Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_14-cv-05398/USCOURTS-cand-3_14-cv-05398-2/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

STEVEN HADEN,

Plaintiff,

v.

J. ESPINOZA, et al.,

Defendants.

Case No. 14-cv-05398-SI 

ORDER GRANTING SUMMARY 

JUDGMENT FOR DEFENDANTS

Re: Dkt. No. 19

INTRODUCTION

Steven Haden filed this pro se prisoner’s civil rights action under 42 U.S.C. § 1983. The 

court screened the complaint and found that it stated a cognizable claim against two defendants for 

deliberate indifference to medical needs. Defendants have moved for summary judgment against 

Haden. Haden has not filed an opposition to the motion. For the reasons discussed below, the 

motion will be granted and judgment entered in defendants’ favor. 

BACKGROUND

The claim remaining for adjudication concerns two prison doctors’ refusal to renew 

Haden’s prescription for Konsyl (psyllium) and refusal to refer him to a specialist for further 

medical evaluation. The following facts are undisputed unless otherwise noted: 

Steven Haden is a prisoner of the State of California, in the custody of the California 

Department of Corrections and Rehabilitations. Haden is housed in San Quentin State Prison. 

The remaining defendants are Dr. J. Espinoza, who saw Haden for two chronic care medical 

appointments in 2013, and Dr. E. Tootell, the chief medical executive at San Quentin.

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The events and omissions giving rise to the complaint occurred at San Quentin State Prison 

from March 2013 through September 2013.

Haden had chronic intermittent constipation for many years. A variety of medications had 

been prescribed for him over the years, and he had been advised to increase the fiber in his diet, to 

increase his water intake and to exercise. According to Dr. Tootell, the treatment for chronic 

constipation generally is “to prescribe more fiber and water in the diet, and exercise by the patient. 

Medications such as laxatives and stool softeners also may be prescribed.” Docket No. 19-1 at 2.

On March 22, 2013, Dr. Espinoza saw Haden for a chronic care appointment, which 

included consideration of his chronic constipation.1 At that time, Haden was taking three 

medicines for his constipation: lactulose, magnesium oxide, and Konsyl (psyllium). Docket No.

19-4 at 32. Upon examining Haden, Dr. Espinoza wrote the following assessment and plan: “We 

will continue the current regimen. It is doing better now even though he is still requiring the same 

medications. Previously, they were thinking about sending him to GI for consult, but that is not 

needed now. We will continue current medications and follow.” Docket No. 19-4 at 32. 

On March 23, 2013, Dr. Tootell approved Dr. Espinoza’s non-formulary2drug request for 

magnesium oxide for Haden’s constipation for one more year.

On June 19, 2013, Haden’s prescription for Konsyl (psyllium) expired. Id. at 33. 

On September 5, 2013, Dr. Espinoza saw Haden for another chronic care appointment. 

Because his prescription for Konsyl had expired more than two months earlier, Haden was only 

taking lactulose and magnesium oxide to treat his constipation. Id. at 18. During the exam, Haden 

showed extreme discontent that Konsyl was no longer being prescribed for him. Id. Despite his 

discontent, Haden showed no symptoms of constipation (e.g., Dr. Espinoza noted that he had a 

soft, non-tender and non-distended abdomen) and he told Dr. Espinoza that he had bowel 

movements regularly, sometimes “two times a day.” Id. Dr. Espinoza wrote that Haden “actually 

does not seem to be constipated. I tried to explain to him that he is having bowel movements just 

 

1 Haden had three chronic medical problems listed for his chronic care appointments in 2013: 

hepatitis C, history of mental illness, and chronic constipation.

2 Non-formulary drugs are not on the prison pharmacy list. Docket No. 19 at 4.

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United States District Court

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about every day and sometimes more than once a day and does not quite meet the definition of 

constipation at this time and I also tried to reassure him that he does not have to have bowel 

movements multiple times a day.” Docket No. 19-4 at 18. She noted that Haden had “been out of 

the Konsyl for a few months and is currently having regular bowel movements.” Id. During this 

evaluation, Dr. Espinoza ruled out the need for additional Konsyl or a colonoscopy based on the 

lack of any “significant symptoms consistent with severe constipation,” but left the possibility of a 

future colonoscopy open, as a potential option should such symptoms develop. Id. At the 

September 5, 2013 appointment, Dr. Espinoza explained that Konsyl was non-formulary, and she 

offered to put in the paperwork to request the non-formulary Konsyl but thought there was a good 

chance it would not be granted. Id. The request was denied on September 6, 2013 by Dr. Pratt, 

the acting chief medical officer, because Haden’s condition had improved without the Konsyl. Id.

at 17.3

In May 2014, Dr. Tootell approved Dr. Pachynski’s non-formulary drug request for 

Citrucel, a laxative, for Haden’s chronic constipation.

In September 2014, Dr. Pachynski noted that Haden was complaining of nausea and 

having multiple bowel movements a day with hard and small stools. She told Haden she would 

make a referral to the GI specialist. Docket No. 19-3 at 24. A colonoscopy was done on Haden 

on June 12, 2015, and showed a normal colon. The doctor who performed the colonoscopy 

recommended increased fiber and water intake for constipation, and a repeat colonoscopy in ten 

years. Docket No. 19-2 at 51-53.

LEGAL STANDARD FOR SUMMARY JUDGMENT

Summary judgment is proper where the pleadings, discovery and affidavits show that 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). The Court will grant summary judgment “against a party who fails to 

 

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The reasons for approval of use of a non-formulary drug in the prison were: (a) treatment 

failures with medications listed in the formulary; (b) documented allergy, side effect, or adverse 

reaction that prevent the use of a formulary medication; and (c) certain exceptions for new 

medications that may save a life or prevent significant morbidity. Docket No. 19-1 at 4.

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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 . . . since a complete failure of proof 

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

immaterial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986); see also Anderson v. Liberty 

Lobby, Inc., 477 U.S. 242, 248 (1986) (a fact is material if it might affect the outcome of the suit 

under governing law, and a dispute about a material fact is genuine “if the evidence is such that a 

reasonable jury could return a verdict for the nonmoving party.”) The moving party bears the 

initial burden of identifying those portions of the record which demonstrate the absence of a 

genuine issue of material fact. The burden then shifts to the nonmoving party to “go beyond the 

pleadings and by her own affidavits, or by the ‘depositions, answers to interrogatories, and 

admissions on file,’ designate ‘specific facts showing that there is a genuine issue for trial.’” 

Celotex, 477 U.S. at 324 (citations omitted.) The Court’s function on a summary judgment motion 

is not to make credibility determinations or weigh conflicting evidence with respect to a disputed 

material fact. See T.W. Elec. Serv. v. Pacific Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 

1987). The evidence must be viewed in the light most favorable to the nonmoving party, and the 

inferences to be drawn from the facts must be viewed in a light most favorable to the nonmoving 

party. See id. at 631.

A verified complaint may be used as an opposing affidavit under Rule 56, as long as it is 

based on personal knowledge and sets forth specific facts admissible in evidence. See Schroeder 

v. McDonald, 55 F.3d 454, 460 & nn.10-11 (9th Cir. 1995) (treating plaintiff’s verified complaint 

as opposing affidavit where, even though verification not in conformity with 28 U.S.C. § 1746, 

plaintiff stated under penalty of perjury that contents were true and correct, and allegations were 

not based purely on his belief but on his personal knowledge). Here, Haden’s complaint was 

made under penalty of perjury and is considered as evidence in evaluating the motion for summary 

judgment.

 

DISCUSSION

Deliberate indifference to an inmate’s serious medical needs amounts to the cruel and 

unusual punishment prohibited by the Eighth Amendment. See Estelle v. Gamble, 429 U.S. 97, 

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104 (1976); Toguchi v. Chung, 391 F.3d 1051, 1057 (9th Cir. 2004). A prison official violates the 

Eighth Amendment only when two requirements are met: (1) the deprivation alleged is, 

objectively, sufficiently serious, and (2) the official is, subjectively, deliberately indifferent to the 

inmate’s health or safety. See Farmer v. Brennan, 511 U.S. 825, 834 (1994). 

The defendants argue that Haden does not meet the subjective, or deliberate indifference, 

prong of the Eighth Amendment test. A defendant is “deliberately indifferent” if she knows that 

an inmate faces a substantial risk of serious harm and disregards that risk by failing to take 

reasonable steps to abate it. See Farmer, 511 U.S. at 837. The defendant must not only “be aware 

of facts from which the inference could be drawn that a substantial risk of serious harm exists,” 

but she “must also draw the inference.” Id. If the defendant should have been aware of the risk, 

but was not, then she has not violated the Eighth Amendment, no matter how severe the risk. 

Gibson v. County of Washoe, 290 F.3d 1175, 1188 (9th Cir. 2002). “[T]o prevail on a claim 

involving choices between alternative courses of treatment, [an inmate] must show that the chosen 

course of treatment ‘was medically unacceptable under the circumstances,’ and was chosen ‘in 

conscious disregard of an excessive risk to [the inmate’s] health.’” Toguchi, 391 F.3d at 1058 

(citation omitted). 

Haden fails to show a triable issue of fact in support of his claim that defendants were 

deliberately indifferent to his serious medical needs. The evidence is undisputed that: (1) on 

March 22, 2013, Dr. Espinoza examined Haden for chronic constipation and prescribed 

medication to treat his condition; (2) Haden’s prescription for Konsyl expired in June 2013; (3) 

upon a follow-up examination on September 5, 2013, while being off Konsyl for more than two 

months, Haden showed no sign of severe constipation and appeared to Dr. Espinoza to be having 

normal bowel movements; (4) Dr. Espinoza continued Haden on his other two constipation 

medications, determined that he did not need Konsyl because he was not experiencing constipation 

without it (although she wrote a request for Konsyl to be approved as a non-formulary drug); and 

(5) Dr. Espinoza determined that a colonoscopy was unnecessary because Haden was not 

experiencing severe constipation, although a colonoscopy would be reconsidered later if Haden’s 

severe constipation returned. The undisputed evidence also shows that Dr. Tootell (a) approved a 

non-formulary request for magnesium oxide for Haden on March 23, 2013; and (b) was not the 

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decision maker who denied the non-formulary request for Konsyl in September 2013. Given the 

undisputed fact that Haden was not exhibiting signs of constipation in September 2013 when he 

was seen by Dr. Espinoza, he has not shown that Dr. Espinoza was aware of facts from which the 

inference could be drawn that a substantial risk of harm existed if she did not prescribe Konsyl or 

refer him to a specialist for further testing, or that she drew that inference. Likewise, Haden has 

not shown that Dr. Tootell was deliberately indifferent to a serious medical need when she made 

her decisions regarding his care. Viewing the evidence and reasonable inferences therefrom in the 

light most favorable to Haden, no reasonable jury could find in his favor on his deliberate 

indifference claim. 

At most, Haden has established that he disagreed with the medical decisions made by Dr. 

Espinoza and Dr. Tootell. However, a mere difference of opinion as to which medically 

acceptable course of treatment should be followed does not establish deliberate indifference. See 

Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). Where doctors have chosen one course of 

action and a prisoner-plaintiff contends that they should have chosen another course of action, the 

plaintiff “must show that the course of treatment the doctors chose was medically unacceptable 

under the circumstances, . . . and the plaintiff must show that they chose this course in conscious 

disregard of an excessive risk to plaintiff’s health.” Jackson v. McIntosh, 90 F.3d 330, 332 (9th 

Cir. 1996) (internal citations omitted). In September 2013, Haden wanted Konsyl as a treatment 

for his chronic constipation, but it is undisputed that his constipation was under control with just 

the lactulose and magnesium oxide. In other words, defendants were treating Haden’s condition 

with other medications which they also continued to prescribe for him. Haden has not raised a 

triable issue of fact that the course of treatment chosen was medically unacceptable and chosen in 

conscious disregard of an excessive risk to his health. 

Haden alleged that the defendants refused to renew his prescription for Konsyl “without a 

replacement/equal substitute” based solely on cost. Docket No. 5 at 3-3. Although Konsyl was a 

non-formulary item, that fact shows nothing about the price of Konsyl and there is simply no 

evidence in the record about the price of Konsyl. Haden has failed to raise a triable issue of fact 

because the undisputed evidence shows that defendants chose not to renew his prescription due to 

the absence of symptoms that warranted it, even though Dr. Espinoza put in a request for Konsyl 

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which she correctly anticipated would be rejected. Docket No. 19-4 at 18. No reasonable jury 

could conclude that defendants’ refusal to renew Haden’s prescription for Konsyl amounted to 

deliberate indifference when his constipation was then being controlled by other medications they 

did prescribe. 

Haden also alleged that the defendants’ delay or refusal to refer him to a specialist or a 

specialty clinic subjected him to substantial risk of serious harm. Docket No. 5 at 4-6. But the 

undisputed evidence shows that Haden did not report or show symptoms that would warrant a 

referral to a specialist. Moreover, the record shows that Dr. Espinoza did not permanently rule out 

a specialist, and decided instead to monitor the patient for symptoms that might warrant such a 

referral at a later time. Specifically, in March she observed that “previously, they were thinking 

about sending him to GI for consult, but that is not needed now,” Docket No. 19-4 at 32, and in 

September observed that “there are no red flags. If he does seem to develop more significant 

symptoms can consider referring him for a colonoscopy.” Docket No. 19-4 at 18. When he 

finally was referred out to a specialist for a colonoscopy in 2015, Haden’s colon was normal, and 

the specialist made the same recommendations of increased dietary fiber and water that the doctors 

at San Quentin had made. No reasonable jury could conclude that defendants’ refusal to refer 

Haden to a specialist in 2013 exposed him to a serious health risk, or that choosing to monitor him 

reflected deliberate indifference to a serious medical need.

When the evidence is viewed in the light most favorable to Haden, and inferences 

therefrom drawn in his favor, no reasonable jury could return a verdict for him and against 

defendants. Defendants therefore are entitled to judgment as a matter of law on the merits in their 

favor.

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CONCLUSION

For the foregoing reasons, the defendants’ motion for summary judgment is GRANTED. 

(Docket No.19.) Judgment will be entered in defendants’ favor and against plaintiff. 

IT IS SO ORDERED.

Dated: June 2, 2016

SUSAN ILLSTON

United States District Judge

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