Charles D. Cullor Plaintiff-Appellant
John Baldwin; Harbons Deol; Sheryl Lockwood-Dahm; Nick Ludwick; Rebecca Bowker; Dave DeGrange; Mark Larson; Stephanie Cooper; Grant Abernathy; Monica Nye Defendants-Appellees
Submitted: February 10, 2016
from United States District Court for the Southern District
of Iowa - Des Moines
SMITH and COLLOTON, Circuit Judges, and ERICKSON,  District
Cullor, an Iowa prison inmate, brought suit against, among
others, John Baldwin, Director of the Iowa Department of
Corrections (IDOC), and Dr. Harbons Deol, Medical Director of
the IDOC, under 42 U.S.C. § 1983 for deliberate
indifference to his serious medical need, in violation of the
Eighth Amendment. Specifically, Cullor alleged that Director
Baldwin and Dr. Deol were deliberately indifferent to his
need for dentures. Cullor sought declaratory and injunctive
relief, as well as compensatory and punitive damages.
Director Baldwin and Dr. Deol moved for summary judgment,
which the district court granted. Cullor now appeals, and we
recite the facts from the record in the light most favorable
to [Cullor], the nonmovant in this summary judgment
disposition." PPS, Inc. v. Faulkner Cty., Ark.,
630 F.3d 1098, 1100 (8th Cir. 2011) (citation
has lived at the Iowa State Penitentiary (ISP) since October
1980. While at the ISP, he has received regular dental
checkups. Cullor has a history of significant tooth decay.
During Cullor's time at the ISP, prison dentists have
extracted several of his teeth. On October 13, 2010, Cullor
had his remaining teeth extracted at the University of Iowa.
ranks inmates' dental needs based on medical necessity.
At the ISP, only the staff dentist is authorized to place an
inmate on the Denture List based on the dentist's
determination that the inmate needs a partial plate or
complete dentures. To qualify for placement on the Denture
List, an inmate must have fewer than eight posterior teeth in
contact or be missing three posterior teeth in a row. This
standard is consistent with the Iowa Medicaid standard, which
provides that patients may qualify for dentures if they are
missing any three adjacent teeth.
records submitted in this case date back to an examination on
July 28, 2005; at that time, Cullor was missing 11 teeth. The
chart note for that examination indicates "Needs
Denture: No." (Bold omitted.) As of August 3, 2005,
Cullor qualified for placement on the Denture List because he
was missing at least three adjacent posterior
teeth and had fewer than eight posterior teeth
in contact. As the magistrate judge recognized, "Viewing
the record in the light most favorable to Cullor, Dr.
[Richard] Snow placed him on the Denture List on August 3,
2005." From August 2006 until November 2009,
Cullor received various dental services, including exams,
x-rays, fillings, and extractions and associated
March 23, 2010, Monica Nye, an ISP dental assistant,
performed a review of Cullor's chart, noting that Cullor
was to remain on the Denture List per Dr. Snow's
directive and was a "Priority II" patient for a
complete upper denture and partial lower denture. On August
12, 2010, the ISP's Health Care Unit (HCU) treated Cullor
for an oral yeast infection, and a notation was made in his
dental chart. Cullor received his annual dental screening on
August 17, 2010. The following day, Dr. Mark Larson referred
Cullor to the University of Iowa for "[f]ull mouth
extractions with IV sedation." Cullor's surgery
occurred on October 13, 2010, leaving him
"edentulous" (without any teeth). A chart note
dated November 1, 2010, indicates that Cullor complained that
the kitchen was not providing him with the soft diet
prescribed to him following his surgery, and he also
requested that his stitches be checked. The following day,
Dr. Stephanie Cooper instructed that all of Cullor's
"meats need to be ground. Well-cooked vegetables only.
Replace fresh fruit with applesauce, canned peaches, or
crushed pineapple." Dr. Cooper ordered the "soft
diet to assist [Cullor] in getting adequate nutrition and
avoid potential issues of choking on food."
chart note for Cullor's annual dental screening on August
8, 2011, indicates that Cullor needed a complete lower
denture, per Dr. Snow's prior directive from August 3,
2005. On August 23, 2011, Cullor sent a kite (written
statement) to the ISP dental staff, inquiring when he would
receive dentures. In the kite, he made multiple complaints,
including being unable to chew effectively, having constant
headaches and jaw pain, worsening acid reflux, and having
difficulty communicating with others. Cullor connected all of
the complaints to his lack of dentures. Nye responded to the
kite, explaining that, at the time, the ISP had a dentist on
staff one day per week and that she did not know how much
time was available to make dentures. She informed Cullor that
she would schedule him to see the dentist, but the records do
not reflect that any dental personnel examined Cullor
regarding this kite.
filed a grievance in October 2011. In that grievance, he
outlined his dental-treatment history; Dr. Snow's
recommendation for dentures on August 3, 2005; the removal of
Cullor's remaining teeth in October 2010; and his
contention that he had a "serious medical need" for
dentures in order to alleviate his pain and constant
headaches and that his inability to chew exacerbated his acid
reflux. He requested that he immediately receive dentures. On
November 2, 2011, Dave DeGrange, an ISP Grievance Officer,
contacted Nursing Supervisor Roger Harrison and asked him to
review Cullor's grievance. After communicating with
Harrison, DeGrange sustained Cullor's grievance. In the
grievance response, DeGrange informed Cullor of
Harrison's statement that Cullor was "near the top
of the list to be seen by the new dentist" for dentures
and that "[t]he process requires several appointments,
fittings, and adjustments for the issuance of dentures."
DeGrange requested that Cullor "be patient" and
assured Cullor that he would "be one of the first
inmates fitted with new dentures." DeGrange was
"unable to provide [Cullor] a definite time frame"
but stated that Cullor would "begin the process for
fitting dentures in the near future."
November 14, 2011, Cullor appealed DeGrange's decision
and requested "a more definitive answer as to when [he]
might get dentures, other than the answer 'your name is
near the top of the list.'" Cullor explained that he
had received this same answer "for over a year" and
"seriously need[ed] relief from the pain." On
November 18, 2011, ISP Executive Officer Rebecca Bowker
denied the appeal, responding that she was "unable to
provide [Cullor] with a definitive date as [he] request[ed]
in [his] grievance appeal." She reiterated that Cullor
was "near the top of the list and will have some
appointments soon to resolve the denture issue." On
November 28, 2011, Cullor appealed to the IDOC Central
Office. On December 13, 2011, IDOC Assistant Deputy Director
Sheryl Lockwood-Dahm denied Cullor's appeal.
March 19, 2012, Cullor filed a deliberate-indifference claim
against, among others, Director Baldwin and Dr. Deol in their
official and individual capacities. In his complaint, Cullor
alleged that Director Baldwin "knowingly and
intentionally refused or failed to establish and maintain
acceptable standards of dental care for prisoners . . . by
failing to insure that adequate and sufficient dentists
[were] employed at the ISP." Cullor alleged that Dr.
Deol "intentionally and knowingly failed or refused to
adequately staff the ISP with sufficient dentists to . . .
provide dental services to [him] and the ISP prisoner
population." The record reflects that the ISP has
employed five dentists since 2009. Dr. Tessa Johnson began
serving as ISP's dentist on July 6, 2012. Prior to Dr.
Johnson's arrival, the ISP employed several dentists on a
part-time basis, including Drs. Larson, Cooper, and
Abernathy. As Cullor concedes, "[a]ll of the part-time
dentists left ISP voluntarily for non-monetary
31, 2012, Nye entered the following chart note: "ASK DR.
DEOL IF WE SHOULD WAIT TO SEE THIS OFFENDER UNTIL LAW SUIT
[SIC] IS SETTLED?" On August 20, 2012, Dr. Johnson,
ISP's dentist since July 2012, examined Cullor and began
creating impressions for dentures. Final impressions were
created on September 17, 2012, and Cullor received complete
upper and lower dentures on November 13, 2012. Thereafter,
Dr. Johnson made follow-up adjustments to Cullor's
testimony before the district court included medical
testimony from two physicians, Dr. Stephen Sparks and Dr.
Deol, and a dentist, Dr. Johnson. Dr. Sparks, a licensed
physician working in the HCU at the ISP, testified that
swallowing large chunks of food due to an inability to chew
would not tend to exacerbate chronic acid reflex. According
to Sparks, patients with esophageal strictures are at a
greater risk for choking episodes when unable to chew;
however, he explained that this esophageal choking-as opposed
to choking in the airway-was distressful but not deadly. Dr.
Sparks testified that the ISP medical staff "thought
[that Cullor] might have had a stricture before 2002."
Dr. Sparks admitted that Cullor "was at an increased
risk for stricture during that time period." He also
testified that ...