Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_11-cv-02507/USCOURTS-caed-2_11-cv-02507-3/pdf.json

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

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

TYRONE INGRAM,

Plaintiff, No. 2:11-cv-2507-EFB P

vs.

B. HAMKAR, et al.,

ORDER AND

Defendants. FINDINGS AND RECOMMENDATIONS

 /

Plaintiff is a state prisoner proceeding without counsel in a civil rights action brought

under 42 U.S.C. § 1983. Defendants move to dismiss for failure to state a claim. Dckt. No. 30. 

For the reasons explained below, the motion must be granted in part and denied in part.

I. The Complaint 

This action proceeds on the verified amended complaint filed on May 24, 2012. Dckt.

No. 13. Plaintiff asserts that defendants denied him adequate medical care when he was housed

at California State Prison, Sacramento (“CSP-Sac”). Id. Specifically, he claims that he had a

knee injury that presented a serious medical need and that defendant Hamkar (his prison

physician) was deliberately indifferent to that need from July 15, 2008 until the date of the

complaint (filed September 22, 2011). Plaintiff alleges that Hamkar: (1) did not provide a stable

brace for plaintiff’s knee at various times during that period, (2) did not order a brace with

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plastic parts (instead ordering a brace with metal parts that were removed for security purposes,

rendering the brace ineffective), (3) did not order that plaintiff be housed in the prison’s

Outpatient Housing Unit, where his movement would have been limited, and (4) ordered that

plaintiff’s knee brace be confiscated on January 5, 2011. Id. at 4, 13. Plaintiff alleges that

defendant Thorpe (a prison nurse) was deliberately indifferent to his knee injury when she

confiscated the brace on January 5, 2011. Id. at 4-5.

Medical records attached to the complaint show that plaintiff submitted a request for a

knee brace on April 13, 2010. Id. at 52 (“I need a new knee brace and having pain in right

knee”). An orthopedist at San Joaquin General Hospital recommended that plaintiff be provided

an “ACL brace” on October 8, 2010. Id. at 12. Plaintiff submitted another request for a brace on

October 31, 2010. Id. at 50 (“I need a brace on rt knee . . . and I’m in a great deal of pain.”). 

Plaintiff underwent surgery on his knee on December 1, 2010 and February 22, 2011. Id.

at 24-29. Upon his discharge from San Joaquin General Hospital (where the February 22, 2011

surgery took place), plaintiff’s surgeon ordered that plaintiff should “[w]ear the knee

immobilizer at night” but could remove the device during the day “and do gentle range of motion

exercises[.]” Id. at 31. On July 7, 2011, the surgeon again recommended, in a letter to prison

physicians Dr. Deams and Dr. Bal, that plaintiff be provided “an anterior cruciate ligament

brace[.]” Id. at 45.

Throughout 2010 and 2011, plaintiff submitted numerous requests for medical care for

knee pain. Id. at 50-60 (dated April 13, 2010; June 15, 2010; October 31, 2010; March 10, 2011;

March 29, 2011; April 1, 2011; April 2, 2011; April 3, 2011; April 5, 2011; April 20, 2011; April

27, 2011).

The complaint’s attachments further reveal that, during the same period, plaintiff

submitted at least three prison grievances alleging that he was being denied an adequate knee

brace. In the first, Log No. SAC 10-10-11382 (filed on May 24, 2010), plaintiff wrote that his

knee was unstable after major knee surgery to repair his ACL and that he needed a stronger

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brace. Id. at 9. Plaintiff alleged that defendant Hamkar was deliberately indifferent to his

serious medical needs by delaying and refusing to provide plaintiff with a stronger brace. Id. at

10. Hamkar responded at the first level of review on July 8, 2010 that “[o]ur plan [regarding the

brace] is to wait for your MRI and an orthopedic evaluation and further recommendation.” Id. at

7. Plaintiff alleges that he submitted this appeal to the third level review office by mail on July

15, 2010, but that he never received any response. Id. at 6. 

In the second appeal, SAC HC 1102960/SAC 10-11-1195 (filed on January 5, 2011),

plaintiff alleged that the brace he had been provided had been altered and rendered useless. Id.

at 14. Plaintiff requested an unaltered brace. Id. At the first level of review, M. Linggi, RN,

responded that the brace was altered for security reasons and referred plaintiff to his physician

for “more information on the effectiveness of the brace[.]” Id. at 13. Linggi further noted, “you

currently have a new brace that you report to be effective.” Id. Plaintiff also submitted an

“Inmate Request for Interview” on January 6, 2011, alleging that defendants had confiscated his

brace and replaced it with the altered brace. Id. at 32. Linggi responded to the request, “I

interviewed you yesterday regarding this exact issue and Dr. Hamkar personally informed me

that your current brace is appropriate.” Id.

In the third appeal, SAC HC 11014068 (filed April 23, 2011), plaintiff alleged that he

was being denied necessary treatment for his knee pain and a knee brace. Id. at 17. Hamkar

responded at the first level of review on May 23, 2011, granting the appeal. Id. at 16. Hamkar

examined plaintiff, determined that his ACL had been re-injured, and ordered a brace. Id.

Plaintiff alleges that, as a result of Hamkar’s deliberately indifferent conduct, plaintiff’s

knee condition deteriorated. Id. at 4. He claims that the failure of defendants to afford plaintiff a

proper brace caused plaintiff’s knee surgery to fail, caused plaintiff to incur significant arthritic

changes, and required that plaintiff undergo a total knee arthroplasty. Id. at 5-6. In addition to

monetary damages, plaintiff seeks an order directing Hamkar “to issue prescribed medical

appliance.” Id. at 3.

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II. Rule 12(b)(6) Standard and Exhaustion

In order to survive a motion to dismiss under Fed. R. Civ. P. 12(b)(6), a complaint must

contain “enough facts to state a claim to relief that is plausible on its face.” Bell Atlantic Corp.

v. Twombly, 550 U.S. 544, 554-55, 562-63, 570 (2007) (stating that the 12(b)(6) standard that

dismissal is warranted if plaintiff can prove no set of facts in support of his claims that would

entitle him to relief “has been questioned, criticized, and explained away long enough,” and that

having “earned its retirement,” it “is best forgotten as an incomplete, negative gloss on an

accepted pleading standard”). Thus, the grounds must amount to “more than labels and

conclusions” or a “formulaic recitation of the elements of a cause of action. Id. at 1965. Instead,

the “[f]actual allegations must be enough to raise a right to relief above the speculative level on

the assumption that all the allegations in the complaint are true (even if doubtful in fact).” Id.

(internal citation omitted). Dismissal may be based either on the lack of cognizable legal

theories or the lack of pleading sufficient facts to support cognizable legal theories. Balistreri v.

Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1990).

The complaint’s factual allegations are accepted as true. Church of Scientology of Cal. v.

Flynn, 744 F.2d 694, 696 (9th Cir. 1984). The court construes the pleading in the light most

favorable to plaintiff and resolves all doubts in plaintiff’s favor. Parks Sch. of Bus., Inc. v.

Symington, 51 F.3d 1480, 1484 (9th Cir. 1995). General allegations are presumed to include

specific facts necessary to support the claim. Lujan v. Defenders of Wildlife, 504 U.S. 555, 561

(1992). 

The court may disregard allegations contradicted by the complaint’s attached exhibits. 

Durning v. First Boston Corp., 815 F.2d 1265, 1267 (9th Cir. 1987); Steckman v. Hart Brewing,

Inc., 143 F.3d 1293, 1295-96 (9th Cir.1998). Furthermore, the court is not required to accept as

true allegations contradicted by judicially noticed facts. Sprewell v. Golden State Warriors, 266

F.3d 979, 988 (9th Cir. 2001) (citing Mullis v. U.S. Bankr. Ct., 828 F.2d 1385, 1388 (9th Cir.

1987)). The court may consider matters of public record, including pleadings, orders, and other

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papers filed with the court. Mack v. South Bay Beer Distributors, 798 F.2d 1279, 1282 (9th Cir.

1986) (abrogated on other grounds by Astoria Fed. Sav. & Loan Ass’n v. Solimino, 501 U.S. 104

(1991)). “[T]he court is not required to accept legal conclusions cast in the form of factual

allegations if those conclusions cannot reasonably be drawn from the facts alleged.” Clegg v.

Cult Awareness Network, 18 F.3d 752, 754-55 (9th Cir. 1994). Neither need the court accept

unreasonable inferences, or unwarranted deductions of fact. Sprewell, 266 F.3d at 988.

 Pro se pleadings are held to a less stringent standard than those drafted by lawyers. 

Haines v. Kerner, 404 U.S. 519, 520-21 (1972). Unless it is clear that no amendment can cure

its defects, a pro se litigant is entitled to notice and an opportunity to amend the complaint before

dismissal. Lopez v. Smith, 203 F.3d 1122, 1127-28 (9th Cir. 2000) (en banc); Noll v. Carlson,

809 F.2d 1446, 1448 (9th Cir. 1987). 

The Prison Litigation Reform Act (“PLRA”) provides that “[n]o action shall be brought

with respect to prison conditions [under section 1983 of this title] until such administrative

remedies as are available are exhausted.” 42 U.S.C. § 1997e(a). “Prison conditions” subject to

the exhaustion requirement have been defined broadly as “the effects of actions by government

officials on the lives of persons confined in prison . . . .” 18 U.S.C. § 3626(g)(2); Smith v.

Zachary, 255 F.3d 446, 449 (7th Cir. 2001); see also Lawrence v. Goord, 304 F.3d 198, 200 (2d

Cir. 2002). To satisfy the exhaustion requirement, a grievance must alert prison officials to the

claims the plaintiff has included in the complaint, but need only provide the level of detail

required by the grievance system itself. Jones v. Bock, 549 U.S. 199, 218-19 (2007); Porter v.

Nussle, 534 U.S. 516, 524-25 (2002) (purpose of exhaustion requirement is to give officials

“time and opportunity to address complaints internally before allowing the initiation of a federal

case”).

Prisoners who file grievances must use a form provided by the California Department of

Corrections and Rehabilitation, which instructs the inmate to describe the problem and outline

the action requested. The applicable regulations have required, since January 28, 2011, that the

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inmate “list all staff member(s) involved” and “describe their involvement[.]” Cal. Code Regs.

tit. 15, § 3084.2(a)(3) (2011). The grievance process has three levels of review to address an

inmate’s claims, subject to certain exceptions. See Cal. Code Regs. tit. 15, § 3084.7. 

Administrative procedures generally are exhausted once a plaintiff has received a “Director’s

Level Decision,” or third level review, with respect to his issues or claims. Id. § 3084.1(b).

Proper exhaustion of available remedies is mandatory, Booth v. Churner, 532 U.S. 731,

741 (2001), and “[p]roper exhaustion demands compliance with an agency’s deadlines and other

critical procedural rules[.]” Woodford v. Ngo, 548 U.S. 81, 90 (2006). For a remedy to be

“available,” there must be the “possibility of some relief . . . .” Booth, 532 U.S. at 738. Relying

on Booth, the Ninth Circuit has held:

[A] prisoner need not press on to exhaust further levels of review once he has

received all “available” remedies at an intermediate level of review or has been

reliably informed by an administrator that no remedies are available.

Brown v. Valoff, 422 F.3d 926, 935 (9th Cir. 2005).

In the Ninth Circuit, motions to dismiss for failure to exhaust administrative remedies are

normally brought under Rule 12(b). See Albino v. Baca, 697 F.3d 1023, 1029 (9th Cir. 2012). 

Nonetheless, it remains well established that credibility of witnesses over material factual

disputes cannot be resolved on paper. Thus, when ruling on an exhaustion motion requires the

court to look beyond the pleadings in the context of disputed issues of fact, the court must do so

under “a procedure closely analogous to summary judgment.” Wyatt v. Terhune, 315 F.3d 1108,

1119, n.14 (9th Cir. 2003). Doing so ensures that a process is followed to test whether disputes

over facts pertaining to whether plaintiff actually exhausted available remedies are truly genuine

and material and therefore warrant live testimony, or whether the dispute(s) may be disposed of

by unrefuted declarations and exhibits. Therefore, following the suggestion in Wyatt, and

because care must be taken not to resolve credibility on paper if it pertains to disputed issues 

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of fact that are material to the outcome, the undersigned applies the Rule 56 standards to

exhaustion motions that require consideration of materials extrinsic to the complaint.1 See

Chatman v. Felker, No. Civ. S-06-2912 LKK EFB, 2010 WL 3431806, at *2-3 (E.D. Cal. Aug.

31, 2010).

Failure to exhaust is an affirmative defense in the sense that defendants bear the burden

of proving plaintiff did not exhaust available remedies. Wyatt, 315 F.3d at 1119. To bear this

burden:

a defendant must demonstrate that pertinent relief remained available, whether at

unexhausted levels of the grievance process or through awaiting the results of the

relief already granted as a result of that process. Relevant evidence in so

demonstrating would include statutes, regulations, and other official directives

that explain the scope of the administrative review process; documentary or

testimonial evidence from prison officials who administer the review process; and

information provided to the prisoner concerning the operation of the grievance

procedure in this case . . . . With regard to the latter category of evidence,

information provided [to] the prisoner is pertinent because it informs our

determination of whether relief was, as a practical matter, “available.”

Brown, 422 F.3d at 936-37 (citations omitted).

Defendants’ motion to dismiss included a notice to plaintiff informing him of the

requirements for opposing a motion to dismiss for failure to exhaust available administrative

remedies. See Woods v. Carey, 684 F.3d 934 (9th Cir. 2012); Stratton v. Buck, 697 F.3d 1004,

1008-10 (9th Cir. 2012); Wyatt v. Terhune, 315 F.3d 1108, 1115, 1120 n.15 (9th Cir. 2003). 

III. Analysis

Defendants advance four arguments in support of dismissal: (1) that plaintiff failed to

exhaust his administrative remedies; (2) that the complaint does not state a claim; (3) that

plaintiff’s request for injunctive relief is barred because it is encompassed by the pending class

actions Plata v. Schwarzenegger and Armstrong v. Brown; and (4) that defendants are entitled to

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 Here, defendants rely on testimonial evidence in the form of declarations from two

prison officials and a documentary record to establish the facts in support of their contention that

plaintiff failed to exhaust.

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qualified immunity. Each argument will be addressed in turn.

A. Exhaustion

Defendants allege that plaintiff failed to file and exhaust an administrative appeal

regarding the allegations of the complaint prior to filing suit. Defendants argue that, even if the

court were to accept plaintiff’s allegations that the prison failed to properly respond to his appeal

Log No. SAC 10-10-11382 after plaintiff submitted it to the third level of review, that appeal

could not exhaust plaintiff’s allegations because it pre-dated January 5, 2011, the date that

plaintiff claims his brace was confiscated by defendant Thorpe under the direction of defendant

Hamkar. Defendants note that Log No. SAC 10-10-11382 does not contain any allegation

regarding the confiscation of the brace. Defendants’ evidence shows that plaintiff has not seen

any appeal through to the third level of review concerning the confiscation of his brace on

January 5, 2011. Dckt. Nos. 30-5 (Declaration of J.D. Lozano ISO Defs.’ Mot. to Dism.), 30-6

(Decl. of L.D. Zamora ISO Defs.’ Mot. to Dism.).

Plaintiff does not dispute defendants’ evidence. Instead, he argues again that the

institution disregarded Log No. SAC 10-10-11382 when he filed it at the third level. As

defendants point out, however, that appeal predated and thus did not challenge the confiscation

of his brace on January 5, 2011. Plaintiff points to no other grievance he filed challenging that

alleged misconduct. Accordingly, there is no genuine dispute as to any fact material to the

question of whether plaintiff failed to exhaust his claim that the defendants wrongfully

confiscated his knee brace on January 5, 2011. Plaintiff’s claim against Thorpe solely concerns

that incident. Accordingly, Thorpe must be dismissed from this action.

Defendants have not established that plaintiff failed to exhaust his administrative

remedies with regard to the remaining allegations against defendant Hamkar, however. Plaintiff

does not allege simply that defendant Hamkar was deliberately indifferent for ordering his brace

confiscated on January 5, 2011. Plaintiff also alleges that Hamkar repeatedly denied him an

adequate knee brace over the course of several years beginning in July 2008. Dckt. No. 13 at 4. 

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Defendants’ motion to dismiss is silent as to whether plaintiff’s grievances served to exhaust this

claim. Accordingly, defendants’ motion to dismiss for failure to exhaust with regard to

defendant Hamkar should be granted only as to plaintiff’s allegations concerning the

confiscation of his brace on January 5, 2011 and otherwise denied.

B. Adequacy of the Complaint

Defendants next argue that plaintiff’s complaint fails to state a claim for deliberate

indifference. According to defendants, an attachment to plaintiff’s complaint shows that his

earlier knee surgery failed not because he was denied a proper brace, but because he suffered

“significant arthritic changes.” See Dckt. No. 13 at 45 (letter from plaintiff’s surgeon stating, “I

feel that his main problem for failure is his significant arthritic changes medially.”). Plaintiff’s

complaint alleges, however, that he suffered these arthritic changes because he was denied a

proper brace. Id. at 6. The exhibits do not establish beyond controversy that plaintiff’s

corrective knee surgery failed for some reason other than the denial of an adequate brace.

Defendants also argue that plaintiff’s difference of opinion with defendant Hamkar as to

what kind of brace he needed does not establish deliberate indifference. From the attachments to

the complaint, however, it appears that sometimes plaintiff was not provided a brace at all and

other times he was provided an altered brace. It is a disputed question whether how defendant

Hamkar responded to plaintiff’s knee injury and whether that response was medically

reasonable. Clearly, plaintiff’s surgeon concluded that he needed an “anterior cruciate ligament

brace such as a double upright knee brace for his right knee” to improve stability. Id. at 45 (Dr.

Dowback’s letter of July 7, 2011 to prison physicians Dr. Deams and Dr. Bal.). Moreover, the

complaint and its attachments show that throughout 2010 and 2011, plaintiff submitted numerous

requests for medical care for knee pain. Id. at 50-60 (dated April 13, 2010; June 15, 2010;

October 31, 2010; March 10, 2011; March 29, 2011; April 1, 2011; April 2, 2011; April 3, 2011;

April 5, 2011; April 20, 2011; April 27, 2011). They also show that during that same period,

plaintiff submitted at least three prison grievances alleging that he was being denied an adequate

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knee brace. The court cannot determine that at this stage of the proceedings whether the refusal

of a brace at some times, and the providing of only a modified brace at other times, were

reasonable responses to plaintiff’s medical need for a knee brace. The record is not clear as to

what periods no brace was provided. It is also unclear as to what modifications were made to the

brace that was sometimes provided, who modified it, the qualifications of that person(s), and

how the changes to that brace altered the way it functioned. As pleaded, plaintiff’s complaint

and its attachments adequately state an Eighth Amendment claim against defendant Hamkar.2

C. Plata and Armstrong

Defendants next argue that plaintiff’s request for injunctive relief is barred because it is

encompassed by the pending class actions Plata v. Schwarzenegger, No. C-01-1351 TCH (N.D.

Cal.) and Armstrong v. Brown, No. 4:94-cv-2307 (N.D. Cal.). Defendants argue that plaintiff’s

individual request for injunctive relief falls within the Plata and Armstrong actions.3

 The Ninth

Circuit has held, however, that Plata does not bar an individual plaintiff from seeking injunctive

relief solely on his own behalf, because Plata sought systemic relief rather than individual relief.

Pride v. Correa, 501 Fed. Appx. 701, 705 (9th Cir. 2012). There is no reason why this rule

should not apply to Armstrong as well. See Armstrong v. Schwarzenegger, 622 F.3d 1058, 1072-

74 (9th Cir. 2010) (discussing plaintiffs’ request for system-wide injunctive relief). 

Accordingly, Plata and Armstrong do not bar plaintiff’s request for individual injunctive relief.

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2

 The court need not consider the adequacy of plaintiff’s complaint against defendant

Thorpe, as plaintiff’s claim against her has not been exhausted.

3

 The court grants defendants’ request for judicial notice of the Stipulation for Injunctive

Relief entered on June 13, 2002 in the Plata action and the Remedial Plan entered in Armstrong

v. Davis, amended January 3, 2001 (Docket. No. 60-4). Fed. R. Evid. 201(b); United States v.

Howard, 381 F.3d 873, 876 n.1 (9th Cir. 2004) (stating that a court may take judicial notice of

court records in another case).

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D. Qualified Immunity

Lastly, defendants argue that they should be afforded qualified immunity. The doctrine

of qualified immunity shields government officials from liability for damages for conduct that

does not violate a clearly established federal right of which a reasonable person would have

known. Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). Because plaintiff has not exhausted his

claim against defendant Thorpe, the court need only consider whether defendant Hamkar should

be afforded qualified immunity.

For the reasons discussed above, plaintiff has stated a claim that defendant Hamkar

violated his Eighth Amendment rights. Therefore, Hamkar’s argument that based on the

complaint and its attachments he is entitled qualified immunity because he simply did not violate

plaintiff’s rights fails for the same reasons.

Hamkar also argues that, even if he did violate plaintiff’s rights, a reasonable person in

defendant Hamkar’s situation would not have known that his actions violated the plaintiff’s

rights because the Armstrong Remedial Plan allowed institutions to modify healthcare appliances

based on security concerns. However, there is clear evidence attached to the complaint that

plaintiff’s surgeon informed the institution’s medical staff that plaintiff required a brace. 

Plaintiff alleges that at times he was provided no brace. Further, based on the allegations of the

complaint it is far from undisputed that the altered brace defendant Hamkar provided to plaintiff

was adequate to accommodate plaintiff’s medical needs and thus discharge the obligations set

forth in the Remedial Plan. Dckt. No. 30-4 at 44 (providing that a necessary medical appliance

may be modified for security reasons to “accommodate” an inmate’s needs but that “[o]nly under

exceptional circumstances will an appliance be rejected and an alternate means provided.”). 

Accordingly, defendant Hamkar’s request for qualified immunity must be denied at this time.

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IV. Order and Recommendation

Defendants did not respond to the September 18, 2013 Order to “within 30 days”

complete and return the form indicating whether they consent to proceed before a magistrate

judge. Accordingly, IT IS HEREBY ORDERED that the Clerk of the Court randomly assign a

United States District Judge to this action.

Further, IT IS HEREBY RECOMMENDED that defendants’ December 28, 2012 motion

to dismiss (Dckt. No. 30) be granted in part and that plaintiff’s claims against defendants Thorpe

and Hamkar for confiscating his knee brace on January 5, 2011 be dismissed without prejudice

for failure to exhaust administrative remedies and otherwise denied.

These findings and recommendations are submitted to the United States District Judge

assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within fourteen days

after being served with these findings and recommendations, any party may file written

objections with the court and serve a copy on all parties. Such a document should be captioned

“Objections to Magistrate Judge’s Findings and Recommendations.” Failure to file objections

within the specified time may waive the right to appeal the District Court’s order. Turner v.

Duncan, 158 F.3d 449, 455 (9th Cir. 1998); Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991).

Dated: July 18, 2013.

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