(CN) - Prison understaffing does not open a dentist to a deliberate-indifference claim from an inmate who waited 18 months for treatment, the full 9th Circuit ruled Thursday.
Backed a narrow majority of six judges, the decision sparked outrage from the remaining five judges on the panel.
"Today, our court overturns more than thirty years of circuit precedent by holding that lack of resources is a defense to a damages claim that a prisoner was denied the constitutionally-required minimum threshold for adequate care," a dissent for the five by Judge Morgan Christen states.
Judge Andrew Hurwitz went further, stating that the ruling opened the door for the mistreatment of prisoners.
"The majority effectively holds that a state can first choose to underfund the medical treatment of its wards, and then excuse the Eighth Amendment violations caused by the underfunding," Hurwitz wrote, joined by the same four dissenting judges. "Today's decision thus not only forecloses relief to inmates who suffer cruel and unusual punishment, but also encourages future constitutional violations."
His dissent emphasized that "having made the policy decision to incarcerate a large number of wrongdoers, California should not be allowed to avoid the Eighth Amendment consequences of that decision by systematically underfunding medical care."
Cion Adonis Peralta brought the case at hand after he had seven cavities filled and was treated for periodontal disease only after being transferred to Mule Creek State Prison.
The inmate had requested dental care almost immediately upon his arrival two years earlier at the Los Angeles county state prison in Lancaster, Calif., claiming that his teeth hurt, he had cavities, and his gums were bleeding.
He was placed on a waiting list nine to 12 months long. While state policy calls for one dentist for every 950 prisoners, the ratio at the prison was close to one to 1,500.
Despite his condition was painful, Peralta waited over three months for medication for a tooth infection, and almost 18 months to get his teeth cleaned.
The staff dentist, S. Brooks, testified that Peralta had sustained severe bone loss by this last visit, and that he cleaned Peralta's teeth but still did not check for cavities.
California transferred Peralta to Mule Creek two months later.
Before clearing Brooks of deliberate indifference to Peralta under Section 1983, a jury had been instructed to consider "the context of the personnel, financial, and other resources available" to the dentist.
The six-judge majority of the 9th Circuit affirmed Thursday that the lack of available resources is a defense.
"What is reasonable depends on the circumstances, which normally constrain what actions a state official can take," Chief Judge Alex Kozinski wrote for the majority.
Providing dental care to prisoners is particularly difficult because security concerns dictate that only one prisoner may be in an examination room at a time, and prisoners must always be accompanied lest they try to use a dental tool as a weapon, according to the ruling.
"These challenges aside, there simply weren't enough dentists at Lancaster to provide every prisoner with dental care on demand," Kozinski wrote. "The ratio of dentists to prisoners was less than half what the state said it should be, there were no office technicians or dental hygienists and, on many occasions, Brooks had no dental assistant. Peralta doesn't argue that Brooks was responsible for these constraints. Nor could he, since Brooks had no control over the budget."
Brooks cannot be held personally liable for failing to give Peralta care that his working conditions make impossible to provide, according to the ruling.
The court narrowed its decision, however, in ruling that inadequate resources will not be a viable defense in non-monetary injunctive claims.
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