Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_10-cv-01928/USCOURTS-caed-2_10-cv-01928-12/pdf.json

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

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

LEON GRAY,

Plaintiff, No. 2:10-cv-1928 TLN EFB P

vs.

DAGE,1

FINDINGS AND RECOMMENDATIONS

Defendant.

 /

Plaintiff is a state prisoner proceeding through counsel in an action brought under 42

U.S.C. § 1983. The case was before the undersigned on April 3, 2013, for hearing on

defendant’s motion for summary judgment. Dckt. No. 62. Attorney Robert Kitay appeared at

the hearing on behalf of plaintiff; attorney Lynne Stocker appeared on behalf of defendant. As

stated on the record, and for the reasons provided below, defendant’s motion must be denied.

I. The Complaint

This action proceeds on the second amended complaint. Dckt. No. 31. According to the

allegations therein, plaintiff, an inmate at Mule Creek State Prison, awoke on the morning of

May 31, 2009, feeling dizzy and weak, with a feeling of “fullness” in his head. Id. ¶ 12. 

1

 The Clerk of the Court shall update the case caption to reflect that Dage is the sole

defendant in this action. 

1

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 1 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

Plaintiff claims that his right hand, arm, leg, and foot were numb, and that he had slurred speech. 

Id. With the assistance of other inmates, plaintiff allegedly visited the prison’s medical clinic on

four occasions throughout the day. Each time, plaintiff and/or the inmates who assisted plaintiff

allegedly explained plaintiff’s symptoms to defendant Dage, the medical technical assistant on

duty.2 Plaintiff claims that he informed defendant that his symptoms were worsening over the

course of the day. Defendant allegedly turned plaintiff away at each visit, accusing plaintiff of

“faking,” and refusing to examine plaintiff. Id. ¶¶ 14-22. Plaintiff claims that by 7:00 p.m., he

could barely speak, walk, or stand, and that his headache had increased to an unbearable

intensity. Id. ¶ 23. Eventually, a nurse took plaintiff’s vital signs and plaintiff was transported

to the San Joaquin General Hospital. Id. ¶ 26. Once transported, plaintiff was allegedly

diagnosed as having suffered a severe stroke. Id. ¶ 27. 

Plaintiff alleges that if defendant had listened to and examined plaintiff during any one of

his four trips to the medical clinic, he would have recognized plaintiff’s symptoms as warning

signs for an impending stroke, and could have taken actions avoid the stroke. Plaintiff asserts

two causes of action against defendant Dage: (1) deliberate indifference to medical needs in

violation of the Eighth Amendment; and (2) failure to obtain reasonable medical care in violation

of California Government Code section 845.6. Plaintiff claims to have suffered various injuries

because of the stroke, and seeks damages. As stated on the record, and as set forth below,

summary judgment is not appropriate as to either of these claims. 

II. Summary Judgment Standards

Summary judgment is appropriate when there is “no genuine dispute as to any material

fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). Summary

judgment avoids unnecessary trials in cases in which the parties do not dispute the facts relevant

to the determination of the issues in the case, or in which there is insufficient evidence for a jury

2

 At the hearing, defense counsel clarified that defendant was actually a licenced

vocational nurse. 

2

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 2 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

to determine those facts in favor of the nonmovant. Crawford-El v. Britton, 523 U.S. 574, 600

(1998); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-50 (1986); Nw. Motorcycle Ass’n v.

U.S. Dep’t of Agric., 18 F.3d 1468, 1471-72 (9th Cir. 1994). At bottom, a summary judgment

motion asks whether the evidence presents a sufficient disagreement to require submission to a

jury.

The principal purpose of Rule 56 is to isolate and dispose of factually unsupported claims

or defenses. Celotex Cop. v. Catrett, 477 U.S. 317, 323-24 (1986). Thus, the rule functions to

“‘pierce the pleadings and to assess the proof in order to see whether there is a genuine need for

trial.’” Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) 

(quoting Fed. R. Civ. P. 56(e) advisory committee’s note on 1963 amendments). Procedurally,

under summary judgment practice, the moving party bears the initial responsibility of presenting

the basis for its motion and identifying those portions of the record, together with affidavits, if

any, that it believes demonstrate the absence of a genuine issue of material fact. Celotex, 477

U.S. at 323; Devereaux v. Abbey, 263 F.3d 1070, 1076 (9th Cir. 2001) (en banc). If the moving

party meets its burden with a properly supported motion, the burden then shifts to the opposing

party to present specific facts that show there is a genuine issue for trial. Fed. R. Civ. P. 56(e);

Anderson., 477 U.S. at 248; Auvil v. CBS "60 Minutes", 67 F.3d 816, 819 (9th Cir. 1995).

A clear focus on where the burden of proof lies as to the factual issue in question is

crucial to summary judgment procedures. Depending on which party bears that burden, the party

seeking summary judgment does not necessarily need to submit any evidence of its own. When

the opposing party would have the burden of proof on a dispositive issue at trial, the moving

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

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

which demonstrate the absence of a genuine material factual issue. See Celotex, 477 U.S. at 323-

24 (1986). (“[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,

3

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 3 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

depositions, answers to interrogatories, and admissions on file.’”). 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. In such a

circumstance, summary judgment must be granted, “so long as whatever is before the district

court demonstrates that the standard for entry of summary judgment . . . is satisfied.” Id. at 323.

To defeat summary judgment the opposing party must establish a genuine dispute as to a

material issue of fact. This entails two requirements. First, the dispute must be over a fact(s)

that is material, i.e., one that makes a difference in the outcome of the case. Anderson, 477 U.S.

at 248 (“Only disputes over facts that might affect the outcome of the suit under the governing

law will properly preclude the entry of summary judgment.”). Whether a factual dispute is

material is determined by the substantive law applicable for the claim in question. Id. If the

opposing party is unable to produce evidence sufficient to establish a required element of its

claim that party fails in opposing summary judgment. “[A] complete failure of proof concerning

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

immaterial.” Celotex, 477 U.S. at 322.

Second, the dispute must be genuine. In determining whether a factual dispute is genuine

the court must again focus on which party bears the burden of proof on the factual issue in

question. Where the party opposing summary judgment would bear the burden of proof at trial

on the factual issue in dispute, that party must produce evidence sufficient to support its factual

claim. Conclusory allegations, unsupported by evidence are insufficient to defeat the motion. 

Taylor v. List, 880 F.2d 1040, 1045 (9th Cir.1989). Rather, the opposing party must, by affidavit

or as otherwise provided by Rule 56, designate specific facts that show there is a genuine issue

for trial. Anderson, 477 U.S. at 249; Devereaux, 263 F.3d at 1076. More significantly, to

demonstrate a genuine factual dispute the evidence relied on by the opposing party must be 

////

4

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 4 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

such that a fair-minded jury “could return a verdict for [him] on the evidence presented.” 

Anderson, 477 U.S. at 248, 252. Absent any such evidence there simply is no reason for trial.

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

evidence, and draws inferences most favorably for the opposing party. See id. at 249, 255; 

Matsushita, 475 U.S. at 587. Inferences, however, are not drawn out of “thin air,” and the

proponent must adduce evidence of a factual predicate from which to draw inferences. American

Int’l Group, Inc. v. American Int’l Bank, 926 F.2d 829, 836 (9th Cir.1991) (Kozinski, J.,

dissenting) (citing Celotex, 477 U.S. at 322). If reasonable minds could differ on material facts

at issue, summary judgment is inappropriate. See Warren v. City of Carlsbad, 58 F.3d 439, 441

(9th Cir. 1995). On the other hand,“[w]here the record taken as a whole could not lead a rational

trier of fact to find for the nonmoving party, there is no ‘genuine issue for trial.’” Matsushita,

475 U.S. at 587 (citation omitted); Celotex., 477 U.S. at 323 (If the evidence presented and any

reasonable inferences that might be drawn from it could not support a judgment in favor of the

opposing party, there is no genuine issue). Thus, Rule 56 serves to screen cases lacking any

genuine dispute over an issue that is determinative of the outcome of the case.

III. Defendant’s Factual Assertions

The defendant has not submitted a declaration. Nor has he been deposed. Instead, to

present his version of the facts defendant relies on the entries he made to a medical progress note

on the date in question. His medical progress note indicates that on May 31, 2009, around 8:00

p.m., defendant saw plaintiff at the Mule Creek State Prison medical clinic.3

 Dckt. No. 62, 

Stocker Decl., Ex. A at 1. Defendant observed plaintiff as having slight facial deviation and

minimal drooling, but noted that this was plaintiff’s “usual baseline.” Id., Ex. A at 1. 

////

3

 A June 2009 medical record from the San Joaquin General Hospital notes plaintiff as

being 73 years old at the time, with a history of hypertension, type 2 diabetes,

hypercholesterolemia, and chronic obstructive pulmonary disease. Id., Ex. B.

5

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 5 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

Defendant noted that plaintiff complained of left sided “weakness and numbness.” Id. Though

seemingly contradictory, defendant also noted that plaintiff did not complain about “loss of

feeling.” See id. (also noting that plaintiff did not complain of a headache). After examining

plaintiff, defendant found that plaintiff’s grip strength was equal, his pupils were equal and

reactive to light, and that he could ambulate fifteen feet without difficulties. Id. In response to

plaintiff’s complaints of leg pain, the medication nurse provided plaintiff with pain medication. 

Id. After taking plaintiff’s vital signs, defendant referred plaintiff to the triage and treatment

area for further evaluation to rule out stroke or transient ischemic attack. Id.

Progress notes from the registered nurse on duty in the triage and treatment area (referred

to in the notes as “TTA”) indicate that plaintiff arrived around 9:00 p.m. Id. at 2. According to

these notes plaintiff told the nurse that when he woke up that morning, his face, hands, and feet

were numb, and that when he attempted to get up, he was stumbling and falling, and that he had

not experienced this problem before. Id. After an examination and an assessment by the

registered nurse, plaintiff was transferred to San Joaquin General Hospital for further evaluation

and treatment. Id.

Plaintiff was seen at the Emergency Room at San Joaquin General Hospital and was

admitted on June 1, 2009 for a cerebrovascular event (stroke). Id., Ex. B. By June 2, 2009,

plaintiff’s condition had stabilized and he was ready for discharge. Id.

////

////

////

////

////

////

////

////

6

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 6 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

IV. Plaintiff’s Factual Assertions

Attached to plaintiff’s deposition transcript, submitted with plaintiff’s opposition,4 is a

copy of plaintiff’s administrative appeal regarding the events of May 31, 2009. This

administrative appeal includes a declaration by plaintiff describing the events, which is dated

July 27, 2009, and is signed under penalty of perjury. Dckt 68, Ex. 9. Plaintiff makes the

following assertions: (1) on the morning of May 31, 2009, he felt dizzy and weak, could not use

his right hand, arm, or leg, and had slurred speech; (2) plaintiff’s cellmate noticed these

symptoms and assisted plaintiff to the medical clinic, because plaintiff could not walk; (3) at the

clinic, plaintiff and/or the inmates assisting him explained these symptoms to the defendant,

including their belief that plaintiff was having a stroke; (4) defendant refused to treat plaintiff;

(5) plaintiff went to the clinic a total of four times that day, but defendant would not examine

plaintiff, take his vital signs, or even call a nurse; (6) during the fourth visit, at 2:45 p.m.,

plaintiff’s speech had become more slurred and his right hand had become useless and “curled”;

(7) defendant still refused to examine plaintiff and instructed plaintiff to return to his cell; (8)

around or after 7:00 p.m., plaintiff was seen by a nurse, who called an ambulance for plaintiff;

and (9) approximately 12 hours had passed before plaintiff received any medical attention.5 

4

 Because plaintiff’s opposition was untimely under Local Rule 230(c), the court issued

an order to show cause why sanctions should not be imposed. Dckt. No. 63. Plaintiff responded

to the order to show cause on February 7, 2013. Dckt. No. 69. The court heard argument from

plaintiff’s counsel as to the question of sanctions and the court will further address the matter at

the May 8, 2013 status conference.

Defendant also objects that plaintiff’s opposition does not comply with Local Rule

260(b), which states that any party opposing a motion for summary judgment “shall reproduce

the itemized facts in the Statement of Undisputed Facts and admit those facts that are undisputed

and deny those that are disputed, including with each denial a citation to the particular portions

of any pleading, affidavit, deposition, interrogatory answer, admission, or other document relied

upon in support of that denial.” Local Rule 260(b). However, plaintiff has included a statement

of facts that is complete with annotations to the evidence in the record on which he relies. It is

apparent from the opposition which facts he disputes and what evidence he relies upon for the

claimed disputes.

5

 Plaintiff’s opposition also includes letters drafted by inmates regarding the events on

May 31, 2009. Dckt. Nos. 67, 38, Exs. 2-8. Defendant objects to those inmate statements as

7

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 7 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

V. Discussion

Defendant argues that (1) plaintiff cannot show that he was deliberately indifferent to

plaintiff’s serious medical needs; (2) that even if plaintiff could, the doctrine of qualified

immunity protects him from liability; and (3) that he is immune from liability under California

Government Code § 845.6 because defendant examined plaintiff in response to his complaints

(including testing reflexes and taking vital signs), provided medication, and sent plaintiff to the

triage and treatment area for further evaluation. 

To succeed on an Eighth Amendment claim predicated on the denial of medical care, a

plaintiff must establish that he had a serious medical need and that the defendant’s response to

that need was deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006); see

also Estelle v. Gamble, 429 U.S. 97, 106 (1976). A serious medical need exists if the failure to

treat the condition could result in further significant injury or the unnecessary and wanton

infliction of pain. Jett, 439 F.3d at 1096. Deliberate indifference may be shown by the denial,

delay or intentional interference with medical treatment or by the way in which medical care is

provided. Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir. 1988). To act with

deliberate indifference, a prison official must both be aware of facts from which the inference

could be drawn that a substantial risk of serious harm exists, and he must also draw the

inference. Farmer v. Brennan, 511 U.S. 825, 837 (1994). Thus, a defendant is liable if he

knows that plaintiff faces “a substantial risk of serious harm and disregards that risk by failing to

take reasonable measures to abate it.” Id. at 847. “[I]t is enough that the official acted or failed

inadmissible because they are not made under penalty of perjury (Dckt. No. 72 at 6). While it is

true that they are not verified under penalty of perjury and therefore not in a form admissible for

trial, some of the inmate letters describe their percipient observations regarding facts that are in

dispute and that information appears to be based on personal knowledge. That content therefore

could be presented in a form admissible at trial and is therefore admissible under Fed. R. Civ. P.

56. See Fraser v. Goodale, 342 F.3d 1032, 1037 (9th Cir.2003). Moreover, some of the content

was also put into the record at the deposition of plaintiff when the letters were used by defense

counsel to examine plaintiff. Nonetheless, for the reasons set forth below, summary judgment

must be denied even without consideration of the letters.

8

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 8 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

to act despite his knowledge of a substantial risk of serious harm.” Id. at 842. A physician need

not fail to treat an inmate altogether in order to violate that inmate’s Eighth Amendment rights. 

Ortiz v. City of Imperial, 884 F.2d 1312, 1314 (9th Cir. 1989). A failure to competently treat a

serious medical condition, even if some treatment is prescribed, may constitute deliberate

indifference in a particular case. Id. 

It is important to differentiate common law negligence claims of malpractice from claims

predicated on violations of the Eight Amendment’s prohibition of cruel and unusual punishment. 

In asserting the latter, “[m]ere ‘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 v. Gamble, 429 U.S. 97, 105-106 (1976)); see also Toguchi v. Chung, 391

F.3d 1051, 1057 (9th Cir. 2004). Moreover, it is well established that mere differences of

opinion concerning the appropriate treatment cannot be the basis of an Eighth Amendment

violation. Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996); Franklin v. Oregon, 662 F.2d

1337, 1344 (9th Cir. 1981).

Defendant contends he was not deliberately indifferent to plaintiff’s medical needs

because plaintiff’s medical records reflect that when plaintiff came to the clinic at 8:00 p.m.

complaining of left-sided weakness and numbness, defendant properly examined and assessed

plaintiff and referred plaintiff to the triage and treatment area to rule out stroke. Defendant

places great reliance on his notation he wrote regarding that 8:00 p.m. visit. Defendant’s

evidence is silent, however, as to what transpired prior to 8:00 p.m. that day.

According to plaintiff’s evidence, the very symptoms that prompted defendant to

examine plaintiff, take his vital signs, and refer him to the triage and treatment area to rule out

stroke, had been known by defendant since that morning. Plaintiff testifies in the declaration

that he prepared for his from 602 grievance that when he awoke on May 31, 2009, he exhibited

symptoms of a stroke, including difficulty walking, slurred speech, and partial paralysis. Dckt.

No. 68, Ex. 9. Plaintiff asserts that with the assistance of other inmates, he went to the medical

9

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 9 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

clinic that morning, where he explained his symptoms to defendant – including his fear that he

was having a stroke. Id. Despite plaintiff’s outward symptoms and the concerns voiced by

plaintiff and the other inmates, defendant refused to offer plaintiff any assistance. Id. Instead,

according to plaintiff’s declaration, the defendant accused plaintiff of arriving “late for picking

up my medication for the morning and thought this was an attempt to get my medicine after

hours.” Id. Plaintiff says that “even though we continued to explain and make clear to them

[Defendant Dage and Correctional Officer Sapata] th[at] I believe[d] I was having a stroke”

defendant was adamant and the inmates helped plaintiff back to his cell. Id.

Significantly, plaintiff adds that “[w]e went back to the clinic 4 times in all that day, but

they kept sending us away stating I was faking it, that nothing was wrong with me and I was

trying to manipulated the staff. He (Mr. Dage) would not examine me, take my vital signs or

even call a nurse for me.” Id. Plaintiff states that “[a]t 2:45 p.m. we returned to the clinic for the

last time, because my speech was more slurred and the paralysis on my right side was so bad by

now that my had was curled and unable to use. After explaining to MTA Dage how I was

increasingly getting worse, he still refused to check me. I was instructed to return to my cell.” 

Id.

According to plaintiff, after visiting the clinic four times, only to be repeatedly turned

away by defendant without examination, he remained in his cell until finally “my celly & friend

talked the COs into calling for a nurse. The Nurse (Nurse Winn) heard my signs and symptoms

and took me to TTA via a wheel chair.” Id. He states he was taken by ambulance to a hospital

and was hospitalized for ten days. After finally receiving medical attention that evening,

plaintiff was diagnosed as having suffered a stroke. Id.

Defendant argues that this declaration testimony cannot defeat summary judgment

because when plaintiff was asked in his deposition to describe his symptoms he could not recall

anything other than “feeling funny.” As the court noted at oral argument, the deposition

transcript plainly shows difficulty by plaintiff remembering and even understanding. But the

10

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 10 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

transcript shows that plaintiff was examined at length without the benefit of referring to his

statement he wrote on July 27, 2009, in support of his Form 602 grievance less than 60 days after

the incident when the details were still fresh. When plaintiff’s counsel later attempted to use the

602 declaration to refresh plaintiff’s recollection, defense counsel repeatedly objected that the

questions had already been asked and answered. While the defendant is free to use the transcript

at trial to try to undermine plaintiff’s reliability, the poor memory three years later does not

render plaintiff’s recorded and sworn recollection soon after the event inadmissible. The

declaration is admissible on summary judgment. Fraser, 342 F.3d at 1037. Moreover, even if

the statement were not under penalty of perjury (which it is), the content of that earlier recording

of what plaintiff previously recalled is nonetheless admissible. The Ninth Circuit in Fraser

noted that the contents of Fraser’s diary:

are recitations of events within Fraser's personal knowledge and, depending on

the circumstances, could be admitted into evidence at trial in a variety of ways. 

Fraser could testify to all the relevant portions of the diary from her personal

knowledge. Fed. R. Evid. 602. If she forgets the exact dates or the details of the

event, she may be able to use the diary to refresh her recollection. Fed. R. Evid.

612. Indeed, even inadmissible evidence may be used to refresh a witness's

recollection. United States v. Frederick, 78 F.3d 1370, 1376 (9th Cir.1996);

United States v. Weller, 238 F.3d 1215, 1221 (10th Cir.2001); United States v.

Muhammad, 120 F.3d 688, 699 (7th Cir.1997). If the diary fails to refresh her

recollection, she might still be able to read the diary into evidence as a recorded

recollection under Fed. R. Evid. 803(5).

Id. at 1037-38. The same can be said of plaintiff’s declaration from July 2009, in which he

describes from personal knowledge what he experienced as he sought but was denied medical

treatment for an ensuing stroke. If, at the time of trial, his health and/or memory have

deteriorated, or for some other reason his recollection has faded, the earlier recorded information

can be used in the same way described in Fraser. It clearly is admissible in opposition to

summary judgement.

If plaintiff’s account of the events set out in the 2009 declaration is credited, a reasonable

jury could find that defendant was “aware of facts from which the inference could be drawn that

a substantial risk of serious harm exists . . . .” Farmer, 511 U.S. at 837. A reasonable juror

11

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 11 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

could also conclude that defendant actually “dr[e]w the inference” that plaintiff was faced with

“a substantial risk of serious harm,” and disregarded that risk at each of plaintiff’s four visits to

the medical clinic. Id. Thus, there are triable disputes as to whether defendant responded to

plaintiff’s objectively serious medical need with a sufficiently culpable state of mind. See id. at

842-43 & n.8 (whether a prison official had the requisite knowledge of a substantial risk may be

shown through the “fact that the risk was obvious” and the prison official may be liable if “he

merely refused to verify underlying facts that he strongly suspected to be true, or declined to

confirm inferences of risk that he strongly suspected to exist”).

While defendant appears to dispute the allegation that plaintiff made four trips to the

clinic urgently seeking medical assistance from defendant, defendant himself has submitted no

testimony or other evidence on the matter and the only evidence before the court is plaintiff’s

testimony that he did. Even if defendant were to submit a declaration disputing the claim, it

would merely underscore the point that there is a genuine dispute of material fact over whether

plaintiff did, or did not, on four occasions earlier that day go--with the assistance of other

inmates--to seek medical assistance but was each time turned away by defendant. Defendant

also notes that his Progress Notes state that when he asked plaintiff what was wrong plaintiff

stated “nothing just need pain meds.” Such a statement would certainly be difficult to reconcile

with plaintiff’s claim that four times during the day he sought help but was turned away. But the

statement is also difficult to reconcile with the Progress Notes of the registered nurse who

examined plaintiff shortly after defendant’s exam. The registered nurse’s notations also attribute

ceratin statements to plaintiff.6

 Those notations quote plaintiff as saying “I woke up this

morning, my face was numb, & my hands and feet were numb. When I attempted to get up, I

was stumbling and falling. I did not have this problem before.” Dckt. No. 62, Stocker Decl., Ex.

6

 The nurse’s Progress Notes state that plaintiff was brought in by correctional officers

and then sent to the triage and treatment area “by [the] LVN for generalized weakness and

possible stroke.” Dckt. No. 62, Stocker Decl., Ex. A at 2.

12

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 12 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

A at 2. Why plaintiff would make that statement to the registered nurse, and yet tell defendant, a

licensed vocational nurse, that “nothing” was wrong, “just need pain meds” is inexplicable. 

However, there is clearly a genuine dispute over what information was presented throughout the

day to defendant regarding plaintiff’s medical needs and risk of stroke, and whether as plaintiff

claims, he was taken by other inmates four times to the clinic to seek help but was repeatedly

turned away by defendant.7 That dispute precludes summary judgment.

Defendant also argues that he is entitled to qualified immunity. Qualified immunity

protects government officials from liability for civil damages where a reasonable person would

not have known their conduct violated a clearly established right. Anderson v. Creighton, 483

U.S. 635, 638-39 (1987). In determining whether the doctrine of qualified immunity provides a

government officer protection, a court must make two inquires: 1) do the facts alleged show that

the officer violated a constitutional right; and 2) was the constitutional right well established. 

Saucier v. Katz, 533 U.S. 194, 201 (2001); Pearson v. Callahan, 555 U.S. 223, (2009) (courts

have discretion to decide which of the two Saucier prongs to address first). A plaintiff invokes a

“clearly established” right when “the contours of the right [are] sufficiently clear that a

reasonable official would understand that what he is doing violates that right.” Anderson v.

Creighton, 483 U.S. 635, 40 (1987). 

Whether the defendant violated a constitutional right and whether the right was clearly

established at the time of the violation are pure legal questions for the court. See Phillips v.

Hust, 477 F.3d 1070, 1079 (9th Cir.2007). However, even where a right was clearly established,

the question remains whether the defendant’s actions violated such right. That question may or

may not turn on facts which are in dispute. “If a genuine issue of material fact exists that

7

 To the extent that the dispute turns on the credibility of plaintiff and defendant, the trier

of fact will have the progress notes to assist in determining which version to believe. The court

must also note, however, that the trier of fact will also likely have the disciplinary records

regarding defendant at plaintiff’s Exhibit C, which indicates a charge against defendant of

“Falsifying Patient and/or Hospital Records.” See Dckt. 68, Ex. C. 

13

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 13 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

prevents a determination of qualified immunity at summary judgment, the case must proceed to

trial.” Serrano v. Francis, 345 F.3d 1071, 1077 (9th Cir.2003); see also Martinez v. Stanford,

323 F.3d 1178, 1183–85 (holding that the district court erred by granting summary judgment

where there were genuine issues of material fact regarding the reasonableness inquiry of the

second Saucier prong).

Here, defendant’s qualified immunity argument is predicated on his assertion that

“Plaintiff’s constitutional rights were not violated because Defendant properly examined and

assessed Plaintiff and referred him to the Triage and Treatment Area for further evaluation.” 

Dckt. No. 62 at 8. Defendant argues that “a reasonable medical professional in Defendant’s

position would have believed that his actions were lawful.” Id. As already discussed, there are

genuine issues of material fact as to whether defendant deliberately disregarded plaintiff’s need

for medical attention during any of plaintiff’s four prior visits to the medical clinic that day –

when defendant was warned that plaintiff may be having a stroke, and plaintiff exhibited

symptoms manifesting a serious medical need. It was well established as of 2009 that an inmate

has a clearly established right not to have his serious medical needs treated with deliberate

indifference. McGuckin v. Smith, 974 F.2d 1050 at 1061-62 (9th Cir. 1992). Accordingly,

summary judgment based on qualified immunity is not appropriate on plaintiff’s Eighth

Amendment deliberate indifference claim.

Finally, defendant argues he is immune from liability on plaintiff’s claim brought under

California Government Code § 845.6. California Government Code § 845.6 states that a public

employee is liable if he or she knows or has reason to know that an inmate requires immediate

medical care, but fails to summon such care. Watson v. State, 21 Cal.App.4th 836, 841 (1993);

Jett v. Penner, 439 F.3d 1091, 1099 (9th Cir. 2006). “Liability under section 845.6 is limited to

serious and obvious medical conditions requiring immediate care,” and “to those situations

where the public entity intentionally or unjustifiably fails to furnish immediate medical care.” 

Watson, 21 Cal.App.4th at 841. As discussed above, there is evidence that defendant had known

14

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 14 of 15
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

since the morning of May 31, 2009, that plaintiff was at risk for a stroke, and that despite

plaintiff’s four treks to the medical clinic throughout the day, defendant refused to provide

plaintiff with any assistance. Based upon this evidence, there are triable disputes as to whether

defendant knew (or should have known) that plaintiff required immediate medical care, and that

without justification, he turned plaintiff away and refused to render aid. Accordingly, summary

judgment as to this claim must also be denied.

VI. Recommendation

For all of the above reasons, IT IS HEREBY RECOMMENDED that defendant’s motion

for summary judgment (Dckt. No. 62) be denied.8

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

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

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

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

“Objections to Magistrate Judge’s Findings and Recommendations.” Failure to file objections

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

Duncan, 158 F.3d 449, 455 (9th Cir. 1998); Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991).

Dated: April 8, 2013.

8

 In light of this recommendation, the parties shall also be prepared to address at the May

8, 2013 status conference, whether the court should consider allowing plaintiff to retain an expert

for trial. 

15

Case 2:10-cv-01928-TLN-EFB Document 75 Filed 04/08/13 Page 15 of 15