Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_24-cv-00118/USCOURTS-caed-2_24-cv-00118-3/pdf.json

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

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

ROBERT L. SMITH,

Plaintiff,

v.

RAMESH DHARAWT, et al.,

Defendants.

Case No. 2:24-cv-0118-JDP (P)

ORDER

Plaintiff Robert Smith is a state prisoner proceeding without counsel in this action under 

42 U.S.C. § 1983. He alleges that defendant doctors J. Ma, Walter Chien, and Ramesh Dharawat,

and nurse Nnaji, violated his Eighth Amendment rights in their treatment and care of him.

Pending before the court are: plaintiff’s motion for injunctive relief, ECF No. 14; defendant Ma’s

motion to dismiss the claims against him, ECF No. 20; and plaintiff’s motion for additional time 

to respond to discovery requests, ECF No. 23. 

After reviewing the briefs, I will grant defendant Ma’s motion and allow plaintiff thirty 

days to file either a notice that he intends to proceed with his claims against defendants Dharawat, 

Chien, and Nnaji, or an amended complaint remedying the deficiencies noted herein. I will also 

grant plaintiff sixty days to respond to the outstanding discovery requests. Finally, I will direct 

the remaining defendants to file a response to plaintiff’s motion for injunctive relief within sixty

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days. 

Motion to Dismiss

A complaint may be dismissed for “failure to state a claim upon which relief may be 

granted.” Fed. R. Civ. P. 12(b)(6). To survive a motion to dismiss for failure to state a claim, a 

plaintiff must allege “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, 678 (2009) (citing Twombly, 

550 U.S. at 556). The plausibility standard is not akin to a “probability requirement,” but it 

requires more than a sheer possibility that a defendant has acted unlawfully. Iqbal, 556 U.S. at 

678. 

For purposes of dismissal under Rule 12(b)(6), the court generally considers only 

allegations contained in the pleadings, exhibits attached to the complaint, and matters properly 

subject to judicial notice, and construes all well-pleaded material factual allegations in the light 

most favorable to the nonmoving party. Chubb Custom Ins. Co. v. Space Sys./Loral, Inc., 710 

F.3d 946, 956 (9th Cir. 2013); Akhtar v. Mesa, 698 F.3d 1202, 1212 (9th Cir. 2012). 

Dismissal under Rule 12(b)(6) can be based on either: (1) lack of a cognizable legal theory, or 

(2) insufficient facts under a cognizable legal theory. Chubb Custom Ins. Co., 710 F.3d at 956. 

Dismissal also is appropriate if the complaint alleges a fact that necessarily defeats the claim. 

Franklin v. Murphy, 745 F.2d 1221, 1228-29 (9th Cir. 1984).

The Complaint’s Allegations against Defendant Ma

The complaint spans twenty-six pages and carefully details several medical procedures, 

examinations, and issues that plaintiff has experienced, since 2007, with his diagnosed condition 

of sinus bradycardia. See generally ECF No. 1. However, the complaint’s allegations against 

defendant Ma, who has been plaintiff’s primary care physician at California State Prison, 

Sacramento, are few and often conclusory. For the purposes of this order, the court will identify

each allegation against defendant Ma. 

The complaint first alleges that in May 2018, when plaintiff suffered a syncope episode at 

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CSP-Sacramento, defendant Ma called for an ambulance and had plaintiff rushed to U.C. Davis 

Hospital for evaluation and care. ECF No. 1 at 5. While at the hospital, plaintiff learned that he

had suffered a tachycardia episode. Id. The complaint next alleges that all defendants 

(presumably including defendant Ma) became aware of plaintiff’s April 2019 pacemaker 

evaluation. Id. at 6. The evaluation noted that plaintiff’s pacemaker was “normally functioning” 

but that for eight seconds during the evaluation, plaintiff’s heart rate was at a dangerous level. Id. 

Following the pacemaker evaluation, defendant Ma evaluated plaintiff and reviewed the hospital 

notes with him. Id. at 7. Defendant Ma explained to plaintiff his plan of care, which included a 

cardiology consultation. Id. 

In August 2019, defendant Ma informed plaintiff that his “echo showed EF at 49%,” “that 

plaintiff had mild changes in his cardiac structure and pressure, including mild concentric 

thickness of the left ventricle, mild dilation of the right atrium and right ventricle” and that 

plaintiff’s “RSVP [was] about 30 [and] his pacemaker interrogation showed over sensing in right 

atrium leading to inappropriate mode switches.” Id. at 8. During this evaluation, defendant Ma 

also informed plaintiff that the oversensing in plaintiff’s pacemaker might have caused plaintiff’s 

dizziness. Id. at 8-9. Finally, the complaint alleges at least three times that all defendants were 

aware of plaintiff’s St. Jude pacemaker interrogation. Id. at 10, 11, & 12. 

Medical Deliberate Indifference 

Courts in Ninth Circuit employ a two-part test when analyzing deliberate indifference 

claims. The plaintiff must satisfy “both an objective standard—that the deprivation was serious 

enough to constitute cruel and unusual punishment—and a subjective standard—deliberate 

indifference.” Colwell v. Bannister, 763 F.3d 1060, 1066 (9th Cir. 2014) (internal quotation 

omitted). 

The objective component examines whether the plaintiff has a “serious medical need,” 

such that the state’s failure to provide treatment could result in further injury or cause 

unnecessary and wanton infliction of pain. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). 

Serious medical needs include those “that a reasonable doctor or patient would find important and 

worthy of comment or treatment; the presence of a medical condition that significantly affects an 

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individual’s daily activities; or the existence of chronic and substantial pain.” Colwell, 763 F.3d 

at 1066 (internal quotation omitted).

The subjective element considers the defendant’s state of mind, the extent of care 

provided, and whether the plaintiff was harmed. “Prison officials are deliberately indifferent to a 

prisoner’s serious medical needs when they deny, delay, or intentionally interfere with medical 

treatment.” Hallett v. Morgan, 296 F.3d 732, 744 (9th Cir. 2002) (internal quotation omitted). 

However, a prison official may only be held liable if he or she “knows of and disregards an 

excessive risk to inmate health and safety.” Toguchi v. Chung, 391 F.3d 1050, 1057 (9th Cir. 

2004). The defendant must therefore have actual knowledge from which he or she can infer that a 

substantial risk of harm exists, and also make that inference. Colwell, 763 F.3d at 1066. An 

accidental or inadvertent failure to provide adequate care is not enough to impose liability. 

Estelle v. Gamble, 429 U.S. 97, 105-06 (1976). Rather, the standard lies “somewhere between 

the poles of negligence at one end and purpose or knowledge at the other . . . .” Farmer v. 

Brennan, 511 U.S. 825, 836 (1994). Accordingly, the defendant’s conduct must consist of “more 

than ordinary lack of due care.” Id. at 835 (internal quotation omitted).

Analysis

Defendant Ma argues that the complaint fails to allege facts suggesting that he was 

deliberately indifferent to plaintiff’s serious medical needs. ECF No. 20-1 at 1. Specifically, he 

argues that there are no allegations that he delayed, denied, or intentionally interfered with 

plaintiff’s treatment for his heart condition. Id. at 4. In fact, defendant Ma argues, the complaint 

shows that he affirmatively cared for plaintiff, and that he referred plaintiff to the hospital and 

reviewed with plaintiff his hospital notes. Finally, defendant Ma argues that the complaint is 

devoid of any allegations that Ma acted as a supervisor to another defendant. Id. at 5. 

Plaintiff argues in opposition defendant Ma was deliberately indifferent to his serious 

medical needs. ECF No. 24. Plaintiff includes arguments that rely on allegations and 

attachments that were not included in the complaint. See generally id. Plaintiff explains that in 

May 2018, defendant Ma sent plaintiff to the hospital via ambulance. Id. at 1-2. And that 

following plaintiff’s evaluation at the hospital, defendant Ma filled out a health care services 

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physician request so that plaintiff could undergo an ablation procedure, which was recommended 

by defendant Chien. Id. at 2. Plaintiff had the procedure in October 2018, and, afterwards, he 

claims to have notified defendant Ma that he was experiencing left leg pain, dizzy spells, nausea, 

shortness of breath, and continued feelings of tachycardia. Id. Plaintiff also informed defendant 

Ma that he had to call “man down” three or four times to get medical attention, but that plaintiff 

was not seen by medical personnel. Id. at 2-3. In January 2019, a St. Jude medical representative 

informed defendant Ma of plaintiff’s pacemaker evaluation, which showed that plaintiff had 

tachycardic episodes at least three times. Id. at 3-4. The St. Jude representative also notified 

defendant Ma that plaintiff needed a follow-up evaluation. Id. Plaintiff claims that defendant Ma 

did not notify plaintiff about several alerts from his pacemaker and that defendant Ma failed to 

inform plaintiff’s health concerns to Ma’s supervisor. Id. at 3-5. Finally, plaintiff argues that 

because he wrote “emergency” at the top of his forms requesting treatment and those requests 

were denied, defendant Ma was deliberately indifferent to his medical needs. Id. at 6. 

Defendant has filed a reply, arguing primarily that plaintiff cannot introduce new 

allegations in his oppositions and that even if the court were to consider plaintiff’s new 

allegations, the complaint fails to sufficiently allege that defendant Ma was deliberately 

indifferent to plaintiff’s serious medical needs. ECF No. 25. 

As an initial matter, defendant Ma is correct that plaintiff cannot add new allegations in 

his opposition brief to survive a motion to dismiss. When ruling on a motion to dismiss, the court 

reviews the allegations in the complaint. The court may not consider new allegations and 

arguments raised in the opposition brief. See Schneider v. California Dep’t. of Corrections, 151 

F.3d 1194, 1197 (9th Cir. 1998). However, even if the court were to consider plaintiff’s new 

allegations, the court would still dismiss the claims against defendant Ma. 

The complaint contains no allegations that defendant Ma delayed, denied, or intentionally 

interfered with plaintiff’s medical needs. The complaint alleges that plaintiff experienced a

syncope episode, and that defendant Ma summoned an ambulance and sent plaintiff for care at the 

hospital. Nothing in these allegations shows that defendant Ma was deliberately indifferent to 

plaintiff’s serious medical needs. On the contrary, it shows that defendant Ma acted diligently in 

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providing proper care for plaintiff. 

Next, plaintiff alleges that defendant Ma filled out the proper form so that plaintiff could 

receive the ablation procedure that was recommended by defendant Chien. Again, this shows that 

plaintiff was receiving adequate care from defendant Ma. The opposition states that following the 

ablation procedure, plaintiff experienced leg pain, dizzy spells, nausea, and other side effects. 

Plaintiff filled out a form requesting an interview with defendant Ma, but there is no allegation 

that defendant Ma actually saw the form or intentionally ignored it. 

Plaintiff next alleges that he requested a follow-up with defendant Ma, but that request 

was denied. However, the document cited to by plaintiff is a health care services physician 

request for services form (to be completed by the requesting physician) which shows that

defendant Ma approved plaintiff for a follow-up evaluation. ECF No. 24 at 13. Even if there was 

a delay in plaintiff receiving treatment, it appears to have been minimal, and plaintiff has not 

alleged that he suffered a harm from the delay itself. See Shapley v. Nevada Bd. of State Prison 

Com’rs, 766 F.2d 404, 408 (9th Cir. 1985) (without more, delayed treatment does not violate 

Eighth Amendment). 

Finally, plaintiff alleges that on July 28, 2019, defendant Ma failed to inform him of an 

irregularity in his pacemaker, but also claims that defendant Ma made him aware of his 

pacemaker irregularities during a follow-up on August 28, 2019. ECF No. 24 at 4. Plaintiff does 

not allege that any of his injuries resulted from any delay in treatment or that they would have 

been avoided had he been treated sooner. See Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 

1989) (delay in providing medical treatment does not constitute Eighth Amendment violation 

unless delay was harmful).

Motion to Additional Time 

Plaintiff requests sixty days to file responses to defendants’ Dharawat and Chien’s 

discovery requests. ECF No. 23. Defendants have not opposed this request. Good cause 

appearing, this request is granted. 

Motion for Injunctive Relief

Plaintiff has filed a motion for injunctive relief. ECF No. 14. In light of the court’s ruling 

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on defendant Ma’s motion to dismiss, the remaining defendants shall file a response to plaintiff’s 

motion within forty-five days of this order’s entry. 

Accordingly, it is hereby ORDERED that:

1. Defendant’s motion to dismiss, ECF No. 20, is granted.

2. Plaintiff’s claims against defendant Ma are dismissed with leave to amend. Plaintiff 

shall file a notice that he wishes proceed on the claims against the remaining defendants or file an 

amended complaint within thirty days. 

3. The Clerk of Court is directed to send plaintiff a section 1983 form complaint. 

4. Plaintiff’s motion for additional time, ECF No. 23, is granted. Plaintiff shall have sixty 

days from the date of this order to respond to defendants’ discovery request. 

5. Within forty-five days of this order, the remaining defendants shall file a response to 

plaintiff’s motion for injunctive relief. 

IT IS SO ORDERED.

Dated: December 13, 2024 

JEREMY D. PETERSON

UNITED STATES MAGISTRATE JUDGE

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