Raoul Lynch v. Sheriff Theodore Jackson, et al

FILED
U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
JUNE 5, 2012
JOHN LEY
CLERK
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 11-11588
________________________
D. C. Docket No. 1:09-cv-03306-CAP
RAOUL LYNCH,
Plaintiff-Appellant,
versus
SHERIFF THEODORE JACKSON,
Individually,
CHARLES FELTON,
Individually, et al.,
Defendants-Appellees.
_______________________
Appeal from the United States District Court
for the Northern District of Georgia
_________________________
(June 5, 2012)
Before DUBINA, Chief Judge, EDMONDSON, Circuit Judge, and RESTANI,*
Judge.
Honorable Jane A. Restani, Judge of the United States Court of International Trade,*
sitting by designation.

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PER CURIAM:
This case involves a prisoner civil rights claim under 42 U.S.C. § 1983 by
Raoul Lynch (“Appellant” or “Plaintiff”) against Fulton County, Sheriff Theodore
Jackson, Chief Jailor Charles Felton, Dr. Valerie Smith, Dr. Roy Brooks, and Dr.
Raymond Williams (collectively “Appellees” or “Defendants”) for allegedly1
violating the U.S. Constitution as well as negligence claims for failing to
appropriately care for Lynch’s periodontal disease. We affirm the judgment of
dismissal of the district court.
BACKGROUND
Because the district court granted Defendants’ motion to dismiss on all but
one of Plaintiff’s claims, we will treat the alleged facts as true as set forth in the
Plaintiff’s Second Amended Complaint (“Complaint”) and draw all reasonable
inferences in the Plaintiff’s favor. Wilson v. Strong, 156 F.3d 1131, 1133 (11th
Cir. 1998). Dr. Smith, Dr. Brooks, and Dr. Williams work for Correctional
Medical Associates, Inc. (“CMA”), the contractual provider of medical and dental
services for Fulton County Jail.
In June 2008 Lynch became a pre-trial detainee in the custody of the Fulton
The original action also named Sargent Angela McCoy, John Doe, Jane Doe, Lieutenant1
Daisy Forbes, and Health Services Director George Herron. The district court dismissed claims
against these defendants from the action and Lynch has not appealed those dismissals.
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County Jail. Lynch immediately informed Defendants that he had periodontal
disease, which caused Lynch serious pain, his teeth to loosen, and his gums to
bleed. Lynch met with Dr. Williams, Dr. Brooks, or Dr. Smith on at least seven
occasions over the first six months of his incarceration. Although Lynch asked
Defendants to treat his periodontal disease, Defendants informed Lynch on three
occasions that “nothing would be done to treat his periodontal disease,” that
Defendants could not treat his periodontal disease at the jail, and that he would
have to wait until after his release to receive treatment. Defendants declined
Lynch’s offer to pay for an outside specialist himself. Dr. Smith recommended
that Lynch have at least four of the offending teeth removed. After two of the four
teeth had been removed, Lynch declined further treatment. Lynch continued to
seek surgical treatment, which Lynch characterized as “(1) pocket reduction
procedures; (2) regenerative procedures; (3) crown lengthening; (4) or soft tissue
grafts.” Lynch also sought non-surgical treatment including “scaling and root
planning . . . , followed by adjunctive therapy . . . .” Although Defendants denied
Lynch access to such treatments, no medical provider prescribed any of the above2
We note for the purposes of the claim adjudicated on a motion for summary judgment2
that Dr. Smith stated in her affidavit, submitted along with Defendants’ motion for summary
judgment, that Dr. Brooks performed scaling and root planting, a form of pocket depth reduction,
on Lynch.
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treatments.
Lynch submitted administrative grievances which were denied. Lynch filed
this action in the Superior Court of Fulton County. Defendants moved for
dismissal in state court and removed the action to federal court. The district court
screened Lynch’s complaint pursuant to 28 U.S.C. § 1915A. The district court
granted Defendants’ motions to dismiss on all claims except for Lynch’s
constitutional claims against Jackson and Felton. The district court then granted
Defendants’ motion for summary judgment on the remaining claim. Lynch now
appeals the district court’s decisions.
JURISDICTION & STANDARD OF REVIEW
We have jurisdiction pursuant to 28 U.S.C. §§ 1291 and 1294. We review
de novo a district court’s grant of a motion to dismiss. Am. Dental Ass’n v. Cigna
Corp., 605 F.3d 1283, 1288 (11th Cir. 2010). We review de novo a district court’s
grant of summary judgment, viewing the record and drawing all inferences in a
light most favorable to the non-moving party. Bashir v. Rockdale Cnty., 445 F.3d
1323, 1326–27 (11th Cir. 2006).
NEGLIGENCE CLAIMS
Lynch argues that the district court erred when it granted Defendants’
motion to dismiss because, 1) Lynch should not be required to submit an affidavit
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from a doctor when asserting a claim of negligence, and 2) the district court3
improperly characterized Felton’s and Jackson’s actions as discretionary rather
than ministerial. Because claims of professional negligence require more than
broad assertions to establish plausibility and the district court properly found the
actions were discretionary, we affirm the district court.
Lynch contends that the district court erred in dismissing his claim for
negligence against Dr. Williams, Dr. Brooks, and Dr. Smith by requiring Lynch to
submit an affidavit from a dental professional. If this case had remained in
Georgia state court, Lynch would have been required to accompany his claim with
an expert affidavit at the time of filing. See O.C.G.A. § 9-11-9.1(a). Although the
case has been removed to federal court and federal procedural rules apply,
Plaintiff must still comply with federal pleading requirements. On a Rule 12(b)(6)
motion to dismiss, the plaintiff has an obligation to provide the grounds for his
entitlement to relief. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007).
“Factual allegations must be enough to raise a right to relief above the speculative
level.” Id. Where a claim for professional negligence is made, “such a claim
Lynch does not put forth a meaningful argument contesting the district court’s finding3
regarding negligence per se before this court. To the extent Lynch appeals the district court’s
dismissal of his negligence per se claim, we affirm the district court’s determination that no
statutory violation took place.
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requires a complaint with enough factual matter (taken as true) to suggest” at least
one negligent professional act or omission. See id. at 556. Lynch’s allegation is
that “Defendants . . . deliberately failed to provide medical care” and that
“[a]dequate treatment for periodontal disease required Mr. Lynch to have surgery.”
Where treatment is offered and refused, as is the case here, Plaintiff must do more
than proffer his own opinion regarding the validity of the actions of medical
professionals. Because Lynch has not put forth non-conclusory statements that the
doctors were professionally negligent, the district court correctly dismissed4
Lynch’s Complaint against the doctors for negligence in both their official and
individual capacities.
Lynch argues that the district court erred when it characterized Felton’s and
Jackson’s actions as discretionary rather than ministerial in dismissing Lynch’s
negligence claims against the sheriff and chief jailor in their official capacities on
the basis of sovereign immunity. Public officials, like Felton and Jackson, have
sovereign immunity when sued in their official capacity, provided defendants are
exercising discretionary rather than ministerial functions. See Gilbert v.
Before the district court, Lynch argued that his claim was not for professional4
negligence, but merely negligence. The district court treated Lynch’s claims against the doctors
as claims for professional negligence. Because Lynch does not now contest this treatment, we
see no reason to disturb the finding of the district court on this issue.
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Richardson, 452 S.E.2d 476, 479 n.4 (Ga. 1994) (noting that claims against a
sheriff in his official capacity enable the sheriff to raise any defense available to
the county, including sovereign immunity). “Providing adequate medical attention
for inmates under defendants’ custody and control is a ministerial act,” but “the
determination of what medical treatment to provide is an act of discretion subject
to official immunity.” Cantrell v. Thurman, 499 S.E.2d 416, 421(Ga. Ct. App.
1998) (finding no sovereign or official immunity where “plaintiff contended that it
was the failure to provide adequate medical care that created liability and not the
choice of treatment”). Furthermore, where liability is based on the official as a
policymaker, that official is protected by sovereign immunity unless his “failure to
adopt other or additional [policy] requirements” shows malice or intent to injure.
Middlebrooks v. Bibb Cnty., 582 S.E.2d 539, 544 (Ga. Ct. App. 2003) (finding the
failure to alter a policy leaving inmate monitoring to the personal judgment of the
deputies to be discretionary and not ministerial). Because Felton and Jackson and
the underlying policy provided for adequate medical attention in the form of tooth
extraction, the district court did not err when it found that Felton and Jackson had
sovereign immunity from Lynch’s negligence claims.5
Lynch does not challenge the district court’s dismissal of his negligence claims against5
Felton and Jackson in their individual capacities.
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CONSTITUTIONAL CLAIMS
Lynch argues that the district court erred when it granted Defendants’
motion to dismiss because: Fulton County’s contract with CMA was facially
unconstitutional, and doctors Smith, Brooks, and Williams were operating under
the color of law. Lynch also contends that the district court erred in granting
Defendants’ motion for summary judgment because Felton and Jackson were
liable for supervising CMA’s policy and Felton and Jackson were deliberately
indifferent to Lynch’s medical needs.
Lynch claims that the district court erred by dismissing his claim against
Fulton County on the basis that the contract was not facially unconstitutional.
Lynch “must establish that no set of circumstances exists under which the Act
would be valid,” United States v. Salerno, 481 U.S. 739, 745 (1987), and that there
is “an excessive risk of serious harm to inmates just because the policy exists,”
Marsh v. Butler Cnty., 268 F.3d 1014, 1036 (11th Cir. 2001) (en banc) (holding
that a policy of releasing sick or injured inmates was not facially unconstitutional
because it was not obviously a danger to inmates). Here, although Lynch notes his
own risk of harm, with regard to the policy he asserts nothing more than that the
dentists at Fulton County Jail informed him that “nothing would be done to treat
his periodontal disease” and that “it was against Fulton County policy to clean
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teeth prior to one year of incarceration.” Lynch made no reference to the policy
vis-à-vis the treatment offered (extraction) and the treatment Lynch believes he
deserved (enumerated surgical and non-surgical procedures). The allegation that
the Fulton County Jail policy did not allow any treatment for periodontal disease
except for tooth extraction is unsupported by the Complaint. Additionally, at oral6
argument, Lynch did not contest Defendants’ assertion that CMA doctors could
always recommend treatment not provided for in the contract. Thus, Lynch has
failed to state a claim that Fulton County Jail’s dental policy and contract with
CMA are facially unconstitutional.7
Lynch claims that the district court erred when it dismissed his claims
against the three doctors in their individual capacities because the district court
incorrectly determined that the doctors were not operating under the color of state
law. We need not reach the color of law issue because the district court correctly
found no deliberate indifference. To bring an action under 42 U.S.C. § 1983 for a
violation of a prisoner’s Eighth Amendment rights to be free from cruel and
Lynch does make such assertions in his brief. Yet in his brief Lynch seems to derive all6
his facts from the record at summary judgment.
Lynch does not challenge the district court’s dismissal of his § 1983 claims against the7
Defendants in their official capacities. Lynch’s arguments focus solely on the portions of the
district court opinions addressing Lynch’s claims against Defendants in their individual
capacities. Thus, the district court’s dismissal of the claims against Defendants in their official
capacities is affirmed.
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unusual punishment, a prisoner must show an objectively serious medical need
and “prove that the prison official acted with an attitude of ‘deliberate
indifference’ to that serious medical need.” Farrow v. West, 320 F.3d 1235, 1243
(11th Cir. 2003) (finding that district court improperly granted summary judgment
because a fifteen-month delay in medical treatment for painful, bleeding gums
constituted deliberate indifference). Serious medical need is considered “one that
has been diagnosed by a physician as mandating treatment or one that is so
obvious that even a lay person would easily recognize the necessity for a doctor’s
attention.” Id. (quoting Hill v. Dekalb Reg’l Youth Det. Ctr., 40 F.3d 1176, 1187
(11th Cir. 1994) (quotation marks and citation omitted), overruled in part on other
grounds by Hope v. Pelzer, 536 U.S. 730, 739 n. 9 (2002)). Deliberate
indifference is “(1) subjective knowledge of a risk of serious harm; (2) disregard
of that risk; (3) by conduct that is more than mere negligence.” McElligott v.
Foley, 182 F.3d 1248, 1255 (11th Cir. 1999). Where medical treatment provided
is “minimally adequate,” no deliberate indifference exists. Harris v. Thigpen, 941
F.2d 1495, 1504 (11th Cir. 1991) (finding that a simple difference in medical
opinion between the prisoner and the medical staff did not support a claim of cruel
and unusual punishment). The district court found that Lynch had “allege[d]
nothing to show that, in deliberate indifference to his needs, they declined
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providing him with treatment that they had the authority to provide.” Here, even
on the facts of the Complaint, a tension exists between the two treatments
prescribed—waiting or having the offending teeth extracted—and the prisoner’s
own medical opinion. Although there may have been medical need, Lynch was
offered adequate treatment and refused that treatment. Moreover, Lynch fails to
make a non-conclusory assertion that the tooth extraction was not only not
adequate treatment, but not the best possible treatment. Lynch cannot claim the
constitutional violation lies in delay when Lynch himself caused the delay in
refusing adequate treatment. Because only a difference in opinion exists, Lynch’s
Complaint does not support a claim that his constitutional rights were violated by
the dentists.8
Lynch contends that the district court erred in granting Defendants’ motion
for summary judgment because Felton and Jackson were deliberately indifferent to
Lynch’s medical needs. Prison officials who rely on medical personnel for the
clinical determinations lack the requisite knowledge for deliberate indifference,
absent evidence that clinical determination were unreliable. See Howell v.
There may be situations where tooth extraction does not constitute adequate treatment.8
See, e.g., Stack v. McCotter, 79 F. App’x 383, 390 (10th Cir. 2003) (unpublished) (finding that
directors in Utah’s Department of Corrections were deliberately indifferent because the
contractor’s entire dental policy was extraction-only). Lynch has not alleged any specific facts
here that would permit us to interpret a doctor’s medical opinion that teeth should be extracted as
anything other than adequate treatment.
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Burden, 12 F.3d 190, 191, 194 (11th Cir. 1994) (finding that a prison official was
deliberately indifferent where he had responsibility over doctors and inmates and
did not provide what doctors saw as the necessary services to medically control
the inmate’s disease). Here, Doctor Smith testified “the state of Lynch’s teeth
when he entered the jail precluded any alternative treatment, other than to pull out
the teeth.” Smith added that “the state of Raoul Lynch’s teeth precluded the
application of alternative treatments including bone grafting, regenerative
procedure, and soft tissue grafting.” Another dentist thought that treatment could
wait until after the prisoner had been released. Lynch offers no evidence that
these clinical determinations were incorrect or unreliable. Assuming Felton and
Jackson were aware of Lynch’s condition, Defendants permissibly relied on the
doctors’ opinions that treatment could either wait or that adequate treatment had
been offered and refused.
Lynch argues that Felton and Jackson were liable for violating Lynch’s
constitutional rights by supervising CMA’s policy. Supervisory theory of liability
requires participation in the alleged constitutional violation or a causal connection
between the actions of the supervising official and the alleged constitutional
deprivation. Brown v. Crawford, 906 F.2d 667, 671(11th Cir. 1990) (finding that
a widespread history of infested drinking water and inmates sleeping on the floor
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could be sufficient to notify the director of the jail of the conditions and hold him
liable as a supervisor, but that such a history did not exist); see Adams v. Poag, 61
F.3d 1537, 1546 (11th Cir. 1995) (finding that the prison official’s procedures for
tracking the medical progress of prisoners did not constitute deliberate
indifference). Here, the policy at issue is not facially unconstitutional or otherwise
responsible for Lynch’s alleged deprivation of treatment. Although certain
services may not be provided by the Fulton County Jail, CMA’s contract and the
Fulton County Jail policy provide for dental surgery where a dental professional
believes it necessary. Lynch has pointed to no evidence to the contrary. Because
the policy provided for adequate care, Felton and Jackson cannot be held liable
under a supervisory theory.
CONCLUSION
For the aforementioned reasons, the district court’s judgment in favor of
Defendants is AFFIRMED.
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