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Mady Chan v. County of Sacramento

July 5, 2011

MADY CHAN, PLAINTIFF,
v.
COUNTY OF SACRAMENTO, ET AL., DEFENDANTS.



The opinion of the court was delivered by: Gregory G. Hollows United States Magistrate Judge

FINDINGS & RECOMMENDATIONS

Plaintiff is a prisoner proceeding pro se and in forma pauperis with a civil rights action pursuant to 42 U.S.C. § 1983. On June 3, 2011, Dr Couch provided a detailed report regarding the dental care plaintiff received at Sacramento County Main Jail (SCMJ) with respect to plaintiff's motion for a preliminary injunction (regarding dental care). The undersigned ordered both parties to file briefing in regards to the report and address the degree to which the jail's dental facility only provides emergency care instead of comprehensive care, and whether an emergency only dental facility comports with the consent decree in Kaiser v. County of Sacramento, CIV S-91-0300 GGH. Both parties have timely filed briefing.

Preliminary Injunction "The proper legal standard for preliminary injunctive relief requires a party to demonstrate 'that he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest.'" Stormans, Inc. v. Selecky, 586 F.3d 1109, 1127 (9th Cir. 2009), quoting Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 129 S.Ct. 365, 374 (2008). The "serious questions" on the merits test survives, but requires an even clearer showing of irreparable harm and hardship if a preliminary injunction were not to be granted. Alliance for the Wild Rockies, 632 F.3d 1127, 1131-32 (9th Cir. 2011).

In cases brought by prisoners involving conditions of confinement, any preliminary injunction "must be narrowly drawn, extend no further than necessary to correct the harm the court finds requires preliminary relief, and be the least intrusive means necessary to correct the harm." 18 U.S.C. § 3626(a)(2).

Plaintiff's complaint alleged the SCMJ dental department was deliberately indifferent to his serious dental needs that has led to seven extracted teeth. In his motion for a preliminary injunction plaintiff requested that he receive permanent fillings instead of temporary fillings, as he believed this was the cause of his dental problems and that he needed dentures. Dr. Couch stated the following:

Over the ten year span of the treatment record 13 teeth received treatment. Every diagnosis involved extensive decay which either made the tooth non-restorable and had to be extracted or the decay was so extensive that it infected the nerve thus necessitating a pulpectomy (a mechanical removal of the nerve or in other words the initial step in root canal therapy). The other procedure performed over the years was called "carries control." This is where the decay is so deep that it is deemed close to exposing the nerve or causing the nerve to be inflamed. Caries control is emergency treatment to arrest the progression of decay until such time allows in the future to arrest the progression of decay until such time allows in the future to provide a more definitive restoration.

Report (Doc. 81) at 1-2.

Dr. Couch further stated that the use of temporary fillings was not negatively affecting plaintiff's dental health and the dentists did not violate the Eighth Amendment with respect to providing the limited amount of care it appears they had the ability to provide. Defendant cites to these statements and then concludes that the preliminary injunction must be denied. Yet, the report contains additional information and after reviewing the entire report from Dr. Couch, it is clear that defendants are missing the point, perhaps on purpose. Dr Couch continued:

The pulpectomy is the initial step in performing a root canal. Many times a dentist will do the pulpectomy to remove the inflamed and infected nerve to relieve the pain and swelling. The canals of the roots are left clean and dry if there is no time to complete the root canal or if it is a procedure that the dentist does not do and needs referral to a specialist . . .

Report at 2.

While permanent fillings were not initially required in these circumstances, that is not the end of the analysis. It appears temporary fillings were used, because the jail's dentists performed the pulpectomies and then planned on someone else proceeding to the next step and performing the actual root canal and then providing permanent fillings.

Therefore, if pulpectomies are the only service that the jail dental clinic performs then it stands to reason they will only place IRM [the temporary] filling material since the tooth has to be reentered in the future.

Report at 2.

Permanent fillings are to be used after a root canal in plaintiff's circumstances. As plaintiff did not receive a root canal, it would make no sense to provide permanent fillings, as Dr. Couch stated, "[p]lacing a permanent restoration [filling] puts the 'cart before the horse' so to speak." While plaintiff's request for permanent fillings at this stage would be premature, the ...


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