Ciaprazi v. Jacobson et al
Filing
129
OPINION & ORDER re: 99 FIRST MOTION for Summary Judgment . filed by Mary J. D'Silva, Allan Jacobson, Carl J. Koenigsmann, Brian Fischer, R. Willim. The Court does not adopt Magistrate Judge Fox's R&R dated March 29, 2016, b ut rather GRANTS defendants' motion for summary judgment in its entirety. The Clerk of Court is directed to enter judgment in defendants' favor and to close Case No. 13 Civ. 4813. (As further set forth in this Order) (Signed by Judge Paul A. Crotty on 9/6/2016) (lmb)
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF NEW YORK
-------------------------------------------------------------- )(
ROBERTO CIAPRAZI,
Plaintiff,
13 Civ. 4813 (PAC) (KNF)
-against-
OPINION & ORDER
ALLAN JACOBSON, R. WILLIM, MARY J.
D'SILVA, CARL J. KOENIGSMANN,
BRIAN FISCHER,
Defendants.
------------------------------------------------------------- )(
HONORABLE PAUL A. CROTTY, United States District Judge:
Plaintiff Roberto Ciaprazi seeks damages and injunctive relief, pursuant to 42 U.S.C.
§ 1983, against Dr. Allan Jacobson and Dr. Reinhard Willim, dentists at Sing Sing Correctional
Facility; Dr. Mary J. D'Silva, Director of Correctional Dental Services for New York State Department of Corrections and Community Supervision (DOCCS); Dr. Carl J. Koenigsmann,
DOCCS Chief Medical Officer; and Brian Fischer, DOCCS Commissioner. Ciaprazi alleges defendants (1) maintained an unconstitutional and unlawful dental policy of denying restorative treatments, such as root canals, to all posterior teeth, providing extraction as the only treatment for all
posterior teeth that may otherwise be restored; and (2) violated his Eighth Amendment rights when
they showed deliberate indifference to his dental needs by enforcing this unconstitutional dental
policy against him. 1 Defendants moved for summary judgement. The matter was referred to Magistrate Judge Kevin Nathaniel Fox for a Report and Recommendation (R&R).
1 "[T]he issue in this case is whether the defendants violated the plaintiffs right to adequate dental care by enforcing
a dental policy alleged to be unconstitutional." Pl. Resp. at 1 (alterations omitted) (quoting R&R at 19). More specifically, Ciaprazi alleges that from 2011 to 2013, Drs. Jacobson and Willim provided him with inadequate dental care
in treating his teeth # 2, # 13, and # 20, Compl. ~~ 103, 105- 06, 108- 09, and that Dr. D' Silva, Dr. Koenigsmann, and
Commissioner Fischer enforced the unconstitutional policy and failed to take corrective measures after he complained
to them about Drs. Jacobson and Willim, id. at~~ 104, 107, 110- 11.
1
On March 29, 2016, the Magistrate Judge issued his R&R that the Court deny defendants'
motion for summary judgment on three principle grounds. First, the Magistrate Judge found that
there is a genuine issue of material fact as to whether DOCCS dental services include root canals
and "whether restorative treatment was permitted, covered or necessary in the circumstances of
the plaintiffs case." R&R at 18. Second, he found that Commissioner Fischer had exhibited sufficient personal involvement to be found liable under § 1983. !d. at 19. And third, Magistrate Judge
Fox concluded that because questions remain about the contents ofDOCCS dental policy, granting
summary judgment on the grounds of qualified immunity is not warranted. !d. at 19-20.
Defendants filed timely objections. See Fed. R. Civ. P. 72(b)(2). Reviewing de novo those
portions of the R&R to which defendants object, the Court concludes that defendants are entitled
to summary judgment.
I.
Legal Standards
a. Review of Objections
A district court may "accept, reject, or modify, in whole or in part, the findings or recom-
mendations made by the magistrate judge." 28 U.S.C. § 636(b)(l)(c). When a timely objection is
made to the magistrate judge's R&R, the Court must review the contested portions de novo, but it
"may adopt those portions of the [R&R] to which no objections have been made and which are not
facially erroneous." La Torres v. Walker, 216 F. Supp. 2d 157, 159 (S.D.N.Y. 2000).
b. Summary Judgment Standard
On a motion for summary judgment, "[i]t is the movant's burden to show that no genuine
factual dispute exists, and all reasonable inferences must be drawn in the non-movant's factor."
Giannullo v. City ofNew York, 322 F.3d 139, 140-41 (2d Cir. 2003) (citingAdickes v. S.H Kress
2
& Co., 398 U.S. 144, 157 (1970)). "[W]here the movant 'fails to fulfill its initial burden' ofprovid-
ing admissible evidence of the material facts entitling it to summary judgment, summary judgment
must be denied, even if no opposing evidentiary matter is presented,' for the non-movant is not
required to rebut an insufficient showing." !d.
c. Eighth Amendment
Under the Eighth Amendment's prohibition of "cruel and unusual punishments," states
must provide inmates adequate medical care, including adequate dental care, see Estelle v. Gamble,
429 U.S. 97, 103 (1976) (medical care); Chance v. Armstrong, 143 F.3d 698, 703- 04 (2d Cir.
1998) (dental care). Although "not every lapse in medical care is a constitutional wrong," Sala-
huddin v. Goard, 467 F.3d 263, 279 (2d Cir. 2006), "the Eighth Amendment forbids not only
deprivations of medical care that produce physical torture and lingering death, but also less serious
denials which cause or perpetuate pain," Todaro v. Ward, 565 F.2d 48, 52 (2d Cir. 1977) (finding
it "well-settled in this circuit that 'a series of incidents closely related in time ... may disclose a
pattern of conduct amounting to deliberate indifference to the medical needs of prisoners"'). Cognizable claims of inadequate dental care "can be based on various factors, such as the pain suffered
by the plaintiff, the deterioration of the teeth due to a lack of treatment, or the inability to engage
in normal activities." Rashid v. McGraw, 2006 U.S. Dist. LEXIS 30611 , *19 (S.D.N.Y. May 18,
2006). "[B]ecause a tooth cavity will degenerate with increasingly serious implications if neglected
over sufficient time, it presents a 'serious medical need' .. . ." Harrison v. Barkley, 219 F.3d 132,
137 (2d Cir. 2000).
To prevail on a § 1983 claim against prison officials, a plaintiff must prove that each defendant "kn[ew] that inmates face[ d] a substantial risk of serious harm and disregard[ed] that risk
by failing to take reasonable measures to abate it." Farmer v. Brennan, 511 U.S. 825, 847 (1994).
3
A prison official's "requisite knowledge of a substantial risk is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence, and a factfinder may
conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious." !d. at 842.
d. Personal Involvement
The "personal involvement of defendants in alleged constitutional deprivations is a prerequisite to an award of damages under§ 1983." Colon v. Coughlin, 58 F.3d 865, 873 (2d Cir. 1995)
(quoting Wright v. Smith, 21 F.3d 496, 501 (2d Cir. 1994)). A plaintiff may demonstrate a defendant's "personal involvement" by showing:
(1) the defendant participated directly in the alleged constitutional violation, (2) the
defendant, after being informed of the violation through a report or appeal, failed
to remedy the wrong, (3) the defendant created a policy or custom under which
unconstitutional practices occurred, or allowed the continuance of such a policy or
custom, (4) the defendant was grossly negligent in supervising subordinates who
committed the wrongful acts, or (5) the defendant exhibited deliberate indifference
to the rights of inmates by failing to act on information indicating that unconstitutional acts were occurring.
!d. (citing Wright, 21 F .3d at 501 ). Although the "mere receipt of a letter from a prisoner is insufficient to establish individual liability, an official's actions and responses arising out of a grievance
may." Bodie v. Morganthau, 342 F. Supp. 2d 193, 203 (S.D.N.Y. 2004). "Personal involvement
will be found . . . where a supervisory official receives and acts on a prisoner' s grievance or otherwise reviews and responds to a prisoner' s complaint." Johnson v. Wright, 234 F. Supp. 2d 352,
363 (S.D.N.Y. 2002).
e. Qualified Immunity
Qualified immunity protects government officials "from liability for civil damages insofar
as their conduct does not violate clearly established statutory or constitutional rights of which a
reasonable person would have known." Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). The right
4
that the plaintiff claims was violated must be clearly established "at the time of the conduct at
issue." Davis v. Scherer, 468 U.S. 183, 197 (1984). Although the Eighth Amendment broadly
guarantees an inmate's right to adequate medical care, see Estelle, 429 U.S. at 104, and to adequate
dental care, see Chance, 143 F.3d at 703- 04, the qualified-immunity inquiry must be undertaken
"in light of the specific context of the case, not as a broad general proposition," Saucier v. Katz,
533 U.S. 194, 201 (2001); see also Anderson v. Creighton, 483 U.S. 635, 640 ("[O]ur cases establish that the right the official is alleged to have violated must have been 'clearly established' in a
more particularized, and hence more relevant, sense.").
II.
Analysis
a. DOCCS Dental Policy
Magistrate Judge Fox found that genuine issues of material fact preclude summary judg-
menton whether DOCCS dental policy is constitutional because (1) the record contains contradictory statements about DOCCS dental policy; (2) the record does not establish that DOCCS dental
policy is similar to other states' dental policies; and (3) the record does not contain admissible
evidence establishing the community standard of care in New York or that DOCCS dental policy
mirrors New York Medicaid. Defendants object to each ofthese findings.
Drs. Jacobson, Stukes, and D'Silva each submitted declarations regarding DOCCS dental
policy. All three dentists stated that posterior root canals are not included in the scope of services
provided by DOCCS. 2 Magistrate Judge Fox, however, found that those statements were contradieted by Dr. D'Silva's statement that "[a] treating dentist may request permission from DOCCS
2 See Jacobson Decl. ~ 15 ("Plaintiff requested a root canal, post, core, and crown on a badly broken down tooth# 2.
These services are not included in the scope of services identified in HSPM # 2.01, nor were they clinically recommended because the tooth was so badly broken down."); Stukes Decl. ~ 11 ("Plaintiff requested a root canal and crown
[on tooth# 20] .... I advised him that not only are these services not recommended, they are not covered under
DOCCS' scope of services. These serves are not clinically recommended because the tooth was so badly broken down
.... "); D'Silva Dec!. ~ 5 ("Posterior root canal therapy is not in the scope of services provided by HSPM #2.0 1.").
5
to perform a root canal on a posterior tooth, especially in circumstances where a root canal is
necessary to prevent a serious risk of harm to a patient's medical health." D'Silva Decl. ,-r 6. But
read in context, Dr. D'Silva's statement simply outlines a reasonable exception to the general policy that "[p ]osterior root canal therapy is not in the scope of services" provided by DOCCS. I d. ,-r
5. There is no contradiction.
Dr. D'Silva attested that DOCCS scope of services mirrors the policies of other states and
localities. Id. ,-r 7. Magistrate Judge Fox, however, disregarded Dr. D'Silva's statements because
she "does not explain the basis of her knowledge, apart from suggested hearsay, about the services
provided by state and local prisons in states other than New York." R&R at 13- 14. But Dr. D'Silva
explained that her personal knowledge comes from her responsibilities as DOCCS Dental Director,
which include communication with other dental directors at state prisons throughout the country.
D'Silva Decl. ,-r 7. There is no suggestion ofhearsay. Indeed, it is whollyunsurprising that DOCCS
Dental Director, by virtue of her position, would read and familiarize herself with other states'
dental policies. See Folio Impressions, Inc. v. Eyer California, 937 F.2d 759, 764 (2d Cir. 1991)
("The test is whether a reasonable trier of fact could believe the witness had personal knowledge.").
Dr. D'Silva further attested that DOCCS scope of services mirrors the policy and procedures provided by New York State Medicaid, which is the community standard of care in New
York, and that root-canal therapy for posterior teeth is not in the scope of services provided by
New York State Medicaid. D'Silva Decl. ,-r,-r 4--5. Magistrate Judge Fox again disregarded Dr.
D'Silva's statement because he thought she had not explained the basis of her knowledge of New
York State Medicaid's policy or procedures. R&R at 13. But a factfinder could reasonably infer
that DOCCS Dental Director would be familiar with the community standard of care in New York.
And it is further reasonable to infer that, if New York State Medicaid is the community standard
6
of care, DOCCS Dental Director would be aware of the scope of services provided by Medicaid.
The problem with Dr. D'Silva's testimony, however, is the document she attached in support of it.
As noted by Ciaprazi, Pl. Resp. at 6, the purported Medicaid Dental Policy and Procedural Code
Manual does not, in fact, mirror DOCCS dental policy as described by Drs. Jacobson, Stukes, and
D'Silva. Whereas the declarants described DOCCS policy as not covering posterior root canals,
the Medicaid Dental Policy and Procedural Code Manual lists only molar root canals as falling
outside the scope of services. D'Silva Decl., Exh. Bat 9.
But this one apparent discrepancy is not sufficiently material to preclude summary judgment. It is undisputed that posterior root canals do not fall within the scope of services provided
by DOCCS. Jacobson Decl. ,-[ 15; Stukes Decl. ,-[ 11; D'SilvaDecl. ,-[ 5; see also D'Silva Decl. Exh.
A at DOCCS 0058 (listing endodontic therapy for ancillary teeth only). It is undisputed that inmates can seek treatments that fall outside the scope of services from an outside provider. Jacobson
Decl. ,-[ 15; Stukes Decl. ,-[ 11; D'Silva Decl. ,-[ 5. And it is undisputed that DOCCS dental policy
mirrors those of many other state and local prisons. D'Silva Decl. ,-[ 7 ("To the best of my
knowledge, the following state correctional facilities do not include root canal therapy on posterior
teeth in their scope of services: Alabama, Alaska, Georgia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Nebraska, Nevada, North Dakota, Oklahoma,
South Dakota, Texas, Utah, West Virginia, Wisconsin, and Wyoming."). There is no genuine dispute of material fact regarding the content of DOCCS dental policy, so the Court cannot accept
the Magistrate Judge's recommendation to deny summary judgment on that basis.
b. Ciaprazi's Dental Treatment
Ciaprazi contends that "dentists at Sing Sing knew about [his] problems with Teeth Nos.
2, 13, and 20 since as early as March 2007," but "refused to provide [him] the prescribed [root
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canal] treatment," and instead "pushed extraction as the only option." Pl. Resp. at 17. He contends
that there remain questions of material fact as to whether extraction was in fact the only course of
treatment available to him "regardless whether [he] was treated by a prison or outside dentist." Id.
at 17-18. But even if Ciaprazi's teeth could have been treated with root-canal therapy, 3 it would
not violate the Eighth Amendment for DOCCS to offer him only extraction. As noted by Dr.
D'Silva, many states and localities have policies of offering extraction and not root canals. D'Silva
Decl. ,-r 7. And many of those policies-a number of which are even more restrictive than New
York' s-have been held to satisfy the Eighth Amendment. 4 Ciaprazi, on the other hand, points to
no similar policies that have been struck down. Rather, his claim boils down to a dispute over the
choice of one routine medical procedure over another, which does not give rise to an Eighth
Drs. Jacobson and Stukes declared that root-canal therapy was not "clinically recommended." Jacobson Decl. ~ 15;
Stukes Decl. ~ 11. Ciaprazi claims that these statements are contradicted by his medical charts. See, e.g., Jacobson
Decl. Exh. A at DOCCS 0142. The Court need not resolve this dispute.
3
See James v. Pa. Dep 't ofCorr., 230 Fed. App'x 195, 197-98 (3d Cir. 2007) (affirming that there was no Eighth
Amendment claim for an extraction that was within the Pennsylvania Department of Corrections' policy of providing
for extractions and not root canals), cert. denied, 552 U.S. 1067 (2007); Gomez v. Westchester Cnty., No. 12 Civ.
6869, 2015 WL 1054902, at *10-11 (S.D.N.Y. Mar. 10, 2015) (Westchester County Jail's refusal to pay for root
canals and crowns did not state an Eighth Amendment claim); Hayes v. Kootenai Cnty., No. 10 Civ. 64, 2013 WL
1290952, at* 12 (D. Idaho Mar. 27, 2013) (upholding the county jail's policy of offering only temporary fillings and
extractions, in part because the inmates "are not entitled to unqualified access to unqualified dental care"); Galindo v.
Cate, No. 11 Civ. 23, 2011 WL 6100623, at *3, *6 (E.D. Cal. Dec. 5, 2011) (screening order) (dismissing deliberate
indifference claim against the dentists when they were not allowed to perform root canals in the California Department
of Corrections system, but could extract the tooth); Bain v. Hsu, No. 06 Civ. 189,2010 WL 3927589, at *1-5 (D. Vt.
Sept. 29, 2010) (concluding that Vermont Department of Corrections' policy of providing extractions and not root
canals or crowns does not violate the Eighth Amendment);Koon v. Ubah, No. 8:06 Civ. 2000, 2008 WL 724041, at
*7 (D. S.C. Mar. 17, 2008) (holding that there was no Eighth Amendment violation where the South Carolina Department of Corrections' policy offered the inmate (1) extractions, but no root canal and crown, at state expense and (2)
offered that the inmate could pay for a private dentist if he wanted a root canal), aff'd, 280 Fed. App'x 255 (4th Cir.
2008); Ball v. Johnson Cnty. Jail, No. 3:03 Civ. 3056,2004 WL 2338105, at *2 (N.D. Tex. Oct. 18, 2004) (R&R) (the
county jail's policy to extract the tooth rather than provide other treatment options did not violate the Eighth Amendment); Del Muro v. Federal Bureau of Prisons, No. 5:03 Civ. 214, 2004 WL 1542216, at *3-4 (N.D. Tex. July 8,
2004) (no Eighth Amendment violation where the prisoner was offered extractions pursuant to prison policy and not
the crowns or a bridge to which he claimed he was entitled); Kopera v. Cook Cnty. Bd of Com 'rs, No. 93 Civ. 3934,
1994 WL 577238, at *4- 5 (N.D. Ill. Oct. 18, 1994) (rejecting an inmate's constitutional challenge to a prison policy
whereby the Cook County Jail offered only extraction options); see also Carrizales v. Moore, No. 13 Civ. 1, 2015 WL
6160191, at *1 (M.D. Tenn. Oct. 19, 2015) (noting that the county jail does not provide root canals); Kolesnik v. Vail,
No. 12 Civ. 5278,2013 WL 4401560, at *1 (W.D. Wash. Aug. 14, 2013) (noting that Washington State Department
of Corrections does not provide posterior root canals).
4
8
Amendment violation. See Chance, 143 F .3d at 702 ("It is well-established that mere disagreement
over the proper treatment does not create a constitutional claim. So long as the treatment given is
adequate, the fact that a prisoner might prefer a different treatment does not give rise to an Eighth
Amendment violation."); see also Mathews v. Raemisch, 513 Fed. App'x 605, 606- 07 (7th Cir.
2013) (affirming summary judgment on inmate's claim of deliberate indifference to his infected
tooth where the prison refused to provide him with a root canal procedure but did offer extraction
because the "dispute is over nothing but the choice of one routine medical procedure versus another").
In sum, the Court finds that Ciaprazi has offered no evidence that DOCCS dental policy of
offering extraction, rather than root-canal therapy, for posterior teeth constitutes cruel and unusual
punishment under the Eighth Amendment. Nor is there any evidence that enforcement of that policy against Ciaprazi in any way violated his rights.
c. Personal Involvement of Commissioner Fischer
Defendants argue that Commission Fischer did not have the requisite personal involvement
in Ciaprazi's treatment to subject him to liability under§ 1983. Specifically, they note that (1) he
never responded to Ciaprazi's letters; (2) he never discussed his dental condition with him; (3) he
never reviewed his letters; and (4) Dr. Koenigsmann responded to Ciaprazi's grievance on Commissioner Fischer's behalf. Compl. ~~ 46, 53, 71; D'Silva Decl.
~
20; Koenigsmann Decl.
~~
8- 9.
Magistrate Judge Fox rejected defendants' argument, holding that "[s]ince in this circuit personal
involvement is found when 'the defendant, after being informed of the violation through a report
or appeal, failed to remedy the wrong,' Colon, 58 F.3d at 873, the fact that Fischer did not discuss
[Ciaprazi's] dental condition with him or that Dr. Koenigsmann responded to the plaintiff on
Fischer's behalf does not satisfy the lack of personal involvement standard." R&R at 19. But more
9
recent, post-Colon authority holds that "mere receipt of a letter from a prisoner is insufficient to
establish individual liability." Bodie, 342 F. Supp. 2d at 203. For example, in Sealey v. Giltner, the
Second Circuit declined to extend liability to the DOCCS Commissioner where he merely referred
an inmate's letter to another prison official. 116 F.3d 47, 51 (2d Cir. 1997); see also Joyner v.
Greiner, 195 F. Supp. 2d 500, 506 (S.D.N.Y. 2002) ("[A] prison administrator is permitted to rely
upon and be guided by the opinions of medical personnel concerning the proper course of treatment
administered to prisoners, and cannot be held to have been 'personally involved' if he does so.").
Although Ciaprazi sent letters to Commissioner Fischer, Commissioner Fischer did not "act[] on,"
"review[]," or "respond[] to" his complaints. Johnson, 234 F. Supp. 2d at 363. He merely referred
them to Dr. Koenigsmann. Accordingly, even if Ciaprazi's claims survived summary judgment,
he has not adduced sufficient evidence of Commissioner Fischer's personal involvement to hold
him liable under§ 1983.
d. Qualified Immunity
Defendants argue that the doctrine of qualified immunity shields them from liability under
§ 1983 because "the law is not clearly established that an inmate has the right to root canal treatment rather than extraction." Obj. at 24. Magistrate Judge Fox (and Ciaprazi) would lodge the
Court's analysis at a higher level of abstraction, pointing to the clearly established right to adequate
medical and dental care. R&R at 19. The Supreme Court, however, has instructed that the qualified-immunity inquiry must be undertaken "in light of the specific context of the case, not as a
broad general proposition." Saucier, 533 U.S. at 201; cf Petrazzoulo v. US. Marshals Serv., 999
F. Supp. 401, 410 (W.D.N.Y. 1998) ("[W]hile prison inmates have a clearly established right to
dental care, they do not have a clearly established constitutional right to dentures. In other words,
10
while inmates cannot be denied a minimal civilized measure of care, they do not have a clearly
established right to receive their preferred course of treatment.").
Defendants here could have reasonably relied on two lines of cases to conclude that their
conduct did not violate the Constitution. First, the Second Circuit has held that "mere disagreement
over the proper treatment does not create a constitutional claim." Chance, 143 F.3d at 702. Defendants, who relied upon DOCCS policy of extractions in lieu of root canals for posterior teeth,
could have reasonably concluded that the choice between those two treatment options did not give
rise to a claim under the Eighth Amendment. Cf Gomez, 2015 WL 1054902, at *10 ("Although
extraction of his tooth was understandably 'not Plaintiffs ideal solution, this procedure would
have been adequate to solve Plaintiffs [cavity] problems."' (quoting O'Connor v. McArdle, No.
04 Civ. 314, 2006 WL 436091, at *7 (N.D.N.Y. Feb. 22, 2006))). Second, defendants could have
relied upon the numerous cases from within and without the Circuit that have held similar policies
to be constitutional. See, e.g., id.; James, 230 Fed. App'x at 197-98; see also footnote 4, supra.
From these cases, the Court concludes that even if DOCCS policy were unconstitutional, Ciaprazi
has not adduced evidence that defendants "violate[ d] clearly established statutory or constitutional
rights of which a reasonable person would have known." Harlow, 457 U.S. at 818. Accordingly,
defendants are immune from liability.
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III.
Conclusion
The Court does not adopt Magistrate Judge Fox's R&R dated March 29, 2016, but rather
GRANTS defendants' motion for summary judgment in its entirety. The Clerk of Court is directed
to enter judgment in defendants' favor and to close Case No. 13 Civ. 4813.
Dated: New York, New York
September 6, 2016
SO ORDERED
PAUL A. CROTTY
United States District Judge
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