Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_15-cv-00275/USCOURTS-casd-3_15-cv-00275-4/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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UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF CALIFORNIA 

Joseph Anthony Hill, 

Plaintiff,

v. 

San Diego Sheriff's Department Medical 

Services Division, San Diego Sheriff's 

Department; UCSD Medical Center; 

Alfred Joshua, M.D. Chief Medical 

Officer, Sheriff's Detention Services 

Bureau; William Gore, Sheriff San Diego 

County, 

Defendants.

 15cv275 LAB (NLS) 

REPORT AND 

RECOMMENDATION FOR ORDER 

GRANTING DEFENDANT 

JOSHUA’S MOTION TO DISMISS 

[Dkt. No. 17] 

 As a pretrial detainee, Plaintiff Joseph Anthony Hill filed this civil rights action 

under 42 U.S.C. § 1983 claiming that Defendants violated his constitutional right to be 

free from cruel and unusual punishment. The claims stem from events occurring on 

December 28, 2013, when Hill was shot during the process of his arrest. Immediately 

after the shooting he was treated at UCSD Medical Center. Hill complains that since the 

shooting he has not received follow-up medical treatment. Consequently, he alleges that 

Defendants San Diego Sheriffs Medical Services Division, UCSD Medical Center, Alfred 

Joshua, MD (Chief Medical Officer for the Sheriff Detention Services Bureau) and 

Sheriff William Gore have been deliberately indifferent to his medical needs by failing to 

provide continuing care. 

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 Defendant Alfred Joshua, M.D. filed a motion to dismiss the complaint on grounds 

that it fails to state a claim against him. Hill’s opposition brief was due October 30, 

2015. As of the date of this order, no opposition brief has been filed. For the following 

reasons, the court RECOMMENDS that the motion to dismiss be GRANTED. 

I. PROCEDURAL BACKGROUND 

On July 13, 2015, the district court adopted this court’s report and recommendation 

(R&R) regarding two of the defendants’ motions to dismiss, and dismissed several claims 

and defendants from this case. The only remaining defendant was Alfred Joshua, M.D., 

who had not yet responded to the complaint. 

Hill was given leave to amend most of the claims in the complaint. His amended 

complaint was due August 28, 2015. As of the date of this order, Hill has not filed an 

amended complaint. 

 On September 17, 2015 the court received notice that the “Order Adopting the 

Report and Recommendation” was returned as undeliverable because Hill is no longer 

located at George Bailey Detention Facility and is apparently on parole. Even though 

under Civil Local Rule 83.11.b Hill must notify the court of any change of address, he 

has not provided a forwarding address. 

 Joshua served this motion to dismiss on Hill by mail on October 1, 2015, to an 

address that differs from the one on the docket. Joshua never informed the court whether 

the motion was returned as undeliverable. 

II. SUMMARY OF COMPLAINT.1,2

 On December 28, 2013, the San Diego Sheriff’s Department shot Hill during the 

                                                                

1

 This “Summary of Complaint” section is quoted directly from this court’s previous 

R&R determining the two previously-filed motions to dismiss in this case. 

2

 These facts are summarized from pages 3-5 of Plaintiff’s complaint. Dkt. No. 1. 

Because this case comes before the court on a motion to dismiss, the court must accept as 

true all material allegations in the complaint and must also construe the complaint, and all 

reasonable inferences drawn from it, in the light most favorable to Plaintiff. Thompson v. 

Davis, 295 F.3d 890, 895 (9th Cir. 2002). 

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process of his arrest. They transported him to UCSD Medical Center for treatment. 

UCSD contracts with the San Diego Sheriff’s Department to provide medical care to 

Detainees. 

While at UCSD doctors discovered that Hill had a shattered bone in his left arm. 

His bicep detached, which likely caused related nerve damage. Doctors also found a 

bullet lodged near Hill’s aorta. 

Hill was admitted to UCSD for stabilization. While hospitalized, he received 

antibiotics and pain killers. 

A. The Lodged Bullet. 

Doctors told Hill they would leave the bullet near his heart in place for the time 

being. They explained that the bullet was too close to the heart to remove. They planned 

to monitor the bullet for movement then act at the appropriate time. The doctors also said 

that if the bullet moved, it could kill him. 

To date, Hill has never been re-evaluated or tested to find out whether the bullet 

moved or if he could benefit from any treatment or surgery. Hill has chest and back pain 

and wonders whether the pain stems from movement of the bullet. He lives in fear that 

on any day the bullet could move, causing his death. 

B. Injuries to the Arm and Hand. 

Doctors put a plastic, removable brace around Hill’s arm and told him the arm 

would heal on its own. They also told him that there was nerve damage associated with 

the arm but that they could not do anything at that time. Instead, they would take a “wait 

and see” approach. 

Approximately eight months after the injury, Hill was taken to UCSD for a nerve 

conduction test. A technician told him that he had extensive nerve damage. Hill did not 

consult with a doctor at that time. 

Hill has not used his arm in over a year. He can no longer use his hand because it 

has atrophied. His fingers curl inward toward his palm and he cannot move his fingers or 

wrist. Hill remains in constant, excruciating pain. The two daily pain killers he receives 

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make no appreciable difference in the level of pain. 

An orthopedic surgeon recently told Hill that if his arm is to function “anywhere 

near properly again,” it would require extensive surgery that includes a bone graft from 

his hip bone. The doctor also said Hill would need extensive surgery and physical 

therapy for his hand and related nerves to function anywhere near properly again. 

Because of the extensive physical therapy required to make his hand functional, the 

doctor recommended fusing Hill’s wrist bone, which would effectively not let Hill use his 

hand. 

Hill believes that if his arm had been tested and treated sooner, he could have 

avoided much of the pain and the loss of functionality. Because Hill cannot use his arm 

he cannot complete normal, basic daily functions—like showering or dressing—without 

help from other inmates. He has not gotten a full night sleep in over a year because most 

sleeping positions cause additional pain. 

C. Relief Requested. 

Hill requests the following injunctive and legal relief: (1) evaluation of the bullet 

lodged near his aorta; (2) surgery and rehabilitation to restore his arm to complete 

functionality; and (3) damages. 

III. DISCUSSION 

A. Motion to Dismiss Standard.3

A Federal Rule of Civil Procedure 12(b)(6) motion to dismiss for failure to state a 

claim tests the legal sufficiency of a plaintiff’s claim. Navarro v. Block, 250 F.3d 729, 

732 (9th Cir. 2001). When considering the motion, the court must accept as true all wellpleaded factual allegations in the complaint. Bell Atlantic Corp. v. Twombly, 556 U.S. 

544, 555 (2007). But the court need not accept as true legal conclusions cast as factual 

                                                                

3

 The case law cited in this R&R, as well as part of the analysis, is identical to the law 

and analysis cited in certain parts of the court’s R&R adjudicating the previously-filed 

motions to dismiss. 

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allegations. Id.; Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (stating “[t]hreadbare 

recitals of the elements of a cause of action, supported by mere conclusory statements” is 

insufficient). 

A complaint must “state a claim for relief that is plausible on its face.” Twombly, 

550 U.S. at 570. To survive a motion to dismiss, a complaint must include nonconclusory factual content. Id. at 555; Iqbal, 556 U.S. at 679. The facts and the 

reasonable inferences drawn from those facts must show a plausible—not just a 

possible—claim for relief. Twombly, 550 U.S. at 556; Iqbal, 557 U.S. at 679; Moss v. 

U.S. Secret Service, 572 F.3d 962, 969 (9th Cir. 2009). 

In addition, factual allegations asserted by pro se petitioners, “however inartfully 

pleaded,” are held “to less stringent standards than formal pleadings drafted by lawyers.” 

Haines v. Kerner, 404 U.S. 519, 520 (1972). Thus, where a plaintiff appears in propria 

persona in a civil rights case, the court “must construe the pleadings liberally and must 

afford plaintiff the benefit of any doubt.” See Karim-Panahi v. Los Angeles Police Dept., 

839 F.2d 621, 623 (9th Cir. 1988). 

B. Deliberate Indifference to Medical Needs. 

Hill bases his three claims for delay in medical care on the due process clause of 

the fourteenth amendment because he was a pretrial detainee during the relevant time 

period. See Bell v. Wolfish, 441 U.S. 520, 545 (1979) (stating “[c]laims by pretrial 

detainees are analyzed under the fourteenth amendment due process clause”). Hill’s 

rights as a pretrial detainee are “at least as great” as a convicted prisoner’s rights. See id.

(holding that “pretrial detainees, who have not been convicted of any crimes, retain at 

least those constitutional rights that we have held are enjoyed by convicted prisoners”). 

Further, while pretrial detainees must bring their claims for failure to address medical 

needs through the due process clause, those claims are analyzed under the “deliberate 

indifference” standard of the eighth amendment. Clouthier v. County of Contra Costa, 

591 F.3d 1232, 1242 (9th Cir. 2010); see Frost v. Agnos, 152 F.3d 1124, 1128 (9th Cir. 

1998) (comparing pretrial detainees' rights under the fourteenth amendment to prisoners' 

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rights under the eighth amendment and applying the same standards). 

Prison officials violate the eighth amendment if they act with deliberate 

indifference to a prisoner’s serious medical needs. Estelle v. Gamble, 429 U.S. 97, 106 

(1976). A plaintiff alleging such a violation must satisfy a two-part test containing both 

an objective and a subjective component. Hallett v. Morgan, 296 F.3d 732, 744 (9th Cir. 

2002) (citation omitted). A plaintiff must prove that the defendant prison official (1) 

deprived him of the “minimal civilized measure of life’s necessities;” and (2) acted with 

deliberate indifference by denying, delaying or intentionally interfering with medical 

treatment. Id. (internal citations omitted). 

A prison official acts with deliberate indifference only if the official “knows of and 

disregards an excessive risk to inmate health or safety.” Farmer v. Brennan, 511 U.S. 

825, 837 (1994). “If a prison official should have been aware of the risk, but was not, 

then the [official] has not violated the Eighth Amendment, no matter how severe the 

risk.” Toguchi v. Chung, 391 F.3d 1051, 1057 (9th Cir. 2004) (internal quotations 

omitted). “Deliberate indifference is a high legal standard.” Id. at 1060. Where a 

prisoner alleges delay in receiving medical treatment, he must show that the delay led to 

further harm. See Shapely v. Nevada Bd. Of State Prison Comm’rs, 766 F.2d 404, 407 

(9th Cir. 1985) (citing Estelle, 429 U.S. at 106). 

C. Defendant Joshua. 

Hill seeks both damages and injunctive relief in his complaint, implying that he is 

suing Joshua in both his personal and official capacities. In his identification of Joshua in 

the complaint, Hill says, “As the Chief Medical Officer, [Joshua] allowed the personnel 

under his supervision, to act with deliberate indifference in that they failed to provide 

adequate medical care for serious condition[s].” Compl., p.2. Hill does not specifically 

mention Joshua anywhere else in the complaint. 

1. Claims Against Joshua in His Personal Capacity. 

There is no respondeat superior liability for government officials due to the actions 

of their subordinates. Iqbal, 556 U.S. at 676. Consequently, “[b]ecause vicarious 

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liability is inapplicable to . . . § 1983 suits, a plaintiff must plead that each Governmentofficial defendant, through the official’s own individual actions, has violated the 

Constitution.” Id. (rejecting conclusory allegations that high level employees “knew of, 

condoned, and willfully” subjected Plaintiff to unconstitutional conditions). Supervisory 

prison officials may only be held liable for the allegedly unconstitutional violations of a 

subordinate if the plaintiff sets forth facts that show (1) how or to what extent they 

personally participated in or directed a subordinate’s actions; and (2) in either acting or 

failing to act, they were an actual and proximate cause of the deprivation of the plaintiff’s 

constitutional rights. See Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978). 

To the extent Hill seeks damages against Joshua, he fails to state a claim because 

he makes no specific factual allegations of individualized constitutional wrongdoing by 

him. For example, he does not allege that Joshua directed subordinates to ignore Hill’s 

medical needs or to only provide minimal medical care. He does not allege facts that 

show Joshua even knew about his condition, or that Hill ever made requests for medical 

treatments that Joshua denied. Even liberally construed, Hill’s complaint fails to set forth 

facts that state an individualized constitutional claim against Chief Medical Officer 

Joshua. See Iqbal, 556 U.S. at 678 (finding a failure to state a plausible claim because 

the pleading was completely “devoid of [the] further factual enhancement” that is 

required to overcome the respondeat superior bar and “nudge[] his claims. . . across the 

line from conceivable to plausible”). 

The court, therefore, recommends that Hill’s claims against Joshua in his personal 

capacity be dismissed with leave to amend. See Krier v. Ray, 341 Fed. Appx. 295, 297 

(9th Cir. 2009) (finding leave to amend a pro se complaint is appropriate if it seems at all 

possible the plaintiff can correct the defect). 

2. Claims Against Joshua in His Official Capacity. 

To the extent that Hill seeks injunctive relief and sues Joshua in his official 

capacity based solely on the claim that he is the Chief Medical Officer, he likewise fails 

to state a claim. “Official capacity suits [under § 1983] . . . ‘generally represent only 

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another way of pleading an action against an entity of which an officer is an agent.’” 

Kentucky v. Graham, 473 U.S. 159, 165-166 (1985) (quoting Monell v. New York City 

Dept. of Social Services, 436 U.S. 658, 690, n.55 (1978)); see Brandon v. Holt, 469 U.S. 

464, 472 (1985) (actions of department head in his official capacity akin to actions of 

municipality itself). 

While the County would be the appropriate defendant in place of Joshua in his 

official capacity, the County may be held liable only if Hill alleges facts to show that a 

constitutional deprivation was caused by the implementation or execution of “a policy 

statement, ordinance, regulation, or decision officially adopted and promulgated” by the 

municipality, or a “final decision maker” for the municipality. Monell, 436 U.S. at 690; 

see Navarro v. Block, 72 F.3d 712, 714 (9th Cir. 1995). In other words, “respondeat 

superior and vicarious liability are not cognizable theories of recovery against a 

municipality.” Miranda v. Clark County, Nevada, 279 F.3d 1102, 1109-10 (9th Cir. 

2002), aff’d in part en banc, 319 F.3d 465 (9th Cir. 2003). 

Here, Hill alleges he did not receive follow-up medical treatment after his arrest in 

December 2013. Compl., pp.3-5. But “a municipality cannot be held liable solely 

because it employs a tortfeasor.” Monell, 436 U.S. at 691; Navarro, 72 F.3d at 714. 

Instead, to allege a claim of municipal liability, Hill must include in his pleading enough 

“factual content” to support a reasonable inference to show that: (1) he was deprived of a 

constitutional right; (2) the county had a policy; (3) the policy amounted to deliberate 

indifference to his constitutional right; and (4) the policy was the “moving force behind 

the constitutional violation.” Van Ort v. Estate of Stanewich, 92 F.3d 831, 835 (9th Cir. 

1996); see also Iqbal, 556 U.S. at 678. 

As currently pleaded Hill’s complaint fails to state a claim against Joshua, in his 

official capacity, or against the county itself, because he fails to allege any facts that 

“might plausibly suggest” that he was denied adequate medical care pursuant to any 

municipal custom, policy, or practice implemented or promulgated with deliberate 

indifference to his constitutional rights, or that such a policy was the “moving force” or 

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cause of his injury. See Hernandez v. County of Tulare, 666 F.3d 631, 637 (9th Cir. 2012) 

(applying Iqbal’s pleading standards to Monell claims); Board of the County Comm’rs v. 

Brown, 520 U.S. 397, 404 (1997) (holding that “a plaintiff must show that the municipal 

action was taken with the requisite degree of culpability and must demonstrate a direct 

causal link between the municipal action and the deprivation of federal rights”). 

 Accordingly, the court recommends that Hill’s claims against Joshua in his official 

capacity be dismissed without leave to amend as to Joshua but with leave to amend as to 

the County itself. See Krier v. Ray, 341 Fed. Appx. at 297. 

IV. CONCLUSION4

For the reasons stated above, this court RECOMMENDS that the district judge: 

(1)GRANT the motion to dismiss Hill’s claims against defendant Joshua in his 

personal capacity with leave to amend. 

(2)GRANT the motion to dismiss Hill’s claims against defendant Joshua in his 

official capacity without leave to amend as to Joshua but with leave to amend as 

to the County itself, if Hill seeks to assert a Monell claim. 

(3)ORDER that the case be administratively closed. 

(4)If the district judge grants leave to amend the claims against defendant Joshua, 

set a deadline for 30 days out after the adjudication of this R&R for Hill to file 

an amended complaint as to defendant Joshua. 

This court FURTHER ORDERS that the Clerk serve a copy of this order to the 

address of record as well as to the address listed on the “Declaration of Service” [Dkt. 

No. 17-2]. 

                                                                

4

 The court notes that dismissal without prejudice due to failure to prosecute would also 

be proper under Civil Local Rule 83.11.b, as more than 60 days have passed since mail to 

Hill’s last designated address was returned as undeliverable (“If mail directed to a pro se 

plaintiff by the clerk at the plaintiff's last designated address is returned by the Post 

Office, and if such plaintiff fails to notify the court and opposing parties within 60 days 

thereafter of the plaintiff's current address, the court may dismiss the action without 

prejudice for failure to prosecute.”) Joshua did not move to dismiss under those grounds. 

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The court submits this Report and Recommendation to the United States District 

Judge assigned to this case pursuant to 28 U.S.C. § 636(b)(1). No later than January 22, 

2016, any party to this action may file written objections with the court and serve a copy 

on all parties. The document should be captioned “Objections to Report and 

Recommendation.” 

Any reply to the objections shall be filed with the Court and served on all parties 

no later than January 29, 2016. The parties are advised that failure to file objections 

within the specified time may waive the right to those objections on appeal of the Court’s 

order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991). 

IT IS SO ORDERED. 

Dated: December 30, 2015 

 

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