Cion Peralta v. T. Dillard, 2014 U.S. App. LEXIS 4226

Lancaster prison had severely limited dental staff and no technicians or hygienists; patient Peralta waited months for care despite complaints of pain and infection.
Prison policy called for one dentist per 950 prisoners, but Lancaster’s ratio was approximately 1:1500 to 1:2000 when including care at other facilities.
Peralta asked for dental care immediately and was placed on a routine waiting list with nine-to-twelve month delays; emergency care was limited.
Over time, Peralta was treated intermittently: an extraction was scheduled but not performed, and he received limited ibuprofen and infection treatment.
Peralta filed a §1983 damages claim against Dr. Brooks, Chief Dental Officer Dillard, and Chief Medical Officer Fitter for deliberate indifference; trial resulted in judgment for Brooks, with Dillard and Fitter granted judgment as a matter of law.
District court and Ninth Circuit analyses focused on whether lack of resources can be a defense to damages under §1983 and how to apply the “deliberate indifference” standard to resource constraints.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether lack of resources can be a defense to damages under §1983.	Peralta argues budget constraints negate liability for deliberate indifference.	Brooks/Dillard/Fitter and district court contend lack of resources can excuse failure to provide care.	No; lack of resources is not a defense to damages for deliberate indifference.
Whether the jury instruction properly stated the law on resources and deliberate indifference.	The instruction correctly reflected resource constraints as relevant to fault.	The instruction was unsupported/misleading given trial evidence.	Instruction was proper and supported by evidence; not misled.
Whether granting judgment as a matter of law against Dillard and Fitter was appropriate.	Sufficient evidence could show supervisory responsibility and deliberate indifference.	No evidence showed actual knowledge; district court correct.	Judgment as a matter of law for Fitter and Dillard was upheld as to Dillard; Fitter affirmed due to qualified immunity.
Whether law-of-the-case and pretrial rulings foreclosed reconsideration of liability.	Law-of-the-case prevented reconsideration of liability.	Pretrial rulings can be revisited as record develops.	Law-of-the-case doctrine did not bar reconsideration; ruling did not alter outcome.

Estelle v. Gamble, 429 U.S. 97 (U.S. 1976) (establishes deliberate indifference standard)
Farmer v. Brennan, 511 U.S. 825 (U.S. 1994) (requires awareness and disregard of substantial risk)
Wilson v. Seiter, 501 U.S. 294 (U.S. 1991) (constraints affect reasonableness of response to risk)
Jones v. Johnson, 781 F.2d 769 (9th Cir. 1986) (budgetary constraints not a defense to cruel and unusual punishment)
Snow v. McDaniel, 681 F.3d 978 (9th Cir. 2012) (reaffirms lack of resources as defense to damages)
Spain v. Procunier, 600 F.2d 189 (9th Cir. 1979) (cost not a defense to cruel punishment; injunctive focus)
Monell v. Dep’t of Soc. Servs., 486 U.S. 658 (U.S. 1978) (local government policy/Monell liability for damages)
Quern v. Jordan, 440 U.S. 332 (U.S. 1979) (Eleventh Amendment sovereign immunity limits damages against states)
Brown v. Plata, 131 S. Ct. 1910 (S. Ct. 2011) (California prison overcrowding and care issues cited)
Hunt v. Dental Dep’t, 865 F.2d 198 (9th Cir. 1989) (deliberate indifference standard in prison dental care)