Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_06-cv-00075/USCOURTS-caed-2_06-cv-00075-7/pdf.json

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

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

MARTIN TRILLO,

Plaintiff, No. CIV S-06-0075 RRB DAD P

vs.

N. GRANNIS, et al.,

Defendants. FINDINGS AND RECOMMENDATIONS

 /

Plaintiff is a state prisoner proceeding pro se with a civil rights action seeking

relief under 42 U.S.C. § 1983. The matter is before the court on defendants’ motion for summary

judgment brought pursuant to Rule 56 of the Federal Rules of Civil Procedure. Plaintiff has filed

a timely opposition to the motion. Defendants have filed a reply. 

BACKGROUND

On January 12, 2006, plaintiff commenced this action by filing a complaint

against defendants Grannis, Howard, Wedell, Hooper, Van Cor, Friend, and Sogge, alleging that

they were deliberately indifferent to his serious medical needs. Specifically, plaintiff alleges that

he suffers from hypertension, hepatitis C and liver damage, carpal tunnel syndrome and pain

associated with damage to his spinal column. Plaintiff claims that he has received inadequate

medical care in violation of his constitutional rights.

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At screening the court determined that plaintiff’s complaint appeared to state

cognizable claims for relief against defendants Grannis, Howard, Wedell, Hooper, Van Cor,

Friend, and Sogge, and in due course, the United States Marshal served plaintiff’s complaint on

those defendants. On April 17, 2006, defendants filed their answer. On April 24, 2006, this

court issued a discovery order. On April 27, 2007, defendants filed the pending motion for

summary judgment, arguing that the evidence presented in support of the motion establishes that

they were not deliberately indifferent to plaintiff’s medical needs. Plaintiff opposes the motion

essentially on the grounds that the evidence he has submitted in opposition to the motion for

summary judgment establishes that defendants’ medical care fell below constitutional standards. 

Defendants have filed a reply, emphasizing that there are no genuine issues of material fact in

this case and they are entitled to summary judgment in their favor. 

SUMMARY JUDGMENT STANDARDS UNDER RULE 56

Summary judgment is appropriate when it is demonstrated that there exists “no

genuine issue as to any material fact and that the moving party is entitled to a judgment as a

matter of law.” Fed. R. Civ. P. 56(c).

Under summary judgment practice, the moving party 

always bears the initial responsibility of informing the district court

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

pleadings, depositions, answers to interrogatories, and admissions

on file, together with the affidavits, if any,” which it believes

demonstrate the absence of a genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986) (quoting Fed. R. Civ. P. 56(c)). “[W]here the

nonmoving party will bear the burden of proof at trial on a dispositive issue, a summary

judgment motion may properly be made in reliance solely on the ‘pleadings, depositions, answers

to interrogatories, and admissions on file.’” Id. Indeed, summary judgment should be entered,

after adequate time for discovery and upon motion, against a party who fails to make a showing

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

party will bear the burden of proof at trial. See id. at 322. “[A] complete failure of proof

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concerning an essential element of the nonmoving party’s case necessarily renders all other facts

immaterial.” Id. In such a circumstance, summary judgment should be granted, “so long as

whatever is before the district court demonstrates that the standard for entry of summary

judgment, as set forth in Rule 56(c), is satisfied.” Id. at 323.

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

opposing party to establish that a genuine issue as to any material fact actually does exist. See

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). In attempting to

establish the existence of this factual dispute, the opposing party may not rely upon the

allegations or denials of its pleadings but is required to tender evidence of specific facts in the

form of affidavits, and/or admissible discovery material, in support of its contention that the

dispute exists. See Fed. R. Civ. P. 56(e); Matsushita, 475 U.S. at 586 n.11. The opposing party

must demonstrate that the fact in contention is material, i.e., a fact that might affect the outcome

of the suit under the governing law, see Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248

(1986); T.W. Elec. Serv., Inc. v. Pacific Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir.

1987), and that the dispute is genuine, i.e., the evidence is such that a reasonable jury could

return a verdict for the nonmoving party, see Wool v. Tandem Computers, Inc., 818 F.2d 1433,

1436 (9th Cir. 1987).

In the endeavor to establish the existence of a factual dispute, the opposing party

need not establish a material issue of fact conclusively in its favor. It is sufficient that “the

claimed factual dispute be shown to require a jury or judge to resolve the parties’ differing

versions of the truth at trial.” T.W. Elec. Serv., 809 F.2d at 631. Thus, the “purpose of summary

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

genuine need for trial.’” Matsushita, 475 U.S. at 587 (quoting Fed. R. Civ. P. 56(e) advisory

committee’s note on 1963 amendments).

In resolving the summary judgment motion, the court examines the pleadings,

depositions, answers to interrogatories, and admissions on file, together with the affidavits, if

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any. Fed. R. Civ. P. 56(c). The evidence of the opposing party is to be believed. See Anderson,

477 U.S. at 255. All reasonable inferences that may be drawn from the facts placed before the

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

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

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

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

1987). Finally, to demonstrate a genuine issue, the opposing party “must do more than simply

show that there is some metaphysical doubt as to the material facts . . . . Where the record taken

as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no

‘genuine issue for trial.’” Matsushita, 475 U.S. at 587 (citation omitted).

On February 10, 2006, the court advised plaintiff of the requirements for opposing

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

F.3d 952, 957 (9th Cir. 1998) (en banc); Klingele v. Eikenberry, 849 F.2d 409 (9th Cir. 1988).

OTHER APPLICABLE LEGAL STANDARDS 

I. Civil Rights Act Pursuant to 28 U.S.C. § 1983

The Civil Rights Act under which this action was filed provides as follows:

Every person who, under color of [state law] . . . subjects, or causes

to be subjected, any citizen of the United States . . . to the

deprivation of any rights, privileges, or immunities secured by the

Constitution . . . shall be liable to the party injured in an action at

law, suit in equity, or other proper proceeding for redress. 

42 U.S.C. § 1983. The statute requires that there be an actual connection or link between the

actions of the defendants and the deprivation alleged to have been suffered by plaintiff. See

Monell v. Department of Social Servs., 436 U.S. 658 (1978); Rizzo v. Goode, 423 U.S. 362

(1976). “A person ‘subjects’ another to the deprivation of a constitutional right, within the

meaning of § 1983, if he does an affirmative act, participates in another's affirmative acts or

omits to perform an act which he is legally required to do that causes the deprivation of which

complaint is made.” Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978).

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Moreover, supervisory personnel are generally not liable under § 1983 for the

actions of their employees under a theory of respondeat superior and, therefore, when a named

defendant holds a supervisorial position, the causal link between him and the claimed

constitutional violation must be specifically alleged. See Fayle v. Stapley, 607 F.2d 858, 862

(9th Cir. 1979); Mosher v. Saalfeld, 589 F.2d 438, 441 (9th Cir. 1978). Vague and conclusory

allegations concerning the involvement of official personnel in civil rights violations are not

sufficient. See Ivey v. Board of Regents, 673 F.2d 266, 268 (9th Cir. 1982).

II. Eighth Amendment and Adequate Medical Care

The unnecessary and wanton infliction of pain constitutes cruel and unusual

punishment prohibited by the Eighth Amendment. Whitley v. Albers, 475 U.S. 312, 319 (1986);

Ingraham v. Wright, 430 U.S. 651, 670 (1977); Estelle v. Gamble, 429 U.S. 97, 105-06 (1976). 

In order to prevail on a claim of cruel and unusual punishment, a prisoner must allege and prove

that objectively he suffered a sufficiently serious deprivation and that subjectively prison officials

acted with deliberate indifference in allowing or causing the deprivation to occur. Wilson v.

Seiter, 501 U.S. 294, 298-99 (1991).

Where a prisoner’s Eighth Amendment claims arise in the context of medical

care, the prisoner must allege and prove “acts or omissions sufficiently harmful to evidence

deliberate indifference to serious medical needs.” Estelle, 429 U.S. at 106. An Eighth

Amendment medical claim has two elements: “the seriousness of the prisoner’s medical need

and the nature of the defendant’s response to that need.” McGuckin v. Smith, 974 F.2d 1050,

1059 (9th Cir. 1991), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133

(9th Cir. 1997) (en banc).

A medical need is serious “if the failure to treat the prisoner’s condition could

result in further significant injury or the ‘unnecessary and wanton infliction of pain.’” 

McGuckin, 974 F.2d at 1059 (quoting Estelle v. Gamble, 429 U.S. at 104). Indications of a

serious medical need include “the presence of a medical condition that significantly affects an

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individual’s daily activities.” Id. at 1059-60. By establishing the existence of a serious medical

need, a prisoner satisfies the objective requirement for proving an Eighth Amendment violation. 

Farmer v. Brennan, 511 U.S. 825, 834 (1994).

If a prisoner establishes the existence of a serious medical need, he must then

show that prison officials responded to the serious medical need with deliberate indifference. 

Farmer, 511 U.S. at 834. In general, deliberate indifference may be shown when prison officials

deny, delay, or intentionally interfere with medical treatment, or may be shown by the way in

which prison officials provide medical care. Hutchinson v. United States, 838 F.2d 390, 393-94

(9th Cir. 1988). Before it can be said that a prisoner’s civil rights have been abridged with regard

to medical care, however, “the indifference to his medical needs must be substantial. Mere

‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not support this cause of action.” 

Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 1980) (citing Estelle, 429 U.S. at

105-06). Deliberate indifference is “a state of mind more blameworthy than negligence” and

“requires ‘more than ordinary lack of due care for the prisoner’s interests or safety.’” Farmer,

511 U.S. at 835 (quoting Whitley, 475 U.S. at 319).

Delays in providing medical care may manifest deliberate indifference. Estelle,

429 U.S. at 104-05. To establish a claim of deliberate indifference arising from delay in

providing care, a plaintiff must show that the delay was harmful. See Berry v. Bunnell, 39 F.3d

1056, 1057 (9th Cir. 1994); McGuckin, 974 F.2d at 1059; Wood v. Housewright, 900 F.2d 1332,

1335 (9th Cir. 1990); Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989); Shapley v.

Nevada Bd. of State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985). “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.” Jett v. Penner, 439 F.3d 1091,

1096 (9th Cir. 2006). See also McGuckin, 974 F.2d at 1060. 

Finally, mere differences of opinion between a prisoner and prison medical staff

as to proper medical care do not give rise to a § 1983 claim. Jackson v. McIntosh, 90 F.3d 330,

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332 (9th Cir. 1996); Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989); Franklin v. Oregon, 662

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

DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

I. Defendants’ Statement of Undisputed Facts and Evidence

Defendants’ lengthy statement of undisputed facts is supported by citations to a

declaration by defendant J. Wedell, who is a physician and surgeon at CSP-Sacramento; a

declaration by defendant J.H. Friend, who is a consulting physician in the private practice of

physical medicine and rehabilitation eletrodiagnosis; a declaration by defendant J. Howard, who

is a Health Care Manager and Chief Medical Officer at CSP-Sacramento; a declaration by

defendant M. Sogge, who is a consulting physician in the private practice of medicine,

specializing in gastroenterology; and copies of plaintiff’s medical records. 

Defendants’ evidence establishes that as early as October 11, 2002, plaintiff’s

medical chart detailed a history of renal cell cancer, hypertension, cervical spine disc disease,

pain in both hands, and hepatitis C – all of which are serious medical conditions. Defendants’

evidence also establishes the following facts 

A. Plaintiff’s Hypertension Treatment

As early as April 16, 2002, Dr. Penner prescribed plaintiff Enalapril to treat his

high blood pressure. On May 22, 2002, plaintiff was evaluated for cardiovascular chronic care

and was diagnosed with hypertension. Plaintiff received frequent blood pressure checks and was

prescribed a variety of high blood pressure medications, including Amlodipine, Amlodipine

Besylate, Enalapril, Clonidine, Hydrochlorothiazide, and Lisinopril. 

Over the course of his treatment, plaintiff suffered three hypertensive episodes. 

On March 8, 2003, plaintiff experienced chest pains and high blood pressure. Dr. Dazo

prescribed Norvasc (an amlodipine besylate) in addition to the medication plaintiff was already

taking. On August 13, 2003, plaintiff experienced headaches and dizziness. At the time,

plaintiff reported that his blood pressure had been under control in the 130/80 range but had

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spiked to 160/100. Accordingly, plaintiff’s medication was changed to Clonidine. By September

7, 2003, plaintiff’s blood pressure had stabilized in the pre-hypertensive range, and remained in

that range until February 2005. On February 1, 2005, plaintiff experienced another spike in his

blood pressure that continued until February 9, 2005, when his hypertension medications were

changed to include the Clonidine skin patch, Hydrochlorothiazide and Lisinopril. The

medication adjustment in February 2005 resulted in successful management of plaintiff’s

hypertension and reduced his blood pressure levels to normal pre-hypertensive ranges. 

B. Plaintiff’s Degenerative Spine Disease Treatment

On October 10, 2002, plaintiff reported a tingling and numbness in his arms and

pain in his legs. On October 11, 2002, plaintiff was prescribed Gabapentin, a widely-used pain

medication and referral for consultation with a specialist was considered. In November 2002,

plaintiff was prescribed Tylenol 3, a stronger pain reliever containing acetaminophen and

codeine, and Gabapentin was discontinued. In January 2003, plaintiff was prescribed Gabapentin

again, in addition to his acetaminophen and codeine. Plaintiff’s primary care physician and

chronic care physicians regularly evaluated him relative to his pain and continued to prescribe

medications. 

On March 6, 2003, plaintiff saw Dr. Michael Hevor, a neurologist, at the Doctors

Hospital of Manteca for evaluation. Plaintiff complained of a stiffness in the cervical region but

did not describe any recent trauma. This was the first medical indication of a problem with

plaintiff’s spine. Dr. Hevor sought to rule out cervical radiculopathy and metastatic disease and

recommended an MRI of plaintiff’s cervical spine. On March 28, 2003, plaintiff underwent an

MRI which revealed no evidence of acute bony injury of the cervical spine C1 through C6. 

However, C7 and T1 were not clearly visible. As plaintiff’s symptoms worsened, Dr. Wedell

requested another MRI of plaintiff’s cervical spine and upper extremities. On October 10, 2003,

plaintiff underwent an MRI at Doctors Hospital in Manteca which revealed that plaintiff’s

cervical vertebrae were normal; bone marrow signals were normal; and vertebral heights were

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maintained. Both C5-6 and C6-7 showed minimal broad-based annular bulge, but there was no

evidence of significant cord compression, myeloathy or central spinal stenosis. 

Based on the results of this MRI, on December 11, 2003, Dr. Wedell requested

physical therapy and a neurological consultation with Dr. Farr, an orthopedic specialist. On

January 15, 2004, plaintiff underwent another MRI, this time of his lumbar spine. The MRI

revealed that plaintiff had mild degenerative disc disease at L1-2 and L2-3. On May 17, 2004,

plaintiff saw Dr. Farr at Doctors Hospital in Manteca who recommend neither another

electromyographic (EMG) examination or surgery but did recommend a whole body bone scan to

rule out metastasis as a source of plaintiff’s pain. On May 28, 2004, plaintiff underwent another

examination of his cervical spine. The examination revealed plaintiff had degenerative disc

disease at C5-6 and C6-7, more prominent at C6-7. 

On August 13, 2004, plaintiff underwent a whole body bone scan. The results

were normal. On August 30, 2005, plaintiff underwent a CT scan of his chest which showed his

chest was clear of any acute disease. Beginning on May 22, 2002, plaintiff’s primary care

physician and chronic care physicians regularly evaluated him, initially because of hypertension,

and, over time, for his renal cell cancer recovery, cervical disc disease, asthma, pain, carpal

tunnel syndrome and hepatitis C conditions. 

Plaintiff has a chronic degenerative disease of the cervical and lumbar spine. 

Degenerative spine disease is a major cause of chronic disability and a common reason for

referral to an MR imaging center. Spinal degeneration to some degree is a normal part of aging. 

Pain can originate from a person’s bones, joints, ligaments, muscles, nerves, and intervertebral

disks, as well as other para-vertebral tissues. 

Plaintiff’s cervical and lumbar spine care included speciality consultation, x-ray

examination, MRI examination, EMG examination, a whole body bone scan, physical therapy,

and regular evaluations by his primary care and chronic care physicians. Plaintiff’s pain 

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management involved a wide variety of prescription pain medications, ranging in strength. 

Plaintiff did not undergo surgery because Dr. Farr did not recommend it. 

C. Plaintiff’s Carpal Tunnel Syndrome Treatment

As noted above, in October 2002, plaintiff reported tingling and numbness in his

arms. Initially, plaintiff’s primary care physicians doubted the presence of carpal tunnel

syndrome, but nonetheless ordered bilateral carpal tunnel splints and wrist braces for him. On

March 6, 2003, when Dr. Hevor examined plaintiff, he recommended nerve conduction studies

of his upper extremities to rule out bilateral carpal tunnel syndrome. 

On March 18, 2003, Dr. Wedell requested a consultation and routine EMG by Dr.

Friend. On November 7, 2003, Dr. Hooper reordered the consultation “ASAP.” On July 26,

2004, Dr. Wedell put in an “urgent” request for the consultation. On September 10, 2004,

plaintiff saw Dr. Friend for an electromyographic examination. 

Dr. Friend noted that plaintiff had intermittent pain and numbness in both hands

during the prior year and a half and ruled out cervical nerve root irritation. Plaintiff underwent

sensory and motor nerve conduction studies revealing that plaintiff’s right and left median nerves

were abnormal as the distal motor and sensory latencies were delayed across the wrist segments. 

This is consistent with compression of both the right and left median nerves at the wrists. The

studies also revealed the median and ulnar nerve distribution of the right and left forearm and

hand were normal and showed no evidence of motor nerve injury. Dr. Friend’s report was the

extent of his involvement in plaintiff’s carpal tunnel syndrome treatment. 

On November 24, 2004, plaintiff saw Dr. Williams at Doctors Hospital of

Manteca for a consultation regarding his carpal tunnel condition. Dr. Williams’ plan of treatment

was to perform carpal tunnel release surgery on plaintiff’s right hand and then on his left hand. 

On February 5, 2005, Dr. Duc requested approval for plaintiff’s right hand surgery, and on April

8, 2005, Dr. Williams performed the surgery. Upon plaintiff’s return to the institution, he saw

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Dr. Hooper who issued a series of post-operative orders for plaintiff’s care, including pain

medication. 

On May 13, 2005, plaintiff underwent x-rays of his hands after reportedly

suffering from pain in both of them. The x-rays revealed that his right hand had some soft tissue

swelling but no bony abnormality, and his left hand had no significant abnormalities. On May

18, 2005, Dr. Williams examined plaintiff for carpal tunnel syndrome in his left hand. On May

24, 2005, Dr. Duc requested approval for plaintiff’s left hand surgery, and on June 18, 2005,

plaintiff was approved for surgery.

D. Plaintiff’s Pain Management Treatment

From April 2002 to March 2006, plaintiff’s pain management included use of a

wide variety of prescription pain medications, ranging from pain relievers used to relieve mild to

moderate pain to prescription medications used to relieve severe pain. Plaintiff was also

prescribed non-sterodial anti-inflammatory drugs, corticosteroids to decrease inflammation and

muscle relaxants. Plaintiff’s primary care physician and chronic care physicians regularly

evaluated his pain and prescribed medications. 

Defendant Howard, the CSP-Sacramento Health Care Manager from May 28,

2004, to January 17, 2005, was not personally involved in plaintiff’s medical care. His only

involvement with plaintiff was in responding to his inmate appeals in which Dr. Howard

acknowledged plaintiff’s concerns about his pain medications, but referred him to California

Code of Regulations 3354(a), which states that inmates may not diagnose illness or prescribe

medication.

E. Plaintiff’s Hepatitis C Treatment 

Hepatitis C is a blood-borne, infectious, viral disease that is caused by a

hepatotropic virus. The infection can cause liver inflammation that is often asymptomatic. 

However, ensuing chronic hepatitis can result in cirrhosis of the liver and liver cancer. The

symptoms of hepatitis C can be medically managed, and a proportion of patients can be cleared

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of the virus by a long course of anti-viral medicines. Chronic hepatitis C is defined as an

infection with hepatitis C virus persisting more than six months. Symptoms specifically

suggestive of liver disease are typically absent until substantial scarring of the liver has occurred. 

However, hepatitis C is a systemic disease, and patients experience a wide spectrum of clinical

manifestations ranging from an absence of symptoms to debilitating illness prior to the

development of advanced liver disease.

Generalized signs and symptoms associated with chronic hepatitis C include

fatigue, marked weight loss, flu-like symptoms, muscle pain, joint pain, intermittent low-grade

fevers, itching, sleep disturbances, abdominal pain, appetite changes, nausea, diarrhea, dyspepsia,

cognitive changes, depression, headaches and mood swings. A hepatitis diagnosis is rarely made

during the acute phase of the disease because the majority of people infected experience no

symptoms during this phase of the disease. Those who do experience the acute phase symptoms

are rarely ill enough to seek medical attention. Current treatment is a combination of Pegasys

and Ribavirin, an antiviral drug, for a period of twenty-four or forty-eight weeks, depending on

the genotype. Indications for treatment include patients with proven hepatitis C virus infection

and persistent abnormal liver function tests. Sustained cure rates occur in seventy-five percent of

people with genotypes HCV 2 and 3 after twenty-four weeks of treatment. They occur in fifty

percent of people with genotype 1 after forty-eight weeks of treatment, and in sixty-five percent

of people with genotype 4 after forty-eight weeks of treatment. Current guidelines strongly

recommend that hepatitis C patients receive hepatitis A and B vaccinations if they have not been

exposed to the viruses because exposure would radically worsen their liver disease. 

On February 6, 2003, Dr. Hooper ordered a blood test for plaintiff and discovered

a hepatitis C viral load of 77,434. Plaintiff was referred to Dr. Sogge, a gastrointestinal

specialist, who saw him for the first time on July 9, 2003. Dr. Sogge noted plaintiff’s viral load

in excess of 70,000 and ordered a liver biopsy. Plaintiff underwent a liver biopsy on September

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 Plaintiff was unable to attend scheduled appointments with Dr. Sogge on December 24, 1

2003, and January 7, 2004. On January 21, 2004, Dr. Sogge saw plaintiff and noted that his viral

load was at 69,000, with genotype 1b and concluded that plaintiff met the criteria for treating

chronic hepatitis C with a combination therapy of Pegasys and Ribavirin. Dr. Sogge prescribed

plaintiff the standard forty-eight week medication regimen. In addition, Dr. Sogge ordered

periodic lab tests and a follow-up visit in three months. 

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8, 2003, but no liver tissue was obtained. Dr. Sogge saw plaintiff again on October 15, 2003, and

ordered him to return for a follow-up visit within one to two months.

On December 10, 2003, Dr. Hooper ordered hepatitis A and B vaccinations for

plaintiff. Plaintiff consented to the vaccinations and received the first shots of the hepatitis A

and B vaccination on December 17, 2003. Plaintiff received the second shot of the hepatitis B 1

vaccination on January 23, 2004, and the final shot of the hepatitis A and B vaccination on June

29, 2004. 

On May 12, 2004, Dr. Sogge saw plaintiff. Plaintiff’s viral load had decreased

significantly and his chem panels were acceptable, so Dr. Sogge chose to continue plaintiff’s

combination therapy. Dr. Sogge saw plaintiff again on November 10, 2004 and ordered a viral

load test which showed an increased value of 55,130. 

On February 2, 2005, Dr. Sogge saw plaintiff again. Plaintiff had received the full

series of combination therapy, but based on his increased viral load, Dr. Sogge concluded that the

combination therapy failed. The FDA had not approved the combination therapy for more than

forty-eight weeks, so Dr. Sogge ordered that plaintiff discontinue it. As noted above, the cure

rate for patients with plaintiff’s hepatitis C genotype is about fifty percent with forty-eight weeks

of treatment. 

On February 1, 2006, Dr. Sogge saw plaintiff again. Plaintiff’s liver function had

not changed. Dr. Sogge ordered another liver biopsy to guide further follow-up. Plaintiff

underwent the biopsy on March 6, 2006. The biopsy revealed mild disease, grade 2, stage 2. 

Plaintiff suffered no ill effects or consequences from his failure to respond to the original

treatment or from the liver biopsies. 

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F. Defendants Grannis and Van Cor’s Involvement in Plaintiff’s Treatment

Defendants Grannis and Van Cor are not doctors and thus do not prescribe

medical treatments or diagnostic procedures. They do not perform medical examinations of, or

otherwise provide medical care for, any inmate. 

II. Defendants’ Arguments

Based on this evidence, defendants argue that they are entitled to summary

judgment because plaintiff’s medical care was reasonable and medically acceptable. (Defs.’ Mot.

for Summ. J. at 3.) Defendants concede that plaintiff suffers from a myriad of serious medical

conditions, but they contend the record demonstrates that the care provided to him was the

complete antithesis of deliberate indifference to serious medical needs. (Id. at 4.) 

Defendants maintain that plaintiff received reasonable and medically acceptable

treatment for his serious medical conditions. (Defs.’ Mot. for Summ. J. at 6-16.) With respect to

plaintiff’s hypertension, defendants contend that the undisputed facts demonstrate that clinicians

were attentive to his medical needs. (Id. at 6.) With respect to plaintiff’s chronic degenerative

disease of the cervical and lumbar spine, defendants argue that plaintiff’s claims amount to a

mere difference of opinion concerning the appropriate treatment. (Id. at 10.) Regarding 

plaintiff’s carpal tunnel syndrome defendants contend that they did not cause, and could not

realistically prevent, any delays in the scheduling of plaintiff’s appointments with specialists. 

(Id. at 12.) Most importantly, defendants note that there is no medical evidence that any delay in

plaintiff’s carpal tunnel treatment resulted in harm to him. (Id.) With respect to plaintiff’s pain

management, defendants argue that he continuously received a wide variety of pain medication

ranging in strength. (Id. at 14.) With respect to plaintiff’s hepatitis C, defendants contend that

his failure to respond to treatment does not constitute an Eighth Amendment violation. (Id. at

17.)

Finally, defendants contend that there is no causal link between the acts or

omissions of defendants Grannis and Van Cor’s and plaintiff’s alleged constitutional deprivation. 

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(Defs.’ Mot. for Summ. J. at 17-18.) Defendants argue that Grannis and Van Cor are not medical

doctors and could not take steps to avert the harm, if any, caused by the health care delivery

system’s alleged failure to attend to plaintiff’s medical needs. In addition, to the extent that

plaintiff has sued defendants Grannis and Van Cor because of their responses to his inmate

appeals, they argue that plaintiff has failed to state a cognizable claim. (Defs.’ Mot. for Summ. J.

at 18.) Defendants contend that the mere denial of plaintiff’s inmate appeals does not implicate

the Due Process Clause. Moreover, they contend California has not created a protected interest

in an administrative appeal system in its prisons. 

III. Plaintiff’s Opposition

Plaintiff argues that because the defendants have violated his constitutional right

to adequate medical care, the court should deny their motion for summary judgment. (Pl.’s

Opp’n to Defs.’ Mot. for Summ. J. at 2.) 

First, plaintiff argues that the treatment he received for his hypertension was not

reasonable or medically acceptable. (Pl.’s Opp’n to Defs.’ Mot. for Summ. J. at 3.) Plaintiff

contends that he filed an inmate appeal on February 19, 2003, because he had been diagnosed

with high blood pressure several years earlier but was not receiving any treatment for the

condition. (Id.) Plaintiff contends that Dr. Penner did not prescribe him medication until May

22, 2002 and that the medication was not effective. Plaintiff contends that Dr. Penner never

referred him to a specialist but instead prescribed six different medications over a three-year

period. Plaintiff contends that as a result of this inadequate and delayed treatment he suffered

from continuous pain, blinding headaches, dizziness, nausea and heart palpitations. (Id.) 

Second, plaintiff contends that the treatment he received for his chronic,

degenerative cervical and lumbar spine disease was not reasonable or medically acceptable. 

(Pl.’s Opp’n to Defs.’ Mot. for Summ. J. at 3.) Plaintiff asserts that although he received

Gabapentin for pain, he needed a stronger pain medication. (Id. at 4.) In addition, plaintiff

contends that defendants Wedell and Hooper refused to submit the necessary “urgent” referral

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requests for him to see a specialist. Plaintiff notes that on October 11, 2002, he reported to

medical staff that he was experiencing tingling and numbness in his arms and pain in his legs. 

Nonetheless, a consultation with a neurologist was not ordered until December 11, 2003, a full

year and two months after he reported his symptoms. (Id.) Moreover, plaintiff contends that he

did not see Dr. Farr, an orthopedic specialist, until six months later still on May 17, 2004. 

According to plaintiff, Dr. Farr reported that plaintiff should have seen him long before his

appointment date and informed plaintiff that his condition had reached a point where surgery was

no longer advisable. Dr. Farr recommended an epidural steroid injection instead. Plaintiff

contends that a timely surgery would have reduced his pain to a minimum and allowed him to

function without large amounts of daily pain medication. In addition, plaintiff contends that

surgery would have slowed down the degeneration of his discs. (Id.) Plaintiff argues that the

delay he experienced in receiving adequate treatment for his cervical and lumbar spine disease

was unreasonable and required Dr. Farr to prescribe the less efficacious treatment, depriving him

of the opportunity to live pain free for some years before he would have to undergo regular

epidural steroid injections. (Id. at 4-5.) 

Third, plaintiff argues that the treatment and care he received for his carpal tunnel

syndrome was not reasonable or medically acceptable. (Pl.’s Opp’n to Defs.’ Mot. for Summ. J.

at 5.) Plaintiff contends that, if defendants had submitted an “urgent” referral request, he would

have been scheduled to see the specialist within two to three weeks. Plaintiff asserts that without

an “urgent” request, scheduling such referral appointments takes months. Plaintiff contends that

he complained of severe pain, numbness, and tingling in his arms for eight months in 2002, but

nearly a year passed before he was referred to and eventually seen by Dr. Hevor, a neurologist. 

Dr. Hevor told plaintiff that he should see a specialist immediately to rule out bilateral carpal

tunnel syndrome. Plaintiff argues that despite his need for immediate treatment, Dr. Wedell

merely submitted a “routine” referral request for an EMG with Dr. Friend on March 18, 2003. 

Subsequently, Dr. Hooper merely submitted another “routine” request for an EMG about eight

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months later on November 7, 2003. Plaintiff contends that throughout this period of unnecessary

delay he continued to complain of severe pain in his hands and tingling and numbness in his

arms. Finally, on July 26, 2004, Dr. Wedell submitted an “urgent” request that plaintiff receive a

consultation with a specialist. Plaintiff notes that he did not actually see Dr. Friend until

September 10, 2004, more than two years after he believed he was suffering from carpal tunnel

syndrome. (Id. at 5-6.) 

Plaintiff maintains that defendants Wedell and Hooper clearly caused this

unreasonable delay in proper treatment by refusing to submit urgent requests for consultation

with a specialist. Plaintiff argues that by the time he saw Dr. Friend, he was unable or unwilling

to diagnose plaintiff with carpal tunnel syndrome but instead agreed with Drs. Wedell and

Hooper that plaintiff was feigning his symptoms in an attempt to obtain drugs. Plaintiff contends

that due to Dr. Friend’s incompetence, another two months passed before he saw Dr. Williams,

who ultimately recommended the necessary carpal tunnel release surgery. (Id.)

Fourth, plaintiff contends that the care he received for pain management was not

reasonable or medically acceptable. (Pl.’s Opp’n to Defs.’ Mot. for Summ. J. at 6.) Plaintiff

argues that Drs. Hooper and Wedell were well aware that he was in a state of continuous and

severe pain, but continued to prescribe a wide variety of ineffective medications. (Id. at 6-7.) 

Fifth, plaintiff argues that the treatment he received for his hepatitis C was not

reasonable or medically acceptable. (Pl.’s Opp’n to Defs.’ Mot. for Summ. J. at 7.) Plaintiff

contends that Dr. Sogge knew as early as February 2003 that plaintiff had tested positive for

hepatitis C. Plaintiff contends that a liver biopsy was to be performed on September 8, 2003, but

inexplicably no liver tissue was obtained as a result of the procedure and no further procedure

was undertaken to obtain the tissue for analysis. (Id. at 7-8.) Plaintiff contends that Dr. Sogge’s

failure to re-schedule a biopsy resulted in his treatment being delayed by a full year. (Id. at 8.) 

Plaintiff points to an expert report from Dr. Natalie Bzowej, M.D. Ph.D., submitted in the case of

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 In that expert report dated September 16, 2003, Dr. Bzowej states that she was then the 2

Director of Clinical Hepatology Research, Department of Transplantation at the California

Pacific Medical Center in San Francisco and that she was retained by the plaintiff in that case as

an expert witness.

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Marks E. Tatum v. D.W. Winslow, No. C 00-3465 VEW (N.D. Cal. 2000). (Id., Ex. G.) 2

Plaintiff cites to Dr. Bzowej’s opinion, expressed in that report, that early evaluation, including

liver biopsy, is imperative for those diagnosed with hepatitis C, and that early evaluation makes it

more likely that the virus can be cleared from the patient’s blood and avoid liver damage. 

Plaintiff concludes that Dr. Sogge’s failure to treat him in a timely fashion resulted in a full year

of liver damage and may well have resulted in plaintiff’s treatment being ineffective. (Id.)

Finally, plaintiff argues that defendants Grannis and Van Cor placed themselves

in the position of making the final judgment as to all of the medical issues in his case. (Pl.’s

Opp’n to Defs.’ Mot. for Summ. J. at 8-9.) In so doing, plaintiff contends that they are

responsible for the care that he did or did not receive. (Id.) 

IV. Defendants’ Reply

In reply, defendants contend that plaintiff has presented no evidence showing that

they were deliberately indifferent to his serious medical needs but instead presents only argument

as to he facts as he perceives them. (Defs.’ Reply at 2.) Defendants contend that because this

case involves complex medical issues with plaintiff contesting the type of treatment he received,

expert opinion is necessary to establish deliberate indifference. (Id.) Defendants note that

plaintiff’s reference to Dr. Bzowej’s report, regarding the treatment of Markus E. Tatum, is

unauthenticated, inadmissible and is not an expert opinion that any of the treatment received by

plaintiff reflects deliberate indifference by prison officials in this case. 

Defendants reiterate that the undisputed facts show that Drs. Wedell and Hooper’s

care and treatment of plaintiff’s serious medical conditions was reasonable and medically

acceptable; that Dr. Friend was involved only with the diagnosis of plaintiff’s carpal tunnel

syndrome and was not involved in scheduling delays that may have occurred; that plaintiff

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alleges nothing more than a difference of opinion as to the course and scope of treatment

provided by Dr. Howard; and that plaintiff merely failed to respond to Dr. Sogge’s extensive

treatment of his hepatitis C in a situation where the medical probability of success is only fifty

percent. Defendants contend that this evidence establishes that they were not deliberately

indifferent to plaintiff’s serious medical needs.

Finally, defendants contend that plaintiff has failed to allege a cognizable federal

constitutional claim against defendants Grannis and Van Cor because the denial of an inmate

appeal does not implicate the Due Process Clause.

ANALYSIS

As an initial matter, the parties do not dispute that plaintiff’s medical conditions

are serious. McGuckin, 974 F.2d at 1059-60 (“The existence of an injury that a reasonable

doctor or patient would find important and worthy of comment or treatment; the presence of a

medical condition that significantly affects an individual’s daily activities; or the existence of

chronic and substantial pain are examples of indications that a prisoner has a ‘serious’ need for

medical treatment.”). Accordingly, resolution of the pending motion for summary judgment

hinges on whether defendants responded to plaintiff’s serious medical needs with deliberate

indifference. Farmer, 511 U.S. at 834; Estelle, 429 U.S. at 106. 

The undersigned finds the delays in treating plaintiff’s carpal tunnel and hepatitis

C conditions to be very troubling. Nonetheless, the court finds that defendants have borne their

initial responsibility of demonstrating that there is no genuine issue of material fact with respect

to the adequacy of the medical care they provided to plaintiff for his hypertension, degenerative

spine disease, pain management, carpal tunnel syndrome, and hepatitis C. First, defendants’

evidence demonstrates that the defendant doctors prescribed appropriate medication for

plaintiff’s medical conditions, adjusting medication dosages when appropriate and switching 

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 For example, over the course of plaintiff’s hypertension treatment, defendants 3

prescribed him Amlodipine, Norvasc, Enalapril, Clonidine, Hydrochlorothiazide, and Lisinopril

until ultimately plaintiff’s blood pressure returned to pre-hypertensive levels. Similarly, over the

course of plaintiff’s pain management treatment, defendants continuously prescribed him pain

relievers ranging in strength, including Tylenol 3, Gabapentin, Naproxen, Triamcinolone,

Methocarbamol, and Vicodin. 

 It is not clear from the parties’ evidence whether Dr. Farr merely recommended or 4

actually administered to plaintiff the epidural steroidal injections.

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medications when necessary. Second, defendants’ evidence demonstrates that the defendant 3

doctors ordered numerous diagnostic tests to determine the cause underlying plaintiff’s medical

complaints. For example, the defendants doctors ordered blood tests, x-ray examinations, MRI

examinations, EMG examinations, nerve conduction studies, liver biopsies and a whole body

bone scan. Third, defendants’ evidence reflects that they referred plaintiff to appropriate

specialists for consultation and treatment regarding his various medical conditions. For example,

plaintiff saw outside specialists with regards to his degenerative spine disease, carpal tunnel

syndrome and hepatitis C. Finally, defendants’ evidence demonstrates that they have provided

plaintiff with medical treatment for all of his medical conditions. In addition to the array of

medication plaintiff has received along with regular evaluations by primary care physicians and

chronic care physicians, defendants have ordered and authorized for plaintiff frequent blood

pressure checks and monitoring of his hypertension, physical therapy, apparently, epidural

steroidal injections for his degenerative spine disease , bilateral carpal tunnel splints and wrist 4

braces as well as surgery for his carpal tunnel syndrome, and the standard forty-eight week

medication regimen involving Pegasys and Ribavirin for his hepatitis C. Defendants’ evidence

demonstrates that plaintiff was seen and treated numerous times by an array of doctors. Initially,

defendants considered conservative treatment options, and as plaintiff continued to complain

about ongoing problems or other medical conditions, defendants modified his medication and

scheduled or referred him for additional medical appointments at the prison or with outside

specialists. Based on defendants’ evidence, the court finds that they provided plaintiff with

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 Moreover, plaintiff primarily complains about Dr. Penner’s treatment of his 5

hypertension, arguing that he prescribed him six different medications over a three-year period

when he should have referred him to a specialist. However, Dr. Penner is not a defendant in this

action. 

21

reasonable and medically acceptable care. Thus, the burden shifts to plaintiff to establish the

existence of a genuine issue of material fact precluding summary judgment in defendants’ favor. 

The court has considered plaintiff’s opposition to the pending motion for

summary judgement as well as his complaint. The undersigned finds that plaintiff has failed to

submit any evidence establishing a legitimate dispute as to a genuine issue of material fact. For

example, plaintiff contends that defendants were deliberately indifferent to his medical needs

because they prescribed a wide variety of ineffective medications for his hypertension and pain

management. However, all that has been submitted by plaintiff as to the ineffectiveness of his

medication is his own contrary opinion regarding the appropriate course of treatment for his

conditions. As noted above, mere differences of opinion between a prisoner and prison medical

5

staff as to proper medical care does not give rise to a § 1983 claim. Jackson, 90 F.3d at 332;

Sanchez, 891 F.2d at 242; Franklin, 662 F.2d at 1344; see also Fleming v. Lefevere, 423 F. Supp.

2d 1064, 1070 (C.D. Cal. 2006) (“Plaintiff’s own opinion as to the appropriate course of care

does not create a triable issue of fact because he has not shown that he has any medical training

or expertise upon which to base such an opinion.”). 

Plaintiff also contends that defendants refused to timely refer him to specialists or

failed to timely treat his medical conditions. Although plaintiff’s care, particularly his being seen

by outside specialists pursuant to referrals, involved inexcusable delays in the undersigned’s

opinion, plaintiff has produced no evidence demonstrating that the defendants named in this

action caused or could have prevented the delays. See McGuckin, 974 F.2d at 1062 (affirming

grant of summary judgment in favor of two physicians because the record failed to demonstrate

that either was responsible for scheduling diagnostic examinations or hindered the performance

of such examinations in that case). Rather, the record appears to reflect that when the defendant

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 Plaintiff has only offered the court his own speculation as to harm possibly resulting 6

from the delays in scheduling consultation appointment with outside physicians following

referrals by prison doctors. For example, plaintiff contends that Dr. Sogge’s failure to treat him

in a timely fashion resulted in liver damage continuing for a full year and may have adversely

affected the results obtained from the combination therapy he eventually received. However,

plaintiff provides no evidence to support his contention. In fact, according to evidence submitted

by defendants, the cure rate for patients with plaintiff’s hepatitis C genotype is only about fifty

percent with forty-eight weeks of treatment. In this regard, the evidence before the court

indicates that plaintiff is similarly situated with one out of two patients who fail to respond to the

combination treatment. 

 Nonetheless, as noted above, the undersigned is very concerned regarding the delay 7

plaintiff experienced in seeing and receiving treatment from outside specialists after referrals

were made by prison doctors. This is a reoccurring issue in cases before this court with the usual

refrain from defendants being that they are not responsible for the scheduling of appointments for

prisoners with specialists. At least in the undersigned’s recent experience, counsel for defendants

do not offer a complete explanation as to the procedure that is to be employed when a referral is

made and where the responsibility lies when delays, such as those in this case, result. Needless

to say, were there evidence here of actual harm suffered as a result of delays in obtaining outside

treatment, the recommendation set forth above would be different and defendants would be

required to come forward, either in support of a motion or at trial, with a detailed explanation of

the governing procedures and the responsibilities of various prison officials in such

circumstances. See Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982) (prison medical staff

must be able to treat medical problems or refer prisoners to others who can and such referrals

may be to physicians outside the prison “if there is reasonably speedy access to these other

physicians or facilities.”) 

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doctors finally were made aware that their referrals of plaintiff for treatment by specialists had

been delayed, they re-submitted their requests and marked them “ASAP” or “urgent.” Most

importantly for resolution of the pending motion for summary judgment, plaintiff has tendered no 

evidence suggesting that any delays in his medical treatment ultimately caused him harm. See 6

Berry, 39 F.3d at 1057; McGuckin, 974 F.2d at 1059; Wood, 900 F.2d at 1335; Hunt, 865 F.2d at

200; Shapley, 766 F.2d at 407. Instead, plaintiff merely argues that he experienced constant pain

during the lengthy delays in treatment. However, as noted above, defendants adequately

addressed plaintiff’s complaints regarding pain by continuously providing him with a wide

variety of prescription pain relievers. 

7

Finally, plaintiff has provided no competent evidence demonstrating that the

course of treatment defendants chose for any of his medical conditions was medically

unacceptable under the circumstances. Jackson, 90 F.3d at 332 (“to prevail . . . Jackson must

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 In light of the conclusion reached above that the defendant doctors are entitled to 8

summary judgment in their favor, the defendants who merely responded to plaintiff’s

administrative appeals regarding his medical care (Grannis, Howard, and Van Cor), likewise

cannot be found to have been deliberately indifferent to plaintiff's serious medical needs. It is

undisputed that defendants Grannis, Howard, and Van Cor did not treat plaintiff. In addition, to

the extent that plaintiff has named them as defendants because of their involvement in the inmate

appeals process, plaintiff fails to state a claim. Ramirez v. Galaza, 334 F.3d 850, 860 (9th Cir.

2003) (“inmates lack a separate constitutional entitlement to a specific grievance procedure”)

(citing Mann v. Adams, 855 F.2d 639, 640 (9th Cir. 1988)).

 Although plaintiff claimed in his original complaint that his rights under Fifth, Eighth, 9

and Fourteenth Amendments had been violated, he failed to allege any such cognizable

constitutional claims. Inadequate medical care constitutes an Eighth Amendment violation. 

Estelle, 429 U.S. at 104. Accordingly, this case properly proceeded on Eighth Amendment

grounds, and any Fifth or Fourteenth Amendment claims should be dismissed for failure to state

a claim.

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show that the course of treatment the doctors chose was medically unacceptable under the

circumstances.”). Nor has plaintiff shown that defendants chose the course of treatment in

conscious disregard of an excessive risk to his health. Id. In fact, the volume and content of

plaintiff’s medical records as well as the frequency of his medical visits contradicts his subjective

belief that defendants ignored or failed to respond reasonably to his medical needs. Plaintiff’s

medical care was certainly inefficient at times due to the failure to schedule consultations with

outside specialists following the issuance of referrals by prison doctors. Nonetheless, plaintiff 

has failed to demonstrate that the defendants named in this action were deliberately indifferent to

his medical needs. 

8

Accordingly, for the reasons set forth above defendants’ motion for summary

judgment should be granted. 

9

CONCLUSION

In accordance with the above, IT IS HEREBY RECOMMENDED that:

1. Defendants’ April 27, 2007 motion for summary judgment be granted; and

2. This action be dismissed. 

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These findings and recommendations are submitted to the United States District

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

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

objections with the court and serve a copy on all parties. A document containing objections

should be titled “Objections to Magistrate Judge’s Findings and Recommendations.” Any reply

to objections shall be served and filed within ten days after service of the objections. The parties

are advised that failure to file objections within the specified time may, under certain

circumstances, waive the right to appeal the District Court’s order. See Martinez v. Ylst, 951

F.2d 1153 (9th Cir. 1991).

DATED: January 10, 2008.

DAD:9

tril0075.57

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