Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_06-cv-01177/USCOURTS-caed-2_06-cv-01177-18/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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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

MATTHEW LEE JASPAR,

Plaintiff, No. 2:06 cv-1177 GEB KJN P

vs.

KHOURY, et al.,

Defendants. ORDER 

 /

I. Introduction

Plaintiff is a prisoner proceeding without counsel who paid the filing fee to

initiate this civil rights action pursuant to 42 U.S.C. § 1983. The case proceeds on plaintiff’s

original complaint filed May 31, 2006 (Dkt. No. 1) against defendant physicians Nicholas

Aguilera and Joseph Bick for deliberate indifference to plaintiff’s medical needs in violation of

the Eighth Amendment. (See Dkt. Nos. 40, 44, (dismissing all other named defendants) and Dkt.

Nos. 38, 40 (dismissing all other claims).) 

Presently pending is defendants’ motion for summary judgment filed July 24,

2009. (Dkt. No. 48.) Plaintiff has filed an opposition (Dkt. No. 56) and defendants filed a reply

(Dkt. No. 61). 

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II. The Complaint

Plaintiff alleges that in November 2002 he was transferred from California State

Prison-Corcoran (“CSP-C”) to the California Medical Facility (“CMF”). (Complaint (“Compl.”),

Dkt. No. 1, at ¶ 1.) While at CSP-C, plaintiff, who has Human Immunodeficiency Virus

(“HIV”), was diagnosed and treated by an HIV Specialist and received testosterone treatments to

combat metabolic dysfunction symptoms associated with plaintiff’s HIV and Highly Active

Antiretroviral Therapy (“HAART”). (Id. at ¶¶ 1, 2.) Plaintiff describes these symptoms as

“deterioration and loss of lean body mass, dramatic changes in body composition, lowered

energy levels, general feeling of weakness and tiredness, and the accumulation of visceral fat in

the body that impinges upon vital organs [such as] heart, lungs, kidneys, liver, etc.” (Id. at ¶ 1.)

Plaintiff alleges that his testosterone treatments had provided “significant improvement of his

condition.” (Id. at ¶ 1.)

The complaint provides that upon plaintiff’s arrival at CMF, defendant Aguilera, a

CMF physician, discontinued plaintiff’s testosterone treatments “without discussion or

consultation,” and “without a physical examination, measurement for waist-hip ratio, DEXA

(Dual Energy X-Ray Absorptiometry), ultra-sound, computed topography, MRI, or any other

medically sound means of evaluation.” (Id. at ¶ 2.) Moreover, “defendant Aguilera refused to

suppliment (sic) plaintiff’s treatment with an equally acceptable course of treatment stating to

plaintiff in a glib and confrontational tongue, ‘You’re just fat.’” (Id. at ¶ 3.)

The complaint states that plaintiff’s “condition . . . remains untreated to this day,

and is continuous in nature. Plaintiff has incurred a ‘physical injury’ as a result of the

interruption and denial of treatment as follows: Painful, progressive deterioration of muscle

tissue, and dehabilitating (sic) accumulation of visceral fat threatening vital organ function as

well as malaise and compromised quality of life that is associated with this type of metabolic

disfunction (sic).” (Id. at ¶ 4.)

The complaint further alleges that “when questioned by plaintiff, defendant

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26 Plaintiff was transferred to CMF on November 21, 2002. (Dkt. No. 48-10, at p. 2.) 1

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Aguilera voiced that [defendant] Dr. Bick [CMF Chief Medical Officer and Aguilera’s

supervisor] informed him that budget constraints prevent treatment for this condition.” (Id. at ¶

2.) The complaint alleges that Bick “acquiesced” in Aguilera’s decision and “failed and/or

refused to terminate the series of acts which led to plaintiff’s present state of deterioration.” (Id.

at ¶ 5.) 

III. Current Contentions

The instant motion seeks summary judgment on the entirety of plaintiff’s

complaint. Plaintiff generally opposes the motion, seeking to “suspend or vacate” it, on the

ground that defendants’ evidence submitted in support of their motion includes a previously

undisclosed and critical fact that changes the substance of this action. For the following reasons,

this court finds plaintiff’s argument persuasive.

At issue is the declaration of CMF physician Dr. U. Pai. (See July 23, 2009

Declaration of U. Pai in Support of Motion for Summary Judgment, Dkt. No. 48-7; resubmitted

by plaintiff in his Opposition, Dkt. No. 56, at 5-7 (hereafter “Pai Decl.”).) Dr. Pai states in

pertinent part that she treated plaintiff for HIV and related illnesses between November 2002 and

May 2003. (Pai Decl. at ¶ 5.) Based upon a two-year-old lab report in plaintiff’s medical

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records, dated November 21, 2000, which showed a total testosterone level of 1,965 nanograms

per deciliter (“ng/dl”) (in excess of the normal range of 241 to 850 ng/dl), Dr. Pai “determined

that [plaintiff’s] testosterone treatments were not medically necessary [and] therefore decided not

to continue the testosterone treatment, and monitor the issue.” (Pai Decl. at ¶ 12.) Dr. Pai states

that her decision was consistent with CDCR policy authorizing only medically-indicated

treatments (id. at ¶¶ 6, 10, 11), “[t]his was discussed with the patient,” and “[d]uring the period

of my medical care of Jaspar, he never repeated any request for testosterone supplements” (id. at

¶¶ 12, 13.)

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Dr. Pai is not referenced in plaintiff’s complaint yet, according to Dr. Pai’s

declaration, she was the first of plaintiff’s medical providers at CMF and the one to make the

critical medical decision that is at the heart of plaintiff’s action. In contrast, defendant Bick

states he treated plaintiff “on March 13, 2003, June 16, 2003, and December 8, 2003” (Bick

Decl. at ¶ 15), while defendant Aguilera states that he treated plaintiff “between May 2003 and

June 2007.

Plaintiff contends that defendants have now “produced medical records which

indicate that a Dr. Pai discontinued plaintiff’s medications against specialist orders.” 

(Opposition (“Oppos.”), Dkt. No. 56, at 2.) Plaintiff asserts, “defendants have deceived plaintiff

to believe that Dr. Aguilera discontinued his specialists prescribed course of medical treatment;

the medical records which indicated, to the contrary, that Dr. Pai discontinued the treatment was

factually omitted from his reach until the time of defendants’ motion. Concealing these facts,

although Aguilera informed plaintiff that Dr. Bick told him to discontinue plaintiff’s treatment

due to budgetary constraints . . . [and] concealing the factual acts of Dr. Pai and records

demonstrating she discontinued plaintiff’s specialist prescribed treatment, is arbitrary conduct

resulting in inadvertent surprise.” (Id.)

Plaintiff has filed a sworn affidavit (Plaintiff’s Declaration (“Pltf. Decl.”), Dkt.

No. 56, at 8-10) in which he states that he sought from “defendant entity” his entire medical

record both before and during this litigation but “[n]ever on either of these requests did defendant

entity or defendants disclose any medical records indicating that Dr. Pai discontinued my

testosterone treatments” or, for that matter, that “Dr. Aquilera discontinued my testosterone

treatments.” (Id. at ¶¶ 2-5). Rather, plaintiff states that he relied on the representations of Dr.

Aguilera “that his Chief Medical Officer, supervisor, Dr. Bick, expressly told him to discontinue

my specialist prescribed testosterone treatments as they were not urgent enough to justify the

monetary expenditure for this treatment. He also made it clear that this was not exclusive to me

and that all patients were subject to having their treatment regiments streamlined and that

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 The court dismissed plaintiff’s conspiracy claim for the following reasons: 2

Plaintiff’s complaint does not allege any facts showing that defendants reached

any sort of agreement to harm him. Instead, plaintiff merely alleges that

defendants “had a mutual meeting of the minds, in direct and/or indirect

participation by common design, to ratify the deprivations of inadequate and

negligent medical [c]are which resulted in the deliberate indifference to plaintiff’s

serious medical needs.” Compl. ¶ 11. As stated above, such conclusory

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treatment I would have received as a free person will not be available to me at CMF.” (Id. at ¶

8.) Plaintiff states that on numerous occasions he informed Dr. Aguilera “of the abrupt changes

in body mass, the loss of lean muscle tissue, and the accumulation of visceral fat that had

occurred since the discontinuation of the testosterone treatments,” and “advised him repeatedly

that the testosterone was not the treatment of choice the specialist [at CPS-C] recommended in

our consultation and treatment period but rather, a steroid used in AIDS patient (which I am) to

treat this metabolic disfunction (sic) known as oxandr[o]lone.” (Id. at ¶ 9.) Plaintiff continues,

“That treatment was unavailable at the time of the specialist’s diagnoses and testosterone shots

were given as a temporary substitute until which time oxandralone (sic) could be ordered and

supplied. I was subsequently transferred to [CMF] where all treatment was discontinued without

consultation.” (Id.)

Plaintiff further states that “[w]hen I received the medical record indicating Dr.

Pai factually discontinued my testosterone treatments, I was shocked and surprised.” (Id. at ¶ 7.) 

He explains that “Dr. Aguilera’s statements were deceiving to me. As the medical records

reflecting Dr. Pai’s actions and involvement were concealed from me, I drafted my causes of

action based on Dr. Aguilera’s mis-information shared with me while under his care in his

professional capacity.” (Id. at ¶ 10.) 

Plaintiff moves for an order suspending or vacating defendants’ motion for

summary judgment, and seeks leave for a 45-day period of time within which to amend his

complaint to add Dr. Pai as a defendant and to re-allege his conspiracy claim previously

dismissed without prejudice by the court.

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statements are insufficient to state a claim for conspiracy. Accordingly, plaintiff’s

conspiracy claim must be dismissed. 

(Findings and Recommendations, Dkt. No. 38, at 6; adopted by Order filed March 13, 2009, Dkt.

No. 40.)

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Defendants respond in pertinent part that “[d]efendants never withheld any

medical records from Jaspar. To the contrary, Jaspar never made a discovery request for a copy

of his medical records. Moreover, the records that Jaspar claims were withheld – records of Dr.

Pai’s treatment of Jaspar – do not create a material dispute of fact sufficient to overcome

Defendants’ summary judgment motion. [Rather,] [t]hese records reinforce Defendants’

argument that CMF’s medical staff . . . [properly withheld] Jaspar’s testosterone treatment . . .” 

(Reply, Dkt. No. 61, at 3.) The attached declaration of defendants’ counsel provides that the only

discovery sought by plaintiff was a First Set of Interrogatories propounded on defendants

Aguilera and Bick, and now-dismissed defendant Khoury. (Dkt. Nos. 61-2, 61-3.) (Declaration

of Deputy Attorney General Anthony P. O’Brien (“O’Brien Decl.”) at ¶¶ 2-5.) 

IV. Discussion

Summary judgment is appropriate when “there is no genuine issue as to any

material fact, and . . . the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P.

56(c). 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’” to resolve material factual issues presented

in the case. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)

(quoting Fed. R. Civ. P. 56(e) Advisory Committee’s note on 1963 amendments).

On March 27, 2008, the court advised plaintiff of the requirements for opposing a

motion for summary judgment. (Dkt. No. 19); see Rand v. Rowland, 154 F.3d 952, 957 (9th Cir.

1998) (en banc), cert. denied, 527 U.S. 1035 (1999); and Klingele v. Eikenberry, 849 F.2d 409

(9th Cir. 1988). Plaintiff was advised in pertinent part that “[i]f there is good reason why

[material] facts are not available to plaintiff when he is required to oppose a motion for summary

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judgment, the court will consider a request to postpone considering the motion.” (Dkt. No. 19, at

4, ¶ 11, lines 19-21.) The court’s instruction was an implicit reference to Fed. R. Civ. P. 56(f),

which provides in full:

(f) If a party opposing the [summary judgment] motion shows by affidavit

that, for specified reasons, it cannot present facts essential to justify its

opposition, the court may:

(1) deny the motion; 

(2) order a continuance to enable affidavits to be obtained,

depositions to be taken, or other discovery to be undertaken; or 

(3) issue any other just order. 

To prevail on a Rule 56(f) motion, the moving party “must show (1) that they

have set forth in affidavit form the specific facts that they hope to elicit from further discovery,

(2) that the facts sought exist, and (3) that these sought-after facts are ‘essential’ to resist the

summary judgment motion.” State of California v. Campbell, 138 F.2d 772, 779 (9th Cir. 1998).

“In making a Rule 56(f) motion, a party opposing summary judgment ‘must make clear what

information is sought and how it would preclude summary judgment.” ’ Margolis v. Ryan, 140

F.3d 850, 853 (9th Cir. 1998) (quoting Garrett v. City and County of San Francisco, 818 F.2d

1515, 1518 (9th Cir. 1987)). The burden is on the party seeking to conduct additional discovery

to put forth sufficient facts to show that the evidence sought exists. Volk v. D.A. Davidson &

Co., 816 F.2d 1406, 1416 (9th Cir. 1987). As more recently summarized by the Ninth Circuit:

Under Rule 56(f), the court may postpone ruling on a summary judgment

motion where the non-moving party needs “additional discovery to explore

‘facts essential to justify the party’s opposition.’ ” Crawford-El v. Britton,

523 U.S. 574, 599, n. 20 (1998) (quoting Fed. R.Civ. Pro. 56(f)). Though

the conduct of discovery is generally left to a district court's

discretion, summary judgment is disfavored where relevant evidence

remains to be discovered, particularly in cases involving confined pro

se plaintiffs. Klingele v. Eikenberry, 849 F.2d 409, 412 (9th Cir. 1988);

Harris v. Pate, 440 F.2d 315, 318 (7th Cir. 1971) (Stevens, J.) (observing

that the combined disabilities of self-representation and confinement

hinder a plaintiff's ability to gather evidence). Thus summary judgment in

the face of requests for additional discovery is appropriate only where such

discovery would be “fruitless” with respect to the proof of a viable claim. 

Klingele, 849 F. 2d at 412.

Jones v. Blanas, 393 F. 3d 918, 930 (9th Cir. 2004) (emphasis added).

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Defendants’ motion is premised on their argument that defendant physicians acted

prudently in refusing plaintiff testosterone based on the relatively high levels of the hormone in

his blood (based on lab (Plaintiff was transferred to CMF on November 21, 2002. (Dkt. No. 48-

10, at p. 2.)) tests conducted in 2000, 2004 and 2007) and the generally deleterious effects of

excessive testosterone for the conventional patient, which may be compounded by plaintiff’s

high cholesterol. However, plaintiff is not a conventional patient. Defendants’ argument and

supporting evidence do not address the role of testosterone – or oxandrolone or any alternative

medication – in treating the metabolic complications associated with HIV/HAART, either

generally or as applied to plaintiff. 

Moreover, defendants provide no evidence relative to plaintiff’s treatment at CSPC prior to his transfer to CMF, precluding the court’s assessment of the considerations

supporting plaintiff’s testosterone treatment while housed at CSP-S, and the impact of these

considerations, if at all, in CMF’s termination of the treatment without providing an alternative.

The court cannot resolve plaintiff’s claim of deliberate indifference to his serious medical needs

without evidence of the accepted standard of care for HIV-positive patients receiving HAART,

both outside and within the prison population, with due consideration to the practical and

budgetary constraints of the state prison system and matters of equity among prisoners. While

the Eighth Amendment sets a high threshold, Estelle v. Gamble, 429 U.S. 97 (1976), the court

must assess evidence specific to plaintiff relative to his unique medical concerns and within the

appropriate reference population.

These circumstances not only satisfy the requirements of Rule 56(f), but those of

Rule 15(a)(2), authorizing amendment of the complaint “when justice so requires.” Plaintiff has

demonstrated by affidavit that the facts presented by defendants in Dr. Pai’s declaration are both

new and material, require development through further discovery, and are essential both to

plaintiff’s action and any motion for summary judgment. Fed. R. Civ. P. 56(f). In addition,

justice requires that plaintiff be granted leave to amend his complaint to incorporate the new facts

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 However, absent the development of additional facts, plaintiff is not granted leave to 3

include a conspiracy claim.

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revealed by Dr. Pai and to add her as a defendant in this action. Fed. R. Civ. P. 15(a)(2). The 3

reasons for CMF’s termination of plaintiff’s testosterone treatment are at the core of plaintiff’s

action, and the apparently pivotal role of Dr. Pai in making this decision renders her inclusion in

this action necessary to resolve plaintiff’s Eighth Amendment claim. Such amendment of the

complaint does not present issues of bad faith or dilatory motive on the part of the plaintiff, nor

result in undue delay or prejudice to defendants. Foman v. Davis, 371 U.S. 178, 182 (1962);

Bowles v. Reade, 198 F.3d 752, 757-58 (9th Cir. 1999).

The court will therefore grant plaintiff’s motion to vacate defendant’s motion for

summary judgment without prejudice to the filing a new motion at the appropriate time. Plaintiff

will be granted leave to file an amended complaint and provided a reasonable period within

which to conduct further discovery. 

V. Conclusion

For the foregoing reasons IT IS HEREBY ORDERED that:

1. Plaintiff’s motion (Dkt. No. 56) to vacate defendants’ motion for summary

judgment is granted;

2. Defendants’ motion for summary judgment (Dkt. No. 48) is denied without

prejudice;

3. Plaintiff is granted leave to file an amended complaint within 60 days of the

filing date of this order;

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4. The Discovery and Scheduling Order filed April 1, 2009 (Dkt. No. 43) is

vacated; a new discovery and scheduling order will be issued in due course.

SO ORDERED. 

DATED: July 23, 2010

_____________________________________

KENDALL J. NEWMAN

UNITED STATES MAGISTRATE JUDGE

/jasp1177.msj

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