United States District Court, W.D. Arkansas, Fayetteville Division
J. FELIX (FERNANDO) CORONA-CERVANTES PLAINTIFF
DR. ROBERT KARAS; SAM CAUDLE, Maintenance, Washington County Detention Center; ISAAC ANH-TUAN LE, D.D.S. DEFENDANTS
REPORT AND RECOMMENDATION OF THE MAGISTRATE
ERIN L. WIEDEMANN UNITED STATES MAGISTRATE JUDGE
a civil rights action filed by the Plaintiff pursuant to 42
U.S.C. § 1983. Plaintiff proceeds pro se and
in forma pauperis.
is presently incarcerated in the Cummins Unit of the Arkansas
Department of Correction. At all times relevant to this case,
Plaintiff was incarcerated in the Washington County Detention
Center (WCDC). While incarcerated in the WCDC, Plaintiff
contends his constitutional rights were violated in the
following ways: he was denied adequate medical care; he was
denied adequate dental care; and he was subjected to
unconstitutional conditions of confinement. Plaintiff has
sued the Defendants in their individual capacities only.
filed a Motion for Summary Judgment (ECF No. 34). A Motion
for Summary Judgment (ECF No. 37) was also filed by Dr. Karas
and Sam Caudle. A hearing was held on July 10, 2017, to
allow the Plaintiff to testify in response to the Motions for
Summary Judgment. At the conclusion of the hearing, the case
was taken under advisement pending preparation of this report
Washington County Defendants were asked to, and did, file a
Post-Hearing Supplement (ECF No. 46) to their Summary
Judgment Motion, containing the medical file of the Plaintiff
from October 2016 until the end of June 2017. While these
records involved care rendered after the time period at issue
in this case, the Court believed the information would be
helpful to a full understanding of the Plaintiff's
testified he was booked into the WCDC on May 30, 2016.
See also (ECF No. 39-2 at 1). He was in pretrial
status until his conviction on May 10 or May 12, 2017. The
period of time at issue in this lawsuit stems from his
booking on May 30, 2016, to his filing of the Complaint on
September 12, 2016. (ECF No. 1).
Factual Background Regarding Dental Claim
became a licensed dentist in June of 2013. (ECF No. 34-1 at
1). In addition to his private practice, beginning in 2015,
he contracted with Dr. Karas to provide dental care at the
WCDC one Saturday per month. (Id.).
does not have access to kiosk requests and has no input into
who is put on the dental list. (ECF No. 34-1 at 2). Detainees
are brought to him one at a time and this is the first time
he learns about the specific dental problem they have.
(Id.). Dr. Le provides only a narrow scope of
services. (Id.). He can treat ongoing infections
with medication or extract teeth. (Id.).
respect to extractions, Dr. Le states:
my process is to take a dental history from the detainee. I
perform a visual examination of the detainee's mouth. If
I identify a tooth that has a level of decay or mobility
(looseness) that I deem to be clinically significant for
potential problems in the short term, I will recommend to the
detainee that the tooth be extracted. I will discuss the
risks and benefits of extraction and obtain a written
consent. I will provide detainee with anesthetic and, when it
has taken effect, perform an extraction using the standard
techniques I was taught in dental school.
(ECF No. 34-1 at 2).
15, 2016, Plaintiff complained of a broken molar and
requested to be placed on the dental call list in order for
the tooth to be extracted. (ECF No. 39-4 at 5). He was placed
on the dental call list. (Id.). The next available
dental call date at the time was July 16, 2015. (ECF No. 39-8
testified that the tooth became infected and the pain kept
him from eating. He submitted another medical request on June
22, 2016. (ECF No. 39-4 at 5). On June 27, 2016, medical
staff responded and placed Plaintiff on the sick call list,
told him he was on the dental call list, and told him he
would be provided pain medication. (Id.).
29, 2016, Plaintiff submitted another medical request about
the broken molar and was told he was on the sick call list.
(ECF No. 39-4 at 5-6). On June 30, 2016, Plaintiff was
examined by a nurse who reported no abscess or drainage and
prescribed Naproxen for pain. (ECF No. 39-7 at 6).
16, 2016, Plaintiff saw Dr. Le. (ECF No. 34-1 at 3). Dr. Le
noted "significant decay in tooth number one (back molar
on the upper right)" and recommended extraction.
(Id.). Plaintiff signed a written consent and the
tooth was extracted. (Id. at 3 & 6). The
consent, among other things, says that "although extreme
care will be used the jaw, teeth roots, bone spicules or
instruments used in the extraction procedure may fracture or
be fractured, requiring retrieval and possible referral to a
specialist." (Id. at 3); (ECF No. 39-7 at 41).
Plaintiff testified that everything was normal at that time.
Plaintiff was prescribed Naproxen and
Cephalexin for three days. (ECF No. 39-7 at 9).
indicated that a few days later, the inflammation from the
extraction had gone down. However, Plaintiff felt a
"little pain" and put in a request because he felt
pieces of tooth in his gum. Plaintiff testified he was told
that the problem would go away on its own. Several months
passed and Plaintiff continued to feel pain in the area of
the extraction and in his right eye. He knew the area had
gotten infected because of the smell, inflammation, taste,
and because it would bleed when he brushed his teeth.
September 14, 2016, Plaintiff asked to see the dentist
related to a "little chunk of teeth." (ECF No. 34-1
at 4). He was placed on the dental call list.
to Dr. Le, a bone spicule, or small piece of bone material
which breaks off the tooth during extraction, is one of the
normal complications that can occur in any tooth extraction.
(ECF No. 34-1 at 2). The bone spicule may "work its way
to the surface and the patient will notice it."
(Id. at 3). When this happens, Dr. Le extracts the
bone spicule. (Id). Plaintiff was seen by Dr. Le on
November 12, 2016, and he recommended removal. (ECF No. 34-1
at 4; ECF No. 46-2 at 10). According to Dr. Le, "[t]his
would have been a minor issue and most likely would not even
have required anesthetic." (ECF No. 34-1 at 4). Dr. Le
states that Plaintiff "declined to have the bone spicule
removed because he had a pending lawsuit."
(Id.); see also (ECF No. 46-2 at 10). Dr.
Le did not see the Plaintiff again during the time period
relevant to this case.
testified, in contrast, that when he went to sign the consent
for extraction, he noted that it said there was a chance his
jaw could become dislocated or he could suffer partial or
total paralysis. Plaintiff testified he became scared and
refused to sign the consent.
testified he continued to get infections and have pain.
Finally, Plaintiff again requested extraction because he
could "not stand" the pain. The bone spicule was
extracted on June 17, 2017. (ECF No. 46-2 at 28 & 31).
Plaintiff testified that after the spicule was extracted he
had no further trouble.
Court has been provided the affidavit of Dr. Lee Hinson. (ECF
No. 34-2). Dr. Hinson indicates he obtained his license to
practice dentistry in 1983 and has practiced general
dentistry in Central Arkansas since then. (Id. at
2). Dr. Hinson indicates he is familiar with the standard of
care of the practice of general dentistry in Fayetteville,
Arkansas, in 2016. (Id.).
Hinson notes that a bone spicule is one of the normal
complications of any tooth extraction. (ECF No. 34-2 at 3).
He indicates the bone spicule is typically not felt by the
patient for a few days or weeks. (Id.). If the
patient consents, the spicule can be removed. (Id.).
Dr. Hinson notes this is normally a "minor procedure
that often does not even require anesthesia."
Hinson states that in his opinion Dr. Le "met the
applicable standard of care in terms of diagnosis and
treatment of the broken molar." (ECF No. 34-2 at 3).
Further, he states that the presence of a bone spicule
"does not, in and of itself, indicate any type of
negligence or malpractice on the part of Dr. Le."
(Id.). According to Dr. Hinson, "Dr. Le's
response to the bone spicule was within the applicable
standard of care." (Id.).
Factual Background as to Denial of Medical Care
Karas has been the jail doctor since January 1, 2016,
pursuant to a contract between Washington County and Karas
Correctional Health. (ECF No. 39-1 at 2); (ECF No. 39-8 at
1). All medical, dental, and mental health care is
coordinated by Karas Correctional Health, which is located
inside the WCDC. (Id.). The term
"provider" is used to "refer to the treating
medical professional who is either a physician or nurse
practitioner." (ECF No. 39-8 at 1).
can make medical requests daily for review by qualified
medical personnel. (ECF No. 39-1 at 2). The requests are made
via an electronic kiosk. (Id.). All kiosk requests
for medical care are reviewed by medical staff. (ECF No. 39-8
at 2). All matters of judgment regarding health services are
made by contract medical staff or staff of the treating
facility. (ECF No. 39-1 at 2); (ECF No. 39-8 at 2).
respect to the language barrier, Dr. Karas states:
The Plaintiff is a Mexican national and his English appears
to be very poor. The language barrier appears to have created
a challenge in communications with the jail staff, but
according to the records, Mr. Corona's complaints in
Spanish were translated by medical staff and medical staff
spoke with Mr. Corona both in Spanish and through the use of
a translator when a Spanish-speaking member of staff was not
involved in his care.
(ECF No. 39-8 at 2).
testified that with respect to his general medical condition,
he was not on any prescription medication when he was booked
into the WCDC. Plaintiff testified that other than colds, the
only medical problem he had before his incarceration was a
rib injury caused when he lifted too much. (ECF No. 39-6 at
17-18). However, on the medical intake questionnaire,
Plaintiff indicated he had a heart attack eight months ago,
attempted to hang himself four years ago but currently had no
thoughts of harming himself, and was allergic to ...