Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_04-cv-00115/USCOURTS-caed-2_04-cv-00115-8/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

 Defendant Dr. Oh was dismissed from this action by order filed May 19, 2006. 1

 On March 27, 2006, plaintiff was directed to file complete copies of documents 2

plaintiff appended to his opposition and reply. After receiving an extension of time, and seeking

1

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

RODNEI FRAZIER,

Plaintiff, No. CIV S-04-0115 MCE PAN P

vs.

DR. JOHN KOFOED, ORDER AND 1

Defendant. FINDINGS & RECOMMENDATIONS

 /

Plaintiff is a state prisoner proceeding pro se with a civil rights action pursuant to

42 U.S.C. § 1983. Plaintiff claims that defendant Kofoed violated his rights under the Eighth

Amendment by acting with deliberate indifference to his serious medical need for treatment of

complete neuropathy of plaintiff’s leg and foot, including failure to provide follow-up medical

care, and by allowing plaintiff’s injury to progress to a 90 degree knee lock, requiring another

surgery. Plaintiff has also included a pendent state law negligence claim arising from the same

facts. This matter is before the court on defendant’s motion for summary judgment.2

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 1 of 16
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

another, plaintiff filed the documents on June 19, 2006. Because plaintiff has now complied

with the order, the court will deny plaintiff’s June 12, 2006 motion for second extension of time. 

2

SUMMARY JUDGMENT STANDARDS UNDER RULE 56

Summary judgment is appropriate when it is demonstrated that there exists “no

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

matter of law.” Fed. R. Civ. P. 56(c).

Under summary judgment practice, the moving party 

always bears the initial responsibility of informing the district court

of the basis for its motion, and identifying those portions of “the

pleadings, depositions, answers to interrogatories, and admissions

on file, together with the affidavits, if any,” which it believes

demonstrate the absence of a genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986) (quoting Fed. R. Civ. P. 56(c)). “[W]here the

nonmoving party will bear the burden of proof at trial on a dispositive issue, a summary

judgment motion may properly be made in reliance solely on the ‘pleadings, depositions, answers

to interrogatories, and admissions on file.’” Id. Indeed, summary judgment should be entered,

after adequate time for discovery and upon motion, against a party who fails to make a showing

sufficient to establish the existence of an element essential to that party’s case, and on which that

party will bear the burden of proof at trial. See id. at 322. “[A] complete failure of proof

concerning an essential element of the nonmoving party’s case necessarily renders all other facts

immaterial.” Id. In such a circumstance, summary judgment should be granted, “so long as

whatever is before the district court demonstrates that the standard for entry of summary

judgment, as set forth in Rule 56(c), is satisfied.” Id. at 323.

If the moving party meets its initial responsibility, the burden then shifts to the

opposing party to establish that a genuine issue as to any material fact actually does exist. See

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). In attempting to

establish the existence of this factual dispute, the opposing party may not rely upon the

allegations or denials of its pleadings but is required to tender evidence of specific facts in the

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 2 of 16
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

3

form of affidavits, and/or admissible discovery material, in support of its contention that the

dispute exists. See Fed. R. Civ. P. 56(e); Matsushita, 475 U.S. at 586 n.11. The opposing party

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, see Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248

(1986); T.W. Elec. Serv., Inc. v. Pacific Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir.

1987), and that the dispute is genuine, i.e., the evidence is such that a reasonable jury could

return a verdict for the nonmoving party, see Wool v. Tandem Computers, Inc., 818 F.2d 1433,

1436 (9th Cir. 1987).

In the endeavor to establish the existence of a factual dispute, 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.” T.W. Elec. Serv., 809 F.2d at 631. Thus, the “purpose of summary

judgment is to ‘pierce the pleadings and to assess the proof in order to see whether there is a

genuine need for trial.’” Matsushita, 475 U.S. at 587 (quoting Fed. R. Civ. P. 56(e) advisory

committee’s note on 1963 amendments).

In resolving the summary judgment motion, the court examines the pleadings,

depositions, answers to interrogatories, and admissions on file, together with the affidavits, if

any. Fed. R. Civ. P. 56(c). The evidence of the opposing party is to be believed. See Anderson,

477 U.S. at 255. All reasonable inferences that may be drawn from the facts placed before the

court must be drawn in favor of the opposing party. See Matsushita, 475 U.S. at 587. 

Nevertheless, inferences are not drawn out of the air, and it is the opposing party’s obligation to

produce a factual predicate from which the inference may be drawn. See Richards v. Nielsen

Freight Lines, 602 F. Supp. 1224, 1244-45 (E.D. Cal. 1985), aff’d, 810 F.2d 898, 902 (9th Cir.

1987). Finally, to demonstrate a genuine issue, the opposing party “must do more than simply

show that there is some metaphysical doubt as to the material facts . . . . Where the record taken

/////

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 3 of 16
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

 Except as otherwise noted, these facts are not in dispute. 3

 The Medical Authorization Review (MAR) Committee is established within each

4

correctional treatment center’s (CTC) service area, and is composed of staff physician

representatives from each institution within the service area. (Cal. Admin. Code., tit. 15,

§ 3352.) The MAR Committee meets to approve or disapprove requests for medical services,

4

as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no

‘genuine issue for trial.’” Matsushita, 475 U.S. at 587 (citation omitted).

On June 10, 2004, the court advised plaintiff of the requirements for opposing a

motion pursuant to Rule 56 of the Federal Rules of Civil Procedure. See Rand v. Rowland, 154

F.3d 952, 957 (9th Cir. 1998) (en banc), cert. denied, 527 U.S. 1035 (1999), and Klingele v.

Eikenberry, 849 F.2d 409 (9th Cir. 1988). 

ANALYSIS

I. Facts3

Plaintiff is an inmate incarcerated at California Medical Facility (“CMF”),

Vacaville, California. Plaintiff suffers from sickle cell anemia, which caused damage to both

hips sufficient to require bilateral hip replacement surgery. On June 9, 1997, Dr. Oh performed

surgery to replace plaintiff’s left hip. During that surgery, plaintiff’s sciatic nerve was damaged. 

Dr. Kofoed did not perform or assist in plaintiff’s June 9, 1997 hip surgery. The last time Dr. Oh

treated plaintiff was on June 26, 1997.

Dr. John Kofoed, M.D. is an orthopedic surgeon who is an independent contractor

with the California Department of Corrections (CDC). Dr. Kofoed is also employed in private

practice by The Specialities Orthopedics Medical Corporation. Dr. Kofoed conducts a weekly

orthopedic clinic on Monday mornings and performs surgery on Tuesday mornings at CMF. 

Dr. Kofoed is an independent contractor with the CDC. Dr. Kofoed is under

contract to “perform examinations, make diagnoses, issue prescriptions, recommend treatment,

and request surgery.” An independent medical review board at CMF decides whether there is a

medical necessity for any surgery recommended for an inmate by a contract doctor. As an 4

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 4 of 16
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

and approved cases are forwarded with supporting documentation to the Health Care Review

(HCR) committee. (Id.) The HCR Committee, which minimally consists of two Assistant

Deputy Directors, a Chief Medical Officer, and two physicians, then meets to approve or deny

services approved by the MAR Committee. (Id. at § 3352.1.)

 Plaintiff attempts to dispute this fact by stating “Dr. Kofoed did not see plaintiff for 14 5

months to see if there was any reasonable treatment for plaintiff’s sciatic nerve damage and

complete neuropathy.” (Pl.’s Opp’n at 9.) However, Dr. Kofoed determined in his examination

of plaintiff on August 18, 1997 that “[t]here was no medical treatment reasonably available

which could have been performed by Dr. Kofoed to repair the damage to plaintiff’s left sciatic

nerve.” In other words, the damage to plaintiff’s left sciatic nerve was permanent and could not

be repaired by Dr. Kofoed.

 Plaintiff appended two documents as Exhibit A to his opposition, page 3 from a 6

declaration by Dr. Kofoed, and page 8 from Points and Authorities in Support of Motion for

Summary Judgment. These two pages were taken from documents filed on September 28, 2001

in Frazier v. California Department of Corrections, et al., CIV S-00-0022 LKK JFM P

(defendants’ motion for summary judgment granted based on plaintiff’s failure to exhaust

administrative remedies prior to suit; case dismissed without prejudice). (Pl.’s June 19, 2006

Response to court order.) A court may take judicial notice of court records. See MGIC Indem.

Co. v. Weisman, 803 F.2d 500, 505 (9th Cir. 1986); United States v. Wilson, 631 F.2d 118, 119

(9th Cir. 1980). 

5

independent contractor, Dr. Kofoed does not have the power to control the surgical schedules of

inmates which he has recommended for surgery, nor to control or insure that inmate patients

attend their physical therapy appointments.

Dr. Kofoed first examined plaintiff on August 18, 1997. Upon examination, Dr.

Kofoed diagnosed plaintiff with “complete sciatic neuropathy.” There was no medical treatment

reasonably available which could have been performed by Dr. Kofoed to repair the damage to

plaintiff’s left sciatic nerve. Dr. Kofoed treated plaintiff by ordering a nerve conduction study, 5

EMG test, and left knee x-ray. Plaintiff was ordered to continue with physical therapy treatments

3 to 4 days per week to help increase the range of motion to plaintiff’s knee. Physical therapy

consisted of whirlpool bath, exercise bicycle, gait training, range of motion/strength exercise,

education and a home exercise program. Dr. Kofoed also referred plaintiff to a neurologist and

physical medicine specialist for pain management.

Dr. Kofoed was aware plaintiff was in pain. (Pl.’s Opp’n, Ex. A. ) 6

/////

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 5 of 16
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

 Plaintiff approximates the time frame between August 18, 1997, the first day Dr. 7

Kofoed examined plaintiff and October 14, 1998, the next time Dr. Kofoed examined plaintiff, as

a period of fourteen months, by rounding the total up by about four days.

 This information is located in Dr. Kofoed’s declaration filed September 28, 2001, at 3 8

& Ex. C, in CIV S-00-0022 LKK JFM P. (See n.5 infra.)

6

Dr. Kofoed did not see plaintiff again until October 14, 1998. 

7

Plaintiff saw other health care providers at CMF between August 18, 1997 and

October 14, 1998. For example, on August 28, 1997, E.R. Johnson, M.D., a physical medicine

specialist, signed a Referring Physician’s Report that stated:

Severe pain (L) foot & leg 2B Reflex Sympathetic Dystrophy

[“RSD”] Request has been made for urgent (L) lumbar sympathetic

block. Please eval[uate] re: any other recommendations.

Dr. Johnson referred plaintiff to neurology at CMF. (Pl.’s Opp’n, Ex. D, at 23.)

On September 4, 1997, plaintiff presented at the B-1 Clinic for follow-up for his

left hip pain. (Pl.’s Opp’n, Ex. D, at 25.) The chart reflects plaintiff was approved for a

sympathetic block trial. (Id.) Plaintiff reported he had tried Elavil before but it didn’t work and

had bad side effects. The chart reflects plaintiff can’t tolerate Tylenol/Codeine, Morphine or

Percodan. (Id.) Plaintiff’s prescription for 10 mg Oxycodone for severe pain was renewed. (Id.)

On September 4, 1997, plaintiff was seen by Dr. Parker, a surgeon at CMF, who

also diagnosed plaintiff with RSD and noted “for Eval. by D. Johe, much less swollen now – for

block for RSD.” (Pl.’s Opp’n, Ex. D, at 24.) 

On September 5, 1997, neurologist Dr. Jaber performed a left sympathetic nerve

block to relieve plaintiff’s discomfort of inflamed nerves. (September 28, 2001 Decl. of Dr.

Kofoed, at 3 & Ex. C. )

8

On September 7, 1997, John H. Friend, M.D., a neurologist, reported the results of

the nerve conduction studies to CMF and confirmed Dr. Kofoed’s diagnosis of complete

neuropathy of the sciatic nerve distribution. (Pl.’s Opp’n, Ex. B.) Dr. Friend recommended

/////

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 6 of 16
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

 All references to “Kofoed Decl.” without reference to a date refer to Dr. Kofoed’s 9

Declaration filed in the instant action on September 21, 2005.

7

plaintiff be “scheduled for repeat EMG testing of the common peroneal and posterior tibial nerve

distributions for evidence of regenerated motor activity in approximately six weeks.” (Id.) 

Plaintiff was treated in the clinic on September 16, 1997 for his complaints of leg

cramps and pain. (Pl.’s Opp’n, Ex. D, at 26.) Dr. J. Johe referred plaintiff back to Dr. Johnson

stating plaintiff “known to you. Severe shooting pain and loss of sciatic nerve function below

knee. No relief from trial of Lumbar Sympathetic Block. Please reevaluate patient.” (Id. at 26.)

On October 23, 1997, plaintiff was examined by Dr. Johnson, who ordered an xray of plaintiff’s hip, physical therapy twice a week for four weeks, Oxycodone 10 mg for severe

pain and a neurology consult. (Id. at 27.)

Plaintiff was treated by various other health professionals between October 23,

1997 and October 14, 1998 and prescribed various pain medications, including Oxycodone,

Toradal and Demerol. (Pl’s Opp’n, Ex. D.)

From August 14, 1997 to February 9, 1998, plaintiff had 50 scheduled physical

therapy appointments, but did not go to 26 of the appointments. Dr. Kofoed maintains that

plaintiff was dropped from the physical therapy program on February 9, 1998 for failure to show

for six scheduled appointments in a row even though plaintiff was authorized to attend physical

therapy until August 5, 1999. (September 21, 2005 Kofoed Decl. (hereafter “Kofoed Decl.” ) at 9

12. ) Plaintiff, however, has provided a memo from Nate Hohsfield, a CMF physical therapist

with ten years’ experience, who claims in his professional opinion it was plaintiff’s pain that

prevented plaintiff from participating in physical therapy. (Pl.’s Opp’n, Ex. H.) Mr. Hohsfield

also opined that the reason plaintiff was in a wheelchair so long after surgery was due to

plaintiff’s pain. (Id.)

/////

/////

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 7 of 16
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

 This information is located in Dr. Kofoed’s declaration filed September 28, 2001, at 7, 10

in CIV S-00-0022 LKK JFM P. (See n.5 infra.)

8

On September 18, 1998, plaintiff was seen by Dr. L.A. Shabayz, who noted

plaintiff’s left knee contracture and referred plaintiff to see Dr. Kofoed in Orthopedics. (Pl.’s

Opp’n, Ex. D at 39.) 

On October 14, 1998, Dr. Kofoed examined plaintiff’s left knee, ordered x-rays

and recommended that arthroscopic surgery be performed to plaintiff’s left knee. 

By October 14, 1998, plaintiff had a left knee contracture (locked at 90 degrees),

which could only be corrected by surgery. Plaintiff contends the contracture was caused by

severe pain and by Dr. Kofoed not seeing plaintiff from August 18, 1997 until October 19, 1998. 

(Pl.’s Opp’n at 9.) In his deposition, plaintiff stated he had a knee contracture as a result of the

sciatic nerve damage. (Pl.’s Dep. Tr. at 28.) On the consultation form, Dr. Kofoed stated the

rationale for the treatment was “(L) knee contracture due to sciatic nerve injury from prior total

hip replacement.” (Pl.’s Opp’n, Ex. D at 39.) In his declaration submitted herein Dr. Kofoed

opined that the contracture was caused by the lack of exercise and the failure of plaintiff’s left

knee to positively respond to physical therapy and a home exercise program. (Kofoed Decl. at

12.)

Plaintiff was seen by other health care providers between October 14, 1998 and

March 9, 1999. (Pl.’s Opp’n, Ex. D, at 40-42.)

Dr. Kofoed performed surgery on plaintiff’s left knee on March 9, 1999. The

surgery was successful as it released plaintiff’s left leg from a 90 degree lock. Plaintiff’s “left leg

was able to extend from 90 degrees to a straight position, 5 degrees short of full extension. . . . 

[Plaintiff] is now able to freely ambulate and walk without any assistance of crutches or a cane.” 

(September 28, 2001 Kofoed Decl. at 7. ) 10

/////

/////

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 8 of 16
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

9

Dr. Kofoed opines that:

Based on information available to Dr. Kofoed, there was no

medical need to perform surgery on plaintiff’s left knee prior to

October 14, 1998, because plaintiff’s knee contracture was being

properly treated by a physical therapy regimen which was designed

to increase mobility to his left knee.

(Kofoed Decl. at 13.) Dr. Kofoed opines that the delay from October 14, 1998, when he first

recommended surgery, to the March 9, 1999 surgery did not increase plaintiff’s left knee

contracture, or cause any additional damage to plaintiff’s sciatic nerve, foot, leg or left knee. 

(Kofoed Decl. at 13.) Plaintiff, however, contends Dr. Kofoed did not see plaintiff between

August 20, 1997 and October 13, 1998 or between October 15, 1998 and May 8, 1999, to

determine whether plaintiff needed surgery or not. (Pl.’s Opp’n at 9.) Plaintiff further contends

that the delay caused plaintiff to suffer pain. (Id.)

Dr. Kofoed states he treated plaintiff in good faith and did not take any action

intended to harm or cause additional pain to plaintiff. (Kofoed Decl. at 13.) Dr. Kofoed further

contends he provided plaintiff the appropriate diagnosis and treatment which was consistent with

the degree of knowledge and skill ordinarily possessed and exercised by members of Dr.

Kofoed’s profession in similar circumstances. (Id.) Plaintiff, on the other hand, contends that

the fact that Dr. Kofoed did not examine or treat plaintiff for a period of fourteen months and

specifically failed to follow-up on tests and other treatments ordered by Dr. Kofoed demonstrates

Dr. Kofoed’s deliberate indifference to plaintiff’s serious medical needs. (Pl.’s Opp’n at 9.) 

Moreover, plaintiff contends that Dr. Kofoed’s failure to provide plaintiff with follow-up care

was not consistent with the degree of knowledge and skill ordinarily possessed and exercised by

members of Dr. Kofoed’s profession in similar circumstances. (Id.)

Finally, plaintiff disputes Dr. Kofoed’s statement that at no time did Dr. Kofoed

fail to perform a medical procedure on plaintiff which should have been performed because Dr.

Kofoed did not examine plaintiff during those fourteen months to see what medical procedures

could have been performed.

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 9 of 16
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

10

 II. Plaintiff’s Claims

In his complaint, plaintiff states that the damage to his sciatic nerve caused him

severe pain and partial paralysis to his left leg and foot. (Id. at 3.) Plaintiff claims that defendant

Kofoed violated his rights under the Eighth Amendment by acting with deliberate indifference to

his serious medical needs by failing to provide any follow up medical care following his release

from the hospital. (Id. at 4.) Plaintiff also claims defendant Kofoed was deliberately indifferent

by failing to perform the knee release surgery for almost five months after Dr. Kofoed examined

plaintiff on October 14, 1998. (Id.) Plaintiff contends his left foot and knee are crippled with

permanent damage to plaintiff’s sciatic nerve. (Id.)

Defendant Kofoed seeks summary judgment on the ground that there is no

evidence he was deliberately indifferent to plaintiff’s need for treatment. 

In order to prevail on his Eighth Amendment claim plaintiff must prove that he

had a “serious medical need” and that defendants acted with “deliberate indifference” to that

need. Estelle v. Gamble, 429 U.S. 97, 105 (1976). A medical need is serious 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) (quoting

Estelle, 429 U.S. at 104). Deliberate indifference is proved by evidence that a prison official

“knows of and disregards an excessive risk to inmate health or safety; the official must both be

aware of the facts from which the inference could be drawn that a substantial risk of serious harm

exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 

Mere negligence is insufficient for Eighth Amendment liability. Frost v. Agnos, 152 F.3d 1124,

1128 (9th Cir. 1998). 

Whether a defendant had requisite knowledge of a substantial risk is a question of

fact and a fact finder may conclude that a defendant knew of a substantial risk based on the fact

that the risk was obvious. Farmer, 511 U.S. at 842. While the obviousness of the risk is not

conclusive, a defendant cannot escape liability if the evidence shows that the defendant merely

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 10 of 16
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

11

refused to verify underlying facts or declined to confirm inferences that he strongly suspected to

be true. Id. Deliberate indifference specifically to medical needs “may be shown by

circumstantial evidence when the facts are sufficient to demonstrate that a defendant actually

knew of a risk of harm.” Lolli v. County of Orange, 351 F.3d 410, 421 (9th Cir. 2003).

“Prison officials are deliberately indifferent to a prisoner’s serious medical needs

when they deny, delay, or intentionally interfere with medical treatment.” Hallett v. Morgan, 296

F.3d 732, 744 (9th Cir. 2002) (internal citations and quotation marks omitted). However, delay

in providing medical treatment to a prisoner does not constitute deliberate indifference unless the

delay causes substantial harm. Shapely v. Nevada Bd. of State Prison Com’rs, 766 F.2d 404 (9th

Cir. 1985). Additionally, “a plaintiff's showing of nothing more than ‘a difference of medical

opinion’ as to the need to pursue one course of treatment over another [is] insufficient, as a

matter of law, to establish deliberate indifference.” Jackson v. McIntosh, 90 F.3d 330, 332 (9th

Cir. 1996) (as amended) (1996). In order to prevail on a claim involving choices between

alternative courses of treatment, a plaintiff must show that the course of treatment the doctors

chose was medically unacceptable under the circumstances and that they chose this course in

conscious disregard of an excessive risk to the plaintiff's health. See Toguchi v. Chung, 391 F.3d

1051, 1058 (9th Cir.2004); Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir.1996) (citing Farmer,

551 U.S. at 837), cert. denied, 519 U.S. 1029 (1996).

Plaintiff’s claim against defendant Kofoed arises out of said defendant’s failure to

provide plaintiff with follow-up care from August 18, 1997 to October 14, 1998 and for delaying

surgical intervention on plaintiff’s contracture to his left knee once he was seen by Dr. Kofoed on

October 14, 1998. Plaintiff was not provided surgery on his knee until March 9, 1999.

Defendant Kofoed does not dispute that he did not see plaintiff for these periods

of time, but contends that plaintiff was not in need of treatment by Dr. Kofoed because he was

under the care of other doctors at the prison and had been prescribed a prescription of physical

therapy and referred to a neurologist for further tests and pain regulation. Dr. Kofoed also argues

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 11 of 16
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

12

that plaintiff suffered no further injury to his knee by virtue of the five month delay prior to

treatment of the knee contracture. Thus, defendant Kofoed argues his actions did not constitute

deliberate indifference to a serious medical need and there was no medical procedure he failed to

provide. 

The medical records provided by plaintiff demonstrate plaintiff was provided

medical care from August 18, 1997 to October 14, 1998. Plaintiff was referred to physical

therapy, a neurologist and a physical medicine specialist for pain management. The medical

records provided by plaintiff demonstrate that these orders were carried out. Plaintiff was seen

by neurologist Dr. Friend for a nerve conduction study. Plaintiff was given a sympathetic block

and he was prescribed pain medications in an effort to stop the pain. While it is common

knowledge that damage to one’s sciatic nerve results in severe pain, and it is undisputed that Dr.

Kofoed was aware plaintiff was in pain, plaintiff has provided no evidence to demonstrate that

Dr. Kofoed, an orthopedic surgeon, was responsible to treat plaintiff for pain. Indeed, many

orthopedic surgeons refuse to administer pain medications and require patients to obtain them

from their general physicians, often to avoid medication interaction problems. Dr. Kofoed

appropriately referred plaintiff to other doctors for pain management. 

Moreover, plaintiff has provided no evidence to support his theory that there was

some alternative treatment Dr. Kofoed could have provided. Indeed, Dr. Kofoed found plaintiff

had suffered complete neuropathy to his sciatic nerve and there was no medical treatment

reasonably available which could have been performed by Dr. Kofoed to repair the damage to

plaintiff’s left sciatic nerve. Even if repair to the nerve had been possible, that repair would have

been referred to a neurologist, not to an orthopedic surgeon. Dr. Kofoed referred plaintiff to a

neurologist and plaintiff was subsequently seen by a neurologist. The neurologist, Dr. Friend,

confirmed the complete neuropathy diagnosis. Plaintiff testified at his deposition that Dr. Friend

told plaintiff on September 7, 1997: “You’re injured. All I can do is keep you comfortable with

/////

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 12 of 16
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

 This information is located in defendants’ points and authorities in support of motion 11

for summary judgment filed September 28, 2001, at 8, in CIV S-00-0022 LKK JFM P. (See n.5

infra.)

 This information is located in Dr. Kofoed’s declaration filed September 28, 2001, at 6, 12

in CIV S-00-0022 LKK JFM P. (See n.5 infra.)

13

pain meds . . . you know. There’s nothing too much more that I can do. Your [sciatic nerve]

injury is too extensive.” (Pl.’s Dep. Tr. at 33.)11

The eventual knee lock sustained by plaintiff is more problematic. Arguably, an

orthopedic surgeon would know that failure to attend physical therapy or maintain a home

exercise program would cause a patient with extensive sciatic nerve injury to eventually sustain a

knee lock. However, plaintiff presents no evidence that Dr. Kofoed knew plaintiff was not going

to physical therapy or that plaintiff was sustaining increasing reductions to his range of motion in

his left leg. Plaintiff has presented no evidence that he requested to see Dr. Kofoed but was

refused, or that he presented to medical clinic with complaints of knee contracture prior to

September 18, 1998. 

Plaintiff has presented no evidence that he requested physical therapy to notify Dr.

Kofoed that plaintiff was in too much pain to perform the physical therapy ordered. Although

plaintiff has provided a statement by physical therapist Nate Hohsfield, dated November 29,

2001, that plaintiff’s inability to perform physical therapy was due to plaintiff’s pain level, Mr.

Hohsfield did not state he had relayed this information to Dr. Kofoed or any other medical

professional in an effort to control plaintiff’s pain so that he could participate in physical therapy. 

Dr. Kofoed, on the other hand, stated he had no information prior to October 14,

1998 that plaintiff’s left knee required surgery, because plaintiff was being treated by physical

therapy designed to increase mobility to plaintiff’s left knee. Dr. Kofoed confirmed that the

physical therapy records of October 20, 1997 showed plaintiff had a 90 degree range of motion in

the left knee which was being treated three to four days a week by physical therapy and exercise

he was to perform at home. (September 28, 2001 Kofoed Decl. at 6. ) Even if Dr. Kofoed had 12

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 13 of 16
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

14

reviewed plaintiff’s medical records during this time, they would not have disclosed the fact that

plaintiff’s knee was starting to lock up. Because plaintiff did not participate in physical therapy

due to his pain, there were no physical therapy records to reflect a gradual contracture of his

knee. There is no evidence that plaintiff presented at medical clinic to complain of such

contracture until September 18, 1998. The contracture appears to be the result of a gradual lack

of activity because the degree of lock in plaintiff’s knee did not increase between October 14,

1998, when Dr. Kofoed first diagnosed the lock and March 9, 1999, when the lock was released

by surgery. There is no evidence that Dr. Kofoed knew plaintiff had a serious medical need for

an immediate orthopedic consultation prior to September 18, 1998.

Thus, there is no evidence in the record that Dr. Kofoed would have performed

the surgery at some point prior to October 14, 1998, even if he had been informed of plaintiff’s

failure to attend physical therapy. On this record, the court cannot find that Dr. Kofoed was

deliberately indifferent to plaintiff’s serious medical needs from October 1997 to October 14,

1998.

Finally, there was an almost five month delay from October 14, 1998 when Dr.

Kofoed was made aware of the contracture, to the surgery on March 9, 1999 when the lock was

released. However, plaintiff has provided no evidence that this delay was caused by the

deliberate indifference of Dr. Kofoed. It is undisputed that all surgeries must first be approved

by the MAR. 

Moreover, plaintiff’s evidence is insufficient to show that any delay in receiving

the surgery caused him substantial harm. Plaintiff provided no evidence that the knee lock

worsened from the date of diagnosis to the date of surgery. While plaintiff did state that he

experienced pain during the five month period of delay, the undisputed evidence shows he was

continuing to receive Oxycodene for pain. (Pl.’s Opp’n, Ex. D, at 42.) Moreover, plaintiff has

failed to demonstrate that the pain he suffered was a direct result of the knee lock rather than

from the injury to his sciatic nerve or his sickle cell anemia. Dr. Kofoed opined that the delay in

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 14 of 16
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

15

surgery did not increase plaintiff’s left knee contracture or cause any additional damage to

plaintiff’s sciatic nerve, foot, leg or left knee. Plaintiff has failed to provide any medical

evidence to the contrary. This court finds that plaintiff has not presented evidence sufficient to

create a triable issue of material fact as to whether defendant Dr. Kofoed deliberately delayed the

surgical repair of his knee lock. 

For all of the foregoing reasons, this court finds that there is no triable issue of

material fact as to whether defendant Kofoed acted with deliberate indifference to plaintiff’s

serious medical needs, and this court further finds that defendant Kofoed is entitled to summary

judgment on plaintiff’s Eighth Amendment claim. Since plaintiff’s constitutional claims are

without merit, the court should decline to exercise supplemental jurisdiction over plaintiff’s state

law negligence claims against Dr. Kofoed as well. See 28 U.S.C. § 1367(c)(3).

On March 8, 2006, plaintiff also filed a motion for summary judgment. In light of

the above findings and recommendations, this court will also recommend that plaintiff’s motion

be denied.

IT IS ORDERED that plaintiff’s June 12, 2006 motion for extension is denied;

and

IT IS HEREBY RECOMMENDED that:

1. Defendant Kofoed’s December 21, 2005 motion for summary judgment be

granted; 

2. The court should decline to exercise supplemental jurisdiction over plaintiff’s

state law negligence claims; 

3. Plaintiff’s March 8, 2006 motion for summary judgment be 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 

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 15 of 16
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

16

“Objections to Magistrate Judge’s Findings and Recommendations.” The parties are advised that

failure to file objections within the specified time may waive the right to appeal the District

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

DATED: August 16, 2006.

001

fraz0115.msj

Case 2:04-cv-00115-MCE -PAN Document 73 Filed 08/17/06 Page 16 of 16