Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_05-cv-01104/USCOURTS-caed-1_05-cv-01104-5/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

BRENDA ALLEN,

 Plaintiff,

 v. 

JEANNE WOODFORD; RICHARD RIMMER;

ROSANNE CAMPBELL; GWENDOLYN

MITCHELL; SAMPATH SURYADEVARA,

M.D., JAUN JOSE TUR, M.D.,

MUHAMMAD ANWAR, M.D., MADERA

COMMUNITY HOSPITAL, A CALIFORNIA

CORPORATION. 

 Defendants.

1:05-CV-01104-OWW-LJO

ORDER GRANTING IN PART AND

DENYING IN PART DEFENDANTS’

MOTIONS TO DISMISS

I. INTRODUCTION

Defendants California Department of Corrections (“CDC”),

Madera County Community Hospital (“MCH”), and Dr. Muhammad Anwar

(“Anwar”), move to dismiss the complaint under Fed. R. Civ. P.

12(b)(6). Plaintiff Brenda Allen ("Allen") opposes the motion. 

II. PROCEDURAL HISTORY

The complaint was filed on August 25, 2005. (Doc. 1.,

Complaint.) CDC moved to dismiss on October 31, 2005. (Doc. 10,

CDC Mot. to Dismiss.) The first amended complaint (“FAC”) was

filed on November 9, 2005. (Doc. 11, FAC.) CDC moved to dismiss

on January 19, 2006. (Doc. 19, CDC. Mot. to Dismiss.) MCH and

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Anwar moved to dismiss on January 24, 2006. (Doc. 20, MCH Mot.

to Dismiss; Doc. 23, Anwar Mot. to Dismiss.) Allen filed her

opposition on March 17, 2006. (Doc. 50, Allen’s Opp’n. to Mot.

to Dismiss (“Allen’s Opposition”).) CDC filed their reply to

Allen’s opposition on March 30, 2006. (Doc. 56, Reply to Resp.

to Mot. to Dismiss (“CDC Reply”).) MCH filed a reply to Allen’s

opposition on March 31, 2006 . (Doc. 58, Reply to Resp. to Mot

re Def. Mot. to Dismiss “MCH’s Reply”).) Anwar also replied to

Allen’s opposition on March 31, 2006. (Doc. 59, Reply to Resp.

to Mot. By Dr. Anwar (“Anwar’s Reply”).) 

III. BACKGROUND

Allen, an inmate at the Central California Women’s Facility

(CCWF), alleges that a surgical procedure performed by Anwar

caused severe scarring, disfigurement, and physical injuries. 

Allen alleges violation of her Eighth and Fourteenth Amendment

rights against cruel and unusual punishment. 42 U.S.C. § 1983.

On August 25, 2005, Allen filed suit against Anwar, MCH and

members of its hospital staff, as well as a number of individual

supervisors at the CDC. (Doc. 11, FAC ¶¶ 3-12.) CDC moved to

dismiss the FAC for failure to exhaust administrative remedies

under 42 U.S.C. §1997e(a). Defendants move to dismiss for

failure to state a claim under the Eighth Amendment. All

defendants move to dismiss Allen’s non-federal claims under Fed.

R. Civ. P. 12(b)(6) and for lack of supplemental jurisdiction

under 28 U.S.C. §1367(a). 

//

IV. FACTUAL HISTORY

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A. Allen’s Medical Condition

While an inmate at CCFW, Allen suffered from boils and

infected ingrown hairs in her armpit, upper buttocks, and groin

areas (hereinafter “medical condition”). (Doc. 11, FAC ¶ 15.) 

Allen claims that in 2004 she requested that CDC refer her to a

dermatologist. (Id. ¶ 18.) Dr. Suryadevara and the CDC rejected

her request and instead directed her to Anwar for surgical

removal of her boils. (Id.) In July 2004, Allen underwent

surgery at MCH, a nonprofit hospital. (Id.) MCH provided

nursing care to Allen as well as the facility for Anwar to treat

her during her surgery. (Doc. 21, MCH Mot. to Dismiss.) Anwar

was an independent contractor at MCH. (Id.) MCH claims that it

was Anwar who exercised his medical judgment and made the

decision to operate on Allen. (Id.) MCH did not give Anwar

instruction or advice on the surgical procedure. (Id.) 

Allen makes several allegations about Anwar’s surgical

procedure. First, Allen claims that Anwar performed a similar

surgery on a fellow inmate, Regina Boyce (“Boyce”). (Doc. 11,

FAC ¶ 16.) Allen alleges that Boyce consented only to the

“lancing” of boils in her armpits but that instead was subjected

by Anwar to more invasive surgery. (Id.) Allen claims that the

surgery left Boyce with limited flexibility in her arms, limited

ability to raise her arms, and loss of sensation in her arms. 

(Id. at ¶ 17.) Allen believes that Boyce filed a claim against

Anwar as a result of the surgery. (Id.) 

Allen further alleges that she consented to Anwar’s surgical

removal of her boils because she thought the procedure would be

minimally invasive. (Id. ¶ 17.) Instead, Anwar removed large

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 The California prison system allows inmates to file inmate 1

appeal forms (Form CDC 602) appealing any “departmental decision,

action, condition, or policy which they can demonstrate as having

an adverse affect upon their welfare.” CAL. CODE REGS. tit. 15,

§ 3084.1 (2006). The appeal system has four levels of review:

(1) an informal level; (2) a first formal level; (3) a second

formal level; and (4) the Director’s level review. CAL. CODE

REGS. tit. 15, § 3084.5 (2006). If an inmate is not satisfied

with the prison’s decision about her appeal, she can appeal

adverse decisions to the next level of review. A prisoner is

required to appeal until all available administrative remedies

are exhausted. 42 U.S.C. § 1997e.

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sections of skin and tissue, including glands and muscles, from

both armpits. (Id.) Anwar did not perform any adequate skin

grafts to restore mobility. (Id.) Allen claims that the surgery

left her with limited flexibility in her arms, limited ability to

raise her arms, and radiating pain. (Id.) She also has severe

pain in her groin and upper buttocks areas. (Id.) Allen claims

that she did not consent to the procedure Anwar actually

performed. (Doc. 50, Allen’s Opp’n, P. 24.) 

Allen attempted to ask Anwar about the results of her

surgery. (Doc. 51-1, Declaration of Margaret McCletchie

(“McCletchie Decl.”) in Supp. of Brenda Allen’s Opp. to Mot. to

Dismiss, Ex. A, Section A.) Anwar dismissed her inquiries. 

(Id.) Anwar has since stopped performing surgeries on CCFW

inmates. (Doc. 50, Allen’s Opp’n, 10.) After her surgery, Allen

filed grievances with the CDC and brought this action against

Defendants.

B. Allen’s Administrative Appeals and Federal Claim.

Allen filed her first 602 complaint at the informal level

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 on August 9, 2004 (“2004 Grievance”). (Doc. 51, McCletchie

Decl., ¶ 3.) She requested the following relief:

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 There is some question as to whether Allen requested a

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second opinion in her initial 602 complaint at the informal

level. The record shows her appealing a denial of a request for

a second opinion but there is no evidence indicating that she

made such a request. (Doc. 51-1, McCletchie Decl., Ex. A,

Section D.) 

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1) that her medical concerns be met 

2) legal advice

3) an explanation from Anwar as to his procedure and

his reaction upon her questioning his procedure. 

(Id. ¶ 4.) 

On August 23, 2004 Allen received a response from CDC

indicating that “the department cannot give [her] legal

advice...[but that she has] the right to have [her] concerns

addressed by the physician who performed [her] surgery.” (Doc.

51, McCletchie Decl. at ¶ 5.) Allen then went to the first

formal level of review to appeal denial of her request for a

second opinion and the denial of viewing her medical file. (Id.

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at ¶ 6.) On September 29, 2004 Allen’s requests were “partially

granted.” (Id. at Ex. A, Section E.) Her medical file was

reviewed by the Chief Medical Officer. An appointment was

scheduled for her to meet with another surgeon a month later. 

(Id.) Whether she actually met with another surgeon and the

outcome of that meeting are unclear from the record. 

Allen filed her second 602 complaint on July 25, 2005 (“2005

Grievance”). (Doc. 51., McCletchie Decl. at ¶ 8.) In this

grievance, Allen made the following complaints: 

1) She was not satisfied with the surgery

2) She was under the impression that the surgery

would be minor

3) Her arms were sewn together too tightly so that

she is unable to lift them “completely upward”

4) She has lost sensation and mobility in her arms 

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5) Questioned why she was not first referred to a

dermatologist

6) Questioned why she was not warned or notified

about Anwar’s previous complaints against him

7) Questioned why she was not given the option to

choose her own doctor

(Id. at Ex. B, Section A.) 

The relief she sought for this grievance was compensation

for pain and suffering, to have a medical review of her file, and

to be assigned a log number. (Doc. 51, McCletchie Declaration,

Exhibit B, Section B.) On August 25, 2005 while Allen’s second

602 was still pending, she filed this lawsuit. 

In response to her 2005 Grievance CDC again “partially

granted” her request on September 14, 2005. (Doc. 51, McCletchie

Decl., Ex. B, Section E.) CDC acknowledged her complaint and

granted her the right to review her health record. (Id.) The

CDC found her concerns to have “merit” and brought the concerns

to the attention of the “appropriate management staff.” (Id.) 

Allen was also given a log number. (Id.) However, the CDC

notified Allen that they were unable to compensate her for pain

and suffering because the CDC was not authorized to grant

monetary compensation. (Id.) 

On September 16, 2005, having filed her complaint in federal

court, Allen appealed to the second-level of review indicating

that she had not received answers to her inquiries. (Doc. 51,

McCletchie Decl., Ex. B, Section F.) On October 1, 2005 Allen

proceeded to take her appeal to the Director’s level and

requested an explanation as to why Anwar was still performing

surgery. (Id. at Section H.) Allen then filed her first amended

complaint on November 9, 2005. After Allen submitted her appeal

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to the Director’s level of review the Chief of Inmate Appeals, N.

Grannis, wrote a letter dated December 23, 2005. (Doc. 51,

McCletchie Decl., Ex. C.) The letter stated that the grievance

was being returned to Allen because she first had to go through

the second level of review before she could appeal to the

Director’s level. (Id. ¶ 12.) The record does not reflect that

there was ever a second level response to her appeal. 

V. STANDARD OF REVIEW

Fed. R. Civ. P. 12(b)(6) provides that a motion to dismiss

may be made if the plaintiff fails “to state a claim upon which

relief can be granted.” However, motions to dismiss under Fed.

R. Civ. P. 12(b)(6) are disfavored and rarely granted. The

question before the court is not whether the plaintiff will

ultimately prevail; rather, it is whether the plaintiff could

prove any set of facts in support of his claim that would entitle

him to relief. See Hishon v. King & Spalding, 467 U.S. 69, 73

(1984). “A complaint should not be dismissed unless it appears

beyond doubt that plaintiff can prove no set of facts in support

of his claim which would entitle him to relief.” Van Buskirk v.

CNN, Inc., 284 F.3d 977, 980 (9th Cir. 2002) (citations omitted).

In deciding whether to grant a motion to dismiss, the court

“accept[s] all factual allegations of the complaint as true and

draw[s] all reasonable inferences” in the light most favorable to

the nonmoving party. TwoRivers v. Lewis, 174 F.3d 987, 991 (9th

Cir. 1999); see also Rodriguez v. Panayiotou, 314 F.3d 979, 983

(9th Cir. 2002). A court is not “required to accept as true

allegations that are merely conclusory, unwarranted deductions of

fact, or unreasonable inferences.” Sprewell v. Golden State

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Warriors, 266 F.3d 979, 988 (9th Cir. 2001).

VI. ANALYSIS

A. Legal Background

1. Motion to Dismiss for Failure to Exhaust

Administrative Remedies Pursuant to 42 U.S.C.

§1997e(a). 

CDC Defendants move to dismiss Allen’s FAC pursuant to the

Fed. R. Civ. P. 12(b)(6) because Allen failed to exhaust her

administrative remedies under 42 U.S.C. §1997e(a). This section

of the Prison Litigation Reform Act (“PLRA”) requires prisoners

to exhaust available administrative remedies before bringing suit

challenging prison conditions under §1983:

“No action shall be brought with respect to prison

conditions under section 1983 of this title, or any

other federal law, by a prisoner confined in any jail,

prison, or other correctional facility until such

administrative remedies as are available are

exhausted.”

24 U.S.C. § 1997e(a).

In the Ninth Circuit, “failure to exhaust nonjudicial

remedies that are not jurisdictional is subject to a Rule 12(b)

motion rather than a motion for summary judgment.” Wyatt v.

Terhune, 315 F.3d 1108, 1119 (9th Cir. 2003). CDC Defendants

have properly brought a Rule 12(b)(6) motion. 

Defendants have the burden to prove the absence of

exhaustion. Fed. R. Civ. P. 8(c)(there is no pleading

requirement under 1997e(a)). Plaintiff is not required to plead

and prove exhaustion of administrative remedies. Wyatt, 315 F.3d

at 1119. 

“In ruling on an unenumerated Rule 12(b)(6) motion to

dismiss for failure to exhaust, ‘the court may look beyond the

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pleadings and decide disputed issues of fact’ by, for example,

considering affidavits submitted by the parties.” Hazleton v.

Alameida, 358 F. Supp. 2d 926, 928 (C.D. Cal. 2005)(quoting

Wyatt, 315 F.3d at 1119-20)). Generally, on a motion to dismiss,

a court may consider two types of “extrinsic” material. First,

“a court may consider material which is properly submitted as

part of the complaint on a motion to dismiss without converting

the motion to dismiss into a motion for summary judgment.” Lee

v. City of Los Angeles, 250 F.3d 668, 688 (9th Cir. 2001)

(internal quotations and citations omitted). A court may even

consider materials not physically attached to the complaint if

their authenticity is not contested and the complaint necessarily

relies on them. Id. Second, a court may take judicial notice of

matters of public record under Fed. R. Evid. 201. Id. For

example, matters of public record may be considered, including

pleadings, orders and other papers filed with the court or

records of administrative bodies. Id. Conclusions of law,

conclusory allegations, unreasonable inferences, or unwarranted

deductions of fact need not be accepted. See Ove v. Gwinn, 264

F.3d 817, 821 (9th Cir. 2001).

2. 42 U.S.C. §1983.

Allen bases her §1983 claim on an alleged Eighth Amendment

violation. To establish liability under §1983 a plaintiff must

show 1) that she has been deprived of a right secured by the

United States Constitution or a federal law and 2) that the

deprivation was effected “under color of state law.” Broam v.

Bogan, 320 F.3d 1023, 1028 (9th Cir. 2003). 

a. Violation of the Eighth Amendment.

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A violation of the Eighth Amendment is made applicable to

the states by the Fourteenth Amendment. Whitley v. Albers, 475

U.S. 312, 317 (1986). Under §1983, an inmate must show

“deliberate indifference to serious medical needs” to maintain an

Eighth Amendment claim based on prison medical treatment. Jett

v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006)(quoting Estelle v.

Gamble, 429 U.S. 97, 104 (1976)). Plaintiff must show a “serious

medical need” by demonstrating that “failure to treat the

prisoner’s condition could result in further significant injury

or the ‘unnecessary and wanton infliction of pain’” and the

defendant’s response to the need was deliberately indifferent. 

Id. This second prong is satisfied by a showing 1) of a

purposeful act or failure to respond to a prisoner’s pain or

possible medical need and 2) harm caused by the indifference. 

Id. Indifference “may appear when prison officials deny, delay

or intentionally interfere with medical treatment, or it may be

shown by the way in which prison physicians provide medical

care.” Id. Yet, an “inadvertent [or negligent] failure to

provide adequate medical care” alone does not state a claim under

§1983. Id. A prisoner need not show that harm was substantial;

however, serious harm provides additional support for an inmate’s

claim that the defendant was deliberately indifferent to his

needs. Id. If the harm is an “isolated exception” to the

defendant’s “overall treatment of the prisoner [it] ordinarily

militates against a finding of deliberate indifference.” Id. 

b. Under Color of State Law

In West v. Atkins, 487 U.S. 42 (1988), the Supreme Court

articulated the standard for the “state action” required to

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support an Eighth Amendment violation in a prison medical case.

The petitioner in Atkins tore his left Achilles tendon at a state

prison in which he was incarcerated. Atkins, 487 U.S. at 43. A

physician under contract to provide medical care examined him and

directed that he be transferred to an acute - care medical

facility operated by the State. Id. The only issue before the

Court was whether petitioner had established that respondent

acted under color of state law in treating West’s injury. 

The traditional definition of acting under color of state

law requires that the defendant in a §1983 action have exercised

power “possessed by virtue of state law and made possible only

because the wrongdoer is clothed with the authority of state

law.” Atkins, 487 U.S. at 49 (quoting United States v. Classic,

313 U.S. 299, 326 (1941)). Id. If defendant’s conduct satisfies

the state action requirement of the Fourteenth Amendment, “that

conduct [is] also action under color of state law and will

support a suit under §1983.” Id. In such circumstances,

defendant’s alleged infringement of plaintiff’s federal rights is

“fairly attributable to the State.” Id. To constitute state

action, the deprivation must be caused by the exercise of some

right or privilege created by the State or by a person for whom

the State is responsible, and the party charged with the

deprivation must be a person who may fairly be said to be a state

actor. Id.; see also, Am. Mfrs. Mut. Ins. Co. v. Sullivan, 526

U.S. 40, 50 (1999). State employment is generally sufficient to

render the defendant a state actor. It is firmly established

that a defendant in a §1983 suit acts under color of state law

when he abuses the position given to him by the State. Atkins,

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487 U.S. at 49. Generally, a public employee acts under color of

state law while acting in his official capacity or while

exercising his responsibilities pursuant to state law. Id. Here

Anwar was a contract physician providing medical services to the

prison and to prisoners who needed surgery. 

3. Eleventh Amendment Immunity.

The Eleventh Amendment bars suits against a state for

damages or injunctive relief, unless the state has consented to

or waived immunity, or Congress has validly abrogated the same.

Seminole Tribe of Fla. v. Florida, 517 U.S. 44, 54-55 (1996); In

re Harleston, 331 F.3d 699, 701 (9th Cir. 2003). The Eleventh

Amendment’s “reference to actions against one of the United

States encompasses not only actions in which a State is actually

named as a defendant, but also certain actions against the state

agents and state instrumentalities.” Regents of the Univ. of

Calif. v. Doe, 519 U.S. 425, 429 (1997); see also Ulaleo v. Paty,

902 F.2d 1395, 1398 (9th Cir. 1990).

B. Summary of Motions For Federal Claims

1. CDC Defendants 

a. Motion to Dismiss Pursuant to The Prison

Litigation Reform Act §1997e(a).

CDC moves to dismiss the FAC for failure to exhaust

administrative remedies under §1997e(a) of the PLRA. CDC argues

that Allen only appealed her 2004 grievance to the first formal

level of review and her 2005 grievance to the second formal level

of review. CDC argues that the PLRA requires Allen to appeal her

grievances to the highest level of review before she can bring

suit against CDC. 

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i. The Exhaustion Requirement and The

California State Inmate Administrative

Appeals Process. 

The PLRA requires that an inmate exhaust all administrative

remedies before bringing suit. 42 U.S.C. § 1997e(a). The

exhaustion requirement is mandatory. McKinney v. Carey, 311 F.3d

1198, 1199 (9th Cir. 2002)(citing Booth v. Churner, 532 U.S. 731,

741 (2001)). “The PLRA’s exhaustion requirement applies to all

inmate suits about prison life, whether they involve general

circumstances or particular episodes, and whether they allege

excessive force or some other wrong.” Porter v. Nussle, 534 U.S.

516, 532 (2002). 

There are two principal policies behind the administrative

exhaustion rule:

The first is to protect an administrative agency’s

authority by giving the agency the first opportunity to

resolve a controversy before a court intervenes in the

dispute. The second is to promote judicial efficiency

by either resolving the dispute outside of the courts,

or by producing a factual record that can aid the court

in processing a plaintiff’s claim. 

Ngo v. Woodford, 403 F.3d 620, 624 (9th Cir. 2005).

A California state inmate exhausts her administrative

remedies within the meaning of the PLRA by pursuing

administrative appeal through all appropriate and available

levels of review. Hazleton, 358 F. Supp. 2d at 929. The

following four steps are available to California state prisoners:

1) informal resolution

2) formal written appeal on a CDC 602 inmate appeal

form

3) second level appeal to the institution head or

designee 

4) third level appeal to the Director of the

California Department of Corrections

Gomez v. Winslow, 177 F. Supp. 3d 977, 979 (N.D. Cal. 2001)

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(internal citations omitted); see Cal. Code Regs., tit. 15

§ 3084, et seq. To fulfill the exhaustion requirement, a

prisoner must pursue her appeal through all three levels of

administrative appellate review (i.e., to the Director’s level),

unless further appeal would be futile. Brady v. Attygala, 196 F.

Supp. 2d 1016, 1020 (C.D. Cal. 2002). 

ii. Allen Fully Exhausted Her Administrative

Remedies. 

To overcome CDC’s motion to dismiss, Allen must show that

she exhausted her administrative remedies under §1997e(a). It is

the possibility of relief that is critical in determining whether

a plaintiff fully exhausts her remedies. Brady, 196 F. Supp. 2d

at 1020. Granting the prisoner’s appeal could constitute the

extent of the relief the prison could offer. Id. at 1021-22.

(citing Cal. Code Regs. tit. 15 § 3084.5(d)); accord Clement v.

Cal. Dept. of Corr., 220 F. Supp. 2d 1098, 1106 (N.D. Cal.

2002)(holding “Plaintiff had received all the relief that the

prison administrative appeal could provide” when prison granted

both Second Level Appeals and provided colonoscopy and special

diet for inmate). Pursuit of an administrative appeal is not

required when no relief whatsoever is left available for the

inmate to obtain through the prison administrative process. Id.

at 1020. Brady v. Attygala, 196 F. Supp. 2d 1016, 1020. (C.D.

Cal. 2002).

In Brady v. Attygala, 196 F. Supp. 2d 1016 (C.D. Cal. 2002),

plaintiff was an inmate whose eye was injured by another

prisoner. Id. at 1017. Prison officials failed to properly

treat his injury and ignored his repeated complaints of pain and

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loss of vision in his eye. Id. at 1018. Brady’s condition

continued for a month during which time he filed a CDC 602

complaint contesting the treatment he received by prison doctors. 

Id. While his appeal was pending at the second level review,

Brady was finally seen by an outside eye specialist who informed

him that his “eye was infected” and “could not be saved.” Id.

Brady’s appeal was forwarded to the second level review the same

day that he saw the eye specialist. Id. Prison officials

granted Brady’s appeal noting that he had already consulted with

the outside specialist. Id. The Court reasoned that Brady had

fully exhausted his remedies because he received the action he

sought during the pendency of his grievance. Id. at 1021. When

Brady’s grievance was “granted” at the second level of review

there was little else he could seek or expect from the prison

administrative process; he had won his appeal and had been

granted all the relief he sought in his grievance. Id. Nowhere

did defendants articulate what other types of relief were still

available from the administrative process for Brady to pursue

after his appeal was granted. Id. Nor did it appear that any

relief in fact existed. Id. CDC acknowledges that money damages

are not an available remedy. (Doc. 51, McCletchie Declaration,

Exhibit B, Section E.) 

As in Brady, Allen has exhausted her administrative remedies

upon receiving the relief she sought from CDC. CDC gave her all

the possible relief they could grant. In her 2004 grievance,

Allen requested: 

1) that her medical concerns be met 

2) that she receive legal advice

3) an explanation from Anwar regarding his surgical

procedure.

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In response, the CDC notified Allen that they could not give her

legal advice. The CDC met Allen’s medical needs by having

medical personnel review her medical file, scheduling an

appointment for her to see another surgeon, and allowing her to

view her own medical file. She was also assigned a log number.

Upon obtaining this relief, there was little else that Allen

could seek or expect from the prison administrative process.

Nowhere did the CDC articulate what other types of relief were

still available for Allen to pursue. Nor did it appear that any

relief for Allen in fact existed. The CDC could not provide

Allen with the explanations she sought from Anwar. He is no

longer employed by the CDC or CCWF. They invited her to seek an

explanation from him directly but did not offer to assist her in

obtaining this explanation. It was reasonable for Allen to infer

that CDC could not provide her any relief with respect to the

answers she sought from Anwar. Also given that Anwar no longer

performs surgeries on CCFW inmates, the possibility of this

remedy is no longer available as he has no relationship with CDC. 

Since Allen’s only remaining request for relief was money

damages, requiring her to appeal to a higher level would not have

given her any more relief than she had already obtained. 

Instead, a further appeal would have potentially "provided the

opportunity that the corrective action taken earlier [by the CDC]

would later be undone." Brady, 196 F. Supp. 2d at 1022. Allen

made two 602 grievances regarding her surgical procedure before

her complaint was filed. This gave the CDC a full opportunity to

consider and investigate her case before she filed suit. Based

on the pleadings, Allen has fully exhausted her administrative

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remedies as there appears to be no remaining relief available

through the CDC. 

iii. CDC Failed To Meet Their Burden Under

§1997e(a).

CDC defendants argue that remedies were still available for

Allen to exhaust. The PLRA requires that defendants

affirmatively meet their burden of raising and proving the

absence of exhaustion. Wyatt, 315 F.3d at 1119. The CDC has

failed to meet this burden. The relief the CDC claims it could

have granted Allen includes:

1) medication and physical therapy for the loss of

mobility in her arms.

2) facilitating a meeting with Anwar

3) additional care and treatment for her injuries

4) referral to a plastic surgeon, a dermatologist, a

physical therapist, a psychiatrist, or any other

of a number of health care providers

(Doc. 56, CDC Reply, 6.) The CDC argues that it did not lack the

authority to provide Allen with further remedies. Had Allen

pursued her complaint to full administrative exhaustion she could

have made specific requests that the institution provide her with

such remedies. 

Allen did not fail to make a request for help with her

injuries. Allen requested in her 2004 grievance that her medical

concerns be met in addition to seeking an explanation about the

details of Anwar’s surgical procedure. None was forthcoming. 

Allen also alleges that she had initially requested to see a

dermatologist before she was referred to Anwar. 

Section 1997e(a) of the PLRA does not require Allen to make

specific requests as to the means by which her concerns should be

met. To require Allen to make specific requests for relief that

she does not want or does not know is available would shift the

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burden of proving the absence of exhaustion to plaintiff rather

than the defendant. Rule 8(a) provides that a complaint must

include only a "short plain statement of the claim showing that

the pleader is entitled to relief." Fed. R. Civ. P. 8(a); see

also, Wyatt, 315 F.3d at 1118. In this circuit, Allen is

required to do no more. See Wyatt, 315 F.3d at 1118 (Only

Congress can change to standard to a requirement of greater

specificity). In addition, the CDC has greater legal expertise

and knowledge about available remedies than Allen. Id. at 1119.

(stating that prison officials have superior access to prison

administrative records in comparison to prisoners, especially

when prisoners move from one facility to another). For these

reasons, §1997e(a) of the PLRA creates a burden on defendants to

raise and prove the absence of exhaustion. Id. The CDC has

failed to meet this burden. 

CDC’s motion to dismiss Allen's complaint for failure to

exhaust her administrative remedies under the PLRA §1997e(a) is

DENIED.

b. CDC Motion to Dismiss For Failure To State A

Claim; Eighth Amendment’s Subjective

Awareness Test of “Deliberate Indifference.”

CDC defendants move to dismiss Allen’s §1983 action for

failure to state a claim in violation of the Eighth Amendment. 

Allen claims that CDC knew or should have known Anwar posed a

risk to her and were deliberately indifferent to her medical

needs. CDC claims that Allen fails to allege facts showing how

medical and nonmedical staff at CDC were deliberately

indifferent. Under the Eighth Amendment, prison officials must

ensure that inmates receive adequate food, clothing, shelter, and

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medical care, and must take reasonable measures to guarantee the

safety of inmates. Farmer v. Brennan, 511 U.S. 825, 834

(1994)(quoting Hudson v. Palmer, 468 U.S. 517, 526-527 (1984); 

Wilson v. Seiter, 501 U.S. 294, 283 (1991); Estelle, 429 U.S. at

103; Willis v. Terhune, 404 F. Supp. 2d 1226, 1230 (E.D. Cal.

2005). The CDC asserts that Allen’s FAC, at most, states a claim

for negligence because Allen fails to show subjective awareness

on the part of medical and nonmedical staff. 

 The deliberate indifference standard involves an objective

and a subjective prong. Willis, 404 F. Supp. 2d at 1230. First,

the alleged deprivation must be, in objective terms,

“sufficiently serious.” Id. (quoting Farmer, 511 U.S. at 834). 

Second, the prison official must “know of and disregard an

excessive risk to inmate health and safety.” Id. Thus a prison

official may be liable under the Eighth Amendment only if he

knows that inmates face a substantial risk of harm and disregards

that risk by failing to take reasonable measures to abate it. 

Id. 

The CDC claims that Allen alleges no facts to show their

personal participation in her surgery. By merely alleging that

CDC referred her to Anwar for surgery, CDC argues that she has

failed to allege the deliberate conduct and subjective awareness

required on their part for a showing of deliberate indifference. 

CDC cannot be found liable under the Eighth Amendment unless they

knew of and disregarded an excessive risk to her health and

safety. Allen would have to allege “deliberate indifference” on

behalf of CDC by stating facts that show each defendant, both

medical and nonmedical personnel, was subjectively aware of the

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risk Anwar posed to her as a patient. Allen must allege that the

CDC defendants were both aware of facts from which the inference

could be drawn that a substantial risk of serious harm exists,

and that they drew such an inference. Farmer, 511 U.S. at 837. 

Allen argues that both medical and nonmedical personnel

subjected her to surgery they knew would cause her physical harm

and acted with the intent in harming her. Anwar performed the

same faulty surgical procedure on Boyce, a fellow inmate, prior

to performing it on her. Allen believes that Boyce filed a

complaint against Anwar after her surgery and put the CDC on

notice of the risk posed by Anwar. Because CDC knew of the risk

and still referred her to Anwar for the surgery, Allen claims

they did so with the intent to harm her. 

In spite of these allegations, Allen fails to allege how

each defendant was subjectively aware of her medical condition

and deliberately indifferent to her medical needs. Allen would

have to show that each defendant’s actions which caused her

deprivation were, objectively, “sufficiently serious.” She would

also have to show that each defendant had a “sufficiently

culpable state of mind.” While Allen alleges a sufficiently

serious medical condition, she fails to show how each CDC

defendant had a sufficiently culpable state of mind. 

Allen is not required to show CDC officials acted or failed

to act believing that harm would actually befall her. Farmer,

511 U.S. at 842. Section 1983 contains no state of mind

requirement independent of that necessary to state a violation of

the underlying constitutional right. Id. at 841. It merely

provides a cause of action. Id. It is enough that CDC officials

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acted or failed to act despite their knowledge of a substantial

risk of harm. Id. Whether defendants had the requisite

knowledge of a substantial risk is a question of fact “subject to

demonstration in the usual ways, including inference from

circumstantial evidence.” Id. If Allen presents evidence

showing that Anwar posed a substantial risk which was

“longstanding, pervasive, well documented, or expressly noted by

defendants in the past and the circumstances suggest that

defendants... had been exposed to information concerning the risk

enough so that they ‘must have known’ about it, such evidence

could be enough to permit a finding of actual knowledge of the

risk.” Farmer, 511 U.S. at 842. Allen also has to allege facts

that speak to the specific role that nonmedical personnel had in

the decision to refer her to Anwar for treatment of her medical

condition.

After such proof, CDC officials may prove that they were

unaware even of an obvious risk to health or safety. Farmer, 511

U.S. at 844. Defendants charged with “deliberate indifference”

can show, for example, that they did not know of the underlying

facts which indicated a sufficiently substantial danger or that

they knew the underlying facts but believed (albeit unsoundly)

that the risk was insubstantial or nonexistent. Id. If

defendants had actual knowledge of a substantial risk to Allen’s

health or safety, they may still avoid liability if they

responded reasonably to the risk. Id. This is true even if the

harm ultimately was not averted. Id. Whether viewed in terms of

duty or deliberate indifference, prison officials who act

reasonably cannot be found liable under the Eighth Amendment. 

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Id. at 845. 

Allen’s FAC, as alleged, fails to show how medical and

nonmedical staff at CDC were “deliberately indifferent” to her

serious medical needs. CDC’s motion to dismiss is granted with

leave to amend. 

c. Eleventh Amendment Immunity: Suits Against

Prison Officials.

CDC raises the issue of Eleventh Amendment Immunity as an

affirmative defense. Allen’s complaint alleges that she sues

defendants, some of whom are state officials, in their “official”

and “individual” capacity. The distinction in capacities is

critical. 

i. Official Capacity Suits.

Suits against an official in his official capacity are

treated as suits against the entity on whose behalf that official

acts. In such suits, the real party in interest is the entity

for which the official works. Hafer v. Melo, 502 U.S. 21, 25

(1991). A federal action for monetary damages against an

individual state official acting in his official capacity is

barred by the Eleventh Amendment in the same way that an action

against a State is barred. Doe v. Lawrence Livermore Nat’l Lab.,

131 F.3d 836, 839 (9th Cir. 1997). 

ii. Personal Capacity Suits.

In contrast, “[p]ersonal-capacity suits seek to impose

personal liability upon a government official for actions [taken]

under color of state law.” Dittman v. California, 191 F.3d 1020,

1027 (9th Cir. 1999)(citing Kentucky v. Graham, 473 U.S. 159, 165

(1985))(internal quotations omitted). To establish personal

liability in a §1983 or §1985 action, it is enough to show that

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the official, “acting under color of state law, caused the

deprivation of a federal right.” Hafer, 502 U.S. at 25 (internal

quotations omitted). Public officials sued in their personal

capacity may assert personal liability defenses, such as

qualified immunity. Dittman, 191 F.3d at 1027. 

CDC raises the Eleventh Amendment immunity as a defense

against Allen’s claims. Allen alleges that the acts or omissions

of medical and nonmedical personnel at CDC, individually and

taken together, were the proximate cause of her injuries. To

recover under §1983 against CDC officials acting in their

individual capacities, Allen must make an inquiry into causation.

Leer v. Murphy, 844 F.2d 628, 633 (9th Cir. 1988). This inquiry

must be individualized and focus on the duties and

responsibilities of each CDC defendant whose acts or omissions

are alleged to have caused the constitutional deprivation. Id.

Allen must prove some degree of individual culpability by each

prison official, including nonmedical prison staff, under the

“deliberate indifference” standard. Id. She is not required to

show proof of an express intent by the individual official to

punish. Id. 

In analyzing the relationship between deliberate

indifference and the constitutional deprivation it is important

to distinguish the causal connection required when a plaintiff,

such as Allen, seeks injunctive or declaratory relief as opposed

to damages. Leer, 844 F.2d at 633. When a prisoner seeks

injunctive or declaratory relief against a myriad of prison

personnel responsible for operating a prison, the focus is on

whether the combined acts or omissions of the state officials

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created living conditions that violate the Eighth Amendment. Id.

However, when the plaintiff seeks to hold individual defendants

personally liable for damages, the causation inquiry between the

deliberate indifference and the Eighth Amendment deprivation is

more refined. The focus, instead, is on whether each individual

defendant was in a position to take steps to avert the incident

but failed to do so intentionally or with deliberate

indifference. Id. In order to resolve this causation issue,

Allen must specifically plead the knowledge, participation, or

deliberate indifference for each named CDC defendant. Id.

CDC’s motion to dismiss claims against individual CDC

officers is GRANTED WITH LEAVE TO AMEND. 

2. Madera Community Hospital’s Motion to Dismiss for

Failure to State a Claim

a. MCH’s Liability Under §1983

MCH moves to dismiss Allen’s §1983 action for failure to

state a claim. MCH argues that Allen's claims are not sufficient

to show the hospital’s direct participation in her constitutional

alleged deprivation. 

When examining the liability of supervisors, "it is clear

that the supervisors are not subject to vicarious liability, but

are liable only for their own conduct." Jeffers v. Gomez, 267

F.3d 895, 915 (9th Cir. 2001); Wesley v. Davis, 333 F. Supp. 2d

888, 892 (C.D. Cal 2004); Bergquist v. County of Cochise, 806

F.2d 1364, 1369 (9th Cir. 1986). In order to establish liability

against a supervisor, a plaintiff must allege facts demonstrating

(1) his or her personal involvement in the constitutional

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deprivation, or (2) a sufficient causal connection between the

supervisor's wrongful conduct and the constitutional violation. 

Jeffers, 267 F.3d at 915; Wesley, 333 F. Supp. 2d at 892. The

sufficient causal connection may be shown by evidence that the

supervisor implemented a policy so deficient that the policy

itself is a repudiation of constitutional rights. Wesley, 333 F.

Supp. 2d at 892 (internal quotations omitted). However, an

individual's general responsibility for supervising the

operations of a prison is insufficient to establish personal

involvement. Id. (internal quotations omitted).

Supervisor liability under §1983 is a form of direct

liability. Munoz v. Kolender, 208 F. Supp. 2d 1125, 1149 (S.D.

Cal. 2002). Under direct liability, Allen must show that MCH

breached a duty to her which was the proximate cause of her

injury. Id. The law allows actions against supervisors under

§1983 as long as sufficient causal connection is present and the

plaintiff was deprived under color of law of a federally secured

right. The requisite causal connection can be established by

setting in motion a series of acts by others which the actor

knows or reasonably should know would cause others to inflict the

constitutional injury. Id. (quoting Johnson v. Duffy, 588 F.2d

740, 743-744 (9th Cir. 1978)). 

Allen claims that her factual allegations are sufficient to

establish a causal connection between MCH and her constitutional

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deprivation. She alleges MCH knew or should have known that

Anwar posed a risk to her and other CCWF inmates and were

deliberately indifferent to this risk. MCH furnished Anwar with

the facilities to perform his faulty surgery on her and other

CCWF inmates although they had knowledge of Anwar’s faulty

procedure. MCH also provided surgical and nursing staff in

connection with Allen's surgery. As a result, Allen argues that

MCH knew of and personally participated in activities that left

her disfigured. 

While Allen correctly asserts that MCH was involved in her

surgery by providing the facilities and staff to Anwar, her

allegations are insufficient to establish a causal connection

between MCH and her injuries. Allen alleges no facts to show MCH

had specific knowledge of Anwar’s alleged lack of competence or a

policy in place that, as implemented, was a cause of her alleged

constitutional violation. Allen alleges no facts to show MCH

breached a duty to her and that such a breach was the cause of

her injuries. The FAC also fails to show that MCH set in motion

a series of acts they knew would cause Allen a constitutional

harm. 

//

b. Acting Under Color of State Law

Even if Allen sufficiently alleges a causal connection

between MCH and her constitutional deprivation, she also has to

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show that MCH was “acting under the color of state law.” Lopez

v. Dep't of Health Servs., 939 F.2d 881, 883 (9th Cir. 1991);

Clement, 220 F. Supp. 2d at 1104 (citing Atkins, 48 U.S. at 48).

MCH asserts that Allen fails to allege facts showing state action

on the hospital’s part. This is incorrect. Allen sufficiently

alleges that a contract existed between MCH and Anwar, under

which MCH provided Anwar with surgical facilities and staff for

Allen’s surgery, knowing that Allen was a CCWF inmate. However,

Allen fails to allege that a contract or any relationship existed

between MCH and Allen, the CDC, or the State of California. 

Aside from alleging that hospital nursing staff tended to Allen

during her 2004 surgery, there are no other facts alleged to

establish what relationship existed between MCH and Allen. 

To state a §1983 claim, a plaintiff must allege facts which

show a deprivation of a right, privilege or immunity secured by

the Constitution or federal law by a person acting under color of

state law. Henderson v. Simi Valley, 305 F.3d 1052, 1056 (9th

Cir. 2002); Lopez 939 F.2d at 883 (citing Parratt v. Taylor, 451

U.S. 527, 535(1981)). State action may be sufficiently alleged

by a complaint stating that a contract existed between a health

care provider and the state. Lopez, 939 F.2d at 883. (state

action was sufficiently alleged by a complaint stating that the

defendant hospital was under contract with the State of Arizona

to provide medical services to indigents); see also West, 487

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U.S. at 54 (A private physician under contract with a state to

provide medical services to inmates is a state actor for purposes

of §1983).

The issue is whether MCH, based on its alleged involvement,

was an agent of the state for Eighth Amendment purposes. Allen

alleges that MCH is a nonprofit hospital. Anwar was a physician

on staff with full privileges at MCH. Allen does not allege the

existence of any contractual relationship between MCH and the CDC

or the State of California. Instead, Allen argues, without

alleging, that the CDC and the State of California delegated to

MCH its duty to provide medical services for Allen. As a result,

Allen contends that MCH acted as a state agent in providing such

services. This agency argument, however, is a conclusion of law

unsupported by factual allegations. A court is not required to

accept as true conclusory allegations or unwarranted deductions

of fact. Sprewell, 266 F.3d 979, 988 (9th Cir. 2001). 

"Actions taken by a private individual may be 'under color

of state law' where there is significant state involvement in the

action." Franklin v. Fox, 312 F.3d 423, 444 (9th Cir. 2002);

Johnson v. Knowles, 113 F.3d 1114, 1118 (9th Cir. 1997)(quoting

Howerton v. Gabica, 708 F.2d 380, 382 (9th Cir. 1983). The

extent of state involvement in the action is a question of fact. 

Lopez, 939 F.2d at 883. The Supreme Court has articulated four

distinct tests for determining when the actions of private

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individuals amount to state action: 1) the public function test

2) the joint action test 3) the state compulsion test and 4) the

governmental nexus test. Franklin, 312 F.3d at 444-445; Johnson,

113 F.3d at 1118; see also Lopez, 939 F.2d at 883. 

Under the public function test, a private party is viewed as

a state actor if the plaintiff establishes that, in engaging in

the challenged conduct, the private party performed a public

function that has been “traditionally the exclusive prerogative

of the state.” Johnson, 113 F.3d at 1118; see also Blum v.

Yaretsky, 457 U.S. 991, 1005 (1982). Under the joint action

test, state action is found where a private person is a “willful

participant in joint activity with the State or its agents” that

effects a constitutional deprivation. Johnson, 113 F.3d at 1119;

see also Howerton, 708 F.2d at 383. Under the state compulsion

test, a private party is fairly characterized as a state actor

when the state has exercised coercive power or has provided such

significant encouragement, either overt or covert, that the

[challenged conduct] must in law be deemed to be that of the

State. Johnson, 113 F.3d at 1119; see also Yaretsky, 457 U.S.

991, 1005. Lastly, under the governmental nexus test, the issue

is whether there is a sufficiently close nexus between the State

and the challenged action of the regulated entity so that the

action of the latter may be fairly treated as that of the State

itself. Johnson, 113 F.3d at 1120.

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While these factors are helpful in determining the

significance of state involvement, “there is no specific formula

for defining state action.” McDade v. West, 223 F.3d 1135, 1139

(9th Cir. 2000); Howerton, 708 F.2d at 383. The extent of state

involvement remains a factual inquiry. “Only by sifting facts

and weighing circumstances can the non-obvious involvement of the

state in private conduct be attributed its true significance.” 

Howerton, 708 F.2d at 383. Allen has failed to allege any facts

to determine the relationship between MCH and the State. 

MCH’s motion to dismiss is GRANTED WITH LEAVE TO AMEND. 

3. Dr. Anwar

a. Anwar’s “Deliberate Indifference”

Anwar also moves to dismiss for Allen’s failure to state an

Eighth Amendment claim. Anwar claims Allen does not allege facts

that show he was deliberately indifferent to her medical needs.

Anwar argues that Allen’s allegations against him amount to no

more than a difference in medical opinion between Allen and

Anwar. He interprets Allen’s allegations as stating a case for

medical malpractice, a cause of action that is insufficient to

state a claim under the Eighth Amendment. 

Deliberate indifference may be manifested in two ways: 1) it

may appear when prison officials deny, delay, or intentionally

interfere with medical treatment or 2) it may be shown in the way

physicians provide medical care. Estelle, 429 U.S. at 104;

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McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1992); Kenney v.

Paderes, 217 F. Supp. 2d 1095, 1097 (D. Haw. 2002). The alleged

indifference must rise to the level of “unnecessary and wanton

infliction of pain.” Kenney, 217 F. Supp. 2d at 1097 (citing

McGuckin, 974 F.2d at 1059). In either case, however, the

indifference to an inmate’s medical needs must be substantial;

inadequate treatment due to negligence, inadvertence, or

difference in judgment between an inmate and medical personnel

does not rise to the level of a constitutional violation. Id. at

1097-1098 (citing Franklin v. Oregon, State Welfare Div., 662

F.2d 1337, 1344 (9th Cir. 1981). 

Liability may be imposed only when the decision by the

professional is such a substantial departure from accepted

professional judgment, practice, or standard, as to demonstrate

that the person responsible actually did not base the decision on

such a judgment. Jensen v. Lane County, 312 F.3d 1145, 1147 (9th

Cir. 2002) (holding that due process implicitly requires the

judgment of a physician be exercised on the basis of substantive

and procedural criteria that are not substantially below the

standards generally accepted in the medical community.) To

successfully allege “deliberate indifference” the allegations

must amount to “something less than acts or omissions for the

very purpose of causing harm or with knowledge that harm will

result.” Farmer, 511 U.S. at 835 (discussing Estelle, 429 U.S.

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97). To show deliberate indifference on the part of Anwar, Allen

must allege any one of the following: 1) that Anwar’s treatment

is a far departure from the standard of care that a medical

provider owes or 2) that Anwar’s conduct was in reckless

disregard of standard or accepted medical practice for treatment

of her condition or 3) that Anwar’s surgery posed such a

dangerous or high risk that an intent to injure may be inferred. 

Allen alleges that she gave consent to a minimally invasive

surgery; that instead, Anwar removed large sections of skin and

tissue, including glands and muscles from both her armpits. She

further alleges that Anwar did not perform any adequate skin

graft to restore mobility. After surgery, she claims to have

been left with limited flexibility in her arms, limited ability

to raise her arms, and that she suffers from radiating pain; that

Anwar had knowledge the surgery was inherently dangerous but

failed to disclose such information to her. Allen alleges that

Anwar also conducted a similar surgery with similar results to

fellow inmate Boyce before he treated Allen. Prior to treating

Allen, Boyce had filed a complaint against Anwar for the outcomes

of her surgery. Accepting all factual allegations as true and

viewing them in a light most favorable to the nonmovingmoving

party, these allegations are sufficient to charge that Anwar’s

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In determining whether a doctor’s conduct was “deliberately 3

indifferent” the Ninth Circuit also inquires whether the

physicians neglect of the condition was an “isolated occurrence,”

or an “isolated exception,” to the doctor’s overall treatment of

the prisoner. Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir.

1990); Toussaint v. McCarthy, 801 F.2d 1080, 1111 (9th Cir.

1986). This inquiry is not necessary for Allen’s case as her

allegations are sufficient to establish a showing of “deliberate

indifference” by Anwar. 

33

surgical procedure deviated from the standard medical practice.3

b. Anwar’s Conduct as “State Action”

Allen further alleges that she and other CCWF inmates

received medical treatment from Anwar at MCH for their medical

needs. Allen alleges that Anwar and CDC had a contract whereby

Anwar would provide CCWF inmates with surgical treatment. There

is nothing in the record to show that Anwar or the CDC disputes

these allegations. 

The medical treatment of prison inmates by prison physicians

(or a prison contract physician) is state action. West, 487 U.S.

at 53-54. As an inmate at CCWF, Allen must rely on prison

authorities to treat [her] medical needs; if the authorities fail

to do so, those needs will not be met. Id. at 54. In light of

this, the State has a constitutional obligation, under the Eighth

Amendment, to provide adequate medical care to Allen and those it

has incarcerated. Id. (explaining this as an inference to be

drawn from Estelle, 429 U.S. 97). It is a physician’s function

within the state system, not the precise terms of the employment,

that determines whether the doctor’s action can fairly be

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attributed to the State. West, 487 U.S. at 55. Whether Anwar is

on the state payroll or is paid by contract, the dispositive

issue concerns the relationship among the State, the physician,

and the prisoner. Id. at 56. Contracting out prison medical

care does not relieve the State of its constitutional duty to

provide adequate medical treatment to those in its custody, and

it does not deprive the State’s prisoners of the means to

vindicate their Eighth Amendment rights. Id. 

Allen sufficiently alleges the relationship between Anwar,

CCWF inmates, and the State. Allen's factual allegations show

that Anwar's conduct constituted state action for the purpose of

§1983. 

Defendant Anwar’s motion to dismiss is DENIED. 

C. Motions As To Non-Federal Claims

1. Supplemental Jurisdiction Under 1367(a)

Title 28 U.S.C. section 1367(a) provides in pertinent part:

“In any civil action of which the district courts have

original jurisdiction, the district court shall have

supplemental jurisdiction over all other claims that

are so related to the claims in the action within such

original jurisdiction that they form part of the same

case or controversy under Article III of the United

States Constitution.”

Allen alleges a §1983 claim for Eighth Amendment violations.

Allen’s state law claims invoke supplemental jurisdiction and

arise from the same controversy as her §1983 claim.

//

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 Cal. Code Civ. P. §340.5 provides in pertinent part: 4

“In an action for injury or death against a health

care provider based on such person’s alleged

professional negligence, the time for the

commencement of action shall be three years after

the date of injury or one year after the plaintiff

discovers or through the use of reasonable

diligence should have discovered, the injury

whichever occurs first.”

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2. Professional Negligence

MCH moves to dismiss Allen's state law professional

negligence claim on the grounds that it is barred by the statute

of limitations under Cal. Code Civ. P. §340.5. MCH claims that 4

under §340.5 the statute of limitations for bringing this cause

of action against them was one year, July 18, 2005. MCH argues

that Allen failed bring her claim within the one year statute of

limitations.

A prisoner’s time to sue a health care provider can be

extended during incarceration up to the maximum of three years

from the time of injury. Belton v. Bowers Ambulance Service, 20

Cal. 4th 928, 930 (Cal. 1999). Cal. Code Civ. P. §352.1 applies

to actions brought by incarcerated individuals like Allen.

Section 352.1(a) provides in relevant part: 

"If a person entitled to bring an action... is, at the

time the cause of action accrued, imprisoned on a

criminal charge, or in execution under the sentence of

a criminal court for a term less than for life, the

time of that disability is not a part of the time

limited for the commencement of the action, not to

exceed two years."

Cal. Code Civ. P. § 352.1; see also Belton, 20 Cal. 4th at 930. 

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Allen was in prison when the facts giving rise to her cause

of action allegedly occurred. Section 352.1 tolls the statute

for two years while Allen is imprisoned. Allen’s surgery

occurred on July 21, 2004. Allen filed her complaint on August

25, 2005, well within the time limit of §352.1. Allen’s cause of

action is not barred by §340.5. 

MCH’s motion to dismiss Allen’s third cause of action for

professional negligence on statute of limitations grounds is

DENIED. 

3. Civil Battery

Each of the defendants brings a motion to dismiss Allen’s

civil battery claim on the grounds that she fails to sufficiently

allege facts that meet the elements of civil battery. A civil

battery claim requires that plaintiff show 1) defendant

intentionally did an act which resulted in a harmful or offensive

contact with the plaintiff's person, 2) plaintiff did not consent

to the contact, and 3) the harmful or offensive contact caused

injury, damage, loss or harm to the plaintiff. Piedra v. Dugan,

123 Cal. App. 4th 1483, 1495 (Cal. Ct. App. 2004)(internal

quotations omitted). A battery is any intentional, unlawful, and

harmful contact by one person with the person of another. Id. A

harmful contact, intentionally done is the essence of a battery. 

Id. A contact is unlawful if it is unconsented to. Id. 

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 Allen signed a form titled “Conditions for Admission to 5

Madera Community Hospital” which includes her consent to medical

and surgical procedures and information on the legal relationship

between the hospital and physician as arising under an

independent contract. (Doc. 22, Decl. of John Frye in Supp. of

Madera Community Hospital's Mot. to Dismiss, Ex. A.) Allen also

signed a form titled “Authorization For and Consent To Surgery or

Special Diagnostic or Therapeutic Procedures” which includes the

specific surgical procedure performed on Allen. Id., Ex. B.

37

Allen alleges that she signed the hospital consent forms5

but did not give informed consent to the surgery Anwar actually

performed. Allen alleges that she was giving consent to a

surgery she thought was minimally invasive. She argues that each

defendant intentionally failed to disclose the true nature of the

surgery. Had she known that the surgery would involve removal of

large sections of skin and tissue, including glands and muscles

from both her armpits, she would not have given her consent. She

claims to have been subjected to an entirely different procedure

from that to which she consented. 

When a physician obtains a patient's consent to a particular

treatment and administers that treatment but an undisclosed

inherent complication occurs, the patient has a claim for

negligence, not battery. Piedra, 123 Cal. App. 4th at 1495-1496.

The battery theory should be reserved for those circumstances

when a doctor performs an operation to which the patient has not

consented. Id. at 1496. When the patient gives permission to

perform one type of treatment and the doctor performs another,

the requisite element of deliberate intent to deviate from the

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consent given is present. Id. However, when the patient

consents to certain treatment and the doctor performs that

treatment but a complication arises, no intentional deviation

from the consent given appears; rather, the doctor in obtaining

consent may have failed to meet his due care duty to disclose

pertinent information. In that situation the action should be

pleaded in negligence. Id. (quoting Cobbs v. Grant, 8 Cal. 3d

229, 240-241(Cal. 1972)).

Allen's factual allegations marginally show the requisite

element of deliberate intent to allege battery. Allen alleges

the consent to minimally invasive surgery, not the radical

medical procedure Anwar performed. Whether Allen consented to

Anwar's surgery, but her condition and his intended minimally

invasive surgery resulted in such inherent complications,

requiring more surgery that caused limited flexibility in her

arms, limited ability to raise her arms, and radiating pain

presents a dispute. Allen does not expressly allege that Anwar

intended to deviate from the consent she gave to her surgery. 

Allen also fails to show how MCH or CDC knowingly engaged in any

harmful or offensive contact to her or that they had any

knowledge of the harmful or offensive contact caused to Allen. 

Allen consented to the procedure stated on the consent form.

Allen does not allege these defendants intentionally failed to

disclose the nature of the surgery or that they knew the specific

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surgery that Anwar would perform. To allege a sufficient claim

for civil battery Allen must plead facts that Anwar performed a

surgical procedure different from the one she consented to,

rather than one which only included undisclosed inherent

complications.

Defendants' motion to dismiss Allen's fourth cause of action

for civil battery is GRANTED WITH LEAVE TO AMEND. 

4. Gross Negligence

Each defendant moves to dismiss Allen’s action for gross

negligence on the ground that she fails to allege facts

sufficient to maintain a gross negligence claim. Defendants

argue that Allen’s complaint alleges no facts to support her

gross negligence claim. 

Gross negligence is defined as either the “want of even

scant care or an extreme departure from the ordinary standard of

conduct." Eastburn v. Reg’l Fire Prot. Auth., 31 Cal 4th 1175,

1185-1186 (Cal. 2003); Wright v. City of Los Angeles, 219 Cal.

App. 3d 318, 343 (Cal. Ct. App. 1990); see also Colich & Sons v.

Pac. Bell, 198 Cal. App. 3d 1225, 1240 (1988).

Allen argues that the facts as alleged are enough for a

claim of gross negligence. Allen alleges that Anwar performed an

unnecessary surgical procedure. Such procedures resulted in

Allen’s permanent disfigurement and disability. Allen is left

with limited flexibility in her arms. Allen has suffered severe

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scarring as a result of the surgery. Allen argues that such

allegations are not conclusions of law, but rather facts that

sustain a cause for gross negligence. 

In order to prevail under a §1983 cause of action, Allen

must prove the higher standard of “deliberate indifference”

rather than gross negligence. Wood v. Housewright, 900 F.2d

1332, 1334 (9th Cir. 1990). Here, a gross negligence cause of

action is redundant and does not entitle Allen to a different

remedy against Anwar from that which she could potentially

recover under her §1983 claim.

Defendant’s motion to dismiss Allen’s fifth cause of action

for gross negligence is GRANTED WITH LEAVE TO AMEND. 

5. Intentional Misrepresentation

Defendants move to dismiss Allen’s claim for intentional

misrepresentation arguing that Allen fails to plead this cause of

action with particularity as required by Rule 9(b) of the Federal

Rules of Civil Procedure. 

Rule 9(b) requires that allegations of fraud are specific

enough to give defendants notice of the particular misconduct

which is alleged to constitute the fraud charged so that they can

defend against the charge and not just deny that they have done

anything wrong. Celado Int’l, Ltd. v. Walt Disney Co., 347 F.

Supp. 2d 846, 855 (C.D. Cal. 2004); see also Neubronner v.

Milken, 6 F.3d 666, 671 (9th Cir. 1993)(internal quotations

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omitted). A pleading is sufficient under Rule 9(b) if it

identifies the circumstances constituting fraud so that the

defendant can prepare an adequate answer from the allegations. 

Neubronner, 6 F.3d at 671. The complaint must specify such facts

as the times, dates, places and other details of the alleged

fraudulent activity. Id. Under California law the elements of

intentional misrepresentation, or actual fraud are: 1)

misrepresentation (false representation, concealment, or

nondisclosure) 2) knowledge of falsity (scienter) 3) intent to

defraud (i.e., to induce reliance) 4) justifiable reliance and 5)

resulting damage. Olson v. Cohen, 106 Cal. App. 4th 1209, 1216-

1217 (Cal. Ct. App. 2003); see also Anderson v. Deloitte &

Touche, 56 Cal. App. 4th 1468, 1474 (Cal. Ct. App. 1997).

Allen alleges that on July 21, 2004 she sought treatment

from CDC defendants for boils. She claims that CDC personnel

misrepresented to her that dermatological care was not

appropriate for her condition and that Anwar’s surgical procedure

was the only treatment option CDC would offer. Allen also claims

that Anwar and MCH, in seeking consent for her surgery,

misrepresented to her that the surgery would be minimally

invasive. She alleges that they made this misrepresentation with

knowledge that the surgery would actually involve the removal of

skin, tissue, and glands. She further argues that they intended

to defraud her so that she would consent to the surgery and that

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she relied on their misrepresentation. Had she known that the

surgery would involve the removal of skin, tissue, and glands,

she would not have consented. As a result, she alleges that she

has suffered damage from the surgery due to limited mobility and

flexibility in her arms, permanent disfigurement, and chronic

pain and humiliation. These allegations are sufficient under

Rule 9(b) in identifying the circumstances constituting fraud so

that defendants are able to prepare an adequate answer from the

allegations. Once intentional fraud is alleged, punitive damages

are an available remedy. 

Defendants’ motion to dismiss Allen’s claim for intentional

misrepresentation is DENIED. 

6. Negligent Misrepresentation

Allen brings a claim against all Defendants for negligent

misrepresentation. Negligent misrepresentation is a separate and

distinct tort of deceit. Friedman v. Merck & Co., 107 Cal. App.

4th 454, 475 (Cal. Ct. App. 2003). Where the defendant makes

false statements, honestly believing that they are true, but

without reasonable ground for such belief, he may be liable for

negligent misrepresentation. Id. The elements of a cause of

action for negligent misrepresentation are: 

1) defendant’s representation is to a past or

existing material fact 

2) the representation must have been untrue

3) the representation was made without any reasonable

ground for believing it to be true

4) the representation was made with the intent to

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induce plaintiff’s reliance

5) the plaintiff, unaware of the falsity of the

representation, acted in reliance upon the truth

of the representation and was justified in this

reliance 

6) the plaintiff sustained damages 

Id. To state a cause of action for negligent misrepresentation

plaintiff must allege facts establishing that defendants owed a

duty to communicate accurate information. Id. California courts

have recognized a duty to communicate accurate information where

providing false information poses a risk of and results in

physical harm to the person. Id. 

Allen sufficiently alleges that Anwar misrepresented facts

that were material to obtaining her consent for surgery. She

alleges that CDC told her dermatological care was unavailable and

that surgery was the only treatment option for her condition. 

She asserts that MCH and Anwar also misrepresented material facts

about the extent and severity of the surgery with the intent to

obtain her consent. She also sufficiently alleges that she

relied on Defendants’ misrepresentations and consented to their

surgery in reliance on their truth. However, Allen fails to

assert facts to show CDC and MCH defendants’ knowledge of Anwar’s

alleged misrepresentations or that they played any role in

causing the misrepresentations to be made. 

Defendant’s motion to dismiss Allen’s claim for negligent

misrepresentation is GRANTED WITH LEAVE TO AMEND.

7. Emotional Distress Claims

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Allen asserts intentional infliction of emotional distress

and negligent infliction of emotional distress. 

To state a claim for intentional infliction of emotional

distress, a plaintiff must allege 1) extreme and outrageous

conduct by the defendant, with the intent or reckless disregard

of the probability of causing emotional distress 2) plaintiff

suffered severe emotional distress and 3) that defendant was the

cause of the emotional distress. Ess v. Eskaton Properties,

Inc., 97 Cal. App. 4th 120, 129 (Cal. Ct. App. 2002). 

To state a claim for negligent infliction of emotional

distress requires that a plaintiff show 1) serious emotional

distress, 2) actually and proximately caused by 3) wrongful

conduct 4) by a defendant who should have foreseen that the

conduct would cause such distress. Austin v. Terhune, 367 F.3d

1167, 1172 (9th Cir. 2004). It is well settled that negligent

infliction of emotional distress is not an independent tort;

rather it is the tort of negligence to which the duty element

applies. Marlene F. v. Affiliated Psychiatric Med. Clinic, Inc.,

48 Cal. 3d 583, 588 (Cal. 1989); Friedman, 107 Cal. App. 4th at

464;. 

Where injury such as mental and emotional distress is caused

by the constitutional violation, that injury is compensable under

§1983. Anderson v. Cent. Point Sch. Dist., 746 F.2d 505, 508

(9th Cir. 1984); Carey v. Piphus, 435 U.S. 247, 263-264 (1978). 

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Allen’s emotional distress claims are properly alleged under her

§1983 claim. 

Arguendo, if a trier of fact finds Anwar intentionally

misrepresented the intended surgery, the intentional distress

claims are viable. The motion to dismiss as to Anwar is DENIED. 

The allegations are insufficient as to MCH and CDC, as there is

no vicarious liability. MCH and CDC Defendants’ motions to

dismiss claims for intentional and negligent infliction of

emotional distress are GRANTED. 

8. Motion to Strike Punitive Damages

a. Motion to Strike; Fed. R. Civ. P. 12(f)

Fed. R. Civ. P. 12(f) provides that “redundant, immaterial,

impertinent, or scandalous matters” may be “stricken from any

pleading.” Fed. R. Civ. P. 12(f). “[Only] pleadings are subject

to motions to strike.” See Qarbon.com, Inc. v. eHelp Corp., 315

F. Supp. 2d 1046, 1048-1049 (N.D. Cal. 2004). However, a “motion

to strike” materials that are not part of the pleadings may be

regarded as an “invitation” by the movant “to consider whether

[proffered material] may properly be relied upon.” United States

v. Crisp, 190 F.R.D. 546, 551 (E.D. Cal. 1999) (quoting Monroe v.

Bd. of Educ., 65 F.R.D. 641, 645 (D. Conn. 1975)).

Motions to strike are disfavored and infrequently granted. 

Bassiri v. Xerox Corp., 292 F. Supp. 2d 1212, 1220 (C.D. Cal.

2003). Motions to strike should not be granted unless it is

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clear that the matter to be stricken could have no possible

bearing on the subject matter of the litigation. Id.

b. California Code of Civil Procedure §425.13

California Code of Civil Procedure §425.13 provides in

pertinent part:

“In any action for damages arising out of the

professional negligence of a health care provider, no

claim for punitive damages shall be included in a

complaint or other pleading unless the court enters an

order allowing an amended pleading that includes a

claim for punitive damages to be filed. The court may

allow the filing... on the basis... that the plaintiff

has established that there is a substantial probability

that the plaintiff will prevail on the claim.”

Cal. Code Civ. P. § 425.13.

Defendants Anwar and MCH each move to strike Allen’s state

punitive damages claim for failure to satisfy §425.13.

Defendants each point out that Allen has neither requested nor

obtained an order from the court allowing for recovery of

punitive damages nor made a showing of a substantial probability

of prevailing. 

Where a state evidentiary rule is intimately bound up with

the rights and obligations being asserted, Erie R.R. v. Tompkins,

304 U.S. 64, 78 (1938) mandates the application of the state

rule. Wray v. Gregory, 61 F.3d 1414, 1417 (9th Cir. 1995).

Section 425.13 is so “intimately bound up” with Allen’s

substantive state law claims that, under the Erie exception, it

applies to bar these claims where there is no compliance to the

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rule. 

Allen argues that §425.13 is a state procedural rule that

does not apply in federal court. She asserts that the Federal

Rules of Civil Procedure govern her state law claim for punitive

damages rather than §425.13. This is incorrect. Allen claims

that she is not required under §425.13 to obtain permission from

the court when requesting punitive damages for her state law

claims against health care providers. 

In support of her position, Allen relies on Jackson v. East

Bay Hospital, 980 F. Supp. 1341 (N.D. Cal. 1997). In Jackson,

Plaintiff claimed punitive damages under the Emergency Medical

Treatment and Active Labor Act of 1986 (EMTALA) which

incorporates state substantive law in determination of damages.

980 F. Supp. 1341 at(N.D. Cal. 1997). The state substantive law

for the determination of damages as applied to EMTALA was

governed by Cal. Civ. Code §3333.2(a), California’s Medical

Injury Compensation Reform Act of 1975 (MICRA). Id. Defendants

moved to apply §425.13, a non-MICRA state procedural requirement,

to Plaintiff’s complaint, thereby striking the punitive damages

claim brought under Plaintiff’s EMTALA federal cause of action.

Id. at 1350. Jackson noted that Erie problems arose by applying

§425.13 to Plaintiff’s claims. Id. at 1352. Jackson reasoned

§425.13 does not apply to Plaintiff’s federal cause of action

because it is a state procedural law, rather than substantive

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law. Id. at 1353. The court also reasoned that §425.13 is not a

central feature of the state’s medical malpractice scheme under

MICRA such that it would render MICRA meaningless. Id. at 1352. 

The court held that §425.13 was not so “intimately bound” to the

state substantive law under MICRA such that it would warrant

application to plaintiff’s claims. Id. 

Allen is not bringing a claim for punitive damages under a

federal act such as EMTALA. Allen’s request for punitive damages

pertains to her state law professional negligence claims against

MCH and Anwar, both health care providers. 

The Ninth Circuit has previously addressed the issue of when

a state procedural law is “so intimately bound” to the

substantive law that it would require application to federal

courts. Where a state procedural law is part of an integrated

scheme for managing medical malpractice claims and constitutes a

central feature of that scheme, that law is ‘intimately bound’

with the substantive claim. Jackson, 980 F. Supp. at 1352; see

also Wray, 61 F.3d at 1417 (applying Nevada rules regarding

admissibility of the findings of the required medical screening

panel rather than the Federal Rules of Evidence). To the extent

that the state evidentiary rule defines what is sought to be

proved – the measure of damages - it may bind the federal court

under Erie principles. D’Orio v West Jersey Health Servs., 797

F. Supp. 371, 376 (D.N.J. 1992). A state’s view of the measure

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of damages is inseparable from the substantive right of action.

Id. 

The legislative intent behind §425.13 shows the rule to be

intimately bound to the state substantive cause of action for

professional negligence. Section 425.13 applies to any action

for damages arising out of the professional negligence of a

health care provider. Cent. Pathology Servs. Clinic, Inc. v.

Superior Court, 3 Cal. 4th 181, 187 (Cal. 1992). The allegations

that identify the nature and cause of a plaintiff’s injury must

be examined to determine whether each is directly related to the

manner in which professional services were provided. Id. at 192. 

The intent of the Legislature is that any claim for punitive

damages in an action against a health care provider is subject to

the statute if the injury that is the basis for the claim was

caused by conduct directly related to the rendition of

professional services. Id.

Allen's cause of action for professional negligence is

directly related to the manner in which MCH and Anwar provided

their professional services. Her claim alleges a lack of

informed consent which speaks to manner in which Anwar and MCH

performed and communicated the risks and outcome of her surgery. 

This communication is a matter that is an ordinary and usual part

of the medical professional services and therefore governed by

§425.13. She complains that the medical services were improper

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and harmful. Her claim is wholly based on the medical services

provided by Anwar at MCH under the auspices of CDC.

The legislative intent underlying §425.13 is to screen and

assure the bona fides and merits of a claim against a health care

provider before a case can be filed. This inquiry cannot be done

without inquiring into the substantive law of the cause of

action, the nature and extent of the medical services, and the

underlying injuries. In all respect, §425.13 is so "intimately

bound up" with the substantive law of Allen's underlying claim

that it must be applied by federal courts when addressing the

issue of punitive damages. Allen must petition the court for

punitive damages pursuant to §425.13 for such relief under her

state law claims. 

Motions to strike Allen’s claim for punitive damages are

GRANTED WITH LEAVE TO AMEND. 

VII. CONCLUSION

A. SUMMARY OF MOTIONS

1. Federal Claims

i. CDC’s motion to dismiss for failure to

exhaust administrative remedies pursuant

to Title 42 U.S.C. 1997e(a) is DENIED.

ii. CDC’s motion to dismiss for failure to

state a claim under §1983 is GRANTED

WITH LEAVE TO AMEND. 

iii. MCH’s motion to dismiss for failure to

state a claim under §1983 is GRANTED

WITH LEAVE TO AMEND. 

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iv. Dr. Anwar’s motion to Dismiss for

failure to state a claim under §1983 is

DENIED. 

2. Non-FederalFederal Claims

i. MCH’s motion to dismiss Allen’s claim

for professional negligence is DENIED. 

ii. Defendants’ motions to dismiss Allen's

claim for civil battery is GRANTED WITH

LEAVE TO AMEND. 

iii. Defendants’ motion to dismiss Allen's

claim for gross negligence is GRANTED

WITH LEAVE TO AMEND.

iv. Defendants’ motions to dismiss Allen’s

claim for intentional misrepresentation

is DENIED. 

v. Defendants’ motions to dismiss Allen’s

claim for negligent misrepresentation is

GRANTED. 

vi. Anwar’s motion to dismiss Allen’s claims

for intentional and negligent infliction

of emotional distress is DENIED. 

vii MCH and CDC Defendants’ motions to

dismiss Allen's claims for intentional

and negligent infliction of emotional

distress is GRANTED. 

viii. Defendants’ Dr. Anwar and MCH Motion to

strike Allen's state law claim for

punitive damages is GRANTED WITH LEAVE

TO AMEND. 

Any amended Complaint shall be filed within twenty days.

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SO ORDERED.

Dated: June 26, 2006

/s/ OLIVER W. WANGER

OLIVER W. WANGER

United States District Judge

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