Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_18-cv-01631/USCOURTS-azd-2_18-cv-01631-4/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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SKC

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Edward Lamar Carpenter,

Plaintiff, 

v. 

Charles L. Ryan, et al.,

Defendants.

No. CV 18-01631-PHX-DGC (JFM)

ORDER

Plaintiff Edward Lamar Carpenter, confined in the Arizona State Prison Complex 

(ASPC)-Lewis, brought this civil rights action pursuant to 42 U.S.C. § 1983. Defendant

Dr. Larry Russell, DDS, moves for summary judgment. (Doc. 136.) Plaintiff was 

informed of his rights and obligations to respond by December 20, 2019, pursuant to Rand 

v. Rowland, 154 F.3d 952, 962 (9th Cir. 1998) (en banc) (Doc. 138). On January 9, 2020, 

Plaintiff filed a belated Response without seeking leave to do so. (Doc. 162.) Although 

Plaintiff’s Response is untimely and does not comply with the procedural rules, the Court 

has considered the Response and exhibits to the extent they are relevant. Because the Court 

finds that summary judgment is warranted, Defendant is not prejudiced by the inability to 

file a reply. The Court will grant the Motion for Summary Judgment.

I. Background

On screening of Plaintiff’s four-count Second Amended Complaint under 28 U.S.C. 

§ 1915A(a), the Court determined that Plaintiff stated Eighth Amendment medical care 

claims against several Defendants, including a dental care claim in Count Four against 

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Defendant Russell based on Russell’s alleged failure to clean Plaintiff’s teeth. (Docs. 12,

28.) The Court has since granted summary judgment to all other Defendants (see

Doc. 159). Plaintiff’s Eight Amendment claim against Defendant Russell is the sole 

remaining claim in this action.

II. Summary Judgment Standard

A court must grant summary judgment “if the movant 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); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). The 

movant bears the initial responsibility of presenting the basis for its motion and identifying 

those portions of the record, together with affidavits, if any, that it believes demonstrate 

the absence of a genuine issue of material fact. Celotex, 477 U.S. at 323.

If the movant fails to carry its initial burden of production, the nonmovant need not 

produce anything. Nissan Fire & Marine Ins. Co., Ltd. v. Fritz Co., Inc., 210 F.3d 1099, 

1102-03 (9th Cir. 2000). But if the movant meets its initial responsibility, the burden shifts 

to the nonmovant to demonstrate the existence of a factual dispute and that the fact in 

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

governing law, and that the dispute is genuine, i.e., the evidence is such that a reasonable 

jury could return a verdict for the nonmovant. Anderson v. Liberty Lobby, Inc., 477 U.S. 

242, 248, 250 (1986); see Triton Energy Corp. v. Square D. Co., 68 F.3d 1216, 1221 (9th 

Cir. 1995). The nonmovant need not establish a material issue of fact conclusively in its 

favor, First Nat’l Bank of Ariz. v. Cities Serv. Co., 391 U.S. 253, 288-89 (1968); however, 

it must “come forward with specific facts showing that there is a genuine issue for trial.” 

Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) (internal 

citation omitted); see Fed. R. Civ. P. 56(c)(1).

At summary judgment, the judge’s function is not to weigh the evidence and 

determine the truth but to determine whether there is a genuine issue for trial. Anderson, 

477 U.S. at 249. In its analysis, the court must believe the nonmovant’s evidence and draw 

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all inferences in the nonmovant’s favor. Id. at 255. The court need consider only the cited 

materials, but it may consider any other materials in the record. Fed. R. Civ. P. 56(c)(3). 

III. Facts1

On March 24, 2011, on initial intake, Plaintiff was given a dental examination in 

which he was found to have generalized bone loss and early/moderate periodontal disease. 

(Doc. 137 (Def.’s Statement of Facts) ¶ 3.) On September 26, and October 3, 2011, 

Plaintiff failed to show up for scheduled dental appointments. (Id. ¶ 4.) On October 17, 

2011, Plaintiff underwent a teeth cleaning. (Id. ¶ 5.) 

Two years later, on May 20, 2013, Plaintiff went to dental for a cleaning and 

underwent a full mouth debridement and hand scaled cleaning. (Id. ¶ 6.) The progress 

notes from this visit indicate that Plaintiff had advanced periodontitis and poor oral 

hygiene. (Id.) 

After two more years, on July 13, 2015, Plaintiff went to dental for another cleaning. 

(Id. ¶ 7.) The progress notes document that Plaintiff had advanced periodontitis, tooth #14 

had palatal root fully exposed without bone coverage, tooth #30 was very mobile and had 

to be held down for cleaning, and tooth #24 was dangling from the gum tissue only. (Id.) 

Plaintiff was instructed to submit a Health Needs Request (HNR) for a dental exam, and 

he indicated he understood and would do so. (Doc. 137-1 at 9.)2 On July 16, 2015, Plaintiff 

submitted an HNR, requesting “new appointment for dentist to do x[-]rays on conditions 

found during cleaning,” and he was placed on the routine care list. (Id. at 12.)

1 Plaintiff did not file a controverting statement of facts, but because a verified 

complaint may be used as an affidavit opposing summary judgment if it is based on 

personal knowledge and sets forth specific facts admissible in evidence, the Court will, 

where relevant, consider the allegations set forth in Plaintiff’s verified Second Amended 

Complaint. See Jones v. Blanas, 393 F.3d 918, 923 (9th Cir. 2004); Schroeder v. 

McDonald, 55 F.3d 454, 460 (9th Cir. 1995). Where Defendant’s facts are not clearly 

contradicted by Plaintiff’s sworn allegations or other evidence in the record, the Court will 

consider those facts undisputed.

2 The citation refers to the document and page number generated by the Court’s 

Case Management/Electronic Case Filing system.

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On August 3, 2015, Plaintiff refused his dental appointment and signed a refusal 

form. (Id. at 14, 16.) As his reason, he wrote “getting out believe court response is 

coming.” (Id. at 16.) 

Nearly three years later, on June 15, 2018, Plaintiff saw Defendant for a “call back” 

visit. (Id. at 18.) The Subjective Notes section from this visit indicates that, on March 4, 

2018, Plaintiff presented to dental with part of the “cap” coming off his lower right molar

and requesting “partials,” and on May 3, 2018, he submitted a request for a cleaning, 

stating, “Need cleaning and dental work haven’t been cleaned in two years.” (Id.)

3

 

At the June 15, 2018 visit, Plaintiff refused treatment and signed a refusal form, 

giving as his reason: “Don’t want tooth out need care.” (Id. ¶ 24.) Plaintiff alleges in the 

Second Amended Complaint that he requested to have his teeth cleaned, and Defendant 

confirmed that Plaintiff needed a deep cleaning but insisted, instead, on pulling his teeth, 

thereby “exposing [him] to a vicious cycle of [his] teeth rotting or falling out because 

Dental will not clean [his] teeth.” (Doc. 13 at 8.)

One week later, on June 22, 2018, Defendant saw Plaintiff for a dental exam, at

which time Plaintiff was given four bitewing and three panoramic x-rays. (Doc. 137 ¶ 13.) 

Upon examination and charting, Defendant noted that Plaintiff had advanced periodontal 

disease and indicated several teeth that required extraction. (Doc. 137-1 at 27.) Under his 

Assessment Notes, Defendant noted class III-IV periodontal disease with advanced bone 

loss and mobility and that the prognosis was “reduced for retaining many natural teeth.” 

(Id. at 27.) Defendant’s treatment plan called for FMD (full mouth debridement) and 

extractions of teeth 30, 11, and 29. (Id. at 29.)

3 Defendant claims that from August 3, 2015 to March 3, 2018, Plaintiff’s records 

do not show he filed any HNRs. (Doc. 137 ¶ 11.) But Defendant does not provide any 

facts regarding how these records are kept or an affidavit from anyone who searched 

Plaintiff’s records and is competent to make this claim. The only evidence Defendant cites 

is the record of Plaintiff’s June 15, 2018 dental visit, showing that Plaintiff requested dental 

care on March 3, 2018 and May 3, 2018. (Doc. 137-1 at 18.) This evidence does not show 

what transpired before these dates. Whether Plaintiff requested dental care during the prior 

three-year period is a question of fact that the Court must resolve in Plaintiff’s favor.

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On July 4, 2018, Plaintiff submitted an HNR, marked “URGENT QUIT 

REFUSING ME TREATMENT.” (Id. at 31.) He requested “emergency teeth cleaning w/ 

prior antibiotic treatment.” (Id.) He wrote: “Why are you deliberately refusing to provide 

me adequate dental care to help save my teeth from rotting. I’m relying on you the only 

dental option I have in prison. See you in court, federal civil case # Cv-01631-DGC-JFM.” 

(Id.) 

On August 10, 2018, Plaintiff was seen in dental for a routine teeth cleaning in 

response to his March 4, 2018 HNR. (Id. at 33.) Dental Hygienist Lucero Ortiz noted 

“[l]ocalized moderate calculus plaque and stain on lower teeth, and #11−13, pus exudate 

from #11, 30.” (Id. at 34.) She charted missing teeth at 1, 3, 4, 10, 12, 14, 16, 17, 21, 24, 

28, and 32. (Id. at 36.)

On September 12, 2018, Plaintiff filed an HNR, stating,

4 months now! On a request to filling back tooth that Dr. 

Russell refuses to fill[.] Yes you cleaned my tooth on 8/10/18 

after 3 years of waiting[.] A tooth being filled is not a 

cleaning[.] Schedule me now. To have this tooth filled or refer 

me to peri[o]dontist a dentist whose goal is to save teeth not 

pull them.

(Doc. 137-1 at 38.)

On September 28, 2018, Dentist Dr. Kendrick Gray saw Plaintiff for routine 

treatment in response to his HNR. (See id.) Dr. Gray noted that Plaintiff went “on and on” 

about his pending lawsuit, accusing dental of letting his teeth “go awry over the past seven 

years” and of not providing a proper toothbrush or deep cleanings. (Id.) Plaintiff pointed 

at tooth #30 and stated he wanted the tooth fixed and possibly a crown because food gets 

trapped inside. (Id.) Dr. Gray took an x-ray of tooth #30, and determined 

[a]fter evaluation of patient’s x-rays and the intra-orally, #30 

is hopeless. It exhibits extreme hypermobility and bone loss. 

The buccal roots are exposed but patient reports no symptoms. 

Patient has overall poor hygiene. Patient had advanced bone 

loss back in 2011 as well per x-rays. Patient persistent about 

getting a regular toothbrush, but it doesn’t appear he was able 

to exercise good oral hygiene even when he had access to a 

regular toothbrush. I have seen [prisoners] with advanced 

periodontal disease exercise good oral hygiene with the 

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toothbrushes given at ADC. Considering level of plaque, 

calculous BU, patient does not appear to have made any efforts 

towards good oral hygiene. 

(Id. at 39.) In his Assessment Notes, Dr. Gray wrote that he could not authorize an alternate

toothbrush and that Plaintiff did not appear to have any dexterity issues that would require 

one. (Id.) He agreed to fill tooth #30 and did so to restore it to use as long as possible, but 

he emphasized to Plaintiff that the tooth was hopeless. (Id. at 39, 40.)

On December 21, 2018, Defendant saw Plaintiff for follow up regarding Plaintiff’s 

advanced periodontal disease. (Doc. 137 ¶ 18.) Defendant assessed Plaintiff with class IV 

periodontal disease with “advance[d] bone los[s], bifurcation involvement, mobility, 

gingival inflammation, chronic food traps & multiple teeth indicated for extraction. 

Furthermore, retaining hopeless non-restorable teeth result[s] in los[s] of support 

base/alveolar bone necessary for future dentures.” (Doc. 137-1 at 43.) Defendant’s Plan 

Notes called for Plaintiff to have a “[c]onsult for advance[d] periodontal disease/bone 

los[s] and the impact that the disease has on the future denture base for dentures.” (Id. at

44.) 

On February 22, 2019, Plaintiff saw Dentist Jose De Los Santos for an “urgent care 

follow up from [a] previous appointment.” (Doc. 137-1 at 45.) Plaintiff underwent a 

scaling and root planing of all four quadrants of his mouth and was given a Chlorohexidine

rinse, which Dr. De Los Santos noted was “[t]o facilitate Patient’s desire to at least give 

his lower right posterior teeth a chance to hold on longer, even though it was explained to 

him that there is no bone holding teeth #s 29, 30, 31, ”. (Doc. 137 ¶ 19; Doc. 137-1 at 

45−46.) Dr. De Los Santos assessed “localized severe chronic periodontitis w/ class III 

mobility of teeth #s 29, 30.” (Doc. 137-1 at 45.) He reiterated, and Plaintiff acknowledged,

that Plaintiff would eventually need extractions of teeth #s 29, 30 due to severe mobility 

and bone loss. (Id. at 46.) 

IV. Discussion

To prevail on an Eighth Amendment medical care claim, a prisoner must 

demonstrate that a defendant acted with “deliberate indifference to serious medical needs.” 

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Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (citing Estelle v. Gamble, 429 U.S. 97, 

104 (1976)). There are two prongs to the deliberate-indifference analysis: an objective 

prong and a subjective prong. For the objective prong, a prisoner must show a “serious 

medical need.” Jett, 439 F.3d at 1096 (citations omitted). A “‘serious’ medical need exists 

if the failure to treat a prisoner’s condition could result in further significant injury or the 

‘unnecessary and wanton infliction of pain.’” McGuckin v. Smith, 974 F.2d 1050, 1059-

60 (9th Cir. 1992), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 

1133, 1136 (9th Cir. 1997) (en banc) (internal citation omitted). Examples of a serious 

medical need include “[t]he 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.” McGuckin, 974 F.2d at 1059-60. 

For the subjective prong, a prisoner must show that the defendant’s response to that 

need was deliberately indifferent. Jett, 439 F.3d at 1096. An official acts with deliberate 

indifference if he “knows of and disregards an excessive risk to inmate health or safety; to 

satisfy the knowledge component, the official must both be aware of facts from which the 

inference could be drawn that a substantial risk of serious harm exists, and he must also 

draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). “Prison officials are 

deliberately indifferent to a prisoner’s serious medical needs when they deny, delay, or 

intentionally interfere with medical treatment,” Hallett v. Morgan, 296 F.3d 732, 744 (9th 

Cir. 2002) (internal citations and quotation marks omitted), or when they fail to respond to 

a prisoner’s pain or possible medical need. Jett, 439 F.3d at 1096. Deliberate indifference 

is a higher standard than negligence or lack of ordinary due care for the prisoner’s safety. 

Farmer, 511 U.S. at 835. “Neither negligence nor gross negligence will constitute 

deliberate indifference.” Clement v. California Dep’t of Corr., 220 F. Supp. 2d 1098, 1105 

(N.D. Cal. 2002); see also Broughton v. Cutter Labs., 622 F.2d 458, 460 (9th Cir. 1980) 

(mere claims of “indifference,” “negligence,” or “medical malpractice” do not support a 

claim under § 1983). “A difference of opinion does not amount to deliberate indifference 

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to [a plaintiff’s] serious medical needs.” Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). 

A mere delay in medical care, without more, is insufficient to state a claim against prison 

officials for deliberate indifference. See Shapley v. Nevada Bd. of State Prison Comm’rs, 

766 F.2d 404, 407 (9th Cir. 1985). The indifference must be substantial. The action must 

rise to a level of “unnecessary and wanton infliction of pain.” Estelle, 429 U.S. at 105.

Finally, even if deliberate indifference is shown, to support an Eighth Amendment 

claim, the prisoner must demonstrate harm caused by the indifference. Jett, 439 F.3d at 

1096; see Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989) (delay in providing 

medical treatment does not constitute Eighth Amendment violation unless delay was 

harmful).

A. Serious Medical Need

Defendants do not argue that Plaintiff’s advanced periodontal disease was not a 

serious medical need, and the record evidence leaves no doubt that Plaintiff suffered from 

severe bone loss and tooth mobility, which several dental providers found serious enough 

to require hand scaling, full mouth debridement, tooth extractions, and possible future 

dentures. Plaintiff had a serious medical need, and the relevant question is whether 

Defendant was deliberately indifferent to that need.

B. Deliberate Indifference 

Plaintiff’s deliberate indifference claim is based on Defendant’s alleged insistence 

in June 2018 that Plaintiff have teeth pulled rather than having his teeth cleaned. (Doc. 13

at 8.) Defendant has produced sufficient evidence to make an initial showing that he was 

not deliberately indifferent to Plaintiff’s serious medical needs in June 2018, the only times

he saw Plaintiff or provided dental treatment to him before July 16, 2018, when Plaintiff 

filed his Second Amended Complaint. 

The evidence shows that Defendant first saw Plaintiff on June 15, 2018, in response 

to Plaintiff’s March 4 and May 3, 2018 requests for a deep cleaning and dental work. (See

Doc. 137-1 at 18.) There is no evidence Defendant provided Plaintiff dental care before 

this, was aware of Plaintiff’s dental complaints, or had any role in scheduling Plaintiff’s 

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cleanings and dental exams. Moreover, it is undisputed that when Defendant saw Plaintiff

on June 15, 2018, Plaintiff refused treatment and signed a refusal form, stating: “Don’t 

want tooth out need care.” (Id. at 24.) This evidence does not demonstrate that Defendant 

refused to treat Plaintiff or deliberately disregarded his serious dental needs. 

It is also undisputed that one week later, on June 22, 2018, Defendant saw Plaintiff 

and took x-rays of Plaintiff’s mouth, conducted a full dental exam, and noted that Plaintiff 

had advanced periodontal disease with several teeth requiring extraction. (Doc. 137 ¶ 13; 

Doc. 137-1 at 27.) Defendant called for Plaintiff to have a full mouth debridement and 

three extractions. (Doc. 137-1 at 29.) This evidence shows that Defendant responded to 

and did not deliberately disregard Plaintiff’s serious dental needs. Further, it is undisputed 

that Plaintiff saw Dental Hygienist Lucero Ortiz for a routine cleaning on August 10, 2018, 

and no evidence that Defendant prevented Plaintiff from receiving such care. (See id. at 

33.) 

The only other time Defendant provided dental care to Plaintiff was on 

December 21, 2018, when he saw Plaintiff for follow up on his periodontal disease. 

(Doc. 137 ¶ 18.) Defendant assessed Plaintiff with class IV periodontal disease, advanced

bone loss, mobility, gingival inflammation, chronic food traps, and multiple teeth that 

required extraction. (Doc. 137-1 at 43.) Defendant also concluded that not removing 

Plaintiff’s unrestorable teeth could further degrade the bone base needed to support 

dentures, and called for Plaintiff to have a consult with a periodontist to evaluate his bone 

loss and the impact his advanced periodontal disease would have on future dentures. (Id.

at 44.) These findings comport with those made by Dr. Gray before this visit and by Dr. 

De Los Santos thereafter, and do not show that Defendant refused to treat Plaintiff’s serious 

dental needs or that his recommendations were deliberately indifferent to those needs.

Because Defendant has satisfied his initial burden of showing that he was not 

deliberately indifferent, the burden shifts to Plaintiff identify evidence that would create a 

genuine issue of material fact on this issue. Nothing in Plaintiff’s Response or its various 

attachments satisfies this burden. Plaintiff merely argues, without support, that Defendant 

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“has caused more than one inmate to lose teeth,” and that, as a doctor, Defendant was 

required to “look for ways to stop disease, treat it at its root, [and] control it,” and he “did 

none of these.” (Doc. 162 at 2.) Plaintiff appears to argue, without any medical evidence, 

that Defendant could have done more to save Plaintiff’s teeth, even though Defendant and 

both Drs. Gray and De Los Santos, who also examined Plaintiff within the same general 

timeframe, determined that they were beyond repair. Moreover, the evidence shows that 

Defendant concluded that trying to save Plaintiff’s unrestorable teeth could cause further 

harm due to ongoing bone loss, which could prevent Plaintiff from having dentures, and 

Defendant therefore referred Plaintiff to a periodontist for further evaluation.4 

The allegations in Plaintiff’s Second Amended Complaint also fail to create a 

genuine issue of material fact that Defendant’s dental treatment and recommendations were 

deliberately indifferent to Plaintiff’s serious dental needs. Plaintiff alleges that, when he 

saw Defendant in June 2018, he requested to have his teeth cleaned and Defendant instead 

insisted on pulling his teeth, thereby contributing to the worsening of Plaintiff’s periodontal 

disease. (Doc. 13 at 8.) Taking as true that Defendant refused to provide a teeth cleaning

on June 15, 2018, when Plaintiff refused treatment, or on June 22, 2018, when Defendant 

provided a full dental exam, this fact does not create a genuine issue of material fact that 

Defendant acted with deliberate indifference. It is undisputed that when Defendant 

examined Plaintiff’s teeth on June 22, 2018, he recommended a full mouth debridement in 

addition to extractions. It also is undisputed that Plaintiff received a teeth cleaning from 

Dental Hygienist Lucero on August 10. 2018. There is, therefore, no evidence that 

Defendant failed to provide proper dental exams or kept Plaintiff from receiving proper 

4

In addition to his arguments in the body of his Response—most of which pertain 

to the care he received from dismissed Defendants Corizon and Nurse Practitioners Boyce 

and Ende—Plaintiff attaches a duplicate of the Controverting Statement of Facts he 

previously filed in response to Defendants Corizon, Boyce, and Ende’s Motion for 

Summary Judgment, which the Court already granted, an unauthorized sur-reply to those 

Defendants’ Reply, and an unauthorized “Supplement” of case law, also in apparent 

support of denying the earlier Motion for Summary Judgment. (See Doc. 162.) Only pages 

1 to 3 of the Response appear to address this Motion for Summary Judgement. 

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cleanings. Plaintiff’s insistence that Defendant try to repair the teeth that Defendant found 

beyond repair shows only a difference of opinion between Plaintiff and Defendant about 

what constituted proper dental treatment, which is insufficient to show deliberate 

indifference. Sanchez, 891 F.2d at 242. Additionally, all three dentists who examined 

Plaintiff’s teeth opined that the teeth Plaintiff wanted treated could not be saved, and 

Defendant further opined that they needed to be pulled to prevent further bone loss. Absent 

any contrary evidence from which a reasonable jury could find that Defendant failed to 

provide appropriate care for Plaintiff’s serious dental needs, Plaintiff’s Eighth Amendment 

claim fails as a matter of law. The Court will grant summary judgment to Defendant.

IT IS ORDERED:

(1) The reference to the Magistrate Judge is withdrawn as to Defendant

Russell’s Motion for Summary Judgment (Doc. 136), and the Motion is granted. 

Defendant Russell is dismissed with prejudice.

(2) The action is terminated with prejudice. The Clerk of Court must enter 

judgment accordingly. 

Dated this 29th day of April, 2020.

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