Opinion ID: 4521344
Heading Depth: 2
Heading Rank: 2

Heading: Extraction

Text: The district court correctly held that a jury could conclude that the objective test was met because Gaffney’s dental pain constituted a sufficiently serious medical condition. See Brock, 315 F.3d at 163 (holding that conditions causing pain falling “somewhere between ‘annoying’ and ‘extreme’” can be serious medical conditions, the condition need not be “life-threatening,” and the pain need not be “at the limit of human ability to bear”); see also Chance, 143 F.3d at 702 (holding that, in determining the seriousness of a condition, a court should consider the existence of chronic and substantial pain). The district court erred, however, in holding that a reasonable jury could not conclude that Perelmuter acted with deliberate indifference to that pain during 7 the extraction. Construed liberally, Gaffney argued that Perelmuter was deliberately indifferent during the extraction in two distinct ways: (1) Perelmuter knew or should have known that ten minutes was insufficient time for the Novocain to take effect and for Perelmuter to properly extract the tooth, 3 and (2) Perelmuter evinced conscious disregard of Gaffney’s pain during the extraction by ignoring his cries of pain, failing to provide further pain relief, and continuing to “dig” and “stab” the area. Viewing the evidence in the light most favorable to Gaffney, both arguments succeed. First, the district court erred in ruling that Gaffney’s claim that Perelmuter “knew or should have known” that ten minutes was insufficient time for the procedure necessarily amounted only to a claim of negligence. This language can also support a claim of culpable recklessness, and the record contains evidence that could support such a finding. See Hathaway III, 99 F.3d at 553 (stating that recklessness is shown where a “prison official knows of and disregards an excessive 3The language “should have known” suggests a negligence standard. Viewing Gaffney’s arguments liberally, however, we read this allegation to mean that ten minutes was so obviously an insufficient amount of time that Perelmutter must have known it was insufficient. 8 risk to inmate health or safety” (emphasis added) (internal quotation marks omitted)). A reasonable jury could infer from the evidence (Gaffney’s declaration about the extraction) that, in fact, ten minutes was obviously an insufficient amount of time and that Perelmuter therefore knew that it was an insufficient amount of time. 4 See Spavone v. N.Y. State Dep’t of Corr. Servs., 719 F.3d 127, 138 (2d Cir. 2013) (“Officials need only be aware of the risk of harm, not intend harm. And awareness may be proven from the very fact that the risk was obvious.” (emphasis added) (internal quotation marks and citation omitted)). That ten minutes was an insufficient time is further supported by the evidence of complications during the extraction: the tooth broke in the gum and Gaffney required several follow-up visits (including two procedures to slice the gum away from the cheek). 4Although Perelmuter argues on appeal that Gaffney did not provide any evidence to support his claim that Novocain takes longer than ten minutes to take effect, Perelmuter did not provide any evidence that disputes that claim, and a reasonable jury could conclude that the risk that Novocain would not have taken effect yet was obvious. Further, the fact that ten minutes may have been an insufficient time (and that Perelmuter was aware it was insufficient) was further supported by Gaffney’s declaration that the dental assistant told Perelmuter that she would reschedule the extraction because there was only ten minutes “left” to do the procedure. 9 Second, a reasonable jury could infer from the evidence that Perelmuter acted recklessly, or even wantonly, by ignoring Gaffney’s cries of pain and continuing with the procedure without providing pain relief or waiting a sufficient amount of time for the Novocain to take effect. Although the district court relied on the fact that Perelmuter injected Gaffney with Novocain, and his notes indicated that he prescribed pain medication after the extraction, the court failed to consider Gaffney’s evidence that, despite the Novocain, he experienced extreme pain during the extraction. 5 See Hathaway v. Coughlin (“Hathaway II”), 37 F.3d 63, 68 (2d Cir. 1994) (stating that, where a doctor was aware of the plaintiff’s pain, “[a] jury could infer deliberate indifference from the fact that [the doctor] knew the extent of [the plaintiff’s] pain, knew that the course of treatment was largely ineffective, and declined to do anything more to attempt to improve [the plaintiff’s] situation” (emphasis added)). 5Whether Perelmuter prescribed pain medication after the extraction is in dispute; Gaffney declared that Perelmuter did not provide any pain relief, and the only evidence showing that medication was prescribed was Perelmuter’s notes stating “Rx: Motrin.” No prescription form was included in the evidence. 10 Further, the district court erred in ruling that Gaffney did not allege that he informed Perelmuter of the pain he was experiencing; Gaffney asserted that he yelled out, moaned and groaned, and held his knees to his chest, and a reasonable jury could infer that Perelmuter knew from that reaction that Gaffney was in pain. A reasonable jury could also conclude that the confluence of factors here (proceeding with insufficient time, ignoring yells of pain, breaking the tooth, repeatedly slipping and stabbing the area), even if considered individually would not show deliberate indifference, taken together show that Perelmuter evinced a conscious disregard to Gaffney’s pain and dental health during the extraction. Cf. Crawford, 796 F.3d at 257 (holding, in a prison sexual abuse case, that “[l]ess severe but repetitive conduct may still be cumulatively egregious enough to violate the Constitution” (internal quotation marks omitted)). Finally, Perelmuter would not be entitled to qualified immunity on this claim, because the right to be free from serious dental pain is clearly established. See Chance, 143 F.3d at 702–04; see also Hathaway II, 37 F.3d at 68–69 (holding that a doctor is not entitled to qualified immunity where a rational jury could find that 11 the doctor was deliberately indifferent because he failed to alleviate pain and suffering despite numerous requests).