment
in violation of the Eighth Amendment’s prohibition against cruel and unusual punishment.
With respect to medical care for inmates, the Eighth Amendment is violated when prison
officials demonstrate “deliberate indifference to serious medical needs.” Estelle v. Gamble,
429 U.S. 97, 104 (1976). In order to establish deliberate indifference, an inmate must
satisfy objective and subjective components of a two-part test. Wilson v. Seiter, 501 U.S.
294, 298–99 (1991). First, the prisoner must show a “serious medical need” by
“demonstrating that failure to treat a prisoner’s condition could result in further significant
injury or the unnecessary and wanton infliction of pain.” Jett v. Penner, 439 F.3d 1091,
1096 (9th Cir. 2006) (cleaned up).
Second, the inmate must show the defendant’s “response to the need was
deliberately indifferent.” Id. To satisfy the subjective test—that the defendant’s response
to a serious medical need was deliberately indifferent—a plaintiff must show both that: (1)
the course of treatment the defendant chose was medically unacceptable under the
circumstances; and (2) the defendant chose this course in conscious disregard of an
excessive risk to the plaintiff’s health. Edmo v. Corizon, 935 F.3d 757, 786 (9th Cir. 2019)
The subjective component is intended to preclude a finding of deliberate
MEMORANDUM DECISION AND ORDER - 14
indifference for accidents or inadvertent or even negligent failure to provide medical care.
Estelle, 429 U.S. at 105–06; Hutchinson v. United States, 838 F.2d 390, 394 (1988);
Farmer v. Brennan, 511 U.S. 825, 835 (1994) (“ordinary lack of due care” is insufficient
to establish deliberate indifference). As such, deliberate indifference entails something
more than medical malpractice or even gross negligence. Toguchi v. Chung, 391 F.3d 1051,
1060 (9th Cir. 2004). Deliberate indifference is only present when a prison official “knows
of and disregards an excessive risk to inmate health or safety; the official must both be
aware of facts from which the inference could be drawn that a substantial risk of serious
harm exists, and he must also draw the inference.” Farmer, 511 U.S. at 837. Thus, a
deliberate indifference claim against a medical provider requires a showing that the
defendant acted with subjective recklessness. Id. at 839–40.
Finally, even if deliberate indifference is shown, the prisoner must demonstrate
harm caused by the indifference to state an Eighth Amendment claim. Jett, 439 F.3d at
1096; Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989) (explaining delay in
providing medical treatment does not constitute an Eighth Amendment violation unless the
delay was harmful).
To bring a constitutional claim under § 1983 against a municipality or other
government entity, a plaintiff cannot rely on respondeat superior liability. Monell v. Dep’t
of Soc. Servs. of New York, 436 U.S. 658, 691 (1978). Under Monell,10 a municipality or
Where, as here, an inmate claims a private entity like Corizon has violated his constitutional rights, the
plaintiff must satisfy the test articulated in Monell. Tsao v. Desert Palace, Inc., 698 F.3d 1128, 1138–40
(9th Cir. 2012) (applying Monell to private entities acting under color of state law).
MEMORANDUM DECISION AND ORDER - 15
entity is subject to liability only if: (1) the plaintiff was deprived of a constitutional right;
(2) the entity had a policy or custom; (3) the policy or custom amounted to deliberate
indifference to the plaintiff’s constitutional right; and (4) the policy or custom was the
moving force behind the constitutional violation. Mabe v. San Bernardino Cty., 237 F.3d
1101, 1110–11 (9th Cir. 2001).
3. Garza’s Motion for Summary Judgment (Dkt. 27)
Garza argues Defendants violated his Eighth Amendment right to be free from cruel
and unusual punishment by refusing to provide him with “proper upper and lower plate
dentures that [do not] have missing teeth, wires protruding and rubbing on and cutting into
his gum[s].” Dkt. 27-1, at 2. Liberally construed, Garza contends Defendants failed to
provide necessary dental care because of IDOC’s Dental SOP, and, in relying on the Dental
SOP rather than medical necessity, Defendants were deliberately indifferent to his serious
dental needs. United States v. Seesing, 234 F.3d 456, 462 (9th Cir. 2000) (explaining pro
se complaints and motions from prisoners must be liberally construed).
a. Garza’s Eighth Amendment Claim
Although not addressed by the parties, it appears Garza’s significant dental issues—
including the loss or extraction of nearly all of his teeth—constitutes a serious medical
need. The Court assumes, without deciding, that Garza’s dental condition is a serious
medical need. However, Garza fails to establish that Defendants acted with deliberate
indifference to his dental condition in his Motion for Summary Judgment.
“Dental care is one of the most important medical needs of inmates.” Hunt, 865 F.2d
at 200 (quoting Ramos v. Lamm, 639 F.2d 559, 576 (10th Cir. 1980)). As such, the Eighth
MEMORANDUM DECISION AND ORDER - 16
Amendment requires “that prisoners be provided with a system of ready access to adequate
dental care.” Hunt, 865 F.2d at 200 (citation omitted). Here, Garza has clearly had ready
access to dental care. For instance, between May 11, 2017 and May 17, 2019, Dr.
Cammann provided Garza with new dentures, repaired Garza’s new dentures three times,
removed Garza’s abscessed tooth, cleaned Garza’s teeth, and treated Garza in multiple
additional appointments.11 The relevant question in this case is thus not whether Garza
received dental care, but whether Defendants were deliberately indifferent to Garza’s
dental condition by failing to provide him with replacement dentures.
In his Motion for Summary Judgment, Garza devotes his argument almost entirely
to the Dental SOP, contending Defendants’ deliberate indifference to his serious dental
needs “is based upon [their] customs, practices, protocols and policies generated and
revolving around administrative convenience and costs that are unrelated to Plaintiff’s
serious dental needs and violate standards of dental care in an evolving society.” Dkt. 271, at 2. Garza argues he was denied new dentures solely because he was not eligible for
them under the Dental SOP. Id. at 4–6; Dkt. 27-2, ¶¶ 1, 3, 6; Dkt. 27-3, ¶¶ 7–10, 14. Garza
also contends the Dental SOP is “on its face unconstitutional,” and that it subjects not only
Garza, but all other inmates who need replacement dentures within a five-year span, to
cruel and unusual punishment. Dkt. 27-1, at 4–5.
See, supra, Section II (May 11, 2017 new dentures; October 2, 2017 delivery of repaired dentures; March
2, 2018 appointment; March 27, 2018 delivery of repaired dentures; September 9, 2018 appointment to
adjust dentures; October 8, 2018 removal of abscessed tooth; January 4, 2019 appointment; March 14, 2019
appointment; April 29, 2019 cleaning; May 17, 2019 appointment including denture repair). Of his seven
dental appointments between March 1, 2018 and May 17, 2019, six were made at Garza’s request to adjust
or repair his dentures.
MEMORANDUM DECISION AND ORDER - 17
In focusing solely on the Dental SOP, Garza neglects to first show replacement
dentures were medically necessary in his case. Garza does not offer any evidence—whether
from a Corizon medical provider, an expert, or any other source—to suggest Defendants
provided constitutionally inadequate medical care in denying his request for replacement
dentures. Garza also completely ignores the evidence showing Dr. Cammann, his treating
dentist, did not simply deny him replacement dentures due to the Dental SOP, but instead
frequently repaired and evaluated his dentures, and repeatedly concluded replacement
dentures were not medically necessary. Dkt. 28-2, ¶¶ 10–12, 14, 16–17, 19, 22. In order
for the Court to assess whether the Dental SOP is unconstitutional, Garza must first show
that Defendants’ refusal to replace his dentures was medically unacceptable and chosen in
conscious disregard of an excessive risk to his health. Without such showing, Garza lacks
standing to challenge the Dental SOP. See, e.g., City of Los Angeles v. Lyons, 461 U.S. 95,
101 (1983) (“It goes without saying that those who seek to invoke the jurisdiction of the
federal courts must satisfy the threshold requirement imposed by Article III of the
Constitution by alleging an actual case or controversy. Plaintiffs must demonstrate a
personal stake in the outcome in order to assure that concrete adverseness which sharpens
the presentation of issues necessary for the proper resolution of constitutional questions.”)
(cleaned up); Warth v. Seldin, 422 U.S. 490, 499 (1975) (“The [Article] III judicial power
exists only to redress or otherwise to protect against injury to the complaining party, even
though the court’s judgment may benefit others collaterally.”).
Garza is not entitled to summary judgment because he does put forth evidence to
establish as a matter of law—or even address—whether Defendants’ failure to give him
MEMORANDUM DECISION AND ORDER - 18
replacement dentures was medically unacceptable. Edmo, 935 F.3d at 786. Nor does Garza
show that Defendants denied him replacement dentures in conscious disregard of an
excessive risk to his health. Id. While Dr. Cammann contends Garza does not need
replacement dentures because his current dentures, although aesthetically damaged, are
fully functional, Garza does not offer any evidence other than his own opinion to show
replacement dentures are medically necessary. “A difference of opinion between a
prisoner-patient and prison medical authorities regarding treatment does not give rise to a
§ 1983 claim.” Franklin v. State of Or., State Welfare Div., 662 F.2d 1337, 1344 (9th Cir.
1981) (citing Mayfield v. Craven, 433 F.2d 873, 874 (9th Cir. 1970)).
In addition to his claims regarding the Dental SOP, Garza argues “delay in providing
dentures is deliberate indifference,” and cites several cases in support. Dkt. 27-1, at 5–6.
Each is inapposite. In Wynn v. Southward, 251 F.3d 588, 593 (7th Cir. 2001), the Seventh
Circuit held the district court erred in granting defendant’s Motion to Dismiss an inmate’s
Eighth Amendment claim with respect to his dentures. Like Garza, the inmate in Wynn
alleged he was unable to chew his food without dentures, significantly impending his
ability to eat.12 Id. The Seventh Circuit held such allegations were sufficient to state an
Eighth Amendment claim at the Motion to Dismiss stage of the litigation. In its Initial
Review Order, this Court similarly held Garza’s allegations regarding his inability to eat
without replacement dentures were sufficient to plead an Eighth Amendment claim.13 To
Incidentally, unlike Garza, the inmate in Wynn did not have any dentures, and alleged prison officers
deliberately misplaced his dentures when they removed him from the general prison population to the
prison’s Isolation Detention Unit.
Pursuant to 28 U.S.C. §§ 1915(e)(2)(B) & 1915A(b), the Court’s Initial Review Order screened Garza’s
Complaint for failure to state a claim upon which relief may be granted.
MEMORANDUM DECISION AND ORDER - 19
obtain summary judgment, Garza must offer much more than unsupported allegations. As
the moving party with the ultimate burden of proof at trial, Garza must present evidence
which would entitle him to a directed verdict if the evidence were to go uncontroverted at
trial. Miller v. Glenn Miller Prods., 454 F.3d 975, 987 (9th Cir. 2006) (citation omitted).
Garza’s unsubstantiated allegations regarding his need for replacement dentures fall far
short of meeting this standard.
Garza next cites to Dean v. Coughlin, 623 F. Supp. 392 (S.D.N.Y. 1985), where the
district court concluded plaintiffs, who represented a class of female inmates incarcerated
at the Bedford Hills Correctional Facility, were entitled to a preliminary injunction ordering
defendants to provide adequate dental care to inmates at the facility. In finding plaintiffs
were likely to succeed on the merits of their Eighth Amendment claim, the court held,
among other things, that the record indicated the prison’s provision of dentures was
severely lacking. Id. at 399. For instance, a dental hygienist first recognized one plaintiff
needed dentures during a visit in December of 1983, but the plaintiff did not receive
dentures until April of 1985. A prison dentist first identified another plaintiff’s need for
full dentures on October 29, 1983, and all of the inmate’s teeth were extracted in
preparation for new dentures in December of 1983. However, the inmate did not receive
new dentures until March of 1985. During the fifteen months she was without dentures, the
plaintiff lost so much weight she had to be placed on a food supplement. Id. By contrast,
here Dr. Cammann repeatedly evaluated Garza’s dentures and consistently determined he
does not have a medical need for replacement dentures because his existing dentures are
MEMORANDUM DECISION AND ORDER - 20
Similarly, in Farrow v. West, 320 F.3d 1235, 1244 (11th Cir. 2003), a prison dentist
acknowledged an inmate’s medical need for dentures on October 19, 1999. Yet, the inmate
did not receive dentures until January 2001. During the fifteen months he was without
dentures, the inmate suffered significant weight loss, pain and bleeding gums. The
defendant dentist recognized the inmate’s weight loss and advised the inmate he needed a
physical examination. In reversing summary judgment in favor of the defendant dentist,
the Eleventh Circuit explained there was sufficient evidence to support the inmate’s Eighth
Amendment claim because the defendant dentist: (1) determined dentures were medically
necessary; (2) was repeatedly made aware of the inmate’s problematic weight loss as a
result of not having dentures; and (3) still delayed in providing the innate with dentures for
more than a year. Id. The Farrow Court held the defendant dentist’s “substantial and
inordinate delay in treatment raise[d] a jury question as to [defendant’s] deliberate
indifference towards Farrow’s serious medical need.” Id. at 1246. Unlike in Farrow, here
the prison dentist instead determined replacement dentures were not medically necessary.
Garza does not put forth any evidence to call Dr. Cammann’s conclusion into question.
And, as further discussed below, Dr. Cammann was also unable to verify any of Garza’s
purported symptoms, despite repeated appointments with Garza and multiple evaluations
of his dentures. See generally Dkt. 28-6.
Finally, in Hunt, 865 F.2d at 199, an inmate lost his dentures in a prison riot and
made repeated requests for dental treatment and replacement dentures. The inmate’s
requests were ignored, and he ultimately filed a grievance claiming his remaining teeth
were breaking, his gums were bleeding and infected, and he was suffering pain and weight
MEMORANDUM DECISION AND ORDER - 21
loss. Despite being aware of the inmate’s symptoms, the prison dentist did not see the
inmate for another three months. Id. In reversing summary judgment in favor of the
defendant dentist and others, the Ninth Circuit explained, “Hunt alleged, and the defendants
did not dispute, that there was a delay of more than three months before Hunt was treated.
Given the serious dental problems which Hunt alleges he repeatedly complained about . . .
it reasonably could be concluded that the delay was deliberate[.]” Id. at 201. Here, Garza’s
medical records instead show he has had an appointment with Dr. Cammann every time he
requested one, including six dental appointments in a little over a year. Garza’s only
grievance was also promptly answered (although, after an appointment with Dr. Cammann,
it was ultimately denied). Like the other cases he cites, Hunt is distinguishable and does
not support Garza’s claim of deliberate indifference.14
In addition to his argument regarding the Dental SOP and citation to the
aforementioned cases, Garza raises two misplaced procedural arguments against the
Corizon Defendants on summary judgment. First, Garza implies he is entitled to summary
judgment because the Corizon Defendants did not produce the contract governing
Corizon’s medical care and services to IDOC during discovery. Dkt. 27-1, at 2–3. While
Corizon objected to Garza’s request for the contract in its response to Garza’s First Set of
Interrogatories and Requests for Documents, it directed Garza to IDOC officials to review
the copy of the contract that IDOC makes available to inmates. Dkt. 27-7, at 2. If Garza
In the two other cases Garza cites, Field v. Gander, 734 F.2d 1313, 1314 (8th Cir. 1984) and Hartsfield
v. Colburn, 371 F.3d 454, 456 (8th Cir. 2004), there was evidence that defendants deliberately ignored the
plaintiffs’ repeated pleas for dental care. By contrast, Dr. Cammann saw Garza and evaluated his dentures
every time he asked her to. Dkt. 28-2, ¶¶ 11, 14, 16, 17, 20, 21, 22.
MEMORANDUM DECISION AND ORDER - 22
was dissatisfied with this response, he should have followed the discovery dispute
procedure set forth in Federal Rule of Civil Procedure 37 and Local Civil Rule 37.1.
Garza’s Motion for Summary Judgment is not the proper avenue to seek additional
discovery from the Corizon Defendants.
Moreover, even if his procedural argument was appropriately raised, the Corizon
Defendants’ response to Garza’s discovery request did not provide grounds to enter
judgment against them. Garza was not denied access to the contract and, absent a showing
of a constitutional violation, the Court lacks jurisdiction to review Garza’s claims regarding
Corizon’s purportedly unconstitutional policy. See, e.g., Warth, 422 U.S. at 499 (“A federal
court’s jurisdiction therefore can be invoked only when the plaintiff himself has suffered
‘some threatened or actual injury resulting from the putatively illegal action[.]’”) (quoting
Linda R.S. v. Richard D., 410 U.S. 614, 617 (1973)).
Second, Garza contends the Corizon Defendants did not dispute the factual
allegations of his Complaint because they claim in their Answer, “the actions of Corizon
Defendants have at all times been in reliance on the policies and procedures of the Idaho
Department of Corrections, and these policies and procedure are rationally related to
legitimate penological objectives.” Dkt. 27-1, at 4. Although the Corizon Defendants raised
the Dental SOP as one of several affirmative defenses to Garza’s allegations in their
Answer (Dkt. 15, at 10) they also specifically denied each of Garza’s allegations regarding
their purported deliberate indifference. Id. at 5–9. Garza’s claim that the Corizon
Defendants did not dispute his factual allegations is inaccurate and is not a reason to enter
summary judgment in his favor.
MEMORANDUM DECISION AND ORDER - 23
In sum, Garza has not presented evidence to establish the elements of a deliberate
indifference claim with respect to any of the Defendants. Because Garza fails to set forth
substantial and competent evidence to show he is entitled to judgment as a matter of law,
Garza’s Motion for Summary Judgment is DENIED.
4. The Corizon Defendants’ Motion for Summary Judgment (Dkt. 28)
In his Complaint, Garza generally alleges replacement dentures are medically
necessary because his upper denture “has teeth missing and [he] is unable to properly chew
his food for digestion and when he tries the upper plate flops around and causes him pain.”
Dkt. 3, ¶¶ 30–31. Garza also contends the “lower partial plate is broken with wires
protruding which dig into his gums when he attempts to chew his food.” Id., ¶ 31. Garza
suggests the “lack of proper dentures subjects Plaintiff to cruel and unusual treatment as
the broken dentures cause Plaintiff pain, discomfort, an inability to adequately chew his
food, bleeding and swollen gums serving no penological or rational and legitimate
purpose.” Id., ¶ 32. The Corizon Defendants argue they are entitled to summary judgment
because there is no evidence to suggest Dr. Camman’s medical care satisfies either prong
of the subjective deliberate indifference standard. The Court must agree.
a. Dr. Cammann
First, all of the evidence in the record suggests Dr. Cammann’s decisions with
respect to Garza’s dentures were medically appropriate. After providing Garza with new
dentures in May of 2017, Dr. Cammann twice sent Garza’s dentures to the lab for repair
upon Garza’s request—once in October of 2017 and again in March of 2018. It is not clear
from the record whether Garza’s dentures were functionally, or merely aesthetically,
MEMORANDUM DECISION AND ORDER - 24
damaged when Dr. Cammann sent them to the lab for repair in the Fall of 2017 and Spring
of 2018.15 However, when Garza submitted another HSR seeking repair for damage to his
dentures on December 13, 2018, Dr. Cammann determined a third repair was not necessary
since the damage was aesthetic and not functional.
Specifically, upon examination of Garza’s dentures on January 4, 2019, Dr.
Cammann noted one tooth was missing. Dkt. 28-6, ¶ 17. Dr. Cammann determined the
missing tooth did not impair functionality because Garza still had 13 upper teeth to
function, while a normal full denture has 14 teeth. Id. Dr. Cammann noted that despite the
missing tooth Garza “still had posterior occlusion (effective contact of the molar and
bicuspid teeth) with lateral excursion which is the reason removable prosthodontic
appliances are fabricated to help a patient achieve functionality.” Id. Dr. Cammann
concluded it was not medically necessary to send Garza’s dentures to the lab for repairs for
a third time in January of 2019 because there was no reason the damage would impair his
ability to masticate food.16 Id. Dr. Cammann explained it would be necessary to send
dentures to the lab or order new dentures if Garza could not eat, developed serious sores in
his mouth as a result of ill-fitting dentures that could not be adjusted in clinic, or if Garza
As noted, in addition to twice sending Garza’s dentures to the lab for repair, Dr. Cammann also adjusted
Garza’s dentures on September 9, 2018 when he complained they were causing him to bite his cheek,
removed one of Garza’s existing teeth due to a periapical abscess on October 8, 2018, and gave Garza a
routine annual dental checkup on April 29, 2019. Dkt. 28-2, ¶¶ 14, 15, 18. Garza does not challenge such
care on summary judgment.
The Corizon Defendants note Garza admitted he could chew food with his dentures more than five months
after his January 2019 appointment with Dr. Cammann because, during a mental health screening on June
25, 2019, after he was removed to restrictive housing, Garza noted his anxiety would decrease once he was
given his (existing) dentures so he could eat. Id.; see also Dkt. 28-10, at 14. Garza does not address this
claim on summary judgment.
MEMORANDUM DECISION AND ORDER - 25
was not able to open and close his mouth in a normal manner. Id., ¶ 18. Dr. Cammann
found Garza had none of these issues upon her January 4, 2019 evaluation. Id.
Nevertheless, Dr. Cammann did smooth the corners of two of Garza’s natural teeth to
address his complaint that such teeth were sharp. Id., ¶ 17.
On March 5, 2019, Garza again submitted an HSR requesting that his dentures be
repaired. Dr. Cammann saw Garza on March 14, 2019, and reevaluated his dentures.
During the March 14, 2019 appointment, Garza complained of a sore spot on his lower
molar region. Dkt. 28-13, at 9. Dr. Cammann adjusted Garza’s dentures and Garza
confirmed his dentures felt better upon adjustment. Id. When Garza complained that he
could not eat tortillas with his dentures, Dr. Cammann again checked his bite and
determined he had even occlusion, meaning he could realistically bite tortillas with the
posterior teeth on his dentures. Id.; Dkt. 28-6, ¶ 20. Dr. Cammann also noted that Garza’s
lower partial dentures appeared secure and did not rock loose, and that his remaining three
teeth (although in bad shape due to calcium buildup and heavy plaque suggestive of a
failure to brush his teeth) served as a good anchor for his partial lower dentures. Dkt. 286, ¶ 20. Ultimately, Dr. Cammann concluded the damage to Garza’s anterior denture teeth
was aesthetic and did not impede his ability to masticate his food, which is a function
performed by the posterior teeth. Id.
On May 1, 2019, Garza submitted a formal request for new dentures. Dr. Cammann
denied the request because Garza’s existing dentures were still functional, and because he
was not yet eligible for new dentures under the Dental SOP. Id., ¶ 22. In denying Garza’s
request, Dr. Cammann reiterated that there was no medical indication that Garza’s dentures
MEMORANDUM DECISION AND ORDER - 26
needed to be replaced. Id.
Following Dr. Cammann’s denial, Garza submitted an HSR complaining his
dentures were broken and that sharp wires were exposed and poking his gums. Dr.
Cammann had another appointment with Garza on May 17, 2019, and again examined his
dentures. Upon evaluation, Dr. Cammann could not find any exposed or sharp wires. Id., ¶
23. Dr. Cammann checked the specific area where Garza claimed wires were protruding,
and found the area was still coated with acrylic and the wires were unexposed. Id.
Nonetheless, Dr. Cammann smoothed and polished the area. Id. Although Garza also
complained of sores in his mouth, Dr. Cammann could not find any mouth sores upon
examination. Id. Dr. Cammann determined Garza’s complaints were likely related to poor
oral hygiene, and again found there was no medical indication that replacement dentures
were necessary because Garza’s existing dentures were functioning properly. Id.
On summary judgment, Dr. Cammann explains she concluded replacement dentures
were not medically necessary because:
[She] determined on multiple occasions that Mr. Garza’s dentures were
otherwise functional and capable of chewing food: The removal appliances
were stable. They had posterior occlusion, which allows him to masticate his
food, and lateral excursions. He was only missing one artificial tooth, #11,
on the upper denture, giving him 13 teeth to function with. On the lower
partial denture, Mr. Garza had a total of 13 teeth to eat with. In all, he had 26
teeth to masticate food with. By comparison, a patient who has all their teeth
in their mouth with “wisdom teeth” has 32. A majority of people have 28
teeth in their oral cavity once they have their wisdom teeth removed. In my
experience, a patient like Mr. Garza would be perfectly capable of eating
food either with his dentures or solely with his remaining teeth.
Id., ¶ 24. In addition, Dr. Cammann explained Garza’s commissary records indicate he was
capable of eating many types of food. For instance, Garza’s 2018 commissary records
MEMORANDUM DECISION AND ORDER - 27
illustrate he purchased and presumably ate things such as chips, raisins, pork rinds,
crackers, atomic fireball candy, mixed nuts, and Snickers. Id., ¶ 25; Dkt. 28-17. After his
May 17, 2019 appointment with Dr. Cammann, Garza continued to purchase and
presumably eat similar items that would be difficult to consume if his dentures were not
functioning, including Jolly Ranchers, Whoppers, Milk Duds, chips, tortillas, nuts, cookies,
and crackers. Id. Finally, Dr. Cammann noted that Garza is 5’5 and weighs 240 pounds. Id.
Dr. Cammann contends this could not occur if Garza was unable to eat. Id.
On summary judgment, the Corizon Defendants have shown Dr. Cammann was
consistently responsive to Garza’s dental needs and that her decision not to replace his
dentures was medically acceptable. Toguchi, 391 F.3d at 1061. The burden thus shifts to
Garza to set forth a genuine dispute of material fact as to the adequacy of Dr. Cammann’s
treatment. “Summary judgment is appropriate if the moving party presents evidence that
shows that no genuine issue of material fact exists and that it is entitled to judgment as a
matter of law. Once the moving party has met this initial burden, the nonmoving party has
the subsequent burden of presenting significant probative evidence tending to support its
claim that material, triable issues of fact remain.” Ferguson v. Greater Pocatello Chamber
of Commerce, 848 F.2d 976, 979 (9th Cir. 1988).
The only evidence Garza submits on summary judgment is his May 14, 2019
grievance and his declaration, which both contend his dentures have teeth missing and
wires protruding into his gums, causing him significant pain and an inability to chew or
digest his food. Dkt. 27-3, ¶¶ 4-5, 12–13; Dkt. 33, at 3 (citing Dkt. 27-5); Dkt. 33-2
(incorporating Dkt. 27-3). Yet, Garza does not respond to Dr. Cammann’s repeated
MEMORANDUM DECISION AND ORDER - 28
conclusion, after multiple evaluations of Garza’s mouth and dentures, that, despite
aesthetic damage to his dentures, Garza still had 26 out of 28 teeth, an even bite, an
anchored lower partial denture, and the ability to chew food with his posterior teeth. Dkt.
28-6, ¶¶ 18, 20, 23, 24. Nor does Garza respond to Dr. Cammann’s specific finding, after
her evaluation on May 17, 2019, that Garza’s dentures did not have any protruding wires
and that the wires of which Garza complained were coated with acrylic and unexposed. Id.,
¶ 23. Garza also ignores Dr. Cammann’s contentions that she smoothed and polished his
dentures to ensure there were no wires protruding, that despite Garza’s complaint of mouth
sores as a result of protruding wires, she could not find any sores in his mouth, and that the
mouth pain of which Garza complained was likely due to poor oral hygiene, and not a
problem with his dentures, since there was no medical indication his dentures would impair
his ability to eat. Id.
In the absence of any contradicting evidence—whether through expert testimony,
recommendations from other treating providers, health records to support his claim that he
is unable to eat, or any other probative evidence to suggest Dr. Cammann’s refusal to
replace his dentures was medically inappropriate17—Garza fails to show Defendants’
failure to provide him with replacement dentures violated the Eighth Amendment. Garza’s
conclusory allegation that he needs replacement dentures is insufficient to overcome Dr.
For instance, Garza does not submit declarations from other inmates to verify his complaint that he is
unable to eat. He also does not cite any of his prison medical records to support his contention that he is
unable to eat or has trouble digesting food. In fact, there are no health services records to suggest Garza
was ever treated for weight loss or any other conditions associated with an inability to chew his food. Dkt.
28-7–28-14. Further, Garza’s commissary purchases, height and weight also undermine his claim that he
has difficulty chewing and digesting his food.
MEMORANDUM DECISION AND ORDER - 29
Cammann’s consistent conclusion that replacement dentures are not medically necessary.
See, e.g. Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989) (explaining differences in
judgment between an inmate and prison medical personnel regarding appropriate medical
diagnosis and treatment are insufficient to withstand summary judgment on a deliberate
indifference claim); Miles v. Daniels, 231 Fed. App’x. 591, 592 (9th Cir. 2007) (affirming
summary judgment in favor of defendant dentist where, inter alia, despite defendant’s
claimed symptoms, there was no evidence to suggest inmate’s medical condition was
exigent); Kamakeeaina v. City & Cty. of Honolulu, No. 11-00770 JMS/RLP, 2014 WL
1691611, at *18 (D. Haw. Apr. 29, 2014) (granting summary judgment on prisoner’s
Eighth Amendment claim against his treating physician where plaintiff did not submit any
competent evidence to show defendant physician’s treatment was medically unacceptable
and plaintiff instead simply disagreed with defendant physician’s “diagnosis concerning
the care he required.”); Elliot v. Reddy, No. 2:10-cv-02980 MCE KJN P., 2014 WL
1877566, at *26 (E.D. Cal. May 9, 2014) (granting summary judgment in favor of prison
physician where plaintiff failed to present contradicting expert evidence, “or any other
remarkable evidence of record” to contradict defendant’s expert’s opinion that physician’s
treatment met the appropriate standard of care).
Second, even if the Court were to instead conclude Garza’s unsubstantiated
allegations are sufficient to defeat summary judgment with respect to the adequacy of Dr.
Cammann’s treatment, Garza ignores the second prong of the subjective element of
deliberate indifference all together, and does not present any evidence to suggest Dr.
Cammann knew of and disregarded an excessive risk to his health when she refused to
MEMORANDUM DECISION AND ORDER - 30
provide him with replacement dentures.18 Toguchi, 391 F.3d at 1058. As detailed herein,
Dr. Cammann evaluated Garza’s mouth and dentures every time he filed an HSR. After
each evaluation, Dr. Cammann determined Garza’s existing dentures were aesthetically
damaged, but that repair and/or replacement was not required because the dentures were
still functional. Dr. Cammann also took steps to adjust or smooth Garza’s dentures to
address his claims of discomfort. Even if Dr. Camman’s conclusion that replacement
dentures were not medically necessary was wrong, there is no evidence she was aware of
a substantial risk of serious harm to Garza’s health as a result of this decision. Instead, Dr.
Cammann’s consistent finding that the damage to Garza’s dentures would not impact his
ability to chew food, coupled with an absence of any evidence to the contrary, illustrates
Dr. Cammann was not aware of, and did not consciously disregard, a serious risk of harm
to Garza’s health in denying him replacement dentures. Dkt. 28-6, ¶¶ 17, 18, 20, 23, 24,
A “complete failure of proof concerning an essential element of the nonmoving
party’s case necessarily renders all other facts immaterial.” Celotex, 477 U.S. at 323. In
addition to the insufficient evidence offered with respect to the adequacy of his medical
treatment, Garza cannot survive summary judgment because he fails to show Dr. Cammann
deliberately disregarded an excessive risk to his health in denying him replacement
In fact, in his Response to the Corizon Defendants’ Motion for Summary Judgment, Garza underscores
Dr. Cammann was not aware that he purportedly had difficulty eating because she did not sit at meals with
him, did not see how hard it was for him to chew food, and did not personally experience the difficulties he
had when chewing and digesting food. Dkt. 33, at 3.
MEMORANDUM DECISION AND ORDER - 31
b. Brewer and Tillemans
Garza also claims Brewer and Tillemans were deliberately indifferent because they
“did not correct the unconstitutional actions of Defendant Cammann nor the illegal policy
of having to wait 5 years to obtain [replacement] dentures.” Dkt. 33, at 4. Brewer and
Tillemans did not participate in Garza’s medical treatment—their only interactions with
Garza involved their review of his May 14, 2019 grievance. Garza’s claim against Brewer
and Tillemans fail because he has not set forth evidence to suggest Dr. Cammann’s
treatment was deliberately indifferent, and, in the absence of a constitutional injury, does
not have standing to challenge the Dental SOP.19
To state a claim against a private entity performing state functions under Monell, a
plaintiff must show: (1) the plaintiff was deprived of a constitutional right; (2) the entity
had a policy or custom; (3) the policy or custom amounted to deliberate indifference to the
plaintiff’s constitutional right; and (4) the policy or custom was the moving force behind
the constitutional violation. Mabe, 237 F.3d at 1110–11. Garza’s claim against Corizon
fails as a matter of law because he has not shown that any individual state actors were
deliberately indifferent to his dental condition. Long v. Cty. of Los Angeles, 442 F.3d 1178,
As noted, Garza contends Defendants denied his request for replacement dentures based solely on the
Dental SOP. As explained in detail, however, Dr. Cammann repeatedly concluded, after multiple
evaluations of Garza’s existing dentures, that replacement dentures were not medically necessary because
Garza’s existing dentures were functional. If Dr. Cammann had instead concluded (or there was other
probative evidence to suggest) Garza needed replacement dentures, but Dr. Cammann did not order them
due to the Dental SOP, the Court would be in the position to review the constitutionality of the Dental SOP.
The Court is not in such position here because there is no evidence to suggest Dr. Cammann’s decision not
to order replacement dentures for Garza was medically inappropriate, regardless of the Dental SOP.
MEMORANDUM DECISION AND ORDER - 32
1186 (9th Cir. 2006) (explaining that to impose liability under Monell, a plaintiff must
show that the entity’s employees violated the plaintiff’s constitutional rights); City of Los
Angeles v. Heller, 475 U.S. 796, 799 (1986) (“[N]either Monell . . . nor any other of our
cases authorizes the award of damages against a municipal corporation based on the actions
of one of its officers when . . . the officer inflicted no constitutional harm.”).
Garza argues Corizon is liable because they enforce the Dental SOP and “this policy
did and continues to subject Plaintiff to cruel and unusual punishment; not providing him
replacement denture[s] because he is not eligible except once every 5 years.” Dkt. 33, at 6.
To prevail on his municipal liability claim, Garza must first set forth evidence that Dr.
Cammann (or any other named Defendant) denied him medically necessary replacement
dentures with a conscious disregard for his health. As explained above, Garza does not do
so on summary judgment. Because Garza fails to support his deliberate indifference claim
against Dr. Cammann—or any other Defendant—his Monell claim against Corizon fails as
a matter of law. Lockett v. Cty. of Los Angeles, 977 F.3d 737, 741 (9th Cir. 2020) (citing
Scott v. Henrich, 39 F.3d 912, 916 (9th Cir. 1994)) (holding municipal defendants could
not be held liable where no constitutional violation occurred).
5. Siegert’s Motion for Summary Judgment (Dkt. 37)
Garza also claims Siegert—the Health Services’ Director for IDOC—was
deliberately indifferent in denying his appeal of Tilleman’s denial of his May 14, 2019
grievance. Siegert did not participate in Garza’s dental treatment. Although Siegert is a
Registered Nurse, she does not provide medical treatment to inmates and does not make
determinations regarding specific medical treatment provided to inmates in her position as
MEMORANDUM DECISION AND ORDER - 33
Health Services Director. Dkt. 37-2, ¶ 3. Nor is Siegert a dentist. As such, Siegert was
entitled to rely on the medical opinion of Dr. Cammann so long as a reasonable person
would not have determined that Dr. Cammann’s treatment of Garza was inferior. Caplinger
v. CCA, 999 F. Supp. 2d 1203, 1217 (D. Idaho 2014) (citing Snow v. McDaniel, 681 F.3d
978, 985 (9th Cir. 2012) overruled on other grounds in Peralta v. Dillard, 744 F.3d 1076,
1083 (2014). Because there is no evidence to suggest Dr. Cammann’s treatment was
medically unacceptable—let alone that Dr. Cammann’s treatment should have appeared
unacceptable to a person untrained in dentistry—Siegert is entitled to judgment as a matter
of law. Caplinger, 999 F. Supp. 2d at 1217.
For the foregoing reasons, Defendants are entitled to summary judgment and
Garza’s case is appropriately dismissed with prejudice.
NOW, THEREFORE, IT IS HEREBY ORDERED:
1. Garza’s Motion for Summary Judgment Against Dr. Cammann, Corizon,
Brewer, Tillemans and Siegert (Dkt. 27) is DENIED;
2. The Corizon Defendants’ Motion for Summary Judgment (Dkt. 28) is
3. Garza’s Request to Grant Summary Judgment Against Defendant Rona Siegert
(Dkt. 32) is DENIED;
4. Garza’s Motion to Strike (Dkt. 34) is DENIED;
5. Siegert’s Motion for Summary Judgment (Dkt. 37) is GRANTED;
MEMORANDUM DECISION AND ORDER - 34
6. The Court will enter a separate judgment in accordance with Fed. R. Civ. P. 58.
DATED: March 31, 2021
David C. Nye
Chief U.S. District Court Judge
MEMORANDUM DECISION AND ORDER - 35
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