Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_16-cv-01243/USCOURTS-caed-1_16-cv-01243-0/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 28:1441 Petition for Removal- Civil Rights Act

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

PERVAIZ A. CHAUDHRY and VALLEY 

CARDIAC SURGERY MEDICAL 

GROUP,

Plaintiffs,

v.

KAREN SMITH, et al.,

Defendants.

Case No. 1:16-CV-1243-LJO-MJS

MEMORANDUM DECISION AND ORDER 

RE DEFENDANTS’ MOTION TO DISMISS

(ECF No. 7)

On June 17, 2016, Plaintiffs Pervaiz A. Chaudhry (“Chaudhry” or “Plaintiff”) and Valley 

Cardiac Surgery Medical Group (“VCSMG”) (collectively, “Plaintiffs”) commenced this action in 

Fresno County Superior Court against Defendants Karen Smith, in her official capacity as the 

Director of the California Department of Public Health (“CDPH”); Steven Lopez, in his personal 

capacity as the Fresno District Office Manager of the CDPH; Eric Creer, in his personal capacity as a 

CDPH employee; Bea Hensleit, in her personal capacity as a former Fresno District Office Manager 

of the CDPH; Shirley Campbell, in her personal capacity; Deidre Kappmeyer, in her personal 

capacity; and Does 1-10, inclusive (collectively, “Defendants”). ECF No. 1 at 10-301. Through this 

suit, Plaintiffs assert two claims against Defendants under 42 U.S.C. § 1983 (“§ 1983”), and seek 

both injunctive relief and monetary damages. Id

 

1

Pincites refer to CM/ECF pagination located at the top of each page. 

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Defendants subsequently removed the action to this Court, invoking federal question

jurisdiction under 28 U.S.C. § 1441. ECF No. 1. Plaintiffs filed a First Amended Complaint 

(“FAC”) on August 29, 2016. ECF No. 6. Now before the Court is Defendants’ motion to dismiss

the FAC pursuant to Federal Rule of Civil Procedure 12(b)(6).

2

ECF No. 7. Plaintiffs filed their

opposition (ECF No. 8), and Defendants replied (ECF No. 9). The matter is appropriate for 

resolution without oral argument. See E.D. Cal. L.R. 230(g). Having reviewed the record and the 

parties’ briefing in light of the relevant law, the Court DENIES Defendants’ motion in its entirety. 

LEGAL STANDARD

A motion to dismiss pursuant to Rule 12(b)(6) is a challenge to the sufficiency of the 

allegations set forth in the complaint. Dismissal under Rule 12(b)(6) is proper where there is either 

a “lack of a cognizable legal theory” or “the absence of sufficient facts alleged under a cognizable 

legal theory.” Balisteri v. Pacifica Police Dept., 901 F.2d 696, 699 (9th Cir. 1990). In considering a 

motion to dismiss for failure to state a claim, the court generally accepts as true the allegations in 

the complaint, construes the pleading in the light most favorable to the party opposing the motion, 

and resolves all doubts in the pleader’s favor. Lazy Y. Ranch LTD v. Behrens, 546 F.3d 580, 588 

(9th Cir. 2008).

To survive a 12(b)(6) motion to dismiss, the plaintiff must allege “enough facts to state a 

claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). 

“A claim has facial plausibility when the Plaintiff pleads factual content that allows the court to 

draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. 

Iqbal, 556 U.S. 662, 678 (2009). “The plausibility standard is not akin to a ‘probability 

requirement,’ but it asks for more than a sheer possibility that a defendant has acted unlawfully.” 

Id. (quoting Twombly, 550 U.S. at 556). “While a complaint attacked by a Rule 12(b)(6) motion to 

dismiss does not need detailed factual allegations, a plaintiff’s obligation to provide the ‘grounds’ 

of his ‘entitlement to relief’ requires more than labels and conclusions.” Twombly, 550 U.S. at 555 

(internal citations omitted). Thus, “bare assertions . . . amount[ing] to nothing more than a 

 

2 All further references to any “Rule” are to the Federal Rules of Civil Procedure, unless otherwise indicated. 

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‘formulaic recitation of the elements’ . . . are not entitled to be assumed true.” Iqbal, 556 U.S. at 

681. “[T]o be entitled to the presumption of truth, allegations in a complaint . . . must contain 

sufficient allegations of underlying facts to give fair notice and to enable the opposing party to 

defend itself effectively.” Starr v. Baca, 652 F.3d 1202, 1216 (9th Cir. 2011). In practice, “a 

complaint . . . must contain either direct or inferential allegations respecting all the material 

elements necessary to sustain recovery under some viable legal theory.” Twombly, 550 U.S. at 562. 

To the extent that the pleadings can be cured by the allegation of additional facts, a plaintiff should 

be afforded leave to amend. Cook, Perkiss and Liehe, Inc. v. Northern Cal. Collection Serv., Inc., 

911 F.2d 242, 247 (9th Cir. 1990) (citations omitted).

FACTUAL ALLEGATIONS3

Chaudhry is a Fresno-based cardiothoracic surgeon with a substantial interest in VCSMG, a 

California general partnership. FAC ¶ 1. Chaudhry, who came to Fresno in 2005, worked with other 

surgeons in VCSMG to establish a cardiac surgery program to serve the medical needs of the 

community, regardless of the patient’s ability to pay, and introduced new techniques to provide care 

for patients who were previously without options. Id. ¶ 13. Prior to the events leading up to this 

lawsuit, Chaudhry and other VCSMG surgeons were active members of the medical staff at 

Community Regional Medical Center (“CRMC”) and other local hospitals in the Fresno area, and 

Chaudhry had an “outstanding” reputation amongst patients, colleagues, and hospitals. Id. ¶ 15. 

On April 2, 2012, Chaudhry performed surgery on Mr. Silvino Perez at CRMC. Id. ¶ 16. 

Chaudhry was continuously present during the surgery and did not leave the operating room to 

speak until after he completed the surgery and Perez had stabilized. Id. ¶ 17. 

On April 11, 2012, unbeknownst to Plaintiffs, CDPH received an anonymous complaint 

falsely alleging that Chaudhry left the operating room while Perez’s chest was still open and left the 

hospital before the surgery was complete, leaving the physician’s assistant to take over the surgery, 

and that Perez entered cardiac arrest. Id. ¶ 18. The caller was not present in the operating room 

during the surgery and his identity was unknown until 2014. Id.

 

3 These allegations are drawn from the FAC, the truth of which the Court must assume for purposes of a Rule 12(b)(6) 

motion to dismiss.

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On or about April 16, 2012, CDPH (including Defendants Kappmeyer and Campbell, who 

were CDPH investigators) began its initial investigation of the anonymous complaint, which 

included an on-site visit to CRMC from April 17-19, 2012, and interviews with CRMC personnel. 

Id. ¶ 19. However, Defendants did not interview Chaudhry, his physician’s assistant, the assistant 

surgeon, or the anesthesiologist during their on-site visit to CRMC. Id. ¶ 20. 

From July 10-17, 2012, Campbell and Kappmeyer conducted further investigations at 

CRMC regarding the April 2 surgery. Id. ¶ 21. On July 13, 2012, Kappmeyer and Campbell 

interviewed Chaudhry without advance notice, and took copious detailed notes during the 

interview. Id. However, CDPH investigators again failed to interview CRMC staff members who 

had been present during the April 2 surgery, but only interviewed again the individuals they had 

previously interviewed during their earlier visit. Id. Furthermore, CDPH investigators “failed to 

review the full medical record available to them, or they negligently failed to understand the 

significance of what they were reading in terms of whether the information in the medical record 

supported the allegations in the complaint or refuted it,” including information that would 

demonstrate that the allegation that Chaudhry left the operating room was false. Id. ¶ 22-23.

CDPH issued to CRMC its initial report containing false allegations against Chaudhry on 

July 17, 2012. Id. ¶ 28. On July 27, 2012, as a result of the CDPH investigation and report, 

Chaudhry was removed from his position as medical director of cardiac surgery. Id.

On August 8, 2012, CDPH sent CRMC a non-public letter containing citations for noncompliance with applicable government conditions, and allowed CRMC the opportunity to review 

and respond to its report about the April 2 surgery, without any public disclosure. Id. ¶ 24. This 

report contained numerous significant errors and misquotes, including some quotations attributed to 

Chaudhry that he did not actually make. Id. Chaudhry was not permitted to contest the report, and 

his attempts to persuade CRMC leadership and other officials to contest said report failed. Id. ¶ 26. 

In February 2013, CRMC submitted its plan of correction to CDPH, which the state 

accepted. Id. ¶ 27. CDPH then publicly disclosed the entire report in March 2013 and assessed 

against CRMC a $75,000 administrative fine. Id. Shortly thereafter, the Fresno Bee published an 

article about this administrative penalty, referencing the CDPH report, and linking it to the April 2 

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surgery that Chaudhry had performed on Perez. Id. Subsequently, Perez’s family filed a medical 

malpractice lawsuit against Chaudhry that was based substantially on allegations contained in the 

April 11, 2012 anonymous complaint and the final CDPH report. Id. The Perez family’s lawsuit 

was widely publicized. Id. ¶ 29. Furthermore, five additional malpractice lawsuits based upon the 

Perez lawsuit and the CDPH report were filed against Plaintiffs. Id.

In June 2014, Plaintiffs’ counsel obtained the handwritten notes of CDPH investigators 

while representing him in the malpractice suits. Id. ¶ 30. Between July 2014 and June 2015, 

Plaintiffs endeavored to correct the CDPH report through administrative channels. Id. ¶¶ 30-49. 

CDPH counsel informed Plaintiffs’ counsel that it was reviewing the entire investigative file and 

requested additional information and documents, which Plaintiffs’ counsel provided. Id. ¶¶ 35-36.

Plaintiffs’ counsel additionally informed CDPH that the Medical Board of California had 

completed its investigation and determined that there were no grounds for discipline against 

Chaudhry in December 2014. Id. ¶ 42. After further communications, CDPH counsel told 

Plaintiffs’ counsel that CDPH was “seriously contemplating changing the report.” Id. ¶ 47. CDPH 

counsel emailed Plaintiffs’ counsel on May 30, 2015 to inform him that a final decision would be 

made soon. Id. ¶ 48. However, on June 19, 2015, CDPH counsel informed Plaintiffs’ counsel that 

CDPH would not correct the report. Id. ¶ 50. 

On July 9, 2015, Plaintiffs’ counsel made a request pursuant to the Public Records Act for 

the names of persons at CDPH who had made the determination not to alter, change, or withdraw 

the CDPH report and documentation received from third parties regarding these decisions. Id. ¶ 53. 

Through CDPH’s August 4, 2015 response, Plaintiffs’ counsel learned that Defendants Creer and 

Lopez were involved in a meeting that occurred on June 17, 2015 regarding the report. Id.

As a result of CDPH’s conduct, Plaintiffs claim that they have suffered grievous and 

irreparable damage to their reputations. Id. ¶ 15. Thus, Plaintiff now brings the following causes of 

action: (1) against Defendant Smith, a violation of Plaintiffs’ due process rights pursuant to § 1983, 

for which Plaintiffs seek an injunction enjoining CDPH from re-broadcasting the report, and 

ordering CDPH to retract said report and issue a new report; and (2) against the remaining 

Defendants, the violation of Plaintiffs’ due process rights pursuant to § 1983 by their involvement 

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in the investigation and preparation of the report and failure to correct the report, for which 

Plaintiffs seek monetary damages for emotional distress and economic harm. Id.

DISCUSSION

I. Timeliness 

Defendants first argue that Plaintiffs’ claims should be dismissed as barred by the two-year 

statute of limitations4generally applicable to § 1983 claims. ECF No. 7-1 at 9-11. According to 

Defendants, the FAC indicates that Plaintiffs’ claims had accrued by December 2013, and their 

claims are untimely because they filed their original complaint in state court on June 17, 2016. Id.

Specifically, Defendants note (1) that as early as July 2012, Plaintiffs had knowledge that CDPH 

had begun its investigation of the anonymous complaint; (2) because Chaudhry was removed as 

medical director of cardiac surgery at CRMC on July 27, 2012, and in March 2013, CDPH imposed 

a $75,000 fine on CRMC, Plaintiffs had knowledge of the alleged damage caused by the report as 

early as March 2013; and (3) the Perez family filed their malpractice lawsuit, based upon the report, 

against Chaudhry in December 2013, which would have enabled Plaintiffs to investigate the bases 

for their lawsuit by using civil discovery at that time. Id. at 10-11. 

Against this argument, Plaintiffs assert that that pursuant to the California Supreme Court’s 

decision in McDonald v. Antelope Valley Community College District, 45 Cal. 4th 88, 99 (2008), 

equitable tolling applies in their situation because they voluntarily elected to pursue an alternative 

administrative remedy to correct the CDPH report. ECF No. 8 at 16-17. 

Equitable tolling is a “judicially created, nonstatutory doctrine ... designed to prevent unjust 

and technical forfeitures of the right to a trial on the merits when the purpose of the statute of 

limitations—timely notice to the defendant of the plaintiff’s claims—has been satisfied.” 

McDonald, 45 Cal. 4th at 99 (internal citations omitted). The doctrine applies “‘(w)hen an injured 

person has several legal remedies and, reasonably and in good faith, pursues one.’” Elkins v. Derby, 

12 Cal. 3d 410, 414 (1974) (en banc) (quoting Myers v. Cty. Of Orange , 6 Cal. App. 3d 626, 634 

 

4

“For actions under 42 U.S.C. § 1983, courts apply the forum state's statute of limitations for personal injury actions, 

along with the forum state's law regarding tolling, including equitable tolling, except to the extent any of these laws is 

inconsistent with federal law.” Jones v. Blanas, 393 F.3d 918, 927 (9th Cir.2004). In California, the statute of limitations 

for personal injury actions is two years. Cal. Code. Civ. Proc. § 335.1. 

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(1970)). McDonald reiterated the long-held principle that courts may permit equitable tolling when 

a plaintiff voluntarily pursues an alternate administrative remedy to address her grievance so long 

as three requirements are satisfied: “timely notice, and lack of prejudice, to the defendant, and 

reasonable and good faith conduct on the part of the plaintiff.” 45 Cal. 4th at 101-02 (citing 

Campbell v. Graham-Armstrong, 9 Cal. 3d 482 (1973), Elkins, 12 Cal. 3d 410, and Addison v. State 

of California, 21 Cal. 3d 313 (1978)). McDonald then held that a plaintiff who had voluntarily filed 

an internal administrative procedure to resolve her employment discrimination grievance could 

invoke equitable tolling to file her case in state court after the relevant statute of limitations had 

expired. Id. at 105. 

The Court agrees with Plaintiffs and finds that McDonald applies here. As a preliminary 

matter, the Ninth Circuit has held that “[a] motion to dismiss based on the running of the statute of 

limitations period may be granted only if the assertions of the complaint, read with the required 

liberality, would not permit the plaintiff to prove that the statute was tolled.” Supermail Cargo v. 

United States, 63 F.3d 1204, 1206 (9th Cir. 1995) (internal citations omitted). Here, the factual 

allegations permit Plaintiffs to demonstrate that the statute may be tolled, as they clearly indicate 

that in September 2014, Plaintiffs voluntarily began an alternative procedure within CDPH to 

resolve their issues with the report, a process that extended until June 2015, and that Plaintiffs had 

some reason to believe that this procedure could result in correcting the CDPH report.

5

FAC ¶¶ 30-

49. This internal procedure, like the one in McDonald, appeared to offer Plaintiffs “a full 

opportunity to formally or informally resolve a dispute in a way that [had the possibility of] 

minimiz[ing] or eliminat[ing] entirely the need for further judicial proceedings.” 45 Cal. 3th at 105.

The Court finds that Plaintiffs’ allegations here are sufficient to satisfy the third requirement 

set forth in McDonald, in that they demonstrate that good faith conduct on the part of Plaintiffs to 

wait until the conclusion of the administrative proceeding before filing suit. See, e.g., McEnroe v. 

 

5 Defendants argue that that CDPH counsels’ statements reflect merely “that CDPH was considering the matter in good 

faith, and that the possibility of changing the report was being considered,” ECF No. 9 at 6 (emphasis in original), thereby 

implying that CDPH counsels’ comments should not have deterred Plaintiffs from filing suit earlier. At this stage of the 

proceedings, however, the Court declines to entertain Defendants’ interpretation of the factual allegations because of its 

obligation to construe the factual allegations in the light most favorable to Plaintiffs. The Court finds that these allegations 

do not foreclose Plaintiffs from demonstrating that they are eligible for equitable tolling. Starr, 652 F.3d at 1216 (“If there 

are two alternative explanations, one advanced by defendant and the other advanced by plaintiff, both of which are 

plausible, plaintiff's complaint survives a motion to dismiss under Rule 12(b)(6).”)

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AT&T Mobility Svcs., LLC., No. 15-cv-02190-HSG, 2015 WL 5168671, at *3 (N.D. Cal. Sept. 3, 

2015). Moreover, Plaintiffs now seek essentially the same relief through the pending suit that they 

sought through the internal procedure. Therefore, Defendants (all of whom are or were affiliated 

with CDPH) clearly had notice of Plaintiffs’ claims against them, satisfying the first requirement of 

McDonald. See 45 Cal. 4th at 102 (“The filing of an administrative claim ... affords a defendant 

notice of the claims against it so that it may gather and preserve evidence, and thereby satisfies the 

principal policy behind the statute of limitations.”). Relatedly, Defendants have not demonstrated 

that they would suffer any prejudice, indicating that the final McDonald requirement has been met. 

See id. Accordingly, the Court finds that Plaintiffs’ claims were equitably tolled during the 

pendency of Chaudhry’s internal grievance with CDPH, which spanned from approximately 

September 2014 to June 2015. See id.

Having found that equitable tolling pursuant to McDonald should apply here6, the Court 

now turns to the question of whether Plaintiffs’ claims were timely filed. This inquiry depends upon

the date that Plaintiffs’ claims had accrued, which would begin the two-year statute of limitations 

period. See Jolly v. Eli Lilly & Co., 33 Cal. 3d 1103, 1114 (1988) (“the limitations period begins 

when the plaintiff suspects, or should suspect, that she has been wronged.”). Plaintiffs assert that 

their claims did not accrue until June 2014. ECF No. 8 at 15-16. As mentioned above, Defendants 

contend that Plaintiffs’ claims had accrued as of December 2013, ECF No. 9 at 4, which would 

mean that the deadline to file this suit passed in December 2015. However, even assuming the 

earlier accrual date of December 2013, the Court would still need to account for the nine-month 

period of equitable tolling from September 2014 until June 2015. “[T]he effect of equitable tolling 

is that the limitations period stops running during the tolling event, and begins to run again only 

when the tolling event has concluded.” Lantzy v. Centex Homes, 31 Cal. 4th 363, 370 (2003) 

(emphasis in original). When the equitable tolling period, September 2014 - June 2015, is taken into 

account, the deadline to file was extended until approximately August 2016. To be clear, ten 

 

6 Defendants’ reply fails to explain why equitable tolling pursuant to McDonald should not apply here. See ECF No. 9 at 

2-6. Rather, Defendants appear to conflate the doctrines of equitable estoppel and equitable tolling, as they premise their 

opposition to Plaintiffs’ equitable tolling argument on the notion that Plaintiffs have not established the requirements for 

equitable estoppel. See id. Because equitable estoppel is not at issue in this case, Defendants’ arguments to this point are 

inapposite. 

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months elapsed between the accrual of Plaintiffs’ claims (December 2013) and the beginning of the 

equitable tolling period (September 2014). The tolling period began again when CDPH notified 

Plaintiffs in June 2015 that they would not change the report, leaving Plaintiffs fourteen remaining 

months (until August 2016) within which to file this suit. Thus, because Plaintiffs filed the 

complaint in June 2016, they filed within two years of their claims’ accrual. 

For these reasons, the Court finds that Plaintiffs’ claims were timely filed and DENIES the 

motion to dismiss on this ground. 

II. Prosecutorial Immunity 

The second basis upon which Defendants seek dismissal of the FAC is prosecutorial 

immunity. ECF No. 7-1 at 11-14. Under the Supreme Court’s decision in Butz v. Economou, 

government officials who perform judicial, quasi-judicial or prosecutorial functions may claim 

absolute immunity for their judicial, quasi-judicial and prosecutorial acts. 438 U.S. 478, 514-15

(1978). Because each Defendant was a CDPH employee acting under color of California law, 

Defendants contend that prosecutorial immunity precludes Plaintiffs’ claims against them. Id. In 

support of this argument, Defendants note that the California Health & Safety Code requires CDPH 

to investigate, inspect and make determinations of “adverse events” reported by health facilities,

and to publish and share its written reports expressing the determinations of these adverse events, 

and that licensees may request a hearing if they dispute a determination by CDPH . Id. (citing Cal. 

Health & Safety Code §§ 1278, 1278.5, 1279.1, 1279(d), 1279.2(a) & (b), 1279.3(b)), 1280.1(b). 

Plaintiffs argue that Defendants cannot claim absolute immunity because the individual 

Defendants were acting in an investigatory, rather than judicial or prosecutorial function. ECF No. 

8 at 18-21. Plaintiffs also analogize this situation to other contexts in which courts have denied 

absolute immunity, such as school board members sitting in as adjudicators in student disciplinary 

proceedings, Wood v. Strickland, 420 U.S. 308, 320-22 (1975), and prison employees deciding 

prison disciplinary proceedings, Cleavinger v. Saxner, 474 U.S. 193, 205-06 (1985). ECF No. 8 at 

21. Plaintiffs also emphasize that the California Health & Safety Code only affords licensees the 

opportunity to request a hearing, and that because they were not licensees, they never had the

opportunity for a hearing to dispute CDPH’s determination. Id. 

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The Court agrees with the position of the Plaintiffs. Defendants bear the burden of 

demonstrating that they are entitled to absolute immunity. Stapley v. Pestalozzi, 733 F.3d 804, 811 

(9th Cir. 2013). Here, Defendants have failed to meet this burden because they have not 

demonstrated that their actions were sufficiently analogous to those of a prosecutor or a judge. The 

Supreme Court has identified six factors “as characteristic of the judicial process” for courts to 

consider in determining whether government officials are entitled to absolute or qualified 

immunity: 

(a) the need to assure that the individual can perform his functions without harassment or 

intimidation; (b) the presence of safeguards that reduce the need for private damages actions 

as a means of controlling unconstitutional conduct; (c) insulation from political influence; 

(d) the importance of precedent; (e) the adversary nature of the process; and (f) the 

correctability of error on appeal.

Cleavinger, 474 U.S. at 202 (citing Butz, 438 U.S. at 511). The Court does not dispute that CDPH 

investigators should be able to perform their functions without harassment or intimidation, and the 

Court does not believe that the factors regarding insulation from political influence and the 

importance of precedent are relevant in this situation. However, the remaining factors applicable to 

this situation direct the Court to find that Defendants are not entitled to prosecutorial immunity. The 

FAC alleges that Plaintiffs themselves had no means of contesting the CDPH investigation or 

officially appealing the report, but that only CRMC had the ability to do so. In other words, 

Plaintiffs have alleged that they had essentially no input into CDPH’s investigation and no official 

recourse from CDPH’s determination not to change its report, and therefore lacked the protections 

afforded to individuals in judicial proceedings as referenced in Butz. ECF No. 8 at 21. Defendants’ 

reply offers nothing to rebut Plaintiffs’ arguments. Therefore, the Court DENIES Defendants’ 

motion to dismiss on the basis of prosecutorial immunity. 

III. Eleventh Amendment 

Next, Defendants assert that Defendant Karen Smith, director of CDPH, is immune from 

suit under the Eleventh Amendment and that this Court lacks jurisdiction. ECF No. 7-1 at 14-16. 

Plaintiffs oppose on the grounds that the FAC sufficiently allege that this case should fall 

within the exception to Eleventh Amendment immunity identified in Ex Parte Young, 209 U.S. 123 

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(1908), because Plaintiffs seek declaratory and injunctive relief on the basis of federal 

constitutional law. ECF No. 8 at 21-22. 

Plaintiffs are correct on this issue. It is well-established that the Eleventh Amendment 

generally bars suits against states, their agencies, and employees acting in their official capacity. 

Aholelei v. Dept. of Public Safety, 488 F.3d 1144, 1147 (9th Cir. 2007) (citations omitted). 

However, pursuant to the Supreme Court’s decision in Ex Parte Young, an exception to the 

Eleventh Amendment exists for suits for prospective declaratory injunctive relief against state 

officers, sued in their official capacities to enjoin an alleged ongoing violation of federal law. See 

Agua Caliente Band of Cahuilla Indians, 223 F.3d 1041, 1045 (9th Cir. 2005)); see also Mohsin v. 

Cal. Dep’t of Water Res., No. 2:13-cv-01236-TLN-EFB, 2015 WL 7282904, at *4 (Nov. 18, 2015)

(finding that the Ex Parte Young doctrine applied because the plaintiff sought prospective 

injunctive relief under federal law against state government defendants). The FAC alleges 

violations of Plaintiffs’ due process rights under the Fourteenth Amendment requests prospective 

injunctive relief—a declaration by the Court ordering Defendant Smith in her official capacity to 

withdraw the report and publish a new report “vindicating” Plaintiffs and an injunction enjoining 

CDPH from re-broadcasting the original report. FAC ¶¶ 69, 71. Defendants, in their reply, 

misapprehend the FAC and the nature of the requested relief, as they cite only case law that federal 

courts lack jurisdiction to instruct state officials on how to conform their conduct to state law. 

Defendants’ jurisdictional argument is clearly inapposite in this case, given that Plaintiffs have 

alleged violations of their constitutional rights under federal law and seek prospective, not 

retrospective relief. See ECF No. 9 at 7. The Court further finds that Karen Smith is properly named 

as a defendant because she is sued in her official capacity as director of the CDPH for prospective 

declaratory and injunctive relief pursuant to § 1983. Freedom From Religion Found., Inc. v.

Geithner, 715 F. Supp. 2d 1051, 1058-59 (E.D. Cal. 2010) (“When sued for prospective injunctive 

relief, a state official in her official capacity is considered a ‘person’ for § 1983 purposes.”). 

Accordingly, the Court DENIES Defendants’ motion to dismiss on these grounds. 

//

//

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IV. Qualified Immunity 

Finally, Defendants argue that this case should be dismissed on the basis of qualified 

immunity, because the FAC has failed to allege facts sufficient to show that the contours of 

Plaintiffs’ constitutional rights were “sufficiently clear that a reasonable official would understand 

that what he is doing violates that right,” and that the “unlawfulness [was] apparent.” ECF No. 7-1 

at 18 (quoting Sinaloa Lake Owners Ass’n v. City of Simi Valley, 70 F.3d 1095, 1099 (9th Cir. 

1995)). 

Plaintiffs counter that Defendants are not entitled to a qualified immunity defense because 

they “cannot claim they could objectively feel their conduct was lawful; that is, intentionally filing 

a false CDPH report and/or not interviewing key witnesses, nor obtaining readily retrievable 

objective documentary electronic evidence showing that the report was false.” ECF No. 8 at 22. 

The Supreme Court has “repeatedly ... stressed the importance of resolving immunity 

questions at the earliest possible stage in litigation.” Hunter v. Bryant, 502 U.S. 224, 227 (1991). 

Nevertheless, “a Rule 12(b)(6) dismissal is not appropriate unless [the Court] can determine, based 

on the complaint itself, that qualified immunity applies.” Groten v. California, 251 F.3d 844, 851 

(9th Cir. 2001). At this stage of proceedings, the Court examines whether the FAC sufficiently 

alleges the violation of a specific constitutional right, whether this right was so clearly established 

as to alert a reasonable individual similarly-situated to Defendants of its constitutional parameters, 

and whether this reasonable individual would have believed that his conduct was lawful. See Via v. 

City of Fairfield, 833 F. Supp. 2d 1189, 1195 (E.D. Cal. 2011) (quoting McDade v. West, 223 F.3d 

1136, 1142 (9th Cir. 2000)). The FAC alleges that 1) Defendants violated Plaintiffs’ Fourteenth 

Amendment due process rights through the publication of a report containing false statements that 

Chaudhry left the operating room during an open-heart surgery and their refusal to correct the 

report despite being presented with evidence that the report contained false statements; 2) that this 

publication resulted in Chaudhry’s removal from his position as medical director of cardiac surgery

at CRMC; and 3) Defendants’ actions significantly and irreparably harmed Plaintiffs’ reputation 

and further caused Plaintiffs significant economic harm. 

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In analyzing Defendants’ qualified immunity claim, the Court will first determine whether 

Plaintiffs have adequately alleged that Defendants violated their Fourteenth Amendment due 

process rights. Although it is well-established that “injury to reputation, standing alone, is not a 

liberty or property interest sufficient to invoke the procedural protections contained in the Due 

Process Clause of the Fourteenth Amendment,” the Supreme Court’s decision in Paul v. Davis, 424 

U.S. 694 (1976), “le[ft] open the door to what has come to be known as the ‘stigma-plus’ claim.” 

Eberhard v. Cal. Highway Patrol, 73 F. Supp. 3d 1122, 1130 (N.D. Cal. 2014) (citing WMX Techs, 

Inc. v. Miller, 197 F.3d 367, 376 (9th Cir. 1999) (en banc)). To plead a “stigma-plus” claim, a 

plaintiff must show “the public disclosure of a stigmatizing statement by the government, the 

accuracy of which is contested, plus the denial of ‘some more tangible interest [] such as 

employment,’ or the alteration of a right or status recognized by state law,” and that he received 

inadequate process for this deprivation. See Ulrich v. City and Cty. of San Francisco, 308 F.3d 968,

982 (9th Cir. 2002) (quoting Paul, 424 U.S. at 701, 711); Westfall v. City of Crescent City, No. CV 

10-4222 NJV, 2011 WL 2110306, at *7-8 (N.D. Cal. May 26, 2011). 

Under this standard and in light of its obligation to construe the factual allegations in the 

light most favorable to Plaintiffs, the Court finds that the FAC adequately alleges a violation of 

Plaintiffs’ Fourteenth Amendment procedural due process rights. First, the FAC’s allegations 

regarding CDPH’s publication of the report falsely stating that Chaudhry left the operating room 

during open-heart surgery constitutes a “stigmatizing statement,” because the report led to 

Chaudhry’s removal from his position at CRMC and substantial damage to his reputation amongst 

patients, colleagues, and the community at large. Stretten v. Wadsworth Veterans Hosp., 537 F2d 

361, 366 (9th Cir. 1976) (citing Board of Regents v. Roth, 408 U.S. 564, 572 (1972)) (“[t]he ‘liberty 

interest’ is the interest an individual has in being free to move about, live, and practice his 

profession without the burden of an unjustified label of infamy”). Relatedly, Chaudhry’s loss of his 

employment as the result of Defendants’ conduct constitutes the denial of a tangible liberty or 

property interest that triggers the Fourteenth Amendment’s due process protections. See Wenger v. 

Monroe, 282 F.3d 1068, 1074 (9th Cir. 2002) (citing Llamas v. Butte Cmty. Coll. Dist., 238 F.3d 

1123, 1129 (9th Cir. 2001)); Gini v. Las Vegas Metro. Police Dept., 40 F.3d 1041, 1044 (9th Cir. 

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1994) (“Discharge assumes a constitutional dimension when the employee has a property interest in 

continued employment, or a liberty interest in not being defamed, as a result of which she may not 

be terminated without due process”). Finally, Plaintiffs’ allegation that they were never given the 

opportunity to contest the report is sufficient to demonstrate that they did not receive due process 

for the deprivation. Matthews v. Harney County, Or. School Dist. No 4, 819 F.2d 889, 892 (9th Cir. 

1987). As mentioned above, Cal. Health & Safety Code § 1280.1 provides only licensees with the 

opportunity to request a hearing to correct deficiencies in CDPH reports, and Plaintiffs have alleged 

that Chaudhry was not a licensee afforded with this opportunity. 

Having found that Plaintiffs sufficiently alleged a violation of their Fourteenth Amendment 

rights, the Court must next evaluate whether there is sufficient causation between Defendants and 

the alleged “stigma-plus” constitutional violation. See Tibbetts v. Kulongoski, 567 F.3d 529, 539 

(9th Cir. 2009). As observed by the Northern District in Eberhard, the Ninth Circuit has not 

explicitly held that the “stigma” and “plus” elements need to be committed by the same government 

actor to state a due process claim, and there is a circuit split on the issue. 73 F. Supp. 3d at 1131. 

However, the Ninth Circuit has recognized that in the context of § 1983 claims, “[t]he requisite 

causal connection can be established not only by some kind of direct personal participation in the 

deprivation but also by setting in motion a series of acts by others which the actor knows or 

reasonably should know would cause others to inflict the constitutional injury.” Gini, 40 F.3d at 

1044 (quoting Merritt v. Mackey, 827 F.2d 1368, 1371 (9th Cir. 1987)). Here, the FAC alleges that 

Defendants, by their publication of the report, caused Chaudhry to be removed from his position at 

CRMC, and that Defendants knew or should have known that the report contained false information 

about Chaudhry, and that Defendants knew or should have known that the report would 

“significantly, substantially and irreparably harm Plaintiffs’ reputation and cause significant 

economic injury to Plaintiffs.” FAC ¶ 73. At this stage of proceedings, these allegations are 

sufficient to state a claim under § 1983 that Defendants violated Plaintiffs’ Fourteenth Amendment 

due process rights. 

Regarding Defendants’ contention that such rights were not clearly established in 2012-13, 

the Court notes that Paul, the Supreme Court case that forms the foundation for the “stigma-plus” 

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doctrine, was decided in 1976. As the cases cited above demonstrate, the Ninth Circuit and its 

district courts have continued to apply the doctrine in the decades that followed, and as early as 

1987, began using the term “stigma-plus.” See, e,g., Castenada v. U.S. Dept. of Agriculture, 807 

F.2d 1478, 1480 (9th Cir. 1987). In line with these cases, the Court has determined that Plaintiffs 

adequately pleaded that Defendants violated their Fourteenth Amendment due process rights, that 

these rights were clearly established at the time of the violation, and that reasonable individuals in 

Defendants’ positions could not have believed that their actions were lawful. Therefore, the Court 

DENIES Defendants’ motion to dismiss on qualified immunity grounds. 

CONCLUSION AND ORDERS

For these reasons, Defendants’ motion to dismiss is DENIED IN ITS ENTIRETY. 

Defendants must answer the FAC within twenty-one (21) days of the date of this Order. 

IT IS SO ORDERED.

Dated: December 16, 2016 /s/ Lawrence J. O’Neill _____ 

UNITED STATES CHIEF DISTRICT JUDGE

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