Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_12-cv-02507/USCOURTS-casd-3_12-cv-02507-1/pdf.json

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

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

ORLANDO LEROY TILFORD,

Plaintiff,

CASE NO. 12cv2507-GPC (MDD)

REPORT AND

RECOMMENDATION RE:

DEFENDANTS’ MOTION FOR

SUMMARY JUDGMENT

[ECF No. 22]

vs.

J. CHAU, et al.,

Defendants.

I. Introduction

This Report and Recommendation is submitted to United States 

District Judge Gonzalo P. Curiel pursuant to 28 U.S.C. § 636(b)(1) and

Local Civil Rules 72.1 and 72.3(f) of the United States District Court for

the Southern District of California. For the reasons set forth herein, the

Court RECOMMENDS Defendants’ Motion for Summary Judgment be

GRANTED. 

II. Procedural History

On October 15, 2012, Plaintiff Orlando Leroy Tilford, an inmate

housed at the Donovan Correctional facility proceeding pro se and in

forma pauperis, filed a Complaint pursuant to 42 U.S.C. § 1983. (ECF

No. 1.) In his Complaint, Plaintiff contends that his Eighth Amendment

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rights were violated when prison officials discontinued his morphine

prescription. (Id. at 2-3.) Plaintiff also contends that his due process

rights were violated because his medication was discontinued without a

fair hearing. (Id. at 5.) On March 11, 2013, Defendants J. Chau, M.D.

and R. Walker, D.O. (“Defendants”) filed an Answer to Plaintiff’s

Complaint. (ECF No. 10.) 

On October 10, 2013, Defendants filed the instant Motion for

Summary Judgment (“MSJ”). (ECF No. 22.) On November 7, 2013, this

Court issued a briefing schedule on Defendants’ Motion and provided

Plaintiff notice pursuant to Rand v. Rowland, 154 F.3d 952 (9th Cir.

1998) (en banc) and Klingele v. Eikenberry, 849 F.2d 409 (9th Cir. 1988).1

Plaintiff filed a request for an extension to file his Response to

Defendants’ Motion on December 13, 2013. (ECF No. 25.) On December

23, 2013, the Court granted Plaintiff’s request for an extension, giving

Plaintiff until January 24, 2014, to file his Response. (ECF No. 27.) 

Plaintiff failed to file a Response and has not filed a request for an

extension. 

III. Statement of Facts

Plaintiff is an inmate housed in the Donovan Correctional Facility. 

Defendant J. Chau, M.D., is a physician employed at Donovan who

served as Plaintiff’s primary care physician. (ECF No. 22-4 (Declaration

of J. Chau, M.D.) at ¶ 4; ECF No. 22-5 (Plaintiff’ Medical Records from

Donovon Correctional Facility) at 102.) On November 21, 2011, Dr. Chau

examined Plaintiff and noted a principle diagnosis of HIV and avascular

necrosis of the hips and knees. (ECF No. 22-5 at 102.) Based on his

observations and on the recommendation of Plaintiff’s Orthopedist, Dr.

1

Defendants also provided Plaintiff with Klingele/Rand notices in

their MSJ. (ECF No. 22-6.) 

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Bentley at Tri-City Hospital, Dr. Chau ordered MRIs of Plaintiff’s knees

and hips. (Id.) The MRIs were performed on January 4, 2012. (Id. at

106-111.) 

On January 10, 2012, Dr. Chau had a follow-up examination with

Plaintiff and reported the results of his prior exam and the MRIs. (Id. at

103.) Dr. Chau diagnosed Plaintiff with HIV, avascular necrosis (a death

of bone tissue) in both hips and knees, and chronic pain stemming from

his avascular necrosis. (Id.) Dr. Chau reported that Plaintiff was taking

several medications, including morphine for treatment of pain. (Id.) Dr.

Chau noted that Plaintiff exhibited a mild limp, but appeared to be

ambulatory without the use of a cane and was in no apparent distress,

though he did note other damage to Plaintiff’s knees. (Id.) Dr. Chau

ordered that Plaintiff’s current medications be continued, including his

morphine, and noted that Plaintiff was scheduled for an appointment

with a hematologist to determine whether Plaintiff’s avascular necrosis

was due to a hematological etiology. (Id.) Dr. Chau discussed with

Plaintiff the importance of adhering to his medication. (Id.) 

Plaintiff saw Dr. Wilkinson, a hematologist, on February 24, 2012. 

(Id. at 97-101.) Dr. Wilkinson ordered additional testing to determine

the cause of Plaintiff’s avascular necrosis, but otherwise agreed with the

evaluation of Plaintiff’s doctors at Donovan. (Id. at 100.) On February

28, 2012, Dr. Chau met with Plaintiff again for a follow-up visit. (ECF

No. 22-4 at ¶ 7; ECF No. 22-5 at 94-95.) Dr. Chau once again ordered

that Plaintiff’s HIV treatment and medications be continued, and

discussed with Plaintiff the importance of adherence to his medication. 

(ECF No. 22-5 at 94.) Dr. Chau also entered orders for the tests

recommended by Dr. Wilkinson and for Plaintiff to receive Pnemovax and

Tdap vaccinations. (Id. at 92-96.)

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On March 1, 2012, samples were collected from Plaintiff for the

tests recommended by Dr. Wilkinson. (Id. at 87-91.) On March 8, 2012,

additional samples were collected for a Factor V (Leiden) Mutation

Analysis. (Id. at 83.) On March 28, 2012, Plaintiff had another

consultation with Dr. Wilkinson. (Id. at 81-85.) Dr. Wilkinson

recommended that Plaintiff be placed on bisphosphonates and

recommended that a prothrombin gene mutation study be performed. 

(Id. at 83-84.) Dr. Chau placed the order for the gene mutation study on

April 6, 2012. (ECF No. 22-4 at ¶ 11; ECF No. 22-5 at 80.) 

On April 10, 2012, blood and urine samples were collected from

Plaintiff for the purpose of determining if Plaintiff was compliant with

his medication. (ECF No. 22-5 at 77, 79.) On April 11, 2012, before the

results of those tests were published, Dr. Chau conducted another followup visit with Plaintiff. (Id. at 115.) Dr. Chau discussed Plaintiff’s

placement on bisphosphonate treatment and entered a prescription for

Fosamax. (Id.) Dr. Chau also began treating Plaintiff for possible

allergic rhinitis and placed Plaintiff on Claritin. (Id. at 75-76.) Dr. Chau

informed Plaintiff that if he was diverting his medication2

 or not

complying with the Pain Management Contract Plaintiff signed on March

12, 2010, his medication would be stopped. (Id. at 75, 112-113.) 

On April 12, 2012, the results of Plaintiff’s urine sample were

reported. (Id. at 77.) Plaintiff’s specimen contained a 7098 ng/ml

concentration of morphine, but was negative for hydromorphone. (Id.) 

Dr. Chau believed that the absence of hydromorphone suggested that

Plaintiff was not taking his medication. (ECF No. 22-4 at ¶ 14.) On

April 15, 2012, Plaintiff’s blood test results were reported. (ECF No. 22-5

2

“Diverting” medication refers to a patient not taking his medication as directed, typically for an improper purpose, such as selling or trading the drugs or taking an improper dosage. 

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at 79.) The test indicated Plaintiff was not taking his morphine

medication. (Id.) Dr. Chau viewed this as confirmation that Plaintiff

was diverting his medication. (ECF No. 22-4 at ¶ 14.) Dr. Chau believed

this to be in violation of paragraph 15(b) of Plaintiff’s Narcotic Pain

Medication Contract. (Id. at ¶ 15.) Dr. Chau also believed the

unaccounted for medication to be a security risk for the prison. (Id. at ¶

16.) 

On April 19, 2012, the results of Plaintiff’s Gene Mutation study

were reported. (ECF No. 22-5 at 73-74.) On April 20, 2012, Dr. Chau

ordered a follow-up visit with Dr. Wilkinson for Plaintiff to review the

results of the Gene Mutation study. (Id. at 72.) On May 8, 2012, Dr.

Chau met with Plaintiff again. (Id. at 68-69.) His notes reflect that

Plaintiff entered the clinic without a walking assistive device and that

Plaintiff stated he does not always use a cane. (Id. at 68-69.) Dr. Chau’s

notes also reflect his assessment that Plaintiff may be diverting his

medication based on the laboratory finding that Plaintiff was negative for

hydromorphone. (Id. at 69.) Dr. Chau informed Plaintiff that the case

would be referred to the Pain Management Committee and that Plaintiff

may be switched to alternative medication in the future. (Id.) 

Additionally, Plaintiff was given a wrist splint and an accommodation

chrono to treat his reported left thumb pain. (Id.) Defendant Dr. Walker

approved the requests for the wrist splint and the accommodation

chrono. (Id. at 70.) 

On May 11, 2012, the Pain Management Committee met and

evaluated the evidence presented by Dr. Chau that Plaintiff was

diverting his medication. (ECF No. 22-4 at ¶ 24; ECF No. 22-5 at 100.) 

Dr. Walker was present and heard the evidence presented by Dr. Chau. 

(ECF No. 22-4, Ex. C.) The Committee determined that Plaintiff was not

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taking his medication as directed, and recommended that Plaintiff be

tapered off the medication. (Id.) The Committee also scheduled followups for Plaintiff with orthopedics and for anti-viral medication

management in the CID clinic, and recommended that Plaintiff remain

on Ibuprofen. (Id.) 

On May 14, 2012, more blood samples were taken from Plaintiff. 

Also on May 14, 2012, Dr. Chau ordered follow-up visits for Plaintiff with

an orthopedic specialist and with a hematologist. (Id. at 60-62, 66.) On

May 21, 2012, Dr. Chau, in accordance with the findings of the Pain

Management Committee, ordered that Plaintiff be tapered off morphine

sulfate over a period of twenty days. (Id. at 58-59.) On May 22, 2012,

another specimen was taken from Plaintiff for further gene analysis. (Id.

at 57.) 

On June 12, 2012, Dr. Chau conducted another follow-up visit with

Plaintiff. (Id. at 55.) During his visit, Plaintiff complained of severe pain

since being taken off morphine. (Id.) Plaintiff complained that the pain

was so bad that he could not eat, though Dr. Chau noted that Plaintiff’s

weight had not changed. (Id.) Plaintiff used a cane, but Dr. Chau

observed no significant limping and did not believe that Plaintiff was in

apparent distress. (Id.) Nevertheless, Dr. Chau ordered that Plaintiff’s

Ibuprofen be increased in light of Plaintiff’s complaints of pain. (Id.) 

On June 18, 2012, Plaintiff had a telephonic orthopedic consultation

with Dr. Christian Bentley. Based on Dr. Bentley’s recommendation, Dr.

Chau ordered MRIs of Plaintiff’s left wrist and elbow. (Id. at 52.) The

scans were performed on July 6, 2012. (Id. at 48-49.) 

In Response to the Pain Management Committee’s decision to

discontinue Plaintiff’s morphine medication, Plaintiff filed a 602

Administrative Appeal. On July 16, 2012, Dr. Chau interviewed Plaintiff

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regarding his Appeal. (Id. at 47.) According to Dr. Chau, Plaintiff

contended that the Committee’s decision was invalid because the testing

showed that Plaintiff had morphine in his system and because Plaintiff

was never found to have sold or traded his medication. (Id.) Plaintiff

also stressed that he needed the morphine to treat his pain. (Id.) That

same day, Dr. Chau put in a recommendation for Plaintiff to receive knee

braces and a double mattress to help alleviate Plaintiff’s complaints of

pain. (ECF No. 22-5 at 46.) On July 25, 2012, Plaintiff had another

consultation with Dr. Wilkinson. (Id. at 42-45.) 

On July 30, 2012, Dr. Chau issued his response denying Plaintiff’s

602 Appeal. (ECF No. 22-4, Ex. D.) Dr. Chau denied the Appeal based

on the findings that Plaintiff’s previously reported morphine levels were

inconsistent with the high dose of medication Plaintiff was supposed to

be taking and that Plaintiff’s signs and symptoms were inconsistent with

Plaintiff’s claims of disability and severe pain. (Id.) Dr. Chau’s response

was reviewed by Dr. Walker. (Id.) Dr. Walker concurred with Dr. Chau’s

opinion, finding the laboratory reports of Plaintiff’s morphine levels

highly significant. (ECF No. 22-3, Ex. B.) Accordingly, Dr. Walker

denied Plaintiff’s Appeal. (Id.) Dr. Walker also found that based on Dr.

Chau’s findings regarding Plaintiff’s functionality, Plaintiff no longer

needed morphine treatment and his pain could be managed with other

medication. (Id.) 

On August 10, 2012, Dr. Chau interviewed Plaintiff regarding a

second 602 Appeal over Plaintiff’s morphine medication. (Id. at 39.) 

Plaintiff contended that the discontinuation of his morphine medication

left him in severe pain, and constituted deliberate indifference to his

medical needs in violation of his Eighth Amendment rights. (Id.) In

addition to reinstatement of his morphine, Plaintiff requested $10,000

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per day from each individual involved in the decision to terminate his

morphine medication until the prescription is reinstated. (Id.) He also

asked that he not be harassed by prison officials based on his Appeal. 

In his Response to Plaintiff’s Appeal, Dr. Chau granted Plaintiff’s

request not be harassed, but denied Plaintiff’s request for monetary

compensation as beyond the scope of a 602 appeal. (ECF No. 22-4, Ex.

E.) Dr. Chau noted that Plaintiff had been treated like any other inmate,

was receiving adequate care, and had been observed moving about

without distress. (Id.) Dr. Walker reviewed the Appeal and concurred

with Dr. Chau’s analysis and decision. (Id.) 

On August 10, 2012, Dr. Chau supplemented Plaintiff’s pain

medication with a 90-day prescription for Tylenol. (ECF No. 22-5 at 40.) 

On October 12, 2012, Dr. Chau conducted another visit with Plaintiff. 

(Id. at 33-35.) Dr. Chau ordered more laboratory testing, updated

Plaintiff’s accommodation chrono, recommended another orthopedic

consultation, and renewed Plaintiff’s HIV medications. (Id. at 33-37.) 

On December 7, 2012, Dr. Chau conducted another visit with

Plaintiff. (Id. at 29-31.) Dr. Chau examined Plaintiff and determined

that Plaintiff’s condition did not warrant reinstatement of narcotic pain

medication. (ECF No. 22-4 at ¶ 47; ECF No. 22-5 at 29.) Plaintiff was

scheduled for another orthopedic follow-up, another follow-up in the

Public Health Clinic, and his Ibuprofen prescription was renewed. (ECF

No. 22-4 at ¶ 47.) 

On December 20, 2012, Dr. Chau entered an order for Plaintiff to

receive an offsite orthopedic consultation and x-rays of his hips and

knees. (ECF No. 22-5 at 27.) The tests were performed the next day and

found that Plaintiff had “minimal osteoarthritic changes [of the] right

hip. No acute bony pathology.” (Id. at 26.) According to Dr. Chau, these

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findings supported his conclusion that Plaintiff did not need narcotic pain

medication. (ECF No. 22-4 at ¶ 48.) On December 26, 2012, Plaintiff

received an orthopedic consultation with Dr. Chadha. (ECF No. 22-5 at

22.) Dr. Chadha reported that Plaintiff had minimal loss of motion, and

though Plaintiff was experiencing pain, Dr. Chadha did not recommend

surgery or narcotic pain medication. (Id. at 21.) Dr. Chau reviewed the

report on December 28, 2012, and believed it confirmed his assessment

that non-steroidal anti-inflammatory medications were appropriate and

that narcotics should not be used. (ECF No. 22-4 at ¶ 49; ECF No. 22-5

at 32.) 

On January 4, 2013, Dr. Chau saw Plaintiff again. (ECF No. 22-4

at 18.) Dr. Chau recommended that Plaintiff’s Ibuprofen be continued

and that Plaintiff receive Neurontin as recommended by Dr. Chadha. 

(Id.) Dr. Chau placed the order for Neurontin along with a

Nonformulatory Drug Request, but the request was denied by Dr. Seeley

on January 8, 2013, on the grounds that formulatory medications would

have to be tried before Neurontin. (Id. at 17-18.) 

Plaintiff filed a health care appeal regarding the denial of

Neurontin. (Id. at 16.) On February 13, 2013, Dr. Chau interviewed

Plaintiff for the first level response to Plaintiff’s healthcare appeal. Dr.

Chau recommended that Plaintiff instead take Amitriptyline, which also

had a sedative effect that Dr. Chau believed would help Plaintiff with his

difficulty sleeping. (Id. at 15.) 

On February 20, 2013, a multi-disciplinary meeting was held to

discuss Plaintiff’s medical conditions. (Id. at 14.) Several medical

professionals, including Dr. Chau, attended. (Id.) According to Dr. Chau,

all medical professionals present agreed that Plaintiff did not exhibit

difficulty with his daily activities. (ECF No. 22-4 at ¶ 52.) They noted

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that Plaintiff was able to occasionally walk without his cane, and had

come to the pill line without his cane, though he refused to take

Amitriptyline. (Id.) Mental health professionals noted that Plaintiff ate

and slept well, and had only minor depression which was caused at least

in part by the relocation of his cellmate to another facility. (Id.) 

Ultimately, the panel concluded that Plaintiff should remain on

Ibuprofen and Amitriptyline for pain. (ECF No. 22-5 at 14.) 

IV. Legal Standard

Rule 56(c) of the Federal Rules of Civil Procedure authorizes the

granting of summary judgment “if the pleadings, depositions, answers to

interrogatories, and admissions on file, together with the affidavits, if

any, show that there is no genuine issue as to any material fact and that

the moving party is entitled to judgment as a matter of law.” The

standard for granting a motion for summary judgment is essentially the

same as for the granting of a directed verdict. Judgment must be

entered, “if, under the governing law, there can be but one reasonable

conclusion as to the verdict.” Anderson v. Liberty Lobby, Inc., 477 U.S.

242, 250-51 (1986). “If reasonable minds could differ,” however,

judgment should not be entered in favor of the moving party. Id. 

The parties bear the same substantive burden of proof as would

apply at a trial on the merits, including plaintiff’s burden to establish any

element essential to his case. Id. at 252; Celotex v. Catrett, 477 U.S. 317,

322 (1986); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). The

moving party bears the initial burden of identifying the elements of the

claim in the pleadings, or other evidence, which the moving party

“believes demonstrates the absence of a genuine issue of material fact.” 

Celotex, 477 U.S. at 323. “A material issue of fact is one that affects the

outcome of the litigation and requires a trial to resolve the parties’

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differing versions of the truth.” S.E.C. v. Seaboard Corp., 677 F.2d 1301,

1305-06 (9th Cir. 1982). More than a “metaphysical doubt” is required to

establish a genuine issue of material fact. Matsushita Elec. Indus. Co.,

Ltd v. Zenith Radio Corp., 475 U.S. 574, 586 (1986).

The burden then shifts to the non-moving party to establish, beyond

the pleadings, there is a genuine issue for trial. Celotex, 477 U.S. at 324. 

To successfully rebut a properly supported motion for summary

judgment, the nonmoving party “must point to some facts in the record

that demonstrate a genuine issue of material fact and, with all

reasonable inferences made in the plaintiff’s favor, could convince a

reasonable jury to find for the plaintiff.” Reese v. Jefferson School Dist.

No. 14J, 208 F.3d 736, 738 (9th Cir. 2000) (citing Fed. R. Civ. P. 56;

Celotex, 477 U.S. at 323; Anderson, 477 U.S. at 249) (modified to reflect a

single plaintiff).

While the district court is “not required to comb the record to find

some reason to deny a motion for summary judgment,” Forsberg v. Pacific

N.W. Bell Tel. Co., 840 F.2d 1409, 1417 (9th Cir. 1988), the court may

nevertheless exercise its discretion “in appropriate circumstances,” to

consider materials in the record which are on file but not “specifically

referred to.” Carmen v. San Francisco Unified Sch. Dist., 237 F.3d 1026,

1031 (9th Cir. 2001). However, the court need not “examine the entire

file for evidence establishing a genuine issue of fact, where the evidence

is not set forth in the moving papers with adequate references so that it

could be conveniently found.” Id. 

In ruling on a motion for summary judgment, the court need not

accept legal conclusions “cast in the form of factual allegations.” Western

Mining Council v. Watt, 643 F.2d 618, 624 (9th Cir. 1981). “No valid

interest is served by withholding summary judgment on a complaint that

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wraps nonactionable conduct in a jacket woven of legal conclusions and

hyperbole.” Vigliotto v. Terry, 873 F.2d 1201, 1203 (9th Cir. 1989).

 “Section 1983 imposes two essential proof requirements upon a

claimant: (1) that a person acting under color of state law committed the

conduct at issue, and (2) that the conduct deprived the claimant of some

right, privilege, or immunity protected by the Constitution or laws of the

United States.” Leer v. Murphy, 844 F.2d 628, 632-33 (9th Cir. 1988); see

also 42 U.S.C. § 1983. 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). “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,

844 F.2d at 633. 

V. Analysis

Plaintiff’s Complaint contains three counts. In counts one and two,

Plaintiff contends he was denied his right to medical care and subjected

to cruel and unusual punishment in violation of the Eighth Amendment

when his morphine medication was discontinued. (ECF No. 1 at 3-4.) In

count three, Plaintiff contends he was denied his right to due process

when the Pain Management Committee determined that Plaintiff was

diverting his pain medication without providing Plaintiff a full and fair

hearing on the issue. (Id. at 5.) In the instant Motion, Defendants

contend that all claims fail as the uncontested evidence shows that

Defendants actively treated Plaintiff’s medical conditions and because

Plaintiff was not entitled to a hearing regarding his morphine

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medication. (ECF No. 22-2.)

1. Deliberately Indifference (Counts 1 and 2)

Defendants contend that Plaintiff’s Eighth Amendment claim fails

because Plaintiff’s disagreement with the decision to terminate his

morphine prescription does not constitute deliberate indifference to

Plaintiff’s serious medical needs. (ECF No. 22-1 at 25.) In his

Complaint, Plaintiff states that he suffers chronic pain as a result of his

avascular necrosis and that his morphine medication was prescribed to

him by his doctors. (ECF No. 1 at 3.) Plaintiff contends that Defendants

exhibited deliberate indifference to his medical needs when they

discontinued his medication despite their knowledge of his serious

medical condition. (Id.) 

The Eighth Amendment is violated when prison officials

demonstrate “deliberate indifference to serious medical needs.” Estelle v.

Gamble, 429 U.S. 97, 104 (1976); Jackson v. McIntosh, 90 F.3d 330, 332

(9th Cir. 1996). A deliberate indifference claim has both an objective and

subjective component: a prisoner must allege he was confined under

conditions posing a risk of ‘objectively, sufficiently serious’ harm,” and

“the officials had a “sufficiently culpable state of mind’” in denying the

proper medical care.” Clement v. Gomez, 298 F.3d 898, 904 (9th Cir.

2002) (quoting Wallis v. Baldwind, 70 F.3d 1074, 1076 (9th Cir. 1995)

(internal quotations omitted)).

Thus, in order to avoid summary judgment, Plaintiff must first

point to evidence in the record which shows an objectively “serious”

medical need, i.e. the “existence of an injury 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 individual’s

daily activities; or the existence of chronic and substantial pain.”

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McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992), overruled on

other grounds by WMX Techs, Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997)

(en banc); Lopez v. Smith, 203 F.3d 1122, 1131-32 (9th Cir. 2000) (en

banc); see also Doty v. County of Lassen, 37 F.3d 540, 546 (9th Cir. 1994).

To avoid summary judgment, the evidence must demonstrate a

triable issue of material fact regarding the subjective component of an

Eighth Amendment violation. “Deliberate indifference is evidenced only

when ‘the official knows of and disregards an excessive risk to inmate

health or safety; the official must both be aware of the facts from which

the inference could be drawn that a substantial risk of serious harm

exists, and he must also draw the inference.’” Clement, 298 F.3d at 904

(quoting Farmer v. Brennan, 511 U.S. 825, 837 (1994)). Thus, the

indifference must be both deliberate and substantial; inadequate

treatment due to malpractice, or even gross negligence, does not amount

to a constitutional violation. Estelle, 429 U.S. at 106, Wood v.

Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990). “This is not an easy

test for [the] Plaintiff] to satisfy[.]” Hallet v. Morgan, 296 F.3d 732, 745

(9th Cir. 2002). Nonetheless, deliberate indifference may be found if

Defendants “deny, delay, or intentionally interfere with [a prisoner’s

serious need for] medical treatment.” Id. (internal citations omitted). 

It is not enough that the plaintiff merely disagree with the course of

treatment provided. Toguchi v. Chung, 391 F.3d 1051, 1058 (9th Cir.

2004). A difference in medical opinion is “insufficient, as a matter of law,

to establish deliberate indifference.” Id. (citing Jackson v. McIntosh, 90

F.3d 330, 332 (9th Cir. 1996). In order to prevail on a claim involving

defendants’ choices between alternative courses of treatment, a prisoner

must show that the chosen treatment “was medically unacceptable under

the circumstances” and was chosen “in conscious disregard of an

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excessive risk to plaintiff’s health.” Jackson, 90 F.3d at 332. In other

words, so long as a defendant decides on a medically acceptable course of

treatment, his actions will not be considered deliberately indifferent even

if an alternative course of treatment was available. Id. 

In Toguchi, for example, the plaintiff contended that the doctor’s

choice of medication was improper because another available drug was

superior. Toguchi, 391 F.3d at 1058. The court rejected the claim

because the plaintiff had not explained how the prescribed drug was

chosen in conscious disregard of his health. Id. Conversely, in Jackson,

the court denied summary judgment for the defendants where plaintiff

alleged that the defendants’ decision to deny him a kidney transplant

was not a medical decision, but rather a decision made out of personal

animosity to the plaintiff. Jackson, 90 F.3d at 332. 

Here, there is no dispute that Plaintiff’s avasular necrosis and pain

constitute a serious medical need. Accordingly, the only remaining

question is whether Defendants were deliberately indifferent to that

need. Estelle, 429 U.S. at 104. Defendants’ discontinuation of Plaintiff’s

morphine medication does not constitute deliberate indifference. 

Defendants have provided considerable evidence to show that the

decision to remove Plaintiff from morphine was a considered and

reasoned decision made by a panel of medical professionals. Those

professionals determined that Plaintiff was not taking his morphine

properly and that alternative treatments were sufficient to treat

Plaintiff’s condition. Plaintiff was observed continuously before and after

his morphine was discontinued and all medical professionals involved in

Plaintiff’s care agreed that Plaintiff’s pain was being well-managed with

non-narcotic medication. 

Defendants provide Plaintiff’s medical records to support their

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claims. (ECF No. 22-5.) Those records are authenticated by the

custodian of medical records for Donovan Correctional Facility (See

Declaration of Douglas Baxter, ECF No. 22-5.) Many of the treatment

notes contained in Plaintiff’s medical record were written by Dr. Chau,

who provided his sworn declaration attesting to the accuracy of those

notes. (Declaration of J. Chau, M.D., ECF No. 22-4.) According to

Plaintiff’s medical records, the decision to remove him from morphine

was based on the professional medical judgment of those involved in the

decision, many of whom are not defendants in this action. (Id.) Dr.

Walker provided a similar assessment in his sworn declaration. (ECF

No. 22-3.) 

There is also considerable evidence that Plaintiff was not taking his

morphine medication as prescribed. Blood and urine tests performed on

April 10, 2012, showed that Plaintiff was negative for hydromorphone. 

(ECF No. 22-5 at 77,79.) According to his sworn declaration, Dr. Chau

believed this result indicated that Plaintiff was not taking his

medication. (ECF No. 22-4 at ¶ 14.) The Pain Management Committee

concurred with Dr. Chau that Plaintiff was not taking his morphine as

prescribed which presented a security risk for the prison and a health

risk for Plaintiff. (Id. at ¶ 24; ECF no. 22-5 at 100.) Plaintiff has

introduced no evidence to contradict the objective laboratory findings

showing that he did not have hydromorphone in his system or to show

that the Defendants’ decision was based on anything other than their

medical judgment. 

Thus, because Defendants reasonably believed, based on objective

medical testing, other medical opinions, and their own professional

judgment, that Plaintiff was not taking morphine as directed and thus

receiving a negligible benefit from it, they did not exhibit deliberate

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indifference in switching Plaintiff to a non-narcotic painkiller. This is

especially true in light of the fact that Defendants took efforts to taper

Plaintiff off his morphine, to replace the morphine with other painkillers

that they believed would effectively treat Plaintiff’s chronic pain, and

continuously met with and observed Plaintiff after his morphine was

stopped to ensure that Plaintiff was functioning well without the narcotic

prescription. (ECF No. 22-5 at 55 [June 12, 2012, treatment notes noting

that Plaintiff was not losing weight, despite claims that pain prevented

him from eating, and that Plaintiff was able to move without apparent

distress]; ECF No. 22-5 at 29-31 [December 7, 2012, treatment notes

describing Dr. Chau’s assessment that Plaintiff was managing well on

non-narcotic medication]; ECF No. 22-4 at ¶ 48 [Dr. Chau’s assessment

that, based on x-rays taken on December 21, 2012, Plaintiff’s condition

did not warrant narcotic medication]; ECF No. 22-5 at 21-22 [December

26, 2012, treatment notes from Dr. Chadha recommending non-steroidal

anti-inflammatory medications to treat Plaintiff].) 

Defendants continued to adjust Plaintiff’s non-narcotic medication

to ensure that Plaintiff’s pain was being effectively managed. (Id. at 15,

40, 55.) Defendants also took other steps, including ordering Plaintiff a

special mattress, to further alleviate Plaintiff’s pain. (Id. at 46.) 

Further, on February 20, 2013, a multi-disciplinary meeting was held to

discuss Plaintiff’s medical conditions. (Id. at 14.) Several medical

professionals, including Dr. Chau, attended. (Id.) According to Dr. Chau,

all medical professionals present agreed that Plaintiff did not exhibit

difficulty with his daily activities. (ECF No. 22-4 at ¶ 52.) They noted

that Plaintiff was able to occasionally walk without his cane, had come to

the pill line without his cane, and had refused to take his prescribed

Amitriptyline. (Id.) Mental health professionals noted that Plaintiff ate

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and slept well, and had only minor depression which was caused at least

in part by the relocation of his cellmate to another facility. (Id.) 

Ultimately, the panel concluded that Plaintiff should remain on

Ibuprofen and Amitriptyline for pain and that morphine was

unnecessary. (ECF No. 22-5 at 14.) 

This falls far short of the high bar required for a showing of

deliberate indifference. Estelle, 429 U.S. at 104. Plaintiff has submitted

no evidence showing that Defendants delayed, denied, or interfered with

treatment. Hallet, 296 F.3d at 745. Rather, the evidence shows that

Defendants actively and continuously treated Plaintiff, taking

considerable efforts to ensure that Plaintiff’s pain was being managed

and that his underlying conditions were being treated. Defendants

consulted with other medical professionals who observed Plaintiff and

considered his medical records, and determined that Plaintiff was being

effectively treated without morphine. Plaintiff’s preference for other

medication and his subjective complaints of pain are insufficient to

overcome this evidence and do not preclude summary judgment. 

Toguchi, 391 F.3d at 1058. 

Accordingly, Plaintiff has failed to show that Defendants were

deliberately indifferent to his medical needs, and his claim fails as a

matter of law. The Court RECOMMENDS that Defendants’ Motion be

GRANTED as to counts one and two of Plaintiff’s Complaint. 

2. Due Process (Count 3)

Plaintiff also contends that Defendants violated his due process

rights when they discontinued his morphine medication without

providing him with a full and fair hearing. (ECF No. 1 at 5.) Plaintiff

states that he signed a Narcotic Pain Medication Agreement and adhered

to its terms. (Id.) He states he never took any non-prescribed drugs and

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that testing showed he had the morphine in his system. (Id.) Finally, he

notes that he was never found to have sold or traded his medications to

other inmates. (Id.) In their Motion, Defendants contend that Plaintiff

was not entitled to a hearing regarding his morphine medication and

therefore his due process rights were not violated. (ECF No. 22-2 at 27-

28.)

“The Due Process Clause of the Fourteenth Amendment provides

that no State shall deprive any person of life, liberty, or property, without

due process of law.” Thompson v. Souza, 111 F.3d 694, 701(9th Cir.

1997) (internal citations omitted). “The Fourteenth Amendment

prohibits prison officials from treating prisoners in a fashion so brutal

and offensive to human dignity as to shock the conscience.” Id. at 701

(internal citations omitted). “To state a claim under section 1983 based

on a Fourteenth Amendment due process violation, [a plaintiff] must

allege a liberty deprivation and a lack of due process.” McRorie v.

Shimoda, 795 F.2d 780, 785 (9th Cir. 1986).

First, as outlined above, Plaintiff has no right to the medication of

his choice. Plaintiff has a right to receive adequate medical care, but has

no right to supplemental care or the care of his choosing. See Roberts v.

Spalding, 783 F.2d 867, 870 (9th Cir. 1986) (holding that a prisoner has

no constitutional right to supplemental or outside care, beyond the care

required under the Eighth Amendment). It is possible, however, for “a

state to create a constitutionally protected liberty interest by establishing

regulatory measures that impose substantive limitations on the exercise

of official discretion.” Baumann v. Arizona Dept. of Corrections, 754 F.2d

841, 844 (9th Cir. 1985) (citing Hewitt v. Helms, 459 U.S. 460, 470-71

(1983).) “To establish a protected interest, a prisoner must show ‘that

particularized standards or criteria guide the State’s decisionmakers.’” 

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Baumann, 754 F.2d at 844 (quoting Olim v. Wakinekona, 461 U.S. 238,

249 (1983). Similarly, published prison regulations may create a

protected interest. Olim, 461 U.S. at 249-250. 

The Narcotic Pain Management Contract does not create such an

interest because it does not purport to limit Defendants’ discretion in

prescribing narcotic medication. Rather, it limits Plaintiff’s conduct as a

condition for receiving narcotic medication. (ECF No. 1, Ex. G; ECF No.

22-5 at 112-113.) Specifically, it advises Plaintiff that his narcotic

medication “is being started on a trial basis.” (ECF No. 22-5 at 113.) 

Plaintiff is also cautioned in the Contract that he is subject to urine drug

screens and his medications may be terminated if his prescribed

medication is not found in the correct amount in his system. (Id. at ¶

15(b).) Nothing in the Contract guarantees Plaintiff the right to narcotic

medication or states that his medication may only be discontinued after a

hearing on the matter. (Id.) Accordingly, Plaintiff does not have a

property right in narcotic pain medication. Olim, 461 U.S. at 249-250. 

Plaintiff has a right to adequate medical care, but as outlined above,

Plaintiff was receiving adequate medical care even after his morphine

was discontinued. 

Second, Plaintiff did not have the right to a hearing during his

administrative appeal process. In general, there is no constitutional

right to a prison administrative appeal or grievance system. Mann v.

Adams, 855 F.2d 639, 640 (9th Cir. 1988). Further, the evidence shows

that the Defendants acted in accordance with the Pain Management

Contract when they discontinued Plaintiff’s morphine. Plaintiff’s

contract specifically provides that his morphine will be discontinued if

morphine is not found in the correct amount in his system. (Id.) 

Laboratory testing of Plaintiff’s blood and urine showed that Plaintiff did

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not have hydromorphone in his system. It was the opinion of Dr. Chau,

Dr. Walker, and the medical professionals on the Pain Management

Committee that the absence of hydromorphone showed Plaintiff was not

compliant with his medication. (ECF No. 22-5 at 100.) The decision to

terminate Plaintiff’s morphine was the reasoned decision of a panel of

medical professionals. (Id.) Thus, the decision to remove Plaintiff from

his medication was well supported. Plaintiff’s contention that he was

never caught selling the morphine is not relevant. 

Plaintiff was also given the opportunity to be heard regarded the

discontinuation of his morphine. He filed a 602 Appeal and was

interviewed by Dr. Chau on July 16, 2012. (ECF No. 22-5 at 47.) He was

interviewed again on August 10, 2012, with regard to his second 602

Appeal. (Id. at 39.) There is no requirement that Plaintiff be afforded an

in-person hearing on the matter or that the evidence conclusively

demonstrate that Plaintiff was selling or trading morphine. Thompson,

111 F.3d at 701. So long as Defendants did not act in a manner that

“shocked the conscious,” there is no due process violation. Id. Plaintiff

has described no such conduct. Accordingly, his claim fails as a matter of

law and the Court RECOMMENDS that Defendants’ Motion be

GRANTED as to Plaintiff’ due process claim. 

3. Qualified Immunity

Defendants also assert the affirmative defense of qualified

immunity. Qualified immunity entitles government officials to “an

immunity from suit rather than a mere defense to liability; and like an

absolute immunity, it is effectively lost if a case is erroneously permitted

to go to trial.” Mitchell v. Forsyth, 472 U.S. 511, 526 (1985) (emphasis in

original). Qualified immunity shields government officials “from liability

for civil damages insofar as their conduct does not violate clearly

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established statutory or constitutional rights of which a reasonable

person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818

(1982) (citations omitted). Generally, qualified immunity doctrine must

“‘give [] ample room for mistaken judgments’ by protecting ‘all but the

plainly incompetent or those who knowingly violate the law.’” Hunter v.

Bryant, 502 U.S. 224, 229 (1991).

Analysis of qualified immunity begins with the two-step sequence of

analysis set forth by the Supreme Court in Saucier v. Katz, 533 U.S. 194

(2001). Initially, a court must determine whether, taken in the light

most favorable to the party asserting the injury, the facts alleged show

that the defendants’ conduct violated constitutional right. Id. at 201

(instructing federal courts not to assume the existence of a constitutional

right even if it is clear that the defendants would be entitled to qualified

immunity). If the answer to that question is no, then the case must be

dismissed as there is no valid cause of action. Vance v. Barrett, 345 F.3d

1083, 1088 (9th Cir. 2003). On the other hand, if a violation could be

made out, the next step is to ask whether the constitutional right was

clearly established and, if so, “whether it would be clear to a reasonable

officer that his conduct was unlawful in the situation he confronted.” See

Saucier 533 U.S. at 202; Robinson v. Solano County, 278 F.3d 1007, 1013

(9th Cir. 2002) (en banc) (explaining that “we must ask first whether the

facts taken in the light most favorable to the plaintiff would establish a

[constitutional] violation.... Only if the answer is in the affirmative

should we address the immunity issue.”); Valdez v. Rosenbaum, 302 F.3d

1039, 1049 (9th Cir. 2002) (having concluded there was no constitutional

violation the court need not reach the issue of qualified immunity). 

Qualified immunity protects “government officials . . . from liability

for civil damages insofar as their conduct does not violate clearly

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established statutory or constitutional rights of which a reasonable

person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818

(1982). Qualified immunity does not protect a defendant when: (1) the

defendant’s action violated a federal constitutional right; and, (2) the

right was clearly established at the time of the conduct at issue. LSO, Lt.

v. Stroh, 205 F.3d 1146, 1157 (9th Cir. 2000). 

Here, as described above, Defendants did not violate Plaintiff’s

constitutional rights. Accordingly, they are entitled to qualified

immunity. Id. If they had, however, because the right to medical care is

clearly established, Defendants would not be entitled to qualified

immunity.

VI. Conclusion

For the reasons set forth herein, it is RECOMMENDED that

Defendants’ Motion for Summary Judgment be GRANTED.

This report and recommendation will be submitted to the United

States District Judge assigned to this case, pursuant to the provisions of

28 U.S.C. § 636(b)(1) (1988). Any party may file written objections with

the court and serve a copy on all parties by June 4, 2014. The document

shall be captioned “Objections to Report and Recommendation.” Any

reply to the objections shall be served and filed by June 18, 2014.

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

DATED: May 13, 2014

 

 Hon. Mitchell D. Dembin

 U.S. Magistrate Judge

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