Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_03-cv-01729/USCOURTS-azd-2_03-cv-01729-1/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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 Defendants represent that Dr. Jones was on active military duty from July 2002 to

January 2003 (Doc. #82 at 2).

WO

 JDN

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Felipe J. Martinez, 

Plaintiff, 

vs.

James W. Baird, et al., 

Defendants. 

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No. CV 03-1729-PHX-RCB (LOA)

ORDER

Plaintiff Felipe J. Martinez, an inmate in the custody of the Arizona Department of

Corrections (ADC), filed this civil rights action pursuant to 42 U.S.C. § 1983 against the

following Defendants: (1) James W. Baird, M.D., who is employed by ADC as the Medical

Program Manager; (2) Robert D. Jones, M.D., Deputy Director of ADC Health Services from

August 2001 to December 20031

; (3) Ronolfo Macabuhay, M.D., an ADC physician, who

cares for inmates and has been the Key Contact Physician from 2003 to the present; and (4)

Wade Seirs, who was a Medical Investigator for ADC from April 2003 to August 2003.

Before the Court are the parties’ cross-motions for summary judgment and Plaintiff’s

unopposed motion to strike the affidavit of Zachary Johnson, which Plaintiff filed in support

Case 2:03-cv-01729-RCB Document 134 Filed 08/24/06 Page 1 of 18
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2

 Plaintiff also contends that Defendants failed to file a separate statement of facts in

opposition his summary judgment motion (Pl.’s Reply in Support of Mot. for Summ. J., Doc.

#120). However, Defendants filed a separate Statement of Facts with their summary

judgment motion and refer to these facts in their opposition motion (Doc. #123). This is

sufficient to comply with Rule 56.1.

3

 Defendants dispute Plaintiff’s characterization of this request as “formal” (Defs.’

Objections (DO) at 8, Doc. #111).

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of his motion as exhibit 472 (Doc. ##82, 104, 106). The Court will grant Plaintiff’s motion

to strike Johnson’s affidavit to the extent that the Court will disregard the affidavit, but will

otherwise deny the motion (Doc. #106). The Court will grant Defendants’ summary

judgment motion, except as to Dr. Macabuhay regarding Count I, and deny Plaintiff’s Motion

for Summary Judgment.

I. Background

The following facts, except as otherwise noted, are undisputed. In May 1998, Plaintiff

was diagnosed with Hepatitis C Virus (HCV). HCV is a viral infection transmitted through

exposure to blood or fluids (Defs.’ Statement of Facts (DSOF) ¶14; Pl.’s Statement of

Disputed Facts (PSDF) ¶ 1). HCV progresses slowly with slightly less than 20% of infected

individuals developing cirrhosis within 10-30 years (DSOF ¶ 18; PSDF ¶ 7). HCV is

sometimes treated by administering Rebetron (a combination of Interferon and Ribavirin),

which can cause serious side effects (DSOF ¶ 19; PSDF ¶ 9). ADC does not exclude inmates

with a past history of illicit IV drug use from eligibility for Rebetron treatment (DSOF ¶ 83;

PSDF ¶ 100). When he was diagnosed in 1998, Plaintiff’s liver function or ALT enzymes

measured 86; normal ALT enzyme levels are 0-40 (DSOF ¶¶ 28, 29; Pl’s Statement of

Undisputed Facts (PSUF) ¶ 2). 

By January 1999, Plaintiff’s ALT was 105 (DSOF ¶ 33; PSDF ¶ 19; PSUF ¶ 4). In

February 1999, Plaintiff requested Rebetron treatment for his HCV3

 (PSUD ¶ 5, ex. 6). In

March 1999, Plaintiff’s ALT was 65 (DSOF ¶ 39; PSDF ¶ 22). In June 1999, his ALT was

119 (DSOF ¶ 45; PSUF ¶ 12). On November 19, 1999, Plaintiff was transferred from ASPCWinslow to ASPC-Lewis in Buckeye, Arizona (DSOF ¶ 47; PSDF ¶ 28).

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 In fact, the record reflects that Plaintiff had been examined approximately three

months before.

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In July 2002, Plaintiff submitted a health needs request (HNR) asking to begin

Rebetron treatment (DSOF ¶ 48; PSDF ¶ 32). In August 2002, Dr. Macabuhay examined

Plaintiff and Plaintiff told him that he wished to be treated with Rebetron (DSOF ¶ 49, ex.

16; PSDF ¶ 33 (in part)). Plaintiff also informed Dr. Macabuhay that he had completed the

protocol for treatment with Rebetron, but had not been started on it (Id.). At that time,

Plaintiff’s ALT was 109 (DSOF ¶ 50; PDSF ¶ 34; PSUF ¶ 20). Lab results dated August 28,

2002 reflected that Plaintiff’s HCV viral load, the amount of virus in the blood, was 789,000

(PSUF ¶ 21, Ex. 19). Dr. Hurowitz, another ADC physician, noted in September 2002, that

Plaintiff appeared to meet the criteria for Rebetron and ordered Plaintiff to be scheduled for

a visit (DSOF ¶ 51; PSDF ¶ 35; PSUF ¶ 21).

 In October 2002, Plaintiff submitted an HNR asking why he had not had blood tests

performed in almost two months when he was undergoing evaluation for Rebetron treatment.

(DSOF ¶ 52; PSDF ¶ 36; PSUD ¶ 22). A response dated October 24, 2002, stated that blood

tests were performed every three months and his last test had been performed on August 20,

2002 (Id.). Also, on October 24, 2002, Plaintiff was examined by Dr. Macabuhay (DSOF

¶ 53, Ex. 19). The next day, Dr. Macabuhay submitted a Consultation Request to the Central

Office for ultrasound and genotyping of Plaintiff, stating that Plaintiff “meets criteria for Rx

[treatment] per protocol, persistently elevated LFT’s, HCV viral load 785,000” (Id.). On

October 31, 2002, Plaintiff’s HCV viral load was 3,200,000 (PSUF ¶ 26, Ex. 24). 

On January 7, 2003, Plaintiff submitted an HNR asking for follow-up regarding his

HCV (Pl.’s Mot. For Summ. J. (PMSJ), Ex. 25). The same day, he filed an inmate letter

seeking an informal resolution of his request for Rebetron treatment, explaining that he had

not been examined for more than six months (PMSJ, Ex. 26).4

 Corrections Officer III Wood

responded the same day telling Plaintiff that he would have to prove that he had contacted

Medical and that Wood wanted to see Medical’s response before answering the request for

informal resolution (Id.). Also in January 2003, Dr. Macabuhay again examined Plaintiff and

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noted that he was waiting for approval from Central Office for a drug screen and genotyping

(DSOF ¶ 55, Ex. 21; PSDF ¶ 45 (in part)). He further noted that Plaintiff reported last using

illicit IV drugs about a year before, i.e., January 2002, and that Plaintiff had completed a drug

awareness program (DSOF ¶ 55, Ex. 21). 

On April 11, 2003, Plaintiff submitted another HNR stating that he had been told in

January that paperwork authorizing Rebetron treatment had been sent to the Central Office

for approval (PMSJ, Ex. 28). Plaintiff asked to be seen and informed of the status regarding

Rebetron treatment (Id.). On April 17, 2003, Plaintiff submitted another inmate letter

seeking informal resolution of the delay in obtaining approval for Rebetron treatment (PSUF

¶ 32, Ex. 29). On May 2, 2003, Plaintiff received a response to his inmate letter informing

him that his medical records had been reviewed by the health care provider, that a referral

for genotyping had been submitted to the Central Office where it was pending decision, and

that pursuant to ADC guidelines for HCV treatment, Plaintiff would have blood drawn after

genotyping was approved by the Central Office (PSUF ¶ 32, Ex. 29). 

On May 9, 2003, Plaintiff filed an inmate grievance regarding the four-month delay

in resolution of the referral to the Central Office and again asked to be approved for Rebetron

treatment (PSUF ¶ 33, Ex. 30). The response to the grievance, dated May 20, 2003, stated

that Plaintiff’s medical records had been reviewed and that after genotyping, documents

would be submitted to Central Office for consideration of the treatment (Id.). On May 20,

2003, lab tests were ordered for genotyping and blood screens of Plaintiff (DSOF ¶ 56; PSDF

¶¶ 47, 48). The results of those tests, received in June 2003, reflected that Plaintiff’s ALT

was 66 and that he had a genotype of 1A, the most common in the United States (Id.). 

 Meanwhile, on May 29, 2003, Plaintiff filed an inmate grievance appeal stating that

he had still not received a response regarding the referral made in January 2003 (PMSJ, Exs.

31, 32). He stated that he had stopped engaging in risky behaviors, completed

alcohol/substance abuse awareness courses and educated himself about HCV (Id.). The

response, dated June 19, 2003, discussed important lifestyle habits, mentioned that the

guidelines for treating HCV were continually being revised, and advised that ADC was

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5

 Defendants object to Exhibit 31 as inadmissible hearsay (DO at 5.). This objection

will be overruled. Exhibit 31 is not submitted to prove the truth of the matter asserted

therein. 

6

 Defendants object to Plaintiff’s Exhibit 41 to the extent that Plaintiff relies on a

CDC report regarding vaccinations for HCV patients (DO at 11). Exhibit 41 is Dr. Jones’

responses to Plaintiff’s request for admissions, question 1 of which refers to a CDC report

dated January 24, 2003. This objection will be overruled. 

7

 According to Defendants, Siers Left ADC in August 2003 (Siers Decl. ¶ 1). 

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committed to providing appropriate health care to inmates (Id.). This response was identical

to a response made to another inmate’s grievance concerning HCV treatment (Id.).5

 

On July 9, 2003, Plaintiff submitted an HNR requesting vaccination for Hepatitis A

and B as part of the protocol that had not yet been ordered (PMSJ, Ex. 34). On September

2, 2003, Plaintiff submitted another HNR seeking vaccination for Hepatitis A and B (PMSJ,

Ex. 35). On September 23, 2003, and October 24, 2003, Plaintiff received the first two

vaccinations for Hepatitis A and B (DSOF ¶ 57; PSUD ¶ 41).6

 

On September 29, 2003, Plaintiff submitted another HNR asking to be seen for his

HCV, stating that he had lost 30 pounds in the previous few months, suffered almost constant

fatigue, sleeplessness, and occasional pain in his right abdomen (PSUF ¶ 42, Ex. 36). Dr.

Macabuhay examined Plaintiff on October 1, 2003 (DSOF ¶ 60, Macabuhay Decl. ¶ 37;

PMSJ, Ex. 37). Plaintiff repeated his symptoms, i.e., his weight loss, fatigue, night sweats,

and abdominal pain, and again requested Rebetron treatment (Id.). Dr. Macabuhay noted in

Plaintiff’s medical records that he planned to complete papers for submission for Rebetron

treatment (Id.). However, Dr. Macabuhay never submitted a request for Rebetron treatment

for Plaintiff (PSUF ¶ 43, Exs. 45 at #4, 44 at #6). 

On November 3, 2003, Plaintiff submitted an inmate letter to Medical Investigator

Siers asking why he was not receiving Rebetron treatment inasmuch as his medical records

reflected that he met the criteria and that he was eligible under ADC protocols7

 (PSDF ¶¶ 65,

66; DSOF, Exs. 5, 6 attached to Siers Affidavit (Ex. D)). Medical Investigator Sherry

Mullen responded that Plaintiff’s medical records had been reviewed and his questions

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answered in the June 19, 2003 response to his appeal (Id.). She further stated the issue was

considered resolved and that there was no indication that Plaintiff had been recommended

for Rebetron treatment (Id.). 

On April 5, 2004, Plaintiff received the third Hepatitis A and B vaccinations (DSOF

¶ 61). On April 14, 2004, Plaintiff’s ALT was 72 (DSOF ¶ 62). On April 21, 2004, Plaintiff

was examined by ADC physician, Dr. Vinluan, who noted that the HCV checklist was

complete (DSOF ¶ 63, Macabuhay Decl. ¶ 40). Plaintiff repeated his desire to receive

Rebetron treatment and told Dr. Vinluan that Dr. Macabuhay had submitted a request for

Rebetron treatment (Id.). In October 2004, Dr. Vinluan provided HCV counseling to

Plaintiff (DSOF ¶ 66).

On December 22, 2004, Plaintiff filed his Second Amended Complaint in this action

(Doc. #53). Plaintiff alleges that Defendants have acted with deliberate indifference to his

serious medical needs in violation of his Eighth Amendment rights and that Defendants have

violated his Fifth and Fourteenth Amendment rights to equal protection by denying and

delaying Rebetron treatment to him, while providing such treatment to other similarly

situated inmates. 

II. Standard for Summary Judgment

A court must grant summary judgment if the pleadings and supporting documents,

viewed in the light most favorable to the non-moving party, “show that there is no genuine

issue as to any material fact and that the moving party is entitled to judgment as a matter of

law.” Fed. R. Civ. P. 56(c); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986).

Under summary judgment practice, the moving party bears the initial responsibility of

presenting the basis for its motion, and identifying those portions of the record, together with

affidavits, which it believes demonstrate the absence of a genuine issue of material fact.

Celotex Corp., 477 U.S. at 323. If the moving party meets its initial responsibility the burden

then shifts to the opposing party who must demonstrate that the fact in contention is material,

i.e., a fact that might affect the outcome of the suit under the governing law, Anderson v.

Liberty Lobby, Inc., 477 U.S. 242, 248 (1986), and that the dispute is genuine, i.e., the

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evidence is such that a reasonable jury could return a verdict for the nonmoving party. Id.

at 250; see Triton Energy Corp. v. Square D. Co., 68 F.3d 1216, 1221 (9th Cir. 1995). The

opposing party need not establish a material issue of fact conclusively in its favor; it is

sufficient that “the claimed factual dispute be shown to require a jury or judge to resolve the

parties' differing versions of the truth at trial.” First Nat'l Bank of Arizona v. Cities Serv.

Co., 391 U.S. 253, 288-89 (1968). Finally, when considering a summary judgment motion,

the evidence of the non-movant is “to be believed, and all justifiable inferences are to be

drawn in his favor.” Anderson, 477 U.S. at 255.

III. Count I: Deliberate Indifference to a Serious Medical Need

Defendants seek summary judgment on the basis that Plaintiff does not have a serious

medical need for Rebetron treatment, i.e., that his eligibility therefor is disputed among the

physicians, and that even if he has a serious medical need, they have not acted with deliberate

indifference to that need (Doc. #82 at 8, 11-12). Defendants further argue that even if factual

disputes exist regarding this claim, they are entitled to summary judgment based on qualified

immunity and that an award of damages is precluded by the Eleventh Amendment (Id. at 16-

17). Plaintiff argues that genuine issues of material fact preclude summary judgment on

either of his claims and that Defendants’ inaction and failure to provide appropriate medical

care defeat any claim to qualified immunity (Doc.# 107). He also seeks summary judgment

on the ground that ADC’s HCV treatment policy does not conform to the CDC’s

recommendations and, therefore, does not conform to the community standard (Doc. #104).

States are prohibited by the Eighth Amendment from incarcerating inmates in

conditions that constitute cruel and unusual punishment of confinement. Pursuant to this

obligation, state officials who act with deliberate indifference to an inmate’s serious medical

needs are liable in a § 1983 action. Estelle v. Gamble, 429 U.S. 97, 103 (1976). The Eighth

Amendment also prohibits deliberate indifference that subjects an inmate to an excessive risk

of future harm. Helling v. McKinney, 509 U.S. 25, 33 (1993). “[D]eliberate indifference to

a prisoner’s serious medical needs is the ‘unnecessary and wanton infliction of pain.’”

Estelle, 429 U.S. at 104-05. A state prison official is deliberately indifferent if he both

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knows of and disregards an excessive risk to an inmate’s health. Farmer v. Brennan, 511

U.S. 825, 837 (1994). Thus, to establish deliberate indifference, a plaintiff must establish

that the alleged harm was “sufficiently serious” and that the official acted with a “sufficiently

culpable state of mind.” Id. at 834 (citing Wilson v. Seiter, 501 U.S. 294, 298, 302-3

(1991)). Mere negligence or medical malpractice does not establish a sufficiently culpable

state of mind. Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9 th Cir. 1980).

However, a prisoner does not have to prove that he was completely denied medical care in

order to demonstrate deliberate indifference. Lopez v. Smith, 203 F.3d 1122, 1132 (9th Cir.

2000). Deliberate indifference may be shown when an official denies, delays, or

intentionally interferes with treatment or by the way that a medical professional provided the

care. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). “[A] mere ‘difference of medical

opinion . . . [is] insufficient, as a matter of law, to establish deliberate indifference.’”

Toguchi v. Chung, 391 F.3d 1051, 1058 (9th Cir. 2004) (citations omitted). To prevail on

a claim involving choices between alternative courses of treatment, a prisoner must show that

the course of treatment the doctors chose was medically unacceptable in light of the

circumstances and that it was chosen in conscious disregard of an excessive risk to plaintiff's

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

A. Serious Medical Need

To meet their burden on summary judgment, Defendants must come forward with the

lack of a triable issue of fact; namely, evidence that Plaintiff either did not have a serious

medical need for Rebetron treatment and/or that Defendants did not act with deliberate

indifference to that need. “A ‘serious’ medical need exists if the failure to treat a prisoner’s

condition could result in further significant injury or the ‘unnecessary and wanton infliction

of pain.’” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1992), overruled on other

grounds, WMX Tech., Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (quoting Estelle,

429 U.S. at 104). 

HCV is a chronic illness that slowly progresses to cirrhosis of the liver (Baird Decl.

¶¶ 5, 6). It is undisputed that HCV is a serious medical condition. However, the parties

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dispute whether Plaintiff has a serious medical need to receive Rebetron treatment for that

condition. Defendants argue that Plaintiff does not meet the criteria for Rebetron. To

support their motion, Defendants attach the declarations of Drs. Baird, Macabuhay, and

Jones. Dr. Macabuhay was the treating physician; Dr. Jones was Deputy Director of ADC

Health Services responsible for medical treatment guidelines; and Dr. Baird was the Medical

Program Manager and developed policy and procedure relating to health care, monitoring,

and clinical supervision of physician supervisors.

The declarations of the physicians all follow the time line summarized above as far

as the testing, counseling, and examinations that Plaintiff received concerning his HCV. All

three physicians declare that in order to be considered for treatment, the patient's ALT levels

must be 2 times normal on 3 occasions, but that Plaintiff’s levels have not been consistently

elevated. Dr. Baird specifically states that the 3 measures of 2 times the normal level must

be consecutive. The three physicians also assert that this qualifying factor - 3 ALT levels

measuring twice the normal - is within the community standard of care for HCV treatment.

Defendants have proffered evidence that the decision to deny HCV treatment was

based upon Plaintiff's lab results. Thus, Defendants have met their initial burden establishing

a lack of a triable issue of fact. The burden shifts to Plaintiff to come forward with evidence

that establishes a triable issue of fact; evidence that Defendants knew of and disregarded a

serious risk to Plaintiff's health. Notably, Defendants set forth in their motion that if an

inmate meets the criteria established by the ADC protocol, he will be treated for HCV (Defs.’

Mot. for Summ. J. (DMSJ) at 16). Defendants state that there is no urgency to initiate

Rebetron treatment and that Plaintiff must show that the delay or denial of treatment led to

further injury. See McGuckin, 974 F.2d at 1060. Plaintiff alleges in his verified Second

Amended Complaint that he suffers symptoms associated with HCV such as daily abdominal

pain, nausea, fatigue, weakness, fever, weight loss, headaches, irritability, anxiety, insomnia,

and joint and muscle aches (Doc.# 53 at 4J). He claims that these symptoms affect his daily

activities and prohibit him from participation in various programs at the prison (Id. at 4K).

These symptoms are set forth in some of the HNRs he submitted when requesting medical

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evaluations and they are noted in his medical records (PMSJ, Exs. 36, 37). Defendants do

not address these symptoms, nor do they contend that such suffering would continue even

with Rebetron treatment. Interestingly, Defendants do not assert or proffer evidence to

support that Plaintiff has not been injured, i.e., that his liver function has not been adversely

affected by the delay or denial of Rebetron treatment. Based on the record before it, the

Court concludes that there is a genuine issue of material fact regarding whether Plaintiff had

a serious medical need for Rebetron treatment.

B. Deliberate Indifference 

Deliberate indifference amounts to criminal recklessness; a defendant must have

known that a plaintiff was at serious risk of being harmed, and decided not to do anything

to prevent that harm from occurring. See Farmer, 511 U.S. at 836-837. A plaintiff does not

have to use words like “reckless” or “intentional” to make out a case for deliberate

indifference. He must merely plead that the defendants behaved in a way that can be

construed to show reckless or intentional conduct. Delay in treating a condition can rise to

the level of deliberate indifference. See Hunt v. Dental Dep’t, 865 F.2d 198, 201 (9th Cir.

1989) (finding a 3-month dely of treatment to be deliberate in light of prisoner's serious

dental problems and repeated complaints); Broughton v. Cutter Labs., 622 F.2d 458, 460 (9th

Cir. 1980) (6-day delay in treating prisoner's hepatitis might constitute deliberate

indifference). Plaintiff has sufficiently made this showing with respect only to Dr.

Macabuhay.

In his opposition to Defendants’ summary judgment motion, Plaintiff submits

evidence that on three occasions physicians noted in his medical records Plaintiff appeared

to meet, or actually met, the criteria for HCV treatment: (1) Dr. Hurowitz’s note on

Plaintiff’s medical record on September 5, 2002 that Plaintiff “appears to meet criteria for

Hep C Rx [treatment]” (DMSJ, Ex. 16); (2) Dr. Macabuhay’s Consultation Request sent to

Central Office on October 25, 2002 noting that inmate “meets criteria for Rx [treatment] per

protocol = persistently elevated LFT's, HCV viral load 785,000” (Id., Ex. 19); and (3) Dr.

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Macabuhay’s note on Plaintiff’s medical records on October 1, 2003 that he planned to

complete papers for submission for HCV treatment (Id., Ex. 22).

Plaintiff also proffers Dr. Macabuhay’s responses to Plaintiff’s Request for

Admissions that include an admission that “no less than three physicians indicated Plaintiff

‘appears to meet criteria for RX’ (Rebetron) (Dr. B. Hurowitz, Dr. Rodolfo Macabuhay and

Dr. H. Whitney” (PMSJ, Ex. 43 at #6). Dr. Macabuhay also admitted that his treatment plan,

as noted in Plaintiff’s medical records on October 1, 2003, was to complete the paperwork

for submission for HCV treatment (Id. No. 8). The evidence shows that this paperwork was

never submitted by Dr. Macabuhay, and there is no contemporaneously made record

reflecting that Dr. Macabuhay changed his mind regarding Plaintiff’s eligibility (Exs. 44 at

#6, 45 at # 4). Dr. Macabuhay stated in Response to Plaintiff’s First Set of Interrogatories

in March 2005, and in his Declaration in October 2005, that he reviewed Plaintiff's medical

records following the October 2003 examination and determined that Plaintiff did not meet

the criteria (PMSJ, Ex. 46 at # 20; DMSJ, Ex. C ¶ 37). Plaintiff responds that there is no

evidence - except Dr. Macabuhay’s interrogatory response and Declaration two years later -

documenting this subsequent review. His assertion is correct. Further, Plaintiff submitted

evidence that he filed an inmate letter after the October 2003 examination inquiring why he

was not receiving Rebetron treatment in light of Dr. Macabuhay’s treatment plan. In

response to his letter, ADC did not inform Plaintiff that Dr. Macabuhay had subsequently

determined that Plaintiff did not qualify for the treatment, nor has any contemporaneous

documentation been submitted to that effect. Instead, Plaintiff was inaccurately told that his

questions had already been addressed in response to an earlier grievance and that there was

no indication that he had ever been recommended for treatment. However, evidence supports

that Dr. Macabuhay planned to recommend Plaintiff for Rebetron, but failed to followthrough despite Plaintiff’s repeated HNRs, inmate letters and inmate grievances. 

On summary judgment, the Court does not weigh the evidence or determine the truth

of the matters asserted but only determines whether there is a genuine issue of material fact

that must be resolved by trial. See Summers v. A. Teichert & Son, Inc., 127 F.3d 1150, 1152

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(9th Cir. 1997). Plaintiff has provided more than a “scintilla of evidence” that three doctors

determined that he either appeared to meet, or met, the criteria for Rebetron treatment. See

Addisu v. Fred Meyer, Inc., 198 F.3d 1130, 1134 (9th Cir. 2000) (“A scintilla of evidence

or evidence that is merely colorable or not significantly probative does not present a genuine

issue of material fact” precluding summary judgment). Further, despite Dr. Macabuhay’s

claim that a subsequent review resulted in a change of medical opinion as to Plaintiff's

eligibility, there is no notation in Plaintiff’s medical records of this review or any reevaluation which led to a decision that Plaintiff did not meet the criteria. Finally, when

Plaintiff filed an inmate letter inquiring specifically about the lack of treatment in light of Dr.

Macabuhay’s October 1, 2003 treatment plan, the response did not indicate any change in Dr.

Macabuhay’s treatment plan. 

Further, contrary to Defendants’ assertion that Plaintiff merely disagreed with the

treatment plan recommended by ADC physicians, or that ADC physicians disagreed among

themselves regarding the appropriate treatment, medical records reflect that all of the

physicians involved concluded that Rebetron treatment was warranted. Only after Plaintiff

filed this action and conducted discovery did Dr. Macabuhay belatedly claim he had changed

his mind some two years earlier regarding Plaintiff’s eligibility to receive Rebetron

treatment, which is wholly undocumented in Plaintiff’s contemporaneous medical records.

A reasonable trier of fact could infer that the failure to follow the treatment plan to submit

Plaintiff for Rebetron treatment, despite repeated medical findings that he was eligible and

Plaintiff’s repeated attempts to obtain such treatment pursuant to those medical findings,

amounted to deliberate indifference. Accordingly, the Court finds that a genuine issue of

material fact exists as to whether Dr. Macabuhay acted with deliberate indifference to

Plaintiff’s serious medical needs, precluding summary judgment as to him. 

1. Drug Use

In their Reply in Support of Motion for Summary Judgment and Response to

Plaintiff's Motion for Summary Judgment, Defendants claim that even if Plaintiff met the

HVC treatment criteria, his drug use prevented him from being a candidate for treatment

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(Doc. #110 at 3-4). Defendants rely on Plaintiff’s deposition in December 2004 in which he

admitted to using drugs in the past and in August 2004 (DMSJ, Exs. F, O). Plaintiff

addresses this argument in his Reply in Support of his Motion for Summary Judgment and

asserts that he does not continue to use drugs and the August 2004 occurrence was an

isolated incident of relapse (Doc.# 120). The ADC does not exclude those patients with a

past history of drug use from receiving HCV treatment; therefore, Plaintiff’s past history of

drug use cited by Defendants is irrelevant (DSOF ¶ 83). Plaintiff’s use of drugs in 2004 was

asserted to be only an isolated use and, regardless, it came after the pertinent dates at issue

in Plaintiff's deliberate indifference claim. Therefore, Defendants’ claim that Plaintiff’s drug

use disqualified him from treatment is insufficient to defeat the finding of a genuine issue of

material fact. 

2. Community Standard

In his Motion for Summary Judgment, Plaintiff alleges that the ADC policy dictating

the criteria for HCV treatment does not meet the community standard of care (PMSJ at 16).

Plaintiff claims that the ADC criteria of “ALT 2 times normal” does not comply with CDC

and NIH recommendations. He submits a copy of a NIH Consensus Statement (2002) which

states that HCV treatment is recommended for those persons with “persistently elevated”

ALT levels (Pl.’s Decl. ¶¶ 96, 97, Ex. 39 at 22). Plaintiff has failed to proffer evidence that

the “2 times normal” requirement deviates from the “persistently elevated” standard to the

extent that it would not fall within the community standard of care. Without more, Plaintiff’s

evidence is insufficient to demonstrate that the ADC policy violates his constitutional rights.

C. Defendants

While Plaintiff has met his burden to set forth specific facts as to Dr. Macabuhay’s

affirmative role in the alleged deliberate indifference, he has not demonstrated that Siers,

Baird, or Jones were in any way the actual and proximate cause of an injury. When a

prisoner attempts to hold a prison employee responsible for deliberate indifference, the

prisoner must establish individual fault. Leer v. Murphy, 844 F.2d 628, 634 (9th Cir. 1988).

Sweeping conclusory allegations will not be sufficient to prevent summary judgment. Id.

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“The prisoner must set forth specific facts as to each individual defendant’s deliberate

indifference.” Id. He must prove that the specific prison official was deliberately indifferent

and that this indifference was the actual and proximate cause of the injury. Id. State officials

are subject to suit under § 1983 only if “they play an affirmative part in the alleged

deprivation of constitutional rights.” King v. Atiyeh, 814 F.2d 565, 568 (9th Cir. 1987). 

 Siers is not a physician and cannot prescribe medical treatment (DMSJ, Ex. D, Siers

Decl. ¶ 5). As a Medical Investigator he assists physicians who respond to inmate grievance

appeals, but does not personally dictate those responses (Id. ¶¶ 3, 4). Moreover, according

to Defendants, Siers stopped working for ADC in August, 2003 (Id. ¶ 1). The ADC Inmate

Grievance System establishes that medical grievances are forwarded to the Facility Health

Administrator and the Director who in turn formulate the responses (PMSJ, Ex. 52 at 9).

Plaintiff has failed to demonstrate that Siers was directly linked to a constitutional violation.

Neither Jones nor Baird ever treated Plaintiff, nor is there evidence that either one of

them reviewed or rejected Plaintiff's grievance appeal and subsequent inmate letter. Plaintiff

alleges that Jones and Baird are part of the Medical Review Committee that exercises the

authority to deny or delay recommendations for inmate treatment (Doc. #53 at 4). But,

according to the evidence, Dr. Macabuhay never submitted the paperwork to obtain approval

for Rebetron treatment so these two defendants were not in a position to deny that treatment.

Plaintiff further alleges that Jones and Baird drafted the ADC HCV treatment policy in order

to save money and try to disqualify 70% of HCV inmates from ever qualifying for the

treatment. Plaintiff has failed to proffer any evidence to support this claim, which could be

viewed as a sweeping conclusory allegation. In light of the foregoing, summary judgment

as to Defendants Siers, Jones, and Baird will be granted.

 D. Qualified Immunity

Dr. Macabuhay claims that he is entitled to qualified immunity. Qualified immunity

is only an immunity from a suit for damages, not for declaratory or injunctive relief. Hydrick

v. Hunter, 449 F.3d 978, 992 (9th Cir. 2006). If a defendant claims qualified immunity, the

court must make two distinct inquires, the “constitutional inquiry” and the “qualified

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immunity inquiry.” See Estate of Ford v. Ramirez-Palmer, 301 F.3d 1043, 1049 (9th Cir.

2002). The “constitutional inquiry” asks whether, when taken in the light most favorable to

the non-moving party, the facts alleged show the official's conduct violated a constitutional

right. Saucier v. Katz, 533 U.S. 194, 201 (2001). If so, a court turns to the "qualified

immunity inquiry" and asks if the right was clearly established at the relevant time. Id. at

201-02. This second inquiry "must be undertaken in light of the specific context of the case,

not as a broad general proposition." Id. at 201.

As discussed supra, the Court has determined that disputed facts, viewed in the light

most favorable to Plaintiff, create a triable issues of fact regarding whether (1) Plaintiff had

a serious medical need for Rebetron treatment and (2) whether Dr. Macabuhay acted with

deliberate indifference to Plaintiff’s serious medical need by failing to follow-through with

recommending him for that treatment after finding he qualified for it. The second step of the

Saucier analysis requires Dr. Macabuhay to demonstrate that the failure to do so did not

violate clearly established constitutional law. Id. The intentional denial or delay of access

to medical care constitutes an Eighth Amendment violation that was clearly established at

the relevant time. See Clement v. Gomez, 298 F.3d 898, 906 (9th Cir. 2002); Lopez, 203

F.3d at 1131.

Dr. Macabuhay argues that since he was following ADC procedure, he had no way

of knowing that his conduct was constitutionally inappropriate. However, the question is not

whether the procedure meets constitutional muster, but whether Plaintiff met the criteria

under the protocol and should have received treatment. Dr. Macabuhay’s argument on the

qualified immunity prong is the same as his defense to the constitutional prong of the

analysis; namely, that Plaintiff had repeated lab work and he did not meet the requirements

for treatment. This argument implicates the same genuine issues of material fact which, if

resolved in favor of Plaintiff, demonstrate deliberate indifference on the part of Dr.

Macabuhay. As a result, Dr. Macabuhay fails to pass the second prong of the Saucier test,

and qualified immunity will be denied.

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E. Eleventh Amendment

Defendants contend that the Eleventh Amendment bars a monetary claim against

officials in their official capacity. A suit against a state official in his official capacity is not

a suit against the official but rather is a suit against the official’s office, so damages are

unavailable. Will v. Mich. Dep’t of State Police, 491 U.S. 58, 71 (1989). But a state official

sued in his official capacity is a person for purposes of § 1983 when prospective relief,

including injunctive relief, is sought. Id. at 71, n. 10. Plaintiff sued Defendant Macabuhay

in both his official and individual capacities (Doc. #53 at 2). Although damages are

prohibited against Macabuhay in his official capacity, Plaintiff may still proceed with his

monetary claim against Dr. Macabuhay in his individual capacity; thus, the monetary claim

will not be dismissed. Defendants are not entitled to summary judgment as to an award of

damages against Dr. Macabuhay based on the Eleventh Amendment.

IV. Count II: Equal Protection

Plaintiff alleges that Defendants arbitrarily and unjustifiably denied him Rebetron

treatment for HVC while other similarly-situated inmates were provided the treatment.

Defendants seek summary judgment as to Plaintiff’s equal protection claim on the basis that

Plaintiff failed to demonstrate that he is being treated differently than other inmates in ADC

custody (Doc. #82 at 13-14). Plaintiff seeks summary judgment on the basis that other

similarly-situated inmates have received the Rebetron treatment, but he has been repeatedly

denied that treatment (PSUF ¶ 92, Doc. #104). 

To state a claim for a violation of the Equal Protection Clause, a plaintiff must show

that the defendants acted with the intent or purpose to discriminate against the him based on

his membership in a protected class. Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir.

1998). Prisoners are not a suspect class. Webber v. Crabtree, 158 F.3d 460, 461 (9th Cir.

1998). If a plaintiff is not part of a suspect class, heightened scrutiny may still be required

where fundamental interests are at issue. Hydrick, 449 F.3d at1002. Although prisoners

enjoy an Eighth Amendment right to medical care, Plaintiff does not claim that he was

discriminated against because he sought medical care. Rather, he claims that he was

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8

 Plaintiff moved to strike one of these affidavits on the ground that the facts attested

to were later discovered to be incorrect (Doc. #106). The Court will grant the motion to the

extent that it will not consider the affidavit, but will otherwise deny the motion.

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discriminated against because the medical care he received differed from medical care other

prisoners received. As such, Plaintiff’s claim does not invoke a fundamental interest

requiring strict scrutiny. However, the Supreme Court has recognized equal protection

claims brought by a “class of one” where a plaintiff alleges that he has been intentionally

treated differently from others similarly situated and that there is no rational basis for the

different treatment. Village of Willowbrook v. Olech, 528 U.S. 562, 564 (2000).

Before reaching the merits of Plaintiff’s equal protection claim, the Court must

determine if Plaintiff and other HCV inmates are similarly situated. In support of his claim,

Plaintiff submitted affidavits of inmates who have received HCV treatment (PMSJ, Ex. 67).

Defendants object to these inmate affidavits because they are attached to Plaintiff’s

Declaration but are not based on Plaintiff's personal knowledge (DO at 3, Doc. #111). The

Court will consider these evidentiary affidavits filed by Plaintiff in support of his pleadings.8

The affidavits of inmates Rexrode, Nelson, and Russey proffered by Plaintiff are insufficient

to establish the similarly situated condition. Only a couple pages of Nelson’s medical

records are attached, and they only show that Nelson had elevated ALT levels on June 1,

2000 and July 12, 2000, and that he received the HCV drug treatment on September 25, 2001

(PMSJ, Ex. 67, Attach. A and B). Such limited medical evidence is wholly insufficient show

that Plaintiff and Nelson, or any other HCV inmates are at the same stage of HCV.

Accordingly, Plaintiff has failed to make the threshold showing that he is similarly situated

to other HCV inmates that he claims received more favorable treatment. For this reason,

summary judgment will be granted to Defendants on the equal protection claim. 

V. Conclusion

The Court finds that a genuine issue of material fact does not exist as to Count II of

the Second Amended Complaint and Defendants’ motion for summary judgment for that

Count will be granted. The Court further finds that a genuine issue of material fact does not

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exist as to liability of Defendants Jones, Baird and Siers, and they will be granted summary

judgment as to Count I of the Second Amended Complaint. However, because the Court

finds that a material issue of fact exists regarding Plaintiff’s Eighth Amendment claim

against Dr. Macabuhay, the Court will deny both Defendants’ and Plaintiff’s motions for

summary judgment for that claim against Dr. Macabuhay. Finally, the Court finds that a

material issue of fact exists as to whether Dr. Macabuhay may be entitled to qualified

immunity and it finds that the Eleventh Amendment does not preclude an award of damages

against Dr. Macabuhay individually.

IT IS ORDERED:

1) Defendants’ Motion for Summary Judgment (Doc. # 82) is granted in part and

denied in part. The Motion is granted as to Defendants Siers, Jones, and Baird, and as to the

equal protection claim (Count II) alleged against Defendant Macabuhay. The Motion is

otherwise denied.

2) Plaintiff’s Motion to Strike Affidavit of Zachary Johnson (Doc. #106) is granted

in part and is otherwise denied.

3) Plaintiff’s Motion for Summary Judgment (Doc. # 104) is denied.

DATED this 23rd day of August, 2006.

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