Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_04-cv-01798/USCOURTS-caed-2_04-cv-01798-23/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

KEITH M. CASSELLS,

Plaintiff, No. CIV S-04-1798 FCD EFB P

vs.

DR. MEHTA, et al.,

Defendants. ORDER

 /

Plaintiff is a prisoner without counsel seeking relief for civil rights violations. See 42

U.S.C. § 1983. On September 25, 2007, the court granted defendants’ July 21, 2006 motion for

summary judgment. The Clerk of the Court entered judgment, and plaintiff timely filed a notice

of appeal. 28 U.S.C. § 1915(a)(3). The appellate court has requested that this court determine

whether the appeal is taken in good faith. For the reasons explained below, the court finds that

the appeal is not taken in good faith.

I. Standards and Analysis

An appeal not taken in good faith is one that is frivolous, meaning the result is obvious or

the arguments are wholly without merit. See Cannon v. Hawaii Corp. (In re Hawaii Corp.), 796

F.2d 1139, 1144 (9th Cir.1986) (quoting Libby, McNeill and Libby v. City National Bank, 592

F.2d 504, 515 (9th Cir.1978); Jaeger v. Canadian Bank, 327 F.2d 743, 746 (9th Cir.1964). Since

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this court granted defendants’ motion for summary judgment, the appellate court will review this

case de novo. Llamas v. Butte Cmty. Coll. Dist., 238 F.3d 1123, 1126 (9th Cir.2001).

This action proceed in this court on the September 15, 2004 verified complaint in which

plaintiff claims that: (1) defendants Andreasen, Mehta, Donahue and Bick were deliberately

indifferent to plaintiff’s serious medical needs by delaying for seven months before sending

plaintiff for a second follow-up appointment for disc fusion surgery; (2) defendants Dr. Mehta

and Dr. Bick failed in December 2003 to provide plaintiff with an eggcrate mattress to ease

discomfort in plaintiff’s arms, hands, and neck; and (3) Dr. Mehta was deliberately indifferent to

plaintiff’s neck condition by substantially delaying “revision surgery” on plaintiff’s neck. 

Plaintiff conceded that he sued defendants Andreasen, Donahue and Bick in their

supervisory capacity and that not one of them was a primary care physician responsible for

dictating or directing plaintiff’s care. Ordinarily, a person is subject to liability under 42 U.S.C.

§ 1983 if he commits or directs an act or omission that violates a plaintiff’s constitutional rights. 

Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978); Taylor v. List, 880 F.2d 1040, 1045 (9th

Cir. 1989). “Supervisory liability exists even without overt personal participation in the

offensive act if supervisory officials implement a policy so deficient that the policy itself is a

repudiation of constitutional rights and is the moving force of the constitutional violation.”

Hansen v. Black, 885 F.2d 642, 646 (9th Cir.1989) (quotation marks and citation omitted). To

hold a supervisor liable for the unconstitutional acts of his subordinates, there must be a “causal

connection between the supervisor’s wrongful conduct and the constitutional violation.” 

Redman v. County of San Diego, 942 F.2d 1435, 1446 (9th Cir. 1991) (en banc). This

connection may be established by showing the supervisor personally participated in or directed

the violation, Taylor, 880 F.2d at 1045, implemented a policy so deficient as to be the moving

force of the violation, Hansen, 885 F.2d at 646, or by omitting to perform an act he was legally

required to do, Johnson, 588 F.2d at 743, such as failing to take adequate steps to address a

violation of which he knew or should have known. See Jones v. Williams, 297 F.3d 930, 937 &

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fn. 4 (9th Cir. 2002). Therefore, to survive summary judgment with respect to his claims against

Andreasen, Donahue and Bick, plaintiff had to adduce evidence that they were involved in an

Eighth Amendment violation in one of these ways. 

Prison officials violate the Eighth Amendment when they engage in “acts or omissions

sufficiently harmful to evidence deliberate indifference to serious medical needs.” Estelle v.

Gamble, 429 U.S. 97, 106 (1976). A prison official is deliberately indifferent when he knows of

and disregards a risk of injury or harm that “is not one that today’s society chooses to tolerate.” 

See Helling v. McKinney, 509 U.S. 25, 35 (1993); Farmer v. Brennan, 511 U.S. 825, 837 (1994). 

The official must “be aware of the facts from which the inference could be drawn that a

substantial risk of serious harm exists, and he must also draw the inference.” Farmer, 511 U.S.

at 837. Deliberate indifference “may be manifested in two ways. It may appear when prison

officials deny, delay or intentionally interfere with medical treatment, or it may be shown by the

way in which prison physicians provide medical care.” Hutchinson v. United States, 838 F.2d

390, 394 (9th Cir. 1988). When a prisoner alleges a delay in medical treatment, he must show

the delay caused an injury. See McGuckin v. Smith, 974 F.2d 1050, 1060 (9th Cir.1992),

overruled on other grounds, WMX Techs., Inc. v. Miller, 104 F.2d 1133, 1136 (9th Cir.1997)

(en banc); see also Wood v. Housewright, 900 F.2d 1332, 1334-35 (9th Cir.1990). The

prolonged experience of pain while waiting for medical attention can establish deliberate

indifference. See Hunt. Dental Dep't, 865 F.2d 198, 200-01 (9th Cir.1989) (concluding that

allegations of three-month delay in replacing dentures, which caused pain to prisoner, stated a

claim of deliberate indifference). However, the question of whether additional treatment is

necessary “is a classic example of a matter for medical judgment.” Estelle, 429 U.S. at 107. 

Prison physicians will not be found to have been deliberately indifferent with respect to such a

decision as long as the decision is medically acceptable under the circumstances. See Jackson v.

McIntosh, 90 F.3d 330, 331 (9th Cir. 1996) (“Where a defendant has based his actions on a

medical judgment that either of two alternative courses of treatment would be medically

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acceptable under the circumstances, plaintiff has failed to show deliberate indifference, as a

matter of law.”).

A. Seven Month Delay Between Appointments with Dr. Remington

As noted above, plaintiff alleged that defendants Andreasen, Mehta, Donahue and Bick

were deliberately indifferent to plaintiff’s serious medical needs by causing a seven-month delay

between appointments with Dr. Remington. Defendants Andreasen, Mehta, Donahue and Bick

contended that there is no genuine dispute about whether they were deliberately indifferent to

plaintiff’s serious medical needs. They assert there is no evidence that they knew of Dr.

Remington’s request but delayed approving it. It was undisputed that on August 14, 2002, Dr.

Remington requested that plaintiff return within 90 days and that plaintiff did not see Dr.

Remington again until at least April 2, 2003. To determine whether any of these defendants are

subject to liability, the court determined whether there was evidence that any of them knew of

Dr. Remington’s recommendation. 

Dr. Mehta was one of plaintiff’s treating physicians. Plaintiff’s primary care physician

was notified of Dr. Remington’s request. The court assumed, arguendo, that Dr. Mehta was the

primary care physician and he knew of the request. But it was undisputed that the UMC was

responsible for arranging the appointment and that it was not aware of the request. Plaintiff

submitted no evidence that the primary care physician could circumvent the UMC and make an

appointment for a prisoner to see a specialist outside the prison. Thus, even if Dr. Mehta was

responsible for conveying the request to the UMC (and there was no evidence to this effect), he

would be subject to liability only if he intentionally refused to convey it or did something to

interfere with the granting of the request once conveyed. As the party with the burden of proof

at trial, plaintiff had the burden of adducing evidence on this point in summary judgment

proceedings. Plaintiff failed in this regard. While Dr. Mehta may have been careless,

negligence is not co-equal with deliberate indifference. Estelle, 429 U.S. at 106. This court

found that on the evidence before it, a reasonable jury could not find that defendant Mehta,

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despite knowing of Dr. Remington’s August 14, 2002 request, interfered with plaintiff’s

treatment by intentionally refusing to convey the request to the UMC or by interfering with the

request after it was conveyed. Thus, defendant Dr. Mehta is entitled to judgment as a matter of

law on this claim.

Plaintiff also failed to satisfy his burden on this claim with respect to Andreasen. It was

undisputed that Andreasen became aware that Dr. Remington’s request for a follow-up

examination had not been fulfilled once plaintiff filed his grievance. In response, Dr. Andreason

promised that the papers required for the follow-up appointment would be processed. In less

than 20 days, plaintiff returned to Dr. Remington. Plaintiff submitted no evidence that Dr.

Andreasen, who was on the UMC, knew of Dr. Remington’s request before plaintiff filed the

grievance. In fact, Dr. Remington’s April 2, 2003, report was not timely placed into plaintiff’s

medical file. There was no evidence about who was responsible for filing and distributing these

records. The court found that on this evidence, no reasonable jury could find that Dr. Andreasen

was the responsible individual. Thus, Dr. Andreasen was entitled to judgment as a matter of law.

With respect to defendant Donahue, the outcome was the same. Plaintiff asserted that he

notified defendant Donahue in passing that his appointment with Dr. Remington was delayed. 

Defendant Donahue submitted evidence that his only involvement was to interview plaintiff

about the lack of a follow-up appointment and to relate that information to Dr. Andreasen. Even

if plaintiff did notify defendant Donahue in passing, the consequence of this fact was a matter of

pure speculation. There was no evidence that Donahue was in a position to ensure that the

appointment was made. He may have forgotten to convey the information to a person with such

authority. He might not have realized the significance of the information at the time. He might

have told a superior, who himself failed to act. There are a number of speculative possibilities. 

But a genuine issue of material fact cannot be based on speculation. It must be based on

evidence that could justify a judgment or verdict in favor of the non-moving party over the issue

in question. Anderson v. Liberty Lobby, Inc., 477 U.S. at 248, 252. On the evidence in the

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record, no reasonable jury could find in plaintiff’s favor on this issue. Therefore, defendant

Donahue is entitled to judgment as a matter of law on this claim.

Finally, the court found that there was no genuine issue for trial about defendant Bick’s

involvement. The evidence showed that Dr. Bick did nothing with respect to plaintiff’s health

care until April 15, 2003, when he signed an evaluation finding that plaintiff had degenerative

disc disease. There was no evidence that either of these defendants in any way caused the delay

between plaintiff’s August 14, 2003, appointment with Dr. Remington and the recommended

follow-up appointment. No reasonable jury could find for plaintiff, and defendants Donahue and

Bick were entitled to judgment as a matter of law.

B. Delay of Surgery

Plaintiff claimed that defendant Dr. Mehta delayed the revision surgery that Dr.

Remington suggested. Dr. Mehta contended that there was no evidence that he caused the delay. 

Dr. Remington raised the specter of revision surgery in his letter dated September 29, 2003. He

also recommended that plaintiff undergo a “discogram” before deciding whether to proceed with

surgery. It is undisputed that plaintiff did not undergo the surgery until a year later, on

September 29, 2004. Defendants submitted evidence that the MAR committee wanted other

opinions about the necessity of surgery and about whether plaintiff was a suitable candidate for it

before approving the surgery. Therefore, the committee referred plaintiff to a neurologist, Dr.

Capazzolli, and to a surgeon at UCSF-MC, Dr. Larson. There was no evidence that Dr. Mehta

was on the MAR. Nor was there any evidence that seeking these opinions was contraindicated

in plaintiff’s case. On this evidence, no reasonable jury could have found that Dr. Mehta knew

plaintiff required revision surgery, but acted to either directly or indirectly cause delay. 

Therefore, defendant Mehta was entitled to judgment as a matter of law on this claim.

C. Denial of Eggcrate Mattress

Plaintiff claimed that in December 2003, defendants Mehta and Bick failed to provide

plaintiff with an eggcrate mattress to ease discomfort in his arms, hands and neck. Defendants 

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 The signature is illegible.

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contended that there was no evidence they knew that failing to renew plaintiff’s authorization for

an eggcrate mattress posed a serious risk to plaintiff’s health. Defs.’ Mot. for Summ. J., at 11. It

was undisputed that about seven months before plaintiff’s initial surgery, the Chief Medical

Officer1

 authorized plaintiff to have an eggcrate mattress and to have a cervical pillow for

herniated dics in plaintiff’s neck, and that about two weeks after the surgery the Chief Medical

Officer approved plaintiff’s use of a wedge pillow because of the surgery. On December 5,

2003, Dr. Mehta recommended plaintiff have an eggcrate mattress for bed sores. Dr. Bick

denied the mattress because plaintiff was not prone to bedsores. It was not clear from the record

why plaintiff was given an eggcrate mattress for herniated cervical discs if such a mattress is not

medically indicated for this condition. However, nothing in the record suggested that plaintiff’s

post-operative condition made the special mattress a medical necessity. Thus, no reasonable jury

could have concluded that Dr. Mehta was deliberately indifferent by recommending an eggcrate

mattress for bedsores and not plaintiff’s post-operative condition. Neither could a reasonable

jury have found that Dr. Bick was deliberately indifferent by refusing to authorize the mattress. 

Therefore, defendants Mehta and Bick are entitled to judgment as a matter of law.

D. Absence of Allegations Against Defendant Khoury

The court found that it was unclear why plaintiff named Nadim K. Khoury as a

defendant. The complaint makes no specific allegations against him. Because plaintiff failed to

state a claim against defendant Khoury, judgment was entered in this defendant's favor as well.

II. Plaintiff’s Objections to the Findings and Recommendations

Plaintiff offered no valid legal or factual basis for rejecting the magistrate judge’s

findings and recommendations. Thus, the undersigned adopted them in full, granted defendants’

motion and directed that judgment be entered in their favor. Without plaintiff having made any

objection arguably showing that the magistrate judge’s decision was erroneous in some regard,

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he cannot make any successful argument on appeal. Thus, the court finds that the outcome of the

appeal is obvious and it is not taken in good faith. 

Accordingly, the court finds that plaintiff’s appeal is not taken in good faith. The Clerk

is directed to serve a copy of this order on the U.S. Court of Appeals for the Ninth Circuit.

Dated: December 5, 2007.

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