Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_11-cv-00414/USCOURTS-caed-2_11-cv-00414-22/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

LINNIE STAGGS, as Administrator of 

the ESTATE OF ROBERT E. 

STAGGS, Deceased, and MELISSA 

STAGGS,

Plaintiffs,

v.

DOCTOR’S HOSPITAL OF 

MANTECA, INC., et al.,

Defendants.

No. 2:11-CV-414-MCE-KJN

MEMORANDUM AND ORDER

Plaintiff Linnie Staggs, as administrator of the Estate of Robert E. Staggs, and 

Melissa Staggs (collectively “Plaintiffs”) bring claims against Doctor’s Hospital of 

Manteca, Inc. (“DHM”) and individual defendants (collectively “Defendants”) seeking 

redress for the medical treatment and subsequent death of Robert E. Staggs 

(“Decedent”) while in custody at the Sierra Conservation Center (“SCC”). The individual 

defendants include, among others, Mario Sattah, M.D. (“Sattah”), Lincoln Russin, M.D. 

(“Russin”), and James Owen, M.D. (“Owen”). Plaintiffs allege that defendants DHM and 

Sattah violated Decedent’s Eighth Amendment rights by exhibiting deliberate 

indifference to Decedent’s medical condition. Plaintiffs allege that defendants Russin 

and Owen negligently provided medical care to Decedent.

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Presently before the Court is Defendants’ Motion to Dismiss under Rule1 12(b)(6). 

ECF No. 124.2 For the following reasons Defendants’ Motion is DENIED.3 Also before 

the Court are Plaintiffs’ Motions to Strike Defendants’ various affirmative defenses. ECF 

Nos. 126 and 130. Those Motions are GRANTED in part and DENIED in part.

BACKGROUND4

Decedent had the Hepatitis C virus and a history of liver problems, including 

cirrhosis. In 2009, while incarcerated at SCC, he began experiencing symptoms 

associated with liver failure. Prison medical staff treated Decedent’s symptoms with 

routine painkillers and performed a series of tests. Plaintiffs allege that the tests showed 

signs of acute Hepatitis C liver disease, cirrhosis, and hepatocellular carcinoma (“HCC”). 

Decedent also underwent two MRIs which reportedly showed a lesion on his liver. 

Prison medical staff continued to treat Decedent’s symptoms with routine painkillers.

On December 26, 2009, Decedent went “man-down” at SCC, an act which elicited 

immediate attention from custodial and medical personnel at the prison. Further testing 

revealed a 5 cm lesion on Decedent’s liver and other smaller lesions throughout the 

liver. Although these results indicated the presence of HCC, medical personnel 

allegedly focused on other cancer-types as the cause of Decedent’s health problems. 

During approximately the same period in December 2009, prison medical personnel 

decided that Decedent should undergo a “three-pass core” liver biopsy in January 2010. 

Plaintiffs allege that this decision was erroneous and unnecessary because (1) where 

cirrhosis is present, conducting a biopsy when lesions are suspected to be HCC creates 

 1 Unless otherwise noted, all references to “Rule” or “the Rules” refer to the Federal Rules of Civil 

Procedure.

2 The Court required that Defendants renotice their initial Motion (ECF No. 121).

3 Because oral argument would not have been of material assistance, the Court ordered this 

matter submitted on the briefs. E.D. Cal. Local Rule 230(g).

4 The following facts are taken from Plaintiffs’ Fourth Amended Complaint. ECF No. 117.

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a substantial risk that the tumor will spread along the needle track; and (2) a liver biopsy, 

while safe in a normal liver, is much more likely to cause bleeding in a cirrhotic liver. 

Two hospitals allegedly refused to perform the procedure because of associated risks to 

Decedent. Plaintiffs allege that other procedures, including a “fine needle aspirate” of 

the lesion and further testing, should have been conducted instead of the three-pass 

core biopsy.

On January 22, 2010, Defendant Sattah performed the three-pass core biopsy at 

Defendant DHM’s facility. Although the universal protocol for the biopsy requires three 

to four hours of supine rest after the procedure, Defendants allegedly failed to ensure 

that Decedent received proper rest. Plaintiffs allege that less than an hour after the 

biopsy Decedent was ordered to leave the hospital and transferred back to SCC. In the 

following days, Decedent’s condition grew significantly worse: his abdomen swelled; he 

could no longer urinate, began vomiting, could not sleep, and was in severe pain. 

Decedent’s attempts to alert SCC personnel of his condition allegedly failed.

On January 24, 2010, Decedent again went “man-down.” On January 25, 2010, 

Decedent was taken to San Joaquin Medical Center for emergency treatment. On 

January 26, 2015, the liver biopsy confirmed the HCC diagnosis. On February 4, 2010, 

Decedent was transferred to a hospice facility where he died on February 12, 2010. The 

cause of death was blood loss into his peritoneum, allegedly as a result of the threepass core liver biopsy.

STANDARD

A. Motion to Dismiss

On a motion to dismiss for failure to state a claim under Federal Rule of Civil 

Procedure 12(b)(6), all allegations of material fact must be accepted as true and 

construed in the light most favorable to the nonmoving party. Cahill v. Liberty Mut. Ins. 

Co., 80 F.3d 336,337-38 (9th Cir. 1996). Rule 8(a)(2) requires only “a short and plain 

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statement of the claim showing that the pleader is entitled to relief” in order to “give the 

defendant fair notice of what the . . . claim is and the grounds upon which it rests.” Bell 

Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 

47 (1957)). A complaint attacked by a Rule 12(b)(6) motion to dismiss does not require 

detailed factual allegations. However, “a plaintiff’s obligation to provide the grounds of 

his entitlement to relief requires more than labels and conclusions, and a formulaic 

recitation of the elements of a cause of action will not do.” Id. (internal citations and 

quotations omitted). A court is not required to accept as true a “legal conclusion 

couched as a factual allegation.” Ashcroft v. Iqbal, 129 S. Ct. 1937, 1950 (2009) 

(quoting Twombly, 550 U.S. at 555). “Factual allegations must be enough to raise a 

right to relief above the speculative level.” Twombly, 550 U.S. at 555 (citing 5 Charles 

Alan Wright & Arthur R. Miller, Federal Practice and Procedure § 1216 (3d ed. 2004) 

(stating that the pleading must contain something more than “a statement of facts that 

merely creates a suspicion [of] a legally cognizable right of action.”)). 

Furthermore, “Rule 8(a)(2) . . . requires a showing, rather than a blanket 

assertion, of entitlement to relief.” Twombly, 550 U.S. at 556 n.3 (internal citations and 

quotations omitted). Thus, “[w]ithout some factual allegation in the complaint, it is hard 

to see how a claimant could satisfy the requirements of providing not only ‘fair notice’ of 

the nature of the claim, but also ‘grounds’ on which the claim rests.” Id. (citing 5 Charles 

Alan Wright & Arthur R. Miller, supra, at § 1202). A pleading must contain “only enough 

facts to state a claim to relief that is plausible on its face.” Id. at 570. If the “plaintiffs . . . 

have not nudged their claims across the line from conceivable to plausible, their 

complaint must be dismissed.” Id. However, “[a] well-pleaded complaint may proceed 

even if it strikes a savvy judge that actual proof of those facts is improbable, and ‘that a 

recovery is very remote and unlikely.’” Id. at 556 (quoting Scheuer v. Rhodes, 416 U.S. 

232, 236 (1974)).

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B. Motion to Strike

An affirmative defense is an “assertion of facts and arguments that, if true, will 

defeat the plaintiff’s [ ] claim, even if all the allegations in the complaint are true.” Black’s 

Law Dictionary (10th ed. 2014). A court may strike an insufficiently pled affirmative 

defense under Federal Rule of Civil Procedure 12(f). 

District courts in this circuit were previously split on whether the heightened 

pleading standard that the United States Supreme Court announced in Twombly and 

Iqbal applied to affirmative defenses. Some courts, including this Court, concluded that 

affirmative defenses were subject to the heightened pleading standard. See, e.g., Wine 

Group LLC, v. L. and R. Wine Co., No. 2:10-cv-022040-MCE-KJN, 2011 WL 130236, at 

*2 (E.D. Cal. Jan. 4, 2011); Dodson v. Strategic Rests. Acquisition Co. II, LLC, 

289 F.R.D. 595 (E.D. Cal. 2013). Other courts, however, declined to apply the 

heightened pleading standard to affirmative defenses, citing Wyshak v. City National

Bank, 607 F.2d 824, 826 (9th Cir. 1979), for the proposition that the pleadings need only 

provide the plaintiff “fair notice” of the defense. See, e.g., Kohler v. Staples the Office 

Superstore, LLC, 291 F.R.D. 464, 468 (S.D. Cal. 2013). 

The Ninth Circuit, however, has resolved the split in the district courts. In Kohler 

v. Flava Enterprises, Inc., the Ninth Circuit explained that “the ‘fair notice’ required by the 

pleading standards only require[s] describing [an affirmative] defense in ‘general terms.’” 

779 F.3d 1016, 1019 (9th Cir. 2015) (quoting 5 Charles Alan Wright & Arthur Miller, 

Federal Practice and Procedure, § 1274 (3d ed. 1998)).5 Accordingly, this Court 

applies the “fair notice” standard, and not the heightened pleading standard announced 

in Twombly and Iqbal, when evaluating motions to strike affirmative defenses.

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 The specific sentence that the Ninth Circuit quoted in Kohler provides: “As numerous federal 

courts have held, an affirmative defense may be pleaded in general terms and will be held to be sufficient, 

and therefore invulnerable to a motion to strike, as long as it gives the plaintiff fair notice of the nature of 

the defense.” Wright & Miller, § 1274 (footnotes omitted).

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ANALYSIS

A. Motion to Dismiss

Plaintiffs’ claims for relief against Defendants DHM and Sattah arise under 

42 U.S.C. § 1983. Plaintiffs allege that Defendants acted with deliberate indifference 

towards Decedent in violation of the Eighth Amendment.

Although medical malpractice does not become a constitutional violation merely 

because the victim is a prisoner, deliberate indifference to the serious medical needs of 

prisoners violates the Eighth Amendment. Estelle v. Gamble, 429 U.S. 97, 104 (1976). 

To prevail here, Plaintiffs must allege that the course of treatment Defendants pursued

was medically unacceptable under the circumstances, and that Defendants pursued this 

course in conscious disregard of an excessive risk to Decedent’s health. See Jackson v. 

McIntosh, 90 F.2d 330, 332 (9th Cir. 1996). Plaintiffs must allege more than merely “a 

difference of medical opinion” as to the proper course of treatment. See Sanchez v. 

Vild, 891 F.2d 240, 242 (9th Cir. 1989). 

Plaintiffs allege that Defendants performed the three-pass core liver biopsy on 

Decedent after two hospitals refused to perform the procedure under any circumstances 

because of an elevated risk of internal bleeding. This repeated refusal, construed in the 

light most favorable to Plaintiffs, plausibly suggests that Defendants’ performance of the 

biopsy was “medically unacceptable under the circumstances.” Jackson, 90 F.2d at 332. 

This fact sufficiently alleges more than a difference of medical opinion. See Sanchez, 

891 F.2d at 242. 

The allegation that two hospitals refused to perform the procedure also

adequately supports Plaintiffs’ claim that Defendants consciously disregarded a 

substantial risk of serious harm to Decedent. See Toguchi v. Chung, 391 F.2d 1051, 

1059 (9th Cir. 2004). Defendants argue that they had no knowledge of the two hospitals’ 

prior refusal or of the Decedent’s subsequent complications. This argument, however, is 

a factual one, and at this early stage of the litigation, all favorable inferences should be 

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resolved in Plaintiffs’ favor. See Cahill v. Liberty Mut. Ins. Co., 80 F.3d 336,337-38 (9th 

Cir. 1996). This includes the inference that if a defendant’s response to a known risk is 

obviously inadequate, then the defendant may have recognized the inappropriateness of 

his conduct. Thompson v. King, 730 F.3d 743, 747 (8th Cir. 2013) (observing that on 

summary judgment circumstantial evidence can be used to establish a subjective mental 

state in a deliberate indifference claim). Plaintiffs have alleged that Decedent’s liver 

problems were known and the three-pass core liver biopsy was an obviously inadequate

response. These allegations support an inference that Defendants consciously 

disregarded substantial risks to the Decedent; Plaintiffs therefore allege sufficient facts to 

state a claim for deliberate indifference. The Motion to Dismiss is accordingly DENIED.

Defendants also seek to dismiss Plaintiffs’ prayer for damages for pain, suffering, 

emotional distress, and punitive damages against Defendants. Defendants argue that 

Cal. Civ. Proc. §§ 377.34 and 425.13 limit damages payable to Decedent’s estate and 

place procedural requirements on claims against health care providers. However, 

Plaintiffs only bring federal constitutional claims against these Defendants, not state law 

negligence claims. See Chaudhry v. City of L.A., 751 F.3d 1096, 1105 (9th Cir. 2014)

(finding that § 377.34 does not apply to § 1983 claims); Estate of Prasad ex rel. Prasad 

v. Cty. of Sutter, 958 F. Supp. 2d 1101, 1121 (E.D. Cal. 2013) (observing that procedural 

requirement of § 425.13 is inapplicable in federal court). Defendants’ request to dismiss

Plaintiffs’ prayer for damagers is therefore DENIED.

B. Motion to Strike

Plaintiffs move to strike various affirmative defenses under Rule 12(f). Motions to 

strike are disfavored in part because of the limited importance of pleading in federal 

practice. Spring v. Fair Isaac Corp., 2015 WL 7188234, at *2 (E.D. Cal. Nov. 16, 2015). 

In the Ninth Circuit, the “fair notice” required by the pleading standard requires only 

describing an affirmative defense in general terms. Castellano v. Access Premier 

Realty7, Inc., 2015 WL 7423821, at *2 (E.D. Cal. Nov. 20, 2015).

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With two exceptions, Defendants’ affirmative defenses satisfy the minimal 

requirement of fair notice. Defendants Russin’s and Owen’s First Affirmative Defense, 

“Failure to State Cause of Action,” attacks Plaintiffs’ prima facie case and need not be 

pleaded as an affirmative defense. See Zivkovic v. So. Cal. Edison Co., 302 F.3d 1080, 

1088 (9th Cir. 2002) (demonstration that plaintiff has not met burden of proof is not 

affirmative defense). Russin’s and Owen’s Nineteenth Affirmative Defense, “Other 

Defenses,” does not provide fair notice of the asserted defense. Plaintiffs’ Motions to 

Strike are therefore GRANTED as to Russin and Owen’s First and Nineteenth 

Affirmative Defenses, but otherwise DENIED.

CONCLUSION

Defendants’ Motion to Dismiss (ECF Nos. 121 and 124) is DENIED.

Plaintiffs’ Motions to Strike are GRANTED in part and DENIED in part, as follows:

1. Plaintiffs’ Motion to Strike (ECF No. 126) is GRANTED as to Defendants 

Russin and Owen’s First and Nineteenth Affirmative Defenses. The Motion is 

DENIED as to all other affirmative defenses.

2. Plaintiffs’ Motion to Strike (ECF No. 130) is DENIED in its entirety.

IT IS SO ORDERED.

Dated: March 7, 2016

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