Section 1983 Civil Liability Against Prison Officials and Dentists for Delaying Dental Care

Published date01 June 2020
Date01 June 2020
Subject MatterArticles
/tmp/tmp-17ISdLJFmFMM71/input 860899CJPXXX10.1177/0887403419860899Criminal Justice Policy ReviewNolasco and Vaughn
Criminal Justice Policy Review
2020, Vol. 31(5) 721 –745
Section 1983 Civil Liability
© The Author(s) 2019
Article reuse guidelines:
Against Prison Officials and
DOI: 10.1177/0887403419860899
Dentists for Delaying Dental
Claire Angelique Nolasco1
and Michael S. Vaughn2
Many prisoners enter correctional facilities in the United States with little history
of good dental hygiene and even less history of access to dentists. Thus, the
incarceration experience presents opportunities for inmates to receive quality
dental care, often for the first time. Dental care delivered by correctional dentists is
complicated, however, by the array of serious dental conditions and difficult to treat
dental problems in clinical settings. These conditions exist within a legal environment
that mandates adequate dental care be provided to prisoners by the state. This article
examines prisoners’ Section 1983 lawsuits, claiming that delays in the delivery of
dental care violate inmates’ federally guaranteed rights. The analysis focuses on what
the U.S. Circuit Courts of Appeals have required of correctional officials and dentists
in the form of dental care, concluding with nine best practices for correctional dental
practitioners to follow to avoid Section 1983 liability.
prison dental care, prison health care, correctional health care, Section 1983 litigation,
civil liability
Inmates present particular problems to correctional dentistry because many enter con-
finement without a childhood or adult history of overall oral hygiene (Anno, 2001).
Racial and ethnic minority groups are overrepresented among the inmate population
1Texas A&M University–San Antonio, TX, USA
2Sam Houston State University, Huntsville, TX, USA
Corresponding Author:
Claire Angelique Nolasco, Criminology and Criminal Justice Program, Department of Social Sciences,
Texas A&M University–San Antonio, One University Way, San Antonio, TX 78224, USA.

Criminal Justice Policy Review 31(5)
(Nowotny, 2017; Simon et al., 2017) most of whom lack knowledge of oral health care
measures, oral hygiene practices, and preventive dental care (Makrides & Shulman,
2017; Treadwell & Formicola, 2008). Prisoners frequently come from the poorest seg-
ments of society without dental insurance or regular dental health providers (Treadwell,
Blanks, Mahaffey, & Graves, 2016) and where dental care is either not a priority or is
not affordable (Nelson, Armogan, Abel, Broadbent, & Hans, 2004; Porter, 2019). The
longer inmates stay incarcerated, the greater the possibility that they receive dental
treatment (Dias & Vaughn, 2008; Mixson, Eplee, Fell, Jones, & Rico, 1990). Boyer,
Nielsen-Thompson, and Hill (2002, p. 146), for instance, found that newly admitted
inmates to the Iowa State prison had “more untreated decay but fewer missing teeth
than most of the male inmate comparison groups.” Indeed, 99% of inmates require
dental care (Barnes et al., 1988) because inmates have more caries (Ormes, Carolyn,
Thompson, & Brim, 1997), periodontal disease (Costa, 2014), and urgent dental care
needs (Clare, 1998) than the general population (Walsh, Tickle, Milsom, Buchanan, &
Zoitopoulous, 2008). Most inmates have fewer teeth, and the teeth they possess are
more likely to be in need of corrective treatment (Badner & Margolin, 1994). One
study reports that only 4.9% of inmates admitted to prison had “completely healthy
periodontal tissues” (Priwe & Carlsson, 2018, p. 392).
Despite historical efforts to aggressively implement dental care to preserve natural
teeth, in resource-starved environments—poor rural areas, inner cities, correctional
facilities—extraction remains the predominant treatment in prison and jails (Frencken,
Pilot, Songpaisan, & Phantumvanit, 1996; Ramos-Rodriguez, Schwartz, Rogers, &
Alos, 2004; Shulman, 2016). Prison dental care is unnecessarily delayed when facili-
ties provide little oral health maintenance, few regular teeth cleanings, rarely fill cavi-
ties, and delay diagnosis and treatment of dental problems (Shulman, 2016).
As “an inmate’s right to treatment for serious and painful dental conditions has
been clearly-established for more than three decades” (Williams v. York, 2018, p. 707),
this article explores Section 1983 correctional dental care lawsuits filed by inmates,
focusing on dental care that is unnecessarily delayed to inmates and the harm they suf-
fer because of that delay. After discussing the methodology employed to find the court
cases, the article describes the legal standard of deliberate indifference to serious med-
ical needs established by the U.S. Supreme Court in Estelle v. Gamble (1976), which
courts have applied to correctional dental care litigation. The article then analyzes 126
cases from the U.S. Circuit Courts of Appeals to determine how courts interpret the
deliberate indifference standard in dental care situations.
To avoid Section 1983 liability, the article identifies best practices for correctional
dentistry. As mentioned, the article analyzes decisions of the U.S. Circuit Courts of
Appeals, which are “mandatory on district courts and other lower courts within the
circuit” and “persuasive authority in the other circuits, both for other courts of appeals
and for lower courts” (Bintliff, 2001, p. 84). Although legal doctrines expressed in indi-
vidual cases are not binding on the entire country, the aim of the article is to provide
general guidelines of best practices that can assist correctional dentists and practitioners
in providing adequate dental care that would pass muster under Section 1983 across
different circuits. The article also recommends that jail and prison administrators should

Nolasco and Vaughn
adopt national standards of care, such as those proposed by the National Commission
on Correctional Health Care (NCCHC, 2018) and best practices articulated by the
American Dental Association (ADA, 2004, 2013) that have the goal of the elimination
of dental disease among correctional populations. If implemented, such policies would
greatly improve prisoners’ overall health, reduce Section 1983 civil liability, and raise
the quality of public health dentistry (Douds & Ahlin, 2016).
The Eighth Amendment to the U.S. Constitution prohibits cruel and unusual punish-
ment. Inmates may seek remedies for violations of federal law pursuant to Title 42
U.S. Code Section 1983 (“Section 1983”). Cases in this article were found by search-
ing the Westlaw online computerized database. Cases from the U.S. Circuit Courts of
Appeals from 1976 through January 31, 2019, were identified using the following
search terms in various combinations and permutations: “dental,” “dentist,” “prison,”
and “jail,” resulting in the identification of 629 cases of which 173 were relevant.
Federal Circuit Courts of Appeals cases were also identified by using the “dental con-
ditions and treatment” keyword in the Westlaw database, producing 201 cases. After
eliminating duplicates from the two search strategies, 126 cases on delay of dental care
form the basis of this article. The authors created a framework on the basis of an induc-
tive doctrinal analysis (Nolasco, Vaughn, & del Carmen, 2010) to synthesize circuit
court decisions on the liability of corrections officials and dentists for delaying dental
treatment to inmates (Nolasco, del Carmen, Steinmetz, Vaughn, & Spaic, 2015). The
authors focused on Section 1983 liability for delay in dental care and did not specifi-
cally examine cases that involved court orders requiring compliance with any of the
dental care treatment standards set by professional bodies such as the ADA or the
U.S. Supreme Court Precedent Pertaining to Medical/
Dental Care
In Estelle v. Gamble (1976), Gamble, an inmate in the Texas Department of Corrections
(today known as the Texas Department of Criminal Justice—Institutional Division),
filed a Section 1983 action against prison officials, alleging that his Eighth Amendment
rights were violated because defendants failed to provide adequate medical care.
Gamble was injured while unloading cotton from a prison truck. He received repeated
medical treatment, including medication, work restrictions, and was allowed to eat in
his cell. The U.S. District Court dismissed the lawsuit but the U.S. Court of Appeals
for the Fifth Circuit reversed. On appeal, the U.S. Supreme Court reversed, holding
that the district court properly dismissed the suit because Gamble’s complaint did not
show that prison officials acted with deliberate indifference to his serious medical
needs. According to the Court, only inadequate medical care that rises to deliberate
indifference violates the cruel and unusual punishment clause of the Eighth
Amendment. Medical malpractice is not deliberate indifference (Banuelos v.

Criminal Justice Policy Review 31(5)
McFarland, 1995; Gobert v. Caldwell, 2006; Hall v. Thomas, 1999; Stewart v. Murphy,
1999; Torraco v. Maloney, 1991; Varnado v. Lynaugh, 1991). Medical negligence or
the lack of adherence to national standards of care is not a constitutional violation
(Duque v. U.S., 2007). Only prison officials’ acts or omissions that indicate deliberate
indifference to serious medical needs violate...

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