Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_14-cv-01330/USCOURTS-casd-3_14-cv-01330-3/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

FRANKLIN ANDRADE, JR., Booking

#1276875,

Civil

No. 14cv1330 GPC (BGS)

Plaintiff, REPORT AND

RECOMMENDATION OF U.S.

MAGISTRATE JUDGE RE: 

GRANTING MOTION TO DISMISS

OF DEFENDANT 

[ECF No. 16.]

v.

COUNTY OF SAN DIEGO, et al.

Defendants.

I. Introduction

Plaintiff Franklin Andrade, Jr. (“Andrade”), currently incarcerated at the George

Bailey Detention Center, is proceeding in pro se and in forma pauperis (“IFP”) in this

civil rights action filed pursuant to 42 U.S.C. § 1983. Before the Court are Defendants,

the County of San Diego (also erroneously sued as San Diego County Board of

Supervisors, San Diego County Jail Director of Health Services, Facility Administrator of

George Bailey Detention) (hereinafter “the County”) and Mike Barletta’s Motion to

Dismiss Plaintiff’s Second Amended Complaint (“SAC”) pursuant to Federal Rules of

Civil Procedure 12(b)(6). [ECF No. 16.] After considering the briefing and for the

reasons stated below, IT IS RECOMMENDED that the motion to dismiss be

GRANTED. 

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II. Factual Background1

Plaintiff, Franklin Andrade, is an inmate at George Bailey Detention Facility.

Andrade alleges in his Second Amended Complaint that at about six months prior to his

incarceration, he was prescribed the hydrocodone medication “Norco” as a pain reliever.

(ECF No. 9 at 6.) Andrade suffers from chronic pain on his right side due to an acute

ligament severance of the right shoulder and bicep. (Id. at 4.) Andrade states that his prior

physician had fully informed him of the benefits and harms of Norco, and Andrade did

not suffer any ill effects from taking Norco. (Id. at 6.)

In October 2013, Andrade met with an unnamed female physician at the George

Bailey Detention Facility and was told that he could not continue receiving Norco, the

medication he was taking before he entered the facility. (Id. at 4.) Instead, the doctor

prescribed another medication that Andrade was not familiar with, called “Roxycodone.”

(Id. at 5.) Andrade states that the doctor did not inform him of the side effects of

Roxycodone, or that it could cause an opioid dependency. (Id. at 4.) Andrade contends

that he did not receive “informed consent” in violation of San Diego County Jail’s “own

guidelines and policies set forth in the Title 15 (minimum jail standards) § 1214." (Id. at

5.) 

After two to three weeks of taking Roxycodone, Andrade found that it provided

only short-term relief. (Id. at 4.) Andrade complained that the medication was only

effective for four hours after ingestion, and that the medication stops working after

midnight. As a result, Andrade claims he would be in pain until 9:30 am. (Id. at 9.) Due

to Andrade’s complaints, an unnamed attending physician increased Andrade’s

medication dosage to three times daily, distributed at 9 am, 1 pm, and 7:30 pm. (Id. at 4-

8.) Andrade requested that the 1:00 pm distribution time be moved to 2:30 am, but his

request was denied. (Id. at 9.) 

On January 19, 2014, Andrade alleges that unidentified nurses in the housing unit

1

 These factual allegations are summarized from Plaintiff’s Second Amended Complaint 

(ECF No. 9.) When citing to a page from a particular document, this Court will refer to page

numbers assigned by the Court’s Electronic Case Management docketing system.

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to which he was assigned stopped dispensing medication to him because they suspected

him of drug abuse. (Id. at 8.) Andrade alleges that “even though Plaintiff was not a

heroin user suffering heroin withdraws, morphine based and opiod [sic] based products

are in a similar family of narcotics [as Roxycodone]”; therefore “medical staff failed to

follow their own guidelines concerning [the inmate] detoxification treatment policy”

because they stopped administering Roxycodone without warning and failed to develop a

detoxification program such as “weaning” or to transfer him to a licensed medical facility

under Title 15, (minimum jail standards) § 1213. (Id. at 7.)

From January 19, 2014 to January 20, 2014, Andrade submitted written and verbal

complaints to alert prison staff that once the Roxycodone medication was stopped (on

January 19, 2014), he began to feel severely ill. (Id. at 8.) On January 21, 2014, Andrade

woke up sick, was unable to eat breakfast, had coughs and sweats, and had chills upon

standing up. (Id.) He then blacked-out, fell backwards, and suffered a concussion and

contusion to the back of his head. (Id.) Andrade’s head wound was closed with nine

stitches, and he was admitted to the UCSD hospital for three days. (Id. at 8-10.) 

On January 28, 2014, Andrade was transferred from the Medical Unit at George

Bailey Detention Facility to General Population. (Id. at 10.) At 9:00 am, Andrade lined

up to receive medication and he was given a pre-measured dosage of a red liquid. (Id.)

Due to its similarities in appearance to Robitussin cough syrup, which Andrade had been

previously prescribed, he mistook the red liquid for cough syrup and swallowed it. (Id.)

The liquid, later discovered by Andrade to be an antiseptic called “Hibicleanse,” burned

his throat and caused him to vomit. (Id. at 11-13.) Andrade was escorted to a medical unit

and placed into a holding cell for five hours, and was told by the attending nurse to keep

vomiting. (Id. at 12.) Andrade stated that no medical staff remained to supervise, and he

was later escorted back to General Population by a custody officer. (Id. at 12.) 

On January 29, 2014, Andrade was escorted into an examination room for a

follow-up examination with the attending physician. (Id. at 12.) Andrade alleges that the

nurse who took his vitals was amused by his sickness and situation, made comments

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about how the Hibicleanse tasted, and made Andrade feel that he “made the stupid

decision of injuring [himself].” (Id. at 12-13.) Andrade further alleges that the attending

physician also added joking remarks and asked him demeaning questions. (Id. at 13.)

When Andrade asked “what’s so “explentive” (sic) funny?”, the attending physician told

the custody sheriff to take Andrade back to his cell without further treatment. (Id. at 13.)

Andrade stated that, at that moment, he was still suffering from the burning sensation in

his throat, unable to eat or swallow without pain, and was still nauseous and suffering

from the effects of the concussion. (Id. at 13.) 

III. Procedural History

On May 29, 2014, Andrade filed his original Complaint in this action which the

Court dismissed on June 9, 2014 for failure to state a claim. The Honorable Gonzalo P.

Curiel explained:

First, to the extent Plaintiff alleges that the “San Diego County Sheriff’s

Department,” and the “San Diego Sheriff’s Department Medical Service” have violated his constitutional rights, his Complaint fails to state a claim because these

entities are not “persons” subject to suit under § 1983. Neither a local law

enforcement department (like the San Diego County Sheriff’s Office), a jail (like the San Diego County Jail), or a state agency (like the California Department of Corrections), are proper defendants under § 1983. See Vance v. County of Santa Clara, 928 F. Supp. 993, 996 (N.D. Cal. 1996) (“Naming a municipal department as a defendant is not an appropriate means of pleading a § 1983 action against a

municipality.”) (citation omitted); Powell v. Cook County Jail, 814 F. Supp. 757, 758 (N.D. Ill. 1993) (“Section 1983 imposes liability on any ‘person’ who violates

someone’s constitutional rights ‘under color of law.’ Cook County Jail is not a ‘person.’); 

While the County of San Diego itself may be considered a “person” and therefore, a proper defendant under § 1983, see Monell v. Department of Social Services, 436

U.S. 658, 691 (1978); Hammond v. County of Madera, 859 F.2d 797, 801 (9th Cir. 1988), Plaintiff has not named the County as a Defendant. Moreover, as a

municipality, the County may be held liable under § 1983–but only where the Plaintiff 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 County, or a “final decision

maker” for the County. Monell, 436 U.S. at 690; Board of the County Commissioners v. Brown, 520 U.S. 397, 402-04 (1997); 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). “Instead, a Monell claim exists only where the alleged constitutional deprivation was inflicted in ‘execution of a government’s policy or custom.’” Id. (quoting Monell, 436 U.S.

at 694). 

As currently pleaded, Plaintiff’s Complaint fails to state a claim under 28 U.S.C.

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§ 1915A(b) because he has failed to allege any facts which “might plausibly suggest” that either the County itself, or any individual County employee (a “person”), like Sheriff Gore, violated his constitutional rights. See Hernandez v.

County of Tulare, 666 F.3d 631, 637 (9th Cir. 2012) (applying Ashcroft v. Iqbal, 556 U.S. 662 (2009)’s pleading standards to Monell claims); Johnson v. Duffy, 588

F.2d 740, 743 (9th Cir. 1978) (42 U.S.C. § 1983 provides for relief only against

those who, through their personal involvement as evidenced by affirmative acts,

participation in another’s affirmative acts, or failure to perform legally required duties, cause the deprivation of plaintiff’s constitutionally protected rights).

[ECF No. 3 at pp. 3-4.]

Andrade was given leave to file a First Amended Complaint. On July 8, 2014, he

filed a First Amended Complaint which was again dismissed by the Court on August 6,

2014 for failure to state a claim. The District Court stated in its order:

As currently pleaded, Plaintiff’s First Amended Complaint fails to state a claim under 28 U.S.C. § 1915A(b) because he has failed to allege any facts which “might plausibly suggest” that the County violated his constitutional rights. See

Hernandez v. County of Tulare, 666 F.3d 631, 637 (9th Cir. 2012) (applying Ashcroft v. Iqbal, 556 U.S. 662 (2009)’s pleading standards to Monell claims); Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978) (42 U.S.C. § 1983 provides for relief only against those who, through their personal involvement as evidenced by

affirmative acts, participation in another’s affirmative acts, or failure to perform legally required duties, cause the deprivation of plaintiff’s constitutionally protected rights). Here, there are no allegations that any individual Defendant was acting in accordance with a County policy, procedure or custom. Monell, 436 U.S.

at 690.

Plaintiff does allege that unnamed medical staff refused to provide him with medication he was receiving before he was incarcerated. Where an inmate’s claim

is one of inadequate medical care, the inmate must allege “acts or omissions

sufficiently harmful to evidence deliberate indifference to serious medical needs.” 

Estelle v. Gamble, 429 U.S. 97, 106 (1976). Such a claim has two elements: “the seriousness of the prisoner’s medical need and the nature of the defendant’s

response to that need.” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1991), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133, 1136

(9th Cir. 1997). A medical need is serious “if the failure to treat the prisoner’s condition could result in further significant injury or the ‘unnecessary and wanton infliction of pain.’” McGuckin, 974 F.2d at 1059 (quoting Estelle, 429 U.S. at 104). Indications of a serious medical need include “the presence of a medical condition that significantly affects an individual’s daily activities.” Id. at 1059-60. By establishing the existence of a serious medical need, an inmate satisfies the

objective requirement for proving an Eighth Amendment violation. Farmer v.

Brennan, 511 U.S. 825, 834 (1994).

In general, deliberate indifference may be shown when prison officials deny, delay, or intentionally interfere with a prescribed course of medical treatment, or it may be shown by the way in which prison medical officials provide necessary care. 

Hutchinson v. United States, 838 F.2d 390, 393-94 (9th Cir. 1988). Before it can be said that a inmate’s civil rights have been abridged with regard to medical care, however, “the indifference to his medical needs must be substantial. Mere

‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not support this cause of action.” Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 1980)

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(citing Estelle, 429 U.S. at 105-06). See also Toguchi v. Chung, 391 F.3d 1051,

1060 (9th Cir. 2004).

Here, Plaintiff only alleges facts that show a difference of opinion between himself and unnamed medical staff regarding the course of his medical treatment. Prior to

his incarceration, Plaintiff received a medication that the medical jail staff informed him they could not provide. (See FAC at 3-4.) Instead, Plaintiff was prescribed a different pain medication. (Id. at 4.) A mere difference of opinion between an inmate and prison medical personnel regarding appropriate medical diagnosis and treatment is not enough to establish a deliberate indifference claim. 

Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989).

Plaintiff also alleges that he was mistakenly given the wrong medication that was

“pre-made by the R.N. or LVN who delivered medication to each of the housing units.” (FAC at 5.) Plaintiff claims that this medication was the same “look,

texture and container” as the medication he was supposed to have received. (Id.) As a result of taking the wrong medication, Plaintiff claims he became ill. (Id.) However, inadequate treatment due to malpractice, or even gross negligence, does not amount to a constitutional violation. Estelle, 429 U.S. at 106; Toguchi, 391

F.3d at 1060.

To the extent that Plaintiff claims he was left alone in his cell after becoming ill and “laughed at by medical staff,” he may have a deliberate indifference to a serious medical need claim. However, the Court cannot direct service of this claim

at this time because Plaintiff’s pleading is completely devoid of any description or

identifying factors necessary to effect service on an individual defendant. 

Moreover, Plaintiff has not named any individuals as Defendants in this matter. 

Thus, if Plaintiff wishes to proceed with this claim, he must file an amended

pleading that provides an adequate description of these individuals whom he claims were deliberately indifferent to his serious medical needs. See Walker v.

Sumner, 14 F.3d 1415, 1422 (9th Cir. 1994) (in order to properly effect service under Rule 4 in an IFP case, the plaintiff is required to “furnish the information

necessary to identify the defendant.”). ” 

[ECF No. 5 at pp. 2-6.]

On October 27, 2014, Andrade filed a Second Amended Complaint. Plaintiff

contends that Defendants violated his constitutional rights by acting with deliberate

indifference to his withdrawal from Roxycodone and to his ingestion of “Hibicleanse”. 

[ECF No. 9.] Defendants filed a motion to dismiss on March 30, 2015. [ECF No. 16.]

IV. Defendants’ Motion to Dismiss Plaintiff’s Complaint

Defendants seek dismissal of Andrade’s Second Amended Complaint (“SAC”)

pursuant to FED.R.CIV.P. 12(b)(6) on the grounds that: (1) Andrade fails to state a claim

against Defendant Mike Barletta, who is alleged to be the “director of the Health Services

Authority” (ECF No. 9 at 2), because the SAC states no facts demonstrating Barletta’s

knowledge of, or involvement with, Andrade’s condition or injury; (2) Andrade fails to

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state a claim for deliberate indifference against the County because he has not shown the

failure to adequately respond to his withdrawal symptoms or to his ingestion of

“Hibicleanse”; and (3) Andrade fails to state a claim under California State law because

the County is immune from suit for injuries to prisoners under California Government

Code § 844.6 and §845.6 [ECF No. 16-1.]

A. FED.R.CIV.P. 12(b)(6) Standard of Review

A Rule 12(b)(6) dismissal may be based on either a “‘lack of a cognizable legal

theory’ or ‘the absence of sufficient facts alleged under a cognizable legal theory.’”

Johnson v. Riverside Healthcare System, LP, 534 F.3d 1116, 1121-22 (9th Cir. 2008)

(quoting Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1990)). In other

words, the plaintiff’s complaint must provide a “short and plain statement of the claim

showing that [he] is entitled to relief.” Id. (citing FED.R.CIV.P. 8(a)(2)). “Specific facts

are not necessary; the statement need only give the defendant[s] fair notice of what ... the

claim is and the grounds upon which it rests.” Erickson v. Pardus, 551 U.S. 89, 127 S.

Ct. 2197, 2200 (2007) (internal quotation marks omitted). 

A motion to dismiss should be granted if plaintiff fails to proffer “enough facts to

state a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S.

544, 570 (2007). “A claim has facial plausibility when the plaintiff pleads factual

content that allows the court to draw the reasonable inference that the defendant is liable

for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 129 S. Ct. 1937, 1949

(2009).

The court need not, however, accept as true allegations that are conclusory, legal

conclusions, unwarranted deductions of fact or unreasonable inferences. See Sprewell v.

Golden State Warriors, 266 F.3d 979, 988 (9th Cir. 2001); Iqbal, 129 S. Ct. at 1949

(“Threadbare recitals of the elements of a cause of action, supported by mere conclusory

statements, do not suffice.”); Twombly, 550 U.S. at 555 (on motion to dismiss court is

“not bound to accept as true a legal conclusion couched as a factual allegation.”). “The

pleading standard Rule 8 announces does not require ‘detailed factual allegations,’ but it

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demands more than an unadorned, the defendant-unlawfully-harmed-me accusation.” 

Iqbal, 129 S.Ct. at 1949 (quoting Twombly, 550 U.S. at 555).

In addition, claims 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. 519-20 (1972); Erickson, 551 U.S. at 94. Because “Iqbal incorporated

the Twombly pleading standard and Twombly did not alter courts’ treatment of pro se

filings, [courts] continue to construe pro se filings liberally when evaluating them under

Iqbal.” Hebbe v. Pliler, 627 F.3d 338, 342 & n.7 (9th Cir. 2010) (citing Bretz v. Kelman,

773 F.2d 1026, 1027 n.1 (9th Cir. 1985) (noting that courts “have an obligation where the

petitioner is pro se, particularly in civil rights cases, to construe the pleadings liberally

and to afford the petitioner the benefit of any doubt.”)).

B. Deliberate Indifference to Serious Medical Needs

Andrade alleges that he was a pretrial detainee at the time the Roxycodone was

dispensed to him, and therefore, refers to the Fourteenth Amendment as the basis for his

deliberate indifference claim. [ECF No. 9 at 8.] Although the Fourteenth Amendment’s

Due Process Clause, rather than the Eighth Amendment’s prohibition of cruel and

unusual punishment, applies to pretrial detainees, Bell v. Wolfish, 441 U.S. 520, 537 n.16

(1979), courts in the Ninth Circuit apply the same standards in both cases. See Clouthier

v. County of Contra Costa, 591 F.3d 1232, 1243-44 (9th Cir. 2010) (applying Eighth

Amendment deliberate indifference standard to medical care claims raised by estate of

suicidal pretrial detainee); see also Lolli v. County of Orange, 351 F.3d 410, 418-19 (9th

Cir 2003) (applying Eighth Amendment deliberate indifference standard to diabetic

pretrial detainee’s claims of inadequate medical treatment). 

To state a deliberate indifference claim, Plaintiff must show a “serious medical

need” such that “failure to treat a prisoner’s condition could result in further significant

injury or the unnecessary or wanton infliction of pain.” Estelle v. Gamble, 429 U.S. 97

(1976). Defendants’ motion to dismiss “assumes” Plaintiff could meet the first element

of deliberate indifference; existence of a serious medical need. [ECF No. 16-1 at 4:25.]

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therefore, the Court need not address this requirement.

As to the second element, a prison official acts in a deliberately indifferent manner

when that official “knows of and disregards an excessive risk to inmate health or safety.” 

Farmer v. Brennan, 511 U.S. 825, 834 (1994). Plaintiff must include in his pleading

enough factual content to show that each Defendant he seeks to hold liable acted with

“deliberate indifference” to his needs. McGuckin, 974 F.2d at 1060; see also Jett v.

Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). “This second prong–defendant’s response

to the need was deliberately indifferent–is satisfied by showing (a) a purposeful act or

failure to respond to [the] prisoner’s pain or possible medical need and (b) harm caused

by the indifference.” Jett, 439 F.3d at 1096. 

“The indifference to [a prisoner’s] medical needs must be substantial. Mere

‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not support this cause of

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

Estelle v. Gamble, 429 U.S. 97, 105-06 (1976)). For example, “a complaint that a

physician has been negligent in diagnosing or treating a medical condition does not state

a valid claim of medical mistreatment under the Eighth Amendment. Medical

malpractice does not become a constitutional violation merely because the victim is a

prisoner.” Estelle, 429 U.S. at 106; see also Anderson v. County of Kern, 45 F.3d 1310,

1316 (9th Cir. 1995). 

1. Defendant Mike Barletta

Defendant Barletta argues for dismissal on the grounds that there are no factual

allegations against him showing a cognizable claim for deliberate indifference. The

allegations in the SAC against Defendant Barletta, in their entirety, are as follows:

“Barletta...is employed as a Director of Health Services Authority... this defendant

... flagrantly [sic] disregard of State law and San Diego County law and

regulations, regarding “informed consent” of “Legend Drugs”, policy. Improperly

supervising custodial medical staff.”

[ECF No. 9 at 2.]

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A person deprives another “of a constitutional right, within the meaning of section

1983, if he does an affirmative act, participates in another’s affirmative acts, or omits to

perform an act which he is legally required to do that causes the deprivation of which [the

plaintiff complains].” Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978). “Causation

is, of course, a required element of a § 1983 claim.” Estate of Brooks v. United States,

197 F.3d 1245, 1248 (9th Cir. 1999). “The inquiry into causation must be individualized

and focus on the duties and responsibilities of each individual defendant whose acts or

omissions are alleged to have caused a constitutional deprivation.” Leer v. Murphy, 844

F.2d 628, 633 (9th Cir. 1988) (citing Rizzo v. Goode, 423 U.S. 362, 370-71 (1976)); 

Berg v. Kincheloe, 794 F.2d 457, 460 (9th Cir. 1986).

The Second Amended Complaint fails to identify any acts showing Defendant

Barletta knew of, and thereafter affirmatively disregarded, an excessive risk to Andrade’s

health or safety. Andrade conclusorily alleges Barletta: “flagrantly (sic) disregard of

State law and San Diego County law and regulations, regarding “informed consent” of

“Legend Drugs”, policy - improperly supervising custodial medical staff.” This general

allegation, however, fails to state any facts from which the Court could infer that Barletta

was personally involved or connected in some way to the decision to not give informed

consent, stop providing Roxycodone or to the administering of Hibicleanse to Andrade. 

See Adams v. Johnson, 355 F.3d 1179, 1183 (9th Cir 2004); Resendiz v. County of

Monterey, 2015 WL 4040439 *4 (N.D. Cal. 2015) (finding the “bare” allegation that

“Defendants fail[ed] to train, supervise and/or promulgate appropriate policies and

procedures in order to prevent harm” did not state facts that would allow the Court to

draw a reasonable inference of liability.) 

Andrade also asserts in his SAC that he is suing Defendant Barletta in his “official

capacity” as supervisor/Director of Health Services Authority. However, there is no

respondeat superior liability under 42 U.S.C. § 1983. Palmer v. Sanderson, 9 F.3d 1433,

1437-38 (9th Cir. 1993). Therefore, any defendant against whom the complaint alleges

only claims based on respondeat superior or vicarious liability, must be dismissed. 

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Monell, 436 U.S. at 691. To avoid the respondeat superior bar, the plaintiff must allege

personal acts by the defendant which have a direct causal connection to the constitutional

violation at issue. Sanders v. Kennedy, 794 F.2d 478, 483 (9th Cir. 1986); Bergquist v.

County of Cochise, 806 F.2d 1364, 1369 (9th Cir. 1986). With respect to supervisors in

particular, a claim may be stated where there exists: “(1) personal involvement in the

constitutional deprivation, or (2) a sufficient causal connection between the supervisor’s

wrongful conduct and the constitutional violation.” Starr v. Baca, 652 F.3d 1202 (9th

Cir.2011). This causal connection may be shown by alleging facts demonstrating the

supervisor knew of an unconstitutional practice coupled with ratification or acquiescence. 

Chavez v. U.S., 683 F.3d 1102, 1110-1111 (9th Cir. 2012).

As this Court explained supra, the SAC does not provide any facts showing

Defendant Barletta was aware of: (1) the unidentified physician or medical staff’s failure

to give informed consent before switching Andrade’s medicine; (2) the unnamed nurses’

decision to stop Andrade’s usage of Roxycodone without weaning or transfer; or (3) the

erroneous administering of Hibicleanse to Andrade by unidentified medical staff. Nor

does the SAC allege any facts demonstrating Barletta in some way directed or sanctioned

these staff actions, which Andrade claims were deliberately indifferent to his medical

needs. Therefore, IT IS RECOMMENDED that Defendants’ Motion to Dismiss

Plaintiff’s Second Amended Complaint for failing to state a claim against Mike Barletta

pursuant to FED.R.CIV.P. 12(b)(6) be GRANTED.

2. The County of San Diego

Andrade also asserts a claim of deliberate indifference against the County of San

Diego under the theory of municipal liability set forth in Monell v. New York Department

of Social Services, 436 U.S. 658, 98 S.Ct. 2018, 56 L.ed.2d 611 (1978). In Monell, the

Supreme Court held municipalities can be held liable under section 1983 for deprivations

of constitutional rights resulting from their formal policies or customs. Id. at 691-93. 

Andrade must, therefore, show that there was a constitutional violation “caused by an

official policy or custom” of the County. See Tsao v. Desert Place, Inc., 698 F.3d 1128,

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1138-39 (9th Cir. 2012).

More specifically, to state a § 1983 claim against a local government under Monell,

a plaintiff must show: (1) he was deprived of a constitutional right; (2) the municipality

had a policy; (3) the policy amounts to deliberate indifference to the plaintiff’s

constitutional right, and (4) the policy is the “moving force behind the constitutional

violation.” Anderson v. Warner, 451 F.3d 1063, 1070 (9th Cir. 2006). “For a policy to be

the moving force behind the deprivation of a constitutional right, the identified deficiency

in the policy must be closely related to the ultimate injury,” and the plaintiff must

establish “that the injury would have been avoided had proper policies been

implemented.” Long v. Cnty. of Los Angeles, 442 F.3d 1178, 1190 (9th Cir. 2006).

Andrade appears to allege that there is a basis for Monell liability because: (1)

“medical staff violated their own guidelines and policies set forth in the Title 15

(minimum jail standards) § 1214"2

 by failing to give Andrade “informed consent” before

prescribing Roxycodone; and (2) “medical staff failed to follow their own guidelines

concerning [the inmate] detoxification policy [under] Title 15, (minimum jail standards)

§ 1213”3

 when, after suspecting him of Roxycodone abuse, they abruptly stopped

distribution of the medication and did not develop a detoxification program such as

“weaning” or transfer him to a licensed medical facility better equipped to handle

2

 Section 1214 of the Title 15 Regulations states: “Informed Consent. The health authority 

shall set forth in writing a plan for informed consent of inmates in a language understood by the inmate.

Except for emergency treatment, as defined in Business and Professions Code Section 2397 and 

Title 15, Section 1217, all examinations, treatments and procedures affected by informed 

consent standards in the community are likewise observed for inmate care. In the case of minors,

 or conservatees, the informed consent of parent, guardian or legal custodian applies where required 

by law. Any inmate who has not been adjudicated to be incompetent may refuse non-emergency 

medical and mental health care. Absent informed consent in non-emergency situations, a court order

 is required before involuntary medical treatment can be administered to an inmate.”

3

 Section 1213 of the Title 15 Regulations states: “Detoxification Treatment. The 

responsible physician shall develop written medical policies on detoxification which shall include 

a statement as to whether detoxification will be provided within the facility or require transfer to 

a licensed medical facility. The facility detoxification protocol shall include procedures and 

symptoms necessitating immediate transfer to a hospital or other medical facility. Facilities 

without medically licensed personnel in attendance shall not retain inmates undergoing 

withdrawal reactions judged or defined in policy, by the responsible physician, as not being 

readily controllable with available medical treatment. Such facilities shall arrange for immediate 

transfer to an appropriate medical facility.” 

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detoxification.4 (ECF No. 9. at 4-7.) 

As to the alleged failure of medical staff to provide Andrade with informed consent

prior to taking Roxycodone, the SAC fails to state a claim because Andrade’s allegations

do not state facts showing execution of an official policy is responsible for his injuries. 

Monnell, 436 U.S. at 691-92. Instead, Andrade has alleged throughout the SAC that

unnamed and unidentified doctors, nurses and medical staff did not follow the County’s

informed consent policy. Andrade’s allegations demonstrate he takes issue not with the

policy, but with the care provided by medical staff. Nevertheless, despite being advised

in two prior court opinions to name or identify the persons whom he claims were

deliberately indifferent to his serious medical needs, Andrade has failed to name any

individuals on the medical staff.5

 Because members of the medical staff, not the

informed consent policy, are alleged to be the moving force behind Andrade’s injury, no

municipal liability on the party of the County has been stated. Moreover, Andrade states

no facts in the SAC alleging that if he had been given informed consent, his injury would

have been avoided. To the contrary, in the SAC Andrade alleges that upon taking

Roxycodone, he learned from other inmates that it was a “replacement medicine for

4

Andrade does not allege a connection between these policies and his

 accidental ingestion of hibicleanse at a later time.

5

 Judge Curiel explained in his August 6, 2014 Order: “[T]he Court cannot direct service of 

this claim at this time because Plaintiff’s pleading is completely devoid of any description or 

identifying factors necessary to effect service on an individual defendant. Moreover, Plaintiff has

 not named any individuals as Defendants in this matter. Thus, if Plaintiff wishes to proceed with

 this claim, he must file an amended pleading that provides an adequate description of these

 individuals whom he claims were deliberately indifferent to his serious medical needs. See Walker

 v. Sumner, 14 F.3d 1415, 1422 (9th Cir. 1994) (in order to properly effect service under Rule 4 in

 an IFP case, the plaintiff is required to “furnish the information necessary to identify the defendant.”). 

[ECF No. 5 at 5:5-13.] Accordingly, Andrade’s naming of defendants “George Bailey detention 

medical staff” and “Administrator of George Bailey detention facility” in the SAC are inadequate 

as found in the Court’s prior orders. See also June 9, 2014 Order finding: “As currently 

pleaded, Plaintiff’s Complaint fails to state a claim under 28 U.S.C. § 1915A(b) because he has 

failed to allege any facts which “might plausibly suggest” that ... any individual County employee

 (a “person”), like Sheriff Gore, violated his constitutional rights. See Hernandez v. County of 

Tulare, 666 F.3d 631, 637 (9th Cir. 2012) (applying Ashcroft v. Iqbal, 556 U.S. 662 (2009)’s 

pleading standards to Monell claims); Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978) 

(42 U.S.C. § 1983 provides for relief only against those who, through their personal involvement 

as evidenced by affirmative acts, participation in another’s affirmative acts, or failure to perform 

legally required duties, cause the deprivation of plaintiff’s constitutionally protected rights).” ECF 

No. 3 at 4:4-12.]

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Oxycodone” and continued to use it from October of 2013 to January 19, 2014. [ECF No.

9 at pp. 6 and 9.] There are no facts alleged in the SAC that would allow the court to

draw a reasonable inference that implementation of the County’s informed consent policy

is responsible for the injuries alleged. Therefore, IT IS RECOMMENDED that the

County’s Motion to Dismiss for failure to state a claim of municipal liability with respect

to the informed consent policy be GRANTED.

Turning to Andrade’s allegation that the medical staff failed to follow their own

guidelines concerning inmate detoxification policy, the SAC again fails to state a claim. 

Specifically, Andrade’s allegations do not state facts that would allow the court to draw a

reasonable inference that execution of the County’s detoxification policy is responsible

for his injuries. Monnell, 436 U.S. at 691-92. Throughout the SAC, Andrade alleges

“jail medical staff” failed to follow the detoxification policy. [See ECF No. 9 at p. 7 (“jail

medical staff failed to follow their own guidelines...”, p. 14 (“medical staff ... has acted

as if it is above the laws that their own county enforces, guidelines that are set in minimal

jail standards (Title 15)....”); p. 14 (“medical staff should not have... stopped Plaintiffs

addiction medication without ‘weaning’...”).] The focus of the SAC is on the actions of

staff which Andrade alleges deviated from the policy in place.6

 Consequently, a claim for

municipal liability has not been stated, because as explained in the Court’s discussion of

Monell supra, a government entity is liable only for injury stemming from a policy of that

entity, not from an individual aberration or isolated act. Monnell, 436 U.S. at 690. Here,

the SAC contains no allegations that jail medical staff were acting in accordance with

policy. IT IS THEREFORE RECOMMENDED that the County’s Motion to Dismiss

Plaintiff’s Second Amended Complaint for failing to state a claim of municipal liability

against the County as to the application of its “detoxification” policy be GRANTED.

 C. Failure to Provide Medical Care under the California Government Code

6

Because Defendants’ motion to dismiss utterly fails to discuss the applicability of the 

policies identified by Andrade, the Court assumes, without deciding, for the purposes of this motion 

only that the informed consent and inmate detoxification policies are in force at the George 

Bailey Detention Center. 

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The County contends that to the extent Plaintiff is attempting to plead a state law

claim for injury caused by an alleged failure to furnish medical care to a prisoner, such a

claim must be denied because public entities are immune from suit under California

Government Code §§ 844.6 and 845.6. [ECF No. 16 at 16 at 6:7-20.] California

Government Code § 844.6(a)(1) provides, “notwithstanding any other provision of this

part, ....a public entity is not liable for (1) An injury proximately caused by any prisoner.;

(2) An injury to any prisoner.” Cal. Gov. Code §844.6. An exception to the immunity

from suit exists pursuant to California Government Code § 845.6 which states:

“Neither a public entity nor a public employee is liable for injury proximately caused by the failure of the employee to furnish or obtain medical care for a

prisoner in his custody; but, except as otherwise provided by Sections 855.8 and

856, a public employee and the public entity where the employee is acting within the scope of his employment, is liable if the employee knows or has reason to

know that the prisoner is in need of immediate medical care and he fails to take

reasonable action to summon such medical care.”

Cal. Gov. Code §845.6.

 Section 845.6, which covers the need for immediate medical care, does not apply

to generalized failures to provide medication or treatment. Nelson v. California,139 Cal.

App. 3d 72, 81 (Ct. App. 1982) (holding “failure of a practitioner to prescribe or provide

necessary medication or treatment ... cannot be characterized as a failure to summon

medical care” under the statute.) California courts have also ruled that the obligation to

summon immediate medical care codified by Section 845.6 does not also include a duty

to properly diagnose or treat a medical condition. Watson v. California, 21 Cal. App. 4th

836, 841-42 (Ct. App. 1993) (holding the failure to summon immediate medical care

under section 845.6 is not equivalent to the failure to provide adequate care.)

As to the Roxycodone withdrawal incident where Plaintiff blacked out and

suffered a contusion to the back of the head that was closed with nine stitches, the SAC

alleges that Plaintiff was taken to the UCSD hospital where he stayed for three days. 

[ECF No. 9 at 10.] Andrade’s allegations demonstrate he received immediate medical

care in response to the head injury and there are no facts alleged in the SAC that would

indicate medical staff failed to take reasonable action to summon care as required under

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Section 845.6. 

With respect to the “Hibicleanse” poisoning incident, the SAC alleges that after

vomiting, Plaintiff was escorted to a medical unit where he was seen by medical staff. 

[Id. at 12.] Because Andrade alleges he was taken to the medical unit and seen by a

L.V.N or R.N., no facts are alleged in the SAC that would state a claim under Section

845.6 for failure to take reasonable action to summon medical care as to Andrade’s

accidental ingestion of Hibicleanse. Therefore, IT IS RECOMMENDED that

Defendants’ Motion to Dismiss Plaintiff’s Second Amended Complaint for failing to

state a claim under California Government Code § 845.6 be GRANTED.

V. CONCLUSION

This report and recommendation of the undersigned Magistrate Judge is submitted

to the United States District Judge assigned to this case, pursuant to the provision of 28

U.S.C. section 636(b)(1). For the reasons set forth above, it is RECOMMENDED that:

1) Defendants’ Motion to Dismiss for failure to state a claim against Mike

Barletta pursuant to FED.R.CIV.P. 12(b)(6) be GRANTED;

2) Defendants’ Motion to Dismiss for failure to state a claim of municipal

liability against the County with respect to the informed consent policy and

detoxification policy be GRANTED; and

3) Defendants’ Motion to Dismiss for failure to state a claim under California

Government Code § 845.6 be GRANTED.

A pro se litigant must be given leave to amend his complaint unless it is absolutely

clear the deficiencies of the complaint cannot be cured by amendment. Lucas v. Dep’t of

Corr., 66 F.3d 245, 248 (9th Cir. 1995). “Under Ninth Circuit case law, district courts are

only required to grant leave to amend if a complaint can possibly be saved. Courts are

not required to grant leave to amend if a complaint lacks merit entirely.” Lopez v. Smith,

203 F.3d 1122, 1129 (9th Cir.2000). Because Plaintiff has twice had the opportunity to

amend his claims for deliberate indifference, and cannot cure the deficiencies in his

complaint, IT IS FURTHER RECOMMENDED that no leave be given to file a third

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amended complaint.

IT IS ORDERED that no later than September 8, 2015, 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.” 

IT IS FURTHER ORDERED that any reply to the objections shall be filed with

the Court and served on all parties no later than September 22, 2015. The parties are

advised that failure to file objections within the specified time may waive the right to

raise those objections on appeal of the Court’s order. See Turner v. Duncan, 158 F.3d

449, 455 (9th Cir. 1998).

DATED: August 18, 2015

Hon. Bernard G. Skomal

U.S. Magistrate Judge

United States District Court

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