Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_16-cv-01783/USCOURTS-casd-3_16-cv-01783-0/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

Richard Blanchard,

Plaintiff,

 v.

County of San Diego, et al.,

Defendants.

Case No.: 16-cv-1783-BAS-AGS

REPORT AND RECOMMENDATION 

ON DEFENDANTS’ MOTIONS TO 

DISMISS (ECF Nos. 31, 50, 52, 59) 

AND ON THE COUNTY’S MOTION 

TO STRIKE SECOND AMENDED 

COMPLAINT (ECF No. 35)

Plaintiff sued prison doctors and others for ignoring his arthritis and injured knee, 

and actively thwarting his attempts to see the required medical specialists. Defendants 

move to dismiss. The main issue is whether the facts plaintiff alleges—which must be 

presumed true at this stage—sufficiently establish an Eighth Amendment violation. 

I

BACKGROUND

Plaintiff Richard Blanchard claims that while he was an inmate at certain San Diego 

County detention and reentry facilities, the County and its contract medical provider, 

Global Medical Staffing, Inc., had a “policy or custom of restricting, if not outright denying 

referrals to specialists when such care is expensive.” (ECF No. 30, at 2, 23.) For example, 

on September 2, 2015, Blanchard saw defendant Dr. John Gill about his rheumatoid 

arthritis and torn meniscus, which required rheumatology and orthopedic consults, 

respectively. According to Blanchard, Dr. Gill acknowledged that Blanchard required 

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“more advance[d] medications” to relieve his arthritis, which could only be obtained from 

a rheumatology specialist. But when Blanchard asked for a referral, he alleges that Dr. Gill 

replied, “You will need to wait until you’re released [11 months later]. The Sheriff’s 

department will not pay for a specialist.” (ECF No. 30, at 5-6.) And when Blanchard 

inquired if he could pay for his own orthopedic specialist to examine his injured knee, 

Dr. Gill purportedly responded, “The San Diego Sheriff’s [Department] would not pay for 

transport and security[.]” (Id. at 6.)

This discouraging appointment prompted Blanchard to engage in fruitless attempts

to hire his own specialists, which he asserts delayed him from finally obtaining statefunded specialist referrals. (See id. at 6-11.) On December 3, 2015—three months after his 

first request to Dr. Gill—prison officials finally arranged for Blanchard to see a 

rheumatologist, and exactly one week later he saw an orthopedic specialist. (Id. at 14-15.)

But it appears his arthritic pain was not sufficiently alleviated until at least June 28, 2016, 

when the rheumatologist increased his medication dosage. (Id. at 21.)

A similar scenario unfolded at the same time with defendant Dr. Cynthia KlinePurviance.

1 On October 27, 2015, Blanchard asked her for an orthopedic referral due to 

“repeated issues related to the torn meniscus,” including “swelling, pain and difficulty 

walking.” (ECF No. 30, at 10.) He asserts that she, too, responded that the “Sheriff’s 

Department would not approve an orthopedic referral[.]” (Id.) As with Dr. Gill, Blanchard 

then discussed the possibility of hiring a private specialist, and Dr. Purviance allegedly 

advised him to “speak to [the] watch commander for arrangement[s].” (Id.) More than six 

weeks after this medical visit, Blanchard finally secured his first appointment with a statefunded orthopedic specialist. (Id. at 15.) And on May 18, 2016, his meniscus was surgically 

repaired. (Id. at 20.)

 

1 The parties appear to refer to defendant Cynthia Kline-Purviance, M.D., as 

“Dr. Purviance.” (See ECF No. 30, at 3; ECF No. 52, at 7.) So, the Court will generally 

refer to her this way as well.

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During the delay before he saw these specialists, Blanchard contends that he suffered 

“debilitating pain,” which made it so difficult to walk that he sometimes required a 

wheelchair. (ECF No. 30, at 11, 13, 15.) For instance, on December 7, 2015, he asserts that 

he “went ‘Man Down’ due to shaking, extreme joint pain in all extremities, extreme fatigue 

and nausea and was taken to medical in a wheelchair[.]” (Id. at 15.) By the next month, he 

claims that he was “distraught and hopeless over the daily pain, suffering and inability to 

have his medical needs addressed.” (Id. at 17.)

Based on these asserted hardships, Blanchard ultimately sued the County of 

San Diego, Global Medical Staffing, Dr. Gill, Dr. Purviance, and other doctors and officials 

for violating his Eighth Amendment rights by denying and frustrating his access to 

necessary medical care. He also accuses most of these defendants of medical malpractice.

II

COUNTY’S MOTION TO STRIKE THE SECOND AMENDED COMPLAINT

The County moves to strike the second amended complaint for being filed without 

proper permission. Within certain time limits, plaintiffs may amend their complaints once 

as a matter of course, as Blanchard did here with his first amended complaint. See Fed. R. 

Civ. P. 15(a)(1); (ECF Nos. 1, 30). But any additional amendments require “the opposing 

party’s written consent or the court’s leave.” Fed. R. Civ. P. 15(a)(2); see also id., Adv. 

Comm. Notes, 2009 amend. (“The 21-day periods to amend once as a matter of course after 

service of a responsive pleading or after service of a designated motion are not 

cumulative.”). The County never gave written consent, and Blanchard failed to seek this 

Court’s approval to file a second amended complaint. Thus, the County’s motion to strike 

should be granted, leaving Blanchard’s properly-filed first amended complaint as the 

operative pleading.

This ruling has no effect whatsoever on the analysis of the pending motions to 

dismiss, because the first and second amended complaints are nearly identical. Blanchard’s 

second amended complaint mainly added medical care he received since his release from 

prison. (Compare ECF No. 30, at 21-22, with ECF No. 33, at 23-24, ¶¶173-176.) The latest 

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amendments did not address any of the alleged defects identified in the defendants’ 

dismissal motions.

III

DEFENDANTS’ MOTIONS TO DISMISS

A. Legal Standard

To survive a motion to dismiss, a complaint must contain sufficient facts to “state a 

claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) 

(citation omitted); see also Fed. R. Civ. P. 12(b)(6). The reviewing court must accept “all 

factual allegations in the complaint as true and constru[e] them in the light most favorable 

to the nonmoving party.” Ebner v. Fresh, Inc., 838 F.3d 958, 962 (9th Cir. 2016) (citation 

omitted). But “‘naked assertions’ devoid of ‘further factual enhancement’” will not suffice. 

Iqbal, 556 U.S. at 678 (citation omitted).

Pro se pleadings demand an especially charitable interpretation, but the court “may 

not supply essential elements of the claim that were not initially pled. Vague and 

conclusory allegations of official participation in civil rights violations are not sufficient to 

withstand a motion to dismiss.” Ivey v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 

268 (9th Cir. 1982) (citations omitted).

B. Color of State Law

As a threshold matter, several defendants—Dr. Gill, Dr. Purviance, Dr. Katherine 

Homann, and Global Medical Staffing, Inc.—move to dismiss on the ground that 

Blanchard failed to adequately allege that they acted under color of state law, as required 

to sustain a federal civil-rights action. (ECF No. 52, at 16-18); see Patel v. Kent School 

Dist., 648 F.3d 965, 971 (9th Cir. 2011) (“To succeed on a [42 U.S.C.] § 1983 claim, a 

plaintiff must show that . . . the conduct complained of was committed by a person acting 

under color of state law[.]” (citation omitted)). “[A] private physician employed by the 

state on a contract basis to provide medical services to inmates act[s] under color of state 

law when treating a prisoner’s injuries.” Florer v. Congregation Pidyon Shevuyim, N.A., 

639 F.3d 916, 925 (9th Cir. 2011) (citing West v. Atkins, 487 U.S. 42, 54 (1988)). Blanchard 

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alleges that the County contracts with Global Medical Staffing “to provide medical staffing 

a[t] the San Diego County Sheriff’s Dept[.],” and that these doctors are GMS employees

who treated him as part of that contract. (ECF No. 30, at 2-3.)

Under the extremely forgiving standard the Court must apply at this early stage, 

these pleadings sufficiently allege that the three doctors and GMS were acting under color 

of state law. See Rodriguez v. Plymouth Ambulance Serv., 577 F.3d 816, 827 (7th Cir. 

2009) (“[W]hen a person accepts employment with a private entity that contracts with the 

state [for medical services to inmates], he understands that he is accepting the responsibility 

to perform his duties in conformity with the Constitution.”); Maggio v. Shelton, No. 14-cv01682-SI, 2015 WL 5126567, at *6-7 (D. Or. Sept. 1, 2015) (collecting cases which hold 

that “private physicians and medical entities may be considered state actors for purposes 

of Section 1983 liability when a state has delegated its obligation to provide medical care 

for inmates to those private entities, even in the absence of a contract”). Defendants also 

contend that Blanchard’s allegations about their contractual relationships are simply wrong 

(see ECF No. 52, at 17-18), but that is an argument that must wait until summary judgment.

C. Constitutionally Inadequate Medical Care

The non-municipal defendants move to dismiss based on Blanchard’s failure to state 

an Eighth Amendment claim of constitutionally inadequate medical care. (ECF No. 50-1, 

at 3-5; ECF No. 52, at 11-16; ECF No. 59, at 5-6.) To state such a claim, a prisoner must 

sufficiently allege two elements: (1) “the existence of a serious medical need,” and (2) the 

prison official’s “deliberate indifference” to that need. Colwell v. Bannister, 763 F.3d 1060, 

1066 (9th Cir. 2014) (citations omitted).

1. Serious Medical Need

A serious medical need exists if, left untreated, it “‘could result in further significant 

injury’ or cause ‘the unnecessary and wanton infliction of pain.’” Colwell, 763 F.3d at 1066

(citations omitted). Thus, serious medical needs include ailments that “significantly affect[] 

an individual’s daily activities” or cause “chronic and substantial pain.” Id. (citation 

omitted). As discussed in the Background section above, Blanchard contends that he 

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suffered from rheumatoid arthritis and a torn meniscus that worsened into “debilitating 

pain” as his requests for rheumatology and orthopedic referrals were denied or delayed, 

sometimes requiring a wheelchair. (ECF No. 30, at 11, 13, 15.) Accepting all these facts as 

true—as the Court must—Blanchard has adequately alleged a serious medical need.

2. Deliberate Indifference

Deliberate indifference is a formidable standard. “[I]solated occurrences of neglect,” 

as well as “mere malpractice, or even gross negligence,” may be inexcusable, but they do 

not amount to deliberate indifference. Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 

1990) (citation omitted); see also Estelle v. Gamble, 429 U.S. 97, 106 (1976) (“Medical 

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

prisoner.”). Rather, deliberate indifference requires at least criminal recklessness; the 

prison official must “know[] of and disregard[] an excessive risk to inmate health or 

safety[.]” Farmer v. Brennan, 511 U.S. 825, 837, 839-40 (1994). The plaintiff “‘must show 

that the course of treatment the doctors chose was medically unacceptable under the 

circumstances’ and that the defendants ‘chose this course in conscious disregard of an 

excessive risk to the plaintiff’s health.’” Hamby v. Hammond, 821 F.3d 1085, 1092 

(9th Cir. 2016) (citations omitted). “[D]elaying access to medical care” can constitute 

deliberate indifference, Estelle, 429 U.S. at 104-05, but “the delay must have caused 

substantial harm.” Wood, 900 F.2d at 1335 (citation omitted). 

(a) Dr. Gill

Despite this high bar, Blanchard makes out a plausible deliberate-indifference case 

against Dr. Gill. Blanchard alleges that Dr. Gill told him that he would need to see a 

rheumatology specialist in order to get “more advance[d] medications” to relieve his 

arthritis. But when Blanchard asked for a referral, he claims that Dr. Gill responded, “You 

will need to wait until you’re released [11 months later]. The Sheriff’s department will not 

pay for a specialist.” (ECF No. 30, at 5-6.) In fact, this information was incorrect, as 

evidenced by the fact that—after months of delay and before his release—Blanchard 

eventually saw two specialists. (Id. at 14-15.) Perhaps Dr. Gill was mistaken. Or perhaps 

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he never said this, and Blanchard is mistaken. Those are questions for summary judgment 

or trial. At this stage, the pleadings sufficiently allege that Dr. Gill knew that Blanchard 

required a specialist’s treatment, refused to make the necessary referral, and provided 

affirmatively false information that delayed Blanchard from obtaining the advanced 

medications he required, causing substantial pain in the meantime. Alternatively, these 

allegations could support the conclusion that Dr. Gill was enforcing a policy or custom of 

discouraging specialist referrals, and that he did so based solely on financial concerns, not 

his medical judgment. Either way, viewed in the light most favorable to Blanchard, these 

facts support a finding of intentional or criminally reckless conduct. Thus, he states a claim 

and Dr. Gill’s motion to dismiss should be denied.

(b)Dr. Purviance

Blanchard accuses Dr. Purviance of similar misconduct, but regarding his orthopedic 

referral. He claims that he asked for such a referral because of “repeated issues related to 

the torn meniscus,” including “swelling, pain and difficulty walking.” (ECF No. 30, at 10.) 

But he states that Dr. Purviance refused under the false premise that the “Sheriff’s 

Department would not approve an orthopedic referral[.]” (Id.) The main difference between 

the facts alleged against Dr. Gill and Dr. Purviance is the length of delay. After Dr. Gill 

purportedly refused to make a rheumatology referral, it took three months before Blanchard 

saw a rheumatologist. (Id. at 5, 14.) But the delay was only six weeks between 

Dr. Purviance’s alleged refusal to make an orthopedic referral and Blanchard’s first 

orthopedic appointment. (Id. at 10, 15.) A six-week delay for an orthopedic referral may 

be reasonable, but the Court cannot resolve that factual dispute yet. Viewed in the light 

most favorable to Blanchard, these allegations support a finding that Dr. Purviance was 

deliberately indifferent in the same manner as Dr. Gill, and that her knowing disregard of 

Blanchard’s serious medical condition resulted in extra weeks of debilitating pain. So, 

Dr. Purviance’s motion to dismiss should be denied, but she too will have a later 

opportunity to contest these allegations.

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(c) Dr. Homann

It is unclear why Blanchard named Dr. Katherine Homann as a defendant. He states 

that on October 20, 2015, she “performed a thorough examination,” prescribed an antiinflammatory for his pain, and indicated that she had completed a rheumatology referral. 

(ECF No. 30, at 10.) On November 10, 2015, she again “performed a detail[ed] 

examination and explained that there was an RH [rheumatology] appointment scheduled 

in about one week and the orthopedic would be about 6 weeks.” (Id. at 11.) Blanchard does 

not allege that any of these statements were lies or that Dr. Homann did anything to delay 

his therapy; he merely contends that it took somewhat longer to see the specialists than she 

stated. Because Blanchard has not alleged that Dr. Homann knowingly delayed his 

treatment, her motion to dismiss the Eighth Amendment claim should be granted.

(d)Dr. Serra

Dr. John Serra is named as a defendant, but Blanchard makes absolutely no 

allegations of any kind against him. In fact, the name “Serra” appears only once in the first 

amended complaint, but that appears to be a typographical error, in which his last name 

was appended onto Dr. Homann’s. (See ECF No. 30, at 3 (“Dr. Katherine Homann Serra 

at all relevant times was acting under color of law.”).) Thus, his motion to dismiss should 

be granted.

(e) Global Medical Staffing, Inc.

Blanchard claims that Global Medical Staffing “has a policy or custom of restricting, 

if not outright denying referrals to specialists when such care is expensive,” that Dr. Gill 

and Dr. Purviance were following that policy when they denied him specialist referrals, 

and that GMS followed that policy by allegedly delaying or canceling his appointments, 

failing to promptly provide medical records, and failing to ensure uninterrupted medication 

access. (ECF No. 30, at 23, 26, 28-32.) Blanchard’s allegations of occasional missed 

appointments and missed medications amount to “isolated occurrences of neglect,” which 

do not constitute deliberate indifference. See Wood, 900 F.2d at 1334 (citation omitted). 

And his claim that GMS has a “policy or custom of restricting” referrals to expensive 

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specialists is merely a “‘naked assertion’ devoid of ‘further factual enhancement.’” See

Iqbal, 556 U.S. at 678 (citation omitted); (ECF No. 30, at 23). Thus, GMS’s motion to 

dismiss the Eighth Amendment claim should be granted.

(f) Deputy Buchanan and Sergeant Weishaar

Finally, Blanchard alleges that two prison officials—Deputy David Buchanan2and 

Sergeant Jeffery Weishaar—were deliberately indifferent to his medical needs by denying 

him a wheelchair on one occasion. On November 23, 2015, Blanchard was slow to respond 

to a doctor call “due to his debilitated state.” (ECF No. 30, at 13.) According to Blanchard, 

as he limped forward, he asked Deputy Buchanan, “[M]ay I have a wheelchair?” Not only 

was the request denied, but Blanchard claims that the deputy told the other medical call 

inmates, “Let ‘Shuffles’ here lead the pack since he is the slowest[.]” (Id.) Three days later, 

Blanchard submitted a grievance about this incident, which Sergeant Weishaar purportedly 

rejected. (Id. at 14.)

Even assuming all these facts as true, they do not make out a claim of deliberate 

indifference. To meet that high standard, “the official must both be aware of facts from 

which the inference could be drawn that a substantial risk of serious harm exists, and he 

must also draw the inference.” Farmer, 511 U.S. at 837. Blanchard does not contend that 

these prison officials knew how serious his medical condition was, or that their conduct 

might pose an excessive risk to his health or safety. Also, the only allegation against 

Sergeant Weishaar is that he later denied Blanchard’s grievance; there is no evidence he 

even knew of this incident when it happened. Sergeant Weishaar’s actions—days 

afterwards—could not have caused Blanchard any physical harm on this occasion. The 

prison officials’ motion to dismiss, therefore, should be granted.

 

2 The parties spell defendant Buchanan’s name variously as “Buchanan” or 

“Buchannan.” (See, e.g., ECF No. 30, at 3, 13; ECF No. 50-1, at 1.) The Court will refer to 

his last name consistently as “Buchanan,” which is the way it is captioned and initially

mentioned in the first amended complaint. (See ECF No. 30, at 1, 3.)

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D. Municipal Federal Civil-Rights Claim

The County of San Diego argues that Blanchard has not alleged a plausible federal 

civil-rights claim against it. To state such a municipal-liability claim, a plaintiff must 

establish that the constitutional violation resulted from “a municipal policy or custom,” or 

from the municipality’s “deliberate indifference” to an inadequate training program. City 

of Canton v. Harris, 489 U.S. 378, 385, 392 (1989); see also Monell v. New York City Dept. 

of Social Servs., 436 U.S. 658, 694 (1978) (holding that local governments may be liable 

under § 1983 for constitutional injuries resulting from that “government’s policy or 

custom”).

In the light most favorable to Blanchard, he alleged that two doctors involved in 

treating inmates told him that the Sheriff’s Department has a policy or custom of denying 

specialist visits.3(ECF No. 30, at 6, 10.) And he asserts that both these doctors in fact 

denied his referral requests—suggesting they were following that policy or custom. These 

claims are further buttressed by the fact that he allegedly had to endure extra weeks or 

months of excruciating pain before the Sheriff’s Department provided those specialist 

appointments. While the County may ultimately prove that these allegations are unfounded, 

Blanchard has adequately stated a claim of municipal liability.

 

3 One view of these allegations would be that the doctors told the truth about the 

County’s custom of denying specialist referrals, and they consciously chose to follow that 

custom against their medical judgment. Another interpretation—which tends to implicate 

the doctors, but exonerate the County—might be that they were lying, and that they 

fabricated this policy or custom in order to delay Blanchard’s treatment. Blanchard need 

not settle on a single theory, as he may pursue inconsistent arguments. See Fed. R. Civ. P. 

8(d)(2) (“A party may set out 2 or more statements of a claim . . . alternatively or 

hypothetically” and the complaint is “sufficient if any one of them is sufficient.”); cf. 

Molsbergen v. United States, 757 F.2d 1016, 1019 (9th Cir. 1985) (rejecting “a policy 

which permits one claim to be invoked as an admission against an alternative or 

inconsistent claim” for motion-to-dismiss purposes); Fed. R. Civ. P. 8(d)(3) (“A party may 

state as many separate claims or defenses as it has, regardless of consistency.”).

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E. Medical Malpractice Claim

Curiously, Dr. Serra is the only defendant who moves to dismiss Blanchard’s 

medical malpractice claim. (See ECF No. 59-1, at 2, 6.) Because Dr. Serra’s name does not 

appear anywhere in the body of the first amended complaint (except for the previouslynoted typographical error), his motion to dismiss should be granted as to this claim as well.

Also, since Deputy Buchanan and Sergeant Weishaar are not mentioned in this claim (see

ECF No. 30, at 34-43), they need not move to dismiss it. But the malpractice claim should 

remain against the other defendants—Dr. Gill, Dr. Purviance, Dr. Homann, Global Medical 

Staffing, and the County of San Diego.

F. Injunctive Relief

Blanchard seeks a wide-ranging injunction aimed at preventing further “deliberate 

indifference to inmates[’] medical needs,” which defendants oppose. Blanchard’s “claims 

for injunctive relief are moot because [he] has been released from custody.” See Jones v. 

Williams, 791 F.3d 1023, 1031 (9th Cir. 2015); (ECF No. 30, at 42, ¶292 (referencing 

release from custody)). So, his injunctive-relief claim must fail.

G. Punitive Damages

Although some defendants move to dismiss Blanchard’s punitive-damages claim 

(ECF No. 52, at 19; ECF No. 59-1, at 7), the Supreme Court has held that “a jury may be 

permitted to assess punitive damages in an action under § 1983 when the defendant’s 

conduct is shown to be motivated by evil motive or intent, or when it involves reckless or 

callous indifference to the federally protected rights of others.” Smith v. Wade, 461 U.S. 

30, 88 (1983). Such punitive damages are available “even when the underlying standard of 

liability for compensatory damages is one of recklessness.” Id. Thus, Blanchard should be 

allowed to seek punitive damages against any defendant against whom he has adequately 

stated a deliberate-indifference claim.

H. Opportunity to Amend

A pro se plaintiff is entitled to an “opportunity to amend the complaint to overcome 

[any] deficiency unless it clearly appears from the complaint that the deficiency cannot be 

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overcome by amendment.” James v. Giles, 221 F.3d 1074, 1077 (9th Cir. 2000) (citations 

omitted). Blanchard has already drafted three versions of this complaint (see ECF Nos. 1, 

30, 33), and he filed the first amendment partly to “address the deficiencies outlined” in 

the County’s initial motion to dismiss. (ECF No. 21, at 1-2.) But this is the first time the 

Court has notified Blanchard of any legal deficiencies in his complaint, so he should be 

given one last opportunity to amend it.

IV

CONCLUSION

This Court recommends that:

1. Defendant County of San Diego’s motion to dismiss the first amended 

complaint (ECF No. 31) be GRANTED as to the injunctive-relief claim

only and otherwise DENIED;

2. Defendant County of San Diego’s motion to strike the second amended 

complaint (ECF No. 35) be GRANTED;

3. Defendant Weishaar and Buchanan’s motion to dismiss the first amended 

complaint (ECF No. 50) be GRANTED;

4. The motion to dismiss the first amended complaint filed by defendants 

Global Medical Staffing, Dr. Gill, Dr. Purviance, and Dr. Homann (ECF 

No. 52) be GRANTED as to the injunctive-relief claim, GRANTED as to 

the Eighth Amendment claim against Dr. Homann and Global Medical 

Staffing only, DENIED as to the medical-malpractice claim, and 

otherwise DENIED;

5. Defendant Dr. Serra’s motion to dismiss the first amended complaint (ECF 

No. 59) be GRANTED; and

6. If the District Judge adopts or modifies this report, Blanchard shall have 

14 days from that order to file a third amended complaint to address the 

identified deficiencies. If he chooses not to file a third amended complaint, 

the case will proceed on the first amended complaint, but only as to the 

remaining defendants and claims.

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Upon being served with a copy of this report, each party has 14 days to file any 

objections. See Fed. R. Civ. P. 72(b)(2). A party may respond to any such objection within 

14 days of being served with it. See id.

Dated: August 8, 2017

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