Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_16-cv-01302/USCOURTS-casd-3_16-cv-01302-3/pdf.json

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

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16-CV-1302-CAB-(NLS)

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

VICENTE ARRAIGA ALVAREZ,

Plaintiff,

v.

DR. S. KO, MD., et al.,

Defendants.

Case No.: 16-CV-1302-CAB-(NLS)

ORDER ADOPTING REPORT AND 

RECOMMENDATION [Doc. No. 35] 

AND DENYING DEFENDANTS’ 

MOTION TO DISMISS [Doc. No. 24]

Plaintiff Vicente Alvarez, a California prisoner, filed this civil rights complaint 

against Defendants under 42 U.S.C. § 1983. On March 24, 2017, Magistrate Judge Nita L. 

Stormes filed a Report and Recommendation recommending the Court deny the motion to 

dismiss filed by Defendants Dr. S. Ko, M.D., Dr. Connall McCabe, M.D., Dr. A. Sangha, 

C.M.E., and Deputy Director J. Lewis. [Doc. No. 35.]

PROCEDURAL BACKGROUND

On May 31, 2016, Plaintiff filed a Complaint alleging that Defendants Ko, McCabe, 

Sangha and Lewis (collectively “Defendants”) were deliberately indifferent to Plaintiff’s 

serious medical need, in violation of the Eight Amendment. [Doc. No. 1 at 1-2.]

On December 14, 2016, Defendants filed a motion to dismiss the Complaint. [Doc. 

No. 24.] On February 15, 2017, Plaintiff filed his opposition to the motion. [Doc. No. 29.] 

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On February 23, 2017, Defendants filed a reply in support of the motion to dismiss. [Doc. 

No. 32.]

On March 24, 2017, Magistrate Judge Nita L. Stormes filed a Report and 

Recommendation recommending that the motion to dismiss filed by Defendants be denied. 

[Doc. No. 35.] On April 7, 2017, Defendants filed an objection to the Report and 

Recommendation. [Doc. No. 37.] On April 24, 2017, Plaintiff filed a reply to the 

objection. [Doc. No. 38.]

FACTUAL BACKGROUND

Defendants do not object to the factual background provided by Magistrate Judge

Stormes [Doc. No. 34 at 2-6] and, therefore, it is incorporated by reference.

REVIEW OF REPORT AND RECOMMENDATION

The duties of the district court in connection with a report and recommendation of a 

magistrate judge are set forth in Federal Rules of Civil Procedure 72(b) and 28 U.S.C. § 

636(b). The district judge must “make a de novo determination of those portions of the 

report . . . to which objection is made,” and “may accept, reject, or modify, in whole or in 

part, the findings or recommendations made by the magistrate judge.” 28 U.S.C. § 636(b). 

The district court need not review de novo those portions of a report and recommendation 

to which neither party objects. See Wang v. Masaitis, 416 F.3d 992, 1000 n. 13 (9th Cir. 

2005); U.S. v. Reyna-Tapia, 328 F.3d 1114, 1121-22 (9th Cir. 2003) (en banc).

A. Deputy Director Lewis

Magistrate Judge Stormes found that Plaintiff sufficiently stated a claim against 

Deputy Director Lewis. [Doc. No. 35 at 14-15.] Defendants object to the ruling as to 

Director Lewis on two grounds. First, Defendants argue that Plaintiff has failed to allege 

any facts that establish her supervisory status over Dr. Ko. [Doc. No. 37 at 2.] However, 

as noted by the Magistrate Judge, Plaintiff alleges Director Lewis was responsible for the 

overall operation of the California Department of Corrections Health Care Department, and 

Director Lewis condoned the actions of her subordinate, Dr. Ko. [Doc. No. 35 at 14.] 

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These allegation are sufficiently pled to establish that Dr. Ko was a subordinate of Director 

Lewis’. 

Second, Defendants object on the grounds that Plaintiff has failed to adequately 

plead supervisory liability on the part of Director Lewis to support a § 1983 claim. 

Defendants argue that Plaintiff’s allegations regarding Director Lewis’ level of 

involvement in decisions about his care are insufficient.

1

[Doc. No. 37 at 3-4.] 

Additionally, Defendants contend the complaint fails to adequately allege the requisite 

deliberate indifference on the part of Director Lewis. [Id. at 4-5.] But, as found by 

Magistrate Stormes, Plaintiff alleges Deputy Director Lewis did more than simply review 

Plaintiff’s administrative appeal. [Doc. No. 35 at 14-15]. As the Recommendation reports, 

Plaintiff alleges that Director Lewis knew Dr. Ko refused to provide effective treatment for 

his chest pains and refused to refer him to a specialist and that Director Lewis condoned 

Dr. Ko’s actions directing Plaintiff to seek medical care at his own expense and denying 

him medical care because it was too expensive. [Id.] Further, as Magistrate Stormes noted, 

Plaintiff alleges that nonetheless Deputy Director Lewis denied his 602 Appeal and that 

the delay in treatment has caused him harm. [Id. at 15.] Thus, Plaintiff has sufficiently 

stated a claim against Deputy Director Lewis for deliberate indifference based upon her 

knowledge of and acquiescence in unconstitutional conduct by her subordinate, Dr. Ko. 

Starr v. Baca, 652 F.3d 1202, 1207 (9th Cir. 2011). Therefore, this Court agrees with the 

Magistrate Judge that the motion to dismiss as to Deputy Director Lewis should be denied.

B. Dr. Sangha

Magistrate Judge Stormes denied Defendants’ motion to dismiss the claim against 

Dr. Sangha. [Doc. No. 35 at 13-14.] Defendants object to the ruling, arguing that the 

complaint is devoid of allegations sufficient to establish Dr. Sangha’s role as Dr. Ko’s 

 

1 Relatedly, Defendants assert that the court need not accept Plaintiff’s allegation of Deputy Director 

Lewis’ job duties even at this stage of the litigation. [Doc. No. 37 at 3-4.] But, an informa pauperis 

complaint should not be dismissed before any factual development is conducted simply because the 

court finds the allegations unlikely. Denton v. Hernandez, 504 U.S. 25, 33 (1992). 

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supervisor and fails to allege how Dr. Sangha knew that the treatment provided by Dr. Ko’s 

was constitutionally deficient. [Doc. No. 37 at 6.] However, as the Magistrate Judge noted, 

Plaintiff does more than merely allege Dr. Sangha reviewed and denied his 602 Appeal, he 

alleges Dr. Sangha knew Dr. Ko refused to provide effective treatment and refused to refer 

him to a specialist, and yet did not take any actions to rectify the situation or stop his 

subordinate’s acts. [Doc. No. 35 at 14.] Further, as Magistrate Stormes pointed out,

Plaintiff also alleges Dr. Sangha referred one of Plaintiff’s 602 Appeals to Dr. Ko for 

investigation despite knowing Plaintiff complained of Dr. Ko’s treatment. [Id. at 14.] 

Additionally, the Complaint alleges Dr. Sangha is responsible for the medical care of all 

inmates at CSP-Centinela including “the supervision, direction, and or proper training of 

the medical staff at CSP-Centinela, including the defendant Dr. S. Ko.” [Doc. No. 1 ¶ 8.] 

These alleged facts are sufficient to state a claim for deliberate indifference based on Dr. 

Sangha’s alleged knowledge and acquiescence in unconstitutional conduct. This Court 

agrees with the Magistrate Judge that the motion to dismiss as to Dr. Sangha should be 

denied. 

C. Dr. McCabe

Magistrate Judge Stormes found that Plaintiff states a cognizable Eighth 

Amendment claim against Dr. McCabe. Defendants object to the ruling, arguing: (1) Dr. 

McCabe’s involvement in Plaintiff’s care was limited to review of his inmate appeal at the 

first level; (2) Dr. McCabe did not treat Plaintiff and interviewed him before Plaintiff had 

any interaction with Dr. Ko; and (3) Plaintiff is simply dissatisfied with Dr. McCabe’s 

decision to deny his healthcare appeal, which is not actionable under § 1983. [Doc. No. 37 

at 6-7.] However, as the Magistrate Judge noted, Plaintiff does not merely allege Dr. 

McCabe denied his administrative appeal, he alleges Dr. McCabe knew about his continued 

chest pains and requests to see a heart specialist, had authority to prevent a constitutional 

violation, and yet denied his request and delayed treatment for medical care that Plaintiff 

alleges was sorely needed. [Doc. No. 35 at 12.] Furthermore, Plaintiff’s allegations 

regarding deliberate indifference to his serious medical need predate his interactions with 

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Dr. Ko. Plaintiff alleges that in October 2014 he began requesting medical assistance for 

his chest pains and to see a heart specialist but that these requests were denied and that the 

delay in treatment caused him harm. [Doc. No. 1 ¶¶ 12-23, 66-70.] As Judge Stormes 

highlighted, Plaintiff alleges Dr. McCabe is responsible for ensuring inmates who are 

transferred to other institutions continue receiving proper care and Dr. McCabe violated 

his Eighth Amendment rights by failing to make sure he received adequate medical care 

when he transferred to Centienela. Therefore, this Court agrees with the Magistrate Judge 

that the motion to dismiss as to Dr. McCabe should be denied.

D. Dr. Ko

Magistrate Judge Stormes concluded that Plaintiff’s Complaint states an Eighth 

Amendment claim for deliberate indifference to medical needs against Dr. Ko. [Doc. No. 

35 at 8-11.] Defendants object to this ruling, arguing the Complaint fails to adequately 

allege deliberate indifference by Dr. Ko or that Dr. Ko persisted in pursuing a medically 

unacceptable treatment path and at best Plaintiff alleges a difference of opinions with Dr. 

Ko. [Doc. No. 37 at 7-9.] In fact, Judge Stormes acknowledges that some, but not all, of 

Plaintiff’s allegations demonstrate a mere difference of opinion, before explaining that 

Plaintiff also alleges he informed Dr. Ko that the initial treatment plan was ineffective, Dr. 

Ko nodded “yes” when Plaintiff asked if he would first need to fall out from a heart attack 

to be referred to a cardiologist, and Plaintiff continues to have chest pains. [Doc. No. 35 

at 9.] 

Defendants also argue the two EKG’s and one chest x-ray performed on Plaintiff

and the changing of Plaintiff’s medication from a NSAID to Tylenol are illustrative of Dr. 

Ko’s responsiveness to Plaintiff’s complaints. [Doc. No. 37 at 7-8.] Defendants assert that 

these actions are in direct contradiction to Plaintiff’s allegation that Dr. Ko failed to order 

diagnostic testing for cardiac disease and the Recommendation’s statement that Dr. Ko did 

nothing in response to Plaintiff’s complaint that the treatment plan was not working. [Id.] 

As to Defendants’ past treatments argument, “it does not dispense with Plaintiff’s 

continued reports of chest pain despite the treatment plan.” [Doc. No. 35 at 11:1-2.] As 

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the Magistrate Judge noted, Plaintiff alleges that the treatment plan of rest, not to work out 

as much and to take Naproxin – was ineffective and that he continues to have chest pains. 

[Id. at 9.] Moreover, as Magistrate Stormes explained, the exhibit containing the EKG 

does not specify which doctor ordered the EKG, and notwithstanding the exhibit, Plaintiff 

alleges that Dr. Ko only performed a verbal examination and did not order any diagnostic 

testing and also alleges that he told Dr. Ko that the treatment plan was not working and that 

Dr. Ko did nothing in response. [Id. at 10.] Furthermore, as the Magistrate Judge pointed 

out, Plaintiff alleges that to the present, he still currently suffers from chest pain, and the

added pain to his right side. [Id.] 

Therefore, the Court agrees with Magistrate Stormes, that if true, these facts could 

demonstrate Dr. Ko knew the treatment plan he placed Plaintiff on was ineffective yet 

continued on the treatment plan anyway and deliberately did not take steps to improve the 

situation. See Jett v. Penner, 439 F.3d 1091, 1097-98 (9th Cir. 2006).

CONCLUSION

The Court has conducted a de novo review of the Report and finds it to be thorough, 

complete, and an accurate analysis of the legal issues presented in the motion to dismiss. 

Therefore, the Court: (1) adopts the Report [Doc. No. 35] in full; (2) rejects Defendants’

objections [Doc. No. 37]; and (3) Denies Defendants’ motion to dismiss [Doc. No. 24]. 

Defendants are instructed to answer the Complaint within the time limits set forth in 

Federal Rule of Civil Procedure 12(1)(A)(i).

It is SO ORDERED.

Dated: May 5, 2017

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