Gomez v. County of Westchester, 649 F. App'x 93

Plaintiff Santiago Gomez, pro se, sued under 42 U.S.C. § 1983 alleging deliberate indifference to serious medical needs based on dental care at Westchester County Jail in August and November 2012.
After administrative exhaustion of some claims, the district court dismissed defendants (County of Westchester, Correct Care Solutions, jail officials, and medical providers) on Rule 12(b)(6) grounds; Gomez appealed.
Key factual allegations: Gomez complained of severe tooth pain on a Sunday; a nurse practitioner examined him Monday, deemed him "ok," referred him to a dentist, and provided pain medication; he saw a dentist four days later when his condition worsened and received treatment that Thursday.
Gomez alleged a related claim that he was denied care in retaliation for filing a federal claim against Correct Care Solutions, stated only in one sentence of the complaint.
The district court dismissed his deliberate indifference and municipal liability claims; Gomez appealed those dismissals.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Deliberate indifference to serious medical needs	Gomez: delay/failure to diagnose and four-day delay in dental care for oral infection shows constitutional deliberate indifference	Defendants: treatment and referral/medication show no subjective recklessness; at most negligent care	Court: Dismissed — alleged facts support negligence but not the subjective recklessness required for deliberate indifference
Objective seriousness of deprivation	Gomez: infection and pain were sufficiently serious	Defendants: some alleged deprivations (e.g., dental floss) not sufficiently serious	Court: Dismissed certain claims (e.g., floss) as not sufficiently serious; November infection treated as not showing deliberate indifference
Municipal liability (Monell)	Gomez: county/medical contractor liable for custom/policy causing unconstitutional care	Defendants: no underlying constitutional violation, so no municipal liability	Court: Dismissed — no underlying constitutional violation, so Monell claims fail
First Amendment retaliation	Gomez: one-sentence allegation that denial of care was linked to filing a federal claim	Defendants: no factual allegations showing causation between complaint and denial of care	Court: Dismissed — allegation conclusory and lacks facts to plausibly plead causation

Chambers v. Time Warner, Inc., 282 F.3d 147 (2d Cir. 2002) (standard for Rule 12(b)(6) review)
Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (plausibility standard for complaints)
Ashcroft v. Iqbal, 556 U.S. 662 (2009) (legal conclusions not entitled to assumed truth)
Smith v. Carpenter, 316 F.3d 178 (2d Cir. 2003) (deliberate indifference standard for inmates)
Caiozzo v. Koreman, 581 F.3d 63 (2d Cir. 2009) (same standard for pretrial detainees)
Salahuddin v. Goord, 467 F.3d 263 (2d Cir. 2006) (objective and subjective components of medical deliberate indifference)
Farmer v. Brennan, 511 U.S. 825 (1994) (subjective deliberate indifference standard)
Harrison v. Barkley, 219 F.3d 132 (2d Cir. 2000) (lengthy unjustified delay can indicate deliberate indifference)
Hernandez v. Keane, 341 F.3d 137 (2d Cir. 2003) (medical malpractice alone not deliberate indifference)
Askins v. Doe No. 1, 727 F.3d 248 (2d Cir. 2013) (Monell liability requires underlying constitutional violation)
Espinal v. Goord, 558 F.3d 119 (2d Cir. 2009) (elements of prisoner retaliation claim)
Gill v. Pidlypchak, 389 F.3d 379 (2d Cir. 2004) (retaliation: protected conduct, adverse action, causation)
LoSacco v. City of Middletown, 71 F.3d 88 (2d Cir. 1995) (issues not raised on appeal are abandoned)