Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_13-cv-01923/USCOURTS-caed-2_13-cv-01923-11/pdf.json

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

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

1

UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

GARY CECIL,

Plaintiff,

v.

JEFF BEARD, et al.,

Defendants.

No. 2:13-cv-1923 TLN KJN P

ORDER

Plaintiff is a state prisoner proceeding without counsel. On August 15, 2014, plaintiff 

filed a document styled, “Ex parte Motion Under Rule 35, Federal Rules of Civil Procedure, 

Medical Examination.” (ECF No. 68.) Defendants filed an opposition with exhibits, and plaintiff 

filed a reply. As set forth more fully below, plaintiff’s motion for medical examination is denied.

The Parties’ Arguments

 Plaintiff contends that his physical condition will become a serious controversy very 

shortly, and seeks a court order requiring the California Department of Corrections and 

Rehabilitation (“CDCR”) to take plaintiff to an outside major hospital for a “full physical 

examination by a certified medical doctor.” (ECF No. 68 at 1.) Plaintiff claims he was 

transferred to R.J. Donovan State Prison (“RJD”) from High Desert State Prison (“HDSP”) for 

hernia repair surgery. (ECF No. 68 at 2.) Plaintiff claims that once he arrived at RJD, he 

discovered there was an ongoing FBI investigation into inmate deaths at RJD. Plaintiff claims his 

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 1 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

primary care physician informed him that RJD doctors allow “hernias to repair themselves,” and 

alleges that Dr. Pankaj Karan was fired shortly after plaintiff’s hernia was diagnosed. (ECF No. 

68 at 2.) Plaintiff states that he was referred to a vascular surgeon due to the large lump above 

plaintiff’s aneurysm “which is considered another hernia, possibly caused by the irritation from 

the abdominal hernia’s excessive intestines rubbing above the iliac artery aneurysm.” (Id.) 

Plaintiff alleges that prison officials at RJD are delaying, denying and interfering with new 

primary care providers medical referral requests, which plaintiff believes is due to the medical 

civil rights lawsuit pending herein. Plaintiff contends that outside appointments are being 

cancelled. 

Plaintiff alleges that both hernias are excruciatingly painful, with nothing being done; at 

times, plaintiff reports the pain is a 9 on a scale of 10, causing tears. Plaintiff’s hernia is not 

“incarcerated.”

Defendants oppose plaintiff’s motion for the following reasons: 

1. Because plaintiff was transferred to RJD, plaintiff seeks relief from the CDCR and 

RJD, neither of which are parties herein, citing Zenith Radio Corp. v. Hazeltine Research, Inc., 

395 U.S. 100, 112 (1969). (ECF No. 77 at 2.) 

2. Defendants argue that the remedy plaintiff seeks is inappropriate because Rule 35 is a 

discovery tool “whose purpose is to ensure that civil trials no longer need to be carried out in the 

dark.” (ECF No. 77 at 2.) Defendants argue that plaintiff seeks to obtain a second opinion in 

order to question the medical judgment of health professionals at RJD. Defendants contend that 

plaintiff may file a health care appeal at RJD if he believes he is being provided inappropriate 

health care. 

3. Defendants also contend that plaintiff failed to demonstrate good cause for such an 

examination. Defendants contend that plaintiff arguments concerning an FBI investigation and 

Dr. Karan’s alleged termination are not based on plaintiff’s personal knowledge and therefore are 

not admissible under Rule 602 of the Federal Rules of Evidence. Defendants submit that 

plaintiff’s health care needs are being monitored and appropriately treated as demonstrated by the 

medical records provided with their opposition. Defendants note that plaintiff was seen by a 

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 2 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3

vascular surgeon, and was then examined by Dr. Sarah Ghayouri, who concluded plaintiff’s left 

iliac aneurysm was stable, and that because plaintiff presented with no vascular complaints, and 

his peripheral pulses were bilaterally normal, without any calf pain or claudication, a CT 

aortogram was not medically necessary. (ECF No. 77 at 4.) Plaintiff’s complaints were noted as 

attributable to plaintiff’s left inguinal hernia, which was described as “small.” (Id.) Defendants 

noted that Dr. Ghayouri discussed with plaintiff a surgical procedure to repair the left inguinal 

hernia, which was described as “an elective procedure.” (Id.) In addition, defendants contend 

that plaintiff failed to identify who would perform the medical examination and where it would 

take place. If such examination were to take place outside RJD, it would add transportation and 

security costs, and defendants argue that all such costs mitigate against plaintiff’s request, 

particularly where plaintiff can seek a remedy through the CDCR Health Care Appeal procedures.

In reply, plaintiff reiterates that he was referred for a surgical consult for hernia repair on 

February 8, 2011, while plaintiff was housed at Wasco reception. Plaintiff was then transferred to 

HDSP, but because plaintiff presented as a high risk patient, it was agreed that a medical transfer 

was appropriate for plaintiff’s hernia repair surgery. Plaintiff has now been waiting 44 months 

for hernia repair. Plaintiff recites from the court’s March 28, 2014 order: “Plaintiff’s hernia is a 

serious medical need, . . . the Ninth Circuit has noted that . . . a prisoner states a cognizable 

deliberate indifference claim where prescribed treatment for a hernia has been delayed for more 

than a year.” (ECF No. 78 at 2, citing ECF No. 35 at 3.) (citations omitted). Plaintiff states that 

he has filed regular medical complaints about constant hernia pain. Plaintiff claims that the last 

time he saw Dr. Ghayouri in an emergency visit for hernia pain, she only confirmed the hernia 

was not “incarcerated,” and sent plaintiff back to housing after only a two to three minute exam. 

(ECF No. 78 at 3.) Plaintiff states there was no vascular exam during this visit.

On August 28, 2014, plaintiff states he saw Dr. Solomon only to hear plaintiff’s medical 

appeals. Plaintiff stated that Dr. Solomon confirmed that Dr. Zepp and Dr. Syverson had already 

recommended hernia repair surgery, attached the documents to the medical appeal, and forwarded 

them to medical for approval. (ECF No. 78 at 4.) Plaintiff alleges that Dr. Solomon “informed 

plaintiff that the hernia issue should [have] been handled long before this medical visit.” (Id.) 

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 3 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

4

Plaintiff states that the medical appeal is still in processing with a September 17, 2014 deadline. 

(Id.) Plaintiff alleges that RJD medical administrators are well aware of plaintiff’s medical 

issues, but are ignoring them and deliberately depriving plaintiff of his hernia repair surgery, 

exposing him to serious harm and pain in violation of the Eighth Amendment. (ECF No. 78 at 4.) 

Rule 35

Rule 35(a) of the Federal Rules of Civil Procedure provides as follows:

(a) Order for an Examination.

 (1) In General. The court where the action is pending may order a 

party whose mental or physical condition--including blood group--

is in controversy to submit to a physical or mental examination by a 

suitably licensed or certified examiner. The court has the same 

authority to order a party to produce for examination a person who 

is in its custody or under its legal control. 

 (2) Motion and Notice; Contents of the Order. The order: 

 (A) may be made only on motion for good cause and on notice 

to all parties and the person to be examined; and 

 (B) must specify the time, place, manner, conditions, and scope 

of the examination, as well as the person or persons who will 

perform it.

Fed. R. Civ. P. 35(a). Plaintiff must demonstrate good cause for either a physical or mental 

examination. Schlagenhauf v. Holder, 379 U.S. 104, 114-22 (1964). 

Medical Records

Defendants provided the following medical records:

On May 16, 2014, plaintiff requested health care services, noting his abdominal hernia 

and “a large lump rising in area of left iliac artery aneurysm. Both issues are becoming more 

painful, and bothersome.” (ECF No. 77 at 35.) The RN noted that plaintiff was seen by his

primary care physician on April 17, and that he was scheduled for follow-up appointment on June 

2, 2014. (ECF No. 77 at 35.)

On June 4, 2014, plaintiff was examined by Dr. Pankaj Karan, who noted that plaintiff’s 

umbilical hernia was stable, no evidence of obstruction, but that they would keep monitoring it. 

(ECF No. 77 at 33.) Dr. Karan stated “[t]here is no point for surgery at this point.” (Id.) Dr. 

Karan noted plaintiff’s “left iliac aneurysm status post stenting in the past now with complaints of 

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 4 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

5

some swelling and tenderness for the last 2 months.” (Id.) Dr. Karan stated she would refer 

plaintiff to a vascular surgeon “to take a look at this situation.” (Id.) 

On June 4, 2014, Dr. Karan issued a referral to vascular surgery for plaintiff. (ECF No. 

77 at 13.) Plaintiff was scheduled for thirty day follow-up for the aneurysm in his left groin. (Id.) 

On June 4, 2014, or June 6, 2014, it appears that plaintiff was also prescribed some form of drug, 

but the handwriting is illegible. (ECF No. 77 at 14.)

On July 2, 2014, plaintiff was examined by Dr. Patrick Freyne, who reported, in pertinent 

part:

ASSESSMENT/PLAN:

1. Hypertension, at goal. Continue metoprolol and amlodipine.

2. History of coronary artery disease, stable. Continue statin, 

aspirin, p.r.n. nitroglycerine and blood pressure control.

3. Benign prostatic hypertrophy, stable. Continue terazosin,

4. Umbilical hernia, stable. No indication for surgery at this time. 

Will follow closely.

5. Hyperlipidemia, at goal. Continue stat in,

6. Left iliac aneurysm, status post stenting, stable. Follow up with 

Vascular Surgery.

EDUCATION: TABE score 6.4. The patient agrees with the 

treatment plan, goals and followup. All questions are answered.

FOLLOWUP: Plan for followup with Primary Care physician in 60 

days.

(ECF No. 77 at 27-28.)

On July 8, 2014, plaintiff requested health care for dizziness; on July 9, 2014, plaintiff 

denied symptoms or pain. (ECF No. 77 at 25.)

On July 13, 2014, plaintiff requested to see a doctor, complaining that he had been 

experiencing extreme sharp pains in the same area as his stented aneurysm -- left iliac artery --

swelling had also increased. (ECF No. 77 at 19.) Plaintiff reported his pain level at between 7 

and 9 at times. (Id.) Plaintiff was referred to his primary care physician marked “Stat.” (Id.)

Plaintiff was seen by an R.N. who noted that a follow-up was set for July 15, 2014, with his 

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 5 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

6

primary care physician. (ECF No. 77 at 22.) “Per Dr. Ghayouri no need to send out. Refer to 

PCP [illegible] to be evaluated for surgery consult (PCP findings of hernia symptoms). (ECF No. 

77 at 22.)

On July 14, 2014, plaintiff was examined by Dr. Ghayouri. (ECF No. 77 at 23-23.) Dr. 

Ghayouri reported, in pertinent part: 

ASSESSMENT/PLAN:

1. Reducible left inguinal hernia. The patient was assured and 

elective surgical treatment was discussed.

2. Coronary artery disease, stable. Continue current medication 

hypertension and hypercholesterolemia, statin, aspirin; 

nitroglycerin, and beta blocker.

3. Benign prostatic hypertrophy, stable.

4. Umbilical hernia, stable.

5. Past history of left iliac aneurysm, status post stenting, stable. 

The patient was referred to see a vascular surgeon due to recent 

complaint of left groin swelling. Vascular surgeon had requested a

CT aortogram, abdominal and lower extremities bilaterally with 

run-off and contrast prior to the visit. After examination of the 

patient, most of the patient's complaint was in regard to this small 

reducible left inguinal hernia. I do not see any indication at this 

time for a GT aortogram of abdominal and lower extremities. Since 

the patient does not have any vascular complaints, peripheral pulses 

are bilaterally normal. Patient denies any type of calf pain or 

claudication. This was deferred at the present time.

EDUCATION: Discussed the assessment and plan, medication, 

diet, exercise, weight management. He verbalized understanding. 

Effective communication was achieved. He summarized 

information, answered questions verbally and nonverbally. ·

EFFECTIVE COMMUNICATION: I discussed with the patient 

findings and treatment options, including their risks and benefits. 

The importance of compliance was discussed. Urgent care 

precautions were discussed. The patient is to return to clinic if not 

significantly better. The patient's questions were answered. I spoke 

slowly, clearly, using simple language.

The patient verbalized, in his own words, understanding and agreed 

to treatment plan, to my satisfaction.

FOLLOWUP: PCP followup p.r.n. and in 30 days.

(ECF No. 77 at 24.) 

////

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 6 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

7

The records provided by defendants reflect that plaintiff is being p[rescribed the following 

medications at RJD:

metoprolol tartrate - for high blood pressure, angina, irregular heart rhythm; symptoms 

caused by overactive thyroid gland; terazosin - for symptoms of enlarged prostate; 

amlodipine besylate - a calcium channel blocker to reduce blood pressure; and lbuprofen 600 mg 

two times per day for pain. (ECF No. 77 at 9-10.)

mirtazapine - antidepressant (ECF No. 77 at 12.)

Crestor - for high cholesterol and high triglycerides in the blood (ECF No. 77 at 49.)

Nitroglycerin - for chest pain (ECF No. 77 at 62)

Plaintiff provided a copy of his August 31, 2014 request for health care services in which 

he states that the prescribed Ibuprofen is no longer relieving his hernia pain. (ECF No. 78 at 6.) 

Plaintiff requested that he either be provided hernia repair surgery, or that he be prescribed 

something to relieve his pain, which he described as a constant 8 to 9 on a scale of ten. (ECF No. 

78 at 6.)

Discussion

First, plaintiff’s allegations as to Dr. Karan are not substantiated with credible evidence 

and plaintiff fails to demonstrate his allegations are within his personal knowledge. Defendants 

provided copies of records from the California Department of Consumer Affairs that reflect that 

Dr. Freyne and Dr. Ghayouri are licensed doctors in good standing. (ECF No. 77 at 66-70.) The 

Consumer Affairs website also reflects that Dr. Pankaj Karan, License Number 54018, holds a 

current license, and has no public record actions noted in the same fashion as the records for Dr. 

Freyne and Dr. Ghayouri. Department of Consumer Affairs, BREEZE, 

<https://www.breeze.ca.gov> (accessed Sept. 18, 2014). Thus, plaintiff’s allegations as to Dr. 

Karan are disregarded.

Second, defendants’ objections to the Rule 35 examination are well-taken, and the 

undersigned is persuaded that a medical examination under Rule 35 is not the appropriate remedy. 

Rather, it appears that plaintiff needs hernia repair surgery and/or better pain management for the 

pain associated therewith.

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 7 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

8

 Third, the undersigned is concerned that plaintiff has not yet received hernia repair 

surgery, despite being transferred to RJD for that purpose. That said, the last time the parties 

filed status reports concerning plaintiff’s medical care at RJD, it was unclear whether hernia 

repair was appropriate given plaintiff’s other medical issues, as well as his concern about the risks 

of such surgery:

On April 16, 2014, plaintiff filed a status report confirming his 

transfer to RJD, and stated that on April 11, 2014, he saw the RJD 

clinic doctor who “ordered more examinations and tests.” (ECF No. 

40 at 2.) Plaintiff also stated that due to his age, heart and other 

health issues, as well as the delay in receiving the surgery, and 

because there have been recent fatalities caused by infections 

resulting from screens used in hernia repair surgeries at RJD, 

plaintiff “may have to live with the pain from [his] abdominal 

hernia” rather than elect to have hernia repair surgery. (ECF No. 40 

at 2.) However, plaintiff will discuss his options with the assigned 

surgical team.

(ECF No. 41 at 2.) Plaintiff has failed to address these concerns in the instant motion, and the 

medical records do not articulate the nature of the discussions medical professionals at RJD have 

had with plaintiff concerning hernia repair surgery. Rather, it appears their focus has been on his 

iliac aneurysm. On this record, the court is unable to construe plaintiff’s filing as a request for 

injunctive relief seeking hernia repair surgery. Moreover, it appears that plaintiff may have 

obtained some assistance through the medical appeals process with Dr. Solomon. The September 

17, 2014 deadline has now passed, and the court is unaware of any further progress, or lack 

thereof, that may have been accomplished through this appeal process. 

For all of these reasons, plaintiff’s motion for Rule 35 examination is denied. However, 

the parties are advised that despite plaintiff’s transfer to RJD, the court is unwilling to require 

plaintiff to start this journey again, by first exhausting his administrative claims at RJD and then 

filing a new civil rights action in the Southern District of California. A federal court has the 

power to issue orders in aid of its own jurisdiction, 28 U.S.C. § 1651(a), and to prevent threatened 

injury that would impair the court’s ability to grant effective relief in a pending action. Sierra 

On-Line, Inc. v. Phoenix Software, Inc., 739 F.2d 1415, 1422 (9th Cir. 1984); Gon v. First State 

Ins. Co., 871 F.2d 863 (9th Cir. 1989). 

////

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 8 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

9

A defendant acts with deliberate indifference when he knowingly fails to respond to a 

serious medical need and, thereby, inflicting harm on the plaintiff. See Farmer v. Brennan, 511 

U.S. 825, 837-42 (1994); Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (defendant is 

deliberately indifferent when he purposefully fails to respond to a prisoner’s pain). Deliberate 

indifference may appear when a defendant denies, delays, or otherwise interferes with medical 

treatment. See Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir.1988). Nevertheless, 

“[d]eliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 1051, 1060 (9th 

Cir. 2004). “Mere ‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not support this 

cause of action.” Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir.1980) (citing 

Estelle, 429 U.S. at 105-06).

Recently, in Colwell v. Bannister, 2014 WL 3953769 (9th Cir. Aug. 14, 2014), the Ninth 

Circuit reiterated its prior findings:

In Snow v. McDaniel, . . ., an NDOC death row inmate brought an 

Eighth Amendment claim after the Utilization Review Panel 

repeatedly refused to authorize hip replacement surgery 

recommended by outside specialists and a treating physician. 681 

F.3d at 983-84. The Panel denied surgery for approximately two 

years, concluding that the condition could be treated with pain 

medication even though it was an “emergency” and “potentially life 

threatening.” Id. The Snow court held that “the circumstances . . . 

raise [d] an inference that the defendants were unreasonably relying 

on their own non-specialized conclusions” instead of the 

recommendations of the plaintiff's treating specialists. Id. at 986. 

Therefore, “a reasonable jury could conclude that the decision of 

the non-treating, non-specialist physicians to repeatedly deny the 

recommendations for surgery was medically unacceptable under all 

of the circumstances.” Id. at 988; see also Hamilton v. Endell, 981 

F.2d 1062, 1067 (9th Cir. 1992) (“By choosing to rely upon a 

medical opinion which a reasonable person would likely determine 

to be inferior, the prison officials took actions which may have 

amounted to the denial of medical treatment, and the ‘unnecessary 

and wanton infliction of pain.’”), overruled in part on other grounds 

as recognized in Snow, 681 F.3d at 986. 

Colwell, 2014 WL 3953769 at *5. See also Wilhelm v. Rotman, 680 F.3d 1113, 1122 (9th Cir.

2012) (citing McGuckin v. Smith, 974 F.2d 1050 (9th Cir. 1992),

1

for the proposition that a 

hernia is “‘an injury that reasonable doctor or patient would find important and worthy of 

 

1

 McGuckin was overruled on other grounds by WMX Technologies v. Miller, 104 F.3d 1133 

(9th Cir. 1997) (en banc).

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 9 of 10
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

10

comment or treatment,’” 974 F.2d at 1059-60; and citing Jones v. Johnson, 781 F.2d 769, 771 

(9th Cir.1986) (“He alleges suffering and pain from his herniated condition. . . .”)). In Colwell, 

the court was addressing the lack of treatment for an inmate’s cataract, which, while serious, 

usually does not cause pain. 

Here, two prior prison physicians have issued referrals for plaintiff to receive hernia repair 

surgery, for which plaintiff has been waiting since 2011, or 44 months. Plaintiff now appears to 

contend that his hernia pain level has increased and is constant at a level of 8 to 9. The medical 

records provided by defendants reflect that plaintiff is being prescribed Ibuprofen, which plaintiff 

now contends is insufficient to alleviate his hernia pain. 

Therefore, the denial of plaintiff’s motion for Rule 35 medical examination is without 

prejudice to plaintiff filing a motion for injunctive relief should health care professionals at RJD 

continue to deny plaintiff appropriate pain medication while he awaits the results of his health 

care appeal through Dr. Solomon. Of course, plaintiff must allege facts demonstrating such 

deliberate indifference and supporting such relief. “A plaintiff seeking a preliminary injunction 

must establish that he is likely to succeed on the merits, that he is likely to suffer irreparable harm 

in the absence of preliminary relief, that the balance of equities tips in his favor, and that an 

injunction is in the public interest.” Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 20 

(2008) (citations omitted). 

For all of the above reasons, IT IS HEREBY ORDERED that plaintiff’s request for 

examination (ECF No. 68) is denied without prejudice. 

Dated: September 19, 2014

/ceci1923.r35

Case 2:13-cv-01923-TLN-KJN Document 79 Filed 09/19/14 Page 10 of 10