Opinion ID: 618214
Heading Depth: 2
Heading Rank: 3

Heading: Adequate Medical Treatment

Text: Holden asserts the prison officials failed to provide adequate medical treatment for his tooth pain. Deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain proscribed by the Eighth Amendment. McRaven v. Sanders, 577 F.3d 974, 979 (8th Cir.2009) (quoting Estelle v. Gamble, 429 U.S. 97, 104, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976)). This indifference extends to prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once prescribed. Id. To show the prison officials failed to provide adequate medical treatment, Holden must prove (1) he suffered from an objectively serious medical need, and (2) defendants knew of the need yet deliberately disregarded it. Hartsfield v. Colburn, 371 F.3d 454, 457 (8th Cir.2004). 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). A prisoner alleging a delay in treatment must present verifying medical evidence that the prison officials ignored an acute or escalating situation or that [these] delays adversely affected his prognosis. See Reece v. Groose, 60 F.3d 487, 491 (8th Cir.1995) (quoting Beyerbach v. Sears, 49 F.3d 1324, 1326 (8th Cir.1995), abrogated on other grounds by Johnson v. Jones, 515 U.S. 304, 115 S.Ct. 2151, 132 L.Ed.2d 238 (1995), as recognized in Reece, 60 F.3d at 492 (internal quotation marks omitted)). Holden contends his tooth pain was a serious medical need. In support of this contention Holden cites several of our previous holdings where we found obvious and serious dental problems constituted a serious medical need. See McAlphin v. Toney, 281 F.3d 709, 711 (8th Cir.2002) (holding a plaintiff who claimed five prior delayed tooth extractions with two more extractions necessary and still delayed, and a spreading mouth infection, demonstrated a sufficient allegation of imminent danger of physical injury under 28 U.S.C. § 1915(g)); Hartsfield, 371 F.3d at 457 (concluding a plaintiff who had severe pain from loose and infected teeth, which caused blood to seep from his gums, swelling, and difficulty sleeping and eating had alleged an objectively serious medical need for dental care in an Eighth Amendment § 1983 action); Boyd v. Knox, 47 F.3d 966, 969 (8th Cir.1995) (deciding a three-week delay in dental care, coupled with knowledge of the inmate-patient's suffering, can support a finding of an Eighth Amendment violation under section 1983). Holden's cases actually illustrate why his tooth pain did not constitute a serious medical need. In each of these cases the inmate either showed outward signs of injury, such as bleeding and swelling, that a layperson would recognize or established a medical professional diagnosed the dental pain as requiring treatment. In contrast, there is no evidence Holden's tooth pain was as severe or obvious as in the cited cases. Nurse Porter evaluated Holden's teeth and gums on multiple occasions and never noted bleeding, swelling, infection or other visible symptoms of tooth pain, nor did she determine Holden's tooth pain required treatment. Holden was observed eating without difficulty. Holden also offered no evidence any delay in treatment negatively impacted his prognosis. If we assume Holden's dental pain was a serious medical need, Holden must also offer evidence to show the prison officials knew about and disregarded his serious dental care need. The level of culpability required to demonstrate deliberate indifference on the part of prison officials is equal to criminal recklessness. See Jenkins v. Cnty. of Hennepin, 557 F.3d 628, 632 (8th Cir.2009). For the prison officials to be liable for deliberate indifference to a serious dental need, 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, 511 U.S. at 837, 114 S.Ct. 1970. In support of Holden's claim the prison officials were aware of and disregarded his tooth pain, Holden identifies his Sick Call Request Forms, which the prison officials delivered to Nurse Porter. These forms alone are insufficient to establish the prison officials were aware of Holden's dental need. Prison officials lacking medical expertise are entitled to rely on the opinions of medical staff regarding inmate diagnosis and the decision of whether to refer the inmate to outside doctors or dentists. See Camberos v. Branstad, 73 F.3d 174, 176 (8th Cir.1995). The prison officials did not sign or in any way acknowledge the contents of the Sick Call Request Forms, and simply delivered them to Nurse Porter upon Holden's request. The prison officials lacked both medical and dental expertise and were entitled to rely upon Nurse Porter's medical opinion. Holden's later refusal to have his tooth extracted undermines his claim of deliberate indifference. See Logan v. Clarke, 119 F.3d 647, 649-50 (8th Cir. 1997). The prison officials fulfilled their duties in delivering Holden's requests to the medical staff of the jail, and delivery of the requests alone is insufficient to establish subjective knowledge of, let alone deliberate indifference to, a serious dental need. We conclude Holden failed to proffer evidence the prison officials provided constitutionally inadequate medical treatment. Because we conclude Holden failed to demonstrate the deprivation of a constitutional right, we do not discuss further the prison officials' claim of qualified immunity.