Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_06-cv-02760/USCOURTS-casd-3_06-cv-02760-2/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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06cv2760

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

JUAN A. PORTILLO,

CDCR #H-80425,

Civil No. 06-2760 BTM (CAB)

Plaintiff, ORDER:

1) DENYING PLAINTIFF’S

MOTION TO FILE SUR-REPLY 

[Doc. No. 37]; 

AND 

2) GRANTING DEFENDANTS’

MOTION FOR SUMMARY

JUDGMENT PURSUANT 

TO FED.R.CIV.P. 56(c)

[Doc. No. 22]

vs.

DAVE S. KHATRI, M.D.;

SUNIL WALIA, M.D.,

Defendants.

I. 

PROCEDURAL BACKGROUND

Juan A. Portillo (“Plaintiff”), a state prisoner currently incarcerated at Centinela State

Prison (“CEN”), proceeding pro se and in forma pauperis, has filed this civil rights action

pursuant to 42 U.S.C. § 1983. In his Complaint, Plaintiff claims Dave Khatri, M.D., CEN’s

Chief Medical Officer, and Sunil Walia, M.D., a CEN doctor, denied him adequate medical care

for his kidney stones in violation of the Eighth Amendment’s Cruel and Unusual Punishments

Clause. (Compl. at 2-7.) 

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1

 Klingele and Rand require the district court to ensure that a pro se prisoner has been given

“fair notice ... of the requirements and consequences of a summary judgment motion.” County of Los

Angeles v. Beltran, 514 F.3d 946, 952 (9th Cir. 2008) (citing Rand, 154 F.3d at 960-61). 

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 Doctors Khatri and Walia (“Defendants”) have filed a Motion for Summary Judgment

pursuant to FED.R.CIV.P. 56 [Doc. No. 22]. In response, the Court notified Plaintiff of the

requirements for opposing summary judgment pursuant to Klingele v. Eikenberry, 849 F.2d 409

(9th Cir. 1988) and Rand v. Rowland, 154 F.3d 952 (9th Cir. 1998) (en banc) [Doc. No. 23].1

After being granted an extension of time [Doc. No. 30], Plaintiff filed an Opposition [Doc. No.

33], to which Defendants have filed a Reply [Doc. No. 34]. Plaintiff has also filed a Motion

requesting leave to file a sur-reply [Doc. No. 37], which Defendants oppose [Doc. No. 38]. 

While this case was randomly referred to the Honorable Cathy A. Bencivengo pursuant

to 28 U.S.C. § 636(b)(1)(B) for disposition, the Court has determined that a Report and

Recommendation regarding the disposition of the pending Motions is not required. See S.D.

CAL.CIVLR72.3(a). The Court finds oral argument unnecessary pursuant to S.D.CAL.CIVLR

7.1.d.1. The Court hereby DENIES Plaintiff’s request for leave to file a sur-reply and

GRANTS Defendants’ Motion for Summary Judgment pursuant to FED.R.CIV.P. 56(c) for the

reasons set forth below.

II. 

FACTUAL BACKGROUND

In his Complaint, Plaintiff claims to have first experienced sharp pain in both sides of

his abdomen in January 2001, shortly after he arrived at CEN; however, several exhibits show

complaints of abdominal pain, kidney stones and urological treatment dating back to 1998 or

1999. (See Compl. at 3, 15; Pl.’s Ex. B; see also Defs.’ Notice of Lodgment in Supp. Of Summ.

J., Decl. & Report of Danny L. Keiller, M.D., [hereafter “Defs.’ Ex. 17”] ¶ 2 & “Defs.’ Ex. 18”

at 000048.) Specifically, Plaintiff alleges a CEN doctor named Mosely, who is not named as

a defendant, examined him in the ‘D’ yard medical clinic, and thereafter ordered an IVP and

/ / /

/ / /

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2

 According to Defendant Khatri, IVP and KUB are abbreviations for different radiological

exams used to diagnose and evaluate kidney stones. (See Defs.’ Notice of Lodgment in Supp. of Summ.

J. [Doc. No. 22-3], Decl. of Dave S. Khatri, M.D. [hereafter “Defs.’ Ex. 8”] at ¶ 9.) IVP is short for

intravenous pyelography and KUB stands for an x-ray of the kidney, ureter and bladder. (Id.)

Intravenous pyelography is a “radiographic visualization ... obtained after intravenous administration

of a radiopaque medium which collects in and is excreted by the kidneys.” See MERRIAM WEBSTER’S

ON-LINE MEDICAL DICTIONARY, available at http://www2.merriam-webster.com/cgi-bin/mwmednlm?

book=Medical&va=intravenous%20pyelogram (last visited Dec. 19, 2008).

3

 Nephrolithiasis means the “presence of renal calculi,” or kidney stones. See Stedman’s Online

Medical Dictionary, available at http://www.stedmans.com (last visited Dec. 19, 2008).

“Hydronephrosis” is the “cystic distension of the kidney caused by the accumulation of urine in the renal

pelvis as a result of obstruction to outflow and accompanied by atrophy of the kidney structure and cyst

formation.” See MERRIAM WEBSTER’S ON-LINE MEDICAL DICTIONARY, available at

http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=hydronephrosis (last visited

Dec. 19, 2008). “Hydro[nephro]sis is the term used to describe the situation when a stone is obstructing

a kidney or ureter.” (Defs.’ Ex. 8 ¶ 8.)

3 06cv2760

KUB sometime in May through September 2001.2 (Compl. at 3.) These radiological tests

revealed intra-renal calcifications, i.e., kidney stones or “bilateral nephrolithiasis,” but no

evidence of renal obstruction or hydronephrosis.3

 (Pl.’s Exs. A & B.) Plaintiff claims during

the next year and a half, he continued to complain to medical staff about the “persist[ent] pain

growing in [his] abdomen.” (Compl. at 3.)

It is on June 27, 2003, that Plaintiff first mentions Dr. Walia, whom he alleges ordered

another KUB. (Id.) This KUB revealed “multiple calcifications” overlying Plaintiff’s left

kidney, “particularly in the upper and mid portion” which the radiologist, J.M. Johnson, M.D.

believed “probably represent[ed] intrarenal calculi.” However, “no calcifications [we]re seen

along the course of [Plaintiff’s] ureter or in [his] pelvis.” (Pl.’s Ex. C.) Plaintiff alleges that

while Dr. Walia was “armed” with this information, he “never order[ed] any treatment to

correct Plaintiff[’s] kidney stone pain.” (Compl. at 4.) 

Walia, however, who was a Staff Physician and Surgeon at CEN from July 1997 through

2007, recalls providing Plaintiff with medical care on several occasions. (See Defs.’ Lodgment

in Supp. of Summ. J. [Doc. No. 22-3], Decl. of Sunil Walia, M.D. [hereafter Defs.’ Ex. 1] ¶¶

1, 5.) On January 20, 2003, Dr. Walia claims he treated Plaintiff’s right drop foot, which was

secondary to sciatic nerve injury caused by a gunshot wound, as well as his “chronic condition

of renal nephrocalcinosis ... or bilateral kidney stones, which he had since 1997.” (Id. ¶ 5.) Dr.

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4

 Dr. Walia also recalls “explaining to Plaintiff that [he] was prescribing Tylenol ... rather than

Motrin because [he] wanted to limit [Plaintiff’s] intake of Motrin, [because it] can lead to kidney

problems and gastritis.” (Defs.’ Ex. 1 ¶ 9.)

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Walia recalls prescribing Plaintiff medication and referring him to medical specialists on several

other occasions, but his review of Plaintiff’s medical records reveal that he treated Plaintiff only

once for complaints based on kidney pain--January 30, 2003. (Id. ¶¶ 8, 10.) 

On that day, Plaintiff presented with complaints of a callous on his drop foot caused by

his prosthesis, as well as “pain to his lumbar region” which Plaintiff claimed was intermittent

since 1997. (Id.; see also Defs.’s Ex. 2 “Outpatient Interdisciplinary Progress Notes.”) Walia

examined Plaintiff and reviewed Plaintiff’s records, which revealed that an IVP dated 5/29/01

showed “bilateral renal lithiasis,” and nephrolithiasis which was “more marked on the left than

the right.” However, Plaintiff’s ureters were “normal in their course and configuration” and

there “was no evidence of hydronephrosis,” therefore, a urological consult which followed

recommended only “expectant treatment.” (Defs.’ Ex. 2.) Because Plaintiff “appeared

anxious,” but was “in no acute distress,” Walia prescribed Tylenol for pain and ordered a

“CBC, Chem-25, urinalysis and a KUB, since his last work up was done” more than a year

prior.4

 (Id.; see also Defs.’ Ex. 3.) Dr. Walia further arranged for a “urology follow-up” “so

KUB findings” could be reviewed by a urologist, and a further follow-up with Plaintiff in the

yard clinic “in one month” when his test results and urology could be discussed. (Id.; see also

Defs.’ Ex. 4.) 

According to Dr. Walia, Plaintiff’s medical records show he was seen in the yard clinic

by other staff physicians in March and April 2003, and pursuant to Walia’s referral, was

examined by a neurologist, Dr. Mosely, in May and June 2003. (Defs.’ Ex. 1 ¶¶ 10-13; see also

Defs.’ Ex. 5.) The KUB Dr. Walia ordered was completed on June 27, 2003–it showed

probable intrarenal calculi in Plaintiff’s left kidney, but “no calcifications ... along the course

of [Plaintiff’s] ureter or in [his] pelvis.” (Defs.’ Ex. 1 ¶ 14; Defs.’ Ex. 6.) Another KUB,

ordered by Dr. Mosely on August 8, 2003 and completed on August 14, 2003, again showed

“several calcific deposits overlying the area of [Plaintiff’s] left kidney and surrounding renal

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5

 During these months, Plaintiff does not specifically refer to, but attaches exhibits entitled

“Physician’s Progress Notes,” “Interdisciplinary Progress Notes” and “Physician’s Orders” which reveal

Plaintiff was examined on at least six separate occasions in CEN’s Urology Clinic: Dec. 9, 2004, March

11, 2005, April 14, 2005, April 26, 2005, May 2, 2005 and June 9, 2005. (See Pl.’s Ex. D.) 

5 06cv2760

hilium” as well as in “the mid portion of [Plaintiff’s] right kidney.” (Defs.’ Ex. 1 ¶ 16; Defs.’

Ex. 7.) However, “[n]o calcifications [we]re seen in the region of the ureters,” and “[n]o

additional abnormalities we[re] observed.” (Defs.’ Ex. 7.)

Plaintiff next alleges that approximately one year later, on July 1, 2004, and after

“consistently complaining about the pain” in his abdomen to unspecified persons, he was sent

to Pioneers Memorial Hospital (“PMH”) where a CT scan of his abdomen and pelvis confirmed

renal stones and “suspicion of gallstones.” (Id.; see also Pl.’s Ex. D.) A new CT scan of

Plaintiff’s kidneys showed “multiple bilateral renal calculi, the largest measuring 1 x 0.5 cm in

the left kidney,” but still “no hydronephrosis or dilated ureter to suggest obstructive uropathy.”

(Pl.’s Ex. D.) Plaintiff admits his “uropathy was not obstructive,” but nevertheless claims

“there was blockage” which he attributes to “surrounding inflammatory within [his] kidney.”

(Compl. at 4.) The radiological report to which Plaintiff refers, however, notes only that his

“appendix [wa]s borderline in size with surrounding inflammatory changes [which] could

reflect appendicitis,” and that a “clinical correlation [wa]s necessary to exclude appendicitis.”

(Pl.’s Ex. D.)

Plaintiff alleges “several more months of complaining about pain in [his] abdomen”

passed until on October 17, 2005, another doctor named Thornton ordered a renal ultrasound.

(See Compl. at 4.)5

 The radiology report dated the same day showed:

... the right kidney to measure 8.6 x 4.9 x 5.3 cm. A 7 mm stone

with shadowing is seen in the mid renal area. The left kidney

measures 9.3 x 4.8 x 5.5 cm. At least three stones with shadowing

are seen involving the upper mid and lower poles. No

hydronephrosis, or cysts, or masses are seen at this time. 

(See Pl.’s Ex. E.) Plaintiff claims that “even though the radiology report was said to show no

hydronephrosis, [he] was still in sever[e] pain.” (Compl. at 4.) 

On or about November 9, 2005, Plaintiff submitted an CDC Form 602 inmate appeal “in

an attempt to get treatment to correct the cause” of his recurrent kidney stones. (Id. at 5

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(emphasis original); see also Pl.’s Ex. H.) In his CDC 602, Log No. CEN 05-1914, which

Plaintiff attaches to his Complaint as Exhibit H, Plaintiff recounts his history of kidney stones

and pain and admits having received several “IVPs, ultrasounds and kidney cat scan tests,” at

CEN as well as a urological consult. Plaintiff’s CDC 602 also claims, however, that “no

treatment ha[d] ever been done” for his condition since 2000, and requests the “removal” of his

stones. (Pl.’s Ex. H at 37, 39.) On December 6, 2005, Plaintiff’s appeal was denied at the

informal level of review because a review of his medical records and October 17, 2005

ultrasound revealed “multiple stones but no swelling of the kidneys, no blood in [his] urine,”

and normal labs and renal function. (Id.) The initial denial of Plaintiff’s appeal was affirmed

at both the first formal and second levels of review on February 2, 2006 and March 6, 2006,

respectively. (Id. at 40-42.)

On or about March 29, 2006, Plaintiff reported to CEN’s Treatment and Triage Unit with

complaints of left flank pain which were “consistent with the pain one suffers when a kidney

stone is moving toward and through a ureter.” (Defs.’ Notice of Lodgment in Supp. of Summ.

J. [Doc. No. 22-3], Decl. of Dave S. Khatri [hereafter “Defs.’ Ex. 8”] ¶ 15.) 

Plaintiff alleges Dr. Khatri, as the Chief Medical Officer, was aware of this and the fact

that a urine test conducted on March 29, 2006 showed “+++Lg” which Plaintiff claims is a

“medical marker for determining the amount of blood in [his] urine.” (Compl. at 5; see also

Pl.’s Ex. G.) Plaintiff asserts that “once blood is detected in the urine” it suggests a blockage

or partial blockage in uropathy “generating enormous amounts of pain.” (Compl. at 5.)

In response, Dr. Khatri claims to have treated Plaintiff with intravenous fluids and

injections of Demerol and Phenegan. (See Defs.’ Ex. 8 ¶ 15; Defs.’ Ex. 9.) When Plaintiff

returned to the Treatment and Triage Unit on the next day, March 30, 2006, with the same

complaints, Dr. Khatri repeated his treatment of IV fluids, and re-injected Plaintiff with

Demerol and Phenergan. (Id. ¶ 16; see also Defs.’ Ex. 10.) 

When Plaintiff returned the third day, March 31, 2006, Dr. Khatri repeated his previous

treatments, but further submitted forms he claims were required to authorize Plaintiff’s transfer

to the PMH Emergency Room. (Defs.’ Ex. 8 ¶ 17; see also Defs.’ Ex. 11.) According to Dr.

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/ / /

Khatri, Plaintiff was transferred to PMH that same day “in order to obtain a second opinion and

so that Plaintiff could receive further treatment if necessary.” (Defs.’ Ex. 8 ¶ 17.) 

At PMH, a CT scan of Plaintiff’s abdomen and pelvis showed “left sided

hydronephrosis with a stone in the left ureter at the pelvic brim and a right ureteral stone S2

level with partial obstruction.” (Defs.’ Ex. 18 at 000049; Pl.’s Ex. G; Defs.’ Ex. 8 ¶ 17; Defs.’

Exs. 11, 12; Compl. at 4-5.) However, “physicians at [PMH] did not make any further

recommendations and ... continued the same care [Khatri] had provided.” (Defs.’ Ex. 8 ¶ 17.)

On April 2, 2006, Plaintiff passed a stone spontaneously while being “treated with

narcotic analgesics.” (Id. ¶ 18; Defs.’ Ex. 18 at 000049.) Plaintiff provided Dr. Khatri with the

stone, which was submitted for laboratory analysis. (Defs.’ Ex. 8 ¶ 18; Defs.’ Ex. 13.)

According to Khatri, the results showed the stone was composed of calcium oxalate, which is

“common for kidney stones.” (Id.) The next day, April 3, 2006, Khatri submitted a request that

Plaintiff be re-evaluated by a urologist. (Defs.’ Ex. 8 ¶ 19; Defs.’ Ex. 14.) On April 12, 2006,

Plaintiff was evaluated by Dr. Walther, another urologist. Dr. Walther noted Plaintiff had

recently passed a stone, conducted an ultrasound of Plaintiff’s kidneys and noted that while

there remained multiple stones in Plaintiff’s left kidney, there was “no appreciable

hydronephrosis” at the time. (Id.; Defs.’ Ex. 15.) 

On May 23, 2006, Plaintiff’s CDC 602 Director’s Level Appeal Decision was decided.

(See Pl.’s Ex. H at 35-36.) In the Director’s Level Decision, N. Grannis, Chief of the CDCR’s

Inmate Appeals Branch, noted that Plaintiff’s appeal contended that he was not receiving

“proper medical treatment” for his kidney stones at CEN. Plaintiff’s appeal was denied,

however, based on findings that Plaintiff’s claims were “refuted by the medical records and

professional staff familiar with [Plaintiff’s] medical history.” (Id. at 35.) Grannis noted that

while Plaintiff was “unhappy with the doctor’s decisions,” the CDCR “only provides medical

services for inmates which are based on medical necessity and supported by outcome data as

effective medical care.” (Id.) Grannis further noted that “it [wa]s inappropriate for [Plaintiff]

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8 06cv2760

to recommend [h]is own treatment and expect his treating physician to implement his

recommendation without medical corroboration.” (Id.)

On December 2, 2008, Plaintiff filed his civil rights complaint pursuant to 42 U.S.C.

§ 1983 seeking no injunctive relief, but rather, general and punitive damages against Drs. Walia

and Khatri. Plaintiff claims Walia and Khatri violated his Eighth Amendment rights by acting

with deliberate indifference to his serious medical needs. Specifically, Plaintiff claims

Defendants’ Walia and Khatri’s refusals to “pass an endoscope into [his] bladder and ureter,”

perform “open abdominal surgery” or “break[] the stone[s] into smaller fragments with sound

waves” constituted cruel and unusual punishment. (See Compl. at 5-6, 10.)

III.

PLAINTIFF’S MOTION REQUESTING LEAVE TO FILE SUR-REPLY

As an initial matter, the Court turns to Plaintiff’s Motion Requesting permission to file

a Reply to Defendants’ Reply to his Opposition to Summary Judgment [Doc. No. 37]. 

Local Rule 7.1 of the Southern District of California governs motion practice. Unless

otherwise ordered, Rule 7.1, subdivision (3) provides only for the filing of a motion, an

opposition and a reply. See S.D.CAL. CIVLR 7.1(3)(1)-(3). 

Here, Plaintiff requests leave to address “certain misrepresentations” made by

Defendants in their Reply which he claims were “clearly designed to mislead the Court, as well

as vil[l]ify Plaintiff and his claims.” (Pl.’s Req. at 1.) Plaintiff does not further describe which

specific assertions he believes are misleading or “villifying.” Moreover, Defendants oppose

his request to re-open briefing on the grounds that Plaintiff was given proper Klingele/Rand

notice at the time their Motion was filed, he was given a “full and fair opportunity to present

evidence and argument” in opposition to summary judgment, he did so, and their Reply “did

not contain any assertion of fact or law that were not contained in their [summary judgment]

papers.” (Defs.’ Opp’n at 2.) 

The Court agrees. Defendants’ Reply raises no new issues not already addressed in their

moving papers and Plaintiff’s Opposition amply addresses the issues before the Court.

Accordingly, Plaintiff’s request is DENIED.

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/ / /

/ / /

IV. 

DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

A. FED.R.CIV.P. 56 Standard of Review

Summary judgment is proper where there is no genuine issue of material fact in dispute

and the moving party has shown it is entitled to judgment as a matter of law. Bias v. Moynihan,

508 F.3d 1212, 1218 (9th Cir. 2007) (citing FED.R.CIV.P. 56(c)).

Under summary judgment practice, the moving party always bears

the initial responsibility of informing the district court of the basis

for its motion, and identifying those portions of “the pleadings,

depositions, answers to interrogatories, and admissions on file,

together with the affidavits, if any,” which it believes demonstrate

the absence of a genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986) (quoting FED.R.CIV.P. 56(c)); Zoslaw v.

MCA Distrib. Corp., 693 F.2d 870, 883 (9th Cir. 1982). The “purpose of summary judgment

is to ‘pierce the pleadings and to assess the proof in order to see whether there is a genuine need

for trial.’” Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)

(citations omitted). 

If the moving party meets its initial responsibility, the burden then shifts to the

nonmoving party to establish, beyond the pleadings, that there is a genuine issue for trial.

Celotex, 477 U.S. at 324; Bias, 508 F.3d at 1218. To avoid summary judgment, the non-moving

party is “required to present significant, probative evidence tending to support h[is] allegations,”

Bias, 508 F.3d at 1218 (citations omitted), and must point to some evidence in the record that

demonstrates “a genuine issue of material fact [which], with all reasonable inferences made in

the plaintiff[]’s favor, could convince a reasonable jury to find for the plaintiff[].” Reese v.

Jefferson School Dist. No. 14J, 208 F.3d 736, 738 (9th Cir. 2000) (citing FED.R.CIV.P. 56;

Celotex, 477 U.S. at 323); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986).

The opposing party cannot rest solely on conclusory allegations of fact or law. Berg v.

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Kincheloe, 794 F.2d 457, 459 (9th Cir. 1986). Instead, to demonstrate a genuine issue requiring

trial, the opposing party “must do more than simply show that there is some metaphysical doubt

as to the material facts.” Matsushita, 475 U.S. at 587 (citation omitted).

The evidence of the opposing party is to be believed. See Anderson, 477 U.S. at 255.

All reasonable inferences that may be drawn from the facts placed before the court must be

drawn in favor of the opposing party. See Matsushita, 475 U.S. at 587. Nevertheless,

inferences are not drawn out of the air, and it is the opposing party’s obligation to produce a

factual predicate from which the inference may be drawn. See Richards v. Nielsen Freight

Lines, 602 F. Supp. 1224, 1244-45 (E.D. Cal. 1985), aff’d, 810 F.2d 898, 902 (9th Cir. 1987).

Because it is relevant in this case, the Court also notes it “does not have a duty to search

for evidence that would create a factual dispute.” Bias, 508 F.3d at 1219 (citing Carmen v.

Unified School Dist., 237 F.3d 1026, 1031 (9th Cir. 2001)). In Carmen, the Ninth Circuit found

it “unfair” to the require the district court to “examine the entire file for evidence establishing

a genuine issue of fact, where the evidence is not set forth in the moving papers with adequate

references so that it could be conveniently found.” Id.; see also Forsberg v. Pacific N.W. Bell

Tel. Co., 840 F.2d 1409, 1417-18 (9th Cir. 1988) (district court is “not required to comb the

record to find some reason to deny a motion for summary judgment”). This is true even where

the non-moving party is proceeding in pro se. See Bias, 508 F.3d at 1219 (affirming summary

judgment for defendants where pro so plaintiff “failed to present any evidence in opposition”

and expressly rejecting pro se litigant’s argument that the district court “should have searched

the entire record to discover whether there was any evidence [to] support[] her claims” because

she was proceeding without counsel). “A district court lacks the power to act as a party’s

lawyer, even for pro se litigants. Bias, 508 F.3d at 1219.

B. Defendants’ Arguments

Defendants seek summary judgment on the following grounds: (1) Plaintiff’s claims

against Dr. Walia are barred by the statute of limitations, (Defs.’ Mem. of P &As in Supp. of

Summ. J. at 7); (2) he has failed to show they acted with deliberate indifference (id. at 7-10),

and they are entitled to qualified immunity. (Id. at 10-11.) Plaintiff opposes, arguing his claims

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against Dr. Walia are timely because Walia “had contact with Plaintiff as late as June 2006,

(Pl.’s Opp’n at 7), that both Drs. Walia and Khatri’s “failure to address” his chronic kidney

stones is “callous[,]” “deliberate[]” and “wanton” and has caused him “unnecessary pain,” as

well as “physical and psychological injury” (id. at 10), and that they are therefore not entitled

to qualified immunity. (Id. at 10-11.)

1. Statute of Limitations

Because section 1983 contains no specific statute of limitation, federal courts apply the

forum state’s statute of limitations for personal injury actions. Lukovsky v. San Francisco, 535

F.3d 1044, 1048 (9th Cir. 2008); Jones v. Blanas, 393 F.3d 918, 927 (9th Cir. 2004);

Maldonado v. Harris, 370 F.3d 945, 954 (9th Cir. 2004); Fink v. Shedler, 192 F.3d 911, 914

(9th Cir. 1999). Until December 31, 2002, the applicable statute of limitations for a personal

injury claim in California was one year. See Jones, 393 F.3d at 927 (citing CAL. CIV. PROC.

CODE § 340(3) (West 2002)). Effective January 1, 2003, the applicable California statute of

limitations was extended to two years. Id. (citing CAL.CIV.PROC.CODE. § 335.1 (West 2004)).

“Under the traditional rule of accrual ... the tort cause of action accrues, and the statute

of limitation begins to run, when the wrongful act or omission results in damages.” Wallace

v. Kato, 595 U.S. 384, 127 S. Ct. 1091, 1097 (2007) (citation omitted). Unlike the length of the

limitations period, “the accrual date of a § 1983 cause of action is a question of federal law that

is not resolved by reference to state law.” Id. at 1095. “Under federal law, a claim accrues

when the plaintiff knows or has reason to know of the injury which is the basis of the action.”

Maldonado, 370 F.3d at 955; Fink, 192 F.3d at 914; Wilson v. Garcia, 471 U.S. 261, 267

(1985). Thus, the statute of limitations begins to run when the plaintiff knows or has reason to

know of the act providing the basis for his injury. Maldonado, 370 F.3d at 955; see also

Lukovsky v. City & County of San Francisco, 535 F.3d 1044, 1048 (9th Cir. 2008). The cause

of action accrues even though the full extent of the injury is not then known or predictable.”

Wallace, 127 S. Ct. at 1097. “Were it otherwise, the statute would begin to run only after a

plaintiff became satisfied that he had been harmed enough, placing the supposed statute in

repose in the sole hands of the party seeking relief.” Id.

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Defendant Walia argues Plaintiff’s claim against him accrued in or sometime after June

27, 2003 when Plaintiff alleges Walia “ordered another KUB” but never “order[ed] any

treatment to correct [his] kidney stone pain.” (Compl. at 4-5; Defs.’ P&As at 7.) In fact. Dr.

Walia claims that because staff physicians at CEN in 2003 worked on a three-month yard

rotation, he did not examine or have any contact again with Plaintiff until March 2004, although

Plaintiff’s medical records show he was treated by another yard physician, Dr. Thornton,

referred to a urologist, Dr. Mosley, and underwent two radiological examinations during the

course of 2003. (Walia Decl. ¶¶ 10-17.) Walia argues that because Plaintiff “does not allege

any facts to suggest [he] treated Plaintiff, or even came into contact with Plaintiff, after June

2003,” Plaintiff’s claims against him are untimely. (Id.) 

In opposition, Plaintiff also points to Dr. Walia’s Declaration, in which he admits having

treated Plaintiff again on March 7, 2004, when he “admitted Plaintiff into the infirmary” based

on his complaints of chest pain. (See Pl.’s Opp’n at 7.) Plaintiff further attaches three

exhibits–all excerpts of his prison medical records– which Plaintiff claims show Dr. Walia “had

contact” with him on February 13, 2006, April 12, 2006, and as late as June 22, 2006. (Id.; see

also Pl.’s Exs. A-C.) However, Plaintiff’s Complaint does not allege any Eighth Amendment

violations by Dr. Walia other than those arising either in January 2003–when Walia examined

him– and in June 2003–when Plaintiff alleges the KUB Walia ordered revealed “multiple

calcifications overlying [his] kidney,” but Walia failed to “order any treatment.” (Compl. at 4.)

Based on these allegations, the Court finds that Plaintiff’s inadequate medical care

claims against Dr. Walia arose on or about June 27, 2003–the date when Plaintiff alleges Dr.

Walia became “armed” with information revealing “multiple calcifications overlying”

Plaintiff’s left kidney, but ordered no “treatment to correct” Plaintiff’s pain. (Compl. at 3-4;

Pl’s Ex. C.) It was at this time Plaintiff “knew or had reason to know of the injury” which

forms the basis of a deliberate indifference claim against Dr. Walia. Maldonado, 370 F.3d at

955; Lukovsky, 535 F.3d at 1048. 

Accordingly, CAL.CIV.PROC. CODE § 335.1’s limitations period began on or about June

27, 2003, and would have expired two years later, on or about June 27, 2005. Maldonado, 370

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6

 While there is no evidence in the record before the Court which indicates the length of

Plaintiff’s prison term of commitment, the Ninth Circuit has noted that California courts have “read out

of the statute the qualification that the period of incarceration must be ‘for a term less than for life’ in

order for a prisoner to qualify for tolling.” Jones, 393 F.3d at 927 n.5 (citing Grasso v. McDonough

Power Equipment, Inc., 264 Cal.App.2d 597, 70 Cal.Rptr. 458, 460-61 (1968); Martinez v. Gomez, 137

F.3d 1124, 1126 (9th Cir.1998) (recognizing the continuing vitality of Grasso)).

7

 In addition, the Ninth Circuit has specifically held that “the applicable statute of limitations

must be tolled while a prisoner completes the mandatory exhaustion process” required by 42 U.S.C.

§ 1997e(a). Brown v. Valoff, 422 F.3d 926, 943 (9th Cir. 2005). The record before this Court shows

that Plaintiff filed Inmate/Parolee CDC 602 Appeal, Log No. 05-1914 on November 9, 2005, alleging

Eighth Amendment inadequate medical care claims related to the “proper” treatment for his kidney

stones. See Compl. at 34-43, Ex. H. Plaintiff’s appeal was denied at the Director’s Level of Review

on May 23, 2006. Id. at 35. Therefore, Plaintiff is also entitled to tolling from November 9, 2005

through May 23, 2006. 

13 06cv2760

F.3d at 954-55. However, Plaintiff did not file this action until December 20, 2006.

Accordingly, unless the statute of limitations is tolled, Plaintiff’s claims against Dr. Walia are

time-barred.

Federal courts also look to state law in order to determine whether it provides a basis for

tolling the statute of limitations. Wallace, 127 S. Ct. at 1098-99; Hardin v. Straub, 490 U.S.

536, 538-39 (1989); Jones, 393 F.3d at 927 (in actions where the federal court borrows the state

statute of limitation, the federal court should also borrow all applicable provisions for tolling

the limitations period found in state law). Under CAL.CIV.PROC. CODE § 352.1, the limitations

period is tolled for an additional “period of up to two years based on the disability of

imprisonment,” so long as Plaintiff was “‘imprisoned on a criminal charge, or in execution

under the sentence of a criminal court for a term of less than for life.’” Jones, 393 F.3d at 927

(citing CAL.CIV.PROC.CODE § 352.1(a)).6

 The tolling statute applies “if the disability existed

at the time the cause of action accrued.” Elliot v. City of Union City, 25 F.3d 800, 802 (9th Cir.

1996). 

Thus, because Plaintiff’s claims arose while he was a prisoner at CEN, he is entitled to

an additional two years of statutory tolling, requiring his claims against Dr. Walia to be filed

on or before June 27, 2007. As noted above, Plaintiff’s Complaint was filed in December

2006. Therefore, Plaintiff’s Eighth Amendment claims against Dr. Walia are timely and his

Motion for Summary Judgment is DENIED on this ground.7

/ / /

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/ / /

/ / /

/ / /

2. Eighth Amendment Inadequate Medical Treatment Claims

Both Defendants Walia and Khatri argue that no genuine issues of material fact exist to

show either of them acted with the deliberate indifference required to support an Eighth

Amendment violation. In the alternative, they argue they are entitled to qualified immunity.

(See Def.’s. P&A’s at 7-11.) 

A. Standard of Review

The Eighth Amendment prohibits punishment that involves the “unnecessary and wanton

infliction of pain.” Estelle v. Gamble, 429 U.S. 97, 103 (1976) (quoting Gregg v. Georgia, 428

U.S. 153, 173 (1976)); Toguchi v. Chung, 391 F.3d 1051, 1057 (9th Cir. 2004). The Eighth

Amendment’s cruel and unusual punishments clause is violated when prison officials are

deliberately indifferent to a prisoner’s serious medical needs. Estelle, 429 U.S. at 105.

“Medical” needs include a prisoner’s “physical, dental, and mental health.” Hoptowit v. Ray,

682 F.2d 1237, 1253 (9th Cir. 1982); Hunt v. Dental Dept., 865 F.2d 198, 200 (9th Cir. 1989).

To show “cruel and unusual” punishment under the Eighth Amendment, the prisoner

must point to evidence in the record from which a trier of fact might reasonably conclude that

Defendants’ medical treatment placed Plaintiff at risk of “objectively, sufficiently serious” harm

and that Defendants had a “sufficiently culpable state of mind” when they either provided or

denied him medical care. Wallis v. Baldwin, 70 F.3d 1074, 1076 (9th Cir. 1995) (internal

quotations omitted). Thus, there is both an objective and a subjective component to an

actionable Eighth Amendment violation. Clement v. Gomez, 298 F.3d 898, 904 (9th Cir. 2002);

Toguchi, 391 F.3d at 1057 (“To establish an Eighth Amendment violation, a prisoner ‘must

satisfy both the objective and subjective components of a two-part test.’”) (quoting Hallett v.

Morgan, 296 F.3d 732, 744 (9th Cir. 2002)).

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 Although the “routine discomfort inherent in the prison setting” is inadequate to satisfy

the objective prong of an Eighth Amendment inquiry, see Johnson v. Lewis, 217 F.3d 726, 731

(9th Cir. 1999), the objective component is generally satisfied so long as the prisoner alleges

facts to show that his medical need is sufficiently “serious” such that the “failure to treat [that]

condition could result in further significant injury or the unnecessary and wanton infliction of

pain.” Clement, 298 F.3d at 904 (quotations omitted); Lopez, 203 F.3d at 1131-32; see also

Doty v. County of Lassen, 37 F.3d 540, 546 (9th Cir. 1994) (“serious” medical conditions are

those a reasonable doctor would think worthy of comment, those which significantly affect the

prisoner’s daily activities, and those which are chronic and accompanied by substantial pain).

However, the subjective component requires the prisoner to also allege facts which show

that the officials had the culpable mental state, which is “‘deliberate indifference’ to a

substantial risk of serious harm.” Frost v. Agnos, 152 F.3d 1124, 1128 (9th Cir. 1998) (quoting

Farmer v. Brennan, 511 U.S. 825, 835 (1994)). “Deliberate indifference” is evidenced only

when “the official knows of and disregards an excessive risk to inmate health or safety; the

official must both be aware of the facts from which the inference could be drawn that a

substantial risk of serious harm exists, and he must also draw the inference.” Farmer, 511 U.S.

at 837; Toguchi, 391 F.3d at 1057.

 Inadequate treatment due to “mere medical malpractice” or even gross negligence, does

not amount to a constitutional violation. Estelle, 429 U.S. at 106; Hallett, 296 F.3d at 744;

Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990). In other words, an “official’s

failure to alleviate a significant risk that he should have perceived but did not, ... cannot ... be

condemned as the infliction of punishment.” Farmer, 511 U.S. at 838; Toguchi, 391 F.3d at

1057 (“If a prison official should have been aware of the risk, but was not, then the official has

not violated the Eighth Amendment, no matter how severe the risk.”) (brackets, footnote and

citations omitted)). The Eighth Amendment proscribes only “the ‘unnecessary and wanton

infliction of pain,’ [] includ[ing] those sanctions that are ‘so totally without penological

justification that it results in the gratuitous infliction of suffering.’” Hoptowit, 682 F.2d at 1246

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(quoting Gregg, 428 U.S. at 173, 183). “This is not an easy test for [a] plaintiff[] to satisfy.”

Hallett, 296 F.3d at 745.

Moreover, a difference of opinion between medical professionals concerning the

appropriate course of inmate treatment or care is not enough, by itself, to support a claim of

deliberate indifference. Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). Nor does a

difference of opinion between the prisoner and his doctors constitute deliberate indifference.

Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996). And, while deliberate indifference can

be manifested if a doctor or prison guard intentionally denies or delays access to medical care

or otherwise interferes with medical treatment already prescribed, see Estelle, 429 U.S. at 104-

05, the delay must also lead to further injury or be somehow harmful. McGuckin v. Smith, 974

F.2d 1050, 1060 (9th Cir. 1992) (noting that harm caused by delay need not necessarily be

“substantial”), overruled on other grounds, WMX Techs., Inc. v. Miller, 104 F.3d 1133, 1136

(9th Cir. 1997); Wood, 900 F.2d at 1339-40; see also Shapely v. Nevada Bd. of State Prison

Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985); Hunt, 865 F.2d at 200 (“[D]elay in providing a

prisoner with dental treatment, standing alone, does not constitute an Eighth Amendment

violation.”).

B. Application to Plaintiff’s Allegations

Here, the evidence in the record is sufficient to show the “objective” component of an

Eighth Amendment inadequate medical treatment claim. See Clement, 298 F.3d at 904.

Plaintiff claims to have been suffering from recurrent kidney stones since 2001, and to have

suffered “inordinate amount[s] of pain and suffering for nearly 21⁄2 years at CEN.” (See Compl.

at 6, Pl’.s Opp’n at 9.) Plaintiff’s medical records and Defendants’ Declarations provide ample

evidentiary documentation which supports Plaintiff’s allegations of recurrent pain, his need for

both physical and radiological examinations to track the size and location of his kidney stones,

various medications, intravenous treatments, urological consults and an eventual

hospitalization. (See Defs.’ Exs. 1-18.) This evidence is more than sufficient to show

Plaintiff’s medical needs were objectively “serious.” See Estelle, 429 U.S. at 105; Madrid v.

Gomez, 889 F. Supp. 1146, 1200-1201 (N.D. Cal. 1995) (“Serious medical needs” include

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“diseases such as asthma, hypertension, epilepsy, diabetes, tuberculosis and lupus” as well as

impairments such as hearing loss, abdominal pains, fractures, kidney stones, etc.).

However, what the record before the Court does not show is any triable issue as to the

subjective component of an Eighth Amendment inadequate medical care claim against either

Dr. Walia or Dr. Khatri. See Frost, 152 F.3d at 1128; Farmer, 511 U.S. at 837. In order to

justify trial, Plaintiff must point to evidence in the record to show that either Dr. Walia or Dr.

Khatri were “deliberately indifferent” to his serious medical needs, i.e, that they knew, yet

consciously disregarded his pain or the need to provide him constitutionally adequate care. See

McGuckin, 974 F.2d at1060; Toguchi, 391 F.3d at 1057. This “subjective approach” focuses

only “on what a defendant’s mental attitude actually was.” Farmer, 511 U.S. at 839.

The record in this case is replete with evidence which shows that Plaintiff suffers from

a serious, painful and recurrent condition. (See Pl.’s Exs. A-G; Defs.’ Ex. 1 ¶¶ 5-19; Ex. 8 ¶¶

4, 9-25; Ex. 18.) Defendants Walia and Khatri, however, have provided their own sworn

declarations summarizing the various physical examinations, radiological and other laboratory

testing, urological referrals, consults, and the prescribed course of Plaintiff’s medications,

intravenous treatments and hospitalization they have provided in response to Plaintiff’s needs

over the course of six years. (Defs.’s Exs. 1, 8.) They have further provided copies of

Plaintiff’s Outpatient Interdisciplinary Progress Notes, their own and other Physician’s Orders,

Consultant’s Records, Radiological Reports, Emergency Room Admission Forms, copies of

Dr. Khatri’s Authorization for Plaintiff’s temporary release to a private hospital for a second

opinion and observation, an ultrasound report, and the testimony of a urological expert, Dr.

Keiller, (Defs.’ Exs. 2-7, 9-18), all which show continued and consistent medical treatment in

response to Plaintiff’s recurrent reports of pain. 

Plaintiff’s only response to this evidence is, essentially, is to disagree with Defendants

as to whether they were responsive enough–specifically, Plaintiff argues that Drs. Walia and

Khatri should have instead, on unspecified occasions, “pass[ed] an endoscope into [his] bladder

and ureter,” performed “open abdominal surgery” or broken his stones into “smaller fragments

with sound waves.” (Compl. at 5.) Plaintiff is not a doctor however, and he has failed to

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28 13 Lithotripsy is the “surgical removal of the [kidney] stone.” Defs.’ Ex. 8 ¶ 8. “Surgery or

lithotripsy is not appropriate ... where the stone is progressing through the urinary system.” Id.

18 06cv2760

provide the Court with any documentary evidence which supports his medical self-diagnosis.

See Jackson, 90 F.3d at 332. Moreover, Plaintiff has failed to point to any evidence in the

record which might reasonably contradict Dr. Khatri’s claim that “[n]one of the urologists who

have examined Plaintiff ... have recommended the surgical removal of [his] kidney stones or

/ / /

/ / /

the use of lithotripsy.”13 (Defs.’ Ex. 8 ¶ 14.) Nor has he provided any evidence which might

reasonably contradict the findings of Dr. Keiller, a urologist who reviewed Plaintiff’s medical

records and history of treatment at CEN at Defendants’ behest. Specifically, Dr. Keiller

concluded that “[i]t is not appropriate to do lithotripsy for scattered, multiple tiny stones in the

kidney,” and that “lithotripsy has much more potential to cause pain or damage,” and in fact,

his review of Plaintiff’s records show that Plaintiff

... was seen multiple times over the last eight years by several

different urologists. Urological and emergency room consultations

have been requested in a timely fashion. None of urologists

recommended surgical intervention or lithotripsy although

lithotripsy was considered and rejected by Dr. Lowe and

considered but not recommended by Dr. Mosely.

(Defs.’ Ex. 18.) Dr. Keiller opines, based on his review of Plaintiff’s records, that all Plaintiff’s

“urological medical care met the standard for care for urology.” Id. Further, D. Keiller

concludes that the “Centinela physicians who treated Plaintiff during this time period,

specifically Drs. Walia and Khatri, also complied with the standard of care with respect to

urological issues.” (Id.) 

Because this evidence is not contradicted anywhere in the record, the Court finds no

genuine issues of material fact exists as to whether either Dr. Walia or Dr. Khatri acted with

deliberate indifference to Plaintiff’s serious medical needs. Estelle, 429 U.S. at 105. The only

decision a reasonable fact finder could reach is that Defendants did not act with deliberate

indifference. Accordingly, the Court GRANTS Defendants’ Motion for Summary Judgment

as to Plaintiff’s Eighth Amendment claims pursuant to FED.R.CIV.P. 56.

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3. Qualified Immunity

Finally, Defendants argue they are entitled to qualified immunity. (Defs.’ P&A’s at 10-

11.) However, because the Court has found no triable issue of fact exists to show that

Plaintiff’s Eighth Amendment rights were violated by either Defendant, the Court need not

reach any issues regarding qualified immunity. See County of Sacramento v. Lewis, 523 U.S.

833, 841 n.5 (1998) (“[The better approach to resolving cases in which the defense of qualified

immunity is raised is to determine first whether the plaintiff has alleged the deprivation of a

constitutional right at all.”); see also Saucier v. Katz, 533 U.S. 194, 201 (2001) (“If no

constitutional right would have been violated were the allegations established, there is no

necessity for further inquiries concerning qualified immunity.”).

V.

CONCLUSION AND ORDER

For all the reasons set forth above, the Court hereby:

1) DENIES Plaintiff’s Motion to File a Sur-Reply [Doc. No. 37]; and

2) GRANTS Defendants’ Motion for Summary Judgment pursuant to FED.R.CIV.P.

56(c) [Doc. No. 22].

The Clerk shall enter judgment for Defendants Walia and Khatri and shall close the file.

IT IS SO ORDERED.

DATED: January 13, 2009

Honorable Barry Ted Moskowitz

United States District Judge

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