Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_11-cv-03185/USCOURTS-caed-2_11-cv-03185-8/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 

FOR THE EASTERN DISTRICT OF CALIFORNIA 

PAUL ANDREW SHIELDS, 

Plaintiff, 

v. 

KELLY L. CANNON, et. al., 

Defendants. 

No. 2:11-cv-3185 JAM AC P 

FINDINGS AND RECOMMENDATIONS 

 Plaintiff is a state prisoner proceeding pro se and in forma pauperis in this action filed 

pursuant to 42 U.S.C. § 1983. This action proceeds on the first amended complaint filed 

February 11, 2013, ECF No. 32. The sole remaining defendants are Dr. Padilla and Sheriff Jones. 

Pending before the court are defendants’ motion for summary judgment, ECF No. 66, and 

plaintiff’s motion to amend the first amended complaint, ECF No. 64. Both motions are fully 

briefed. 

PROCEDURAL BACKGROUND 

 The original complaint alleged that plaintiff was denied medical treatment for hepatitis C 

and cirrhosis in violation of the Eighth Amendment and that he was denied diabetic snacks in 

violation of the First and Eighth Amendments. ECF No. 1. Defendants filed a motion to dismiss 

the original complaint, ECF No. 13, which the court granted, ECF No. 28. Plaintiff was given 

leave to amend with respect to his denial of medical treatment claim only. ECF No. 28. 

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On February 11, 2013, plaintiff filed a first amended complaint against defendants 

Cannon, Maness, Padilla, and Jones. ECF No. 32. Defendants filed a motion to dismiss the first 

amended complaint. ECF No. 41. By order dated September 18, 2013, the court granted the 

motion to dismiss in part and denied it in part. ECF No. 45. The court granted the motion to 

dismiss as to defendants Cannon and Maness, as well as to defendant Jones in his individual 

capacity. Because the court found that plaintiff stated a colorable deliberate indifference claim 

and a colorable Monell claim, the court denied the motion to dismiss as to Padilla in his 

individual capacity and Padilla and Jones in their official capacities. Padilla and Jones answered 

the complaint on January 13, 2014. ECF No. 55. 

On February 14, 2014, the court issued a discovery and scheduling order requiring all 

pretrial motions to be filed on or before September 1, 2014. ECF No. 56 at 5. On August 22, 

2014, plaintiff filed a motion for leave to amend the amended complaint, ECF No. 64, 

accompanied by a proposed amended complaint, ECF No. 65. 

On August 29, 2014, defendants Padilla and Jones filed a motion for summary judgment 

on the first amended complaint. ECF No. 66. On September 11, 2014, defendants filed an 

opposition to plaintiff’s motion to amend the complaint. ECF No. 67. On September 22, 2014, 

the court granted plaintiff’s request for a thirty-day extension of time to file a response to 

defendants’ summary judgment motion. Plaintiff replied to defendants’ opposition to the motion 

to amend on September 30, 2014. ECF No. 72. On October 27, 2014, plaintiff opposed 

defendants’ motion for summary judgment. ECF No. 73. Defendants replied to plaintiff’s 

opposition to the motion for summary judgment on November 5, 2014. On February 3, 2015, 

plaintiff filed a supplemental declaration in relation to his opposition to defendants’ summary 

judgment motion. ECF No. 76. 

ALLEGATIONS OF THE FIRST AMENDED COMPLAINT 

Plaintiff asserts that Cannon, Maness, defendant Padilla, and defendant Jones violated his 

rights under the Eighth Amendment when they failed to provide treatment for plaintiff’s hepatitis 

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C and cirrhosis during his incarceration at the Sacramento County Main Jail (SCMJ).1 

Specifically, plaintiff alleges that when he arrived at SCMJ on or about January 20, 2009, he 

immediately notified medical staff of his medical issues and requested treatment. Id. at 12. 

On March 1, 2011, plaintiff submitted a health care service request for treatment of his 

liver diseases, stating that he had severe abdominal pain and diarrhea. Id. at ¶ 14. 

 On June 27, 2011, he filed a grievance stating that he had been trying to get treatment for 

hepatitis C since he arrived at the jail but that his requests had been ignored. Id. at ¶ 15. On 

August 16, 2011, he filed a second grievance requesting medical treatment. Id. at ¶ 16 & Ex. H. 

 On September 2, 2011, Kelly Cannon, the Patient Grievance Coordinator for Correctional 

Health Services, SSD, responded to plaintiff’s grievances, advising him that he was being treated 

for cirrhosis and that “Correctional Health does not treat Hepatitis C.” Id. at ¶ 17 & Ex. H. 

 On September 13, 2011, plaintiff filed an appeal directed to Eric Maness, the division 

commander, to express dissatisfaction with Cannon’s response. ECF No. 32 at ¶ 18. Maness did 

not respond. Id. Instead, plaintiff received another response from Cannon, stating in relevant part 

that Cannon and defendant Padilla, the Medical Director, had reviewed plaintiff’s medical records 

and that plaintiff’s request for treatment was denied because “CHS does not treat Hepatitis C and 

does not have a specific contract with any provider to treat our Hepatitis patients.” Id. at ¶ 19 & 

Ex. J. Plaintiff was advised of the option to secure treatment with an outside physician at his own 

expense. Id. Due to not receiving medical treatment for cirrhosis and hepatitis C, plaintiff 

suffered severe abdominal pain, liver pain, diarrhea, fatty liver, and increased risk of premature 

death. Id. at ¶¶ 19−20, 22, 27, 30. 

Plaintiff alleges that Sheriff Jones implemented the policy of denying treatment to inmates 

suffering from hepatitis C and that as the Sheriff of Sacramento County, Jones is the “ultimate 

authority” and no polices are made without his knowledge and approval. Id. at ¶ 21. 

Plaintiff seeks damages and states that defendants are sued in both their individual and 

//// 

 

1

 Because Cannon and Maness were dismissed pursuant to the court’s September 18, 2013 order, 

the first amended complaint proceeds against defendants Padilla and Jones only. 

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official capacities.2 Id. at ¶¶ 6−9, 32. 

ALLEGATIONS OF THE PROPOSED AMENDED COMPLAINT3

 In the proposed amended complaint (“SAC”), ECF No. 65, plaintiff re-alleges the 

majority of the allegations contained in the first amended complaint (“FAC”), with one notable 

distinction. In the SAC, plaintiff alleges that Correctional Health Services does have a policy of 

providing treatment for inmates suffering from hepatitis C and that grievance coordinator Kelly 

Cannon lied when she stated, in response to plaintiff’s grievances, that CHS does not treat 

hepatitis C.4 Plaintiff alleges that Dr. Padilla knew of Cannon’s untruthful statement and relied 

on it in denying plaintiff Hepatitis C treatment. Sheriff Jones and Maness, the division 

commander, were also aware of Cannon’s misstatement of the policy, but failed to correct her lie. 

Plaintiff also appears to allege that defendants allowed Cannon, who is not a medical 

professional, to make a medical decision regarding his treatment, and that defendants “willfully 

turn[ed] a blind eye” to the violation of plaintiff’s rights. Id. at ¶ 24. Plaintiff contends that based 

on this “new evidence,” Cannon and Maness should be re-joined as defendants. 

DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT 

I. Defendants’ Argument 

 Defendants contend that they are entitled to judgment as a matter of law on both plaintiff’s 

deliberate indifference claim and Monell claim. 

As to the deliberate indifference claim, defendants contend that SCMJ has an express 

written policy regarding hepatitis C (“HCV”) treatment for inmates and that plaintiff was 

evaluated and treated pursuant to this policy. ECF No. 66 at 6. Dr. Padilla reviewed plaintiff’s 

medical records and determined based on his medical judgment that plaintiff was not a candidate 

for HCV treatment due to the presence of several contraindications to therapy. Id. at 9, 11. 

 

2

 Pursuant to the court’s September 18, 2013 order, the FAC proceeds against Padilla in both his 

individual and official capacity and against Jones in his official capacity only. 

3

 The court does not consider the allegations contained in the proposed amended complaint when 

evaluating defendants’ motion for summary judgment, but includes them here to provide context 

for the arguments plaintiff makes in his opposition to defendants’ summary judgment motion. 

4

 Plaintiff explains that he became aware of this policy in August 2014 while conducting 

discovery. 

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Specifically, the policy provides that while “[p]atients who are positive for Hepatitis C will be 

treated . . . according to eligibility criteria established by the [National Health Institute],” 

“[p]atients who have absolute contraindications will not be referred for treatment.” Id. at 7. 

According to the policy, “poorly controlled diabetes” is an absolute contraindication for 

treatment. Id. In addition, current use of alcohol or drugs is listed as a contraindication that 

would require an assessment for individualized treatment and eligibility. Id. Because Dr. Padilla 

determined that plaintiff’s diabetes was poorly controlled and that plaintiff was continuing to 

abuse alcohol, Padilla concluded that plaintiff was ineligible for HCV treatment. 

 Defendants submit a number of plaintiff’s lab test results in support of Dr. Padilla’s 

conclusion that plaintiff’s diabetes was uncontrolled and that plaintiff was continuing to abuse 

alcohol. With respect to plaintiff’s claim that he was denied treatment for cirrhosis, defendants 

submit documentation indicating that when plaintiff began having symptoms that he believed 

were caused by HCV, Correctional Health Services began plaintiff on Lactulose for treatment of 

his cirrhosis. However, plaintiff subsequently requested that the Lactulose be discontinued. ECF 

No. 66 at 8. 

 Defendants contend that plaintiff’s claim amounts to nothing more than an alleged 

difference of opinion concerning the appropriate course of medical treatment, which is 

insufficient to establish deliberate indifference. ECF No. 66 at 13. Defendants argue that while 

they have produced evidence that Dr. Padilla relied on his medical judgment in determining that 

plaintiff was not a candidate for HCV therapy based on his assessment that plaintiff’s diabetes 

was uncontrolled, plaintiff has failed to produce evidence that Padilla’s actions or failures to act 

were in conscious disregard of an excessive risk to plaintiff’s health or were medically 

unacceptable under the circumstances. Id. at 13-14. Defendants assert that because Dr. Padilla 

made a reasoned medical decision based on plaintiff’s test results and medical history, Padilla 

was not deliberately indifferent as a matter of law and defendants are entitled to summary 

judgment on this claim. Id. at 14-15. 

 With respect to the Monell claim, defendants move for summary judgment on the grounds 

that plaintiff has not established an underlying constitutional violation and therefore cannot 

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prevail on his claim. ECF No. 66 at 15. Even assuming a constitutional violation, defendants 

assert that plaintiff has failed to produce evidence that SCMJ had a policy or custom of not 

treating inmates with hepatitis C, particularly in light of SCMJ’s express written policy regarding 

HCV treatment and the fact that plaintiff was treated according to this policy. Id. at 16. 

Defendants further contend that plaintiff cannot identify an official with policy making authority 

who deprived plaintiff of HCV or cirrhosis treatment and that to the extent plaintiff alleges that 

grievance coordinator Cannon caused plaintiff to be denied treatment, plaintiff has produced no 

evidence indicating that she had control over his medical care. Id. at 17. Accordingly, 

defendants assert that summary judgment is appropriate because plaintiff has failed to establish 

the essential elements of a Monell claim. 

II. Plaintiff’s Opposition 

 Plaintiff submitted a memorandum in opposition to defendants’ summary judgment 

motion, ECF No. 73 at 1-58, as well as a statement of “Genuine Disputed Facts” in support of his 

opposition, id. at 59-78, in which he makes an effort to provide citations to the record in support 

of his asserted disputed facts. He also attaches a number of exhibits to his opposition and has 

filed a supplemental declaration, ECF No. 76, in which he explains the relevance of the attached 

exhibits. 

It is well-established that the pleadings of pro se litigants are held to “less stringent 

standards than formal pleadings drafted by lawyers.” Haines v. Kerner, 404 U.S. 519, 520 (1972) 

(per curiam). Nevertheless, “[p]ro se litigants must follow the same rules of procedure that 

govern other litigants.” King v. Atiyeh, 814 F.2d 565, 567 (9th Cir. 1987), overruled on another 

ground by Lacey v. Maricopa County, 693 F.3d 896 (9th Cir. 2012) (en banc). However, the 

unrepresented prisoners' choice to proceed without counsel “is less than voluntary” and they are 

subject to the “handicaps . . . detention necessarily imposes upon a litigant,” such as “limited 

access to legal materials” as well as “sources of proof.” Jacobsen v. Filler, 790 F.2d 1362, 

1364-65 & n.4 (9th Cir. 1986). Inmate litigants, therefore, should not be held to a standard of 

“strict literalness” with respect to the requirements of the summary judgment rule. Id. 

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 The court is mindful of the Ninth Circuit's more overarching caution in this context, as 

noted above, that district courts are to “construe liberally motion papers and pleadings filed by 

pro se inmates and . . . avoid applying summary judgment rules strictly.” Ponder, 611 F.3d 

at 1150. Accordingly, the court considers the record before it in its entirety despite plaintiff's 

failure to be in strict compliance with the applicable rules. However, only those assertions in the 

opposition which have evidentiary support will be considered. 

Plaintiff sets forth two primary arguments in opposition to defendants’ summary judgment 

motion. First, plaintiff asserts that there is a dispute of material fact as to whether plaintiff was 

eligible for HCV treatment. Specifically, plaintiff claims that a prescription from another doctor 

shows he was eligible for HCV therapy, that his glucose test results and medical records show 

that his diabetes was controlled or at its goal, and that there is a factual dispute as to whether 

plaintiff was abusing alcohol. Plaintiff’s second argument is that defendants did not rely on 

plaintiff’s medical history or test results at all in denying him treatment; instead, defendants 

denied plaintiff treatment because the grievance counselor (Cannon) stated in response to 

plaintiff’s grievances that CHS does not provide treatment for hepatitis C. Plaintiff contends that 

because Cannon’s statement was the only reason he was ever given for being denied HCV 

treatment, Cannon’s statement must have been the reason he did not receive treatment. 

 Plaintiff asserts that Dr. Padilla was both aware of plaintiff’s serious medical need for 

treatment for hepatitis C and cirrhosis, and that Padilla acted in conscious disregard of this need. 

Plaintiff asserts that Dr. Padilla was subjectively aware of plaintiff’s need for treatment because 

Padilla reviewed plaintiff’s medical records and therefore understood that HCV treatment was 

necessary to prevent further injuries to plaintiff. Id. at 35. Despite this knowledge, Padilla failed 

to respond reasonably to plaintiff’s serious medical needs, intentionally interfered with the 

treatment prescribed by another doctor, and deliberately tried to deceive plaintiff into thinking 

that he could not receive treatment for HCV while incarcerated at SCMJ. Id. at 36, 38. Plaintiff 

asserts that his claim is not based on a difference of medical opinion concerning treatment 

options, because he was never treated for HCV. Plaintiff states that he “may have been 

monitored or evaluated [for HCV] but never treated.” Id. at 41. 

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 With respect to his Monell claim, plaintiff alleges that in denying plaintiff treatment, 

defendants instituted a policy or custom that was contrary to their established administrative 

policy regarding hepatitis C treatment and that this policy or custom of non-treatment was the 

moving force behind his injuries. Id. In other words, plaintiff appears to allege that defendants’ 

failure to treat plaintiff’s serious medical needs was a result of a custom of disregarding their own 

written policy, which expressly provided for treatment of inmates with hepatitis C. Id. at 50-52. 

III. Defendants’ Reply 

 In reply, defendants emphasize that the issue on summary judgment is not what the most 

appropriate course of treatment for plaintiff was, but whether defendants’ “failure to timely give a 

certain type of treatment was, in essence, criminally reckless.” ECF No. 74 at 3. Defendants 

filed formal objections to the evidence offered by plaintiff in opposition to defendants’ summary 

judgment motion, ECF No. 74-2, and assert that plaintiff has failed to produce any competent 

evidence that contraindications to HCV therapy were not present, that plaintiff’s diabetes was 

well-controlled, or that plaintiff’s elevated GGT levels were not due to continuing alcohol abuse. 

Id. Defendants further assert that in cases involving complex medical issues where the plaintiff 

contests the type of treatment he received, expert opinion will almost always be necessary to 

establish deliberate indifference, yet plaintiff failed to provide any expert testimony. Id. at 2-3. 

Defendants contend that plaintiff is not qualified to offer an opinion regarding his eligibility for 

HCV treatment and that plaintiff’s improper lay opinion is insufficient to establish a factual 

dispute as to whether plaintiff was eligible for such treatment. Id. at 3-5. 

As to the Monell claim, defendants assert that Cannon’s two statements that “CHS does 

not treat Hepatitis C” are insufficient by themselves to establish the existence of a long-standing 

policy or custom of non-treatment, particularly in light of the fact that plaintiff was treated and 

monitored according to SCMJ’s express written treatment policy. ECF No. 74 at 7-8. While 

plaintiff alleges that Cannon caused plaintiff to be denied HCV treatment, defendants contend 

that Cannon is a grievance coordinator and not a policymaker or medical professional. Id. at 8. 

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IV. Legal Standard for Rule 56 (Summary Judgment) Motions 

Summary judgment is appropriate when the moving party “shows that there is no genuine 

dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. 

Civ. P. 56(a). Under summary judgment practice, the moving party “initially bears the burden of 

proving the absence of a genuine issue of material fact.” Nursing Home Pension Fund, Local 144 

v. Oracle Corp. (In re Oracle Corp. Securities Litigation), 627 F.3d 376, 387 (9th Cir. 2010) 

(citing Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)). The moving party may accomplish 

this by “citing to particular parts of materials in the record, including depositions, documents, 

electronically stored information, affidavits or declarations, stipulations (including those made for 

purposes of the motion only), admission, interrogatory answers, or other materials” or by showing 

that such materials “do not establish the absence or presence of a genuine dispute, or that the 

adverse party cannot produce admissible evidence to support the fact.” Fed. R. Civ. 

P. 56(c)(1)(A), (B). 

 When the non-moving party bears the burden of proof at trial, “the moving party need 

only prove that there is an absence of evidence to support the nonmoving party's case.” Oracle 

Corp., 627 F.3d at 387 (citing Celotex, 477 U.S. at 325); see also Fed. R. Civ. P. 56(c)(1)(B). 

Indeed, summary judgment should be entered, after adequate time for discovery and upon motion, 

against a party who fails to make a showing sufficient to establish the existence of an element 

essential to that party's case, and on which that party will bear the burden of proof at trial. See 

Celotex, 477 U.S. at 322. “[A] complete failure of proof concerning an essential element of the 

nonmoving party's case necessarily renders all other facts immaterial.” Id. In such a 

circumstance, summary judgment should be granted, “so long as whatever is before the district 

court demonstrates that the standard for entry of summary judgment ... is satisfied.” Id. at 323. 

 If the moving party meets its initial responsibility, the burden then shifts to the opposing 

party to establish that a genuine issue as to any material fact actually does exist. See Matsushita 

Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). In attempting to establish the 

existence of this factual dispute, the opposing party may not rely upon the allegations or denials 

of its pleadings but is required to tender evidence of specific facts in the form of affidavits, and/or 

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admissible discovery material, in support of its contention that the dispute exists. See Fed. R. 

Civ. P. 56(c)(1); Matsushita, 475 U.S. at 586 n.11. Moreover, “[a] Plaintiff's verified complaint 

may be considered as an affidavit in opposition to summary judgment if it is based on personal 

knowledge and sets forth specific facts admissible in evidence.” Lopez v. Smith, 203 F.3d 1122, 

1132 n.14 (9th Cir. 2000) (en banc).5

The opposing party must demonstrate that the fact in contention is material, i.e., a fact that 

might affect the outcome of the suit under the governing law, see Anderson v. Liberty Lobby, 

Inc., 477 U.S. 242, 248 (1986); T.W. Elec. Serv., Inc. v. Pacific Elec. Contractors Assoc., 809 

F.2d 626, 630 (9th Cir. 1987), and that the dispute is genuine, i.e., the evidence is such that a 

reasonable jury could return a verdict for the nonmoving party, see Wool v. Tandem Computers, 

Inc., 818 F.2d 1433, 1436 (9th Cir. 1987). 

 In the endeavor to establish the existence of a factual dispute, the opposing party need not 

establish a material issue of fact conclusively in its favor. It is sufficient that “the claimed factual 

dispute be shown to require a jury or judge to resolve the parties' differing versions of the truth at 

trial.” T.W. Elec. Serv., 809 F.2d at 631. Thus, the “purpose of summary judgment is to ‘pierce 

the pleadings and to assess the proof in order to see whether there is a genuine need for trial.’” 

Matsushita, 475 U .S. at 587 (citations omitted). 

 “In evaluating the evidence to determine whether there is a genuine issue of fact,” the 

court draws “all reasonable inferences supported by the evidence in favor of the non-moving 

party.” Walls v. Central Costa County Transit Authority, 653 F.3d 963, 966 (9th Cir. 2011) (per 

curiam). It is the opposing party's obligation to produce a factual predicate from which the 

inference may be drawn. See Richards v. Nielsen Freight Lines, 602 F. Supp. 1224, 1244–45 

(E.D. Cal. 1985), aff'd, 810 F.2d 898, 902 (9th Cir. 1987). Finally, to demonstrate a genuine 

issue, the opposing party “must do more than simply show that there is some metaphysical doubt 

as to the material facts. ... Where the record taken as a whole could not lead a rational trier of 

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5

 Plaintiff filed a verified First Amended Complaint in this case. See ECF No. 32. 

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fact to find for the nonmoving party, there is no ‘genuine issue for trial.’” Matsushita, 475 U.S. at 

587 (citation omitted). 

 In applying these rules, district courts must “construe liberally motion papers and 

pleadings filed by pro se inmates and ... avoid applying summary judgment rules strictly.” 

Thomas v. Ponder, 611 F.3d 1144, 1150 (9th Cir. 2010). However, “[if] a party fails to properly 

support an assertion of fact or fails to properly address another party's assertion of fact, as 

required by Rule 56(c), the court may ... consider the fact undisputed for purposes of the motion 

....” Fed. R. Civ. P. 56(e)(2). 

V. Undisputed Material Facts 

 The court finds the following facts to be undisputed:6

 Defendant Padilla is currently the Medical Director for the Sacramento County Main Jail 

(“SCMJ”) and has been in that position since 2010. Declaration of Dr. Robert Padilla 

(“Padilla Decl.”) (ECF No. 66-5) at 1, ¶ 1. 

 As Medical Director, Padilla oversees healthcare at SCMJ. Id. ¶ 2. 

 One of Padilla’s responsibilities as Medical Director is to collaborate with other 

individuals and several committees on policies for the administration of health services to 

inmates at SCMJ and to adhere to those policies. Id. at ¶ 3. 

 At all times relevant to the complaint, plaintiff suffered from diabetes mellitus. 

Defendants’ Undisputed Facts (“Facts”) (ECF No. 66-2) at ¶ 1.7

 In 2002, plaintiff was diagnosed with hepatitis C (“HCV”), but was not prescribed 

medical treatment. Facts ¶ 2. 

 On April 11, 2005, a liver biopsy revealed that plaintiff had developed “cirrhosis of the 

liver with stage (4) fibrous.” Plaintiff was not prescribed treatment at that time. Facts ¶ 3. 

 On September 18, 2006, while incarcerated at San Quentin State Prison, plaintiff was seen 

by Dr. Lopin. Facts ¶ 4. The record indicates that Dr. Lopin wrote the following 

assessment/plan for plaintiff: 

 

6

 In his opposition papers, plaintiff purports to “dispute” the majority of the facts asserted in 

defendants’ statement of undisputed facts. However, is clear from plaintiff’s responses that he 

does not actually dispute each fact, but rather disagrees with how particular facts should be 

interpreted or argues that the fact does not entitle defendants to summary judgment. 

7

 Where, as here, defendant’s Undisputed Facts are supported by the submitted evidence, and not 

seriously contested by plaintiff, the court cites only to the relevant paragraph of defendant’s 

Undisputed Facts. 

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1. Cirrhosis. Continued monitoring. 

2. Hepatitis C virus positive, hepatitis B virus positive. Stage IV 

liver disease. The patient was seen by infectious disease on 

6/26/2006, and therapy was recommended for the hepatitis if 

the patient could achieve better control of his diabetes; i.e., 

bringing the A1C to approximately 6.5. 

3. Diabetes mellitus, fair to poor control secondary to compliance 

issues. The patient takes insulin NPH 12 units b.i.d. and regular 

6 units b.i.d. He has only been receiving his evening dose on a 

regular basis. The morning dose he receives 3 days a week, 

Fridays, Saturdays, and Sundays, because he does not work. 

His work schedule Monday through Thursday is interfering 

with his receiving medications in the morning on those days. 

The patient states that, early in the mornings, the drugs are not 

available, and he needs to get to work. At this time, the patient 

is going to wait at the recommendation of this doctor and 

others who have preceded me until the medication is available. 

Ideally, this patient will comply fully with the insulin regimen, 

bring the A1C down, and then we can proceed to therapy for 

his hepatitis. 

Facts ¶ 4; First Amended Complaint (“FAC”) (ECF No. 32) Exh. D at 22. 

 Plaintiff did not receive any treatment for HCV from 2002-2009. Facts at 3, ¶ 5. 

 Plaintiff arrived at Sacramento County Main Jail on or about January 20, 2009. Facts at 4, 

¶ 8. He remained incarcerated at SCMJ until March 15, 2012. Plaintiff’s Declaration 

(ECF No. 73) Exh. P at 121. 

 Upon plaintiff’s arrival at SCMJ, the medical staff noted that plaintiff suffered from the 

following conditions: bipolar disorder, antisocial personality disorder, insulin dependent 

diabetes mellitus, hypertension, hepatitis C with cirrhosis, and gastroesophageal reflux 

disease. Facts at 4, ¶ 9. Liver function tests and tests for plaintiff’s diabetes were ordered 

and completed. Id. at ¶ 10. 

 When plaintiff first arrived at SCMJ in 2009, he was not having any difficulties with 

hepatitis C. Plaintiff states that he did not start having symptoms until 2011. Plaintiff’s 

Deposition (“Deposition”) (ECF No. 66-4) at 6:10-17. 

 The record indicates that on or about March 1, 2011, plaintiff filed a health services “kite” 

requesting to see a doctor about treatment for liver disease because he was having severe 

stomach pain and diarrhea. Plaintiff states in the document that it is his second health 

service kite. FAC Exh. E at 25. 

 The record indicates that on June 27, 2011, plaintiff submitted an inmate grievance 

alleging that he had been asking for hepatitis C treatment for two and a half years, but was 

constantly refused treatment and told by medical staff that they do not treat his type of 

illnesses. He states in the grievance that he has been having complications and that he has 

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had blood drawn, but has not received any of the results. FAC Exh. F at 27.8

 On or about June 27, 2011, Correctional Health Services began plaintiff on Lactulose for 

his cirrhosis. Padilla Decl. at 4, ¶ 13. 

 On July 29, 2011 and July 30, 2011, plaintiff refused to take his Lactulose and on July 31, 

2011 he asked that it be discontinued altogether. Facts at 6, ¶ 18. 

 The record indicates that on or about August 16, 2011, plaintiff submitted another inmate 

grievance regarding his lack of hepatitis C and cirrhosis treatment. He states in the 

grievance that his June 17, 2011 grievance had not been responded to. FAC Exh. G at 29. 

 On or about September 2, 2011, Kelly Cannon, the Patient Grievance Coordinator, 

responded to plaintiff’s June 27, 2011 and August 16, 2011 grievances. The record 

reveals that Cannon responded to plaintiff, in relevant part, as follows: 

Correctional Health does not treat Hepatitis C. You were being 

treated for your Cirrhosis; on 7/30/11 you refused the Lactulose and 

requested that it be discontinued. If you want to start back on 

Lactulose, you will need to sign up for Nurse sick call and request 

it. 

Lab results are not typically reported to the patient unless they are 

not within normal limits or something is newly diagnosed. You can 

take that as, no news is good news and that your labs are normal for 

you and that there have been no significant changes. If you do not 

want to accept that, you can sign up for the nurse sick call and ask 

the Nurse to go over the results with you. 

FAC at 31. 

 The record indicates that on or about September 13, 2011, plaintiff wrote a letter 

addressed to “Captain, Erik Maness” explaining that plaintiff only refused to take 

Lactulose because he was not told that it was to treat his cirrhosis and that had he been 

properly informed, he would not have rejected it. He also wrote that “Kelly Cannon said 

that correctional health does not treat Hepatitis C, which is deliberate indifference to [his] 

serious medical needs,” and that he “know[s] for a fact that you have contracts with 

outside medical providers.” FAC Exh. I at 33. 

 On September 22, 2011, Cannon replied to plaintiff’s September 13, 2011 letter addressed 

to Maness. The record indicates that Cannon responded as follows: 

In response to your appeal dated 9-3-11, I have reviewed your 

appeal and your medical file with the Medical Director. The review 

indicates the following: You are welcome to send in a pink medical 

kite and request to start back on the Lactulose if you want to restart 

treatment. CHS does not treat Hepatitis C and does not have a 

specific contract with any provider to treat our Hepatitis patients. 

 

8

 Defendants do not “admit” any facts with respect to plaintiff’s grievances or health services kite 

but do not seriously dispute that these documents were filed. 

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FAC at 35. The letter also informed plaintiff that he could seek hepatitis C treatment from 

a physician in the community at his own expense. Id. 

 Plaintiff did not seek a community physician to treat his HCV. Facts at 7, ¶ 20. 

A. SCMJ’s Hepatitis C Treatment Policy 

 Sacramento County Main Jail has an express written policy that defines protocols and 

procedures for treatment of inmate-patients diagnosed with or suspected to suffer from 

hepatitis C. The policy is entitled Administrative Policy 1714 and was adopted in 2006. 

Administrative Policy 1714 (“Policy 1714”) follows the guidelines set forth by the 

National Institute of Health (NIH) and represents medically accepted practices at the time 

the policy is in place. Facts ¶ 6. 

 Policy 1714 provides that: 

Hepatitis C is a serious and potentially life threatening chronic 

disease. Patients who are positive for hepatitis C will be treated 

with interferon and ribavirin according to eligibility criteria 

established by NIH and under the consultative care of a 

gastroenterologist. 

[] 

Patients who have absolute contraindications for treatment will not 

be referred for treatment. 

Patients who are not eligible for interferon treatment will be 

followed regularly every 3-6 months and informed of their current 

status. 

ECF No. 65 at 48; FAC Exh. F at 93. 

 A “contraindication” is a condition or factor that serves as a reason to withhold certain 

medical treatment. Padilla Decl. at 4, ¶ 17. 

 Under the heading “PROCEDURE,” Policy 1714 provides that: 

Persons suspected of being positive for Hepatitis C by history or 

known risk factors should be screened. 

If positive, liver function tests, immune status to Hepatitis A and B, 

HIV and viral load should be determined. Other co-morbid 

conditions or potential contraindications should be determined, 

such as disease, depression, pregnancy, thyroid disease. 

History of substance abuse is not an absolute contraindication to 

treatment depending on the severity of disease and length of time 

away from drugs or alcohol. 

 Policy 1714 further provides that “[t]herapy is currently contraindicated for . . . [s]evere 

concurrent disease: [s]evere HTN, heart failure, CAD, poorly controlled diabetes, COPD.” 

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ECF No. 65 at 50; FAC Exh. F at 95. 

 Policy 1714 states that HCV therapy must be individualized for “current users (within 6 

months of last use) or drugs or alcohol.” ECF No. 65 at 49; FAC Exh. F at 94. 

 In the “DISCUSSION” section of Policy 1741, there is a notation that: 

Patients with recent (less than 6 months) histories of drug and 

alcohol abuse are difficult to assess for severity of illness and most 

specialists recommend waiting until the effects on the liver are 

solely from the virus. However, if the status of the patient is 

deteriorating, the six month “clean and sober” period may be 

waived as an eligibility criterion. 

ECF No. 65 at 47-48; ECF No. 73 at 92-93. 

B. Dr. Padilla’s Review 

 Dr. Padilla declares that he reviewed plaintiff medical records to evaluate whether or not 

plaintiff was eligible to receive HCV antiviral therapy. Padilla Decl. at 4, ¶ 16. 

 Based on Dr. Padilla’s own medical training and experience, his review of plaintiff’s 

medical history, including lab testing done of plaintiff’s liver function, glucose levels over 

time, daily glucose levels, and GGT levels, and in light of the guidelines set for in Policy 

1714, Dr. Padilla determined that HCV treatment was inappropriate for plaintiff based on 

the presence of several contraindications to HCV therapy. Padilla Decl. at 4, ¶ 16. 

 Dr. Padilla declares that pursuant to Policy 1714 and the NIH guidelines in place at the 

time, “Plaintiff’s uncontrolled diabetes was an absolute contraindication to HCV antiviral 

therapy and thus, plaintiff was ineligible [for treatment].” Padilla Decl. at 4, ¶ 18. 

 Dr. Padilla declares that plaintiff was not eligible for HCV therapy “due to the presence of 

another contraindication to therapy; i.e. that several liver function tests revealed that any 

negative effect to plaintiff’s liver was attributable to continuing alcoholism as opposed to 

Hepatitis C.” Padilla Decl. at 6, ¶ 43. 

C. Plaintiff’s Lab Tests 

 As part of the management and monitoring of plaintiff’s chronic care condition (diabetes 

mellitus) and his reported HCV and cirrhosis, SCMJ tested plaintiff’s glucose and liver 

function frequently. Padilla Decl. at 3, ¶ 9. 

1. Glucose Testing 

 For management of his diabetes, plaintiff received daily glucose testing. Padilla Decl. at 

3, ¶ 11. 

 There are two ways to test glucose levels. A test on Glycohemoglobin reflects glucose 

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levels over time, while the finger stick method measures glucose levels at a particular 

point in time. Padilla Decl. at 5, ¶ 19. 

i. Glycohemoglobin Tests (A1C Tests) 

 Glycohemoglobin tests reflect glucose level over time because Glycohemoglobin levels 

increase as glucose levels remain high for an extended period of time. Padilla Decl. at 5, ¶ 

19. 

 Plaintiff’s Glycohemoglobin test results from his time at SCMJ are reflected on his lab 

reports under the heading “Hemoglobin 1AC immunoassay” (hereafter “A1C”). 

 The normal range for Glycohemoglobin is 4.4%-6.6%. Padilla Decl. at 5, ¶ 19. 

 Dr. Padilla declares that in order to be eligible for HCV treatment, plaintiff’s A1C level 

needed to be at 6.5%.9

 Padilla Decl. at 5, ¶ 19. 

 Plaintiff’s test results reveal the following: 

o On June 4, 2009, plaintiff’s A1C level was at 9.2%. ECF No. 66-6 Exh. F at 107. 

o On November 23, 2009, plaintiff’s A1C level was at 8.7%.10 Padilla Decl. at 5, ¶ 

22. 

o On August 10, 2011, plaintiff’s A1C level was at 8.8%. ECF No. 66-6 Exh. H at 

110. 

o On March 14, 2012, plaintiff’s A1C level was at 10%. ECF No. 66-6 Exh. I at 114. 

ii. Finger Stick Tests 

 Plaintiff received finger stick glucose testing twice daily while incarcerated at SCMJ. The 

results of plaintiff’s finger stick tests are reflected in the “Diabetic Flow Sheets.” Padilla 

Decl. at 3, ¶ 11; 5, ¶ 19. 

 To be in an appropriate range, plaintiff’s glucose level should have been between 65-99 

ml/dL. Padilla Decl. at 5, ¶ 25. 

 Plaintiff’s test results show the following glucose levels:11

o January 21, 2009: 208 ml/dL. ECF No. 66-6 Exh. C. 

 

9

 This fact is undisputed to the extent that plaintiff acknowledges that Padilla used 6.5% as an 

eligibility criterion. 

10 Defendants purport to attach the November 23, 2009 test results as “Exhibit G,” but nothing is 

attached. See ECF No. 66-6 at 108. 

11 These are not the only results available, see ECF No. 66-6 at 18-103, but are the results that 

defendants cite to. 

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o January 22, 2009: 112 ml/dL. Id. 

o April 23, 2009: 40 ml/dL. Id. at Exh. J. 

o June 4, 2009: 250 ml/dL.12 Padilla Decl. at 5, ¶ 29. 

o October 5, 2009: 77 ml/dL. ECF No. 66-6 Exh. K. 

o November 3, 2009: 209 ml/dL. Id. at Exh. L. 

o November 23, 2009: 232 ml/dL.13 Padilla Decl. at 5, ¶ 7. 

o December 1, 2009: 248 ml/dL. ECF No. 66-6 Exh. M. 

o August 4, 2010: 251 ml/dL.14 Id. at Exh. N. 

o December 10, 2010: 251 ml/dL.15 Id. at Exh. O. 

o May 31, 2011:299 ml/dL. Id. at Exh. P. 

o August 10, 2011: 278 ml/dL.16 Id. at Exh. H. 

o August 17, 2011: 354 ml/dL. Id. at Exh. Q. 

o September 16, 2011: 220 ml/dL. Id. at Exh. R. 

o September 22, 2011: 179 ml/dL. Id. at Exh. S. 

o December 12, 2011: 253 ml/dL. Id. at Exh. T. 

o March 14, 2012: 371 ml/dL. Id. at Exh. I. 

 Dr. Padilla declares that he relied on plaintiff’s glucose test results, among other factors, 

in determining that plaintiff’s uncontrolled diabetes rendered plaintiff ineligible for HCV 

antiviral therapy. See Padilla Decl. at 4, ¶¶ 16, 18. 

2. Liver Tests 

 SCMJ tested plaintiff’s liver function frequently. Padilla Decl. at 3, ¶ 9. Plaintiff 

received liver testing on the following dates: January 21, 2009; January 22, 2009; April 

23, 2009; October 5, 2009; November 3, 2009; December 1, 2009; August 4, 2010; 

December 9, 2010; May 31, 2011; August 10, 2011; August 17, 2011; September 16, 

2011; September 22, 2011; December 12, 2011; March 14, 2012. Id. ¶ 12; Facts ¶ 14. 

 To test plaintiff’s liver function, SCMJ tested plaintiff’s levels of alanine aminotransferase 

(“ALT”), bilirubin, and aspartate aminotransferase (“AST”). Padilla Decl. at 3, ¶ 9. 

 Both ALT and AST levels are reliable tests for liver damage. Id. 

 When the liver is damaged, it releases ALT levels into the bloodstream, which makes the 

ALT levels go up. Id. 

 Most increases in ALT levels are caused by liver damage. Id. The ALT test is typically 

done with other tests that check for liver damage, including AST, alkaline phosphatase 

(“ALP”), lactate dehydrogenase (“LDH”), and bilirubin. Id. 

 Dr. Padilla declares that in determining that HCV antiviral therapy was inappropriate for 

 

12 This lab report indicates that the “mean plasma glucose” level was 250 ml/dL. 

13 This test result is listed as “Exhibit G” but is not attached. 

14 Dr. Padilla’s declaration states that the glucose level on August 4, 2010 was 340 ml/dL, but the 

attached lab report lists the glucose level as 251 ml/dL. 

15 Dr. Padilla’s declaration lists the date of this test as December 1, 2010, but the test itself is 

dated December 10, 2010. 

16 The lab report lists the “mean glucose level” as 236 ml,dL, but lists the “glucose” level as 278 

ml/dL. 

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plaintiff, Padilla relied in part on lab testing done of plaintiff’s liver function. See Padilla 

Decl. at 4, ¶ 16. 

3. Glucose Tolerance Tests (GGT Tests) 

 Following plaintiff’s request for HCV treatment, several Glucose Tolerance Tests (GGT) 

were performed. Padilla Decl. at 6, ¶ 44. GGT refers to gamma-glutamyl transferase 

(GGT). Id. 

 A GGT test may be used to determine the cause of elevated levels of ALP. Padilla Decl. 

at 6, ¶ 44. See also Plaintiff’s Opposition (ECF No. 73) Exh. C at 84. 

 GGT tests can be used to screen for chronic alcohol abuse (it will elevated in about 75% 

of chronic drinkers) and to monitor for chronic alcohol use/and or abuse in people who are 

receiving treatment for alcoholism or alcoholic hepatitis. Padilla Decl. at 6, ¶ 44. See 

also Plaintiff’s Opposition (ECF No. 73) Exh. C at 84. 

 Plaintiff’s GGT was tested on May 31, 2011. He had a GGT level of 84 U/L, just within 

the upper limit of the reference range. Padilla Declr. at 6, ¶ 8; Exh. P at 135. 

 The record indicates that the lab report lists the reference range for GGT as “3-85 U/L.” 

See Padilla Declr. Exh. P, R, T, I. 

 On September 16, 2011, plaintiff’s GGT level was 139 U/L, “greatly exceeding the 

reference range limits.” Padilla Decl. at 6, ¶ 46; Exh. R. 

 On December 12, 2012, plaintiff’s GGT level was 199 U/L. Padilla Declr. at 6, ¶ 47; Exh. 

T. 

 On March 14, 2012, plaintiff’s GGT level was 417 U/L, “over five times the limit of the 

upper reference range.” Padilla Decl. at 6, ¶ 48; Exh. I. 

 Dr. Padilla declares that he determined that that plaintiff’s GGT tests “revealed that the 

negative effects to Plaintiff’s liver were more attributable to alcoholism than Hepatitis C 

and that because Plaintiff was continuing to abuse alcohol, he could not be compliant with 

the requirements for HCV treatment or a liver transplant.” Padilla Decl. at 6-7, ¶¶ 43, 49, 

51. 

 Padilla declares that “[e]ach time [he] evaluated Plaintiff’s condition [he] determined, 

under the circumstances discussed above, that HCV treatment was inappropriate for 

Plaintiff at that time because based on [Padilla’s] medical judgment and opinion, Plaintiff 

was not eligible for treatment based on several absolute contraindications to treatment 

including poorly controlled diabetes and the presence of continued alcohol abuse.” 

Padilla Decl. at 7 ¶ 52. 

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VI. Plaintiff’s Evidence 

Plaintiff submits the following additional evidence in opposition to defendants’ motion for 

summary judgment: 

 On January 23, 2009, Dr. Roof signed an order which stated the following in regards to 

plaintiff: “Medical to resume treatment of diabetes mellitus, hypertension, GERD, 

cirrhosis, hepatitis C, Angina.” ECF No. 73 Exh. B at 82. 

 A “Medical Record Treatment Sheet” from CHS dated November 3, 2009 states: “DM @ 

goal.” ECF No. 73 Exh. A at 80. 

 Plaintiff’s diabetic flow sheets contain some test results showing that plaintiff’s glucose 

level was within the normal range. ECF No. 73 Exh. U1-U4 at 136-39. 

 The California Department of Corrections and Rehabilitation’s “Inmate Medical Services 

Policies and Procedures” for Hepatitis C, revised in 2008, states: “EXCLUSION 

CRITERIA FOR HCV TREATMENT . . . Medical conditions. Patients with poorly 

controlled . . . diabetes mellitus (hemoglobin A1C > 8.5%). ECF No. 73 Exh. E at 90. 

 On May 22, 2013, plaintiff had an A1C test done showing that his A1C levels were at 

8.3%. FAC at 141. 

 GGT tests do not indicate the cause of a patient’s liver damage, but show only that the 

liver is damaged. ECF No. 73 Exh. C at 84-85. 

 Plaintiff has not had a drink of alcohol since 1999. Plaintiff’s Declaration (ECF No. 73) 

Exh. P at 122. 

 Plaintiff was not told that Lactulose was for cirrhosis treatment. Plaintiff’s Declaration 

(ECF No. 73) Exh. P at 122. 

 Plaintiff has never met Dr. Padilla or been examined by him. Plaintiff’s Declaration (ECF 

No. 73) Exh. P at 122. 

VII. Legal Standards Governing Eighth Amendment Claim 

In order to state a §1983 claim for violation of the Eighth Amendment based on 

inadequate medical care, plaintiff must allege “acts or omissions sufficiently harmful to evidence 

deliberate indifference to serious medical needs.” Estelle v. Gamble, 429 U.S. 97, 106 (1976). 

To prevail, plaintiff must show both that his medical needs were objectively serious, and that 

defendants possessed a sufficiently culpable state of mind. Wilson v. Seiter, 501 U.S. 294, 299 

(1991); McKinney v. Anderson, 959 F.2d 853, 854 (9th Cir. 1992) (on remand). The requisite 

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state of mind for a medical claim is “deliberate indifference.” Hudson v. McMillian, 503 U.S. 1, 

5 (1992). 

A serious medical need exists if the failure to treat a prisoner’s condition could result in 

further significant injury or the unnecessary and wanton infliction of pain. Indications that a 

prisoner has a serious need for medical treatment are the following: 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. See, e.g., Wood v. Housewright, 900 F.2d 1332, 1337-

41 (9th Cir. 1990) (citing cases); Hunt v. Dental Dept., 865 F.2d 198, 200-01 (9th Cir. 1989). 

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

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

In Farmer v. Brennan, 511 U.S. 825 (1994), the Supreme Court established a very 

demanding standard for “deliberate indifference.” Negligence is insufficient. Farmer, 511 U.S. 

at 835. Even civil recklessness (failure to act in the face of an unjustifiably high risk of harm 

which is so obvious that it should be known) is insufficient to establish an Eighth Amendment 

violation. Id. at 836-37. It not enough that a reasonable person would have known of the risk or 

that a defendant should have known of the risk. Id. at 842. Rather, deliberate indifference is 

established only where the defendant subjectively “knows of and disregards an excessive risk to 

inmate health and safety.” Toguchi v. Chung, 391 F.3d 1051, 1057 (9th Cir. 2004) (internal 

citation omitted). Deliberate indifference can be established “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.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (internal citations omitted). 

A physician need not fail to treat an inmate altogether in order to violate that inmate's 

Eighth Amendment rights. Ortiz v. City of Imperial, 884 F.2d 1312, 1314 (9th Cir.1989). A 

failure to competently treat a serious medical condition, even if some treatment is prescribed, may 

constitute deliberate indifference in a particular case. Id. However, “[a] difference of opinion 

between a physician and the prisoner – or between medical professionals – concerning what 

medical care is appropriate does not [without more] amount to deliberate of indifference.” Snow 

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v. McDaniel, 681 F.3d 978, 987 (9th Cir. 2012), overruled on other grounds, Peralta v. Dillard, 

744 F.3d 1076, 1083 (9th Cir. 2014). To establish that the difference of opinion rises to the level 

of deliberate indifference, a prisoner must show that the defendant’s chosen course of treatment 

was medically unacceptable and in conscious disregard of an excessive risk to plaintiff’s health. 

Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996). Furthermore, in cases involving complex 

medical issues where plaintiff contests the type of treatment he received, expert opinion will 

almost always be necessary to establish the necessary level of deliberate indifference. 

Hutchinson v. United States, 838 F.2d 390 (9th Cir.1988). 

VIII. Analysis of Eighth Amendment Claim17

There is no dispute in this case that plaintiff’s medical needs were serious – during all 

periods relevant to the complaint, plaintiff suffered from cirrhosis of the liver and hepatitis C, a 

serious and potentially life-threatening chronic condition. See McGuckin, 974 F.2d 1059-60. 

Accordingly, the only issue is whether Dr. Padilla was deliberately indifferent to plaintiff’s need 

for treatment of cirrhosis and hepatitis C. 

Defendants’ evidence establishes that plaintiff received Lactulose for treatment of his 

cirrhosis and that with respect to plaintiff’s hepatitis C, Dr. Padilla made a reasoned medical 

decision based on his review of plaintiff’s medical history and lab test results that plaintiff was 

ineligible for HCV therapy due to his poorly controlled diabetes and continuing alcohol abuse. 

 

17 As established in this court’s September 18, 2013 order, plaintiff was a pre-trial detainee at 

Sacramento County Main Jail in 2010 and 2011 and was convicted by a jury on January 31, 2012. 

ECF No. 45. Persons who have been arrested, but not convicted of a crime, derive their rights 

from the due process clause of the Fourteenth Amendment, rather than from the Eighth 

Amendment’s prohibition against cruel and unusual punishment. See Gibson v. County of 

Washoe, Nev., 290 F.3d 1175, 1187 (9th Cir. 2002), cert. denied, 537 U.S. 1106 (2003). Due 

process imposes, at a minimum, the same protections that the Eighth Amendment imposes: 

persons in custody have the established right not to have officials be deliberately indifferent to 

their serious medical needs. Id. Comparable standards apply, with Fourteenth Amendment 

analysis borrowing from Eighth Amendment standards. Frost v. Agnos, 152 F.3d 1124, 1128 

(9th Cir. 1998); Redman v. County of San Diego, 942 F.2d 1435, 1440-41 & n.7 (9th Cir. 1991) 

(discussing pre-trial detainees); Carnell v. Grimm, 74 F.3d 977, 979 (9th Cir. 1996) (“[D]ue 

process rights are at least as great as the Eighth Amendment protections available to a convicted 

prisoner.”). Thus, although plaintiff’s rights are governed by the Fourteenth Amendment, the 

court may refer to the Eighth Amendment standard as a base reference for the minimal 

protections due. 

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This evidence supports defendants’ claim that Dr. Padilla’s conduct was medically acceptable 

under the circumstances, and defendants have met their initial burden of demonstrating that there 

is an absence of evidence to support plaintiff’s claim that Padilla was deliberately indifferent to 

plaintiff’s need for treatment of cirrhosis and hepatitis C. Accordingly, the burden shifts to 

plaintiff as the non-moving party “to establish that a genuine issue as to any material fact actually 

does exist.” 

Plaintiff argues that there is a material dispute of fact as to whether he was eligible for 

HCV treatment and argues in the alternative that Dr. Padilla denied him HCV treatment not 

because he was ineligible for treatment but because Cannon, the grievance coordinator, stated that 

CHS does not treat hepatitis C. 

 To the extent plaintiff alleges that Dr. Padilla denied him treatment based on grievance 

coordinator Cannon’s misstatement of the applicable hepatitis C treatment policy, the court notes 

that plaintiff’s claim is not based on a difference of opinion between medical professionals or 

between plaintiff and his doctor. Rather, plaintiff’s claim is that Dr. Padilla’s decision to deny 

him HCV treatment was not a medical decision. However, this distinction does not help plaintiff. 

Although he is adamant that he was denied treatment because of Cannon’s statement that CHS 

does not treat hepatitis C, plaintiff provides no evidence from which a reasonable trier of fact 

could conclude that Dr. Padilla, the medical director, relied on Cannon’s statement in denying 

plaintiff HCV therapy. Plaintiff argues repeatedly that he was never told he was ineligible for 

treatment and that Cannon’s statement must have been the reason he was denied treatment since it 

was the only reason he was ever given for not receiving treatment. However, this conclusory 

allegation does not rebut defendants’ sworn declaration that Dr. Padilla based his decision on his 

own medical judgment and his review of plaintiff’s lab results and medical history. The fact that 

plaintiff was not told he was ineligible for HCV treatment is certainly troubling, but it does not 

permit the inference that Dr. Padilla made a decision to deny treatment based on the grievance 

coordinator’s response to an inmate appeal in which she misstated the treatment policy. Because 

a reasonable trier of fact could not conclude from plaintiff’s evidence that Dr. Padilla relied on 

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Cannon’s statement in denying plaintiff treatment, plaintiff’s argument here cannot defeat 

defendants’ motion for summary judgment. 

 The court now turns to plaintiff’s argument that a genuine dispute of material fact exists as 

to whether plaintiff was eligible for HCV treatment. In his sworn declaration, Dr. Padilla 

declares that he determined that plaintiff was ineligible for treatment based on several 

contraindications for therapy – namely his uncontrolled diabetes and his continued abuse of 

alcohol. Plaintiff asserts that there is a dispute of fact as to whether his diabetes was “poorly 

controlled” and as to whether plaintiff was continuing to abuse alcohol. These issues are 

significant because if plaintiff’s evidence reveals a genuine dispute of fact as to whether Padilla’s 

decision to deny plaintiff HCV treatment was medically acceptable under the circumstances, then 

defendants are not entitled to summary judgment on the deliberate indifference claim. See 

Jackson, 90 F.3d at 332. 

1. Dr. Roof’s “Prescription” 

Plaintiff initially asserts that he was prescribed HCV treatment in 2009 by Dr. Roof, and 

that, contrary to Dr. Padilla’s opinion, Dr. Roof’s order shows that plaintiff was eligible for HCV 

therapy. In support of his argument, plaintiff submits a copy of a document entitled “Physician 

Orders” dated November 23, 2009, allegedly signed by Dr. Roof, and contends that in this order, 

Dr. Roof “prescribed” plaintiff HCV treatment. See ECF No. 73 Exh. B at 82. Defendants argue 

that this “order” is inadmissible and that in any case the document is not a prescription for HCV 

treatment, but rather discharge papers signed by Dr. Roof, a psychiatrist at UC Davis, transferring 

plaintiff from the psychiatric department to SCMJ. ECF No. 74 at 5. 

Even assuming that the above document would be admissible at trial, the undersigned 

finds that it is insufficient to raise a triable issue of fact as to whether plaintiff was eligible for 

HCV treatment. The purported “prescription” merely states “CHS orders: medical to resume 

treatment of Diabetes Mellitus, Hypertension, GERD, Cirrhosis, Hepatitis C, Angina.” There is 

no indication that the document is a prescription of any kind, much less for HCV antiviral 

therapy. Moreover, the fact that plaintiff had not already been receiving HCV therapy and the 

document directs CHS to “resume treatment” (emphasis added) further supports the conclusion 

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that the document is not a prescription for a new treatment. Furthermore, even if Dr. Roof had 

found plaintiff eligible for HCV treatment in 2009, a mere difference of opinion between Dr. 

Roof and Dr. Padilla as to whether plaintiff was eligible for HCV therapy would be insufficient to 

form the basis of a deliberate indifference claim against Dr. Padilla. See Snow, 681 F.3d at 987 

(a difference of opinion between medical professionals concerning what medical care is 

appropriate does not without more amount to deliberate indifference). 

2. Poorly Controlled Diabetes 

 Plaintiff next argues that his evidence establishes or at least creates a dispute of fact as to 

whether his diabetes was controlled. Plaintiff directs the court’s attention to several lab tests in 

which his glucose levels were “in range,” as well as to other documents in his medical file that 

indicate his diabetes was controlled or at its goal. 

a. Finger Stick Glucose Tests 

In his declaration, Dr. Padilla opined that plaintiff’s glucose levels, as measured by the 

finger stick tests and reflected in the Diabetic Flow Sheets, needed to be between 65-99 ml/dL in 

order for plaintiff to be eligible for HCV treatment. In response, plaintiff first argues that one of 

the glucose test results cited by defendants was within range and therefore does not support 

Padilla’s conclusion that plaintiff was ineligible for treatment. ECF No. 73 at 23. Specifically, 

plaintiff’s lab result on October 5, 2009 was 77 ml/dL and was therefore within the 65-99 ml/dL 

range. Plaintiff also submits copies of his Diabetic Flow Sheets covering the range of March 

2009 through May 2009 and argues that they contain twenty-five test results in the mornings 

alone that were within the appropriate range. ECF No. 73 at 21. However, plaintiff’s evidence 

does not rebut, and is actually consistent with, Padilla’s conclusion that plaintiff’s diabetes was 

poorly controlled because it shows that not all of plaintiff’s test results were within the required 

range. The fact that some of plaintiff’s glucose level tests were within range while others were 

not would not permit a trier of fact to find that Dr. Padilla’s conclusion that plaintiff’s diabetes 

was uncontrolled was erroneous, much less medically unacceptable under the circumstances. 

b. CHS Medical Record Treatment Sheet 

 Plaintiff also submits a copy of a Medical Record Treatment Sheet from CHS and 

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contends that it shows that his diabetes was “at its goal” in 2009. ECF No. 73 at 18. The 

treatment sheet contains a notation dated November 3, 2009 that reads, in relevant part, “DM @ 

goal.” ECF No. 73 Exh. A at 80. Defendants object on the grounds that plaintiff is a lay person 

and is not qualified to interpret this medical record. ECF No. 74-2 at 3. The court has reviewed 

this document and finds that the document makes no reference to whether plaintiff’s diabetes was 

at its goal with respect to eligibility for HCV treatment. Plaintiff’s interpretation of this treatment 

sheet without more is insufficient to create a triable issue of fact as to whether plaintiff’s diabetes 

was controlled for purposes of receiving HCV therapy. 

c. A1C Glucose Tests 

Plaintiff next takes issue with Dr. Padilla’s interpretation of plaintiff’s A1C levels. In his 

declaration, Dr. Padilla opined that in order to be eligible for HCV treatment, plaintiff’s A1C 

levels needed to be at 6.5%. Padilla opined that plaintiff was ineligible for HCV treatment 

because plaintiff’s four A1C tests indicated levels of 8.7%, 8.8%, 9.2%, and 10.0%. In response, 

plaintiff argues that Dr. Padilla erred in using 6.5 as the A1C cutoff for HCV eligibility. Plaintiff 

contends that Policy 1714 does not define “poorly controlled” diabetes, and directs the court’s 

attention to a copy of the CDCR’s 2008 “Inmate Medical Services Policies and Procedures” for 

Hepatitis C, which contains the following notation: “EXCLUSION CRITERIA FOR HCV 

TREATMENT . . . Medical conditions. Patients with poorly controlled . . . diabetes mellitus 

(hemoglobin A1C > 8.5%). ECF No. 73 Exh. E at 90. Plaintiff also submits a copy of his lab 

results from his time at Mule Creek State Prison, which show that on May 22, 2013, plaintiff’s 

A1C level was at 8.3%. ECF No. 73 at 21, Exh. V at 141. Plaintiff asserts that the document 

shows that plaintiff’s A1C was 8.3% when he started receiving HCV treatment and that it 

therefore “disputes defendants assertion that the patient’s A1C had to be 6.5” in order to qualify 

for HCV treatment. ECF No. 76 at 8, ¶ 21. 

 Plaintiff is correct that the portion of Policy 1714 included in the record does not contain a 

definition for “poorly controlled” diabetes. However, plaintiff has not produced evidence that 

would allow a trier of fact to find that it was medically unacceptable under the circumstances for 

Dr. Padilla to conclude that plaintiff’s A1C levels needed to be at 6.5% in order for plaintiff to be 

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eligible for treatment. Plaintiff’s own exhibits contain an assessment plan from Dr. Lopin in 

which Lopin states that “therapy was recommended for [plaintiff’s] hepatitis if [he] could achieve 

better control of his diabetes, i.e. bringing the A1C down to approximately 6.5.” ECF No. 32 

Exh. D at 22 (emphasis added). 

To the extent plaintiff relies on the May 22, 2013 test result to show that his A1C level did 

not need to be at 6.5% in order to qualify for HCV treatment, this document fails to provide 

sufficient support for plaintiff’s claim. This test result shows that plaintiff’s A1C level was at 

8.3%, but does not indicate that plaintiff actually received HCV treatment at this time. Even if 

plaintiff could establish that he received HCV treatment at a time when his A1C level was at 

8.3%, this would not help plaintiff’s argument because plaintiff’s A1C levels were not at 8.3% 

during the time he was incarcerated at SCMJ. Rather, his four A1C tests taken at SCMJ indicate 

that his lowest recorded A1C level was at 8.8%. Thus, even if Dr. Padilla had required plaintiff’s 

A1C level to be at 8.5% rather than 6.5%, plaintiff still would not have been eligible for HCV 

treatment. 

d. Plaintiff Not Informed of His Poorly Controlled Diabetes 

 Plaintiff repeatedly complains that he was never informed of his lab results or told that his 

diabetes was uncontrolled, and asserts that he was misled into believing that his lab results were 

normal because of grievance coordinator Cannon’s statements in response to his grievances. 

Specifically, plaintiff contends that Cannon mislead him when she denied his request for his lab 

results and told him that “no news [was] good news” and that he could assume his results were 

“normal for [him].” While Cannon may have been negligent in making these statements, the fact 

that plaintiff was not informed that his diabetes was uncontrolled has no effect on the propriety of 

Dr. Padilla’s determination that plaintiff’s diabetes was uncontrolled and that plaintiff was 

therefore ineligible for HCV treatment. 

 With respect to plaintiff’s diabetes, defendants have produced evidence through sworn 

declarations and medical records that Dr. Padilla reviewed plaintiff’s medical history and lab tests 

and determined based on his medical judgment that plaintiff’s diabetes was poorly controlled. 

Dr. Padilla’s position is supported by his own expert declaration as well as copies of the glucose 

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test results he relied on in making his determination. Even the medical records submitted by 

plaintiff contain several notations indicating that plaintiff would need to “achieve better control of 

his diabetes” before he could proceed with HCV therapy. See ECF No. 73 Exh. L at 110:10-11, 

110:18-19. On this record, a rational trier of fact could not conclude that Padilla’s determination 

was medically unacceptable under the circumstances. Accordingly, the undersigned finds that 

there is no genuine dispute of fact as to whether Dr. Padilla was deliberately indifferent to 

plaintiff’s medical needs when he denied plaintiff HCV treatment based on his determination that 

plaintiff was ineligible for treatment due to his poorly controlled diabetes. 

3. Continuing Alcohol Abuse 

Plaintiff next asserts that a factual dispute exists regarding plaintiff’s alleged continued 

abuse of alcohol and that this dispute is material because Dr. Padilla relied on this finding in 

denying plaintiff HCV treatment. Specifically, plaintiff contends that Dr. Padilla could not have 

determined based on the results of plaintiff’s GGT tests that plaintiff’s liver damage was caused 

by continuing alcohol use as opposed to hepatitis C. ECF No. 73 at 27-28. Plaintiff asserts that 

the GGT tests show only that the liver is damaged and do not point to a specific condition that 

may be causing the injury. Id. 

In support of this argument, plaintiff submits a printout with the heading “Lab Tests 

Online,” which appears to be an article from the website of the American Association for Clinical 

Chemistry.18 ECF No. 73 Exh. C at 84. The article explains how the GGT is used, what it is used 

for, and what GGT test results mean. In relevant part, the article states that “[i]n general, an 

increased GGT level indicates that a person’s liver is being damaged but does not specifically 

point to a condition that may be causing the injury.” Id. (emphasis added). The article 

acknowledges that GGT can be used to screen for chronic alcohol abuse, but goes on to state that 

“[a]n elevated GGT level suggests that something is damaging the liver but does not indicate 

 

18 Defendants object to this exhibit on the grounds that the document is hearsay, lacks 

foundation, and lacks authentication. Defendants further assert that because plaintiff is not a 

medical expert, he is not qualified to interpret lab results and cannot rely on the article as the type 

of learned treatise used by medical professionals in rendering expert opinion testimony. ECF No. 

74-2 at 4. 

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specifically what . . . Elevated levels may be due to liver diseases, such as hepatitis or cirrhosis . . 

They may also be caused by alcohol abuse or drugs that are toxic to the liver.” Id. at 84-85. 

Plaintiff asserts that this article shows that Padilla could not have determined based on plaintiff’s 

GGT tests that plaintiff was using alcohol. In addition, plaintiff asserts in a sworn declaration 

that plaintiff has not had access to alcohol while in prison and has not had a drink since 1999. 

ECF No. 73 Exh. P at 122. Finally, plaintiff asserts that even if he was using alcohol, the “six 

month clean and sober period” should have been waived as an eligibility criterion pursuant to 

Policy 1714, which provides for waiver of this period where the patient’s condition is 

deteriorating. 

Here, the court finds that even if there is a dispute of fact as to whether plaintiff was 

continuing to abuse alcohol during his time at SCMJ, the dispute is not material. See Anderson v. 

Liberty Lobby, Inc., 477 U.S. at 248 (a material fact is one that might affect the outcome of the 

suit under the governing law). Dr. Padilla states in his declaration that plaintiff was ineligible for 

HCV treatment because of an absolute contraindication to treatment: poorly controlled diabetes. 

The undisputed evidence establishes that under Policy 1714, patients who have absolute 

contraindications for treatment will not be referred for treatment, and poorly controlled diabetes is 

an absolute contraindication for HCV therapy. Thus, a finding that plaintiff was not using alcohol 

would not permit a trier of fact to conclude that Padilla’s decision to deny HCV therapy was 

medically unacceptable under the circumstances because Padilla’s decision would still be 

supported by plaintiff’s poorly controlled diabetes. Because a dispute of fact regarding plaintiff’s 

alcohol use is not material, plaintiff’s evidence here does not defeat defendants’ motion for 

summary judgment. 

4. Cirrhosis Treatment 

 The majority of plaintiff’s arguments concern his lack of treatment for hepatitis C rather 

than cirrhosis. However, because plaintiff initially claimed that that he was denied treatment for 

both hepatitis C and cirrhosis, the court now addresses plaintiff’s cirrhosis treatment. 

Defendants’ evidence establishes that plaintiff was prescribed Lactulose for treatment of his 

cirrhosis, and that plaintiff twice refused to take his medication and subsequently asked that the 

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Lactulose be permanently discontinued. In response, plaintiff argues that he only refused the 

Lactulose because he was not told what it was for and that he would not have refused it if he had 

known it was for cirrhosis. The record indicates that after plaintiff complained in his letter to 

Maness that he was not told what the Lactulose was for, Cannon informed plaintiff that if he 

wanted to start taking Lactulose again, he should contact a nurse. The record is unclear as to 

whether plaintiff contacted a nurse or started taking Lactulose again, but considering that plaintiff 

was given instructions on how he could resume treatment of his cirrhosis, there is no basis for a 

trier of fact to find that Padilla was deliberately indifferent to plaintiff’s serious medical need for 

treatment of his cirrhosis. 

5. Conclusion 

 In sum, defendants have produced evidence that Dr. Padilla relied on plaintiff’s lab 

results, medical history, and Dr. Padilla’s own medical judgment in determining that plaintiff’s 

poorly controlled diabetes rendered him ineligible for HCV treatment. Plaintiff has not 

sufficiently rebutted defendants’ evidence and has not established that a genuine dispute of 

material fact exists regarding whether Padilla’s decision was medically acceptable under the 

circumstances and in conscious disregard of an excessive risk to plaintiff’s health. Accordingly, 

the undersigned recommends that defendants’ motion for summary judgment be granted as to 

plaintiff’s deliberate indifference claim. 

IX. Monell Claim 

The court now turns to plaintiff’s claims against defendants Padilla and Jones in their 

official capacities. An “official capacity” lawsuit is simply another way of pleading an action 

against the employing entity. Monell v. Dept. of Social Services of New York, 436 U.S. 658 

(1978). In order to establish liability under Monell, a plaintiff must prove that (1) that [the 

plaintiff] possessed a constitutional right of which he was deprived; (2) that the municipality had 

a policy; (3) that this policy amounts to deliberate indifference of the plaintiff’s constitutional 

right; and (4) that the policy is the moving force behind the constitutional violation.” Dougherty 

v. City of Covina, 654 F.3d 892, 900 (9th Cir. 2011) (internal quotation marks omitted). Liability 

may also be established based on the adoption of an unconstitutional custom, even if that custom 

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has not received formal approval through the entity’s official decision-making channels. Neveu 

v. City of Fresno, 392 F.Supp.2d 1159, 1171 (E.D.Cal.2005) (quoting Monell, 436 U.S. at 690-

91). Liability based on municipal policy may be satisfied in three ways: 

(1) by showing that a municipal employee committed the alleged 

constitutional violation under a formal governmental policy or 

longstanding practice that is the customary operating procedure of 

the local government entity; 

(2) by establishing that the individual who committed the 

constitutional tort was an official with final policymaking authority 

and that the challenged action itself was an act of official 

governmental policy; or 

(3) by proving that an official with final policymaking authority 

either delegated policymaking authority to a subordinate or ratified 

a subordinate's unconstitutional decision or action and the basis for 

it. 

Sepatis v. City & County of San Francisco, 217 F.Supp.2d 992, 1005 (N.D. Cal. 2002) (quoting 

Fuller v. City of Oakland, Cal., 47 F.3d 1522, 1534 and Gillette v. Delmore, 979 F.2d 1342, 

1346–47 (9th Cir.1992)). 

The court first notes that because plaintiff did not become aware of SCMJ’s hepatitis C 

treatment policy (Policy 1714) until after the first amended complaint was filed, the allegations 

set forth in plaintiff’s first amended complaint are framed differently in his opposition to 

defendants’ motion for summary judgment. Specifically, in his first amended complaint, plaintiff 

alleged an outright policy of not providing treatment for hepatitis C, based on Cannon’s statement 

that CHS does not treat hepatitis C. On summary judgment, however, plaintiff argues that there is 

a written policy providing for hepatitis C treatment, i.e. Policy 1714, but that there is a custom of 

disregarding the written treatment policy. Plaintiff alleges that he was denied treatment according 

to this unwritten custom. 

Specifically, plaintiff argues on summary judgment that Dr. Padilla “[did] absolutely 

nothing to determine[] if plaintiff was eligible for HCV treatment” and instead “collaborated with 

Kelly Cannon” to disregard the written treatment policy in order to deny plaintiff HCV treatment. 

ECF No. 73 at 54- 55, 58. According to plaintiff, the policy of disregarding Policy 1714 is 

persistent and widespread because he “tried for thirty eight months to be treated for HCV” but 

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was denied treatment. Plaintiff asserts that by Padilla’s own admission, Padilla is a policymaking 

official because one of Padilla’s responsibilities as Medical Director is “to collaborate with other 

individuals regarding and several committees on policies for the administration of health services 

to inmates at [SCMJ] . . . and adhere to those policies.” Plaintiff further contends that Padilla had 

actual or constructive knowledge that plaintiff was denied treatment according to the unwritten 

custom of non-treatment because Padilla either decided with Cannon to “invoke” the policy of 

non-treatment or reviewed Cannon’s invocation of the policy and failed to correct it. 

Defendants argue that they are entitled to summary judgment because plaintiff has not 

established an underlying constitutional violation, Cannon’s statements are insufficient to 

establish a policy or custom that is persistent and widespread, there is no evidence that Cannon 

caused plaintiff to be denied medical treatment, and Cannon is not a policymaking official. 

As discussed above, the undersigned finds that plaintiff was not deprived of a 

constitutional right when he was denied HCV therapy while incarcerated at SCMJ. Accordingly, 

plaintiff cannot establish one of the essential elements of a Monell violation and defendants are 

entitled to summary judgment on this claim. See Celotex, 477 U.S. at 322 (“[A] complete failure 

of proof concerning an essential element of the nonmoving party's case necessarily renders all 

other facts immaterial.”). 

Moreover, even assuming that a constitutional violation occurred, plaintiff still could not 

prevail on his Monell claim because the evidence before the court would not permit a rational 

trier of fact to conclude that the alleged policy of non-treatment was the “moving force” behind 

the denial of HCV treatment. Construed in the light most favorable to plaintiff, the record 

indicates that Padilla and Cannon reviewed plaintiff’s medical file together and that following this 

review, Cannon informed plaintiff that CHS does not treat hepatitis C. If this were the only 

evidence before the court, it might be sufficient to permit the inference that the reason Padilla did 

not provide plaintiff with HCV therapy was because SCMJ had a policy of not treating hepatitis 

C. However, defendants have provided evidence that the reason plaintiff was denied treatment 

was not because of Cannon’s statement or a policy of non-treatment, but because plaintiff was 

found ineligible for HCV therapy pursuant to Policy 1714. To rebut this evidence, plaintiff was 

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required to provide at least some evidence from which a trier of fact could reasonably conclude 

that Cannon’s statement was evidence of a custom of non-treatment and that Dr. Padilla denied 

plaintiff treatment because of this custom and not because plaintiff was ineligible for treatment. 

See Dougherty, 654 F.3d at 900. Plaintiff has failed to meet that burden. Plaintiff’s conclusory 

allegation that Padilla “[did] absolutely nothing” to determine if he was eligible for HCV 

treatment does not create a triable issue of fact. While plaintiff argues that Padilla never met with 

or examined plaintiff and that plaintiff was never told he was ineligible for treatment, these facts 

do not give rise to the inference that Padilla did nothing to determine whether plaintiff was 

eligible for HCV therapy. Nor do they rebut Padilla’s sworn statement that his determination was 

based on his review of plaintiff’s medical history and lab results, as well as his own medical 

judgment. In light of Dr. Padilla’s expert declaration and plaintiff’s medical records and lab test 

results, to conclude that Dr. Padilla’s decision was based on a custom of non-treatment rather than 

on his medical opinion would be, on this record, entirely speculative. Because a rational trier of 

fact could not find that plaintiff was denied HCV therapy because of a custom of non-treatment, 

and because no constitutional violation occurred, defendants are entitled to summary judgment on 

this claim. 

MOTION TO AMEND THE COMPLAINT 

 Plaintiff moves to amend the first amended complaint on the grounds that he has 

discovered new evidence relevant to his claim and asserts that defendants Cannon and Maness 

should be re-joined as defendants. ECF No. 64. Defendants oppose the motion and assert that 

even if the court considers the allegations in the proposed amended complaint, plaintiff is still not 

entitled to relief. ECF No. 67. 

 As described above, the main difference between the proposed second amended complaint 

(SAC) and the first amended complaint on which this action proceeds is that in the SAC, plaintiff 

unequivocally alleges that SCMJ has a written policy in place for treating hepatitis C. However, 

plaintiff primarily uses this fact to allege that Cannon lied about the existence of the policy and 

that plaintiff was denied HCV treatment because of Cannon’s lie. Other than his conclusory 

allegations that Dr. Padilla relied on Cannon’s misstatement of the policy in denying plaintiff 

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treatment, plaintiff has alleged no facts that plausibly give rise to an inference that Cannon’s 

statement caused plaintiff to be denied treatment. In this regard, plaintiff’s SAC suffers from the 

same deficiencies this court identified in plaintiff’s FAC, which resulted in the initial dismissal of 

defendants Cannon and Maness pursuant to the court’s September 18, 2013 order, ECF No. 45. 

Like the FAC, plaintiff’s SAC fails to sufficiently allege a causal connection between the acrions 

of Cannon and Maness and the alleged deprivation of plaintiff’s constitutional rights. Moreover, 

as discussed above, the undersigned finds that no constitutional violation occurred when plaintiff 

was denied HCV therapy. As a result, amendment in this case would be an exercise in futility. 

See Steckman v. Hart Bewing, Inc., 143 F.3d 1293, 1298 (9th Cir.1998) (“Although there is a 

general rule that parties are allowed to amend their pleadings, it does not extend to cases in which 

any amendment would be an exercise in futility, or where the amended complaint would also be 

subject to dismissal ...”) (citations omitted). It is therefore recommended that plaintiff’s motion 

to amend the complaint be denied. 

Accordingly, IT IS HEREBY RECOMMENDED that: 

1. Defendants’ motion for summary judgment (ECF No. 66) be GRANTED; and 

2. Plaintiff’s motion for leave to amend the amended complaint (ECF No. 64) be DENIED. 

These findings and recommendations are submitted to the United States District Judge 

assigned to this case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within fourteen days 

after being served with these findings and recommendations, any party may file written 

objections with the court, which shall be captioned “Objections to Magistrate Judge’s Findings 

and Recommendations.” Due to exigencies in the court's calendar, no extensions of time will 

be granted. A copy of any objections filed with the court shall also be served on all parties. The 

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

appeal the District Court’s order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991). 

DATED: March 18, 2015 

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