United States District Court, W.D. Arkansas, Fayetteville Division
MICHAEL R. TURNER PLAINTIFF
SHERIFF TIM HELDER; DR. ROBERT KARAS; KARAS MEDICAL SERVICES; SERGEANT J. BYRD (#414); NURSE LANDON HARRIS; and R. WALKER DEFENDANTS
REPORT AND RECOMMENDATION OF THE MAGISTRATE
L. WIEDEMANN UNITED STATES MAGISTRATE JUDGE
a civil right case filed by the Plaintiff pursuant to 42
U.S.C. § 1983. Plaintiff proceeds pro se and
in forma pauperis.
is currently incarcerated in the Benton Unit of the Arkansas
Department of Correction (ADC). At all times relevant to this
Complaint, Plaintiff was incarcerated in the Washington
County Detention Center (WCDC). Plaintiff contends his
constitutional rights were violated when he was forced to
wait fifty-one days for treatment of a painful dental
filed a Motion for Summary Judgment (ECF No. 23). A hearing
was held on July 10, 2017, to allow Plaintiff to testify in
response to the Motion. Plaintiff testified by video from the
ADC. At the conclusion of the hearing, the Motion was taken
under advisement pending preparation of this Report and
was booked into the WCDC on August 8, 2016, on pending
criminal charges and a parole violation. (ECF No. 25-2 at
1-7). He reported to the booking officer that he had a
toothache. (Id. at 5); see also (ECF No.
25-7 at 13).
to Corporal Mulvaney, emergency medical services are
available twenty-four hours a day at the WCDC. (ECF No. 25-1
at 2); see also (ECF No. 25-6 at 1-6). Officers are
trained to respond to medical emergencies and can provide
temporary lifesaving care while EMS or other medical
personnel are in route. (ECF No. 25-1 at 2) The primary
medical provider is the facility medical provider and his
personnel. (Id.). Pursuant to a contract
with Washington County, Dr. Karas and Karas Correctional
Health have provided all medical and dental care at the WCDC
since January 1, 2016. (ECF No. 25-1 at 3). "[A]ll
medical, dental, and mental health coordination for inmates
at the [WCDC] is provided pursuant" to the contract.
(ECF No. 25-8 at 1). All matters of judgment regarding health
services are within the sole province of the contract medical
staff. (ECF No. 25-1 at 3). No employee of the WCDC is
authorized to make non-emergency medical decisions.
(Id.). No one in the Sheriff's Office
makes any decisions as to whether or not to provide a
particular medication, diagnostic testing, or medical
treatment based on cost. (Id.).
make medical and dental complaints via an electronic kiosk.
(ECF No. 25-1 at 2). The complaints are reviewed by medical
to Corporal Mulvaney, the WCDC acknowledges that dental
health directly affects an individual's total health and
medical status. (ECF No. 25-1 at 2). Detainees receive
emergency dental care and other dental treatment as deemed
necessary by a contract dentist. (Id.).
Emergency dental care is available to those detainees
experiencing acute dental problems such as severe pain,
infection, bleeding gums, etc. (Id. at 3). The
severity of the pain or infection will determine if the
problem is an emergency. (Id.). Medical
staff are responsible for assessing whether a dental
complaint constitutes an emergency. (Id.).
The contract with Dr. Karas "requires that a dentist be
provided between 6 and 8 hours per month." (ECF No. 25-8
at 2). Detainees are put on the dental list when they make a
complaint. "They are seen in order of their
complaint." (Id.). The dentist sees
inmates on one day per month and typically sees fifteen to
twenty inmates. (Id.).
to Dr. Karas, "[d]ental caries (cavities) are rampant in
the inmate population." (ECF No. 25-8 at 2). As a
the dentist list is generally full. The dental list may have
20 to 40 patients on it at a time. Anyone who is not seen is
moved up the list to be seen at the next available time slot.
The protocol for a typical dental complaint in the [WCDC] is
to examine the area of the complaint, place the inmate on an
antibiotic for 10 days to cover dental abscess in the root
canal, and provide a pain killer for 10 days. Usually, an
nsaid like naprosyn is used and can be given for longer than
10 days if the patient is having persistent pain.
Emergent dental needs are treated immediately in the same way
that . . . emergent medical needs are. However, a broken or
decayed tooth would not be considered an emergency dental
An emergent dental need would usually entail either trauma
from a blow to the mouth or jaw (causing a lost, but intact
tooth, that could be put back into place) or fever and a
marked amount of facial swelling due to dental abscess. For a
mild abscess, medical providers at the jail could drain most
of these types of abscesses. If that is not possible, the
inmate could be sent to the Emergency room, but not
necessarily to a dentist.
a week before his arrest, Plaintiff knew he had a cavity.
(ECF No. 25-7 at 17-18). Any pain he was in as a result of
the cavity may have been masked because of his illegal drug
use. (Id. at 19-20 & 70). A few days prior to
Plaintiff's arrest, when he was flossing, a piece of his
tooth fell out. (Id. at 18). He did not go to the
dentist before his arrest to have this fixed. (Id.
at 19). He did not seek help with the pain.
(Id.). The cavity had not progressed enough
that he had problems eating. (Id.).
fact, Plaintiff indicated he had not been to a dentist since
2007. (ECF No. 25-7 at 68). When he had cavities and/or
broken teeth previously, he usually had them taken care of
within two weeks. (Id. at 69).
August 11, 2016, Plaintiff waived his revocation hearing and
his parole was revoked. (ECF No. 25-2 at 8); (ECF No. 25-7 at
11). Plaintiff submitted his first written request for dental
care on August 25, 2016. (ECF No. 25-3 at 2). Plaintiff was
put on the sick call list for the next day.
(Id.). He was not seen but was instead put
on the list to see the dentist and prescribed Naproxen in the
interim. (ECF No. 25-4 at 16). The Naproxen prescription was
for August 26th to September 22, 2016. (Id. at
August 27, 2016, Plaintiff was told he was put on the dental
list. Plaintiff testified he was initially unaware he had
been prescribed Naproxen. (ECF No. 25-7 at 24). Plaintiff
testified that once he knew he had been prescribed the
medication, he never refused it. However, Plaintiff believed
there was one occasion on which he was not in the barracks to
receive the medication.
testified that he took Naproxen for thirty-seven days until
the prescription ran out. Plaintiff testified that the
Naproxen did not completely eliminate the pain but that it
"took the edge off." Plaintiff testified that on
September 3, 2016, the tooth broke off just above the gum
line "leaving a sharp and jagged base." (ECF No.
25-3 at 4). Plaintiff stated the tooth was "extremely
uncomfortable and painful as well."
(Id.). He said it made it difficult to eat.
(Id.). He asked if he could be seen by the
dentist "as soon as humanly possible."
(Id.). He noted he had been complaining about the
toothache since he was booked in. (Id.).
Nurse Walker responded that the dentist only came once a
month and that inmates were seen in the order they were added
to the list. (Id.). Nurse Walker stated
Plaintiff was on the list, although she was not sure where on
the list he fell. (Id.). She said a dentist
would be there sometime "this month."
September 23, 2016, Plaintiff submitted a request stating
that he put in a request on August 25, 2016, to see the
dentist because he had a cavity causing him a "good
amount of pain and discomfort. (ECF No. 25-3 at 6). He noted
he had been told he was on this list to see the dentist and
given Naproxen for the pain. (Id.). He
stated he had put in a second request to see the dentist on
September 3, 2016, when the tooth broke off "causing
even more pain and discomfort." (Id.).
He indicated he was told he was still on the list and his
medication remained the same dose and strength.
(Id.). That day, Plaintiff stated he had
been told his prescription for Naproxen had been for thirty
days and ran out. (Id.). He indicated he
still had not been seen by a dentist and his broken tooth was
still causing him a "great amount of pain and
discomfort." (Id.). He asked that the
situation be immediately rectified. (Id.).
In response, he was told that the provider would be
same day, Dr. Veronica Dockery reviewed his request and
authorized Plaintiff to have Naproxen for one more week. (ECF
No. 25-4 at 15). She said any longer could cause intestinal
bleeding and increase cardiovascular risk.
September 24, 2016, the dentist was at the WCDC seeing
inmates. Plaintiff was not seen. Plaintiff submitted a
grievance. (ECF No. 25-3 at 6). He stated that the broken
tooth was causing him great pain and discomfort especially
when he ate. (Id.). He said he had been on
the dental list for thirty days and was at risk of infection
as well as other "compounded" medical problems.
asserted that he had not been provided acceptable medical
care by the provider and the duty to provide care fell back
on the facility. (Id.).
response, Sergeant Byrd said there were over fifty inmates on
the list and that the dentist only had time to see twenty
inmates. (ECF No. 25-3 at 6). Plaintiff was informed that the
twenty inmates seen had been on the list longer than he had.
(Id.). Sergeant Byrd said he would forward
the grievance to the medical supervisor.
testified that in addition to his requests/grievances, he
complained verbally about his dental pain. (ECF No. 25-7 at
73). Each time he complained, Plaintiff stated he was merely
advised he was on the dental list. (Id.).
October 1, 2016, Plaintiff submitted a request that stated he
was in a "great amount of pain" and extremely
uncomfortable. (ECF No. 25-3 at 7). He stated it was very
difficult to eat and sleep. (Id.). He noted
he had been receiving Naproxen since August 26, 2016, but had
been told that day that his prescription had run out and no
new order had been placed. (Id.). He stated
he still had not seen the dentist and needed "to be
given medication for this pain. In fact I would really like
to be given something strong[er] because although Naproxen
alleviates some of the pain it does not remove it all. . . .
I am being denied medical treatment, being forced to wait in
excess of 36 ...