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Ramirez v. Sanchez

United States District Court, N.D. Illinois, Eastern Division

May 8, 2018



          John Robert Blakey Judge

         Plaintiff 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. [29]. 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. [57]. For the reasons explained below, this Court grants Defendants' motion.

         I. Background

         A. Local Rule 56.1

         The following facts come primarily from Defendants' Local Rule 56.1 statement of undisputed material facts [58]. Plaintiff did not file a statement of additional facts, although he responded to Defendants' statement [62]. Defendants ask this Court to disregard a number of those responses as inadequate denials of Defendants' proffered facts. See [63] at 2-3.

         This 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).

         Accordingly, 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 These responses do not cite any record evidence justifying the denial, and merely denying a fact that has evidentiary support “does not transform it into a disputed issue of fact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.

         Plaintiff also contests paragraphs 61-63 of Defendants' statement of facts because they interpret a “document not attached to the record.” [62] ¶¶ 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 [58] ¶¶ 4, 61-63. Thus, construing Plaintiff's responses as hearsay objections, this Court overrules that objection.

         Finally, Plaintiff objects to various portions of testimony cited by Defendants in their statement of facts as “opinion.” See, e.g., [62] ¶ 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.

         B. Plaintiff's Cracked Tooth

         Beginning around March 2014 and for the period relevant to his claim, Plaintiff was incarcerated at the Kane County jail.[1] See [58] ¶ 1; [60-2] at 2. On July 13, 2014, Plaintiff bit into something hard at dinner, around 5:00 p.m. [58] ¶ 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] at 5.

         Plaintiff 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]; [58] ¶¶ 8-9. Plaintiff disputes that he did not request medication. See [60-2] at 5.

         On July 17, 2014, Traina-the dentist providing care to inmates-examined Plaintiff. [58] ¶¶ 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. [58] ¶ 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. [58] ¶¶ 15-17.

         In her 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. [58] ¶¶ 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.

         The 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.

         On 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.

         Plaintiff 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. [58] ¶ 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.

         Hickey 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.

         On 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.

         On 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. See id.

         On 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.

         C. Extraction of Plaintiff's Tooth

         Finally, on September 25, 2014, Traina successfully extracted Plaintiff's upper left wisdom tooth (tooth # 16). [58] ¶ 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 pain. Id.

         After 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 [58] ¶ 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]; [58] ¶ 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 ...

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