Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_12-cv-01213/USCOURTS-caed-1_12-cv-01213-2/pdf.json

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

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This case was incorrectly originally filed in the 1

Southern District of California, Case No. 3:12-cv-01769-JLS-WVG,

and transferred to this District on July 25, 2012.

28 U.S.C. § 1915A(a). 2

DISMISSAL ORDER - 1

Rosati v. Igbninso, 1:12-cv-01213-RRB

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

PHILIP ROSATI,

Plaintiff,

vs.

IGBINOSO, Chief Medical

Officer, California Department

of Corrections and

Rehabilitation; and SUSAN

HUBBARD, Secretary, California

Department of Corrections and

Rehabilitation, 

Defendants.

Case No. 1:12-cv-01213-RRB

DISMISSAL ORDER

Philip Rosati, a state prisoner appearing pro se and in forma

pauperis, filed a civil rights Complaint under 42 U.S.C. § 1983.1

Rosati is currently in the custody of the California Department of

Corrections and Rehabilitation, incarcerated at the R. J. Donovan

Prison, Facility 3, San Diego.

I. SCREENING REQUIREMENTS

This Court is required to screen complaints brought by

prisoners seeking relief against a governmental entity or officer

or employee of a governmental entity. This Court must dismiss a 2

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 1 of 10
28 U.S.C. § 1915(e)(2)(B); 42 U.S.C. § 1997e(c); see 3

Lopez v. Smith, 203 F.3d 1122, 1126 & n.7 (9th Cir. 2000) (en

banc).

42 U.S.C. § 1997e(a); see Woodford v. Ngo, 548 U.S. 81, 4

93–95 (2006) (“proper exhaustion” under § 1997e(a) is mandatory and

requires proper adherence to administrative procedural rules).

See Booth v. Churner, 532 U.S. 731, 734 (2001). 5

Fed. R. Civ. P. 8(a)(2). 6

Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell 7

Atlantic Corp. v. Twombly, 550 U.S. 554, 555 (2007)).

DISMISSAL ORDER - 2

Rosati v. Igbninso, 1:12-cv-01213-RRB

complaint or portion thereof if the prisoner has raised claims that

are legally “frivolous or malicious,” that “fails to state a claim

on which relief may be granted,” or that “seeks monetary relief

against a defendant who is immune from such relief.” Likewise, a 3

prisoner must exhaust all administrative remedies as may be

available, irrespective of whether those administrative remedies 4

provide for monetary relief.5

In determining whether a complaint states a claim, the Court

looks to the pleading standard under Federal Rule of Civil

Procedure 8(a). Under Rule 8(a), a complaint must contain “a short

and plain statement of the claim showing that the pleader is

entitled to relief.” “[T]he pleading standard Rule 8 announces 6

does not require ‘detailed factual allegations,’ but it demands

more than an unadorned, the-defendant-unlawfully-harmed-me

accusation.” Failure to state a claim under § 1915A incorporates 7

the familiar standard applied in Federal Rule of Civil Procedure

12(b)(6), including the rule that complaints filed by pro se

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 2 of 10
Wilhelm v. Rotham, 680 F.3d 1113, 1121 (9th Cir. 2012). 8

Iqbal, 556 U.S. at 678–69; see Moss v. U.S. Secret 9

Service, 572 F.3d 962, 969 (9th Cir. 2009) (quoting and applying

Iqbal and Twombly). 

Iqbal, 556 U.S. at 678 (quoting Twombly, 550 U.S. at 10

557). 

Id. 11

Id. (quoting Twombly, 550 U.S. at 555). 12

DISMISSAL ORDER - 3

Rosati v. Igbninso, 1:12-cv-01213-RRB

prisoners are to be liberally construed, affording the prisoner the

benefit of any doubt, and dismissal should be granted only where it

appears beyond doubt that the plaintiff can plead no facts in

support of his claim that would entitle him or her to relief.8

This requires the presentation of factual allegations

sufficient to state a plausible claim for relief. “[A] complaint 9

[that] pleads facts that are ‘merely consistent with’ a defendant’s

liability . . . ‘stops short of the line between possibility and

plausibility of entitlement to relief.’” Further, although a court 10

must accept as true all factual allegations contained in a

complaint, a court need not accept a plaintiff’s legal conclusions

as true. “Threadbare recitals of the elements of a cause of 11

action, supported by mere conclusory statements, do not suffice.”12

II. GRAVAMEN OF THE COMPLAINT

Rosati alleges that he is a transsexual male suffering from

Gender Identity Disorder (“GID). Rosati further alleges that he

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 3 of 10
Consisting of surgical removal of the male genitalia and 13

surgical reconstruction with female genitalia. 

Prior to being imprisoned Rosati partially emasculated 14

himself by surgically removing his testicles. 

DISMISSAL ORDER - 4

Rosati v. Igbninso, 1:12-cv-01213-RRB

requested gender reassignment surgery, but was refused because 13

CDCR policy precludes evaluation of the extent of GID and, if

considered medically necessary, gender reassignment surgery.14

According to Rosati his GID causes him to suffer serious adverse

psychological distress. Rosati complains that the refusal to

complete his gender reassignment surgery constitutes deliberate

indifference to a serious medical condition. Rosati seeks a

psychiatric examination by a GID expert to assist in determining

whether his GID condition is extreme and, if considered medically

necessary, sexual reassignment surgery.

III. DISCUSSION

In denying relief at the final level of administrative review

the Director held:

DIRECTOR'S LEVEL DECISION:

Appeal is denied.

ISSUES:

Your CDCR 602-HC indicated you were diagnosed with Gender

Identity Dysphoria (GID) and you were a transgender (male

to female) individual; you stated on July 19, 2010, you

submitted a CDC 7362, Health Care Services Request Form,

requesting to see your primary care provider (PCP) to

request sex reassignment surgery (SRS) or surgery to

remove your penis and reposition your urethra so you

could sit to urinate without making a mess; you indicated

your request was ignored; as of July 29, 2010, you had

not seen a nurse or a PCP; you also reported a history of

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 4 of 10
DISMISSAL ORDER - 5

Rosati v. Igbninso, 1:12-cv-01213-RRB

prior self-mutilation attempts and you felt having male

genitalia while having other physical characteristics of

a woman, had led to significant psychological distress;

you believed SRS, along with hormonal treatment, and

living as a female was the only appropriate measures for

GID; and you claimed you were being denied key aspects of

therapy for you condition; and you believed CDCR policy

was discriminatory against transgender individuals.

You requested the following:

• An immediate appointment with a PCP and

documentation of your request for SRS. 

• A consultation with a surgeon regarding SRS.

• The Medical Authorization Review Committee

(MARC) evaluates your request and you receive

an answer on this matter. 

PRIOR APPEAL HISTORY:

Informal Level: 

The informal level was bypassed and the appeal was

elevated from the informal level to the first level of

review.

First Level:

At the first level, submitted on July 29, 2010, you

stated your issues and requests as noted above.

The First Level Response (FLR) stated your appeal was

denied and indicated:

• Your request was considered cosmetic and not

medically necessary; therefore, your request

for a consultation and SRS was denied.

Second Level:

At the second level, submitted on October 31, 2010, you

disagreed with the FLR; you claimed SRS was not cosmetic;

and you believed treatment, including SRS was medically

necessary for your condition.

The Second Level Response (SLR) stated your appeal was

partially granted and indicated:

• You received an appointment with your PCP

regarding your request for SRS.

• Your PCP evaluated you and thoroughly reviewed

your UHR and indicated SRS or a consultation

with a provider who performed this surgery was

not medically indicated, as this was a

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 5 of 10
DISMISSAL ORDER - 6

Rosati v. Igbninso, 1:12-cv-01213-RRB

cosmetic procedure which could not be carried

out while in prison per the California Code of

Regulations, Title 15.

• Review by MARC was not medically necessary.

• The Chief Medical Officer agreed with the

PCP's decision.

• Your appeal was accepted and filed.

BASIS FOR DIRECTOR'S LEVEL DECISION:

At the Director's Level of Review (DLR), submitted on

January 4, 2011, you stated you clearly cited (in all

your writings) SRS was not elective nor cosmetic, but

rather medically necessary, and the only recognized

treatment for patients with extreme GID; and you believed

denying you this treatment was deliberate indifference

towards your medical needs.

A review of the appeal file was performed and revealed

the following:

• Your recent and current treatment for GID

included mental health follow-up, Delestrogen

(estradiol valerate) injections and

Spironolactone (Aldactone), an anti-androgen

medication.

• None of your providers involved in your

management documented you as having a profound

or severe case of GID, and/or required

consideration for SRS to appropriately manage

your condition.

• Documentation indicated your status was stable

and you were exhibiting symptom control.

• A consultation with the endocrinologist for

GID management was approved in December 2010;

the appointment was pending.

The Department shall provide only medical services for

patient-inmates that are based on medical necessity and

supported by outcome data as effective medical care. In

the absence of available outcome data for a specific

case, treatment will be based on the judgment of the

physician that the treatment is considered effective for

the purpose and is supported by diagnostic information.

Inmates may not demand particular medication, diagnostic

evaluation, or course of treatment. The California Code

of Regulations (CCR), Title 15, Section 3354, Health Care

Responsibilities and limitations, (a) Authorized Staff,

states, "Only facility-employed health care staff,

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 6 of 10
Docket 1 at 56–58. The Decision was signed by L. Zamora, 15

Chief, California Prison Health Care Services, on behalf of the

Director, CDCR.

DISMISSAL ORDER - 7

Rosati v. Igbninso, 1:12-cv-01213-RRB

contractors paid to perform health services for the

facility, or persons employed as health care consultants

shall be permitted within the scope of their licensure,

to diagnose illness or, prescribe medication and health

care treatment for inmates. No other personnel or inmate

may do so."

You are considered an active partner and participant in

the health care delivery system. You are encouraged to

cooperate with your clinicians in order to receive the

proper care and management of your condition. You will

continue to be evaluated and treatment will be provided

based on your clinician's evaluation, diagnosis, and

recommended treatment plan, in accordance with

appropriate policies and procedures.

You may request the services of an outside consultant by

following the directions in the California Code of

Regulations, Title 15, Section 3354 (c). However, be

advised all costs associated with an outside

consultation, including evaluations, tests, custodial

supervision, transportation, etc., are the responsibility

of the person requesting the outside evaluation.

After review, there is no compelling evidence that

warrants intervention at the Director's Level of Review

as your medical condition has been evaluated by licensed

clinical staff and you have received and/or are receiving

adequate medical care. 

RULES AND REGULATIONS:

The rules governing these issues are: California Code of

Regulations, Title 15; Inmate Medical Services Program

Policies and Procedures (2006); Mental Health Services

Delivery System (MHSDS); and the Department Operations

Manual.

ORDER:

No changes or modifications are required by the

institution.

This decision exhausts your available administrative

remedy within the CDCR.15

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 7 of 10
Estelle v. Gamble 429 U.S. 97, 104–105 (1976); Whitley v. 16

Albers, 475 U.S. 312, 319 (1986).

Estelle, 429 U.S. at 105. 17

42 U.S.C. § 1997e(e). 18

See Oliver v. Keller, 289 F.3d 623, 626–27 (9th Cir. 19

2002).

Estelle, 429 U.S. at 106. 20

Whitley, 475 U.S. at 319. 21

DISMISSAL ORDER - 8

Rosati v. Igbninso, 1:12-cv-01213-RRB

It is unquestionably the law that the deliberate indifference

to the serious medical needs of a prisoner violates the Eighth

Amendment. To make a claim, Rosati must show that Defendants 16

exhibited “deliberate indifference to serious medical needs.”17

Where a plaintiff has failed to allege a physical injury, he may

not bring an action for mental or emotional injury. While the 18

physical injury need not be significant, it must be more than de

minimis.

19

In Estelle the Supreme Court distinguished “deliberate

indifference to serious medical needs of prisoners,” from

“negligen[ce] in diagnosing or treating a medical condition,”

holding that only the former violates the Constitution. In short, 20

Eighth Amendment liability requires “more than ordinary lack of due

care for the prisoner's interests or safety.” In determining 21

deliberate indifference, the court scrutinizes the particular facts

and looks for substantial indifference in the individual case,

indicating more than mere negligence or isolated occurrences of

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 8 of 10
Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990). 22

Jett v. Penner, 429 F.3d 1091, 1096 (9th Cir. 2006) 23

(internal quotation marks and citations omitted).

Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996); 24

see Franklin v. State of Or., State Welfare Div., 662 F.2d 1337,

1344 (9th Cir. 1981) (noting that a disagreement between a prisoner

and a medical professional over the most appropriate course of

DISMISSAL ORDER - 9

Rosati v. Igbninso, 1:12-cv-01213-RRB

neglect. The Ninth Circuit has spoken to the subject of the 22

appropriate test under Estelle:

In the Ninth Circuit, the test for deliberate

indifference consists of two parts. First, the plaintiff

must show a serious medical need by demonstrating that

failure to treat a prisoner's condition could result in

further significant injury or the unnecessary and wanton

infliction of pain. Second, the plaintiff must show the

defendant's response to the need was deliberately

indifferent. This second prong—defendant's response to

the need was deliberately indifferent—is satisfied by

showing (a) a purposeful act or failure to respond to a

prisoner's pain or possible medical need and (b) harm

caused by the indifference. 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. Yet, an

inadvertent [or negligent] failure to provide adequate

medical care alone does not state a claim under § 1983.

A prisoner need not show his harm was substantial;

however, such would provide additional support for the

inmate’s claim that the defendant was deliberately

indifferent to his needs. 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.23

In this case, neither Defendant has deliberately ignored or

failed to respond to Rosati’s medical needs. At most, Rosati’s

Complaint establishes a disagreement with the prescribed course of

treatment, which is “insufficient as a matter of law, to establish

deliberate indifference.” “To prevail on a claim involving choices 24

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 9 of 10
treatment cannot give rise to a viable claim of deliberate

difference).

Toguchi v. Chung, 391 F.3d 1051, 1058 (9th Cir. 2004) 25

(quoting Jackson v. McIntosh).

“The district courts may decline to exercise supplemental 26

jurisdiction over a claim under subsection (a) if— . . . (3) the

district court has dismissed all claims over which it has original

jurisdiction . . . .” 28 U.S.C. § 1367(c).

DISMISSAL ORDER - 10

Rosati v. Igbninso, 1:12-cv-01213-RRB

between alternative course of treatment, a prisoner must show that

the chosen course of treatment ‘was medically unacceptable under

the circumstances,’ and was chosen ‘in conscious disregard of an

excessive risk to [the prisoner’s] health.’” Rosati’s claim does 25

not meet this standard. 

IV. CONCLUSION/ORDER

Because it does not appear that Rosati can plead facts

sufficient to state a colorable claim of deliberate indifference,

the complaint is properly dismissed without leave to amend. To the

extent that the Complaint may raise state-law claims, this Court

declines to exercise its supplemental jurisdiction over them.26

Accordingly, it is therefore ORDERED that the Complaint on

file herein is DISMISSED without prejudice and the Clerk of the

Court is directed to enter judgment dismissing the Complaint.

IT IS SO ORDERED this 26 day of April, 2013. th

S/RALPH R. BEISTLINE

UNITED STATES DISTRICT JUDGE

Case 1:12-cv-01213-RRB Document 15 Filed 04/26/13 Page 10 of 10