Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_11-cv-00075/USCOURTS-azd-2_11-cv-00075-0/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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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

VICTOR A. PARSONS, )

)

Plaintiff, ) CIV 11-00075 PHX NVW MEA

)

v. ) REPORT AND RECOMMENDATION

)

CHARLES L. RYAN, )

RONOLFO MACABUHAY, TERRY ALLRED,)

BRUCE McMORRON, IHS DR. ROE, )

DR. ADU-TUT, )

)

) 

Defendants. )

______________________________ )

TO THE HONORABLE NEIL V. WAKE:

Before the Court is Plaintiff’s motion (Doc. 21) for

leave to amend his complaint. This matter is before the

undersigned on referral from the District Judge, and the

determination of the undersigned is dispositive of some of

Plaintiff’s claims. Accordingly, the undersigned makes the

following proposed findings of fact, report, and recommendation

pursuant to Rule 72(b), Federal Rules of Civil Procedure, and 28

U.S.C. § 28(b)(1)(B) and (C).

Case 2:11-cv-00075-NVW Document 28 Filed 07/15/11 Page 1 of 16
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 Procedural background

Plaintiff, who is confined in the Arizona State Prison

Complex in Buckeye, Arizona, filed a prisoner civil rights

complaint on January 10, 2011, alleging Defendants violated his

constitutional rights while incarcerated. Plaintiff asserts

Defendants failed to provide adequate medical care to Plaintiff,

in violation of his Eighth Amendment rights. The complaint

alleges two counts for relief and seeks injunctive relief and

compensatory and punitive damages. Plaintiff simultaneously

filed a motion seeking preliminary injunctive relief, i.e.,

immediate and specific medical treatment. 

In Count I of the complaint Plaintiff alleges the

denial of a liver biopsy and interferon treatment for Hepatitis

C violated his Eighth Amendment rights to be free of cruel and

unusual punishment, i.e., that Defendants had acted with

deliberate indifference to Plaintiff’s serious medical needs. 

In Count II of the complaint Plaintiff alleges he has

suffered from abdominal pain, diarrhea, nausea, vomiting, and

other symptoms caused by the bacterium H. pylori. Plaintiff

alleged he suffered from January 2010 through November 2010

without being treated and that, since November 2010, his

symptoms have escalated in severity. The motion for injunctive

relief alleges Plaintiff did not receive the entire course of

medication prescribed to treat this condition.

In a decision issued January 27, 2011, the Court

concluded Plaintiff’s medical treatment for Hepatitis C since

2006 indicated Defendants had provided care consistent with the

“standard medical practice for persons with the type, grade, and

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stage of HCV that Plaintiff has.” Doc. 7. Accordingly, the

Court concluded Plaintiff had failed to state a claim that the

treatment given for Plaintiff’s Hepatitis C was deliberate

indifference to Plaintiff’s serious medical needs. However, the

Court determined Plaintiff had sufficiently stated a claim

against Defendant Macabuhay and Defendant McMorran “based upon

[Plaintiff’s] abdominal condition”, and ordered Defendants

Macabuhay and McMorran to answer Count II of the complaint.

As outlined in the original complaint, the basis for

Defendants Ryan, Allred, Roe, and Adu-Tutu’s liability was their

supervisory capacity with regard to inmates’ medical treatment

for Hepatitis C or their denial of Plaintiff’s grievances and

grievance appeals with regard to his medical treatment. In the

original screening order the Court noted that section 1983

liability could not be predicated on the principle of respondeat

superior or the bald allegation that a defendant denied an

inmate relief in an administrative grievance. Accordingly, the

Court also dismissed these Defendants from the suit in the

service order. 

On February 7, 2011, Plaintiff filed a motion to amend

his complaint and lodged a proposed amended complaint. See Doc.

9. The Magistrate Judge denied the motion to amend without

prejudice on February 16, 2011. See Doc. 10. Plaintiff

returned service packets for Defendant Macabuhay and Defendant

McMorran to the Court. Service was executed on Defendants, who

answered the complaint on April 25, 2011. See Doc. 15. 

On April 26, 2011, Defendants filed a motion seeking to

dismiss the remaining count of the complaint for Plaintiff’s

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1 Prior to 2009, Rule 15(a), Federal Rules of Civil Procedure,

allowed a plaintiff to amend their complaint once as a matter of

course at any time prior to the service of a “responsive pleading.”

The rule now provides that a plaintiff may amend their complaint once

without leave of the Court “within: (A) 21 days after serving it, or

(B) if the pleading is one to which a responsive pleading is required,

21 days after service of a responsive pleading or 21 days after

service of a motion under Rule 12(b), (e), or (f), whichever is

earlier.”

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failure to exhaust his administrative remedies with regard to

this claim prior to filing suit. A scheduling order was issued

April 27, 2011, requiring that any amendment to the complaint be

filed by June 3, 2011, and that discovery in this matter be

completed by October 28, 2011. See Doc. 18. On April 28, 2011,

Plaintiff was ordered to file a response to the motion to

dismiss on or before May 28, 2011. See Doc. 19. Plaintiff

filed a response to the motion to dismiss on May 18, 2011. See

Doc. 20. No reply to the response was filed and the motion to

dismiss is pending.

On May 19, 2011, Plaintiff filed a motion seeking to

amend his complaint. See Doc. 21. Defendants responded to the

motion to amend, see Doc. 22, and simultaneously filed a motion

asking the Court to screen the lodged amended complaint prior to

requiring Defendants to answer the complaint. See Doc. 23.

Plaintiff seeks to amend his complaint to “allege

further facts to restore count one; add defendants.” Doc. 21 at

1. Citing to a 1991 case from the Second Circuit Court of

Appeals and an unpublished opinion from the District of Arizona,

Plaintiff contends that he is allowed to amend his complaint

“once without leave of the court and if the plaintiff is

alleging a civil rights violation.”1 Id. at 2-3. 

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Plaintiff argues that respondeat superior liability is

available as a theory of relief because “In this case, the level

of liability and involvement of the defendants (Hep C. Committee

Member)... are not predicated on merely a denial of grievances,

but allegations that were encompassed and the substance of the

plaintiffs inherent grievance-deliberate indifference to a

serious medical need.” Id. at 3-4. In the lodged Amended

Complaint Plaintiff contends Defendants Ryan, Macabuhay, Allred,

McMorran, Abu-Tutu, Dr. Roe, and Taylor, “played an active role

in denying me access and appropriate medical care and being

deliberately different (sic) to may serious medical needs of

treatment for Hep C. and H-pylori.” Id., Attach. at 2A.

Plaintiff alleges “plaintiffs (sic) have not adhered to their

own disease control and treatment policies ... Have failed to

accurately monitor my progressing disease with inadequate

testing that does not gauge the diseases (sic) aggressiveness,

failing to provide a community standard of care and withholding

necessary treatment my condition calls for...” Id., Attach. at

4. 

With regard to Defendants who are named as defendants

in Count I of the lodged Amended Complaint pursuant to their

respondeat superior liability, Plaintiff argues that these

Defendants’ 

deliberate indifference to my Hep C [is

demonstrated] by knowingly adhering to

inadequate Hep C. monitoring practices that

do not adequately monitor progressing Hep C,

failing to conduct further detailed testing

when chemical markers of liver damage has

been present and ongoing then acting contrary

to outlined D.O. medical guidelines; and

knowingly denying me medical treatment Hep C

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calls for when the initial diagnostising

(sic) doctor recommended treatment.

Id. at 6. 

With regard to personal liability for violation of

Plaintiff’s Eighth Amendment rights, Plaintiff alleges that

after he was transferred to his current housing assignment in

June 2007, he met with Defendant Macabuhay and expressed concern

about fatigue and mental fog. Plaintiff conveyed to Defendant

Macabuhay his worries that Hepatitis C was more aggressive in

some people and his concern that the tests offered by the prison

inmate medical system did not reveal liver damage caused by

Hepatitis C until it was too late to effectively treat the

condition. Plaintiff alleges that, at that time, he had flulike symptoms and liver pains and that he requested Defendant

Macabuhay perform a liver biopsy, which request was denied.

Plaintiff argues that Defendant Macabuhay’s deliberate

indifference to his serious medical condition is exhibited by

Defendant’s failure to order a liver biopsy at that time. 

In the lodged Amended Complaint Plaintiff alleges he

met with Terry Allred in early 2009, and that at that time

Plaintiff expressed his concern about having Hepatitis C and not

being adequately treated for this disease while incarcerated.

Plaintiff states he noted for Terry Allred that his last lab

tests in 2005 of 2006, which showed no serious liver disease or

damage at that time despite his testing positive for Hepatitis

C, were too far in the past to be valid. Plaintiff asserts he

appealed Mr. Allred’s denial of Plaintiff’s requests for further

liver tests to Charles Ryan, who took eight months to respond

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2

In most civil actions, the submission and filing of a

complaint are simultaneous events. That is not the case

when a prisoner submits a complaint with an application to

proceed in forma pauperis, where there is normally a gap in

time between the submission of the complaint and its

filing. Vaden v. Summerhill, 449 F.3d 1047, 1050 (9th Cir.

2006). After a prisoner applies for in forma pauperis

status and lodges a complaint with the district court, the

district court screens the complaint and determines whether

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and said he felt no treatment was required. Plaintiff asserts

that Mr. Ryan is “not a medical professional”.

Plaintiff notes that he was scheduled for liverfunction tests in January of 2011 but does not indicate if he

did receive those tests or what those tests indicated with

regard to the status of Plaintiff’s Hepatitis C and whether or

how far the disease has progressed or Plaintiff’s current liver

function.

Analysis 

The Court is required to screen complaints brought by

prisoners seeking relief against a governmental entity or an

officer or an employee of a governmental entity. See 28 U.S.C.

§ 1915A(a) (2003 & Supp. 2010). The Prison Litigation Reform

Act, 42 U.S.C. § 1997e(c)(1), requires dismissal of allegations

that fail to state a claim upon which relief can be granted.

See, e.g., O’Neal v. Price, 531 F.3d 1146, 1153 (9th Cir. 2008);

Grinter v. Knight, 532 F.3d 567, 572 (6th Cir. 2008). The Court

must dismiss a complaint or portion thereof if a plaintiff has

raised claims that are legally frivolous or malicious, that fail

to state a claim upon which relief may be granted, or that seek

monetary relief from a defendant who is immune from such relief.

See 28 § 1915A(b)(1) & (2) (2006 & Supp. 2010).2

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it contains cognizable claims. If not, the district court

must dismiss the complaint. Id.; see also 28 U.S.C. §

1915A. In practice... [t]he complaint is filed only after

the district court identifies cognizable claims. See Ford

v. Johnson, 362 F.3d 395, 398 (7th Cir. 2004).

O’Neal v. Price, 531 F.3d 1146, 1151 (9th Cir. 2008).

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Rule 15(a), Federal Rules of Civil Procedure, provides

that a plaintiff should be given leave to amend his complaint

when justice so requires. “Courts are free to grant a party

leave to amend whenever ‘justice so requires,’ Fed. R. Civ. P.

15(a)(2), and requests for leave are generally granted with

‘extreme liberality.’” Moss v. United States Secret Serv., 572

F.3d 962, 972 (9th Cir. 2009), quoting Owens v. Kaiser Found.

Health Plan, Inc., 244 F.3d 708, 712 (9th Cir. 2001). However,

granting a plaintiff leave to amend “is subject to the

qualification that the amendment not cause undue prejudice to

the defendant, is not sought in bad faith, and is not futile.”

Thornton v. McClatchy Newspapers, Inc., 261 F.3d 789, 799 (9th

Cir. 2001) (internal quotations omitted).

Futility of amendment is sufficient to justify denial

of a motion for leave to amend. See Gordon v. City of Oakland,

627 F.3d 1092, 1094-95 (9th Cir. 2010). A claim in a proposed

amended complaint is futile if it would be immediately “subject

to dismissal” pursuant to Rule 12(b)(6), Federal Rules of Civil

Procedure, for failure to state a claim on which relief may be

granted, accepting all of the facts alleged as true. See

Steckman v. Hart Brewing, Inc., 143 F.3d 1293, 1296-98 (9th Cir.

1998); Briggs v. Mississippi, 331 F.3d 499, 508 (5th Cir. 2003).

The Ninth Circuit Court of Appeals recently stated that “the

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3

Even if Owens made progress in curing the deficiencies in

the three claims that were dismissed without prejudice at

screening, he also tried to evade the § 1915A ruling by

pressing forward with the claims that were dismissed for

failure to state a claim. And this action could not have

been inadvertent; Owens expanded the two claims to four

times their original length. The magistrate judge was not

obligated to reward intransigence; these claims are

frivolous and again would have faced immediate dismissal.

We have held that leave to amend may be denied if the new

complaint does not cure deficiencies in the old one and is

doomed to the same fate.

Owens v. Hinsley, 635 F.3d 950, 956 (7th Cir. 2011).

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‘proper test to be applied when determining the legal

sufficiency of a proposed amendment is identical to the one used

when considering the sufficiency of a pleading challenged under

Rule 12(b)(6).’” Nordyke v. King, ___ F.3d ___, 2011 WL

1632063, at *18 n.12, quoting Miller v. Rykoff–Sexton, Inc., 845

F.2d 209, 214 (9th Cir. 1988). The Seventh Circuit Court of

Appeals has concluded that “leave to amend may be denied if the

new complaint does not cure deficiencies in the old one and is

doomed to the same fate.” Owens v. Hinsley, 635 F.3d 950, 956

(2011).3

To state a claim for relief pursuant to section 1983,

a plaintiff must allege that: (1) the named defendant deprived

him of a right, privilege or immunity guaranteed by the United

States Constitution or federal law; and (2) the defendant acted

under the color of state law. See, e.g., Long v. County of Los

Angeles, 442 F.3d 1178, 1185 (9th Cir. 2006); Crumpton v. Gates,

947 F.2d 1418, 1420 (9th Cir. 1991). The Court must construe

pro se filings liberally. See, e.g., Hebbe v. Pliler, 627 F.3d

338, 342 (9th Cir. 2010). 

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To survive a motion to dismiss, a complaint must

contain sufficient factual matter, accepted as true, to state a

claim to relief that is plausible on its face. See, e.g., Cook

v. Brewer, 637 F.3d 1002, 1006 (9th Cir. 2011), quoting Ashcroft

v. Iqbal, 129 U.S. 1937, 129 S. Ct. 1937, 1949 (2009) (quoting

Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S. Ct. 1955,

1964-65 (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.” Iqbal, 129 S. Ct. at 1949. The “[f]actual

allegations must be enough to raise a right to relief above the

speculative level.” Twombly, 550 U.S. at 555, 127 S. Ct. at

1964-65. Although allegations of a pro se complaint are held to

a less stringent standard than formal pleadings drafted by a

lawyer, vague or sweeping conclusory allegations will not

suffice to state a claim for relief. See, e.g., Cook, 637 F.3d

at 1007; Ivey v. Board of Regents of Univ. of Alaska, 673 F.2d

266, 268 (9th Cir. 1982). Ergo, a plaintiff’s recitation of

particular words in allegations in an attempt to bring his claim

within the rubric of a constitutional violation should not be

sufficient to allow the claim to survive screening. The Court

may not supply essential elements of the claim that were not

pled by invoking the “liberal construction” doctrine. See Pena

v. Gardner, 976 F.2d 469, 471-72 (9th Cir. 1992); Ivey, 673 F.2d

at 268. Compare Byrd v. Maricopa Cnty. Sheriff’s Dep’t, 629

F.3d 1135, 1140 (9th Cir. 2011).

To state a section 1983 claim for violation of the

Eighth Amendment regarding their medical treatment, a plaintiff

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4

We have found “deliberate indifference” in a variety of

circumstances, including where a prison official (1) knows

of a prisoner’s need for medical treatment but

intentionally refuses to provide it; (2) delays necessary

medical treatment based on a non-medical reason; or (3)

prevents a prisoner from receiving needed or recommended

medical treatment.

Rouse v. Plantier, 182 F.3d 192, 197 (3d Cir. 1999). 

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must show that the defendant acted with deliberate indifference

to serious medical needs. E.g., Helling v. McKinney, 509 U.S.

25, 32, 113 S. Ct. 2475, 2480 (1993); Jett v. Penner, 439 F.3d

1091, 1096 (9th Cir. 2006). “Deliberate indifference is a high

legal standard.” Toguchi v. Chung, 391 F.3d 1051, 1060 (9th

Cir. 2004). Deliberate indifference in the medical context may

be shown by a purposeful act or failure to respond to a

prisoner’s pain or possible medical need, and harm caused by the

indifference. See Jett, 439 F.3d at 1096. Deliberate

indifference may also be shown when a prison official

intentionally denies, delays, or interferes with medical

treatment. Id.4 

Notably, however, a claim of negligence, even gross

negligence constituting medical malpractice, is not equivalent

to a claim of deliberate indifference. See, e.g., Toguchi, 391

F.3d at 1060-61. Because negligence does not constitute

deliberate indifference rising to the level of a violation of

the Eighth Amendment’s prohibition against cruel and unusual

punishment, to be actionable a defendant’s behavior must be

willful. See, e.g., id. at 1057 (“Mere negligence in diagnosing

or treating a medical condition, without more, does not violate

a prisoner’s Eighth Amendment rights.”); Taylor v. Adams, 221

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5

In determining whether a delay in treatment rises to the

level of deliberate indifference ... relevant factors

include: “(1) the seriousness of the medical need; (2)

whether the delay worsened the medical condition; and (3)

the reason for the delay.” Goebert, 510 F.3d at 1327.

 Therefore, “[u]ltimately, there are ... four

requirements: an objectively serious need, an objectively

insufficient response to that need, subjective awareness of

facts signaling the need, and an actual inference of

required action from those facts.” Id.

Alexander v. City of Muscle Shoals, Ala., 766 F. Supp. 2d 1214, 1238

(N.D. Ala. 2011).

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F.3d 1254, 1258 (11th Cir. 2000). Additionally, the federal

courts have repeatedly held that a delay in medical care,

without more, is insufficient to state a claim against prison

officials for deliberate indifference because this indifference

is not “substantial”. See, e.g., Shapley v. Nevada Bd. of State

Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985).5 The Ninth

Circuit Court of Appeals has repeatedly stated that if an

inmate’s allegation of deliberate indifference is based on

prison officials’ choices among alternative courses of medical

treatment for a serious condition, when the inmate believes

another course of treatment is warranted, then the inmate has

not stated a claim for violation of the Eighth Amendment. See,

e.g., Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996);

Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989).

To the extent Plaintiff asserts that the Arizona

Department of Corrections’ protocol for the treatment of inmates

with Hepatitis C violates Plaintiff’s constitutional right to be

free of cruel and unusual punishment, for a policy to be the

moving force behind the deprivation of a constitutional right,

the identified deficiency in the policy must be “closely related

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to the ultimate injury.” Gibson v. County of Washoe, 290 F.3d

1175, 1196 (9th Cir. Cir. 2002). In order to state a claim

that the Arizona Department of Corrections’ Hepatitis C protocol

was the moving force behind a violation of his constitutional

rights, Plaintiff must plausibly allege that he has actually

been harmed by the policy itself and that the harm was caused by

an inherent flaw in the policy, i.e., something other than

professionally-informed discretion. See Long v. County of Los

Angeles, 442 F.3d 1178, 1189-90 (9th Cir. 2006). In a decision

issued by the Seventh Circuit Court of Appeals, the court held

that even if a group of prisoners had proven that an

institution’s protocol for the diagnosis and treatment of

Hepatitis C fell below constitutionally acceptable standards of

medical care for inmates, a particular prisoner inmate was not

entitled to relief because that prisoner had not demonstrated

personal injury or causation. See Roe v. Elyea, 631 F.3d 843

(7th Cir. 2011). See also McKenna v. Wright, 386 F.3d 432, 437

(2d Cir. 2004).

Plaintiff has not plausibly alleged that any defendant

named in the lodged Amended Complaint was willfully blind to a

serious risk of harm to Plaintiff with regard to his diagnosis

of Hepatitis C. Plaintiff does not allege that Mr. Allred or

Mr. Ryan were informed by Defendant Macabuhay, or any other

medical professional, that not performing a liver biopsy on

Plaintiff at that time would be harmful to Plaintiff.

The federal courts have found that deliberate

indifference was shown, with regard to a plaintiff’s Hepatitis

C treatment, if the defendant delayed testing or treatment with

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the specific knowledge that such delay would actually cause harm

and where the delay was caused by other than medical reasons,

such as retaliation or an improper classification of inmates

pursuant to a faulty policy. See Elyea, 631 F.3d at 863

(“Although administrative convenience and cost may be, in

appropriate circumstances, permissible factors for correctional

systems to consider in making treatment decisions, the

Constitution is violated when they are considered to the

exclusion of reasonable medical judgment about inmate health”);

Johnson v. Doughty, 433 F.3d 1001, 1013 (7th Cir. 2006);

Martinez v. Garden, 430 F.3d 1302, 1304 (10th Cir. 2005);

McKenna, 386 F.3d at 437; Ledoux v. Davies, 961 F.2d 1536, 1537

(10th Cir. 1992) (holding that acts by non-medical prison

officials that prevent access to treatment recommended or

prescribed by medical personnel may constitute deliberate

indifference).

The claim that Defendant Macabuhay should have ordered

different tests or treatment for Plaintiff’s Hepatitis C and

that Terry Allred or Charles Ryan should have trumped Defendant

Macabuhay’s decision in this regard based on Plaintiff’s

concerns that his disease might be progressing fast enough to

warrant more imminent testing, or a liver biopsy as compared to

a fibroid test, simply represents a disagreement over the course

of treatment afforded to Plaintiff. Plaintiff has not provided

any facts which could support an allegation that the treatment

or tests he sought were denied for a non-medical reason,

therefore his claim sounds solely in negligence and cannot be

pursued under section 1983.

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The lodged Amended Complaint asserts that Plaintiff

should have received more aggressive treatment than what

Defendants administered and that the protocol established by

Defendants for allocating Hepatitis C treatment is not

sufficiently aggressive with regard to inmates who are in the

early stages of this disease; this is an allegation of a

difference of medical opinion that does not give rise to an

Eighth Amendment violation. Absent a plausible allegation that

Mr. Allred and Mr. Ryan knew medical personnel were mistreating

or not treating Plaintiff’s Hepatitis C, the named non-medical

defendants cannot be charged with the scienter of deliberate

indifference. See Spruill v. Gillis, 372 F.3d 218, 236 (3d Cir.

2004). 

Accordingly,

IT IS RECOMMENDED that Plaintiff’s motion (Doc. 21) for

leave to amend his complaint to add the claims and defendants in

Count I of the lodged Amended Complaint be denied.

This recommendation is not an order that is immediately

appealable to the Ninth Circuit Court of Appeals. Any notice of

appeal pursuant to Rule 4(a)(1), Federal Rules of Appellate

Procedure, should not be filed until entry of the district

court’s judgment. 

Pursuant to Rule 72(b), Federal Rules of Civil

Procedure, the parties shall have fourteen (14) days from the

date of service of a copy of this recommendation within which to

file specific written objections with the Court. Thereafter,

the parties have fourteen (14) days within which to file a

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response to the objections. Pursuant to Rule 7.2, Local Rules

of Civil Procedure for the United States District Court for the

District of Arizona, objections to the Report and Recommendation

may not exceed seventeen (17) pages in length. 

Failure to timely file objections to any factual or

legal determinations of the Magistrate Judge will be considered

a waiver of a party’s right to de novo appellate consideration

of the issues. See United States v. Reyna-Tapia, 328 F.3d 1114,

1121 (9th Cir. 2003) (en banc). Failure to timely file

objections to any factual or legal determinations of the

Magistrate Judge will constitute a waiver of a party’s right to

appellate review of the findings of fact and conclusions of law

in an order or judgment entered pursuant to the recommendation

of the Magistrate Judge. 

DATED this 14th day of July, 2011.

Case 2:11-cv-00075-NVW Document 28 Filed 07/15/11 Page 16 of 16