Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_16-cv-02431/USCOURTS-cand-3_16-cv-02431-3/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 28:1441 Petition for Removal- Civil Rights Act

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For the Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

CHARLES ANDERSON MILLER,

Plaintiff,

v.

CALIFORNIA DEPARTMENT OF 

CORRECTIONS AND REHABILITATION 

(CDCR), et al.,

Defendants.

Case No. 16-cv-02431-EMC 

ORDER GRANTING IN PART AND

DENYING IN PART DEFENDANTS’ 

MOTION FOR SUMMARY JUDGMENT

Docket Nos. 94, 109

I. INTRODUCTION

In this pro se prisoner‟s civil rights action, Charles Anderson Miller complains about 

medical care he received at the Correctional Treatment Facility - Soledad (CTF-Soledad). 

Defendants have filed a motion for summary judgment, which Mr. Miller has opposed. For the 

reasons discussed below, Defendants‟ motion for summary judgment will be granted with respect 

to the pain medication claim, granted for two Defendants with respect to the total knee 

replacement claim, denied for three Defendants with respect to the total knee replacement claim, 

and denied with respect to the state law claims.

II. BACKGROUND

The following facts are undisputed unless otherwise noted.

There are two main areas of dispute in this action. First, Mr. Miller contends that Dr. 

Bright and other Defendants were deliberately indifferent when, starting in June 2014, they denied 

a Request For Services for him to receive a total knee replacement (TKR).1 Second, Mr. Miller 

 

1

In various documents in the record, the surgery is referred to by different names, e.g., total knee 

replacement, total joint replacement, and total knee arthroscopy. For sake of clarity, the surgery 

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contends that several Defendants were deliberately indifferent to his serious medical needs and 

acted with retaliatory intent when they tapered him off MS-Contin, a form of morphine, in mid2015.

A. Requests For Services

In the California prison system, a Request For Services (RFS) is a form used by doctors “to 

request medical services for an inmate that [are] not available at the prison, such as specialty 

consults, certain imaging studies, and certain medical or surgical procedures.” Docket No. 95 at 

1-2 (Hall Decl.).2 A requesting physician prepares the RFS and submits it to someone higher in 

the medical bureaucracy at the prison, such as the chief physician and surgeon, for review. The 

reviewer signs the RFS to signal his approval, authorization, denial or deferral of the RFS. See id.

at 2; see, e.g., Def MSJ 281.3The reviewer then returns the RFS form to the utilization 

management registered nurse (UMRN). Some more involved procedures require further approval, 

e.g., from the chief physician advisor in Sacramento or regional utilization management advisors. 

See id.; see also Hall Depo., RT 50; Beregovskaya Depo., RT 22. 

As the RFS makes its way through the prison medical bureaucracy, the UMRN enters the 

RFS on the InterQual system, obtains a tracking number from InterQual, writes the tracking 

number on the RFS, and sends it to the reviewer (e.g., the chief physician and surgeon). InterQual 

is “a computer-based management system that track[s] the RFS and [makes] an initial 

determination about whether the request [meets] certain medical criteria, as determined by 

guidelines programmed into the system.” Docket No. 95 at 2. 

If the reviewer approves the RFS, the UMRN forwards the RFS to the scheduler (to 

schedule the appointment) or to the next level reviewer (if further approval is required). Docket 

 

will be referred to as a TKR throughout this order.

2

This general information about RFSs is taken from the declaration of nurse Davina Hall, a 

Defendant in this action. Nurse Hall described how the system worked when she handled the RFS 

for Mr. Miller. No one has suggested that her description of the RFS process and the use of the 

InterQual system in this case differs from how those things normally worked. 

3

Throughout this order, the Court refers to “Def MSJ” with a page number. Those documents are 

found in Docket No. 97, which sequentially paginates most of Mr. Miller‟s medical records. 

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No. 95 at 2. If the reviewer denies the RFS, the UMRN forwards the denied RFS to the inmate‟s 

Primary Care Provider. Docket No. 95 at 2.

B. Events Occurring Before Mr. Miller Arrived At CTF in June 2014

The events and omissions on which Mr. Miller‟s legal claims are based occurred in and 

after June 2014, while Mr. Miller was at CTF-Soledad. It is, however, necessary to reach further 

back in time to provide some background information about his medical needs.

Charles Miller was 60 years old when he arrived at CTF-Soledad from Corcoran in June 

2014. 

He had been in prison since about 2002 serving a sentence totaling 115 years to life in 

prison. Docket No. 118 at 2; AG1584 (Jan. 14, 2002 abstract of judgment).

Mr. Miller fell and hurt his knee at a non-prison hospital on March 31, 2009. Docket No. 

118 at 2. 

A CT scan of his right knee was done in May 2009. Docket No. 118 at 2; Def MSJ 25.

Eventually, arthroscopic surgery of the right knee was recommended for Mr. Miller. He 

underwent a stress test and received a cardiology clearance on about July 28, 2011, because a 

doctor wanted a cardiology clearance before Mr. Miller underwent the surgery. Docket No. 118 at 

4; Def MSJ 169-170. 

The arthroscopic surgery was done on August 9, 2012. Docket No. 118 at 6. The surgical 

procedures performed included a partial meniscectomy; chondroplasty; removal of a significant 

portion of the pyrophosphate crystals; and a synovectomy. Def MSJ 190-92. 

Mr. Miller states that Dr. Chandrasekaran informed him at a follow-up appointment on 

August 21, 2012 that he “would need to have a total knee replacement surgery in the foreseeable 

future.” Docket No. 118 at 7. The doctor‟s progress note does not mention TKR, as Mr. Miller 

concedes. Id.; Def MSJ 203.

At another follow-up appointment on November 21, 2012, Dr. Chandrasekaran noted that 

Mr. Miller had had arthroscopic debridement “with basically good results” and that the “cold 

weather is aggravating his problem.” Dr. Chandrasekaran recommended steroid injections in the 

future. He also wrote: “Ultimately, he will end up having knee replacement. Then you can refer 

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him to an orthopedic surgeon also for checking it.” Def MSJ 213-14. 

Much of the disagreement in this case concerns the severity of the arthritis in Mr. Miller‟s 

knee. X-rays of Mr. Miller‟s right knee were done on December 28, 2012. The radiologist‟s 

report stated the following: “IMPRESSION: Minimal arthritic change with considerable 

chondrocalcinosis.” Def MSJ 218 (emphasis added). Chondrocalcinosis “is a metabolic 

abnormality causing crystal formations in joints, also known as „pseudogout.‟” Docket No. 96 at 

11 n.7. Chondrocalcinosis is treated medically rather than surgically, according to Dr. Barnett. Id.

X-rays of Mr. Miller‟s right knee were done again on December 10, 2013. The 

radiologist‟s report stated: “IMPRESSION: No acute osseous abnormality. Moderate to severe 

osteoarthritis. Significant chondrocalcinosis suggesting CPPD arthropathy. Small effusion. 

Osteopenia. “ Def MSJ 238 (emphasis added).

4

Mr. Miller had a consultation with Dr. Smith, an orthopedist, on February 28, 2014. Dr. 

Smith found that Mr. Miller “has very painful range of motion of the knee and severe crepitus 

with range of motion. He is confined to a wheelchair part time but can ambulate with pain.” Def 

MSJ 256. Dr. Smith mentioned that a December 2013 x-ray “confirm[ed] severe degenerative 

arthritis as well as probable calcium pyrophosphate deposition disease. There is calcification in 

the menisci.” Id. Dr. Smith recommended that Mr. Miller “undergo a consultation for a total knee 

replacement given the severity of arthritis in his right knee and the fact that he is nearly wheelchair 

bound at this time. Therefore, I am recommending that and we will try and get him scheduled for 

 

4

 X-rays were done in later years that seemed to show little change, and noted moderate arthritis 

of the knee. 

X-rays were done on January 22, 2015 and compared to the December 10, 2013 x-rays. 

the radiologist‟s report for the January 22, 2015 x-rays stated: “IMPRESSION: NO 

SIGNIFICANT CHANGE OR ACUTE OSSEOUS ABNORMALITY. MODERATE ARTHROSIS. 

CHONDROLCALCINOSIS SUGGESTING CPPD CRYSTAL DEPOSITION DISEASE.” Def 

MSJ 322 (emphasis added; capitalization in source). 

The radiologist‟s report for an x-ray done on April 30, 2015 found “[m]oderate 

osteoarthritis of the right knee with associated Chondrocalcinosis. No effusion.” Def MSJ 381.

The radiologist‟s report for x-rays done on May 6, 2015 found “[m]oderate medial 

compartment arthritis. Mild lateral compartment and patellofemoral joint arthritis. 

Chondrocalcinosis is redemonstrated. No fracture or joint effusion. IMPRESSION: Right greater 

than left knee joint arthritis.” Def MSJ 385.

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the total knee replacement.” Id. 

Mr. Miller saw Dr. Moon, his primary care physician (“PCP”) on March 19, 2014. Dr. 

Moon said he would prepare an RFS to seek approval for Mr. Miller to be seen by an orthopedic 

specialist. Docket No. 118 at 9.

On April 4, 2014, Mr. Miller went to Pacific Orthopedic Medical Group for an 

appointment with Dr. Alade, an orthopedist, who examined him and ordered x-rays. Def MSJ 

259-261. Dr. Alade‟s notes recount the patient‟s history, as provided by the patient, including that 

the patient had received “medicines, surgical procedure and steroid injections to his knee.” Id. at 

259 (emphasis added). Dr. Alade wrote that Mr. Miller‟s medical history included “diabetes, 

hypertension, cardiac problems . . . [H]e has also had some kidney stent and cardiac stent 

placements.” Id. Mr. Miller weighed 256 pounds and was 5 feet 7-1/2 inches tall. Id. Dr. Alade 

noted that the x-rays showed “marked narrowing of the lateral compartment of the knee with 

calcification of the medial and lateral meniscus, tibiofemoral interval space less than 2 mm 

laterally and about 3 mm medially to involve the right knee.” Id. at 260. Dr. Alade wrote: 

Since no response to conservative treatment of exercise, medications 

and arthroscopic surgery, including injection, authorization request

to be submitted for a total knee arthroplasty. Prior to surgery, 

medical clearance due to heart problems and having had a stent, and 

other metabolic problems to include hypertension and diabetes. 

Baseline laboratory studies have been ordered to include CBC, 

coagulation studies, arthritic panel and a comprehensive metabolic 

panel. Patient to return back to examiner for surgery when 

medically cleared and authorization is obtained.

Id. at 260 (emphasis added). Dr. Alade‟s understanding that Mr. Miller had tried steroid 

injections that were unsuccessful was wrong. Mr. Miller did not have his first steroid injection 

until more than a year later, in September 2015. See Def MSJ 452.

Mr. Miller states that, on June 4, 2014, Dr. Moon told him the arthroplasty was being 

approved by the medical authorization committee at Corcoran and he would be referred back to 

Dr. Alade for scheduling and pre-op tests to be done. Dr. Moon filled out an RFS listing a 

diagnosis of “severe arthritis” and requesting “total knee arthroplasty.” Def MSJ 272. On June 9, 

2014, Dr. Beregovskaya denied the RFS Dr. Moon had prepared because Dr. Moon had not 

adequately explained or documented the need for the requested services. Def MSJ 282. The next 

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day, Dr. Beregovskaya replaced the denied RFS with a new RFS she drafted on behalf of Dr. 

Moon. Def MSJ 281. (This June 10 RFS is discussed in more detail in Section C, below.)

C. The Transfer to CTF-Soledad

On June 9, 2014, Mr. Miller began his transfer from CSP-Corcoran to CTF-Soledad. 

While en route, early on the morning of June 10, 2014, Mr. Miller became light-headed, lost 

consciousness and was taken by ambulance to a hospital in Templeton, California. The medical 

records indicate he complained of chest pain. See Def MSJ 277, 280. After a few hours, he was 

released from the hospital and transported to a prison in San Luis Obispo. Def MSJ 277-278. On 

June 12, 2014, he was taken from that prison to CTF-Soledad. Docket No. 118 at 13. 

D. The Conflicting Results On the RFS

One of the key issues in this action concerns the conflicting decisions on a single RFS. 

That RFS was approved at Corcoran and denied at CTF-Soledad -- with both decisions occurring 

close in time.

1. RFS Is Approved At Corcoran

As mentioned above, on June 10, 2014, Dr. Beregovskaya prepared a new RFS on behalf 

of Dr. Moon -- at a time when Mr. Miller was either on his way out or had left Corcoran. Def 

MSJ 281. Dr. Beregovskaya‟s RFS listed the “principle diagnosis” as “TJR” and the “requested 

service(s)” as “ortho.” Id. 

The RFS was approved on June 17, 2014, by Dr. Wang, the chief medical officer at 

Corcoran. Def MSJ 283; see also Docket No. 115, Ex. 13 at AG5732. The RFS form has the 

notation “met” at the upper right corner, apparently a reference to the InterQual criteria having 

been met. An InterQual Review Summary for the RFS states “criteria met” for TKR. Docket No. 

115-2 at 39 (AG5733). 

The UMRN at Corcoran then e-mailed the approved RFS to her counterpart at CTFSoledad, i.e., nurse Davina Hall, at 2:45 p.m. on June 18, 2014, with this message: “Please 

forward approved RFS from Corcoran to your scheduler.” Docket No. 127 at Exhibit O 

(AG4136). Nurse Hall sent a reply e-mail at 10:53 a.m. on June 19, 2014, stating: “Thanks, we 

are working on it.” Id. Nurse Hall declares that she does not recall whether she read that e-mail 

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from Corcoran on June 18 or 19, and does not recall whether a copy of the RFS was attached to 

the e-mail. Docket No. 95 at 3. 

2. RFS Is Denied At CTF-Soledad

Meanwhile, a copy of the RFS that Dr. Beregovskaya had prepared on June 10, 2014 (but 

which had not yet been approved by Dr. Wang at Corcoran) was sent to CTF-Soledad, the prison 

to which Mr. Miller was being transferred. 

Nurse Davina Hall received the RFS on June 12 or 13, 2014 from the Receiving & Release 

staff at CTF-Soledad. Nurse Hall was the UMRN at CTF-Soledad, and one of her duties as the 

UMRN was to process RFSs. The RFS she received was signed by Dr. Beregovskaya, had no 

signature to indicate whether it had been approved or denied, and did not have an InterQual 

tracking number written on it. Docket No. 95 at 2 (Hall Decl.). Nurse Hall checked InterQual and 

saw that the RFS had already been input into the system and issued a tracking number, but that no 

decision had been made on the RFS. Docket No. 95 at 2. Nurse Hall wrote the InterQual tracking

number on the RFS and forwarded it to Dr. Bright, the chief physician and surgeon at CTFSoledad. At the time nurse Hall received the RFS, she was unaware that medical staff at Corcoran 

were still processing the same RFS. Docket No. 95 at 3. 

Dr. Bright denied the RFS on June 18, 2014. The brief note on the RFS indicates that Dr. 

Bright denied the RFS because there was only “mild” disease, based on a December 28, 2012 xray. Def MSJ 285. Dr. Bright gave a fuller explanation at his deposition as to why a knee 

replacement was not approved:

[T]he reason that I didn‟t approve it is that you don‟t have evidence, 

objective evidence, of severe disease, which is the first step in the 

criteria for having a total knee replacement. And so in reviewing 

that and the imaging that we had, we didn‟t have that, . . . so because 

of that, we wouldn‟t approve that. [¶] Also, you proved very 

functional. And, like I explained before, a total knee procedure is a 

large procedure with lots of risks and complications, especially for 

somebody who is obese and has other co-morbidities, such as 

yourself. We don‟t want to put you in a situation where the risk may 

outweigh the benefit. So that‟s the first step. [¶] And, again, I 

didn‟t say that you would never have it. People who have arthritis 

of the knee or any joint, as it advances, may need a total joint 

replacement. But that is a time -- continuum over time until it 

finally progresses to the point it‟s severe and affects their ability to 

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function well. That‟s when we address it again. [¶] Those are the 

reasons why it was denied here.

Docket No. 128 (Bright Depo.) RT 108-09. Dr. Bright had not treated or met Mr. Miller before he 

denied the RFS. Likewise, there is no evidence that Dr. Wang had treated or met Mr. Miller 

before he granted the RFS at Corcoran.

Nurse Hall received the denied RFS from Dr. Bright on June 18 or 19, 2014. Nurse Hall 

does not recall whether she responded to the Corcoran nurse‟s e-mail before or after she had 

received Dr. Bright‟s denial of the RFS. Docket No. 95 at 3. According to nurse Hall, when she 

responded to the Corcoran nurse‟s email, she “was simply informing” that nurse that nurse Hall 

“had received the RFS form (on June 12 or 13, 2014) and had already forwarded it to the doctor 

for a decision. [Her] response was not a confirmation that [she] received [Corcoran‟s] approved 

RFS, or that [she] had submitted the approved RFS for scheduling.” Docket No. 95 at 3. Nurse 

Hall also stated that, even if she had received the approved RFS from Corcoran, she would not 

have sent it for scheduling because there would have been two conflicting forms -- the one 

approved at Corcoran and the one denied at CTF-Soledad by Dr. Bright. Nurse Hall did not have 

the authority to unilaterally decide which RFS form she would process -- resolving the conflict 

would be a job for the doctors or reviewers. Nurse Hall declares that, had she been aware of the 

conflicting forms, she would have brought them to the attention of Dr. Bright or another 

supervisor and awaited further instructions. Docket No. 95 at 3. Nurse Hall also declares that, 

because she was aware of only Dr. Bright‟s denial of the RFS, she forwarded the denied RFS to 

Mr. Miller‟s PCP, and had no further involvement. Id.

Dr. Bright admits that someone on the utilization management staff informed him on June 

18, 2014, that medical staff at Corcoran approved on June 17, 2014 a request for Mr. Miller to 

return to Dr. Alade for an ortho consult. Docket No. 132, Ex. 4 (RFA No. 26).

E. Mr. Miller‟s Care at CTF-Soledad

Mr. Miller saw Defendant Dr. Ahmed on June 16, 2014 “the best I recall” and Dr. Ahmed 

said he had already done an RFS for Mr. Miller to have TKR that had been approved at Corcoran 

but needed to be re-approved at CTF-Soledad. That did not make sense to Mr. Miller because he 

had not even arrived at CTF-Soledad by June 10, 2014 for Dr. Ahmed to have acted as his PCP. 

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Docket No. 118 at 13. 

Mr. Miller saw Dr. Ahmed again on July 16, 2014. Docket No. 118 at 14. At this 

appointment, Mr. Miller learned that Dr. Bright had denied the TKR request but did not learn the 

reason for the denial. Dr. Ahmed‟s notes for this visit stated “Denial of RFS (ortho) . . . to 

discuss. RFS for ortho consult denied as x-ray (2012) showed mild” change in the 

chondrocalcinosis. Docket No. 116, Ex. 11 (AG507)

On October 2, 2014, Dr. Ahmed told Mr. Miller that Dr. Bright denied the RFS for a TKR. 

Docket No. 118 at 14-15. Mr. Miller states that Dr. Ahmed showed Mr. Miller on the computer 

screen a June 10, 2014 RFS that had Dr. Ahmed‟s handwriting and stamp, but this document later 

disappeared from Mr. Miller‟s medical records. Docket No. 118 at 14-15. Even Mr. Miller 

questions whether this RFS was correct as it would have been written before he even arrived at 

CTF-Soledad and Dr. Ahmed said there must have been some mistake on the date as to when the 

RFS was prepared and submitted. Docket No. 118 at 15; see also id. at 22. Dr. Ahmed continued 

to rely on the December 2012 x-ray to minimize Mr. Miller‟s condition while denying a TKR. Id.

at 19. 

Mr. Miller filed an inmate appeal (form CDC-602) complaining of the denial of the TKR. 

See Docket No. 131 at 37-75. 

On January 7, 2015, Dr. Ahmed interviewed Mr. Miller for his inmate appeal. Mr. Miller 

tried to tell Dr. Ahmed that someone at Corcoran had approved the TKR, but Dr. Ahmed was 

disinterested. Dr. Ahmed said it did not matter what anyone other than he and Dr. Bright had 

ordered or approved, and that, from now on, it was what Dr. Bright and he wanted to do that 

mattered. Docket No. 118 at 22. Dr. Ahmed also stated that they had decided to provide a more 

conservative course of treatment than a TKR, consisting of long-acting morphine for pain and 

physical therapy. Docket No. 118 at 22. Dr. Ahmed was hostile during that visit, accusing Mr. 

Miller of being racist and making things up, and said he would write up a rule violation report if 

Mr. Miller continued “wasting [his] time with this nonsense.” Docket No. 118 at 22-23. That 

comment made Mr. Miller stop challenging Dr. Ahmed further at that one interview. Dr. Ahmed

said he would deny the inmate appeal, but would order another x-ray due to Mr. Miller‟s chronic 

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pain, do an RFS for physical therapy evaluation, and would see Mr. Miller again when the x-ray 

and physical therapy reports were in. Id. at 23. Dr. Ahmed signed the written first level response 

that denied the inmate appeal on January 20, 2015. That response stated, in part, that the RFS had 

been denied by Dr. Bright “due to presence of mild disease on x-ray dated December 28, 2012 and 

InterQual criteria were not met.” Docket No. 131 at 45. 

Significantly, before the inmate appeal received a decision at the next level, there was a 

newer x-ray report in Mr. Miller‟s file. Specifically, the radiologist‟s report for the January 22, 

2015 x-rays stated that there was “moderate arthrosis” and chondrocalcinosis. See footnote 4, 

supra. 

On March 17, 2015, Defendant Dr. Posson, the chief medical executive at CTF-Soledad, 

signed the second level response denying Mr. Miller‟ s inmate appeal. Id. at 51. In response to 

Mr. Miller‟s request for an explanation as to the reason for the denial of the TKR, Dr. Posson 

wrote that Mr. Miller had not received the required approval for a TKR before he left Corcoran, 

and that he had an episode of chest pain that required evaluation for a heart attack in the 

emergency room during his transfer to CTF-Soledad. Docket No. 131 at 49. Dr. Posson also 

wrote that the x-rays did not show evidence of severe disease; the latest x-rays showed moderate 

(not severe) arthrosis on January 22, 2015; pain was being managed on long-acting morphine with 

the help of physical therapy; Mr. Miller was able to function in his job; and Mr. Miller had refused 

a pain control visit with his PCP on March 3, 2015. Id. Mr. Miller states that the missed 

appointment was simply because the medication he wanted had already been ordered.

F. Pain medication

Long-term use of opiates has “been found ineffective for chronic non cancer pain and thus 

should not be prescribed, especially to patients at high risk of addiction.” Docket No. 96 at 13 & 

n.8. Extended release opiates such as MS Contin are particularly hazardous and prone to abuse. 

Id.

At an appointment on April 7, 2015, Dr. Ahmed said he was renewing Mr. Miller‟s MSContin (morphine) prescription. Mr. Miller states that Dr. Ahmed did not mention any plan to 

taper Mr. Miller off the morphine but did say he (Dr. Ahmed) had been asked to take the case to 

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the pain management committee “to justify the use of morphine for more then [sic] five years 

pending the future TRK/TJR surgery if any.” Docket No. 1-2 at 26.

The pain management committee recommended that Mr. Miller‟s morphine be tapered to 

elimination. A typewritten “Pain Management Note” from April 8, 2015, described Mr. Miller‟s 

case, noting that he was functioning well and was able to work in the kitchen pushing a broom and 

a cart without difficulty. The note further stated that Mr. Miller had “moderate OA [i.e., 

osteoarthritis] of the right knee with pseudogout and is functioning well. . . . Does not qualify for 

total knee. Total knees are indicated with advance arthritis that interferes with function. He does 

not meet criteria for narcotics. He has moderate disease and is fully functional.” Def MSJ 344. 

The note appears to be signed by Dr. Bright.

Dr. Ahmed‟s morphine-tapering instructions were written on Mr. Miller‟s medication chart 

in a note dated April 8, 2015. Def MSJ 346. The instructions show that the morphine (which had 

until then been 30 mg. in the morning and 30 mg. in the evening) was to be tapered over 5 weeks 

until it was discontinued. Id.; see also Docket No. 96 at 13. During the weeks the morphine was 

being tapered, Mr. Miller was given aspirin and later an antihistamine, sulindac (a non-steroidal 

anti-inflammatory drug (NSAID)) and offered Tegretol for his pain and withdrawal symptoms. 

See Def MSJ 346, 361, 379, 382, 384, 389. He also was given ice for knee pain on April 30. 

Colchicin (a gout medication) was prescribed for Mr. Miller‟s CPPD. Def MSJ 382, 384. 

Mr. Miller learned that Dr. Ahmed had ordered him to be tapered off the morphine on 

April 10 or 11, when he went to obtain his morphine and learned that his evening dosage has been 

reduced from 30 mg. to 15 mg. Thereafter, Mr. Miller filed numerous health care service request 

forms beginning on April 11, 2015 and through August 2015, complaining about knee pain and 

reiterating his demands for TKR. Docket No. 1-2 at 27; see Def MSJ 353-401. Mr. Miller was 

seen by Defendant nurse Roberto Deluna and other nurses in response to several of his health care 

services request forms.

Nurse Deluna saw Mr. Miller in response to Mr. Miller‟s first health care service request 

form dated April 12, 2015, that complained of severe pain due to the change in medication. Def 

MSJ 353. Mr. Miller wrote that he had “experienced greater right knee pain then [sic] before the 

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tapering had begun; as well as nausea, sweats, alternating chills, abdominal cramps, nasal 

drip/drainage, and explosive diarrhea-- in the form of addiction withdrawal symptoms” from the 

morphine. Docket No. 1-2 at 29 (Complaint, ¶ 78). Nurse Deluna saw Mr. Miller the next day, 

took Mr. Miller‟s vital signs; noted that he did not appear to be in acute distress and had eaten 

breakfast; and planned for Mr. Miller to continue the current plan and keep his April 21, 2015 

appointment. Def MSJ 353. Mr. Miller states that nurse Deluna denied his request to see Dr. 

Ahmed immediately and told Mr. Miller, “„No, your [sic] going to have to just kick the morphine 

slowly, so deal with it.‟” Docket No. 1-2 at 29. Dr. Ahmed had just written the directions for the 

morphine taper and, according to Dr. Barnett, nurse Deluna was obligated to follow medical 

orders written by supervising physicians. As Dr. Barnett also explains, the sentiment conveyed by 

nurse Deluna was accurate: detoxifying “from years of opiate use is difficult no matter how 

gradually the dosages are reduced.” Docket No. 96 at 14. 

Dr. Ahmed wrote a prescription for loratadine (an antihistamine) on April 21, 2015. Def 

MSJ 369. 

Dr. Ahmed saw Mr. Miller on April 29, 2015, at which time Mr. Miller complained of 

knee pain. Dr. Ahmed planned to add naproxen and ordered an x-ray. Def MSJ 372-373 An xray done on April 30, 2015 revealed “moderate osteoarthritis of the right knee with associated 

chondrocalcinosis.” Def MSJ 381. 

Dr. Ahmed saw Mr. Miller again on May 5, 2015. Def MSJ 382. Dr. Ahmed ordered 

another knee x-ray and wrote that the patient agreed to try a medication, colchicin, for gout. Def 

MSJ 382-383. The medication was added to Mr. Miller‟s list of medications, which now included 

aspirin, an antihistamine and a gout medication, in addition to the reduced dosage of morphine. 

Nurse Deluna processed Mr. Miller‟s May 11, 2015 health care services request form on 

May 14, 2015, and noted that the patient had an appointment to see his PCP that day. Def MSJ 

386.

Mr. Miller saw Dr. Ahmed on May 14, 2015. Def. MSJ 387. Dr. Ahmed noted that there 

was “no bone on bone change,” and moderate degenerative joint disease. Id. Dr. Ahmed planned 

to add Tegretol (also known as carbamazepine) to Mr. Miller‟s medications. Id. Mr. Miller told 

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Dr. Ahmed that he did not consent to take antidepressant, antiseizure/anticonvulsant, or 

antipsychotic/psychoactive drugs for off-label use to treat his knee pain because he had seen 

prison doctors do that for other inmates “turning them into virtual zombies; also reminding Dr. 

Ahmed about plaintiff‟s health care complication risk problems and a concern for adverse sideeffects. Dr. Ahmed told plaintiff the carbamazepine would have no appreciable side effects (or at 

best minimal ones if it did) or present foreseeable complications.” Docket No. 1-2 at 33. Dr. 

Ahmed incorrectly told Mr. Miller carbamazepine was not an anticonvulsant. See id.

Carbamazepine also “is commonly used to treat pain,” and “is approved for treatment of chronic 

pain by” the California Correctional Health Care System. Docket No. 96 at 14 & n. 11. Like other 

anti-epilepsy drugs, carbamazepine “is frequently prescribed as an alternative to opiate pain 

medications.” Docket No. 96 at 16. Tegretol and Sulindac (an NSAID) were added to the list of 

medications Mr. Miller was prescribed. Def MSJ 389. The starting dose of Tegretol for Mr. 

Miller was 200 mg. each night, which was the minimal starting daily dose recommended by the 

manufacturer. Docket No. 96 at 15.

Mr. Miller took only one Tegretol pill and stopped. He asked for the prescription for 

Tegretol to be stopped and wrote that he had not given Dr. Ahmed informed consent to prescribe 

“any anticonvulsant, antiseizure, or antidepression medication for my RIGHT KNEE PAIN and 

told him not to do so before he did it leading me to believe this medication wasn‟t. After I took it, 

5-15-2015, I experienced heart pulsations, light-headedness, dizziness and cramps, then learned its 

an ANTICONVULSANT!!!” Def MSJ 391. Although Mr. Miller attributes heart pulsations, 

light-headedness, dizziness and cramps to the single dose of Tegretol, he also had experienced 

those problems on many other days on which he was not taking Tegretol. See, e.g., Def MSJ 316 

(January 9, 2015 complaints of nausea, vomiting and dizziness); Def MSJ 323 (complaints of 

vomiting and diarrhea less than a week before a January 30, 2015 appointment). Mr. Miller also 

had a long history of complaints of chest pain; cardiac issues are mentioned throughout his 

medical records from as early as 2004 through 2016 -- including a trip to the hospital due to chest 

pains and passing out on June 10, 2014. See, e.g., Def MSJ 4, 30, 119, 245, 246, 412, 500, 513, 

593. 

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Nurse Deluna saw Mr. Miller on May 31, 2015 in response to his May 30, 2015 health care 

services request form complaining of knee pain. Nurse Deluna took Mr. Miller‟s vital signs, noted 

the condition of his knee, analyzed it as an “alteration in comfort” and “rt. knee pain,” and planned 

for the patient to be put in the PCP line as scheduled for pain control evaluation. Def MSJ 401. 

Nurse Deluna saw Mr. Miller on June 15, 2015 in response to his June 11, 2015 health care 

services request form in which he requested to see a pain specialist. Def MSJ 403. Nurse Deluna 

took his vital signs, and planned for him to see a PCP as scheduled. The next scheduled 

appointment date was July 10, 2015. Def MSJ 403. 

In the ensuing months, various non-narcotics medications were prescribed for Mr. Miller‟s 

pain, including Tylenol and NSAIDs. See, e.g., Def MSJ 425 (July 10, 2015 medication list 

includes acetaminophen, aspirin, sulindac (an NSAID), and two antihistamines); Def MSJ 452 

(steroid injection to knee on September 2, 2015); Def MSJ 507 (February 8, 2016 medication list

includes aspirin); Def MSJ 565 (April 13, 2016 medication list includes capsaicin cream, aspirin 

and Tylenol). Warm compression and exercise also were recommended for Mr. Miller. In March 

2016, a rollator (i.e., a walker with wheels) was ordered for him. Def MSJ 539. 

Mr. Miller filed an inmate appeal claiming that he had been deprived of pain medication in 

retaliation for his prior inmate appeal about the TKR. Docket No. 131 at 77. Dr. Posson signed 

the decision that denied the inmate appeal at the second level. Id. at 83. 

Dr. Barnett opines that Mr. Miller was properly tapered off his morphine; that the doctors 

properly tapered Mr. Miller to minimize his withdrawal symptoms; that Dr. Ahmed prescribed 

appropriate pain medication to replace the morphine; and that nurse Deluna acted appropriately

within the scope of his license to address Mr. Miller‟s pain and drug withdrawal symptoms. 

Docket No. 96 at 16. 

At Dr. Bright‟s suggestion, Mr. Miller was referred to Defendant Dr. Williams, a physical 

medicine and rehabilitation specialist, for a consultation about his functioning and treatment 

related to his right knee pain. See Def MSJ 434-36. In his July 30, 2015 consultation report, Dr. 

Williams noted that Mr. Miller was severely obese with a body mass index of 41.2, had a 

significant medical history, including diabetes and hypertension; and the patient admitted he had 

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not been fully compliant with the exercise program taught by the physical therapist. Id. at 434-35. 

Dr. Williams noted that the medical records indicated that the patient was fully functional with a 

cane. Id at 435. Dr. Williams also noted that there were several x-rays, including an x-ray from 

April 2015 showing moderate osteoarthritis with associated chondrocalcinosis on the right knee. 

Id. at 435. Dr. Williams recommended physical therapy for core strengthening and to establish an 

exercise program for the knee and back. Dr. Williams determined that “the patient does not have a 

severe pain, meaning a degree of discomfort that significantly disables the patient from reasonable 

independent function and is overall modified independent with a cane.” Id. at 436. Dr. Williams 

also stated that Mr. Miller “has not exhausted all conservative treatment options and surgery was 

not recommended. “ Id. Dr. Williams recommended that Mr. Miller start physical therapy and be 

considered for knee steroid injections. Id. 

III. VENUE AND JURISDICTION

Venue is proper in the Northern District of California because the events or omissions 

giving rise to the complaint occurred at a prison in Monterey County, which is located within the 

Northern District. See 28 U.S.C. §§ 84, 1391(b). The Court has federal question jurisdiction over 

this action brought under 42 U.S.C. § 1983. See 28 U.S.C. § 1331.

IV. LEGAL STANDARD FOR SUMMARY JUDGMENT

Summary judgment is proper where the pleadings, discovery and affidavits show that there 

is “no genuine dispute as to any material fact and [that] the moving party is entitled to judgment as 

a matter of law.” Fed. R. Civ. P. 56(a). A court will grant summary judgment “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 . . . since a complete 

failure of proof concerning an essential element of the nonmoving party‟s case necessarily renders 

all other facts immaterial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). A fact is 

material if it might affect the outcome of the lawsuit under governing law, and a dispute about 

such a material fact is genuine “if the evidence is such that a reasonable jury could return a verdict 

for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). 

In a typical summary judgment motion, a defendant moves for judgment against a plaintiff 

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on the merits of his claim. In such a situation, the moving party bears the initial burden of 

identifying those portions of the record which demonstrate the absence of a genuine dispute of 

material fact. The burden then shifts to the nonmoving party to “go beyond the pleadings, and by 

his own affidavits, or by the „depositions, answers to interrogatories, or admissions on file,‟ 

designate „specific facts showing that there is a genuine issue for trial.‟” Celotex, 477 U.S. at 324.

A verified complaint may be used as an opposing affidavit under Rule 56, as long as it is 

based on personal knowledge and sets forth specific facts admissible in evidence. See Schroeder

v. McDonald, 55 F.3d 454, 460 & nn.10-11 (9th Cir. 1995) (treating plaintiff‟s verified complaint 

as opposing affidavit where, even though verification not in conformity with 28 U.S.C. § 1746, 

plaintiff stated under penalty of perjury that contents were true and correct, and allegations were 

not based purely on his belief but on his personal knowledge). Mr. Miller‟s complaint is made

under penalty of perjury, so the facts therein are considered in the adjudication of the summary 

judgment motion. 

The court‟s function on a summary judgment motion is not to make credibility 

determinations or weigh conflicting evidence with respect to a disputed material fact. See T.W. 

Elec. Serv. v. Pac. Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 1987). The evidence must 

be viewed in the light most favorable to the nonmoving party, and inferences to be drawn from the 

facts must be viewed in a light most favorable to the nonmoving party. See id. at 631.

V. DISCUSSION

A. Eighth Amendment Claims

Deliberate indifference to an inmate‟s serious medical needs violates the Eighth 

Amendment‟s proscription against cruel and unusual punishment. See Estelle v. Gamble, 429 U.S. 

97, 104 (1976); Toguchi v. Chung, 391 F.3d 1051, 1057 (9th Cir. 2004). To establish an Eighth 

Amendment claim on a condition of confinement, such as medical care, a prisoner-plaintiff must 

show: (1) an objectively, sufficiently serious, deprivation, and (2) the official was, subjectively, 

deliberately indifferent to the inmate‟s health or safety. See Farmer v. Brennan, 511 U.S. 825, 

834 (1994). These two requirements are known as the objective and subjective prongs of an 

Eighth Amendment deliberate indifference claim.

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1. Objective Prong

To satisfy the objective prong, there must be a deprivation of a “serious” medical need. A 

serious medical need exists if the failure to treat an inmate‟s condition “could result in further 

significant injury” or the “„unnecessary and wanton infliction of pain.‟” Jett v. Penner, 439 F.3d 

1091, 1096 (9th Cir. 2006). 

The evidence in the record suffices to allow a jury to conclude that Mr. Miller‟s right knee 

problems presented a serious medical need. The evidence shows that he had arthritis in his knee, 

pyrophosphate crystal depositions in his knees (also known as pseudogout), and longstanding 

complaints of knee pain. On this record, a reasonable jury could conclude that his knee problems 

satisfied the Eighth Amendment‟s objective prong.

2. Subjective Prong

For the subjective prong, there must be deliberate indifference. A defendant is deliberately 

indifferent if he knows that an inmate faces a substantial risk of serious harm and disregards that 

risk by failing to take reasonable steps to abate it. Farmer, 511 U.S. at 837. The defendant must

not only “be aware of facts from which the inference could be drawn that a substantial risk of 

serious harm exists,” but he “must also draw the inference.” Id. Deliberate indifference may be 

demonstrated when prison officials deny, delay or intentionally interfere with medical treatment, 

or it may be inferred from the way in which prison officials provide medical care. See McGuckin 

v. Smith, 974 F.2d 1050, 1062 (9th Cir. 1992) (finding that a delay of seven months in providing 

medical care during which a medical condition was left virtually untreated and plaintiff was forced 

to endure “unnecessary pain” sufficient to present colorable § 1983 claim), overruled on other 

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

must be “harm caused by the indifference,” although the harm does not need to be substantial. See

Jett, 439 F.3d at 1096. 

Negligence does not amount to deliberate indifference and does not satisfy the subjective 

prong of an Eighth Amendment claim. See Wilhelm v. Rotman, 680 F.3d 1113, 1122-23 (9th Cir. 

2012) (finding no deliberate indifference but merely a “negligent misdiagnosis” by defendantdoctor who decided not to operate because he thought plaintiff was not suffering from a hernia).

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A difference of opinion as to which medically acceptable course of treatment should be 

followed does not establish deliberate indifference. Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 

1989) (summary judgment for defendants was properly granted because plaintiff‟s evidence that a 

doctor told him surgery was necessary to treat his recurring abscesses showed only a difference of 

opinion as to proper course of care where prison medical staff treated his recurring abscesses with 

medicines and hot packs). “[T]o prevail on a claim involving choices between alternative courses 

of treatment, a prisoner must show that the chosen course of treatment „was medically 

unacceptable under the circumstances,‟ and was chosen „in conscious disregard of an excessive 

risk to [the prisoner‟s] health.‟” Toguchi, 391 F.3d at 1058. 

Prison officials cannot avoid Eighth Amendment liability by simply declaring that they 

disagree with a specialist‟s or treating doctor‟s prescribed course of care. The limits of the 

difference-of-opinion rule were illustrated in Snow v. McDaniel, 681 F.3d 978 (9th Cir. 2012), 

overruled on other grounds by Peralta v. Dillard, 744 F.3d 1076 (9th Cir. 2014), where the Ninth 

Circuit determined that the district court erred in granting summary judgment for defendants who 

argued that their refusal to approve double hip-replacement surgery for a prisoner who could 

barely walk due to hip pain showed a mere difference of opinion. In Snow, the prison medical 

committee repeatedly refused to authorize a double hip-replacement surgery, even though an 

orthopedic surgeon and the prisoner‟s treating physician considered the requested surgery to be an 

emergency. See id. at 986. Not only had the medical committee refused to authorize the surgery, 

the committee “gave no medical reason for the denials” and some evidence suggested the refusal 

was due to the warden‟s dislike of death row prisoners such as the plaintiff. Id. at 986-87. Snow

rejected the defendants‟ argument that their choice to treat the prisoner with medications rather 

than surgery showed merely a difference of opinion that did not amount to an Eighth Amendment 

violation. Id. at 987-88. Although there was “clearly a difference of medical opinion,” the 

evidence in the record and inferences therefrom could allow a reasonable jury to “conclude that 

the decision of the non-treating, non-specialist physicians to repeatedly deny the recommendations 

for surgery was medically unacceptable under all of the circumstances.” Id. at 988. Significantly, 

the defendants sent the prisoner for evaluation by orthopedic surgeons, both of whom 

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recommended double hip-replacement surgery. Id. One of those surgeons testified at his 

deposition that the prisoner‟s likelihood of success after the surgery was very high, that surgery 

would help improve the prisoner‟s health and mobility, and that the surgery would allow the 

prisoner to avoid the use of the medications that were causing other health problems for the 

prisoner. On this record, “it should be for the jury to decide whether any option other than surgery 

was medically acceptable.” Id. The court acknowledged that “a medication-only course of 

treatment may have been medically acceptable for a certain period of time,” but saw the multi-year 

delay in approving the recommended surgery as presenting a triable issue as to medical 

acceptability of defendants‟ course of treatment under the circumstances. Id.

a. Total Knee Replacement (TKR)

Defendants Dr. Bright, Dr. Ahmed and nurse Hall are not entitled to summary judgment on 

Mr. Miller‟s claim that they were deliberately indifferent in response to his request for TKR 

surgery. Defendants Dr. Posson and Dr. Williams are, however, entitled to summary judgment on 

the claim.

i. Dr. Bright, Dr. Ahmed and Nurse Hall

Dr. Bright: There are triable issues as to whether Dr. Bright deliberately ignored more 

recent information in the medical file supporting a determination that a TKR was necessary and 

instead chose to rely on an outdated x-ray to deny the TKR. Dr. Bright specifically relied on a 

December 2012 x-ray which showed mild disease and testified that the primary reason he had 

denied the RFS was because Mr. Miller did not “have evidence, objective evidence, of severe 

disease, which is the first step in the criteria for having a total knee replacement.” Bright Depo., 

RT 108-109. But the then-current information in Mr. Miller‟s medical record suggested he had 

severe arthritis when Dr. Bright denied the RFS on June 18, 2014. When Mr. Miller arrived at 

CTF-Soledad in June 2014, there was (1) an x-ray report from December 10, 2013, stating that 

Mr. Miller‟s right knee had “moderate to severe” arthritis, and (2) two orthopedists had 

recommended a TKR. Orthopedist Dr. Smith had recommended in February 2014 that Mr. Miller 

“undergo a consultation for a total knee replacement given the severity of arthritis in his right knee 

and the fact that he is nearly wheelchair bound at this time.” Def MSJ 255. Dr. Smith noted in his 

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report that the x-rays from December 2013 “confirm severe degenerative arthritis.” Id. 

Orthopedist Dr. Alade had recommended in April 2014 that Mr. Miller be authorized to have a 

TKR and be returned to him (Dr. Alade) for the surgery. A reasonable trier of fact could conclude 

that Dr. Bright was deliberately indifferent to a serious medical need when he chose to rely on the 

December 2012 x-ray that showed only “minimal arthritic change,” DEF MSJ 218, when that xray predated another x-ray showing more advanced arthritis and predated the recommendations 

from two orthopedic specialists for Mr. Miller to have TKR.

There also is a triable issue as to whether Mr. Miller met the CDCR‟s objective criteria for 

a TKR, a factor that informs whether Dr. Bright acted with deliberate indifference. The InterQual 

computer program is used to make an initial determination about whether a patient meet certain 

objective medical criteria for a requested service. At Corcoran, it was determined that the 

InterQual criteria were met for a TKR. There is a genuine issue as to whether Dr. Bright ignored

objective medical criteria when he denied the RFS. 

As mentioned earlier, orthopedist Dr. Alade had recommended in April 2014 that Mr. 

Miller be authorized to have a TKR. Although Dr. Alade‟s recommendation had a flawed 

assumption (i.e., that Mr. Miller unsuccessfully had tried steroid injections) and a precondition to 

surgery (i.e., Mr. Miller had to receive a medical clearance), these do not show the absence of a 

triable issue on the claim that Dr. Bright was deliberately indifferent in denying the TKR in June 

2014. First, Dr. Alade‟s recommendation for TKR was based, in part on the mistaken belief that 

Mr. Miller had exhausted conservative treatment options. Dr. Alade assumed that Mr. Miller had 

tried steroid injections without success when in fact Mr. Miller had not had any steroid injections. 

Dr. Bright did not mention that problem at the time he denied the RFS for a TKR, and a 

reasonable trier of fact might conclude he did not rely on the absence of steroid injections to deny 

the TKR. Second, Dr. Alade‟s recommendation for TKR was conditioned on Mr. Miller first 

obtaining a medical clearance due to his heart and other medical problems. But Dr. Bright did not 

mention the need for a medical clearance at the time he denied the RFS for a TKR, and a 

reasonable trier of fact might conclude he did not rely on the absence of a medical clearance in 

denying the TKR. Moreover, Defendants have not shown that a medical clearance is obtained 

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before a surgery is approved; it may be that, to avoid an unnecessary medical visit, a medical 

clearance will not be sought until after a surgery is approved. 

The limits in Dr. Alade‟s recommendation are important facts, but they appear to go to the 

value of Mr. Miller‟s claim, rather than the existence of an Eighth Amendment violation. For 

example, if Mr. Miller would not have been given a medical clearance due to his morbid obesity,5

diabetes, hypertension and other medical problems, then Dr. Bright‟s denial of the RFS arguably 

did not cause much actual damage to Mr. Miller. And if steroid injections had to be tried before a 

TKR would ever be permitted, then Dr. Bright‟s denial of the RFS might be viewed as having 

caused little, if any, actual damage to Mr. Miller. Because Dr. Bright denied the RFS, Mr. 

Miller‟s case did not progress to the point where the medical clearance was sought or to the point 

where someone weighed the importance of trying steroid injections before sending him for a TKR.

Mr. Miller argues that Defendants mischaracterized the December 2012 x-ray as showing 

only mild disease because the x-ray report actually stated that he had “minimal arthritic changes.” 

Whatever difference there may be between mild and minimal is not sufficient to create a genuine 

issue of fact for trial. Insofar as Mr. Miller means that the additional statement in the December 

2012 x-ray that there is “considerable chondrocalcinosis” meant that he did not have mild disease, 

this argument fails because he has not shown that he has any medical expertise to opine about the 

meaning of the finding of chondrocalcinosis on an x-ray. Nor does he present any admissible 

evidence on this point. If this case ever goes to trial, he will need to hire a medical expert to 

discuss chondrocalcinosis and the significance of it for the TKR decision-making.

Mr. Miller also argues the fact that the RFS had been approved at Corcoran before or 

simultaneously with Dr. Bright‟s denial of the RFS at CTF-Soledad establishes his claim. If this 

was all the evidence showed, Mr. Miller would have established nothing more than a difference of 

opinion between Dr. Bright on one hand, and Corcoran doctors on the other hand. That difference 

 

5 Mr. Miller was 5 foot 7-1/2 inches tall. His weight bounced around, usually between 250 and 

280 pounds in 2014-2016. See, e.g., Def MSJ 287 (253 on June 12, 2014); 303 (270 on October 2, 

2014); 311 (280 on December 30, 2014); 325 (270 on February 21, 2015); 342 (273 on April 7, 

2015); 403 (264 on June 15, 2015); 442 (268 on August 6, 2015); 532 (254 on March 7, 2016). 

His weight was in the same range even before the TKR was under consideration. See, e.g., Def 

MSJ 66 (274 on December 14, 2009); 117 (271 on June 10, 2010); 221 (270 on August 15, 2013). 

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of opinion would not in itself show an Eighth Amendment violation. “[T]o prevail on a claim 

involving choices between alternative courses of treatment, a prisoner must show that the chosen 

course of treatment „was medically unacceptable under the circumstances,‟ and was chosen „in 

conscious disregard of an excessive risk to [the prisoner‟s] health.‟” Toguchi, 391 F.3d at 1058. 

On the other hand, Defendants are not entitled to summary judgment because the evidence

supporting an inference that that Dr. Bright may have consciously disregarded the December 2013 

x-ray and the two orthopedists‟ recommendations for a TKR takes this case beyond the typical 

difference-of-opinion case like Toguchi and moves it closer to Snow v. McDaniel. The existence 

of the x-ray showing moderate to severe arthritis and the existence of two orthopedists‟ 

recommendations for TKR – passed over for an earlier x-ray showing mild arthritis -- could permit 

a trier of fact to find that Dr. Bright‟s decision was made in conscious disregard of an excessive 

risk to Mr. Miller‟s health. 

Dr. Ahmed: There are triable issues on Mr. Miller‟s claim that Dr. Ahmed was 

deliberately indifferent to Mr. Miller‟s need for the TKR. Viewing the evidence in the light most 

favorable to Mr. Miller, a reasonable trier of fact could conclude that Dr. Ahmed relied on the 

outdated December 2012 x-ray to deny the TKR and chose to ignore the two orthopedists‟ 

recommendations and the December 2013 x-ray. Dr. Ahmed apparently took the position that, 

once Dr. Bright denied the RFS on June 18, 2014, Dr. Ahmed was powerless to challenge the 

decision or to further pursue a TKR for Mr. Miller. But Dr. Ahmed has not come forth with 

undisputed evidence that, as a PCP, he was unconditionally bound forever by Dr. Bright‟s June 18, 

2014 decision on the RFS. 

Nurse Hall: Triable issues as to whether nurse Hall acted with deliberate indifference to 

Mr. Miller‟s serious medical needs preclude summary judgment for her. Nurse Hall received an 

email from a nurse at Corcoran on June 18 or 19 forwarding the RFS that had been approved at 

Corcoran. Although nurse Hall declares that she was without power to schedule the surgery 

because Dr. Bright had denied the RFS, she does not explain what became of the approved RFS. 

A reasonable trier of fact could conclude that she was aware of the approved RFS when she 

received the e-mail from the Corcoran UMRN that asked her to “forward approved RFS from 

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Corcoran” to the scheduler. At the summary judgment stage, this moving defendant is not entitled 

to a presumption that she handled the conflicting RFSs properly when she provides no evidence 

that she did so. A reasonable trier of fact could conclude that she knew there was both a granted 

and a denied RFS. And a reasonable trier of fact could conclude that, if a UMRN had conflicting 

RFS results (i.e., one granting and one denying the RFS), it would be deliberately indifferent to

simply ignore the RFS that had been granted. 

Defendants argue that nurse Hall had no authority to overrule Dr. Bright‟s decision. That 

may be true but, by not bringing the conflicting RFSs to his attention, she preempted Dr. Bright 

from reconsidering the denial and changing his mind. This situation is akin to the situation where 

a guard does not bring a patient to a medical care provider: the guard might not have any authority 

to provide medical care, but she can still be liable for refusing to bring the patient to someone who 

can provide medical care.

ii. Dr. Posson and Dr. Williams

Dr. Posson: Viewing the evidence in the light most favorable to Mr. Miller, no reasonable 

jury could conclude that Dr. Posson was deliberately indifferent to Mr. Miller‟s serious medical 

needs. Dr. Posson denied Mr. Miller‟s two inmate appeals at the second level. As the Court 

explained in the order of service, there is no liability for merely denying or mishandling an inmate 

appeal. See Docket No. 30 at 6. Dr. Posson‟s potential Eighth Amendment liability, if any, would 

be based on his response to an ongoing medical need rather than on his failure to grant or properly 

handle an inmate appeal about an event that had already occurred. Thus, the fact that he denied 

the inmate appeal about Dr. Bright‟s decision made months earlier does not in itself support 

liability for Dr. Posson. 

Potential liability might exist if there was an ongoing need for a TKR at the time Dr. 

Posson made his decision. Here, however, there was new information about Mr. Miller‟s 

condition when Dr. Posson addressed the inmate appeal. By the time Dr. Posson considered Mr. 

Miller‟s first inmate appeal about the TKR, Mr. Miller had had further x-rays in January 2015

showing only moderate arthritis, rather than severe arthritis. The two orthopedists‟ 

recommendations were still in the file, but they relied on earlier x-ray reports that showed severe 

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arthritis. Although the evidence in the record could allow a reasonable trier of fact to conclude that 

severe arthritis supports a TKR, there is no similar evidence that moderate arthritis supports a 

TKR. Since, at the time Dr. Posson considered Mr. Miller‟s case, Mr. Miller‟s then-current x-rays 

taken in 2015 showed only moderate arthritis, no competent evidence in the record would permit a 

reasonable trier of fact to conclude that Dr. Posson acted with deliberate indifference in not 

ordering a TKR in response to the inmate appeal. Dr. Posson is entitled to summary judgment on 

the TKR claim.

Dr. Williams: On the evidence in the record, no reasonable jury could find in favor of Mr. 

Miller‟s claim that Dr. Williams acted with deliberate indifference to his serious medical needs. It 

is undisputed that, at the time Dr. Williams saw Mr. Miller for a consultation, Dr. Williams knew: 

(1) Mr. Miller‟s then-current x-rays in 2015 showed only moderate arthritis; (2) Mr. Miller had 

never received steroid injections, contrary to the assumption of the orthopedist who recommended 

at TKR in April 2014; (3) Mr. Miller‟s records stated he was able to move about with the aid of a 

cane; (4) Mr. Miller had reported being less than fully compliant with physical therapy that had 

been given him in the past; and (5) Mr. Miller was morbidly obese and had hypertension and 

diabetes. Given this information that was known to Dr. Williams in 2015, no reasonable trier of 

fact could find that Dr. Williams was deliberately indifferent when he recommended that Mr. 

Miller try steroid injections, exercise and physical therapy to address his knee pain. Dr. Williams 

is entitled to summary judgment on the TKR claim.

At the time Dr. Williams evaluated Mr. Miller, circumstances were different from those 

present when Dr. Bright and Dr. Ahmed acted. When Dr. Bright and Dr. Ahmed denied the TKR 

in June 2014 and in the several months thereafter, the most current information in the file was the 

December 2013 x-ray showing moderate to severe osteoarthritis, as well as the recommendations 

by the two orthopedists for a TKR based on severe arthritis. In contrast, by the time Dr. Williams 

evaluated Mr. Miller in July 2015, there was a newer x-ray from January 2015 showing only 

moderate arthrosis. The orthopedists‟ recommendations had been made at a time when an x-ray 

showed a more severe condition, and there is no evidence in the record that the orthopedists would 

have recommended TKR if they had the January 2015 x-ray showing moderate arthrosis. The 

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deliberate indifference inquiry depends on the facts actually known to a defendant when he acts or 

fails to act, and the facts known to each defendant were not identical. By the time Dr. Williams 

(like Dr. Posson) did anything regarding Mr. Miller‟s TKR request, additional facts less favorable 

to a TKR were known that were not the same as those present when Dr. Bright and Dr. Ahmed 

had denied the TKR in 2014.

b. The Morphine Taper

Having carefully reviewed the evidence, the Court concludes that no reasonable jury could 

find in Mr. Miller‟s favor on his Eighth Amendment claim against Dr. Bright, Dr. Posson, Dr. 

Ahmed, and nurse Deluna for their actions in tapering and eventually ending Mr. Miller ‟s 

morphine prescription. It is undisputed that Mr. Miller was tapered from the morphine he had 

taken for several years, that the tapering took place over about five weeks, and that the morphine 

eventually was discontinued. Mr. Miller‟s evidence also suggests that many other inmates also 

were tapered from opiates as a result of prison-wide policies. 

Defendants have presented evidence that their decisions to wean Mr. Miller from morphine 

and to provide other medications were pursuant to the exercise of their medical judgment. The 

evidence shows that Mr. Miller was weaned from morphine gradually over a five-week period, 

during which time he was seen by nurse Deluna and other nurses repeatedly and by Dr. Ahmed on 

several occasions. He argues that nurse Deluna did not do anything for him, but the medical 

records plainly show the nurse was not wholly inert. Nurse Deluna took the patient‟s vital signs, 

observed that the patient being weaned from morphine was not in acute distress, and noted the 

patient‟s next appointment with his primary care provider. Nurse Deluna may not have done 

anything Mr. Miller wanted (such as a return to higher morphine levels), but that does not support 

a reasonable inference that nurse Deluna did nothing at all. Mr. Miller states that nurse Deluna 

denied his request to see Dr. Ahmed immediately and told Mr. Miller a few days into the tapering 

process that he would “have to just kick the morphine slowly, so deal with it.‟” Docket No. 1-2 at 

29. As Dr. Barnett notes, the sentiment conveyed by nurse Deluna was accurate: detoxifying

“from years of opiate use is difficult no matter how gradually the dosages are reduced.” Docket 

No. 96 at 14. 

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Several medications were provided to Mr. Miller to address his complaints during the 

morphine taper. And in the months after the morphine was discontinued, Mr. Miller continued to 

receive non-narcotic pain medications. Defendants also present Dr. Barnett‟s opinion testimony 

that the taper was properly done to minimize withdrawal symptoms, and that appropriate and 

adequate medications were prescribed to replace the morphine.

6

Mr. Miller has no medical expertise and offers no competent evidence as to the proper use 

of morphine for chronic non-cancer pain, such as his knee pain. Mr. Miller is able to show that he 

wanted morphine, but does not offer competent evidence to controvert the defense evidence that 

morphine is ineffective for chronic non-cancer pain. Indeed, his repeated complaints of severe 

pain in the years before the taper even began support the view that the morphine was ineffective 

for his knee pain. 

Tegretol was an anticonvulsant; Mr. Miller had categorically refused to take 

anticonvulsants. Mr. Miller took only a single pill before stopping the Tegretol. There must be 

“harm caused by the indifference” for an Eighth Amendment violation. See Jett, 439 F.3d at 1096. 

Mr. Miller has not provided evidence that would allow a reasonable jury to conclude that he was 

harmed by the single Tegretol pill he took. The symptoms he attributes to having experienced 

after taking a single Tegretol pill were symptoms he experienced on other days when he was not 

taking Tegretol, e.g., nausea, vomiting, heart problems, and dizziness. He only speculates that the

single pill caused his symptoms that day. Not only does he not provide anything more than 

speculation that the single pill harmed him, he does not dispute Defendants‟ evidence that Tegretol 

is often used for pain relief. 

Mr. Miller and the doctors sharply disagree as to whether his morphine should have been 

tapered and eventually discontinued. And Mr. Miller disagrees that the medications provided to 

 

6 Dr. Barnett stated in his declaration that: (a) “Dr. Ahmed (in association with decisions by Dr. 

Bright and Dr. Posson, supervisors for Dr. Ahmed) properly tapered Miller off his opioid pain 

medication (MS Contin);” (b) “Dr. Ahmed, Dr. Bright and Dr. Posson properly tapered Miller 

from opiates to minimize his withdrawal symptoms;” and (c) Dr. Ahmed prescribed appropriate 

and adequate pain medicine to replace the denied Morphine.” Docket No. 96 at 16. Dr. Barnett 

further declared that “[t]he decision to discontinue chronic opiate therapy and Dr. Ahmed‟s choice 

of non-narcotic therapy (including carbamazepine) is within the community standard.” Id. at 18.

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him as his morphine was tapered were good enough to address his pain and withdrawal symptoms. 

Those disputes do not show a genuine dispute as to a material fact because the patient‟s personal 

preference does not set the Eighth Amendment standard. The difference of opinion between Mr. 

Miller and Defendants as to the proper course of care does not show deliberate indifference. 

Instead, Mr. Miller must show or raise a triable issue of fact that the course of treatment a doctor 

chose was medically unacceptable under the circumstances and that the doctor chose this in 

conscious disregard of an excessive risk to Mr. Miller‟s health. See Toguchi, 391 F.3d at 1058.

Mr. Miller fails to make that showing. 

Plaintiff did not submit evidence (other than his opinion) that the non-morphine medicines 

given to Plaintiff were medically insufficient to address his pain. The prescription of Tegretol did 

not amount to an Eighth Amendment violation. What exists here is the sort of differences of 

opinion about the best way to address pain that courts have repeatedly held either not to state a 

claim or not to create a triable issue on the deliberate indifference prong of an Eighth Amendment 

claim. See, e.g., Shiira v. Hawaii, No. 15-16338, slip op. at 1, 4 (9th Cir. Nov. 16, 2017) 

(affirming summary judgment for defendants who deprived plaintiff of methadone and Percodan

but offered over-the-counter pain medication and treatment for potential detoxification symptoms;

plaintiff‟s expert did not testify that offering alternative pain medications would be medically 

inappropriate); Fausett v. LeBlanc, 553 F. App‟x 665 (9th Cir. 2014) (affirming summary 

judgment for defendants where doctors did not provide Valium ordered in hospital-discharge 

instructions after spinal-fusion surgery and instead provided substitute medicine and other pain 

medications); Gauthier v. Stiles, 402 F. App‟x 203 (9th Cir. 2010) (affirming dismissal; plaintiff‟s 

disagreement with the dosage and type of pain medication administered after surgery not 

deliberate indifference); Burton v. Downey, 805 F.3d 776, 785 (7th Cir. 2015) (reversing denial of 

defense motion for summary judgment; jail health-care provider‟s decision to provide synthetic 

opioid rather to provide opioids or contact the doctor who prescribed the opioids before 

incarceration was not deliberate indifference); Brauner v. Coody, 793 F.3d 493, 497 (5th Cir. 

2015) (although plaintiff stated that he required more pain relief than the over-the-counter and 

prescription medications provided by prison doctors for his undisputed bone infection with open 

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sores, “these are „classic example[s] of a matter for medical judgment‟” and, as a matter of law, do 

not amount to deliberate indifference); Hill v. Curcione, 657 F.3d 116, 123 (2d Cir. 2011) (district 

court properly dismissed claim that prison officials were deliberately indifferent in not prescribing 

medication stronger than Motrin for plaintiff‟s broken wrist because the medication decision was a 

matter of medical judgment); Meuir v. Green Cnty. Jail Employees, 487 F.3d 1115, 1119 (8th Cir. 

2007) (summary judgment properly granted for defendants on inmate‟s claim that nurses were 

deliberately indifferent in prescribing Motrin but not medicated mouthwash for bleeding gums); 

id. at 119 (“In the face of medical records indicating that treatment was provided and physician 

affidavits indicating that the care provided was adequate, an inmate cannot create a question of 

fact by merely stating that she did not feel she received adequate treatment”).

Defendants presented a declaration from Dr. Barnett, a doctor whose expertise included the 

management of knee injuries, painful knees and degenerative conditions of the knees, and had 

published writings on the treatment of chronic pain. See Docket No. 96 at 2. Dr. Barnett opined 

that Mr. Miller was properly tapered off his morphine; that the doctors properly tapered Mr. Miller 

to minimize his withdrawal symptoms; that Dr. Ahmed prescribed appropriate pain medication to 

replace the morphine; and that nurse Deluna acted appropriately within the scope of his license to 

address Mr. Miller‟s pain and drug withdrawal symptoms. Docket No. 96 at 16.

On the evidence in the record, no reasonable jury could find that Dr. Bright (as part of the 

management committee) was deliberately indifferent to Mr. Miller‟s serious medical needs when 

the committee determined that Mr. Miller did not meet the criteria for morphine and recommended 

discontinuation of the morphine for Mr. Miller. On the evidence in the record, no reasonable jury 

could find that Dr. Ahmed‟s decision to taper the morphine and his care for Mr. Miller during the 

tapering period amounted to deliberate indifference to Mr. Miller‟s serious medical needs. On the 

evidence in the record, no reasonable jury could find that nurse Deluna‟s responses to Mr. Miller‟s 

several health care service request forms during the morphine taper amounted to deliberate 

indifference to his serious medical needs. Finally, on the evidence in the record, no reasonable 

jury could find that the use of non-narcotic pain medications in the months after the morphine 

taper concluded amounted to deliberate indifference to Mr. Miller‟s serious medical needs. 

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Defendants are entitled to summary judgment in their favor Mr. Miller‟s claims pertaining to the 

pain medications and morphine taper. 

B. Retaliation Claim 

“Within the prison context, a viable claim of First Amendment retaliation entails five basic 

elements: (1) An assertion that a state actor took some adverse action against an inmate (2) 

because of (3) that prisoner's protected conduct, and that such action (4) chilled the inmate's 

exercise of his First Amendment rights, and (5) the action did not reasonably advance a legitimate 

correctional goal.” Rhodes v. Robinson, 408 F.3d 559, 567-68 (9th Cir. 2005) (footnote omitted). 

The provision of adequate medical care to inmates to maintain their health is a legitimate 

correctional goal. 

Mr. Miller alleged in his complaint that the decision to taper the morphine and the tapering 

itself were done to retaliate against him for his inmate appeal that he first filed on December 10, 

2014. Docket No. 1-2 at 48-50. He filed an inmate appeal and routinely threatened litigation or 

inmate appeals (CDC-602 form) if he did not get what he wanted in dealing with the medical staff. 

See, e.g., Def MSJ 363 (4/21/15 doctor‟s note: “pt. extremely upset [about morphine taper] & 

threatened to take legal action.”); see also Def MSJ 394, 427. And he frequently made references 

to his pending or upcoming litigation. See, e.g., Def MSJ 402; Docket No. 131 at 77 (requesting 

names of pain management committee “for inclusion in lawsuit,” and that he “be granted 

injunctive/declaratory relief by Court.”). But Mr. Miller does not provide any competent evidence 

to dispute Defendants‟ evidence that the reduction and eventual elimination of the morphine 

reasonably advanced legitimate medical goals. Cf. Barnett v. Centoni, 31 F.3d 813, 816 (9th Cir. 

1994) (summary judgment proper for defendants on claim of retaliatory reclassification when the 

reclassification was supported by “some evidence” and served a legitimate penological goal). 

The undisputed evidence shows that Defendants were exercising reasonable medical 

judgment when they decided to decrease and eventually eliminate the dosage of morphine for the 

patient who had only chronic musculoskeletal pain. The undisputed evidence shows that opiates 

have been found ineffective for chronic non-cancer pain and that the pain management committee 

determined that Mr. Miller did not meet the criteria for narcotics. The undisputed evidence also 

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shows that the dosage of morphine was gradually decreased, other non-narcotic drugs were offered 

as morphine dosage got very low, and Mr. Miller was seen several times by nurses and Dr. Ahmed 

during the tapering process. 

While the morphine taper did start after protected First Amendment activity, the evidence 

shows that the taper advanced a legitimate medical goal of ending morphine for a patient whose 

pain was not of the sort that warranted the use of morphine. Taking a prisoner off opiates that are 

not appropriate for his medical condition also advances the legitimate penological goal of reducing 

prescription drug abuse and drug addiction among the prison population. Given that the morphine 

taper reasonably advanced a legitimate medical goal that was also a “legitimate correctional goal,”

Mr. Miller is unable to establish one of the essential elements of a retaliation claim. See Rhodes, 

408 F.3d at 567-68. Viewing the evidence and the reasonable inferences therefrom in the light 

most favorable to Mr. Miller, no reasonable jury could find in his favor on the retaliation claim 

with regard to the taper and discontinuation of the morphine. Defendants are entitled to judgment 

as a matter of law on the retaliation claim.

C. Qualified Immunity

The defense of qualified immunity protects “government officials . . . from liability for 

civil damages insofar as their conduct does not violate clearly established statutory or 

constitutional rights of which a reasonable person would have known.” Harlow v. Fitzgerald, 457 

U.S. 800, 818 (1982). In Saucier v. Katz, 533 U.S. 194 (2001), the Supreme Court set forth a twopronged test to determine whether qualified immunity exists. First, the court asks: “Taken in the 

light most favorable to the party asserting the injury, do the facts alleged show the officer's 

conduct violated a constitutional right?” Id. at 201. If no constitutional right was violated if the 

facts were as alleged, the inquiry ends and defendants prevail. See id. If, however, “a violation 

could be made out on a favorable view of the parties' submissions, the next, sequential step is to 

ask whether the right was clearly established. . . . „The contours of the right must be sufficiently 

clear that a reasonable official would understand that what he is doing violates that right.‟ . . . The 

relevant, dispositive inquiry in determining whether a right is clearly established is whether it 

would be clear to a reasonable officer that his conduct was unlawful in the situation he 

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confronted.” Id. at 201-02 (quoting Anderson v. Creighton, 483 U.S. 635, 640 (1987)). Although 

Saucier required courts to address the questions in the particular sequence set out above, courts 

now have the discretion to decide which prong to address first, in light of the particular 

circumstances of each case. See Pearson v. Callahan, 555 U.S. 223, 236 (2009). 

With regard to the TKR, the same triable issues of fact that preclude summary judgment 

for Defendants Dr. Bright, Dr. Ahmed and nurse Hall on the merits of Mr. Miller‟s Eighth 

Amendment claim also preclude summary judgment in their favor on the qualified immunity 

defense. Taking the evidence in the light most favorable to Mr. Miller, it would be clear to a 

reasonable correctional medical care provider that an Eighth Amendment violation would occur by 

denying TKR to a patient who had severe knee arthritis on then-current x-rays for whom two 

orthopedic specialists had recommended TKR. See, e.g., Egberto v. Nevada Dep’t of Corr, 678 F. 

App‟x 500, 505 (9th Cir. 2017) (district court erred in granting summary judgment for defendants 

based on qualified immunity because “a reasonable jury could conclude that Appellees delayed or 

denied recommended back-care treatment for non-medical reasons, including personal animus. It 

was clearly established during the relevant time period that such conduct would violate [the 

inmate‟s] Eighth Amendment right”); Clement v. Gomez, 298 F.3d 898, 906 (9th Cir. 2002) 

(summary judgment reversed on claim that prison officials were deliberately indifferent to medical 

needs following inmates‟ exposure to pepper spray because the law was clearly established that 

intentionally delaying care for serious medical needs violates Eighth Amendment); Jackson v. 

McIntosh, 90 F.3d 330, 332 (9th Cir. 1996) (summary judgment properly denied on qualified 

immunity defense to medical care providers who refused to provide a kidney transplant to an 

inmate; law was clearly established that Eighth Amendment was violated by deliberate 

indifference to medical needs). It also would be clear to a reasonable nurse that an Eighth 

Amendment violation would occur by disregarding an RFS decision granting an important and 

needed medical procedure to an inmate.

For Dr. Posson and Dr. Williams, the evidence in the record does not establish a violation 

of Mr. Miller‟s constitutional rights in their responses to his request for TKR. These Defendants 

prevail on the first prong of the Saucier analysis. Even if a constitutional violation had been 

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shown, however, these Defendants would prevail on the second prong of the Saucier analysis. A 

reasonable medical staff member would not have understood that it would violate an inmate‟s 

constitutional rights to deny a TKR for the inmate whose then-current x-rays showed only 

moderate arthritis, who had not exhausted conservative treatment options, and who had significant 

other medical problems (i.e., morbid obesity, hypertension and diabetes) weighing against surgery. 

Dr. Posson and Dr. Williams are entitled to judgment as a matter of law on the qualified immunity 

defense for these claims.

With regard to the morphine taper and the retaliation claims, the evidence in the record 

does not establish a violation of Mr. Miller‟s constitutional rights. Defendants prevail on the first 

prong of the Saucier analysis. Even if a constitutional violation had been shown, however, 

defendants would prevail on the second prong of the Saucier analysis. With the undisputed 

evidence being that opiates are not effective for chronic non-cancer pain, and that the patient 

continued to complain of pain while on morphine, a reasonable medical staff member would not 

have understood that discontinuing the morphine through a gradual tapering and replacing it with 

accepted non-narcotic pain medications would violate the prisoner's Eighth Amendment rights or 

right to be free of retaliation. With regard to the Tegretol, the law was not clear it would be 

unconstitutional to prescribe to a patient complaining of opiate withdrawal symptoms a 

medication that was often used for aiding in opioid withdrawals merely because that medication 

also was primarily marketed as an anticonvulsant and the patient had expressed a desire not to take 

anticonvulsants. Defendants are entitled to judgment as a matter of law on the qualified immunity 

defense for these claims.

D. State Law Claims

Defendants argue that Mr. Miller‟s state law claims should be rejected because he failed to 

comply with the California Tort Claims Act in that he did not adequately describe in his claim 

form some of the specific legal theories of relief he has included in his complaint. The state law 

claims in the complaint are for a violation of the Bane Act (California Civil Code Section 52.1), 

negligence, intentional infliction of mental distress, and breach of a doctor‟s fiduciary duty to his 

patient. Defendants‟ argument fails because they have not shown that a person‟s legal theories 

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must be alleged in the tort claim form to comply with the California Tort Claims Act. 

The Tort Claims Act requires that the tort claim state the “date, place, and other 

circumstances of the occurrence or transaction which gave rise to the claim asserted” and provide 

“[a] general description of the . . . injury, damage or loss, insofar as it may be known at the time of 

the presentation of the claim.” Cal. Gov‟t Code section 910(c) and (d). As Defendants argue, the 

“state law claims are subject to dismissal „if [the complaint] alleges a factual basis for recovery 

which is not fairly reflected in the written claim‟” under the Tort Claims Act. Docket No. 94 at 23 

(quoting Fall River Joint Unified School Dist. v. Superior Court, 206 Cal.App.3d 431, 434 (Cal. 

Ct. App. 1988)). 

The factual basis for recovery alleged in Mr. Miller‟s complaint is fairly reflected in the 

written tort claim. Like his complaint, Mr. Miller‟s tort claim mentioned that defendants had 

denied him a TKR, terminated the pain medication he had been receiving for several years, and 

retaliated against him for his inmate appeals. See Docket No. 97-2 at 203-04 (tort claim form). 

The facts in the complaint are much more detailed, but the general factual bases for the wrongs 

alleged are fairly reflected in the written tort claim. The legal theories of recovery also are 

mentioned in his written tort claim. He wrote that his “type of case” was “State Civil Rights, MM, 

IIED, statutes,” -- which appears to be shorthand for a Bane Act claim (because that Act provides 

a cause of action for interference with state and federal civil rights), medical malpractice; and 

intentional infliction of emotional distress. See Docket No. 97-2 at 203 (response to question 17). 

His description of the injury included references to California Civil Code § 52.1 (i.e., the Bane 

Act), California Government Code § 845.6 (i.e., a statutory negligence provision), federal 

constitutional rights, emotional distress, and inadequate medical care. Docket No. 97-2 at 204 

(response to questions 19, 20 and 21). Defendants have not established that Mr. Miller failed to 

comply with the California Tort Claims Act presentation requirements. See Stockett v. Association 

of Cal. Water Agencies Joint Powers Ins. Auth., 34 Cal. 4th 441, 447 (Cal. 2004) (“Only where 

there has been a „complete shift in allegations, usually involving an effort to premise civil liability 

on acts or omissions committed at different times or by different persons than those described in

the claim,‟ have courts generally found the complaint barred. . . . Where the complaint merely 

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elaborates or adds further detail to a claim, but is predicated on the same fundamental actions or 

failures to act by the defendants, courts have generally found the claim fairly reflects the facts pled 

in the complaint.”); see, e.g., id. at 443 (plaintiff “is not barred from asserting additional wrongful 

dismissal theories in his complaint where, as here, the notice of claim informs the public entity of 

the employment termination cause of action giving rise to the claim and provides sufficient detail 

for investigation by the public entity”); Blair v. Superior Court, 218 Cal. App. 3d 221, 223-24

(Cal. Ct. App. 1990) (tort claim form that stated that passenger was injured because State had 

negligently constructed and maintained the highway surface, particularly by failing to sand it to 

prevent icing, was sufficient to encompass a claim in complaint that the State had failed to provide 

warning signs and a guardrail on the highway because negligent construction and maintenance 

could reasonably be read to encompass all three theories of liability). Defendants are not entitled 

to summary judgment on the state law claims.

E. Mr. Miller‟s Motion To Exclude Dr. Barnett‟s Declaration

Mr. Miller has moved to strike or exclude Dr. Barnett‟s declaration on the ground that Dr. 

Barnett lacks sufficient expertise to testify about Mr. Miller‟s care. Much of Mr. Miller‟s 

argument is more of a disagreement with the substance of Dr. Barnett‟s statements rather than 

showing that Dr. Barnett lacks the qualifications to render an expert opinion or make the 

statements in his declaration. 

Dr. Barnett‟s declaration and curriculum vitae show he is amply qualified to testify about 

Mr. Miller‟s medical care, chronic pain and morphine tapers. Dr. Barnett received his M.D. in 

1975, currently is licensed to practice medicine in California, is board-certified in family 

medicine, and has worked in correctional healthcare settings for about a decade. Docket No. 96 at 

1-2. He is employed by the California Correctional Health Services as Chief Medical Consultant 

for the Receiver‟s Office of Legal Affairs. Id. at 1. As Chief Medical Consultant, his duties 

include reviewing medical records to monitor the quality of healthcare provided to California 

inmates, instructing nurses and physicians regarding standards of care, and providing direct 

medical care to inmates. Id. at 2. His expertise includes treatment of conditions that manifest in 

the prison population, including the management of knee injuries, painful knees and degenerative 

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conditions of the knee. He has published writings on the standards of medical care applicable in 

prisons, and treatment of chronic pain. Id. He also is a member of the Opioid Workgroup 

Integrated Health Care and Policy Taskforce, a meeting of professionals sponsored by the 

California Department of Public Health to address prescription opioid misuse and abuse in 

California. Id. 

Defendants offer Dr. Barnett‟s declaration to provide some medical opinions about the 

case and to give a coherent overview of the course of care. Dr. Barnett has adequate qualifications 

to provide the expert testimony about pain medication and the handling of the RFSs in this case. 

His medical training and years of practice also provide an adequate basis for him to interpret the 

medical records in this case. Reading medical records is something within the general knowledge 

of a practicing physician, regardless of board certification. Mr. Miller complains that Dr. Barnett 

lacks orthopedic expertise. But Dr. Barnett did not testify to anything requiring specialized 

orthopedic knowledge, e.g., he did not purport to offer an opinion about how to do a TKR or how 

to do an arthroscopic meniscectomy. Mr. Miller‟s motion to strike or exclude Dr. Barnett‟s 

declaration is DENIED. Docket No. 109. 

F. Miscellany

Mr. Miller‟s bloated presentation of his opposition greatly hindered the Court‟s analysis of 

the motion for summary judgment. The Court earlier cautioned Mr. Miller to be less longwinded 

in his presentations and directed him to comply with the page limits and the line-spacing limits in 

his filings. See Docket No. 30 at 11-12; Docket No. 104. Mr. Miller‟s motion to strike Dr. 

Barnett‟s declaration had nine pages of single-spaced text, in disregard to the Court‟s directions 

that his filings had to be double-spaced. Mr. Miller‟s opposition papers ignored the page limits. 

His opposition brief was 25 pages, but it was augmented by a 37-page declaration and a 36-page 

supplemental declaration that overflowed with legal arguments. 

The Court reads hundreds or thousands of pages of filings each week. For this reason, 

strict compliance with page and line-spacing limits is mandatory for both represented and pro se

litigants. Mr. Miller must in the future comply with the page and spacing limits set out in the 

order of service. Any declaration he submits must have only facts; any declaration he submits 

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must not have argument about his views as to why Defendants should be held liable and must not 

have statements made solely on information and belief. Legal arguments in a declaration will be 

considered part of the legal brief for page-limit purposes. Failure to comply with any of these 

requirements will result in the Court striking and disregarding the non-compliant documents. 

G. Referral To Pro Se Prisoner Mediation Program

The Court has granted summary judgment on some claims. There remains for adjudication 

Mr. Miller‟s Eighth Amendment claim regarding the denial of the TKR and his state law claims. 

This case appears a good candidate for the court's mediation program. 

Good cause appearing therefor, this case is now referred to Magistrate Judge Robert Illman 

for mediation or settlement proceedings pursuant to the Pro Se Prisoner Mediation Program. The 

proceedings will take place within one hundred twenty days of the date this order is filed. 

Magistrate Judge Illman will coordinate a time and date for mediation or settlement proceedings 

with all interested parties and/or their representatives and, within five days after the conclusion of 

the proceedings, file with the Court a report for the prisoner mediation or settlement proceedings. 

VI. CONCLUSION

For the foregoing reasons, Defendants‟ motion for summary judgment is GRANTED IN 

PART AND DENIED IN PART. Docket No. 94. All Defendants are entitled to judgment in 

their favor on the Eighth Amendment claim and retaliation claim regarding their discontinuation 

of morphine and medication decisions, as well as on the defense of qualified immunity for those 

claims. Dr. Posson and Dr. Williams are entitled to judgment in their favor on the Eighth 

Amendment claim regarding the TKR, as well as on the defense of qualified immunity for those 

claims. Defendants‟ motion for summary judgment is otherwise denied.

Mr. Miller‟s motion to strike and exclude Dr. Barnett‟s declaration is DENIED. Docket 

No. 109. 

///

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This action is now referred to Magistrate Judge Illman for mediation or settlement 

proceedings pursuant to the Pro Se Prisoner Mediation Program. The Clerk will send a copy of 

this order to Magistrate Judge Illman.

IT IS SO ORDERED.

Dated: January 24, 2018

______________________________________

EDWARD M. CHEN

United States District Judge

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