Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_16-cv-00562/USCOURTS-caed-1_16-cv-00562-1/pdf.json

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

---

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

JERARDO BARRIOS,

Plaintiff,

vs.

HAROLD TATE, M.D., et al.,

Defendants.

Case No. 1:16-cv-00562-RRB

DISMISSAL ORDER

Jerardo Barrios, a California state prisoner appearing pro se and in forma pauperis,

brings this civil rights action under 42 U.S.C. § 1983 against Harold Tate, M.D.1 Barrios’

claim arises out of his incarceration in the Special Housing Unit (“SHU”) at the California

Correctional Institution–Tehachapi(“CCI”).Barrios is currently incarcerated at the Calipatria

State Prison. 

I. SCREENING REQUIREMENT

This Court is required to screen complaints brought by prisoners seeking relief

against a governmental entity or officer or employee of a governmental entity.

2 This Court

must dismiss a complaint or portion thereof if the prisoner has raised claims that are legally

“frivolous or malicious,” that “fails to state a claim on which relief may be granted,” or that

1

 In addition to Dr. Tate, Barrios names as Defendants in this action: S. Shiesha,

M.D., Chief Medical Executive CCI; V. Baniga, M.D., Chief Physician & Surgeon CCI; and

J. Lewis, Deputy Director Policy & Risk Management Services, California Health Care

Services.

2

 28 U.S.C. § 1915A(a).

DISMISSAL ORDER

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Case 1:16-cv-00562-RRB Document 10 Filed 06/24/16 Page 1 of 17
“seeks monetary relief against a defendant who is immune from such relief.”3 Likewise, a

prisoner must exhaust all administrative remedies as may be available,4irrespective of

whether those administrative remedies provide for monetary relief.

5

In determining whether a complaint states a claim, the Court looks to the pleading

standard under Federal Rule of Civil Procedure 8(a). Under Rule 8(a), a complaint must

contain “a short and plain statement of the claim showing that the pleader is entitled to

relief.”6“[T]he pleading standard Rule 8 announces does not require ‘detailed factual

allegations,’ but it demands more than an unadorned, the-defendant-unlawfully-harmed-me

accusation.”7 Failure to state a claim under § 1915A incorporates the familiar standard

applied in Federal Rule of Civil Procedure 12(b)(6), including the rule that complaints filed

by pro se prisoners are to be liberally construed, affording the prisoner the benefit of any

doubt, and dismissal should be granted only where it appears beyond doubt that the

plaintiff can plead no facts in support of his claim that would entitle him or her to relief.

8

This requires the presentation of factual allegations sufficient to state a plausible claim for

3 28 U.S.C. § 1915(e)(2)(B); 42 U.S.C. § 1997e(c); see Lopez v. Smith, 203 F.3d

1122, 1126 & n.7 (9th Cir. 2000) (en banc).

4

42 U.S.C. § 1997e(a); see Woodford v. Ngo, 548 U.S. 81, 93–95 (2006) (“proper

exhaustion” under § 1997e(a) is mandatory and requires proper adherence to

administrative procedural rules); Booth v. Churner, 532 U.S. 731, 741 (2001) (exhaustion

of administrative remedies must be completed before filing suit).

5

 See Booth, 532 U.S. at 734.

6

 Fed. R. Civ. P. 8(a)(2).

7 Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atlantic Corp. v.

Twombly, 550 U.S. 554, 555 (2007)).

8

 Wilhelm v. Rotham, 680 F.3d 1113, 1121 (9th Cir. 2012).

DISMISSAL ORDER

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Case 1:16-cv-00562-RRB Document 10 Filed 06/24/16 Page 2 of 17
relief.

9

“[A] complaint [that] pleads facts that are ‘merely consistent with’ a defendant’s

liability . . . ‘stops short of the line between possibility and plausibility of entitlement to

relief.’”10 Further, although a court must accept as true all factual allegations contained in

a complaint, a court need not accept a plaintiff’s legal conclusions as true.11“Threadbare

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

do not suffice.”12 

II. GRAVAMEN OF COMPLAINT

July 2, 2014. While housed in the SHU at CCI Barrios injured his right knee, ankle,

and foot in a fall. 

July 10, 2014: Barrios submitted a health care request.

July 11, 2014. Dr. Tate ordered x-rays of the ankle and foot, but no x-rays were

taken of the knee. The x-rays were reviewed and found “no acute fracture or dislocation.”13

At the request of Barrios examined Barrios’ knee. Dr. Tate then prescribed ibuprofen for

the pain and sent Barrios back to his housing unit.

July 15, 2014. Dr. Tate diagnosed Barrios with: (1) possible ligament derangement

of right foot; and (2) right knee strain. In the Progress Notes Dr. Tate noted:

Extremities: moderate swelling of the right foot and lower Leg without heat; there is

moderate bruising of the right great toe and along the medial right foot from the right

9

Iqbal, 556 U.S. at 678–79; see Moss v. U.S. Secret Service, 572 F.3d 962, 969

(9th Cir. 2009) (quoting and applying Iqbal and Twombly). 

10

 Iqbal 556 U.S. at 678 (quoting Twombly, 550 U.S. at 557). 

11

 Id.

12

 Id. (quoting Twombly, 550 U.S. at 555).

13

 Complaint, p. 21 (Exh. B). This report was signed by R. Waters, MD.

DISMISSAL ORDER

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toe through the mid· foot; flexion of the right knee is from 15° of flexion to 100° of

flexion; the right knee could not be adequately examined because the inmate could

/would not relax his thigh muscles; there was no obvious right knee effusion or

ligamentous laxity

11 11 Jul '14: X·ray pf the right foot shows no acute fractures

Dr. Tate prescribed:

1. Repeat x-ray of right foot

2. Continue naproxen 250 mg BIO

3. Inmate counseled to elevate right foot as much as possible while in the cell

4. Will cast the foot if no improvement this week

5. Lower bunk

6. RTC 7 to 10 days

14

July 24, 2014. Dr. Tate diagnosed Barrios with: (1) possible ligament derangement

of right foot; (2) right knee strain; and (3) tinea pedis mocassin type. Dr. Tate noted:

Extremities: there is mild-to-moderate erythema of the right lower extremity from

the knee downwards without heat; mild tinea pedis mocassin type is present; mild

edema is present over the dorsal right foot halfway up the leg

Right Knee: patient tenses the knee flexors and extensors so that range of motion

cannot be determined; Patellar Grinding, Lachman's and McMurrray's Tests are all

negative; there is moderate laxity of the femoro-tibial and femoro-fibular ligaments

Right Ankle: there is no heat in the joint; Drawer Test is negative; ankle flexion,

extension, inversion and eversion are all WNL

X-ray of the right foot and ankle are without bony abnormality

Dr. Tate prescribed:

1. A 7243 RFS is submitted for MRI of the right ankle (lnterQual consulted)

2. Add ranitidine 150 mg BID for GI protection

3. Continue elevation and non-weight-bearing as much as possible ,

4. Clotrimazole 1% Topical Cream BID

5. RTC 15 to 30 days

15

14

 Complaint, p. 50 (Exh. I).

15

 Id., p. 51.

DISMISSAL ORDER

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August 13, 2014. Dr. Tate diagnosed: (1) possible ligament derangement of the

right foot; (2) right knee strain; and (3) tinea pedis mocassin type. Dr. Tate noted:

Extremities: there is mild erythema of the right lower extremity from the knee

downwards without heat; mild tinea pedis mocassin type is present; slight edema

is present over the dorsal right foot halfway up the leg Right Knee: patient tenses

the knee extensors so that range of motion cannot be determined; Patellar Grinding,

Lachman's and McMurrray's Tests are all negative; there is mild laxity of the femorotibial ligament Right Ankle: there is no. heat in the joint; Drawer Test is negative;

ankle flexion, extension, inversion and eversion are all WNL

11 Jul '14 & 15 Jul '14: X·rays of the right foot and ankle are without bony

abnormality

In Part A Dr. Tate stated:

1. Appellant's request to be assigned to another doctor is beyond the scope of a

602 Appeal and is DENIED

2. Appellant's request for an MRI of both the right foot and ankle is medically

unnecessary since the femoro· fibular ligament appears to have markedly improved;

an MRI of the right ankle was requested by RFS on 24 Jul '14 and thus Appellant's

request for an MRI is PARTIALLY GRANTED

3. Appellant's request for stronger pain medication is GRANTED in that the dose

of naproxen will be doubled from 250 mg to 500 mg BID 

4. Possible ligament derangement of the right foot

5. Right Knee Strain 

6 Tinea Pedis Mocassin Type

Dr. Tate concluded:

1. This Appeal is PARTIALLY GRANTED at the First Level of Review

2. Await processing of the 7243 RFS

3. Continue elevation and.non·weight·bearing as much as possible

4. Refer Appellant for Physical Therapy for strengthening and gait training

5. RTC 30 to 45 days

16

August 14, 2014. Dr. Baniga responded to Barrios CDCR-602HC Inmate/Parolee 

Health Care Appeal at the first level.

16

 Id., p. 52 (Exh I).

DISMISSAL ORDER

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Case 1:16-cv-00562-RRB Document 10 Filed 06/24/16 Page 5 of 17
The First Level Appeal, received on 7/31/2014 stated that you have seen the

doctor regarding pain in your knee, ankle, and foot. You stated that the

doctor focused on your foot only and your knee and ankle are still in severe

pain. You also stated you were never called for a follow up appointment and

your knee and ankle are still in excruciating pain. You requested to be

assigned to a different Doctor, to have an MRI of your knee and ankle, and

to be prescribed stronger pain medication.

During the interview you attended on 08/13/2014, your Primary Care

Provider (PCP) thoroughly reviewed your case history and performed an

assessment of your medical condition. Based on the results, your PCP noted

that inmates are assigned their provider based on CDC number and housing

in accordance with policy; as such, your request for a different provider is

denied. It is noted that an MRI of both your knee and ankle are medically

unnecessary however an MRI for your ankle was requested by referral on

07/24/2014; partially granting your request. Your prescription for naproxen

will be doubled for 250 mg to 500 mg; granting your request for stronger pain

medication.17

August 22, 2014. Barrios’ knee was x-rayed, which x-ray found:

FINDINGS:

Fragmentation Involves the medial tibial plateau consistent with old tibial plateau

fracture.

No acute fracture or joint effusion.

Joint spacing Is preserved.

IMPRESSION:

Old medial tibial plateau fracture.18

September 3, 2014. An MRI was performed on Barrios’ right knee, which found:

FINDINGS: An old medial tibial plateau fracture is present with nonunion. An

associated tear of the posterior horn of the medial meniscus is present.

Moderate degenerative changes are present within the medial compartment with

diffuse cartilage loss. ·

The lateral meniscus appears intact.

The anterior cruciate, posterior cruciate, medial collateral, lateral collateral, and

patellar ligaments appear intact. The visualized portion of the quadriceps tendon is

unremarkable.

17

 Complaint, p. 26 (Exh. C). 

18

 Complaint, p. 31 (Exh. D). Report electronically signed by R. Waters MD.

DISMISSAL ORDER

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Case 1:16-cv-00562-RRB Document 10 Filed 06/24/16 Page 6 of 17
Mild chondromalacia is present at the patellofemoral joint. The signal within the

visualized marrow appears to be within normal limits.

No joint effusion or popliteal cyst is seen.

IMPRESSION:

1. Old fracture of the medial tibial plateau with nonunion.

2. Tear of the posterior horn of the medial meniscus.

3. Moderate degenerative changes within the medial compartment.19

September 4, 2014. Dr. Shiesha responded to Barrios CDCR-602HC

Inmate/Parolee Health Care Appeal at the second level.

The First Level Appeal, received on 7/31/2014, stated that you have seen the

doctor regarding pain in your knee, ankle, and foot. You stated that the

doctor focused on your foot only and your knee and ankle are still in severe

pain. You also stated you were never called for a follow up appointment and

your knee and ankle are still in excruciating pain. You requested to be

assigned to a different doctor, to have an MRI of your knee and ankle, and

to be prescribed stronger pain medication.

During the interview you attended on 08/13/2014, your Primary Care

Provider (PCP) thoroughly reviewed your case history and performed an

assessment or your medical condition. Based on the results, your PCP noted

that inmates are assigned their provider based on CDC number and housing

in accordance with policy; as such, your request for a different provider is

denied. lt is noted that an MRI of both your knee and ankle are medically

unnecessary; however, an MRI for your ankle was requested by referral on

07/24/2014; partially granting your request. Your prescription for naproxcn

will be doubled for 250 mg to 500 mg; granting your request for stronger pain

medication.

At the First Level of Review this appeal was Partially Granted.

In the Second Level Appeal, received on 9/4/2014, you stated that you are

satisfied with the approval for an MRI on your ankle/foot; however, you are

dissatisfied with the denial of an MRI on your knee. You stated that your

knee is very much in pain and if your request had been accepted by your

doctor you could have had an MRI on your knee when the MRI was done on

your ankle/foot. You stated that now you will have to wait to get another MRI

and the pain medication does not do much for the pain but you would rather

take it than nothing.

Your issues were carefully reviewed at the Second Level; however, no new

information was presented which warrants modification of the First Level

Appeal Decision. The CCR, Title 15, Section 3350(a) establishes that the

19

 Id., p. 33. Report electronically signed by D. Goller MD.

DISMISSAL ORDER

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Case 1:16-cv-00562-RRB Document 10 Filed 06/24/16 Page 7 of 17
Department shall provide medical services for inmates based on medical

necessity, supported by outcome data and based on the judgment or the

physician. You may not demand particular medication, diagnostic evaluation,

or course of treatment. The CCR, Title 5, Section 3354 Health Care

Responsibilities and Limitation, (a) Authorized Staff, states, "Only facilityemployed health care staff, contractors paid lo perform health services for

the facility, or persons employed as health care consultants shall be

permitted within the scope of their licensure to diagnose illness or prescribe

medication and health care treatment for inmates. No other personnel or

inmate may do so." You have been seen and treated as deemed appropriate

by your PCP for your current medical conditions. You will continue to receive

proper treatment. Should your treatment regimen be modified-to include

further diagnostics or medication changes-it will he done at the discretion of

your provider based on outcome data and Department policy. Should you

need to be seen prior to your next scheduled appointment, you may submit

a CDCR 7362 Health Care Services Request Form to medical staff.

20

September 17, 2014. Dr. Tate diagnosed: (1) an old fracture of the right tibia;

(2) sprain of the right knee and foot; and (3) tinea Pedis Mocassin type. In the Progress

Note Dr. Tate noted:

Extremities: there is no heat, redness or swelling of the right lower extremity;

range of movement is full extension to 100' of flexion; the femoro·tibial

ligament is mildly lax with mild tenderness to palpation; all other ligaments

are intact; there is no effusion

Right Ankle: there is no heat; Drawer Test is negative; ankle flexion,

extension, inversion and eversion are all WNL 

03 Sep '14: MRI of the Right Knee shows and [sic] old fracture of the medial

tibial plateau with non-union, a tear of the posterior horn of the medial

meniscus, and moderate degenerative changes of the medial compartment

MRI of the Right Foot &. Ankle is not on file in the eUHR

In Part A Dr. Tate stated:

1. Appellant's request for results of an MRI of his right foot is DEFERRED

until the result is filed, but will be GRANTED 

2. Appellant's request for Orthopedic referral and management Is not

medically necessary and is DENIED since surgical intervention does not

appear warranted for an old injury

20

 Complaint, pp. 27-28 (Exh. C).

DISMISSAL ORDER

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3. Appellant's request for reassignment to another Primary Care Physician

is beyond the scope of a 602 Medical Appeal and is DENIED since inmates

cannot choose their own physicians

4. Appellant's request for adjustment of his pain medications is GRANTED

in that oxcarbazeptne 300 mg BID will be added to ibuprofen

5. Appellant's request for "proper" treatment of his musculoskeletal injuries

is GRANTED since he is and has been under a Physician's supervision since

his injury

6. Appellant's request for a knee brace is medically unnecessary since

"most braces of elastic or leather with hinges are of little value" (Practical

Orthopedics, Fourth Edition, Mosby Publishing, 1995; pg 218, Fig 11-17)

7. Old Fracture of the Right Medial Tibial Plateau with Non-Union and

Degenerative Changes

8. Right Medial Meniscus Tear

9. Right Foot Sprain

10. Tinea Pedis Mocassin Type

Dr. Tate then concluded:

1. This Appeal is PARTIALLY GRANTED at the First Level of Review

2. Continue ibuprofen 400 mg TIO PRN and add oxcarbazepine 300 mg BID

for pain management

3. Await report of MRI of right ankle

4. Physical Therapy referral

5. RTC 60 - 90 days

21

September 28, 2014. Barrios was transferred to Pelican Bay State Prison.

April 21, 2015. By correspondence to the Third Level of Review Barrios submitted

a request that he be permitted to file his appeal from the Second Level Decision untimely.

22

Although shown as received by the Health Care Appeals Board on July 3, 2015, it does not

appear from the documents attached to the Complaint what action, if any, was taken on 

Barrios’ request. However, as noted above, Barrios does affirmatively allege it was denied.

21

 Complaint, pp. 34–35 (Exh. D).

22

 Complaint, p. 29 (Exh. C). 

DISMISSAL ORDER

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After his transfer to Pelican Bay Barrios was seen by an orthopedic specialist who

performed a partial knee replacement on June 10, 2015. Barrios alleges that, although

after his surgery his pain diminished, his mobility is still impaired as he is unable to do a

complete squat. Barrios contends that this continued impairment is as a result of

Dr. Tate’s failure to properly diagnose the fracture of Barrios’ knee. Barrios contends that

the actions of the Defendants constituted deliberate indifference to his serious medical

needs in violation of the Eighth Amendment right to be free from cruel and unusual

punishment.

III. DISCUSSION

The Supreme Court, holding that the infliction of unnecessary suffering on prisoners

violated the Eighth Amendment, stated:

[D]eliberate indifference to serious medical needs of prisoners constitutes

the unnecessary and wanton infliction of pain proscribed by the Eighth

Amendment. This is true whether the indifference is manifested by prison

doctors in their response to the prisoner’s needs or by prison guards in

intentionally denying or delaying access to medical care or intentionally

interfering with the treatment once prescribed. Regardless of how evidenced,

deliberate indifference to a prisoner’s serious illness or injury states a cause

of action under § 1983.23

In Estelle the Supreme Court distinguished “deliberate indifference to serious medical

needs of prisoners,” from “negligen[ce] in diagnosing or treating a medical condition,”

23 Estelle v. Gamble, 429 U.S. 97, 104–105 (1976) (footnotes, internal quotation

marks and citations omitted).

DISMISSAL ORDER

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holding that only the former violates the Constitution.24

In short, Eighth Amendment liability

requires “more than ordinary lack of due care for the prisoner's interests or safety.”25

In determining deliberate indifference, the court scrutinizes the particular facts and

looks for substantial indifference in the individual case, indicating more than mere

negligence or isolated occurrences of neglect.26 The Ninth Circuit has spoken to the subject

of the appropriate test under Estelle:

In the Ninth Circuit, the test for deliberate indifference consists of two parts. 

First, the plaintiff must show a serious medical need by demonstrating that

failure to treat a prisoner’s condition could result in further significant injury

or the unnecessary and wanton infliction of pain. Second, the plaintiff must

show the defendant’s response to the need was deliberately indifferent. 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 a prisoner’s pain or possible medical need and (b) harm caused by the

indifference. Indifference may appear when prison officials deny, delay or

intentionally interfere with medical treatment, or it may be shown by the way

in which prison physicians provide medical care. Yet, an inadvertent [or

negligent] failure to provide adequate medical care alone does not state a

claim under § 1983. A prisoner need not show his harm was substantial;

however, such would provide additional support for the inmate’s claim that

the defendant was deliberately indifferent to his needs. If the harm is an

isolated exception to the defendant’s overall treatment of the prisoner [it]

ordinarily militates against a finding of deliberate indifference.27

A defendant must purposely ignore or fail to respond to a prisoner’s pain or medical

need in order for deliberate indifference to be established. Where the claim is based upon

24

 Id. at 106. 

25

 Whitley v. Albers, 475 U.S. 312, 319 (1986).

26

 Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990). 

27

Jett v. Penner, 429 F.3d 1091, 1096 (9th Cir. 2006) (alterations in the original;

internal quotation marks and citations omitted).

DISMISSAL ORDER

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delay in providing a specified treatment, a prisoner has no claim for deliberate medical

indifference unless the delay was harmful.28

To make a claim, Plaintiff must show that Defendants exhibited “deliberate

indifference to serious medical needs.”29 Such a showing is sufficient to demonstrate the

“unnecessary and wanton infliction of pain proscribed by the Eighth Amendment.”30 The

Constitution “does not necessitate comfortable prisons,”31nor is the Eighth Amendment a

mandate for “broad prison reform” or excessive federal judicial involvement.32 However,

the Eighth Amendment does not permit inhumane conditions, and prison conditions are

subject to scrutiny under its provisions.33

“Deliberate indifference is a high legal standard. A showing of medical malpractice

or negligence is insufficient to establish a constitutional deprivation under the Eighth

28 McGuckin v. Smith, 974 F.2d 1050, 1060 (9th Cir. 1992), overruled on other

grounds, WMX Technologies, Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc).

29

 Estelle v. Gamble, 429 U.S. 97, 105 (1976). 

30

Id. at 104 (quoting Gregg v. Georgia, 428 U.S. 153, 173 (1976)) (internal

quotation marks and citation omitted)). 

31 Farmer v. Brennan, 511 U.S. 825, 832 (1994) (quoting Rhodes v. Chapman, 452

U.S. 337, 349 (1981))

32 Hoptowit v. Ray, 682 F.2d 1237, 1246 (9th Cir. 1982) (abrogated on other

grounds by Sandlin v. O’Connor, 515 U.S. 472 (1995)).

33

 Farmer, 511 U.S. at 832.

DISMISSAL ORDER

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Amendment.”34 A mere difference of medical opinion regarding the course of medical

treatment is “insufficient as a matter of law, to establish deliberate indifference.”35 

As against Drs. Baniga and Shiesha the Court’s review of the record indicates that

the relief Barrios requested, an MRI on his knee, was granted on September 3, 2014. 

How, either Dr. Baniga or Dr. Shiesha somehow disregarded Barrios’ serious medical

needs escape logical explanation. With respect to J. Lewis, Barrios simply alleges that he

denied Barrios’ serious medical needs. The Court assumes that this was the Third Level

appeal. Accordingly, it suffers the same infirmity as do the allegations against the doctors. 

Therefore, the Complaint as against them must be dismissed for failure to state a claim

upon which relief may be granted.

The allegations against Dr. Tate stand on a different footing. Specifically, Barrios

contends that he was told by Dr. Tate that: 

[. . .] I had an “old fracture” on my tibia and a tear on my meniscus and

some loose fragments. This information is to be true, Dr. Tate even went as

far as to convince plaintiff that fracture happened years past, even asked

questions about if I ever broken my tibia which he insinuated it happened

many years ago. Plaintiff mentioned to Dr. Tate that the fracture looks old

because he (Dr. Tate) ignored plaintiff many requests and took so long to xray and MRI plaintiff right knee and since then had healed. Plaintiff was

34 Toguchi v. Chung, 391 F. 3d 1051, 1060 (9th Cir. 2004); see Hallett v. Morgan,

296 F.3d 732, 744 (9th Cir. 2002); see also Wood v. Housewright, 900 F.2d 1332, 1334

(9th Cir. 1990) (stating that even gross negligence is insufficient to establish a

constitutional violation); Broughton v. Cutter Labs., 622 F.2d 458, 460 (9th Cir. 1980) (per

curiam) (noting mere indifference, medical malpractice, or negligence do not support a

cause of action under the Eighth Amendment).

35 Toguchi, 391 F.3d at 1059–60 (citing Jackson v. McIntosh, 90 F.3d 330, 332 (9th

Cir. 1996)); Franklin v. State of Oregon, State Welfare Div., 662 F.2d 1337, 1344 (9th Cir.

1981) (noting, also, that a disagreement between a prisoner and a medical professional

over the most appropriate course of treatment cannot give rise to a viable claim of

deliberate indifference).

DISMISSAL ORDER

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Case 1:16-cv-00562-RRB Document 10 Filed 06/24/16 Page 13 of 17
never informed that the fracture did not heal properly or extent of damage

caused by Dr. Tate inadequate medical care.36

It is clear from the Complaint taken as a whole that, in advising Barrios concerning

the nature of the injury to Barrios’ knee, Dr. Tate was referring to the September 3 MRI

report authored by Dr. Goller that, as relevant to the Complaint, specifically found an “[o]ld

fracture of the of the medial tibial plateau with nonunion” and “moderate degenerative

changes within the medial compartment.”37 Dr. Tate’s reliance upon the radiologist’s report 

clearly does not rise to the level of deliberate indifference. Furthermore, other than his bare

conclusory allegation, Barrios has failed to allege that the current limitations on his mobility

are in any way related to a failure to properly diagnosis a fracture, even if such failure did

in fact occur. Indeed, the very exhibits upon which Barrios relies eviscerate his claims.

On January 7, 2015, Barrios was seen by telemedicine by Richard Cross, M.D. In

his report, Dr. Cross stated:

On examination via telemedicine it is obvious that this knee has an effusion

and he has pain with flexion max beyond 120 degrees. I am not able to test

his cruciate or collateral ligaments obviously via telemedicine but there is

obvious evidence of internal derangement in the form of a chronic effusion

which needs to he evaluated more thoroughly. Therefore, I will recommend

and request a standard MRI study of this left knee looking for internal

derangement.38

A MRI was conducted on March 2, 2015, which, as relevant to this action, showed: 

“Focal avulsion fracture is identified the medial tibial plateau, with slight medial

36

 Complaint, ¶ 14, pp. 12–13.

37

 Complaint, p. 33 (Exh. D). Report electronically signed by D. Goller MD.

38

 Complaint, p. 43 (Exh. G). Electronically signed by Richard Cross M.D.

DISMISSAL ORDER

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displacement. Edema at the medial tibial plateau consistent with contusion/non-displaced

fracture.”39 On March 23, after reviewing the MRI Report, Dr. Cross reported:

The MRI reveals significant degenerative joint disease isolating primarily to

his medial compartment. On telemedicine conference it was evident that his

pain was at least 90% isolated at the medial compartment. He had mild

varus deformity and no significant flexation contracture. He appears to have

stable exam. MRI shows cruciate and collateral ligaments intact. After

evaluating this patient it appears as though he is an excellent candidate for

partial knee replacement and therefore we will respectfully request

authorization for this surgery.

40

As noted above, Barrios received this surgery on June 10, 2015. Notably, nothing

in Dr. Cross’s report refers directly, indirectly, or even inferentially, to the alleged “fracture”

of the knee cap. As relevant to the Complaint, the difference is with respect to the degree

of the degenerative changes of the medial compartment—deemed “moderate” by

Dr. Goller (accepted by Dr. Tate), but “significant” by Dr. Cross. In short, the sole logical

conclusion that a trier of fact could reach on the evidence pleaded is that Barrios’

continued impairment is as a result of a degenerative condition, not an untreated fracture.

IV. CONCLUSION/ORDER

Taken as a whole and in proper context, Barrios’ allegations against Dr. Tate more

likely than not do not even rise to the level of medical malpractice, let alone deliberate

indifference. Section 1983 does not provide a cause of action for medical malpractice

claims.41 Thus, even if Dr. Tate’s “error” did rise to the level of medical malpractice, it would

39

 Id., p. 45 (Exh. G). Signed by Martin Kernberg, MD.

40

 Id., p. 47 (Exh. G).

41

Loftis v. Almagar, 704 F.3d 645, 647 (9th Cir. 2012) (citing Estelle v. McGuire,

502 U.S. 62, 67 (1991)).

DISMISSAL ORDER

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constitute a violation of state, not Federal, law. To the extent that Barrios may plead a

claim under California law, the Court declines to exercise jurisdiction over such a claim.

42

Therefore, the Complaint is hereby DISMISSED in its entirety as against all

Defendants. Normally, the Court would grant Plaintiff leave to file an amended complaint. 

In this case it is plainly evident that Barrrios cannot truthfully plead a viable cause of action

under Federal law based upon the medical treatment received while incarcerated at the

California Correctional Institution–Tehachapi. Accordingly, dismissal is without leave to

amend.43

This Court, having fully considered the matter finds that reasonable jurists could not

disagree with this Court’s resolution of Plaintiff’s constitutional claims or that jurists could

conclude the issues presented are adequate to deserve encouragement to proceed further. 

Therefore, any appeal would be frivolous or taken in bad faith.44 Plaintiff’s in forma

pauperis status is hereby REVOKED.

42

“The district courts may decline to exercise supplemental jurisdiction over a claim

under subsection (a) if— . . . (3) the district court has dismissed all claims over which it has

original jurisdiction . . ..” 28 U.S.C. § 1367(c).

43 See Hartman v. California Dept. of Corr. and Rehab., 707 F.3d 1141, 1130 (9th

Cir. 2013) (“A district court may deny leave to amend when amendment would be futile.”);

Lopez v. Smith, 203 F.3d 1122, 1130–31 (9th Cir. 2000) (en banc) (explaining that leave

to amend should be given unless amendment would be futile).

44

28 U.S.C. § 1915(a)(3); see Hooker v. American Airlines, 302 F.3d 1091, 1092

(9th Cir. 2002).

DISMISSAL ORDER

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The Clerk of the Court is directed to enter judgment of dismissal without prejudice

to bringing an action under otherwise applicable state law in the appropriate California

state court.

IT IS SO ORDERED this 24th day of June, 2016.

S/ RALPH R. BEISTLINE

UNITED STATES DISTRICT JUDGE

DISMISSAL ORDER

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