United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER
Robert Blakey Judge
Moses Ramirez sued Defendants Kathleen Sanchez, Barbara
Traina, and Cindy Fennell under 42 U.S.C. § 1983 for the
allegedly inadequate dental care they provided to him at the
Kane County jail. . Plaintiff claims that Defendants
violated his Eighth Amendment rights by demonstrating
deliberate indifference to dental issues he suffered in 2014.
Id. Defendants moved for summary judgment on the
grounds that Plaintiff failed to exhaust his claims and
ultimately fails to show that he received constitutionally
inadequate care. . For the reasons explained below, this
Court grants Defendants' motion.
Local Rule 56.1
following facts come primarily from Defendants' Local
Rule 56.1 statement of undisputed material facts .
Plaintiff did not file a statement of additional facts,
although he responded to Defendants' statement .
Defendants ask this Court to disregard a number of those
responses as inadequate denials of Defendants' proffered
facts. See  at 2-3.
Court has “broad discretion” to enforce the local
rules. Benuzzi v. Bd. of Educ. of Chi., 647 F.3d
652, 655 (7th Cir. 2011). The local rules governing summary
judgment motions demand that the non-moving party's
responses to the moving party's statements of fact
contain “specific references” to record evidence
to justify any denial. Local R. 56.1(b)(3); see also
Malec v. Sanford, 191 F.R.D. 581, 584 (N.D. Ill. 2000).
Thus, purely argumentative denials, legal conclusions, and
unsupported general denials do not belong in Local Rule 56.1
statements. See Phillips v. Quality Terminal Servs.,
LLC, 855 F.Supp.2d 764, 771 (N.D. Ill. 2012);
Malec, 191 F.R.D. at 584. District courts may
disregard improper denials and deem the opponent's
factual allegations admitted. See Aberman v. Bd. of Educ.
of Chi., 242 F.Supp.3d 672, 677 (N.D. Ill. 2017).
this Court disregards Plaintiff's responses to the
following paragraphs of Defendants' statement of facts:
11, 13, 15, 16, 18, 21, 23, 24, 29, 35, 36, 39, 45, 46, 66,
71, 77, and 78. These responses do not cite any record
evidence justifying the denial, and merely denying a fact
that has evidentiary support “does not transform it
into a disputed issue of fact sufficient to survive a motion
for summary judgment.” Roberts v. Advocate Health
Care, 119 F.Supp.3d 852, 854 (N.D. Ill. 2015). This
Court also disregards Plaintiff's denials of paragraphs
20 and 53, which cite portions of the record that fail to
refute the statement of fact. See Malec, 191 F.R.D.
at 584. Defendants' corresponding statements of fact are
deemed admitted. Aberman, 242 F.Supp.3d at 677.
also contests paragraphs 61-63 of Defendants' statement
of facts because they interpret a “document not
attached to the record.”  ¶¶ 61-63. True,
these paragraphs discuss Kane County jail's grievance
process, for which Defendants failed to provide any
documentation. But Defendants' statements of fact about
that process permissibly rely upon testimony from Plaintiff
and Sanchez-the jail's Health Services Administrator-both
of whom described a practice they knew about firsthand.
See  ¶¶ 4, 61-63. Thus, construing
Plaintiff's responses as hearsay objections, this Court
overrules that objection.
Plaintiff objects to various portions of testimony cited by
Defendants in their statement of facts as
“opinion.” See, e.g.,  ¶ 47.
But this assertion provides no cognizable basis for
discounting Defendant's statements of fact, which are
supported by specific citation to admissible record evidence.
See Malec, 191 F.R.D. at 583.
Plaintiff's Cracked Tooth
around March 2014 and for the period relevant to his claim,
Plaintiff was incarcerated at the Kane County
jail. See  ¶ 1; [60-2] at 2.
On July 13, 2014, Plaintiff bit into something hard at
dinner, around 5:00 p.m.  ¶ 7. By the time he went
to bed, around 9:00 p.m., he felt a “sharp pain”
and realized he had “a hole” in his tooth. [60-2]
testified that he requested medical attention the next day
using the computer kiosk available to inmates. See
id. at 3, 5. The kiosk in Plaintiff's cellblock
provided the primary means for Plaintiff to register
grievances or submit requests, whether for medical services
or commissary items. See id. at 3-4. For medical
issues, inmates could also submit handwritten forms
requesting medical attention by giving them to a corrections
officer. See [58-5] at 4. When inmates submitted
medical requests through the kiosk, the jail's
administrative staff or nurses received and distributed the
requests. See id. at 4-6; [58-3] at 2. The first
documented instance of Plaintiff seeking medical attention
for his tooth is a notation in his “Medical Progress
Notes” from July 16, stating that at the “morning
med pass” Plaintiff asked to see a dentist because his
molar was cracked, but did not request pain medication.
[58-6];  ¶¶ 8-9. Plaintiff disputes that he did
not request medication. See [60-2] at 5.
17, 2014, Traina-the dentist providing care to
inmates-examined Plaintiff.  ¶¶ 2, 10. There is
no evidence that Traina knew about Plaintiff's dental
complaints or request for treatment before July 17.
Id. ¶ 11. On that day, Traina performed a
dental exam and took an x-ray of “tooth #16, ”
Plaintiff's upper left-side third molar (or wisdom
tooth). See id. ¶ 12; [58-3] at 3-4; [58-18] at
2. She determined that tooth #16 was cracked,
“unrestorable, ” and should be extracted. 
¶ 12; [58-7]. Traina testified that dentists sometimes
extract even restorable wisdom teeth because they can cause
“more problems down the line.” [58-3] at 14.
Absent “complaints of pain or infection” by a
patient, such an extraction could be safely performed weeks
or months later. Id. Traina did not perform the
extraction on July 17 because she had numerous inmate
patients requiring her care that day; absent an emergency,
Traina treated inmates on a “first-come, first-serve
basis, ” and Plaintiff did not require emergency
treatment.  ¶¶ 15-17.
initial July 17 exam, Traina did not observe any signs of
infection, but she prescribed an antibiotic and motrin, a
pain medication, as prophylactic measures.  ¶¶
13-14; [58-3] at 5. The antibiotic ensured that no infection
would arise that could compromise the effectiveness of
numbing agents used in the eventual extraction, and the
motrin prescription ensured that Plaintiff would have access
to pain medication if he needed it. [58-3] at 5, 14. At her
deposition, Traina did not recall-or see noted in her
records-that Plaintiff complained of any pain. Id.
at 5. One of Plaintiff's medical records-dated July
17-indicates that at some point he complained of pain, but
does not clarify if he experienced pain on July 17, or if
that merely prompted his appointment with Traina.
See [58-7] (“pt c/o pain/cracked
tooth”). That document also notes Plaintiff's
motrin prescription, id., and Plaintiff testified
that a nurse gave him ibuprofen on July 17, [60-2] at 7.
record does not provide the original scheduled date for
Plaintiff's extraction. On August 7, however, Plaintiff
submitted a kiosk entry asking when his tooth would be
removed. [58-8]. The entry does not indicate that Plaintiff
experienced pain. See id. Traina wrote an undated,
handwritten note on Plaintiff's 10:01 a.m. entry telling
him that he was “on the dental list” and would be
seen “as soon as your turn comes up.”
Id. That note instructed Plaintiff to request
additional pain medication as needed. Id. Traina
testified that, according to her normal practice and the
jail's procedures, she generally received kiosk entries
like this one within a week of submission and would give her
response to a nurse to return to the inmate at the next med
call. [58-3] at 9. Sanchez-a nurse who held a supervisory
administrative role during the relevant period-testified that
handwritten notes like Traina's were delivered to inmates
in paper form, with a copy retained in their medical file.
[58-5] at 14-15.
August 11, Plaintiff again asked when the extraction would
take place. [58-9]; [61-8] at 2-3. That kiosk entry does not
indicate that Plaintiff was in pain; instead, Plaintiff asked
that his payment for treatment be returned since the
extraction had not been performed. [58-9]. A corrections
officer named John Hickey reached out to the medical
administrator on August 19; he then replied to Plaintiff that
it was his understanding that Plaintiff had elected to
postpone his extraction until after a court date. See
id.; [61-8] at 2-3.
testified that he had a court date around that time but
denied that he voluntarily rescheduled the extraction,
indicating that the jail rescheduled medical appointments if
a court date arose. See [60-2] at 13. Plaintiff
admitted, however, that he had no “reason to
dispute” that he requested a delay in treatment in
August 2014. Id. at 7. If an inmate postpones a
dental appointment, they fall to the bottom of the list of
patients in line for dental care.  ¶ 18. The prison
medical staff generally informs inmates requesting delays
that their request will have this effect. Id.;
[58-3] at 19. Traina's records contain a note on August
12 that Plaintiff “put in request to delay” his
treatment “until after court date 8/21.” [58-7];
see also [58-3] at 15. Traina testified that she
could have performed the extraction on August 12 if Plaintiff
“had not asked for the delay.” [58-3] at 15.
closed out the August 11 grievance on August 26 without
receiving a further response from Plaintiff. [58-9]. (A
duplicate grievance that appears to have been accidentally
submitted 20 minutes after the first grievance was closed out
on August 19. See id.) Plaintiff claimed that he
“took” the August 11 grievance “all the way
to the commander and to the sheriff” right after the
“closing date”-meaning, right after August 26.
See [60-2] at 14.
August 13, Plaintiff appears to have met with a member of the
jail's medical staff, in response to his kiosk requests.
[58-10]. That staff member's notes indicate that
Plaintiff “denied the need” for medical
assistance and presented no signs of “acute
distress.” See id.; [58-3] at 16.
September 12, Plaintiff submitted a medical request form
“to see a doctor, ” stating that this was his
second such request. [61-2] at 2. The form states that a
nurse gave him “some pills that did not help, ”
but does not specify which pills, which nurse, which earlier
request he referred to, or what type of care he sought.
September 16, Traina recorded that Plaintiff
“missed” his dental appointment because he was
“in court.” [58-7]. She testified that had
Plaintiff attended his appointment she could have performed
the extraction. [58-3] at 16. Plaintiff testified that he had
no reason to dispute that he had an appointment on September
16, or that he missed it due to a court appearance. [60-2] at
7. On September 18, Plaintiff's rescheduled appointment
had to be canceled because Traina's equipment
malfunctioned. [58-7]; [58-3] at 16. Another appointment set
for September 23 had to be rescheduled because not enough
correctional officers were available to escort inmates to the
dental office, as required by the jail's procedures.
[58-7]; [58-3] at 17. Plaintiff does not dispute the reasons
for these cancellations. See [60-2] at 7-8.
Extraction of Plaintiff's Tooth
on September 25, 2014, Traina successfully extracted
Plaintiff's upper left wisdom tooth (tooth # 16). 
¶ 32. Traina did not see Plaintiff between July 17 and
September 25, nor was she aware of any complaints from
Plaintiff other than his August 7 grievance. Id.
¶ 31; [58-3] at 8. On September 25, Traina did not note
any swelling or infection around Plaintiff's tooth,
although he showed the effects of periodontal disease-a
condition leading to bone loss that Traina noted as she
performed the extraction. [58-3] at 6-7, 17. Her notes from
the extraction say that she gave Plaintiff two carpules of
lidocaine-a relatively “small amount” of the
numbing agent. See [58-7]; [58-3] at 17. Plaintiff
recalled receiving up to four injections, stating that he was
“still in pain, ” and Traina told him:
“I'm going to have to give you more because
it's not working.” [60-2] at 9. According to
Plaintiff, the fourth injection successfully addressed his
completing the extraction, Traina placed a suture, observed
hemostasis (meaning that the extraction area had stopped
bleeding), prescribed antibiotics as a prophylactic, and
scheduled a follow-up appointment. See  ¶
36; [58-3] at 8, 17; [58-13]; [58-14]. Traina noted in her
records around 9:30 a.m. that Plaintiff “did not want
any pain medication.” [58-13];  ¶ 35.
Plaintiff testified that he was in pain after the extraction
and that Traina told him he would receive
“medication” back in “the pod”
(referring to Plaintiff's area or block of the jail).
[60-2] at 4, 9-10. Plaintiff says that ...