Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_13-cv-02143/USCOURTS-caed-2_13-cv-02143-4/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

1

UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

THOMAS T. ALFORD,

Plaintiff,

v.

DR. GYAAMI et al.,

Defendants.

No. 2:13-cv-2143 DAD P

ORDER AND

FINDINGS AND RECOMMENDATIONS

Plaintiff is a state prisoner proceeding pro se with a civil rights action seeking relief under 

42 U.S.C. § 1983. This matter is before the court on a motion for summary judgment brought 

pursuant to Rule 56 of the Federal Rules of Civil Procedure on behalf of defendants Dr. Gyaami 

and Dr. Calderon. Plaintiff has filed an opposition to the motion, and defendants have filed a 

reply. 

For the reasons discussed below, the court will recommend that defendants’ motion for 

summary judgment be granted.

BACKGROUND

Plaintiff is proceeding on an amended complaint against defendants Dr. Gyaami and Dr. 

Calderon. Therein, plaintiff alleges that defendant Dr. Gyaami failed to provide him with 

adequate dental care. For example, plaintiff alleges that Dr. Gyaami forced plaintiff to “flop 

around like [a] fish” in the dental chair during a teeth cleaning and never provided him with an 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 1 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

anesthetic during the procedure. Plaintiff also alleges that defendant Dr. Calderon, defendant Dr. 

Gyaami’s supervisor, covered up defendant Dr. Gyaami’s improper conduct and included false 

statements in reports addressing defendant Dr. Gyaami’s conduct. In terms of relief, plaintiff 

requests damages as well as an independent dental examination and further dental treatment. 

(Am. Compl. at 5-5f & Ex. C.)

SUMMARY JUDGMENT STANDARDS UNDER RULE 56

Summary judgment is appropriate when the moving party “shows that there is no genuine 

dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. 

Civ. P. 56(a).

Under summary judgment practice, the moving party “initially bears the burden of 

proving the absence of a genuine issue of material fact.” In re Oracle Corp. Securities Litigation, 

627 F.3d 376, 387 (9th Cir. 2010) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)). 

The moving party may accomplish this by “citing to particular parts of materials in the record, 

including depositions, documents, electronically store information, affidavits or declarations, 

stipulations (including those made for purposes of the motion only), admission, interrogatory 

answers, or other materials” or by showing that such materials “do not establish the absence or 

presence of a genuine dispute, or that the adverse party cannot produce admissible evidence to 

support the fact.” Fed. R. Civ. P. 56(c)(1)(A), (B). 

When the non-moving party bears the burden of proof at trial, “the moving party need 

only prove that there is an absence of evidence to support the nonmoving party’s case.” Oracle 

Corp., 627 F.3d at 387 (citing Celotex, 477 U.S. at 325.). See also Fed. R. Civ. P. 56(c)(1)(B). 

Indeed, summary judgment should be entered, after adequate time for discovery and upon motion, 

against a party who fails to make a showing sufficient to establish the existence of an element 

essential to that party’s case, and on which that party will bear the burden of proof at trial. See

Celotex, 477 U.S. at 322. “[A] complete failure of proof concerning an essential element of the 

nonmoving party’s case necessarily renders all other facts immaterial.” Id. In such a 

circumstance, summary judgment should be granted, “so long as whatever is before the district 

court demonstrates that the standard for entry of summary judgment, . . ., is satisfied.” Id. at 323.

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 2 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3

If the moving party meets its initial responsibility, the burden then shifts to the opposing 

party to establish that a genuine issue as to any material fact actually does exist. See Matsushita 

Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). In attempting to establish the 

existence of this factual dispute, the opposing party may not rely upon the allegations or denials 

of its pleadings but is required to tender evidence of specific facts in the form of affidavits, and/or 

admissible discovery material, in support of its contention that the dispute exists. See Fed. R. 

Civ. P. 56(c)(1); Matsushita, 475 U.S. at 586 n.11. The opposing party must demonstrate that the 

fact in contention is material, i.e., a fact that might affect the outcome of the suit under the 

governing law, see Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986); T.W. Elec. Serv., 

Inc. v. Pacific Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 1987), and that the dispute is 

genuine, i.e., the evidence is such that a reasonable jury could return a verdict for the nonmoving 

party, see Wool v. Tandem Computers, Inc., 818 F.2d 1433, 1436 (9th Cir. 1987).

In the endeavor to establish the existence of a factual dispute, the opposing party need not 

establish a material issue of fact conclusively in its favor. It is sufficient that “the claimed factual 

dispute be shown to require a jury or judge to resolve the parties’ differing versions of the truth at 

trial.” T.W. Elec. Serv., 809 F.2d at 631. Thus, the “purpose of summary judgment is to ‘pierce 

the pleadings and to assess the proof in order to see whether there is a genuine need for trial.’” 

Matsushita, 475 U.S. at 587 (citations omitted).

“In evaluating the evidence to determine whether there is a genuine issue of fact,” the 

court draws “all reasonable inferences supported by the evidence in favor of the non-moving 

party.” Walls v. Central Costa County Transit Authority, 653 F.3d 963, 966 (9th Cir. 2011). It is 

the opposing party’s obligation to produce a factual predicate from which the inference may be 

drawn. See Richards v. Nielsen Freight Lines, 602 F. Supp. 1224, 1244-45 (E.D. Cal. 1985), 

aff’d, 810 F.2d 898, 902 (9th Cir. 1987). Finally, to demonstrate a genuine issue, the opposing 

party “must do more than simply show that there is some metaphysical doubt as to the material 

facts . . . . Where the record taken as a whole could not lead a rational trier of fact to find for the 

nonmoving party, there is no ‘genuine issue for trial.’” Matsushita, 475 U.S. at 587 (citation 

omitted).

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 3 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

4

OTHER APPLICABLE LEGAL STANDARDS

I. Civil Rights Act Pursuant to 42 U.S.C. § 1983

The Civil Rights Act under which this action was filed provides as follows:

Every person who, under color of [state law] . . . subjects, or causes 

to be subjected, any citizen of the United States . . . to the 

deprivation of any rights, privileges, or immunities secured by the 

Constitution . . . shall be liable to the party injured in an action at 

law, suit in equity, or other proper proceeding for redress. 

42 U.S.C. § 1983. The statute requires that there be an actual connection or link between the 

actions of the defendants and the deprivation alleged to have been suffered by plaintiff. See 

Monell v. Department of Social Servs., 436 U.S. 658 (1978); Rizzo v. Goode, 423 U.S. 362 

(1976). “A person ‘subjects’ another to the deprivation of a constitutional right, within the 

meaning of § 1983, if he does an affirmative act, participates in another’s affirmative acts or 

omits to perform an act which he is legally required to do that causes the deprivation of which 

complaint is made.” Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978).

Moreover, supervisory personnel are generally not liable under § 1983 for the actions of 

their employees under a theory of respondeat superior and, therefore, when a named defendant 

holds a supervisorial position, the causal link between him and the claimed constitutional 

violation must be specifically alleged. See Fayle v. Stapley, 607 F.2d 858, 862 (9th Cir. 1979); 

Mosher v. Saalfeld, 589 F.2d 438, 441 (9th Cir. 1978). Vague and conclusory allegations 

concerning the involvement of official personnel in civil rights violations are not sufficient. See

Ivey v. Board of Regents, 673 F.2d 266, 268 (9th Cir. 1982).

II. The Eighth Amendment and Inadequate Dental Care

The unnecessary and wanton infliction of pain constitutes cruel and unusual punishment 

prohibited by the Eighth Amendment. Whitley v. Albers, 475 U.S. 312, 319 (1986); Ingraham v. 

Wright, 430 U.S. 651, 670 (1977); Estelle v. Gamble, 429 U.S. 97, 105-06 (1976). In order to 

prevail on a cruel and unusual punishment claim, a prisoner must allege and prove that 

objectively he suffered a sufficiently serious deprivation and that subjectively prison officials 

acted with deliberate indifference in allowing or causing the deprivation to occur. Wilson v. 

Seiter, 501 U.S. 294, 298-99 (1991).

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 4 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

5

There is no question that “[d]ental care is one of the most important medical needs of 

inmates.” Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989) (quoting Ramos v. Lamm, 

639 F.2d 559, 576 (10th Cir. 1980). To prevail on an Eighth Amendment claim that arises in this

context, the prisoner must allege and prove “acts or omissions sufficiently harmful to evidence 

deliberate indifference to serious medical needs.” Estelle, 429 U.S. at 106. An Eighth 

Amendment claim has two elements: “the seriousness of the prisoner’s medical need and the 

nature of the defendant’s response to that need.” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th 

Cir. 1991), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 

1997) (en banc).

A medical need is serious “if the failure to treat the prisoner’s condition could result in 

further significant injury or the ‘unnecessary and wanton infliction of pain.’” McGuckin, 974 

F.2d at 1059 (quoting Estelle, 429 U.S. at 104). Indications of a serious medical need include 

“the presence of a medical condition that significantly affects an individual’s daily activities.” Id.

at 1059-60. By establishing the existence of a serious medical need, a prisoner satisfies the 

objective requirement for proving an Eighth Amendment violation. Farmer v. Brennan, 511 U.S. 

825, 834 (1994).

If a prisoner establishes the existence of a serious medical need, he must then show that 

prison officials responded to the serious medical need with deliberate indifference. See Farmer, 

511 U.S. at 834. In general, deliberate indifference may be shown when prison officials deny, 

delay, or intentionally interfere with medical treatment, or may be shown by the way in which 

prison officials provide medical care. Hutchinson v. United States, 838 F.2d 390, 393-94 (9th

Cir. 1988). Before it can be said that a prisoner’s civil rights have been abridged with regard to 

medical care, however, “the indifference to his medical needs must be substantial. Mere 

‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not support this cause of action.” 

Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 1980) (citing Estelle, 429 U.S. at 

105-06). See also Toguchi v. Soon Hwang Chung, 391 F.3d 1051, 1057 (9th Cir. 2004) (“Mere

negligence in diagnosing or treating a medical condition, without more, does not violate a 

prisoner’s Eighth Amendment rights.”); McGuckin, 974 F.2d at 1059 (same). Deliberate 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 5 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

6

indifference is “a state of mind more blameworthy than negligence” and “requires ‘more than 

ordinary lack of due care for the prisoner’s interests or safety.’” Farmer, 511 U.S. at 835.

Delays in providing medical care may manifest deliberate indifference. Estelle, 429 U.S. 

at 104-05. To establish a claim of deliberate indifference arising from delay in providing care, a 

plaintiff must show that the delay was harmful. See Hallett v. Morgan, 296 F.3d 732, 745-46 (9th 

Cir. 2002); Berry v. Bunnell, 39 F.3d 1056, 1057 (9th Cir. 1994); McGuckin, 974 F.2d at 1059; 

Wood v. Housewright, 900 F.2d 1332, 1335 (9th Cir. 1990); Hunt v. Dental Dep’t, 865 F.2d 198, 

200 (9th Cir. 1989); Shapley v. Nevada Bd. of State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 

1985). In this regard, “[a] prisoner need not show his harm was substantial; however, such would

provide additional support for the inmate’s claim that the defendant was deliberately indifferent to 

his needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). 

Finally, mere differences of opinion between a prisoner and prison medical staff or 

between medical professionals as to the proper course of treatment for a medical condition do not 

give rise to a § 1983 claim. See Snow v. McDaniel, 681 F.3d 978, 988 (9th Cir. 2012); Toguchi, 

391 F.3d at 1058; Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996); Sanchez v. Vild, 891 

F.2d 240, 242 (9th Cir. 1989); Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981).

DEFENDANTS’ STATEMENT OF UNDISPUTED FACTS AND EVIDENCE 

Defense counsel has submitted a statement of undisputed facts supported by declarations

signed under penalty of perjury by defendants Dr. Gyaami and Dr. Calderon. That statement of 

undisputed facts is also supported by citations to plaintiff’s dental records, his requests for health 

care services, and his inmate appeals and prison officials’ responses thereto. The evidence 

submitted by the defendants in support of the pending motion for summary judgment establishes 

the following.

From June 6, 2008, to the present, plaintiff has been confined at California Medical 

Facility (“CMF”). Defendants Dr. Gyaami and Dr. Calderon (who is defendant Dr. Gyaami’s 

supervisor) are both dentists. At the time this action arose, both were employed by the California 

Department of Corrections at CMF. On January 19, 2009, plaintiff sought treatment for a crown 

that had come off a molar tooth (tooth 18). On February 3, 2009, in response to plaintiff’s health 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 6 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

7

care services request, Dr. Sorunke examined plaintiff, removed old cement from the crown, recemented the crown on the tooth, and scheduled plaintiff for a comprehensive examination. 

(Defs.’ SUDF 3-6, Exs. C-D, Gyaami Decl.) 

On June 3, 2009, plaintiff saw defendant Dr. Gyaami for a comprehensive dental exam. 

During the exam, defendant Dr. Gyaami noted light tartar, plaque, and bone loss, and diagnosed 

plaintiff has having generalized periodontitis, a condition indicative of poor oral hygiene over 

many years. Periodontitis is an inflammatory disease affecting the tissues surrounding and 

supporting the teeth that causes progressive loss of the alveolar bone around the teeth. If left 

untreated, periodontitis can lead to the loosening and subsequent loss of teeth. Measures to 

prevent periodontal disease include twice-daily brushing and daily flossing, rinsing daily with 

warm salt water, and teeth cleaning (or scaling) every three to six months. Brushing and flossing 

removes the plaque on the surface of and between the teeth. Rinsing with warm salt waters kills 

bacteria. Scaling removes accumulated calculus – hardened plaque that cannot be removed by 

brushing or flossing. Scaling is typically performed using a powered ultrasonic instrument with a 

vibrating metal tip that chips off the tartar and a water-spray to wash it and keep the tip cool. 

(Defs.’ SUDF 7-12, Ex. D, Gyaami Decl., Calderon Decl.) 

When healthy, teeth are very strong and are unlikely to be damaged by cleaning. If a 

patient’s teeth are soft or weak, however, ultrasonic scaling can chip off some of the surface 

enamel even when a dentist is careful and properly performs the scaling. When such chipping 

occurs, the tooth can usually be repaired by filling in any crevice or gap. Patients with 

periodontal disease who have not had their teeth cleaned for a long time are often unpleasantly 

surprised by defects that appear in their teeth when all the accumulated plaque and tartar are 

removed. (Defs.’ SUDF 13-14, Calderon Decl.)

Defendant Dr. Gyaami’s prescribed course of treatment for plaintiff’s periodontitis was 

for plaintiff to brush and floss better, rinse with warm salt water, and schedule another visit to 

have his teeth scaled. Plaintiff consented to Dr. Gyaami’s prescribed course of treatment. On 

July 21, 1999, defendant Dr. Gyaami scaled all of plaintiff’s teeth using a powered ultrasonic 

scaler. Customarily, scaling is performed without an anesthetic. But if a patient is sensitive or 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 7 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

8

requests an anesthetic, it is customary practice to note the patient’s sensitivity or request and 

administer an anesthetic, absent some reason not to do so. Before and during the scaling on July 

21, 2009, plaintiff did not state or otherwise indicate that he was in pain. Before and during the 

scaling on July 21, 2009, plaintiff requested no anesthetic, and defendant Dr. Gyaami 

administered none. At no time did plaintiff communicate to defendant Dr. Gyaami that he had 

any difficulty obtaining the items needed to follow defendant Dr. Gyaami’s prescribed course of 

treatment for his periodontitis. (Defs.’ SUDF 15-21, Ex. D, Gyaami Decl.) 

Defendant Dr. Gyaami next saw plaintiff on February 3, 2010, to re-cement the crown on 

plaintiff’s molar (tooth 18), which Dr. Sorunke had re-cemented on February 3, 2009, but had 

come off again. On that occasion, in addition to re-cementing the crown, defendant Dr. Gyaami 

noticed a cavity on the surface of plaintiff’s tooth 15 – known as a mesial cavity – which 

defendant Dr. Gyaami planned to fill on plaintiff’s next visit. At no time during defendant Dr. 

Gyaami’s session with plaintiff on February 3, 2010, did plaintiff complain about or mention any 

problem with defendant Dr. Gyaami’s scaling of his teeth on July 21, 2009. (Defs.’ SUDF 22-24, 

Ex. D, Gyaami Decl.) 

Defendant Dr. Gyaami next saw plaintiff on July 12, 2010, when he filled tooth 15 as had 

been planned on February 3, 2010, and also filled cavities on plaintiff’s teeth 4, 5, and 13. While 

filling plaintiff’s teeth on July 12, 2010, plaintiff did not complain about or mention any problem 

with the defendant’s scaling procedure on July 21, 2009, or any other treatment he gave to him. 

Later on July 12, 2010, plaintiff complained that defendant Dr. Gyaami’s filling of tooth 15 

resulted in that tooth being too tight against the adjacent tooth, preventing plaintiff from being 

able to floss. Defendant Dr. Gyaami attended to this complaint on July 29, 2010, when he used 

an abrasive strip to smooth the contact area and make flossing easier. During defendant Dr. 

Gyaami’s session with plaintiff on July 29, 2010, plaintiff expressed no complaint about 

defendant Dr. Gyaami’s scaling treatment on July 21, 2009 or any other treatment provided by the

defendant. (Defs.’ SUDF 25-29, Ex. D, Gyaami Decl.) 

On August 17, 2010, plaintiff requested dental care for another crown that had come off 

one of his molars (tooth 30). Defendant Dr. Gyaami saw plaintiff on August 23, 2010, and reCase 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 8 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

9

cemented the crown. During defendant Dr. Gyaami’s treatment session with plaintiff on August 

23, 2010, plaintiff expressed no complaint about defendant Dr. Gyaami’s scaling procedure on 

July 21, 2009 or any other treatment by the defendant. (Defs.’ SUDF 30-32, Ex. D, Gyaami 

Decl.) 

Plaintiff did not see defendant Dr. Gyaami again until May 23, 2012, when they met 

concerning an inmate appeal that plaintiff submitted on April 24, 2012. In that inmate appeal, 

plaintiff had complained about defendant Dr. Gyaami’s treatment and requested a different dentist 

and the repair of damage defendant Dr. Gyaami allegedly caused to plaintiff. When defendant 

Dr. Gyaami met with plaintiff on May 23, 2012, plaintiff refused to be interviewed by the 

defendant. Defendant Dr. Gyaami’s attempted interview with plaintiff was the last time that 

defendant Dr. Gyaami saw plaintiff. (Defs.’ SUDF 33-35, Ex. D, Gyaami Decl., Calderon Decl.)

As defendant Dr. Gyaami’s supervisor, defendant Dr. Calderon was responsible for 

responding to plaintiff’s inmate appeal regarding the treatment provided by Dr. Gyaami at the 

first level of review. In responding to plaintiff’s appeal, defendant Dr. Calderon reviewed 

plaintiff’s dental chart, which reflected that defendant Dr. Gyaami had treated plaintiff on six 

occasions from June 3, 2009, to August 23, 2010. Based on his review of plaintiff’s dental 

records, defendant Dr. Calderon found that defendant Dr. Gyaami’s prescribed course of dental; 

treatment for plaintiff’s periodontitis – to brush and floss better, rinse with warm salt water, and 

to schedule another visit to have his teeth scaled – was the correct treatment for plaintiff’s 

condition. Defendant Dr. Calderon also found that defendant Dr. Gyaami’s treatment of plaintiff 

concerning the crown replacements and filling of cavities was proper and that plaintiff had not 

complained about pain or expressed any other complaint about defendant Dr. Gyaami’s treatment 

until nearly two years after his last visit with defendant Dr. Gyaami. Based on his findings, 

defendant Dr. Calderon denied plaintiff’s inmate appeal at the first level of review and cancelled 

it because it was untimely under the governing prison regulations. In denying and canceling 

plaintiff’s inmate appeal at the first level of review, defendant Dr. Calderon did not cover up any 

improper conduct by defendant Dr. Gyaami. (Defs.’ SUDF 36-41, Exs. D-E, Calderon Decl.)

/////

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 9 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

10

Plaintiff appealed the cancellation of his inmate appeal directly to the Office of Third 

Level Appeals, which also cancelled that appeal and advised plaintiff on the procedure for 

appealing a cancelled appeal. On March 27, 2013, acting on the advice given by the Office of 

Third Level Appeals, plaintiff submitted a new appeal challenging the cancellation of his inmate 

appeal against defendant Dr. Gyaami. Plaintiff’s new inmate appeal ultimately resulted in the 

issuance of a modification order calling on CMF to process plaintiff’s inmate appeal beginning at 

the first level of review. In accordance with the modification order, the appeal was reviewed and 

partially granted at the first level by assigning a different dentist, Dr. Kapoor, to treat plaintiff –

and otherwise denied. The same decision was made at both the second and third levels of review. 

(Defs.’ SUDF 42-46, Ex. E.) 

Plaintiff next sought dental treatment on July 23, 2013, when he requested “emergency 

tooth repair” for a “severe toothache.” Plaintiff stated in his request that “Dr. Gyaami can’t 

perform the work” because by that time plaintiff had sued the defendant. On July 30, 2013, Dr. 

Hu saw plaintiff, noted defective fillings in and gross caries below the gingival or gum line of 

plaintiff’s teeth 1 and 2. He also found those teeth to be “nonrestorable” and proposed extracting 

them on plaintiff’s next visit. Plaintiff consented to Dr. Hu’s prescribed treatment, and Dr. Hu 

performed the extractions of teeth 1 and 2 on August 6, 2013. On August 12, 2013, Dr. Kapoor 

saw plaintiff for a post-operation check-up. Plaintiff reported no pain, and Dr. Kapoor advised 

him to avoid chewing on the right side of his mouth. Plaintiff advised Dr. Kapoor of a tooth in 

the left upper posterior, which Dr. Kapoor noted was tooth 15 and needed an evaluation for a 

broken cusp. (Defs.’ SUDF 47-54, Ex. D.) 

A frequent cause of fractured cusps is inadequate dentin support of cusps from extensive 

caries or large restorations. They are not caused by a dentist scaling tartar from teeth. Dr. 

Kappor found gross decay in the roots of tooth 15 and decay in teeth 13, 14, and 18. Based on his 

assessment of plaintiff’s condition, Dr. Kapoor planned to extract plaintiff’s tooth 15, which was 

not restorable, and to replace the crowns in plaintiff’s teeth 13, 14, and 18. Plaintiff consented to 

Dr. Kapoor’s treatment plan on December 12, 2013. However, on January 9, 2014, plaintiff 

refused to have tooth 15 extracted, citing a need to clarify the need to extract the tooth “for legal 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 10 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

11

reasons.” On March 13, 2014, plaintiff requested that Dr. Kappor put a crown on tooth 15 –

despite Dr. Kapoor's explanation that tooth 15 was non-restorable because of decay into the roots 

– and refused treatment on his other teeth. (Defs.’ SUDF 55-60, Ex. D, Calderon Decl.) 

According to defendant Dr. Gyaami’s declaration, he strives to provide the best possible 

dental care to his patients and did so during his treatment of plaintiff. At no time during his 

treatment of plaintiff did defendant Dr. Gyaami intentionally or knowingly disregard any risk of 

harm to plaintiff or cause him any harm. (Defs.’ SUDF 61-62, Gyaami Decl.) 

ANALYSIS

Based on the undisputed evidence submitted in connection with the pending motion, the 

undersigned finds that the defendants are entitled to summary judgment in their favor on the 

merits of plaintiff’s Eighth Amendment deliberate indifference claim. As an initial matter, the 

undersigned finds that based on the evidence submitted on summary judgment and described 

above, the defendants have borne their initial burden of demonstrating that there is no genuine 

issue of material fact with respect to the adequacy of the care they provided to plaintiff in 

connection with the plaintiff’s dental needs.

Thus, given the evidence submitted by the defendants in support of the pending motion for 

summary judgment, the burden shifts to plaintiff to establish the existence of a genuine issue of 

material fact with respect to his inadequate dental care claim. The court has reviewed plaintiff’s 

verified complaint and his opposition to defendants’ pending motion. The court finds, as both 

parties acknowledge, that there is a factual dispute in this case concerning defendant Dr. 

Gyaami’s care during plaintiff’s dental cleaning on July 21, 2009. On the one hand, defendant 

Dr. Gyaami maintains that plaintiff did not state or indicate in any way that he was in pain and he 

did not request an anesthetic during his cleaning. On the other hand, plaintiff maintains that on 

July 21, 2009, he informed defendant Dr. Gyaami that he was suffering extreme pain and 

sensitivity, but the defendant refused to stop the treatment or provide plaintiff with an anesthetic

to reduce his suffering.

Notwithstanding this factual dispute, the court concludes that based on the record in this 

case, the defendants are entitled to judgment as a matter of law. First, viewing the evidence in the 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 11 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

12

light most favorable to plaintiff, plaintiff has not satisfied the objective component for an Eighth 

Amendment violation. It is well established that an Eighth Amendment deprivation “must be, 

objectively, ‘sufficiently serious’ and result in the denial of ‘the minimal civilized measure of 

life’s necessities.” Farmer, 511 U.S. at 834. Plaintiff’s alleged need for an anesthetic during a 

dental cleaning is not documented in his dental records or supported by medical evidence and is

not the type of objectively serious medical need that triggers constitutional protection provided by 

the Eighth Amendment’s Cruel and Unusual Punishment Clause. See McGuckin, 974 F.2d at 

1059-60 (“The existence of an injury that a reasonable doctor or patient would find important and 

worthy of comment or treatment; the presence of a medical condition that significantly affects an 

individual’s daily activities; or the existence of chronic and substantial pain are examples of 

indications that a prisoner has a ‘serious’ need for medical treatment.”); Doty v. County of 

Lassen, 37 F.3d 540, 546 (9th Cir. 1994) (“The ‘routine discomfort’ that results from 

incarceration and which is ‘part of the penalty that criminal offenders pay for their offenses 

against society’ does not constitute a ‘serious’ medical need.”). 

Although the Ninth Circuit has not specifically addressed the precise circumstances before 

this court, as defense counsel observes, a federal court in Michigan has analyzed a similar 

deliberate indifference claim based on allegedly inadequate dental care. Bout v. Bolden, 22 F. 

Supp. 2d 646 (E.D. Mich. 1998), aff’d 225 F.3d 658 (6th Cir. 2000). That court rejected a 

prisoner’s characterization of his serious medical need as one for anesthesia, explaining: 

Plaintiff’s “serious medical need” was not for anesthesia, but rather 

for tooth repair. Plaintiff’s disagreement with the course of 

treatment – the decision to drill without anesthesia rather than 

further delay treatment given the minor nature of the repair and 

relatively brief period of pain – does not state a constitutional 

claim. Had [the dentist] gratuitously drilled plaintiff’s teeth for no 

good medical reason, then the evidence would clearly support a 

finding of willful and wanton infliction of pain and plaintiff would 

have supported a direct claim for cruel and unusual punishment 

contrary to the Eighth Amendment. However, where pain was an 

incidental part of a dentist’s chosen course of treatment, the 

question is not whether [the dentist] was indifferent to the 

incidental pain, but rather whether he was indifferent to the 

plaintiff’s existing dental condition. Plaintiff conceivably may have 

some other claim against [the dentist] – for battery, perhaps, for 

malpractice, perhaps – but he does not have a constitutional claim 

arising out of his treatment . . . . 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 12 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

13

Bout, 22 F. Supp. 2d at 651.

1

 Under this line of reasoning, plaintiff’s “serious medical need” in 

this case was for treatment of his periodontitis. That plaintiff may have experienced pain as an 

incidental part of the course of treatment provided for that condition fails to state a cognizable 

constitutional claim. 

In any event, even if plaintiff could satisfy the objective component of an Eighth 

Amendment violation, he has not come forward with any evidence satisfying the subjective 

component. Specifically, before it could be said that defendant Dr. Gyaami violated plaintiff’s 

right to adequate dental care, the defendant’s indifference to plaintiff’s dental needs would need 

to be substantial. Only indifference that offends “evolving standards of decency” violates the 

Eighth Amendment. Estelle, 429 U.S. at 106. Here, plaintiff’s deliberate indifference claim 

against defendant Dr. Gyaami is based on the defendant’s refusal to provide him with an 

anesthetic during a single dental cleaning. Again, viewing the evidence in the light most 

favorable to plaintiff, based on the record before this court, defendant Dr. Gyaami’s refusal is not 

the kind of indifference that could fairly be classified as rising to the level of “repugnant to the 

conscience of mankind.” Estelle, 429 U.S. at 106.

 

1

The district court in Bout relied in part on the decision in Snipes v. DeTelle, 95 F.3d 586 (7th 

Cir. 1996). In that case the Seventh Circuit held that removal of a toenail without the use of 

anesthetic should be viewed as a course of treatment, and that even if the desire for anesthetic 

were a separable medical need, denial of that need was not objectively sufficiently serious to 

constitute the denial of the minimal civilized measure of life’s necessities, regardless of the 

doctor’s motives, because it is not the type of barbaric treatment the Eighth Amendment 

prohibits. 95 F.3d at 591-92. Accordingly, the court rejected a prisoner’s contention that “a risk 

of needless pain” was enough to bring a claim within the purview of the Eighth Amendment:

To say the Eighth Amendment requires prison doctors to keep an 

inmate pain-free in the aftermath of proper medical treatment would 

be absurd. It would also be absurd to say . . . that the Constitution 

requires prison doctors to administer the least painful treatment. 

That may be preferable, but the Constitution is not a medical code 

that mandates specific medical treatment. . . .

Whether and how pain associated with medical treatment should be 

mitigated is for doctors to decide free from judicial interference, 

except in the most extreme situations. 

Id. at 592.

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 13 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

14

At most, plaintiff has asserted a claim for negligence and/or one based on a mere 

difference of opinion as to the appropriate course of medical treatment for his condition in 

connection with his dental cleaning as well as the other dental care defendant Gyaami provided

him. However, it is well established that mere ‘indifference,’ ‘negligence,’ or ‘medical 

malpractice’ will not support this cause of action.” Broughton, 622 F.2d at 460 (9th Cir. 1980) 

(citing Estelle, 429 U.S. at 105-06). See also Wood, 900 F.2d at 1334 (“In determining deliberate 

indifference, we scrutinize the particular facts and look for substantial indifference in the 

individual case, indicating more than mere negligence or isolated occurrences of neglect.”); 

McGuckin, 974 F.2d at 1060 (an “isolated occurrence” or “isolated exception” to a defendant’s 

overall treatment which militates against finding deliberate indifference). 

It is also well established that a mere difference of opinion between a prisoner and prison

medical personnel as to the proper course of medical care does not give rise to a cognizable § 

1983 claim. See Snow, 681 F.3d at 988; Jackson, 90 F.3d at 332; Sanchez, 891 F.2d at 242; 

Franklin, 662 F.2d at 1344; see also Fleming v. Lefevere, 423 F. Supp. 2d 1064, 1070 (C.D. Cal. 

2006) (“Plaintiff’s own opinion as to the appropriate course of care does not create a triable issue 

of fact because he has not shown that he has any medical training or expertise upon which to base 

such an opinion.”). To establish that a difference of medical opinion as to the appropriate course 

of treatment amounted to deliberate indifference, plaintiff must “show that the course of treatment 

the doctors chose was medically unacceptable under the circumstances” and that “they chose this 

course in conscious disregard of an excessive risk to [the prisoner’s] health.” Jackson, 90 F.3d at 

332. See also Toguchi, 391 F.3d at 1058. 

In this case, plaintiff has not come forward with any evidence demonstrating that the 

course of treatment provided by defendant Dr. Gyaami, and tacitly approved defendant Dr. 

Calderon who reviewed plaintiff’s inmate appeal, was medically unacceptable under the 

circumstances.

2

 Plaintiff also has not come forward with any competent evidence demonstrating

 

2

Insofar as plaintiff claims that defendant Dr. Calderon violated his constitutional rights by 

cancelling his initial inmate appeal as untimely, he fails to state a cognizable claim for relief. 

Prison officials are not required under federal law to process inmate grievances in a specific way 

or to respond to them in a favorable manner. Even if prison officials delay, deny, or erroneously 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 14 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

15

that defendants chose or approved of plaintiff’s course of treatment in conscious disregard of an 

excessive risk to his health. By merely expressing his opinion in this regard, plaintiff fails to 

create a genuine issue of material fact. See, e.g., Hansen v. United States, 7 F.3d 137, 138 (9th 

Cir.1993) (“When the non-moving party relies on its own affidavits to oppose summary 

judgment, it cannot rely on conclusory allegations unsupported by factual data to create an issue 

of material fact.”); Fed. R. Civ. P. 56(c)(4) (“An affidavit or declaration used to support or oppose 

a motion must be made on personal knowledge, set out facts that would be admissible in 

evidence, and show that the affiant or declarant is competent to testify on the matters stated.”).3

/////

 

screen out a prisoner’s inmate grievance, they have not deprived him of a federal constitutional 

right. This is because “inmates lack a separate constitutional entitlement to a specific prison 

grievance procedure.” Ramirez v. Galaza, 334 F.3d 850, 860 (9th Cir. 2003) (citing Mann v. 

Adams, 855 F.2d 639, 640 (9th Cir. 1988)). See also, e.g., Wright v. Shannon, No. CIV F-05-

1485 LJO YNP PC, 2010 WL 445203 at *5 (E.D. Cal. Feb. 2, 2010) (plaintiff’s allegations that 

prison officials denied or ignored his inmate appeals failed to state a cognizable claim under the 

First Amendment); Walker v. Vazquez, No. CIV F-09-0931 YNP PC, 2009 WL 5088788 at *6-7 

(E.D. Cal. Dec. 17, 2009) (plaintiff’s allegations that prison officials failed to timely process his 

inmate appeals failed to a state cognizable under the Fourteenth Amendment); Towner v. 

Knowles, No. CIV S-08-2833 LKK EFB P, 2009 WL 4281999 at *2 (E.D. Cal. Nov. 20, 2009) 

(plaintiff’s allegations that prison officials screened out his inmate appeals without any basis 

failed to indicate a deprivation of federal rights); Williams v. Cate, No. F-09-0468 OWW YNP 

PC, 2009 WL 3789597 at *6 (E.D. Cal. Nov. 10, 2009) (“Plaintiff has no protected liberty interest 

in the vindication of his administrative claims.”). 

3

The undersigned notes that in other contexts, courts within this circuit have consistently 

rejected a prisoner’s attempt to dictate the terms of their pain medication. See, e.g., Parlin v. 

Sodhi, No. 10–6120 VBF (MRW), 2012 WL 5411710 at *4 (C.D. Cal. Aug. 8, 2012) (“At its 

core, Plaintiff’s claim is that he did not receive the type of treatment and pain medication that he 

wanted when he wanted it. His preference for stronger medication – Vicodin, Tramadol, etc., –

represents precisely the type of difference in medical opinion between a lay prisoner and medical 

personnel that is insufficient to establish a constitutional violation.”); Tran v. Haar, No. CV 10–

07740 CJC (SS), 2012 WL 37506 at *3–4 (C.D. Cal. Jan. 9, 2012) (plaintiff’s allegations that 

defendants refused to prescribe “effective medicine” such as Vicodin and instead prescribed 

Ibuprofen and Naproxen reflected a difference of opinion between plaintiff and defendants as to 

the proper medication necessary to relieve plaintiff’s pain and failed to state an Eighth 

Amendment claim); Ruiz v. Akintola, No. CIV S–09–0318 JAM GGH P, 2010 WL 1006435 at

*7 (E.D. Cal. Mar. 17, 2010) (granting summary judgment in favor of defendants on plaintiff’s 

inadequate medical care claim where he presented no expert evidence that the Ultram which 

defendants prescribed, instead of the Norco that U.C. Davis physicians had recommended, was 

not medically warranted or reasonable), aff'd No. 10–16516 (9th Cir. Nov. 2, 2011). 

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 15 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

16

Accordingly, for all of the reasons discussed above, the undersigned will recommend that 

defendants’ motion for summary judgment be granted.4 

OTHER MATTERS

Insofar as plaintiff asserts state law tort claims in his amended complaint, a district court 

may decline to exercise supplemental jurisdiction over state law claims if the district court has 

dismissed all claims over which it has original jurisdiction. 28 U.S.C. § 1367(c)(3). The court’s

discretion to decline jurisdiction over state law claims is informed by the values of judicial 

economy, fairness, convenience, and comity. Acri v. Varian Associates, 114 F.3d 999, 1001 (9th 

Cir. 1997) (en banc). In addition, “[t]he Supreme Court has stated, and [the Ninth Circuit] ha[s] 

often repeated, that ‘in the usual case in which all federal law claims are eliminated before trial, 

the balance of factors . . . will point toward declining to exercise jurisdiction over the remaining 

state law claims.’” Id. (quoting Carnegie-Mellon Univ. v. Cohill, 484 U.S. 343, 350 n.7 (1988)).

Of course, “primary responsibility for developing and applying state law rests with the 

state courts.” Curiel v. Barclays Capital Real Estate, Civ. No. S–09–3074 FCD KJM, 2010 WL 

729499 at *1 (E.D. Cal. Mar. 2, 2010). Here, consideration of judicial economy, fairness, 

convenience, and comity all point toward declining to exercise supplemental jurisdiction. 

Therefore, the undersigned will recommend declining to exercise supplemental jurisdiction over 

plaintiff’s state law claims.

CONCLUSION

IT IS HEREBY ORDERED that the Clerk of the Court is directed to randomly assign a 

United States District Judge to this action.

IT IS HEREBY RECOMMENDED that:

1. Defendants’ motion for summary judgment (Doc. No. 26) be granted; 

2. The court decline to exercise supplemental jurisdiction over any state law claims and 

dismiss any state law claims without prejudice to plaintiff re-filing them in state court; and

 

4

In light of the recommendation set forth in these findings and recommendations, the 

undersigned declines to address defendants’ alternative argument that they are entitled to 

summary judgment in their favor based on the affirmative defense of qualified immunity.

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 16 of 17
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

17

3. This action be closed.

These findings and recommendations are submitted to the United States District Judge 

assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within fourteen days 

after being served with these findings and recommendations, any party may file written 

objections with the court and serve a copy on all parties. Such a document should be captioned 

“Objections to Magistrate Judge’s Findings and Recommendations.” Any response to the 

objections shall be filed and served within seven days after service of the objections. The parties 

are advised that failure to file objections within the specified time may waive the right to appeal 

the District Court’s order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991). 

Dated: June 1, 2015

DAD:9

alfo2143.57msj

Case 2:13-cv-02143-KJM-DAD Document 33 Filed 06/02/15 Page 17 of 17