Brown v. Coyner

CLERK'S OFFICE □

IN THE UNITED STATES DISTRICT COURT AT ROANOKE, VA

FOR THE WESTERN DISTRICT OF VIRGINIA March 17, 2025

ROANOKE DIVISION yeaa □□□□□□ Cl

DEMMERICK E. BROWN, )

)

Plaintiff, ) Case No. 7:22CV00251

)

Vv. ) OPINION AND ORDER

)

T. COYNER, ET AL., ) JUDGE JAMEs P. JONES

)

Defendants. )

Demmerick E. Brown, Pro Se Plaintiff; Grace Morse-McNelis, FRITH

ANDERSON + PEAKE, PC, for Defendants K. Smith; Brittany E. Shipley and Rosalie

P. Fessier, TIMBERLAKE SMITH, Staunton, Virginia, for Defendant Wiedemann;

and Ann-Marie C. White Rene, Assistant Attorney General, OFFICE OF THE

ATTORNEY GENERAL OF VIRGINIA CRIMINAL JUSTICE AND PUBLIC SAFETY DIVISION,

Richmond, Virginia, for Defendants White, Graham, Holloway, Manis, Amonette,

Wyatt, Dillman, Clarke, and Robinson.

The plaintiff, Demmerick E. Brown, an unrepresented Virginia prison inmate,

filed this action under 42 U.S.C. § 1983, alleging that the defendants failed to

provide him with adequate dental care. After review of the record, I conclude that

the defendants’ pending motions for summary judgment must be granted and

Brown’s summary judgment motion must be denied.

I. BACKGROUND.

The claims alleged in this action arose while Brown was confined at Augusta

Correctional Center (Augusta), a prison operated by the Virginia Department of

Corrections (VDOC).1 Ultimately, he filed the Second Amended Complaint that I

have considered as the operative pleading in the case. It names as defendants several

VDOC administrators and prison officials: Harold W. Clarke, former VDOC

Director; David A. Robinson, VDOC Chief of Operations; G. Holloway, Chief

Regional Administrator; Carl Manis, Regional Administrator; P. White, Warden; L.

Graham, Operation Manager; J. Chittum, Grievance Coordinator; Mark Amonette,

Chief Physician; Adam Wyatt, Chief Dentist; and Jeffery Dillman, Health Services

Director. Brown also names as defendants three medical providers at Augusta — T.

Coyner, a dental assistant; K. Smith, a physician; and Werner Wiedemann, a dentist.

Brown alleges that while he was confined at Augusta in 2020 and 2022, the

defendants’ actions or inactions deprived him of adequate dental care constituting

deliberate indifference to his serious medical needs. He seeks compulsory damages.

Brown, age 64, alleges that he was born with a rare disease that makes him

vulnerable to having infections elsewhere in the body attack his heart valves. He

claims to have had four open heart surgeries made necessary from infections that

damaged his heart valves and that he has two mechanical heart valves and a

pacemaker.

1 Brown is now incarcerated at another Virginia prison, Deerfield Correctional

Center (Deerfield).

In November 2020, Brown was confined at Virginia’s Red Onion State Prison

(Red Onion) and developed a gum infection from a deteriorated dental filling. A

doctor at Red Onion prescribed antibiotics, and a dentist put in a temporary filing,

and noted that Brown had strong healthy teeth. In April 2021, after his transfer to

Augusta, Brown saw the contract dentist, Dr. Wiedemann, for a gum infection. The

dentist allegedly recommended extracting Tooth 24 as the cause of the recurring

infections, but Brown refused extraction, based on the Red Onion dentist’s findings.

Dr. Wiedemann said that COVID-19 restrictions prevented him from performing

non-emergency dental treatment to repair the tooth, that the waiting list for such care

was backed up two years, and that Brown’s best option was to have the tooth

extracted. Brown insisted that repair of his tooth was an emergency because of his

heart issues. Neither the dentist nor any other prison official Brown informed took

any action to get Brown emergency dental care.

Months later, when Brown asked for treatment for another possible gum

infection, Dr. Wiedemann allegedly refused to treat him immediately because of

inadequate resources at Augusta, citing VDOC Operating Procedure (OP) 720.6. Dr.

Wiedemann also told Warden White that Brown’s needs did not require outside

dental treatment. In addition, Augusta’s institutional physician, Dr. Smith, allegedly

refused to arrange treatment by an outside dentist for Brown’s dental needs, despite

knowing of his heart problems.

A local cardiologist who examined Brown in September 2021 allegedly told

him that consequences of untreated dental infections could be deadly for him.

Brown spoke with Dr. Wiedemann and Dr. Smith about the cardiologist’s warning.

The dentist told Dr. Smith that extraction of one tooth would take care of the

infection problem, and Dr. Smith said he would not go against the dentist’s

professional advice.

Brown filed this lawsuit in May 2022, and officials sent him soon after to an

outside dentist for extraction of Tooth 24. After speaking to that dentist, Brown

decided against extraction of Tooth 24. In October 2022, the dentist decided that

Teeth 31 through 29 were the cause of Brown’s gum infections. Brown also claims

that after delays of dental care in 2020–2021, he was diagnosed with seven additional

cavities.

I previously granted in part and denied in part the defendants’ motions to

dismiss. Brown v. Coyner, No. 7:22CV00251, 2024 WL 1374807, at *1 (W.D. Va.

Mar. 30, 2024). I left the following claims to be decided:

1. Dr. Wiedemann was deliberately indifferent to Brown’s serious

medical need for dental treatment, in violation of the Eighth

Amendment;

2. Defendants Manis, Holloway, Robinson, Clarke, Amonette,

Wyatt, and Dillman were deliberately indifferent to Brown’s

serious medical need for dental treatment, in violation of the

Eighth Amendment;

3. VDOC restrictions allowing delay or denial of nonemergency

dental treatment, based on COVID-19 restrictions or shortages in

facility staffing and resources, are unconstitutional, and VDOC

administrators Clarke, Robinson, Amonette, Wyatt, and Dillman,

as policy makers, should be liable because application of these

policies violated Brown’s Eighth Amendment rights by delaying

necessary dental care;

4. Dr. Smith was deliberately indifferent to Brown’s serious

medical need for dental treatment, in violation of the Eighth

Amendment;

. . . .

6. Warden White was deliberately indifferent to Brown’s serious

medical need for dental treatment, in violation of the Eighth

Amendment; and

. . . .

8. Defendant Graham was deliberately indifferent to Brown’s

serious medical need for dental treatment, in violation of the

Eighth Amendment. . . .

Id. at *5. I granted the defendants’ motions to dismiss as to “all claims of vicarious

liability, all claims against the defendants in their official capacities, all First

Amendment and Fourteenth Amendment claims, all claims against defendant

Chittum” and all claims against defendant Coyner. Now before me are four motions

for summary judgment, filed by the remaining defendants and Brown, and the

plaintiff’s responses to those motions.2

2 Dr. Smith and Dr. Wiedemann have filed separate summary judgment motions,

each supported by a declaration from the defendant and attached medical records. Mem.

Supp. Mot. Summ. J., Smith Decl., ECF No. 124-1; Mem. Supp. Mot. Summ. J. Ex. A.,

Wiedemann Decl., ECF No. 130-1. The other defendants (Amonette, Clarke, Dillman,

Graham, Holloway, Manis, Robinson, White, and Wyatt) have filed a joint summary

II. EVIDENCE ON SUMMARY JUDGMENT.

Based on Dr. Wiedemann’s personal recollection and dental records, he

presents the following evidence. On April 20, 2021, Dr. Wiedemann saw Brown in

response to an Emergency Grievance about a bump beside Tooth 29 (the lower right

bicuspid), in which he had a temporary filling. Brown reported that his tooth and

jaw were asymptomatic. Dr. Wiedemann’s examination of Tooth 29 revealed an

obvious swelling of the buccal plate, a temporary filing on the distal aspect, and an

occlusal amalgam (filling) with no mobility. The dentist took a periapical X ray of

Teeth 28 and 29 that revealed a deep temporary filling on Tooth 29 that extended

almost to the pulp, as well as an apical lesion on the tip of the root. Dr. Wiedemann

diagnosed Brown with an infection of a deep temporary filling to Tooth 29. He

classified the dental condition as Class 2, or low priority. Because Brown was

asymptomatic other than the non-painful bump, he recommended, and Brown

agreed, to medicate and watch Tooth 29. Dr. Wiedemann prescribed antibiotics for

seven days, and Brown indicated he would notify the dental staff if he had any

further trouble with that tooth.

On April 20, 2021, Dr. Wiedemann also completed Brown’s dental charting.

This documentation indicated that Brown was missing Teeth 1 (upper right third

judgment motion, supported by the defendants’ affidavits. Mem. Supp. Mot. Summ. J.,

ECF No. 135. Brown has filed a document, ECF No. 141, that he refers to as seeking

summary judgment, but it also asks for denial of the defendants’ motions.

molar), 2 (upper right second molar), 4 (upper right second bicuspid), 5 (upper right

first bicuspid), 10 (upper left lateral incisor), 12 (upper left first bicuspid), 13 (upper

left second bicuspid), 14 (upper left first molar), 16 (upper left third molar), 17

(lower left third molar), 19 (lower left first molar), 30 (lower right first molar), and

32 (lower right third molar). The charting also indicates that Brown had existing

fillings on Teeth 3 (upper right first molar), 15 (upper left second molar), 18 (lower

left second molar), 20 (lower left second bicuspid), 21 (lower left first bicuspid), 24

(lower left central incisor), 28 (lower right first bicuspid), 29 (lower right second

bicuspid), and 31 (lower right second molar). Dr. Wiedemann also noted that Brown

has prosthetic heart valves and a pacemaker, is allergic to penicillin, has had

rheumatic fever, and reported having had four open heart surgeries and a history of

heart disease, heart murmur, hypertension, blood clotting problems, and respiratory

disease. He also noted Brown’s report that he had smoked for twenty years and had

chronic lung disease.

In the next several months, Brown filed numerous request forms to the dental

staff, complaining that he should receive immediate or outside dental care because

of his heard issues. Staff reviewed and responded to these requests, advising Brown

that COVID-19 restrictions limited outside dental care and that the Augusta dental

office had no full-time dental assistant. Staff repeatedly informed Brown, however,

that he was on the list for a non-emergency dental exam. In response to Brown’s

request in late August 2021, staff informed him that VDOC policy at the time

prohibited any inmate from being sent to an outside dentist for routine dental care.

On September 7, 2021, Dr. Wiedemann answered Brown’s Emergency

Grievance, raising an issue similar to his complaint in April of 2021. The dentist

refilled Brown’s prescription for antibiotics and ordered that he be scheduled for the

next available appointment time.

On September 8, 2021, Dr. Wiedemann saw Brown who complained of a

swelling, but reported that the tooth was otherwise asymptomatic. When the dentist

examined Brown, he noted a swelling localized to the lingual aspect of Tooth 24,

which had an existing composite filling in good condition. Tooth 25 presented with

a failed, existing filling and with recurrent caries. One periapical X ray revealed an

apical lesion on Tooth 24 and a large chip on more than one surface of that tooth.

Dr. Wiedemann found no obvious apical pathologies present on Tooth 25. He

diagnosed Brown with a periapical abscess to Tooth 24 and caries to Tooth 25, both

classified as nonemergency dental needs. He ordered that Brown be scheduled for

extraction of Tooth 24 and restoration of Tooth 25. The dentist performed caries

removal on Tooth 25 and placed a temporary filing on that tooth. He educated

Brown about oral hygiene and advised Brown to allow removal of Tooth 24. Dr.

Wiedemann determined that a filling would not be adequate treatment for Tooth 24

and due to its condition, Brown’s general dental hygiene, and his multiple carious

teeth, he was not a candidate for root canal therapy.

On September 9, 2021, Dr. Wiedemann consulted with Dr. Smith about

having Brown pause his Warfarin, a medication to prevent blood clots, in order to

prepare for the upcoming extraction. The dentist next saw Brown on September 10,

2021, for a pre-surgery consultation, in which they discussed stopping Warfarin for

five days prior to the extraction of Tooth 24 and taking pre-operative antibiotics

because of his prosthetic heart valves. Brown asked to delay the extraction until

after a soon-to-be-scheduled procedure to replace batteries in his pacemaker and

defibrillator. Dr. Wiedemann agreed to this delay and advised Brown to notify

dental staff once the procedure had been completed so he could proceed with the

extraction.

On September 21, 2021, Brown filed a request asking to have his tooth

extracted as soon as possible, but he did not want to pause his blood thinner

medication beforehand. Staff noted that the dentist would confer with Dr. Smith

about this request. Brown did not notify dental staff that his pacemaker issues had

been addressed. Although Brown asked again for more antibiotics, the dental staff

refused such requests absent a change in symptoms.

On January 6, 2022, Brown filed a request for his operative work to be

performed. Staff responded, stating that due to staffing shortages, he would remain

on the examination list. In response to Brown’s complaints in February and March

2022, that he had not had cavities repaired, staff stated that he remained on the

examination list.

On March 10, 2022, Dr. Wiedemann saw Brown in the dental office to consult

with him about his treatment plan. The dentist noted on Brown’s report that all teeth

were asymptomatic, and exam of Tooth 24 revealed no swelling. Brown reported

that Teeth 6 and 7 needed fillings. But on exam, the dentist found that these teeth

showed shallow caries that did not require immediate treatment. The dentist advised

Brown to notify dental staff if his teeth became symptomatic. On March 24, May

19, and June 2, 2022, dental staff responded to Brown’s demands for outside dental

care and his complaints about inadequate care at Augusta. Staff advised him that he

remained on the list to be seen if he experienced an emergency condition or when

staffing shortages were addressed.

On August 18, 2022, another dental provider reviewed Brown’s medical

history and performed X rays of Brown’s teeth. Thereafter, Brown was scheduled

for an off-site procedure at Beaumont Correctional Center (Beaumont), where a new

dental clinic had begun taking patients in July 2022. Brown saw a provider at

Beaumont on September 12, 2022, who performed fillings to Teeth 3, 6, and 7. Dr.

Wiedemann consulted with Dr. Smith on October 5, 2022, about pausing Warfarin

for four days before any extraction appointment for Brown and then ordered a pause

in that medication for Brown from October 22 to 26, 2022. Dr. Wiedemann also

prescribed prophylactic antibiotics for Brown. Brown later decided not to comply

with the Warfarin hold, but after consultation with Dr. Smith, Dr. Wiedemann

approved Brown for extractions if necessary.

On October 26, 2022, Brown saw a provider at Beaumont, for possible

extraction of Tooth 24. At that time, the provider noted that Tooth 24 was

asymptomatic, had no mobility, and was not causing any pain. Brown did not want

the tooth extracted, so no extraction occurred. On November 20, 2022, Dr.

Wiedemann prescribed prophylactic antibiotics for Brown’s next upcoming off-site

appointment at Beaumont. After consultation with Dr. Smith, he did not order a

preoperative hold on Brown’s Warfarin. On November 15, 2022, Brown consented

to extraction of Tooth 31. Brown transferred from Augusta to Deerfield on

December 28, 2022.

Dr. Smith, a licensed physician with residency training in family medicine,

provided medical care to Augusta inmates from 2015 through May 2023, and served

as Medical Director for five years of that time. His evidence overlaps significantly

with Dr. Wiedemann’s evidence. Brown came to Augusta in April 2021. During

intake, medical staff identified him as requiring referral to the physician because of

his implantable cardioverter defibrillator (ICD), similar to a pacemaker and used to

monitor and regulate heart rhythms. The intake form also documented Brown’s

history of congestive heart failure, other heart issues, and respiratory disease.

Dr. Smith examined Brown on April 12, 2021, noting that Brown was overdue

for a battery check or replacement for his cardiac device. The doctor ordered that

he be scheduled with a cardiac expert as soon as possible after the two-week

quarantine then in effect because of the COVID-19 protocols; he marked this order

as urgent. Dr. Smith followed up on this order and ensured that Brown saw an expert

about his cardiac device.

In April 2021, Dr. Wiedemann, dentist for Augusta inmates, diagnosed Brown

with a gum infection near Tooth 29, ordered medication to treat the infection, and

advised Brown to follow up if any other problems arose. Dr. Wiedemann saw Brown

on September 8, 2021. After the dental examination, Dr. Wiedemann noted a

recommended plan to schedule Brown to have an extraction of Tooth 24 and to

restore Tooth 25. On September 10, 2021, Dr. Wiedemann talked to Brown about

the planned extraction, noting:

Consult with pt. regarding warfarin and necessity of stopping this

medication for 5 days prior to an extraction. Also mentioned need for

antibiotics pre-med due to prosthetic heart valves. Pt. understood both

issues, however, he is due to have pacemaker/defibrillator batteries

replaced at any time and would like to delay the extraction until after

that procedure is completed (he states he saw the cardiologist 2 weeks

ago and doesn’t know exactly when that appointment will occur). I

concur with his decision. Pt. states the antibiotic has improved the tooth

situation significantly already and the tooth remains asymptomatic. Pt.

will notify us when he is ready to proceed.

Wiedemann Decl. Ex. A.A at 21, ECF No. 130-1. On September 23, 2021, Dr.

Wiedemann documented a conversation with Dr. Smith about medications prior to

removal and replacement of the ICD device. Dr. Wiedemann also noted that Brown

“is fine, teeth are not hurting, nor are the gums.” Id. at 22.

Brown underwent a cardiology procedure on October 4, 2021, at Augusta

Health to replace his ICD device. Dr. Smith saw Brown on October 6, 2021, and

prescribed a post-operative antibiotic. A note in the dental records indicates that

Brown asked the next day for more antibiotics, but the dentist found no need unless

Brown’s symptoms changed. Other cardiology exams and procedures followed later

in October 2021 and in January 2022.

The dental team noted on December 9, 2021, that Brown had complained

about not receiving timely dental care. The team reiterated that Brown’s dental

procedures had been put on hold until after his pacemaker procedure and that Brown

was to notify dental staff after the cardiac issue had been resolved.

Dr. Smith notes Brown’s cardiology evaluation of his ICD in late January

2022. However, Dr. Smith does not recall that the cardiologist spoke to him about

arranging an appointment for Brown with an outside dentist or remember any

discussions with that specialist about dental issues.

On March 3, 2022, Dr. Smith saw Brown and noted the inmate’s complaints:

He is upset about the length of time it is taking to receive dental care.

He is very upset that the dentist is allegedly refusing to do anything

other than pull teeth. I expressed compassion and explained that while

I sympathize with him I was not able to control how the dentist ran his

practice. He was quite understanding of this.

Smith Decl. at ¶ 33, ECF No. 124-1.

Dental records indicate that Dr. Wiedemann saw Brown for a dental

examination on March 10, 2022, and classified his issues as minor. Records also

show Brown was seen at Beaumont on August 18, 2022, and returned to that facility

for dental care on September 12, October 26, and November 15, 2022. As to each

of these visits, Dr. Wiedemann signed off on the chart, indicating that he had

reviewed the offsite treating dentist’s notes. In October and November 2022, after

the offsite dentist recommended tooth extractions, Dr. Wiedemann documented

consulting with Dr. Smith and determining that no pause of Brown’s Warfarin

medication prior to the extractions would be imposed.

Dr. Smith last saw Brown in the chronic care clinic on December 28, 2022,

just before his transfer to Deerfield. He noted that overall, Brown was doing well.

He reported no unusual bleeding on his blood thinner medication, and his vital signs,

oxygen saturation, and weight were stable. Dr. Smith reviewed labs and ordered

new labs and a follow up with cardiology.

Dr. Smith states that as Medical Director at Augusta, he oversaw the medical

care that a private contracting company provided to inmates. Since Dr. Smith is not

a dentist, he states that making recommendations about dental care would be outside

the scope of his medical practice. Moreover, the medical and dental departments

were two separate entities, with the dental department managed by VDOC. Thus,

Dr. Smith relied on the dentist to determine Brown’s dental needs, other than

consultations about medications that might have an impact on other, chronic medical

conditions.

II. DISCUSSION.

A. The Summary Judgment Standard.

A court should grant summary judgment “if the movant shows that there is no

genuine dispute as to any material fact and the movant is entitled to judgment as a

matter of law.” Fed. R. Civ. P. 56(a). A genuine dispute exists “if the evidence is

such that a reasonable jury could return a verdict for the nonmoving party.”

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). To avoid summary

judgment, Brown must present sufficient evidence that could carry the burden of

proof of his claims at trial. Id. at 249. He “must set forth specific facts showing that

there is a genuine [factual] issue for trial” on which the jury could find in his favor.

Id. at 248.3

3 I have omitted internal quotation marks, alterations, and/or citations here and

throughout this Opinion unless otherwise noted.

B. The Eighth Amendment Standard.

“[S]ociety does not expect,” nor does the Eighth Amendment require, that

inmates have “unqualified access to health care.” Hudson v. McMillian, 503 U.S. 1,

8 (1992). Rather, only “deliberate indifference to serious medical needs of prisoners

constitutes the unnecessary and wanton infliction of pain” that violates constitutional

protections. Estelle v. Gamble, 429 U.S. 97, 104 (1976). Thus, the prisoner plaintiff

must show that, objectively, he was suffering from a serious medical need and,

subjectively the prison staff was aware of the need for medical attention but failed

to respond reasonably to that need. Iko v. Shreve, 535 F.3d 225, 241 (4th Cir. 2008).

“A deliberate indifference claim consists of two components, objective and

subjective.” Jackson v. Lightsey, 775 F.3d 170, 178 (4th Cir. 2014). Objectively,

the inmate’s medical condition must be serious” in the sense that it “has been

diagnosed by a physician as mandating treatment or . . . is so obvious that even a lay

person would easily recognize the necessity for a doctor’s attention.” Id. “A medical

condition need not be life threatening to be serious; rather, it could be a condition

that would result in further significant injury or unnecessary and wanton infliction

of pain if not treated.” Gayton v. McCoy, 593 F.3d 610, 620 (7th Cir. 2010); accord

Scott v. Clarke, 64 F. Supp. 3d 813, 822 (W.D. Va. 2014).

[A] tooth cavity is a degenerative condition, and if it is left untreated

indefinitely, it is likely to produce agony and to require more invasive

and painful treatments, such as root canal therapy or extraction,” and

“presents a serious medical need.” Furthermore, an abscessed tooth “is

not a simple toothache. It is a bacterial infection of the root of the tooth,

and it can spread to the adjacent gum and beyond — way beyond. It is

often painful and can be dangerous.

Formica v. Aylor, 739 F. App’x 745, 756 (4th Cir. 2018) (unpublished).

Subjectively, the prison official must have “actual . . . knowledge of both the

inmate’s serious medical condition and the excessive risk posed by the official’s

[own] action or inaction.” Jackson, 775 F.3d at 178. Id. “[W]hen a medical

professional of a jail facility knows of a serious medical need, the Eighth

Amendment requires reasonable action.” Formica, 739 F. App’x at 757. Put another

way, the defendant must have known the plaintiff was suffering from a condition

which pose[d] a risk to the prisoner such that it “would result in further significant

injury or unnecessary and wanton infliction of pain if not treated.” Id. at 755. “The

necessary showing of deliberate indifference can be manifested by prison officials

in responding to a prisoner’s medical needs in various ways, including intentionally

denying or delaying medical care, or intentionally interfering with prescribed

medical care.” Id. at 754.

Furthermore, to be unconstitutional, a defendant’s conduct must have been

“so grossly incompetent, inadequate, or excessive as to shock the conscience or to

be intolerable to fundamental fairness.” Miltier ex rel. Miltier v. Beorn, 896 F.2d

848, 851 (4th Cir. 1990), overruled in part on other grounds by Farmer v. Brennan,

511 U.S. 825, 837 (1994). Specifically, “delay can rise to the level of an Eighth

Amendment violation when the delay results in ‘some substantial harm to the

patient’ such as a ‘marked exacerbation of the prisoner’s medical condition’ or

‘unnecessarily prolonged an inmate’s pain.’” Wilder v. Krebs, No. 2:17-763-CMC-

MGB, 2018 WL 4020211, at *3 (D.S.C. Aug. 23, 2018) (quoting Formica, 739 F.

App’x at 755). On the other hand, “[a]n inmate’s mere disagreement with the course

of treatment provided by medical officers will not support a valid Eighth

Amendment claim.” Jackson v. Sampson, 536 F. App’x 356, 357 (4th Cir. 2013)

(unpublished). “[T]he essential test is one of medical necessity and not simply that

which may be considered merely desirable.” Bowring v. Godwin, 551 F.2d 44, 48

(4th Cir. 1977).

C. Brown’s Separate Deliberate Indifference Claims.

Brown’s many submissions essentially raise two deliberate indifference

arguments. First, that the dentist allegedly made erroneous decisions about Brown’s

dental care needs, as allegedly proven by decisions made months later by another

dental professional. Second, the other defendants did not properly classify and

address his dental issues as emergencies because of his heart issues.

Brown’s claims against Dr. Wiedemann center on Brown’s opinion that the

dentist misdiagnosed which tooth had caused what Brown refers to as reoccurring

gum infections. This contention rests on records showing that a different dentist,

months later, determined that different teeth were then causing problems and should

be extracted. Such “mere disagreements among physicians or between a prisoner

and his physician do not equate to deliberate indifference.” Chamberlain v.

Mathena, No. 7:19-CV-00879, 2021 WL 789858, at *4 (W.D. Va. Mar. 1, 2021)

(citing Hogge v. Stephens, No. 3:09CV582, 2010 WL 3834856, at *5 (E.D. Va. Sept.

24, 2010) (“A mere disagreement between doctors does not establish that one doctor

was deliberately indifferent.”), aff’d, 469 F. App’x 160 (4th Cir. 2012)).

Moreover, the two dentists based their diagnoses and treatment decisions on

different symptoms Brown exhibited many months or even years apart. Even if Dr.

Wiedemann, in responding to the symptoms presented to him in April and

September of 2021, made a misdiagnosis or ill-advised treatment decision, such

actions are, at most, medical negligence, which does not rise to the level of a

constitutional claim. Estelle, 429 U.S. at 106 (“Medical malpractice does not

become a constitutional violation merely because the victim is a prisoner.”).

The Fourth Circuit has held that an abscessed tooth, or a tooth cavity if “left

untreated indefinitely” so that they cause degeneration and pain, can be serious

medical needs. Formica 739 F. App’x at 756. Taken as a whole, however, evidence

of Dr. Wiedemann’s treatment of Brown’s dental issues does not support any claim

of deliberate indifference. The undisputed medical records indicate that Dr.

Wiedemann prioritized Brown’s emergency grievance requests concerning dental

care in April and September 2021 and examined him as soon as possible to evaluate

his then-current condition and address any urgent needs.

On April 20, 2021, on the day that Brown filed his emergency grievance, the

dentist visually examined Brown’s teeth, took X rays, and prescribed antibiotics to

treat a diagnosed gum infection. Brown reported no pain, so the dentist advised him

to contact dental staff if he had further trouble with Tooth #29, the tooth at issue

during the April exam.4 Instead of doing so, in the summer of 2021, Brown

complained to dental staff repeatedly, about being denied dental care, although they

had no record of receiving any request for specific dental care from Brown, and

asking to see an outside dentist. Wiedeman Decl. 16–18, ECF No. 130-1. Staff

notified Brown that they could only provide emergency care at present but would

place or retain him on the list for non-emergency care.

When Brown next filed an emergency grievance about his dental needs in

September 2021, he was scheduled to see Dr. Wiedemann within a day. At no time,

did Brown present to Dr. Wiedemann complaining of pain in a tooth or gums.

During the September 8, 2021, exam, the dentist visually examined Brown’s teeth,

took X rays, diagnosed a pain free bump as an abscess near Tooth 24, prescribed

antibiotics, and diagnosed caries on Tooth 25. He removed some caries and placed

4 Brown alleges that Dr. Wiedemann told him at the April 2021 exam that tooth 24

was the cause of the infection. Medical records do not support this claim, although the

dentist did identify Tooth 24 as being a problem during the September 2021 examination.

a temporary filling in Tooth 25. Indeed, after Brown took the antibiotics, he soon

reported that Tooth 24 was asymptomatic. Dr. Wiedemann recommended extraction

of Tooth 24, based on his belief that its condition could not be restored by a filling

or even a root canal. The court cannot second-guess such medical judgments.

Russell v. Sheffer, 528 F.2d 318, 319 (4th Cir. 1975).

Brown’s heart condition placed him at a higher-than-normal risk of harm from

infections and other dental procedures. However, Dr. Wiedemann considered

Brown’s heart condition in assessing Brown’s condition and prescribing treatment.

He conferred with Dr. Smith about how to handle related medications before any

scheduled tooth extraction. Although he and Dr. Smith would have preferred to stop

Brown’s Warfarin prescription for five days before any extraction, Brown refused

and suffered no heart-related effects from tooth extractions.

Furthermore, Brown himself bears responsibility for some of the delay in his

dental care. When extraction of Tooth 24 was to be scheduled in 2021, Brown asked

for it to be postponed, pending his cardiac procedure, and delayed for months

advising the dental department that the cardiac procedure had been completed. Once

Beaumont’s dental department could take patients, Dr. Wiedemann referred Brown

to that facility for extraction of Tooth 24, but Brown refused that treatment.5 In

5 Brown decided against extraction of Tooth 24, based on a different dentist’s

diagnosis of its condition months after Dr. Wiedemann made the initial recommendation.

These disagreements between dentists’ recommendations do not prove that Dr.

short, Dr. Wiedemann offered Brown prompt and attentive evaluation of any

reported dental needs and prescribed treatment for any such needs. Such medical

treatment does not fall within the scope of deliberate indifference. Coker v. Corizon

Med. Servs., 645 F. App’x 888, 891 (11th Cir. 2016) (unpublished) (affirming

summary judgment for defendant dentists where defendants identified and offered

to resolve the plaintiff’s dental needs, but plaintiff refused treatment and demanded

different treatment).

Brown also claims that Dr. Wiedemann at one point told him that Dr. Smith,

as Brown’s primary care physician, could decide whether referral to an outside

dental clinic was warranted. Dr. Smith’s evidence, which Brown has not refuted,

reflects that the medical department and the dental department were separate entities,

and that Dr. Smith had no expertise to bring to bear on any of Brown’s dental issues.

Moreover, the record indicates that the two providers consulted frequently on how

to safely adjust Brown’s heart-related medications prior to dental procedures. These

facts do not support any claim that either professional knew that the dental

procedures provided to Brown, or the nonemergency dental care recommended and

postponed due to appointment backlogs and staffing shortages, placed him at an

excessive risk of harm and ignored that risk. Certainly, Brown has not shown that

Wiedemann violated Brown’s constitutional rights through his differing diagnosis months

earlier when viewing different symptoms.

Dr. Wiedemann's or Dr. Smith’s actions were “so grossly incompetent, inadequate,

or excessive as to shock the conscience or to be intolerable to fundamental fairness.”

Miltier, 896 F.2d at 851. I also find no material disputed fact on which Brown could

persuade a jury that the dentist or physician was deliberately indifferent to any

serious medical need. Accordingly, I will grant the motions for summary judgment

these defendants have filed and deny Brown’s summary judgment motion against

them.

I make similar findings as to Brown’s Eighth Amendment claims against

defendants Manis, Holloway, Robinson, Clarke, Dillman, White, and Graham.

Brown allegedly informed each of these individuals, through grievances, appeals, or

contacts with his family, of his belief that his dental needs in 2020 and 2021 should

be treated as an emergency because of his cardiac issues and that he should be

referred to an outside dental facility for treatment.

The defendants’ evidence as to each of these individuals shows that none of

them is a dentist or a cardiologist. Thus, each of them could rightfully rely on Dr.

Wiedemann, and to some extent, on Dr. Smith as Brown’s treating physician, to

evaluate whether at any specific time, Brown’s nonemergency dental problems

presented an excessive risk of harm if left untreated until the backlog cleared, or new

dental staff or facilities became available. Therefore, I will grant summary judgment

for Manis, Holloway, Robinson, Clarke, Dillman, White, and Graham as to Brown’s

Eighth Amendment claims, and deny Brown’s motion seeking summary judgment

on such claims.

Two other defendants, Dr. Wyatt, as Chief Dentist, and Dr. Amonette, as

Medical Director and Chief Physician in 2021, are also entitled to summary

judgment on the Eighth Amendment claims.

It is undisputed that Dr. Wyatt serves as the administrative clinical manager

of dental care to VDOC inmates. He does not travel to the prisons to administer

dental care or treatment to prisoners. He also does not intervene in any dental

clinician’s decision regarding treatment of that clinician’s assigned inmate patients.

Rather, he relies on the professional opinions of the dental clinicians regarding

patient care.

One of Dr. Wyatt’s duties is to review, inquire about, and respond to Level II

inmate grievance appeals about dental issues. In fulfilling this duty, Dr. Wyatt relies

on information provided by an inmate’s caregiving dentist. On July 27, 2021, he

contacted Dr. Wiedemann about Brown’s claim of being denied access to dental

care. Dr. Wiedemann responded that he had reviewed Brown’s chart and provided

a summary of his contact with Brown on April 20, 2021. Based on this information,

Dr. Wyatt informed defendant Dillman who issued a Level II response that the

grievance was unfounded.

Similarly, Dr. Amonette was an administrator in 2021, not a clinical

physician. His job duties included peer review of VDOC medical providers for

management of chronic diseases, assisting in formulation of standard treatment

guidelines and procedures, discussing cases to assist in determining best

management of a medical condition, providing offsite care for inmates, and

investigating complaints about inmate care, as needed. Dr. Amonette states that he

“did not make decisions or recommendations regarding the diagnosis or treatment

of inmate’s medical or dental needs unless [he] was conducting utilization reviews

for off-site care, consulting with a treating physician, or responding to a complaint

about care.” Mem. Supp. Mot. Summ. J. Amonette Aff. ¶ 4, ECF No. 135-1. Rather,

the undisputed evidence is that Dr. Amonette’s job was to ensure that contract

doctors complied with medical operating procedures. He relied on the professional

judgment of the treating doctors and did not substitute his own judgment for their

opinions regarding an inmate’s treatment. The Chief Dentist, not the Medical

Director or Chief Physician, would be responsible for approving off-site dental care

for an inmate, if recommended by the institutional dental provider. Amonette did

not review any off-side care request for Brown while he was at Augusta in 2021-

2022.

As discussed, I find no respect in which Dr. Wiedemann or Dr. Smith has

acted with deliberate indifference toward Brown’s dental needs. Thus, Dr. Wyatt

and Dr. Amonette could rightfully rely on Dr. Wiedemann and Dr. Smith to

supervise necessary dental care for Brown and to ensure proper protection for his

compromised heart. While Brown expressed to Dr. Wyatt and Dr. Amonette his

layman’s opinion that his untreated cavities and other dental needs warranted off-

site, emergency treatment, the administrators had no medical evidence from Brown’s

providers suggesting that off-site treatment was warranted on an emergency basis at

the times of which Brown complains. I conclude that Dr. Wyatt and Dr. Amonette

are entitled to summary judgment, and that Brown’s summary judgment motion

against them must be denied.

D. Brown’s Claims of Unconstitutional VDOC Policies.

In Brown’s Claim 3 he contends that defendants Clarke, Robinson, Amonette,

Wyatt, and Dillman should be liable for VDOC restrictions on dental care in 2020

and 2021 that were unconstitutional because they prevented him from receiving

sooner care that he believed was essential for his health. He apparently refers to the

COVID-19 restrictions allowing dentists to address only urgent or emergency dental

needs and to OP 720.6, which recognizes that nonemergency dental care may be

delayed in cases of staffing shortages. Brown fails to make the case that either of

these restrictions is unconstitutional.

Dr. Wyatt has provided evidence about VDOC dental policies, among other

things, in his affidavit in support of summary judgment. Generally, OP 720.6

governs dental services for VDOC inmates. Dr. Wyatt is responsible for reviewing,

updating, or rewriting this policy regularly, as needed. This procedure is designed

as guidance for provision of adequate, necessary, and cost-effective dental care to

inmates. Under VDOC COVID-19 restrictions, the dental policy did not deny any

inmate urgent (Class 3) or emergent (Class 4) dental care. Rather, VDOC

administrators adjusted procedures to comply with the Governor’s orders to provide

any such essential dental care and postpone only nonurgent or nonemergent care.

Under state laws governed by the Virginia Board of Dentistry (Board), each

dentist is considered the clinical supervisor of his or her individually assigned dental

clinic and staff. The Board is the sole governing body, charged with determining if

a licensed dental practitioner in Virginia continues to practice legally and in

accordance with the standard-of-care guidelines this Board defines. Each dentist is

considered “accountable to the [B]oard for any clinical instructions (direct/indirect

supervision) to be performed during the dental treatment of their patients within their

practice.” Mem. Supp. Mot. Summ. J. Wyatt Aff. ¶ 7, ECF No. 135-8. Whatever a

dentist’s organizational position or associated job duties, including administrative

tasks, each dentist is held individually accountable under his or her professional

dental license to practice dentistry in accordance with the Board. This professional

obligation for all Virginia dentists remained in effect during and after the COVID-

19 pandemic. Moreover, the Board holds each licensed dentist accountable to

practice under the Board’s Dentistry Guidelines, which incorporate provisions from

other regulatory and standard-of-care practices set forth by the American Dental

Association.

VDOC dental leadership consists of the Chief Dentist, Regional Dental Clinic

Directors, and Dental Supervisors. The function of these officials is to provide

administrative supervision to clinical providers and their assigned clinical staff, such

as dental hygienists and dental assistants, and to make clinical recommendations

based on current research, evidence-based practices, and organizational

administrative directives. VDOC Dental Leadership initiatives are formed to help

ensure that each licensed dental practitioner, as a clinical supervisor, remains free to

govern his or her practice while making informed clinical decisions “without

conflicting the governing bodies.” Id. at ¶ 11. VDOC dental leadership

professionals and the Board are not positioned to dictate treatment options or

methods of treatment to licensed dental practitioners.

VDOC dental leadership received notice of the COVID-19 airborne threat in

early March 2020. The Governor declared a State of Emergency through Executive

Order No. 51 on March 12, 2020. At that time, Dr. Wyatt, as VDOC Chief Dentist,

notified all VDOC dentists of the recommendation to suspend all non-essential

treatment and to perform any in-person treatment using “N95 (single use)

protection” until further notice from the regulatory agencies. Wyatt Aff. at ¶ 15.

This directive is consistent with other protocols designed for pandemics or highly

infectious disease.

On March 25, 2020, the Board, the Governor, and the state health

commissioner issued notice of Commonwealth of Virginia Order of Public Health

Emergency Two, directed to all licensed professional clinical providers and limiting

care to essential treatment. VDOC released an official memo to its medical

professionals and posted that memo on the VDOC Health Services Unit (HSU)

policy/memorandum board. Dr. Wyatt immediately began providing daily updates

to VDOC dental providers of information received from governing bodies. HSU’s

research team also processed and publicized peer-reviewed/evidence-based research

practices related to the immediate COVID-19 pandemic threat, as passed along by

state and national dental and medical associations. VDOC decisions related to dental

pandemic policies were based on the most current guidelines set out by regulators.

More specifically, instructions passed to all health authorities of medical and dental

clinics throughout Virginia were to address essential care only during the pandemic

through remote support. VDOC Dental, in response, attempted to create a safer

clinical environment to provide triage and palliative treatment for dental needs rated

as Class 3 and Class 4, using appropriate and available protective equipment.

VDOC’s COVID-19 dental policies conformed with policies in place during the

same period in settings outside prison and jail facilities.

The defendants Brown indicated as possibly responsible for the challenged

policies, Clarke, Robinson, Dr. Amonette, Dr. Wyatt, and Dillman, have moved for

summary judgment, arguing generally that COVID-19 restrictions and OP 720.6

served legitimate penological purposes. On the evidence in the record, I must agree.

It is well established that a prison regulation which impinges on inmates’

constitutional rights is still constitutional if it is reasonably related to a legitimate

penological interest. Turner v. Safley, 482 U.S. 78, 85 (1987). The Supreme Court

has set out relevant factors for courts to consider in determining the reasonableness

of a prison regulation: (1) a valid, rational connection between the prison regulation

and legitimate, neutral penological interests put forward to justify it; (2) the presence

of alternative means to exercise the rights that remain open to inmates; (3) the impact

that accommodation of inmates’ asserted constitutional rights will have on guards,

other inmates, and the allocation of prison resources; and (4) an absence of obvious,

easy alternatives to achieve the same penological objectives. Id. at 89–91. This

analysis is grounded in the principle that the “prison administrators . . . , and not the

courts, [are] to make the difficult judgments concerning institutional operations.”

Id. at 89. The inmate bears the burden to prove the invalidity of the challenged

prison regulation. Overton v. Bazzetta, 539 U.S. 126, 132 (2003).

The COVID-19 pandemic presented medical professionals with new

challenges in safely providing medical and dental care to anyone. The defendants’

evidence outlines the nature of national and state directives issued in 2020 and 2021

to anyone providing medical care to address only essential care and to use

appropriate protective equipment when doing so. VDOC dental leadership

implemented these directives and relayed later updates from national health

organizations to dental and medical professionals serving VDOC inmates. But the

defendants’ evidence also reflects that neither the COVID-19 directives nor OP

720.6 recommended denying treatment for any VDOC inmate’s urgent or emergent

dental care needs. When a dental provider determined that an inmate needed such

care, that provider was to schedule the inmate for treatment at the facility or, if that

was not possible due to staffing or other issues, to order that he be transported to an

outside facility for the necessary dental care. I cannot find that such policies,

particularly given the health and safety threat that COVID-19 posed to the inmate

community and the country at larger, were contrary to the first facet of the Turner

analysis. Indeed, I find a rational connection between such regulations and VDOC’s

legitimate and neutral penological interest in preventing the spread of the COVID-

19 virus among inmates or staff, while still fulfilling VDOC’s obligation to provide

necessary dental care. The policies also met the second Turner facet — inmates

could be placed on a waiting list for nonemergency dental care, to receive such

treatment when the prison had safe resources to make it available. The third Turner

factor overlaps with the first, because keeping staff and other inmates safe during a

pandemic inevitably affects these populations and costs prison resources to

implement new safety protocols. Finally, in response to the fourth Turner factor,

Brown has not put forward any easy and available alternatives that VDOC officials

could have implemented to achieve the same safety concerns, while focusing on

providing inmates with necessary medical and dental care, as constitutionally

required. 6 In fact, his case centers on his disagreement with his dental provider

about whether his otherwise-nonemergency dental issues qualified for off-site

emergency treatment or not, as already discussed.

Based on the evidence before me, I conclude that the administrative

defendants (Clarke, Robinson, Amonette, Wyatt, and Dillman), in implementing

6 Buried in one of Brown’s many separate responses to the defendants’ motions,

are his complaints that after he sought discovery of COVID-19 directives on which VDOC

officials relied, the defendants objected to this request as seeking documents difficult to

produce and overly broad. While Brown’s submission would normally have been docketed

and addressed as a separate motion, since it was titled “Motion for Sanctions,” I cannot

find that the court’s failure to treat it as such has resulted in prejudice to Brown. The so-

called motion does not ask the court to compel further discovery responses, nor does it

address the defendants’ discovery objection or provide any more particularized list of

COVID-19 directives that Brown sought to discover that were relevant to his claims. Most

importantly, based on the defendants’ undisputed evidence of VDOC implementation of

the state and national COVID-19 directives, no policy applied to a VDOC inmate such as

Brown ever called for denial of dental care that his treating provider assessed as medically

necessary, the watch word for any policy alleged to affect an inmate’s Eighth Amendment

rights regarding medical care. Bowring, 551 F.2d at 48. For that same reason, I conclude

that Brown has not demonstrated that the VDOC implemented any national or state

COVID-19 restriction in such a way as to violate Brown’s constitutional rights, which

makes moot his burdensome discovery request for copies of all COVID-19 restrictions.

Therefore, while I will direct that the Motion for Sanctions be docketed as such, I will also

deny it as without merit.

state and national COVID-19 restrictions, and in applying OP 420.6, did not deprive

Brown of urgent or emergent dental care as determined by his treating dental

professional. Therefore, I find that these defendants are entitled to summary

judgment, and that Brown’s summary judgment motion must be denied as to this

claim.

III. CONCLUSION.

For the reasons stated, it is hereby ORDERED as follows:

1. The Clerk shall copy pages 9–12 of ECF No. 143-1 and docket those pages

as a Motion for Sanctions. For the reasons discussed, that motion is hereby

DENIED.

2. The defendants’ Motions for Summary Judgment, ECF Nos. 123, 129, and

134, are GRANTED, and the plaintiff’s Motion for Summary Judgment,

ECF No. 141, is DENIED.

A separate judgment will issue herewith.

ENTER: March 17, 2025

/s/ JAMES P. JONES

Senior United States District Judge