Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ared-5_17-cv-00281/USCOURTS-ared-5_17-cv-00281-5/pdf.json

Parties Involved:
Jerome Allen Bargo
Plaintiff
Correct Care Solutions
Defendant
John Does
Defendant
Wendy Kelley
Defendant
Steven Stringfellow
Defendant

Document Text:

IN THE UNITED STATES DISTRICT COURT 

EASTERN DISTRICT OF ARKANSAS 

PINE BLUFF DIVISION 

JEROME ALLEN BARGO PLAINTIFF 

ADC #75423 

v. No: 5:17-cv-00281 KGB-PSH 

WENDY KELLEY, et al. DEFENDANTS 

PROPOSED FINDINGS AND RECOMMENDATION 

INSTRUCTIONS 

 The following Recommendation has been sent to United States District Judge 

Kristine G. Baker. You may file written objections to all or part of this 

Recommendation. If you do so, those objections must: (1) specifically explain the 

factual and/or legal basis for your objection, and (2) be received by the Clerk of this 

Court within fourteen (14) days of this Recommendation. By not objecting, you may 

waive the right to appeal questions of fact. 

DISPOSITION 

I. Introduction

 Plaintiff Jerome Allen Bargo, an inmate at the Arkansas Department of 

Correction’s (“ADC”) Varner Unit, filed a complaint pursuant to 42 U.S.C. § 1983 

on October 31, 2017, alleging that he was denied appropriate dental care in violation 

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of the United States Constitution and Arkansas law (Doc. No. 2). Bargo sued ADC 

Director Wendy Kelley, Correct Care Solutions (CCS), dentist Dr. Steven 

Stringfellow,1

 and John Does. Id. After conducting discovery, Bargo identified John 

Doe A and John Doe B as Defendant Kelley. See Doc. Nos. 63 & 67. Bargo later 

clarified certain allegations in his complaint after conducting discovery. See Doc. 

Nos. 92 & 100. Bargo sues defendants in both their official and individual 

capacities. Doc. No. 2 at 2. He seeks injunctive relief and money damages. Doc. 

No. 2 at 9-11. 

 The Court previously determined that Bargo exhausted available 

administrative remedies with respect to the following claims: 

1) Bargo’s claim that Kelley restricted his access to adequate dental hygiene 

supplies; 

2) Bargo’s claim against Dr. Stringfellow based on a delay in treatment after 

his January 31, 2017 appointment; and 

3) Bargo’s claim against Kelley and CCS for not providing root canals and 

crowns. 

                                                             1

 From July 2016 through May of 2017, Correct Care Solutions provided dental 

care to the Varner Unit through the services of Dr. Stringfellow, who was on site at the 

Varner Unit twenty hours per week and on call along with the Regional Dental Director 

twenty-four hours a day. See Doc. No. 126 at 4; Doc. No. 125-4. Dental services were 

provided through other dentists after May 2017. 

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Doc. Nos. 72, 80, 81 & 83. All other claims against CCS and Stringfellow were 

dismissed. Doc. No. 83. 

 Before the Court is a motion for summary judgment, brief in support, and 

statement of undisputed facts filed by Kelley (Doc. Nos. 105-107), along with 

Bargo’s response, brief in support, and statement of undisputed facts (Doc. Nos. 120-

122). Also before the Court is a motion for summary judgment, brief in support, and 

statement of undisputed facts filed by CCS and Dr. Stringfellow (Doc. Nos. 108-

110), along with Bargo’s response, brief in support, and statement of undisputed 

facts (Doc. Nos. 123-125). CCS and Dr. Stringfellow filed a reply (Doc. No. 126). 

 For the reasons described herein, the undersigned recommends that 

defendants’ motions for summary judgment be granted. 

II. Legal Standard 

 Under Rule 56 of the Federal Rules of Civil Procedure, summary judgment is 

proper if “the movant shows that there is no genuine dispute as to any material fact 

and that the moving party is entitled to a judgment as a matter of law.” Fed. R. Civ. 

P. 56(a); Celotex v. Catrett, 477 U.S. 317, 321 (1986). When ruling on a motion for 

summary judgment, the court must view the evidence in a light most favorable to 

the nonmoving party. Naucke v. City of Park Hills, 284 F.3d 923, 927 (8th Cir. 

2002). The nonmoving party may not rely on allegations or denials, but must 

demonstrate the existence of specific facts that create a genuine issue for trial. Mann 

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v. Yarnell, 497 F.3d 822, 825 (8th Cir. 2007). The nonmoving party’s allegations 

must be supported by sufficient probative evidence that would permit a finding in 

his favor on more than mere speculation, conjecture, or fantasy. Id. (citations 

omitted). An assertion that a fact cannot be disputed or is genuinely disputed must 

be supported by materials in the record such as “depositions, documents, 

electronically stored information, affidavits or declarations, stipulations (including 

those made for purposes of the motion only), admissions, interrogatory answers, or 

other materials . . .”. Fed. R. Civ. P. 56(c)(1)(A). A party may also show that a fact 

is disputed or undisputed by “showing that the materials cited do not establish the 

absence or presence of a genuine dispute, or that an adverse party cannot produce 

admissible evidence to support the fact.” Fed. R. Civ. P. 56(c)(1)(B). A dispute is 

genuine if the evidence is such that it could cause a reasonable jury to return a verdict 

for either party; a fact is material if its resolution affects the outcome of the case. 

Othman v. City of Country Club Hills, 671 F.3d 672, 675 (8th Cir. 2012). Disputes 

that are not genuine or that are about facts that are not material will not preclude 

summary judgment. Sitzes v. City of West Memphis, Ark., 606 F.3d 461, 465 (8th 

Cir. 2010). 

III. Facts

 The following undisputed facts are taken from those submitted by the parties 

(see Doc. Nos. 107, 109, 122, 124 & 126) and the following documentary evidence: 

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Bargo’s relevant dental and medical records (Doc. No. 109-1); Bargo’s deposition 

testimony transcript (Doc. No. 109-2); the affidavit of Susan McDonald, D.D.S. 

(Doc. No. 109-3); and a copy of grievance VU-17-00303 (Doc. Nos. 125-1 – 125-

2). Disputed facts are noted. 

 Bargo’s Dental Care 

 Bargo has been incarcerated with the ADC for approximately 14 years. Doc. 

No. 109-2 at 75. This lawsuit concerns disagreement over the treatment Bargo 

requests for teeth numbers 13 and 14, which have been recommended for extraction. 

Doc. No. 2. Bargo has refused to agree to extraction of teeth numbers 13 and 14 

unless extraction is “the only viable solution in the dentistry.” Doc. No. 109-2 at 46. 

Bargo instead demands that root canals and crowns be provided for those teeth, if 

such treatment is viable. Id. at 46-47. Bargo currently has all of his 32 teeth, 

including four wisdom teeth. Id. at 48-49 & 75. Excepting teeth numbers 13 and 

14, Bargo’s teeth are in good condition. Doc. No. 109-1; Doc. No. 109-2 at 49. He 

has not required any dental fillings while incarcerated at the Varner Unit. Doc. No. 

109-2 at 52. 

 Bargo’s dental records indicate that he first reported having pain in tooth 

number 14 on February 29, 2012. Doc. No. 109-1 at 35. Dr. Johnny Canady 

examined Bargo and recommended extraction of tooth number 14, noting that the 

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canals of the tooth appeared to be calcifying. Id. Dr. Canady documented that Bargo 

declined to have the tooth pulled. Id.

 On August 2, 2016, Bargo requested treatment for the “reoccurrence of pus 

filled pimple on gum in exact same spot.” Doc. No. 109-1 at 3. Two days later, Dr. 

Michael Dienberg examined Bargo and noted: 

Reviewed medical history with patient. Concerns include NCPMH, 

NKDA, #14 recurrent decay is present and may be restorable. Tooth 

may be abscessed, fistula and/or cyst may be present. Place on 

restorative list #14, if remove existing restoration and decay is 

extensive, then extract tooth. Offered antibiotics, but pt. refused. 

Id. at 6-7.2

 The dental records do not indicate whether Bargo was scheduled for this 

attempted restoration. 

 Bargo did not see a dentist again until January 2017. On January 14, 2017, he 

requested to be seen for a “reoccurrence of abscess on gum.” Id. at 8. Bargo stated 

that he saw a dentist several months before and was told he would be rescheduled 

but had not been. Id. Bargo was examined by Dr. Steven Stringfellow on January 

31, 2017. Id. at 9. Dr. Stringfellow noted that “#14 had a large fistulous tract,” that 

                                                            

2 Bargo maintains that Dr. Dienberg noted the need to take an x-ray but could not 

because there was no nurse assistant there that day; CCS and Dr. Stringfellow deny that it 

was necessary to take an x-ray to diagnose an abscessed tooth and recommend extraction. 

See Doc. No. 126-6. The Court finds this dispute to be immaterial. Dr. Dienberg 

recommended that Bargo receive a filling if one was feasible; if not, he recommended 

extraction. Dr. Dienberg is not a defendant in this case, and none of Bargo’s remaining 

claims concern the failure to obtain an x-ray at the August 2016 encounter with Dr. 

Deinberg.

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a “PA radiograph shows lesion at apex,” and that “decay is present and is not 

restorable.” Id. Dr. Stringfellow further noted that Bargo should be started on 

medication and placed on a surgery list for extraction of #14. Id. Dr. Stringfellow 

also informed Bargo that he should submit a request form if he desired further 

treatment. Id. Bargo insists that Dr. Stringfellow attempted to take x-rays but was 

unsuccessful; CCS and Dr. Stringfellow maintain that x-rays were taken on this date. 

Doc. No. 109-2 at 93-98; Doc. No. 126 at 7. CCS and Dr. Stringfellow acknowledge 

that the x-ray film they claim was taken during this encounter with Dr. Stringfellow 

is not in Bargo’s dental chart. Doc. No. 126 at 7. The dental records do not indicate 

that Bargo was placed on the surgery list for extraction. 

 Bargo submitted grievance VU-17-00303 on April 19, 2017, stating that that 

he was treated by an unknown dentist “about a year ago” at his annual dental 

cleaning and once again “after weeks or months without being called back.” Doc. 

No. 125-1. With respect to his second visit, Bargo stated, 

When I stated what the other Dentist had said he examined the 

tooth/abscess and decided to take xrays. However, three (3) attempts 

were made to take xrays but resulted in nothing. I was prescribed 

antibiotics and told I’d be rescheduled at which time the xray would be 

working. Now, months later I’m still waiting and still in pain. The 

Dentist also said the tooth could be saved by doing a root canal but that 

CCS prohibited such treatment. . . . 

Id. Bargo proceeded to Step Two, and the Health Services Administrator (“HSA”) 

responded on May 17, 2017. Doc. No. 125-2 at 1. The HSA acknowledged that 

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Bargo was seen in August 2016 by Dr. Deinburg and again in January 2017 by Dr. 

Stringfellow who placed Bargo on the procedure list for extraction. Id. Because 

Bargo had not yet received the procedure, the HSA found Bargo’s grievance to be 

with merit and informed Bargo that he would be scheduled for a dental procedure. 

Id. On July 13, 2017, Bargo’s appeal was found to be with merit due to a delay in 

his treatment after the HSA’s response. Id. at 2. The appeal response stated that the 

issue was resolved, however, because Bargo was subsequently seen by Dr. James 

Dove, as described below.

 On June 6, 2017, Dr. Dove examined Bargo and noted that “tooth #14 is 

nonrestoable [sic] due to infection” and that extraction is the “only offered remedy.” 

Doc. No. 109-1 at 13-14. Bargo’s teeth were cleaned on June 8, 2017 by dental 

hygienist Bailey Cover Dietrich, who noted that “Pt has gingivitis and/or perio 

disease and needs full mouth debridement or perio scaling.” Id. at 14. 

 On July 5, 2017, Dr. Dove saw Bargo at his scheduled surgery appointment. 

Id. at 16. Dr. Dove noted “Pt. appointed for extraction of tooth #14. Pt. questions 

extraction at this time. Pt. states small ‘pimple’ is present.” Id. Dr. Dove also noted: 

“Radiograph taken of upper left quadrant. Teeth #’s 13 and 14 are non restorable 

and both should be extracted, due to history of abscess and on tooth #13 recurrent 

decay on mesial and distal root surfaces.” Id. Dr. Dove’s notes also indicate that 

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Bargo refused treatment and was told to return to the clinic to have the teeth 

extracted. Id. Dr. Dove noted: 

Pt. informed extraction is only treatment for teeth #’s 13 and 14. Pt. 

understands the risks of delaying extractions. Advised patient to 

contact infirmary if area becomes painful or swollen. Informed patient 

of recommended treatment. If patient desires further treatment, a 

request form should be submitted. 

Id. Dr. Dove noted in an addendum on December 6, 2017 (more than 5 months 

later): 

This Pt. refused treatment, but also refused analgesic therapy, denying 

that the “pimple” hurt. Pt. refused all treatment at this time and repeated 

he was not suffering or in pain, he just did not want his back teeth 

extracted. Pt. was reminded of the risks of refusing therapeutic 

analgesics, antibiotics, and extraction of non restorable teeth. Pt. also 

informed not all teeth can be “saved” with fillings or root canals. These 

teeth are badly fractured and the prognosis of any treatment other than 

extractions is very poor. 

Id. Bargo testified in his deposition that he intended to have tooth #14 extracted at 

this appointment, but once Dr. Dove told him that he also needed to have tooth #13 

extracted, Bargo refused and insisted on having an x-ray taken. Doc. No. 109-2 at 

60-61. He acknowledged that x-rays were then taken but he still declined to have 

either tooth extracted. Id. 

 In March 2018, Dr. Nancy Malcolm examined Bargo and noted: 

PT has tooth #14 that is abscssed [sic] and needs to be extracted but is 

filing a lawsuit to get a root canal and is in the mindset that he will win. 

He would like to put off doing anything at this point in time. Pt admits 

that he has been having pus drain from the gums around this tooth. Area 

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is inflamed and swollen and tooth is (+++) to percussion and palpation. 

PT that was taken previously does show tooth to be abscessed. 

Id. at 22. Dr. Malcolm told Bargo that root canals were not provided for incarcerated 

persons, and warned him that by putting off extraction, he may lose more bone and 

risk infection of other teeth. Id. 

 Dr. Susan McDonald’s Opinion 

 Dr. Susan McDonald is a dentist employed by CCS. Doc. No. 109-3 at 1. She 

executed an affidavit offering expert testimony regarding the dental issues at hand. 

Id. Dr. McDonald reviewed Bargo’s dental records from January 1, 2008 to the 

present. Id. She agreed with Dr. Dove that because teeth numbers 13 and 14 are 

badly fractured, the prognosis of any treatment besides extraction is poor. Id. at 2. 

In her affidavit, Dr. McDonald noted that at all relevant times, Bargo was provided 

with antibiotics and pain medication as appropriate. Id. In Dr. McDonald’s opinion, 

the issue in this case is the significant decay in teeth numbers 13 and 14. Id. She 

explained that once bacteria enters the sterile field of the tooth and causes infection, 

the teeth are no longer restorable. Id. 

 Dr. McDonald explained the process of a root canal, which is performed by 

removing the nerve and blood vessels and then placing a filling material inside the 

tooth. Id. A crown is then cemented on top of the remaining tooth structure which 

functions as a dental prosthesis. Id. She stated that a root canal and crown are similar 

to providing a one-tooth denture, because the tooth itself is no longer living. Id. In 

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Dr. McDonald’s opinion, Bargo has no medical need for a prosthetic tooth, and he 

is able to masticate sufficiently. Id. According to Dr. McDonald, Bargo is placing 

himself at risk of further infection by refusing extraction of teeth numbers 13 and 

14, and extraction of the teeth would promptly eliminate the infection. Id. at 2-3. 

 Dr. McDonald also explained in her affidavit that root canals and crowns are 

not a service that CCS is contracted to perform. Id. In addition, Dr. McDonald 

opined that even if CCS was contracted to perform root canals on inmates, a root 

canal and crown are not indicated in Bargo’s case for either tooth. Id. She attached 

to her affidavit illustrations of a tooth, tooth decay, and a root canal procedure, and 

explained that Bargo’s cavities affected the enamel, dentin, and the pulp, which 

contains the nerves and blood vessels. Id. Dr. McDonald stated that because the 

sterile field of both teeth was broken, and the nerves and blood vessels became 

infected, extraction was the appropriate remedy to prevent recurrent infection. Id. 

She further opined that the prognosis for a successful root canal and crown on the 

affected teeth is poor due to extensive destruction of the root structure in both teeth 

and the presence of calcified canals in tooth number 14.3

 Id.

                                                            

3 Dr. McDonald did not offer an opinion concerning whether teeth numbers 13 and 

14 would have been restorable by root canal and crown at the times Bargo was treated at 

the ADC in 2016, 2017, or March of 2018. Dr. Stringfellow has opined that tooth 

number 14 most likely was not restorable in January of 2017 (Doc. No. 121-3 at 3-4); Dr. 

Dove recorded that teeth numbers 13 and 14 were not restorable as of mid-2017 (Doc. 

No. 109-1 at 13-14). 

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 In Dr. McDonald’s professional opinion, the dental care and treatment 

provided to Bargo was appropriate and satisfactory during the relevant period of 

time. Id. She stated that her conclusion is consistent with sound dental practices and 

her professional judgment and her opinions are stated to a reasonable degree of 

medical certainty. Id. 

Bargo does not offer any expert testimony in support of his position. He 

claims, however, that Dr. Stringfellow told him in January 2017 that tooth number 

14 was restorable. See Doc. No. 107-1 at 100; Doc. No. 121-1. 

 Dental Hygiene Supplies 

 In his deposition testimony, Bargo admitted that the toothpaste available to 

him at the ADC is approved by the ADA (American Dental Association), that it is 

good toothpaste, and that he does not have any problems with the toothpaste. Doc. 

No. 109-2 at 70-71 & 111. Bargo testified that he wants more choices of toothpaste, 

including one that is designed for sensitive teeth that also fights gingivitis. Id. at 71. 

Bargo also testified that he has access to dental floss and that he is able to use the 

dental floss on some of his teeth. Id. at 72-73 & 112. Bargo testified that the dental 

floss is designed like a rubber band and is not easy to use because it slips and causes 

his gums to bleed. Id. at 72-73. Bargo testified that he is provided a toothbrush that 

he uses but he does not like that the bristles fall out. Id. at 73-74 & 113. Bargo 

testified that he is able to reach and clean all of his teeth, including his wisdom teeth, 

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even though the toothbrush is too short, making it difficult to reach his back teeth. 

Id. at 74-75. 

IV. Analysis 

 A. Sovereign Immunity 

 Defendants correctly assert that Bargo’s monetary claims against them in their 

official capacities are barred by sovereign immunity. A suit against a defendant in 

his or her official capacity is in essence a suit against the State of Arkansas, and any 

official capacity claim for monetary damages against that defendant is barred by the 

doctrine of sovereign immunity. Will v. Michigan Department of State Police, et al., 

491 U.S. 58, 71 (1989); Nix v. Norman, 879 F.2d 429, 431-432 (8th Cir. 1989). 

Accordingly, the undersigned recommends that defendants be awarded summary 

judgment with respect to Bargo’s official capacity claims for money damages. 

Bargo’s official capacity claims for injunctive relief are discussed below. 

 B. Qualified Immunity 

 Defendants argue they are entitled to qualified immunity as to Bargo’s claims 

against them in their individual capacities. Qualified immunity protects government 

officials from liability for damages insofar as their conduct does not violate “clearly 

established statutory or constitutional rights of which a reasonable person [in their 

positions] would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). 

Qualified immunity is a question of law and is appropriately resolved on summary 

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judgment. McClendon v. Story County Sheriff’s Office, 403 F.3d 510, 515 (8th Cir. 

2005); Mitchell v. Forsyth, 472 U.S. 511, 526 (1985). To determine whether a 

defendant is entitled to qualified immunity, the Court must consider two questions: 

(1) do the facts alleged by plaintiff establish a violation of a constitutional or 

statutory right; and (2) if so, was that right clearly established at the time of the 

defendant’s alleged misconduct. Wright v. United States, 813 F.3d 689, 695 (8th 

Cir. 2015). 

For a right to be clearly established, “[t]he contours of the right must 

be sufficiently clear that a reasonable official would understand that 

what he is doing violates that right.” Anderson v. Creighton, 483 U.S. 

635, 640, 107 S.Ct. 3034, 97 L.Ed.2d 523 (1987). “This is not to say 

that an official action is protected by qualified immunity unless the very 

action in question has previously been held unlawful.” Id. (citing 

Mitchell v. Forsyth, 472 U.S. 511, 535 n. 12, 105 S.Ct. 2806, 86 

L.Ed.2d 411 (1985)). “But it is to say that in the light of pre-existing 

law the unlawfulness must be apparent.” Id. (citations omitted). 

Petitioners can show a clearly established right through “cases of 

controlling authority in their jurisdiction at the time of the incident” or 

through a “consensus of cases of persuasive authority such that a 

reasonable officer could not have believed that his actions were lawful.” 

Wilson v. Layne, 526 U.S. 603, 617, 119 S.Ct. 1692, 143 L.Ed.2d 818 

(1999). The pertinent inquiry is whether the state of the law at the time 

gave the official “fair warning” that such conduct was unlawful in the 

situation he confronted. Hope v. Pelzer, 536 U.S. 730, 741, 122 S.Ct. 

2508, 153 L.Ed.2d 666 (2002); Saucier v. Katz, 533 U.S. 194, 202, 121 

S.Ct. 2151, 150 L.Ed.2d 272 (2001). 

Wright, 813 at 695-96. Courts may exercise “their sound discretion in deciding 

which of the two prongs of the qualified immunity analysis should be addressed first 

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in light of the circumstances of the particular case at hand.” Pearson v. Callahan, 

555 U.S. 223, 236 (2009). 

Legal Standard: Eighth Amendment Deliberate Indifference 

 The Eighth Amendment’s proscription of cruel and unusual punishment 

obligates prison officials to provide adequate medical care to inmates in their 

custody. Estelle v. Gamble, 429 U.S. 97, 102–03 (1976). An inmate’s Eighth 

Amendment right to treatment for serious and painful dental conditions is wellestablished. Williams v. York, 891 F.3d 701, 707 (8th Cir. 2018). To succeed with 

an inadequate medical care claim, an inmate must show that the prison official was 

deliberately indifferent to the inmate’s serious medical needs. Coleman v. Rahija,

114 F.3d 778, 784 (8th Cir. 1997). This requires a two-part showing that (1) the 

inmate suffered from an objectively serious medical need, and (2) the prison official 

knew of the need yet deliberately disregarded it. Id.; see also Farmer v. Brennan,

511 U.S. at 837; Estelle v. Gamble, 429 U.S. 97, 105 (1976). “A serious medical 

need is one that has been diagnosed by a physician as requiring treatment, or one 

that is so obvious that even a layperson would easily recognize the necessity for a 

doctor’s attention.” Coleman v. Rahija, 114 F.3d 778, 784 (8th Cir. 1997). 

 Additionally, the Eighth Circuit has held that a “prisoner must show more than 

negligence, more even than gross negligence, and mere disagreement with treatment 

decisions does not rise to the level of a constitutional violation.” Estate of Rosenberg 

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by Rosenberg v. Crandell, 56 F.3d 35, 37 (8th Cir. 1995). Finally, an inmate alleging 

that a delay in medical treatment constitutes deliberate indifference is required to 

“‘place verifying medical evidence in the record to establish the detrimental effect 

of delay in medical treatment.’” Laughlin v. Schriro, 430 F.3d 927, 929 (8th Cir. 

2005) (quoting Crowley v. Hedgepeth, 109 F.3d 500, 502 (8th Cir. 1997)). If the 

inmate does not, he fails to raise a genuine issue of fact on an essential element of 

his claim, and summary judgment is appropriate. Id. See also Corwin v. City of 

Independence, MO, 829 F.3d 695 (8th Cir. 2016) (summary judgment appropriate 

where pretrial detainee failed to produce verifying medical evidence showing a 

detrimental effect due to delay in treating fractured wrist). 

Kelley – Dental Hygiene Supplies 

In his complaint, Bargo alleges that ADC Director Kelley restricted his access 

to toothpaste, hard-bristle tooth brushes, and dental floss loops (similar to rubber 

bands) that are not approved by the American Dental Association (“ADA”). In his 

deposition, he admitted that the dental hygiene supplies provided by the ADC are in 

fact ADA approved and adequate to clean his teeth. He does not like the dental floss 

or the short hard-bristled tooth brushes, but acknowledges that he is able to reach the 

back of his teeth with those brushes and to floss albeit with some difficulty. He also 

acknowledges that all of his teeth are in good condition with the exception of teeth 

numbers 13 and 14. Bargo testified that he would like certain dental products that 

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are specifically designed for gingivitis. Although a dental hygienist has indicated 

he may have some gum disease, Bargo has produced no evidence to show that the 

lack of these products contributed to or caused him to develop gum disease. Because 

there is no evidence to show that Kelley was deliberately indifferent to Bargo’s 

medical needs in choosing what dental hygiene supplies are available to inmates, 

Kelley is entitled to qualified immunity and this claim should be dismissed with 

prejudice. 

Dr. Stringfellow – Delay in Treatment 

 An abscessed tooth and tooth decay present serious medical needs. See, e.g., 

Hartsfield v. Colburn, 371 F.3d 454, 457 (8th Cir. 2004) (court found serious 

medical need where plaintiff “presented evidence that he suffered extreme pain 

from loose and infected teeth, which caused blood to seep from his gums, swelling, 

and difficulty sleeping and eating”). Bargo asserts that Dr. Stringfellow was 

deliberately indifferent to his serious dental needs because he did not obtain x-rays 

at the January 31, 2017 appointment and did not schedule Bargo to re-take the xrays or have surgery. Dr. Stringfellow maintains that he took x-rays as 

documented in the medical record. He also argues that he cannot be liable for any 

delay in scheduling Bargo’s extraction because Bargo has stated that he would 

refuse extraction and would only accept a root canal as treatment. 

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 There is a factual dispute as to whether x-rays were taken on January 31. 

The x-ray film is not in Bargo’s dental records. Bargo maintains that Dr. 

Stringfellow’s attempts to take x-rays were unsuccessful, and Dr. Stringfellow told 

him that he would be rescheduled to come back to try again. Bargo’s contention 

is that if x-rays had been taken on January 31 or at a procedure scheduled shortly 

after that visit, he may be able to show that his teeth could have been restored with 

dental fillings at that time, even if the x-rays taken in July 2017 showed that his 

teeth were no longer restorable. 

Assuming that Bargo’s version of events is correct, he fails to provide any 

evidence that Dr. Stringfellow’s claimed failure to obtain x-rays on January 31 or 

shortly after was due to deliberate indifference to Bargo’s serious medical needs. 

According to Bargo’s position, Dr. Stringfellow attempted to take x-rays at the 

January 31 appointment but his efforts were unsuccessful. At that point, says 

Bargo, Dr. Stringfellow told Bargo that he would be rescheduled to return for xrays. At the January 31 appointment, Dr. Stringfellow addressed Bargo’s dental 

needs. He either took or attempted to take x-rays, he noted decay and the need for 

an extraction, prescribed antibiotics, and stated that Bargo would be placed on the 

list for surgery. 

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 It is undisputed that Bargo’s follow-up appointment was not promptly 

scheduled,4

 and he was not seen again until June 2017. Bargo claims that the delay 

resulted from Dr. Stringfellow’s failure to schedule the follow-up appointment, 

with deliberate indifference to Bargo’s serious medical needs. This claim fails as 

a matter of law. The parties do not address whether Dr. Stringfellow was actually 

responsible for scheduling appointments or for placing a patient on a procedure 

list, or if such actions were the responsibility of another CCS employee. But even 

if Dr. Stringfellow was responsible for scheduling appointments or procedures, 

Bargo has offered no evidence that Dr. Stringfellow’s failure to do so was because 

he was deliberately indifferent to Bargo’s serious medical needs. At worst, under 

the facts submitted to the Court, Dr. Stringfellow’s failure would constitute 

negligence.5

 And as noted above, mere negligence does not amount to a 

constitutional violation. 

Additionally, Bargo has the burden of proving with verifying medical 

evidence that the delay from January 31, 2017 to June 2017 was detrimental to his 

condition. Bargo has not provided any such evidence. 

                                                            

4

 Bargo filed a grievance in mid-April complaining that he had not been seen 

again. In response, the HSA found Bargo’s grievance to be with merit because he had 

not been seen even though Dr. Stringfellow had placed Bargo on the procedure list. See 

Doc. No. 125-2 at 2. 

5

The Court makes no finding regarding whether Dr. Stringfellow’s actions or 

inactions amounted to negligence.  

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20 

 In sum, Bargo offers no evidence that Dr. Stringfellow intentionally or with 

deliberate indifference delayed his treatment or that he was harmed by the delay. 

The evidence in the record simply does not support a finding that Dr. Stringfellow 

was deliberately indifferent to Bargo’s serious medical needs. Dr. Stringfellow is 

therefore entitled to summary judgment on Bargo’s delay-in-treatment claim. 

CCS & Kelley – Root Canals & Crowns 

 Bargo insists that he should be provided a root canal and crown in lieu of 

extraction, and that the policy not to provide root canals deviates so far from normal 

standards as to amount to deliberate indifference. In Smith v. Jenkins, the Eighth 

Circuit held that evidence of deliberate indifference can be established by showing 

that the course of treatment “so deviated from professional standards that it 

amounted to deliberate indifference in violation of [the defendant’s] eighth 

amendment right to be free from cruel and unusual punishment.” 919 F.2d 90, 93 

(8th Cir. 1990). The Eighth Circuit acknowledged, however, that proof that a course 

of treatment deviated from professional standards requires expert testimony. Id. The 

Court notes that Bargo has offered no expert opinion that a failure to provide root 

canals and crowns to him constituted such a deviation from professional standards 

that it amounted to deliberate indifference. 

 The majority of courts examining this issue have found that a prison’s refusal 

to restore a tooth rather than extract it is not an Eighth Amendment violation if

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21 

extraction is a medically appropriate treatment for the prisoner.6 The United States 

District Court for the District of North Dakota has thoroughly described the relevant 

case law: 

[I]t appears that the cases in which the courts have actually held an 

“extraction only” policy to be unconstitutional are few. One case that is 

frequently cited is Heitman v. Gabriel, 524 F.Supp. 622 (W.D. 

Mo.1981) (“While it is by no means unprecedented for an old-fashioned 

prison regime to offer tooth extraction as the ‘only dental care’ [citation 

omitted] no case has been found where such a limitation has been 

deemed judicially tolerable.”); see Stack v. McCotter, 79 Fed. App’x 

383, 389.4 (10th Cir. 2003) (citing Heitman); Michel B. Mushlin, 1 

Rights of Prisoners § 4.14 (4th ed., database updated Oct. 2010) (same). 

Heitman, however, is an extreme case. There a county jail had refused 

to provide any dental care short of extraction—not even routine dental 

fillings when that would suffice to alleviate an inmates’ pain. 

There are other cases, however, where the courts have suggested that 

“extraction only” policies might violate the Eighth Amendment—in 

certain circumstances, or have concluded that the issue is an open one. 

See, e.g., Chance v. Armstrong, 143 F.3d 698, 703–704 (2d Cir. 1998); 

Mitchell v. Liberty, No. 8–341–B–W, 2009 WL 33435, at * *4–5 (D. 

Me. 2009). One notable case is the Second Circuit’s decision in 

Chance, supra, where the court overturned a summary dismissal of a § 

1983 action in which a prisoner had alleged that his Eighth Amendment 

rights had been violated when extraction was the only treatment 

offered, and according to the prisoner, “there were less invasive 

procedures that would have saved his teeth.” Id. at 704. Without 

making a definitive ruling, the Second Circuit suggested that extraction 

might be constitutionally deficient if it was offered simply because it 

was an “easier and less efficacious treatment” and was not based upon 

                                                             6

 In applying qualified immunity, the Eighth Circuit Court of Appeals subscribes 

to “a broad view of the concept of clearly established law, and we look to all available 

decisional law, including decisions from other courts, federal and state, when there is no 

binding precedent in this circuit.” Turner v. Arkansas Ins. Dep’t, 297 F.3d 751, 755 (8th 

Cir. 2002); Vaughn v. Ruoff, 253 F.3d 1124, 1129 (8th Cir. 2001). 

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22 

the exercise of sound medical judgment. Id. at 703. One of the cases 

that the court cited as authority was Dean v. Coughlin, 623 F. Supp. 

392 (S.D.N.Y.1985), which the court characterized as “holding that 

‘dental needs for fillings, crowns and the like—are serious medical 

needs as the law defines that term.’” Chance, 143 F.3d at 703 (quoting 

Dean, 623 F. Supp. at 404) (emphasis added). On the other hand, a 

number of courts have held that prison policies that offer extraction in 

lieu of such things as crowns, implants, and even root canals in certain 

situations do not violate the Eighth Amendment. E.g., James v. 

Pennsylvania Dept. of Corrections, 230 Fed. Appx. 195, 2007 WL 

1231730, *1–2 (3d Cir. 2007) (unpublished per curiam decision) 

(concluding that there was no Eighth Amendment claim for an 

extraction that was within the policy of providing for extractions and 

not root canals for abscessed teeth, and the decision was not based on 

any ulterior motive other than routine patient care); Koon v. Udah, No. 

8:06–2000, 2008 WL 724041, at *7 (D.S.C. Mar. 17, 2008) (no Eighth 

Amendment violation where prison offered extraction only and not a 

root canal and crown at state expense based on prison policy); Wilkens 

v. Ward, No. Civ–05–254–M, 2007 WL 2407082, at *6–7 (W.D. Okla. 

Aug. 22, 2007) (no Eighth Amendment violation where prisoner was 

refused a root canal and offered extraction only pursuant to prison 

policy); Del Muro v. Federal Bureau of Prisons, No. 5:03–CV–214–B, 

2004 WL 1542216, at * 3–4 (N .D. Tex. July 8, 2004) (no Eighth 

Amendment violation where the prisoner was offered extraction only 

pursuant to prison policy and not the crowns or a bridge that he claimed 

he was entitled to); Kopera v. Cook County Bd. of Com’rs, 1994 WL 

577238, No. 93–C–3934, at *5 (N.D. Ill. Oct. 18, 1994) (rejecting an 

inmate’s constitutional challenge to a prison policy whereby only 

extraction services are provided); see also Brathwaite v. Corr. Med. 

Servs., 630 F. Supp. 2d 413 (D. Del. 2009). 

Also, there are courts that have held that extraction in lieu of restorative 

work did not violate the Eighth Amendment, but it is not clear from the 

facts of those cases whether the offer of extraction was based upon a 

determination that it was an appropriate treatment under the prisoner’s 

particular circumstances or a blanket prison policy. E.g., McQueen v. 

Karr, 54 Fed. Appx. 406 (table), 2002 WL 31688891, at *1 (5th Cir. 

2002) (unpublished per curiam); Campbell v. St. Clair County Jail,

2:08–cv–10224, 2008 WL 186376, at *2 (E.D. Mich. Jan. 22, 2008). 

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The Eighth Circuit has yet to explicitly weigh in on this issue. In Moore 

v. Jackson, 123 F.[3]d 1082 (8th Cir. 1997), the court overruled a 

district court’s grant of summary judgment in favor of prison officials 

and allowed a prisoner’s Eighth Amendment claim to proceed in a case 

where treatment for a troubled tooth had been unreasonably delayed. 

In its discussion of the seriousness of the prisoner’s medical condition, 

the court noted that, in addition to the evidence of pain suffered by the 

prisoner during the delay in treatment, there was also evidence that the 

delay eliminated the possibility of restoring the tooth and ensured 

extraction. Id. at 1087 n. 3. 

In Davis v. Norris, the court affirmed the dismissal of an inmate’s claim 

that jail staff had exhibited deliberate indifference to his serious dental 

needs by denying him a root canal. Davis v. Norris, 198 F.3d 249 

(Table), 1999 WL 1006437, at *1 (8th Cir. 1999). However, the dispute 

in that case centered not on a particular jail policy but rather competing 

recommendations from two dentists; one examining dentist had 

recommended a root canal and while the other had recommended an 

extraction. The Eighth Circuit simply concluded that a disagreement 

over a particular type of treatment did not give rise to an Eighth 

Amendment claim. 

A dispute over the constitutionality of a jail’s extraction-only policy 

was front and center in Meuir v. Greene County Jail Employees, 487 

F.3d 1115, 1119 (8th Cir. 2007). There an inmate asserting a claim of 

deliberate indifference to his dental care sought to end the Greene 

County Jail’s unwritten extraction-only policy. The Eighth Circuit 

observed that, prior to filing suit, the inmate had been transferred from 

the Greene County Jail to another facility where his dental ailments had 

apparently been treated without complaint. Given that the inmate did 

not anticipate ever returning to the Greene County Jail, the court 

concluded he had not demonstrated a likelihood of future injury and 

therefore lacked standing to challenge the extraction-only policy. 

Based on the foregoing, it is apparent that there is no “clearly 

established” right on the part of prisoners to dental treatment in the form 

of crowns and implants in lieu of extraction, particularly when the latter 

appropriately resolves the underlying problem and does not unduly 

compromise the prisoner’s health. 

 

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Greywind v. Podrebarac, No. 1:10-CV-006, 2011 WL 4750962, at *6–8 (D.N.D. 

Sept. 12, 2011), report and recommendation adopted, No. 1:10-CV-006, 2011 WL 

4743751 (D.N.D. Oct. 5, 2011), aff’d, 471 F. App’x 544 (8th Cir. 2012). 

 Numerous more recent cases outside of the Eighth Circuit hold that a prison’s 

refusal to provide root canals in lieu of extraction is not a constitutional violation. 

See e.g., Mathews v. Raemisch, 513 F. App’x 605, 607 (7th Cir. 2013); Baughman 

v. Garcia, 254 F. Supp. 3d 848, 877–78 (S.D. Tex. 2017); Kleser v. Rosenthal, 

No. 15-CV-602, 2016 WL 3982471, at *4 (E.D. Wis. July 22, 2016); Gomez v. 

Westchester Cty., No. 12-CV-6869 RA, 2015 WL 1054902, at *11 (S.D.N.Y. Mar. 

10, 2015), aff’d sub nom. Gomez v. Cty. of Westchester, 649 F. App’x 93 (2d Cir. 

2016); Mounce v. Doe, No. CIV.A. 12-669, 2014 WL 2587698, at *32 (E.D. La. 

June 10, 2014). 

 In light of the case law cited above, the Court finds that CCS and Kelley are 

entitled to qualified immunity on this claim. First, Bargo has offered no expert 

opinion that a failure to provide root canals and crowns to him constituted such a 

deviation from professional standards that it amounted to deliberate indifference. 

Also, there is no evidence before the Court that extraction was not a medically 

appropriate treatment for Bargo under the circumstances. In fact, the record 

supports a finding that extraction was and is a medically appropriate treatment for 

Bargo, would resolve the problems the affected teeth are causing, and would not 

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compromise his health. It is undisputed that Bargo’s other teeth are in good 

condition, and he will still be able to eat if the infected teeth are extracted. Bargo’s 

medical records establish that several dental providers over years of treatment 

determined that extraction of his abscessed teeth was an appropriate treatment and 

would resolve his recurrent infections. And Dr. McDonald opined that the 

treatment provided to Bargo was appropriate. Accordingly, the Court finds that 

extraction was a medically appropriate treatment option for Bargo, and the policy 

to provide Bargo with extraction instead of a root canal under the facts presented 

does not amount to deliberate indifference in violation of the Eighth Amendment.7

 

 Further, even if this Court found that the facts alleged by Bargo establish a 

violation of a constitutional right, the defendants are still entitled to qualified 

immunity. As recognized in Greywind, the right of prisoners to dental treatment 

in the form of crowns and implants in lieu of extraction has not been “clearly 

established,” now or at the time of the alleged misconduct, especially when an 

extraction would appropriately resolve the underlying problem and would not 

unduly compromise the prisoner’s health. The Court believes that the case law 

has also not clearly established the existence of a right of an inmate to root canals 

and crowns in lieu of extraction. Based on the state of the case law, then, CCS 

                                                             7 See Davis v. Norris, supra (a disagreement over a particular type of 

treatment does not give rise to an Eighth Amendment claim). 

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and Kelley were not on notice, and thus did not have “fair warning,” that Bargo’s 

claimed right to root canals and crowns had been clearly established, and a policy 

that did not allow such treatment was unlawful. 

 For these reasons, CCS and Kelley are entitled to qualified immunity under 

both prongs of the qualified immunity analysis. They should be awarded summary 

judgment on Bargo’s claims regarding the policy not to provide inmates with root 

canals, and those claims should be dismissed with prejudice. 

C. Injunctive Relief 

 Sovereign and qualified immunity do not apply to Bargo’s remaining claims 

for injunctive relief. See Mead v. Palmer, 794 F.3d 932, 937 (8th Cir. 2015); 

Monroe v. Ark. State Univ., 495 F.3d 591, 594 (8th Cir. 2007). Bargo seeks 

“appropriate dental treatment” including root canals, crowns, and treatment of 

gum diseases,” as well as “ADA approved toothbrushes and dental floss . . .”. 

Doc. No. 2 at 10. As discussed above, Bargo has access to appropriate dental 

hygiene supplies and his constitutional claims on that issue fail. Likewise, Bargo 

has not shown a constitutional violation with respect to the policy of not providing 

root canals in lieu of extraction. If there is no constitutional violation, there is no 

necessity for injunctive relief. See Falls v. Nesbitt, 966 F.2d 375, 380 (8th Cir. 

1992). Bargo’s claims for injunctive relief should therefore be dismissed. 

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 D. State Law Claims

 Because Bargo’s constitutional claims are subject to dismissal, the Court 

should decline to exercise jurisdiction over his state law negligence claims. See 

Gibson v. Weber, 433 F.3d 642, 647 (8th Cir. 2006) (Congress unambiguously gave 

district courts discretion in 28 U.S.C. § 1367(c) to dismiss supplemental state law 

claims when all federal claims have been dismissed). 

V. Conclusion 

 For the reasons stated herein, Bargo’s official capacity claims for money 

damages should be dismissed, Bargo’s claims for injunctive relief should be 

dismissed, and the defendants are entitled to qualified immunity on Bargo’s other 

claims. The undersigned recommends that the defendants’ motions for summary 

judgment (Doc. Nos. 105 & 107) be granted. Bargo’s constitutional claims should 

be dismissed with prejudice. Further, the Court should decline to exercise 

supplemental jurisdiction over Bargo’s state law negligence claims and dismiss 

those claims without prejudice. 

 SO RECOMMENDED this 23rd day of January, 2020. 

___________________________________ 

UNITED STATES MAGISTRATE JUDGE 

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