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Ninth Circuit: Budgetary Constraints May Excuse Deliberate Indifference to Prisoner’s Serious Medical Needs; En Banc Review Granted

On January 7, 2013, a divided Ninth Circuit panel held that a prison employee, alleged to be deliberately indifferent to a prisoner’s serious medical needs, can avoid liability for damages by establishing that his inability to provide necessary medical care resulted from a lack of resources over which he had no control.

In a well-reasoned dissent, Circuit Judge Marsha S. Berzon criticized the majority decision on the ground that it could not be reconciled with settled precedent holding that budgetary constraints do not justify constitutionally deficient care or conduct.

While incarcerated at the California State Prison in Lancaster in 2004, Cion A. Peralta sought dental care for cavities, bleeding gums and pain throughout his mouth. Over the course of a year and a half he was seen by a prison dentist, Dr. Sheldon Brooks, three times. Dr. Brooks gave Peralta ibuprofen twice and antibiotics on one occasion; he asked Peralta to identify which tooth hurt the most, X-rayed that tooth and offered to extract it, but never checked for other cavities or infections.

Peralta filed suit pursuant to 42 U.S.C. § 1983, alleging that Dr. Brooks had been deliberately indifferent to his serious dental needs. Brooks presented evidence that the dentist-to-prisoner ratio was inadequate for him to provide proper care for all prisoners, and at trial the jury was instructed that he could not be held responsible for failing to provide services if he lacked the resources to do so.

The jury returned a verdict in favor of Dr. Brooks. Peralta appealed, arguing that regardless of budgetary constraints, Brooks could not be absolved of liability if, despite having actual knowledge of a serious medical need, he failed to provide care responsive to that need.

Ignoring circuit precedent squarely supporting Peralta’s position, such as Jones v. Johnson, 781 F.2d 769 (9th Cir. 1986) and Snow v. McDaniel, 681 F.3d 978 (9th Cir. 2012) [PLN, Oct. 2013, p.52], the majority upheld the disputed jury instruction, in effect allowing prison officials to shield themselves from liability, regardless of their personal actions or inactions, by pointing to systemic funding deficiencies.

“We see no reason to impose an injustice upon employees of prison systems in an attempt to avoid injustices to inmates,” the majority wrote. “Nor do we see any reason to drive prison employees out of positions where they can at least try to ameliorate afflictions, even though they have no apotropaion that will effect cures in the absence of sufficient resources.”

In a separate, unpublished ruling also entered on January 7, 2013, the appellate court addressed Peralta’s appeal of the district court’s Fed.R.Civ.P. Rule 50 judgment as a matter of law in favor of Dr. Thaddeus Dillard, the Chief Dental Officer at the California State Prison in Lancaster, and Dr. Junaid Fitter, the facility’s Chief Medical Officer.

The Court of Appeals upheld the district court’s judgment, finding that “a reasonable juror would not have a legally sufficient evidentiary basis to find for Peralta on his claims against Dr. Dillard and Dr. Fitter for deliberate indifference.” Both doctors, who were supervisors, were not directly deliberately indifferent to Peralta’s medical needs, the Court held.

Judge Berzon issued another dissenting opinion in that ruling, based both on the issues raised in the decision concerning Dr. Brooks and also because Dillard and Fitter could have been found liable “regardless of whether they knew of Peralta’s own serious medical needs. They need only be aware that ‘someone in [Peralta’s] situation’ – namely other Lancaster prisoners – had a ‘substantial risk of serious harm’ in the absence of timely care.”

She noted that “These defendants had the authority to make decisions regarding which prisoners were to receive medical treatment when – within the staffing and funding constraints of the prison – but nonetheless rubber stamped the decision to keep Peralta on the routine waiting list.” See: Peralta v. Dillard, 520 Fed.Appx. 494 (9th Cir. 2013).

On June 26, 2013, the Ninth Circuit Court of Appeals granted en banc review of the panel’s ruling as to Dr. Brooks; the en banc decision remains pending. See: Peralta v. Dillard, 704 F.3d 1124 (9th Cir. 2013), review en banc granted.

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