Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_06-cv-00821/USCOURTS-caed-2_06-cv-00821-8/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

ROBERT M. JOHNSON, 

Plaintiff, No. CIV S-06-0821 MCE EFB P

vs.

ARNOLD SWARTZENEGGER,

et al.,

Defendants. FINDINGS AND RECOMMENDATIONS

 /

Plaintiff is a prisoner without counsel suing for alleged civil rights violations. See 42

U.S.C. § 1983. This action proceeds on plaintiff’s April 17, 2006, original verified complaint, in

which he alleges that defendants were deliberately indifferent to his medical needs in violation of

the Eighth Amendment to the United States Constitution. Defendants filed a motion for

summary judgment on March 14, 2007. 

I. Facts

Plaintiff is an inmate currently serving his sentence at California State Prison, Solano.

Plaintiff transferred from California State Prison, Sacramento to CSP Solano on or about April

24, 2005. Verified Complaint (“Compl.”), at ¶ 3. He was diagnosed with hepatitis C, cirrhosis

and end-stage liver disease prior to his transfer to CSP Solano. Defs.’ Mot. for Summ. J.,

Attach. 7, Decl. of Alvaro Traquina, (“Traquina Decl.”), ¶¶ 6. He takes a prescription

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medication named Lactulose because of his diagnoses. Compl., at ¶4; Traquina Decl., at ¶¶ 6-8;

Defs.’ Mot. for Summ. J., Attach. 6, Decl. of Folashade Naku (“Naku Decl.”), at ¶ 2. Lactulose,

a medication commonly prescribed for people with constipation, also is prescribed to people who

have cirrhosis. Naku Decl., at ¶ 7. Lactulose may be given to prevent intestinal bacteria from

creating ammonia, and as a laxative to evacuate blood from the intestines. Id.

Defendant Alma Hughey is a compliance coordinator at CSP Solano whose only

relationship to the pharmacy at CSP Solano is that she signed time cards for employees of CSP

Solano. Defs.’ Mot. for Summ. J., Attach. 5, Decl. of Alma Hughey (“Hughey Decl.”), ¶¶ 1, 3. 

She had no authority to order medication, to distribute medication, nor to assist in plaintiff’s

medical care. Id., at ¶ 4. She was not aware of any medical diagnosis concerning plaintiff and

did not know, nor did she have reason to know of, the medications that were prescribed to

plaintiff. Id., at ¶5. She did not deliberately withhold medication from plaintiff nor hinder his

ability to obtain medication. Id., at ¶6. 

Chief Medical Officer Alvaro Traquina, MD, did not participate in plaintiff’s medical

care. Traquina Decl., at ¶ 2. He did receive a letter from the plaintiff’s sister regarding

plaintiff’s prescription. Traquina Decl., at ¶ 3. In response to this letter, Dr. Traquina took

reasonable steps to ensure that plaintiff’s medical needs were met. Traquina Decl., at ¶¶ 3, 4. 

He also granted an inmate appeal filed by plaintiff. Traquina Decl., at ¶¶ 4-5. In this inmate

appeal, plaintiff stated that he received his Lactulose prescription as ordered and without delay

from June 2005 through August 25, 2005 (the date that he was interviewed for his intermediate

appeal). Traquina Decl., at ¶ 5; Naku Decl., at ¶ 4. Dr. Traquina states that he did not

intentionally or recklessly disregard plaintiff’s medical condition and in fact did all that he could

to ensure that plaintiff’s medical needs were met. Traquina Decl., at ¶¶ 8-9. 

Pharmacist Folashade Naku was not involved in plaintiff’s medical or pharmaceutical

care when plaintiff was first transferred to this CSP Solano. Naku Decl., at ¶ 2. She is a

pharmacist, not a treating physician. Naku Decl., at ¶¶ 1-2. Dr. Naku was not aware of

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plaintiff’s medical conditions or prescriptions until June 2005, when she interviewed plaintiff. 

Naku Decl., at ¶ 2. She was not the Pharmacist in charge at CSP Solano and was not aware of

every patient’s medical needs. Id. When Naku became aware of his condition, she met with

plaintiff and immediately began dispensing the proper prescribed amount of medication to the

plaintiff. Naku Decl., at ¶ 3.

Plaintiff alleges that the defendants in this action consciously disregarded health risks to

him by deliberately withholding Lactulose Solution. Compl., at 3. He further claims that the

lack of Lactulose allegedly caused ammonia poisoning that, three months later, caused him to

suffer hepatic encephalopathy, and ultimately lose consciousness and fall into a coma. Id. 

Defendants state that they did not deliberately withhold medication from plaintiff. Traquina

Decl., at ¶¶ 8-9; Naku Decl., at ¶ 8; Hughey Decl., at ¶ 6. Defendants claim that none of them

was aware of the plaintiff’s diagnoses, prescriptions, or medical history when he first transferred

to CSP Solano on April 25, 2005. Traquina Decl., at ¶ 2; Naku Decl., at ¶ 2; Hughey Decl., at 

¶ 2, 4-6. Plaintiff filed a grievance on May 9, 2005, stating that a Lactulose refill request he

submitted four days prior had not been processed. Compl., Ex. A. The following day, his

grievance was granted and his prescription was refilled. Id. At the second level of review,

defendant Traquina found that, during an interview with plaintiff, conducted by defendant Naku,

plaintiff “acknowledged that [he had] been receiving [his] medication, as ordered and without

delay, since June 2005.” Compl., Ex. B. 

Defendant Naku also interviewed plaintiff on August 25, 2005, for his inmate appeal that

preceded this lawsuit. Naku Decl., at ¶ 4. In this interview, plaintiff admitted that he had

received his medication “like clockwork” since the June 2005 interview between plaintiff and

defendant Naku. Naku Decl., at ¶ 4; Compl., Ex. A. Following this interview, defendant Naku

future-dated plaintiff’s prescriptions so that the medication would arrive regularly. Naku Decl.,

at ¶ 5. Defendant Naku also ordered larger bottles of the medication in question so that plaintiff

would receive his medication in larger doses, which would in turn reduce the number of trips to

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the pharmacy that the plaintiff made during the course of a month. Naku Decl., at ¶ 5. 

Defendant Naku’s involvement with the plaintiff’s medical care did not include ordering

medication from sources outside of the prison. Naku Decl., at ¶ 2. She was unaware of any

problems that the plaintiff encountered in obtaining his medication prior to October 26, 2005,

when plaintiff apparently slipped into a coma. Naku Decl., at ¶¶ 6, 8. In fact, defendant Naku

recalls that plaintiff returned unopened bottles of Lactulose to the pharmacy following her

interview with plaintiff in August 2005. Naku Decl., at ¶ 6. Defendant Naku asserts that she did

not intentionally or recklessly deprive or deny plaintiff medication. Naku Decl., at ¶ 8. Plaintiff

did not file any inmate 602 complaints or otherwise complain to any of the doctors herein (or to

anyone else) that his medication was not being timely delivered at any time from June 2005 to

October 29, 2005 (the date that exhibits in his complaint suggest he slipped into a coma). 

Moreover, Exhibit C to plaintiff’s complaint (his California Government Tort Claim), dated

October 19, 2005, does not allege that plaintiff failed to receive his prescribed amount of

Lactulose at any time after June, 2005. 

Lactulose is most commonly prescribed to people diagnosed with constipation. Naku

Decl., at ¶ 7; Traquina Decl., at ¶ 7. Lactulose is also prescribed to people diagnosed with

cirrhosis, hepatitis C, and/or end-stage liver disease. Naku Decl., at ¶ 7; Traquina Decl., at ¶ 7. 

Cirrhosis, hepatitis C, and end-stage liver disease all progress to the point where, despite

medication and good medical care, persons diagnosed with these diseases suffer deteriorating

health consequences. Traquina Decl., at ¶ 6. These three diseases naturally cause persons

diagnosed with any or all said diseases to experience altered states of consciousness, coma, and

eventually, organ failure, even with regular doses of Lactulose or other medications. Traquina

Decl., at ¶ 6. Plaintiff’s pre-existing diagnoses of cirrhosis, hepatitis C, and/or end-stage liver

disease naturally progressed to the point where he suffered the injuries set forth in his complaint. 

Id. Defendant Traquina alleges that none of the alleged acts and omissions set forth in plaintiff’s

complaint actually caused any of his injuries. Traquina Decl., at ¶ 6. 

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II. Summary Judgment Standards

Summary judgment pursuant to Fed. R. Civ. P. 56(a) avoids unnecessary trials in cases

with no disputed material facts. See Northwest Motorcycle Ass’n v. United States Dep’t of

Agric., 18 F.3d 1468, 1471 (9th Cir. 1994). At issue is “whether the evidence presents a

sufficient disagreement to require submission to a jury or whether it is so one-sided that one

party must prevail as a matter of law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251-52

(1986). 

Rule 56 serves to screen the latter cases from those which actually require resolution of

genuine disputes over facts material to the outcome of the case; e.g., issues that can only be

determined through presentation of testimony and evidence at trial such as credibility

determinations of conflicting testimony over dispositive facts.

In three recent cases, the Supreme Court, by clarifying what the

non-moving party must do to withstand a motion for summary

judgment, has increased the utility of summary judgment. First, the

Court has made clear that if the non-moving party will bear the

burden of proof at trial as to an element essential to its case, and

that party fails to make a showing sufficient to establish a genuine

dispute of fact with respect to the existence of that element, then

summary judgment is appropriate. See Celotex Corp. v. Catrett,

477 U.S. 317 (1986). Second, to withstand a motion for summary

judgment, the non-moving party must show that there are “genuine

factual issues that properly can be resolved only by a finder of fact

because they may reasonably be resolved in favor of either party.”

Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986) (emphasis

added). Finally, if the factual context makes the non-moving

party's claim implausible, that party must come forward with more

persuasive evidence than would otherwise be necessary to show

that there is a genuine issue for trial. Matsushita Elec. Indus. Co. v.

Zenith Radio Corp., 475 U.S. 574 (1986). No longer can it be

argued that any disagreement about a material issue of fact

precludes the use of summary judgment.

California Arch. Bldg. Prod. v. Franciscan Ceramics, 818 F.2d 1466, 1468 (9th Cir.), cert.

denied, 484 U.S. 1006 (1988) (parallel citations omitted) (emphasis added). In short, there is no

"genuine issue as to material fact," if the non-moving party "fails to make a showing sufficient to

establish the existence of an element essential to that party's case, and on which that party will

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 On August 2, 2006, the court informed plaintiff of the requirements for opposing a

motion pursuant to Rule 56 of the Federal Rules of Civil Procedure. See Rand v. Rowland, 154

F.3d 952, 957 (9th Cir.1998) (en banc), cert. denied, 527 U.S. 1035, 119 S.Ct. 2392, 144

L.Ed.2d 793 (1999), and Klingele v. Eikenberry, 849 F.2d 409, 411-12 (9th Cir.1988).

2

 The nonmoving party with the burden of proof “must establish each element of his

claim with significant probative evidence tending to support the complaint.” Barnett v. Centoni,

31 F.3d 813, 815 (9th Cir. 1994) (internal quotations omitted). A complete failure of proof on an

essential element of the nonmoving party’s case renders all other facts immaterial, and entitles

the moving party to summary judgment. Celotex, 477 U.S. at 322. 

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bear the burden of proof at trial." Grimes v. City and Country of San Francisco, 951 F.2d 236,

239 (9th Cir. 1991) (quoting Celotex, 477 U.S. at 322).

Thus, to overcome summary judgement an opposing party must show a dispute that is

both genuine, and involving a fact that makes a difference in the outcome.1 Two steps are

necessary. First, according to the substantive law, the court must determine what facts are

material. Second, in light of the appropriate standard of proof, the court must determine whether

material factual disputes require resolution at trial. Id., at 248. 

When the opposing party has the burden of proof on a dispositive issue at trial, the

moving party need not produce evidence which negates the opponent’s claim. See e.g., Lujan v.

National Wildlife Fed’n, 497 U.S. 871, 885 (1990). The moving party need only point to matters

which demonstrate the absence of a genuine material factual issue. See Celotex v. Cattret, 477

U.S. 317, 323-24 (1986). 

If the moving party meets its burden, the burden shifts to the opposing party to establish

genuine material factual issues. See Matsushita Elec. Indus. Co., 475 U.S. at 586.2

 The opposing

party must demonstrate that the disputed facts are material, i.e., facts that might affect the

outcome of the suit under the governing law, see Anderson, 477 U.S. at 248; T.W. Elec. Serv., Inc.

v. Pacific Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 1987), and that disputes are

genuine, i.e., the parties’ differing versions of the truth require resolution at trial, see T.W. Elec.,

809 F.2d at 631. There can be no genuine issue as to any material fact where there is a complete

failure of proof as to an essential element of the nonmoving party's case because all other facts are

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 A verified complaint may be used as an affidavit in opposition to the motion. 

Schroeder v McDonald, 55 F. 3d 454, 460 (9th Cir. 1995); McElyea v. Babbitt, 833 F.2d 196,

197-98 (9th Cir. 1987) (per curiam).

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thereby rendered immaterial. Celotex, 477 U.S. at 323. The opposing party may not rest upon the

pleadings’ mere allegations or denials, but must present evidence of specific disputed facts. See

Anderson, 477 U.S. at 248.3

 Conclusory statements cannot defeat a properly supported summary

judgment motion. See Scott v. Rosenberg, 702 F.2d 1263, 1271-72 (9th Cir. 1983). 

The court does not determine witness credibility. It believes the opposing party’s

evidence, and draws inferences most favorably for the opposing party. See Anderson, 477 U.S. at

249, 255. Inferences, however, are not drawn out of “thin air,” and the proponent must produce

evidence of a factual predicate from which to draw inferences. American Int’l Group, Inc. v.

American Int’l Bank, 926 F.2d 829, 836 (9th Cir.1991) (Kozinski, J., dissenting) (citing Celotex,

477 U.S. at 322).

If reasonable minds could differ on material facts at issue, summary judgment is

inappropriate. See Warren v. City of Carlsbad, 58 F.3d 439, 441 (9th Cir. 1995). On the other

hand,“[w]here the record taken as a whole could not lead a rational trier of fact to find for the

nonmoving party, there is no ‘genuine issue for trial.’” Matsushita, 475 U.S. at 587 (citation

omitted). In that case, the court must grant summary judgment.

With these standards in mind, it is important to note that plaintiff bears the burden of

proof at trial over the issue raised on this motion, i.e., whether the defendant acted with deliberate

indifference to the plaintiff’s safety. Equally critical is that “deliberate indifference” is an

essential element of plaintiff’s cause of action. Therefore, to withstand defendant’s motion,

plaintiff may not rest on the mere allegations or denials of his pleadings. He must demonstrate a

genuine issue for trial, Valandingham v. Bojorquez, 866 F.2d 1135, 1142 (9th Cir. 1989), and he 

must do so with evidence upon which a fair-minded jury "could return a verdict for [him] on the

evidence presented." Anderson v. Liberty Lobby, Inc., 477 U.S. at 248, 252. 

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III. Discussion

Plaintiff claims that he suffered hepatic encephalopathy and coma as a result of

defendants’ refusal to provide him with Lactulose. A prisoner who claims his Eighth Amendment

guarantee against cruel and unusual punishment has been violated by inadequate medical care

must allege that on a specific day an identified state actor with individual responsibility for

obtaining or providing medical care knew the prisoner faced substantial risk of serious harm but

deliberately disregarded the risk by failing to take reasonable measures resulting in avoidable

persistent severe pain or avoidable substantial personal injury. Estelle v. Gamble, 429 U.S. 97,

106 (1976); Farmer v. Brennan, 511 U.S. 825, 837 (1994).

To state a claim defendants provided constitutionally inadequate medical care, plaintiff

must allege acts or omissions evidencing identified defendants knew of and disregarded plaintiff’s

serious medical needs. Estelle, 429 U.S. at 106; Farmer, 511 U.S. at 837. Neither defendants’

negligence nor plaintiff’s general disagreement with the treatment he received suffices to state a

claim. Estelle, 429 U.S. at 106; Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir. 1988);

Jackson v. McIntosh, 90 F.3d 330, 331 (9th Cir. 1996). 

A medical need is serious if the failure to treat the prisoner's condition could result in

further significant injury or the “ ‘unnecessary and wanton infliction of pain.’” McGuckin v.

Smith, 974 F.2d 1050, 1059 (9th Cir.1992) (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)).

When, as here, the prisoner seeks only damages against a defendant, the “inquiry into causation

must be individualized and focus on the duties and responsibilities of each individual defendant

whose acts or omissions are alleged to have caused a constitutional deprivation.” Leer v. Murphy,

844 F.2d 628, 633 (9th Cir.1988). Leer explained that “it is important to distinguish the causal

connection required when a plaintiff seeks injunctive or declaratory relief as opposed to

damages.” Id.

When a plaintiff seeks to hold an individual defendant personally liable for damages, the

causation inquiry between the deliberate indifference and the eighth amendment deprivation must

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be more refined. The court must focus on whether the individual defendant was in a position to

take steps to avert the [harm], but failed to do so intentionally or with deliberate indifference . . . .

[I]n order to prevail and recover damages against any of the named prison officials, the plaintiff

in this case must prove (1) that the specific prison official, in acting or failing to act, was

deliberately indifferent to the mandates of the eighth amendment and (2) that this indifference

was the actual and proximate cause of the deprivation of plaintiff’s eighth amendment right to be

free from cruel and unusual punishment. Id. at 633-34 (emphasis added).

The court finds that plaintiff has failed to raise a triable issue of fact as to whether

defendants’ alleged indifference was the “actual and proximate cause” of his suffering from

hepatic encephalopathy and lapsing into a coma. Plaintiff has not submitted any competent

evidence showing that the interference with his prescribed course of Lactulose almost five months

prior to his hospitalization was the cause of the deterioration of his condition. Nor has he shown

that the interruption in his course of medication was due to deliberate indifference on the part of

any defendant. Instead, the evidence shows that the problems plaintiff encountered in receiving

the correct amount of Lactulose following his transfer to CSP Solano were immediately addressed

and corrected upon his filing of a grievance, and that there was no interruption of his Lactulose

refills from June 2005 to October 29, 2005. Defendants also submit evidence that plaintiff’s

condition would have worsened, even with an uninterrupted course of treatment with Lactulose. 

Because plaintiff has failed to raise a genuine dispute over a material issue of fact

concerning the requisite causal connection between defendants’ actions or inactions and the

alleged Eighth Amendment violation, summary judgment is appropriate. See Id. at 634 (affirming

summary judgment in favor of defendants; no causal connection between prison officials’ actions

and assault on inmates); see also Wood v. Housewright, 900 F.2d 1332, 1335 (9th Cir.1990).

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Accordingly, it is hereby RECOMMENDED that:

1. Defendants’ March 14, 2007, motion for summary judgment be granted;

2. Judgment be entered in their favor; and

3. The Clerk be directed to close the case. 

These findings and recommendations are submitted to the United States District Judge

assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within fourteen days

after being served with these findings and recommendations, any party may file written objections

with the court and serve a copy on all parties. Such a document should be captioned “Objections

to Magistrate Judge’s Findings and Recommendations.” Failure to file objections within the

specified time may waive the right to appeal the District Court’s order. Turner v. Duncan, 158

F.3d 449, 455 (9th Cir. 1998); Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991).

Dated: February 14, 2008.

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