Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_09-cv-01300/USCOURTS-caed-2_09-cv-01300-11/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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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

WILLIAM THOMAS COATS, No. 2:09-cv-1300-CMK-P

Plaintiff, 

vs. ORDER

MICHAEL FOX,

Defendant.

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Plaintiff, a state prisoner proceeding pro se, brought this civil rights action

pursuant to 42 U.S.C. § 1983. Pursuant to the written consent of all parties, this case was before

the undersigned as the presiding judge for all purposes, including entry of final judgment. See 28

U.S.C. § 636(c). Pending before the court is defendant’s motion for summary judgment (Doc.

53). Plaintiff filed an opposition to the motion (Doc. 56), and defendant file his reply thereto

(Doc. 61). 

I. BACKGROUND

A. Plaintiff’s Allegations

This case proceeds on plaintiff’s original complaint (Doc. 1). In his complaint,

plaintiff alleges he was diagnosed with Hepatitis C in 2007. While at Deuel Vocational Institute1

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Tracy Reception Center (DVI), on May 30, 2008, Dr. Melcher prescribed treatment for plaintiff’s

Hepatitis C, to start immediately, of Interferon/Ribavirin. He was again prescribed treatment of

Interferon/Ribavirin by Dr. Tan on June 10, 2008. And again on October 3, 2008, plaintiff was

prescribed treatment of Interferon/Ribavirin by Dr. Imperial and Pat Nachin, APRN. However,

defendant Fox interfered with the treatment prescribed, and vetoed the treatment. The court,

reading the complaint liberally, determined plaintiff’s complaint states a claim for deliberate

indifference in violation of the Eighth Amendment against Dr. Fox, interpreting plaintiff’s claims

as Dr. Fox deliberately interfering with the treatment prescribed plaintiff. 

B. Defendant’s Evidence

Defendant submitted a statement of undisputed fact in support of his motion for

summary judgment. The statement of undisputed facts is supported by defendant’s declaration,

as well as declarations from Dr. Mendoza and defendant’s attorneys of record, with attached

exhibits, and a declaration from the custodian of medical records. The relevant evidence is

summarized below: 

Declaration of Defendant Fox

• Dr. Fox declares he is the Chief Physician and Surgeon for Deuel

Vocational Institution (DVI); in this position, Dr. Fox has both clinical and

administrative duties including seeing patients, answering and signing

inmate appeals, authorizing new medication orders, and performing small

procedures, as well as chart reviews and auditing. 

• Dr. Fox states he found no documentation in plaintiff’s medical file

indicating he personally treated plaintiff between December 2007 and

January 2009.

• Dr. Fox further declares he did not approve any discontinuation order for

Interferon and Ribavirin that he could find in the record, nor did he rescind

any treatment plans for Interferon and Ribavirin established by specialists.

• Dr. Fox states his name appears on the Medication Administration

Records for the Ribavirin at Exhibit B because he was the Chief Medical

Officer, and as such his name was sometimes substituted for that of the

prescribing doctor. In addition, the Medication Administration Records

simply records the medications an inmate is prescribed and receives; they

are not used to order the discontinuation of a medicine. 

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• Dr. Fox opined in his declaration that plaintiff’s medical records

evidenced numerous risk factors that weigh against treatment with

Interferon and Ribavirin.

• Plaintiff’s medical records, dated May 30, 2008, show plaintiff was

examined via telemedicine by Gregory P. Melcher, M.D., Clinical

Professor of Medicine at UC Davis. Dr. Melcher diagnosed plaintiff with

Chronic hepatitis C, Genotype 1a & 2b. His recommendation was to treat

plaintiff as genotype 1, obtain a liver biopsy to determine the stage of the

disease, which would indicate proper treatment. (Dr. Fox Declaration,

Exhibits A-2, A-3).

• Plaintiff’s medical records dated October 3, 2008, show plaintiff was

examined by Joanne Imperial, MD. Dr. Imperial’s recommended orders

included no liver biopsy, but treatment with Pegasys, Ribavirin, Polate,

Tylenol, CDC, Heptimax, and a return to clinic in 6 weeks with labs. 

(Exhibit A-9).

• Medical records dated October 27, 2008, record a telephone call from

Nurse Annie Cramphon questioning plaintiff only taking Ribavirin and not

Pegasys. The consultation notes, which appears to be authored by Pat

Nachin, APRN, states: “We had recommended he start Hepatitis C

treatment after he was seen in telemedicine hepatitis C clinic. He should

have started Pegasys and Ribavirin. On the same day we received a note

from Annie Crumphorn stating that the medications would not be started

on him until he goes to a permanent facility. He should according to Dr.

Michael Fox not be on any meds for Hepatitis C.” The record states the

Plan to be: “This needs to be looked into by DVI staff tomorrow. He

should not be just on Ribavirin without the Pegasys and also he needs all

his labs drawn appropriately.” (Exhibit A-11). 

• Medical records dated October 30, 2008 (originally dated October 29,

2008) indicates Dr. Imperial’s recommended ordering to discontinue

Ribavirin, Pegasys, and Tylenol, order CBC drawn, and schedule plaintiff

for follow-up telemedicine clinic for Hep C evaluation when lab results

are available. The recommended order was signed by Dr. Mendoza on

behalf of Dr. Imperial. (Exhibit A-12).

• Medication Administration Record print out for plaintiff shows Ribavirin

prescription, with Dr. Fox’s name printed on the form (no signature), with

an original fill date of October 17, 2008, began on October 19. A second

Medication Administration Record print out for plaintiff, again with Dr.

Fox’s name printed on the form (no signature), shows the discontinuation

of Pegasys and Ribavirin. (Exhibit B).

Declaration of J. Mendoza

• Dr. Mendoza explains his signature on Dr. Imperial’s discontinuation

order. He states he signed the order on behalf of Dr. Imperial. He further

states that any physician on staff can sign the orders on behalf of the

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specialist, and the signing physician simply relies on the prescribing doctor

and does not review the patient’s medical records.

• Dr. Mendoza explains physician orders do not need approval by the Chief

Medical Officer to be processed. 

C. Plaintiff’s Evidence

Plaintiff contends there is a genuine issue of material facts as to whether

defendant Fox ordered the discontinuation of his treatment. Plaintiff produces several documents

presumably from his medical file. Specifically relevant, he produces a copy of the Medication

Administration Record which has Dr. Fox identified as the doctor, the same as the defense

produced. In addition, plaintiff produced a Request for Services form, indicating Dr. Fox

ordered a liver biopsy/GI consult to consider on June 3, 2008. 

D. Undisputed Facts

It is clear from the above, that there is no dispute over whether or not plaintiff’s

treatment was discontinued. Both parties produced the same medical records, indicating Dr.

Imperial recommended treatment to include both Ribavirin and Pegasys. The Ribavirin

treatment was started on or about October 19, 2008, and discontinued on or about October 30,

2008. It appears that there is no dispute over whether or not the Pegasys was ever given, as it

appears it was ordered to begin but was discontinued prior to the first injection. There is also no

dispute that Dr. Imperial signed the recommended treatment order. 

II. STANDARD FOR SUMMARY JUDGMENT

The Federal Rules of Civil Procedure provide for summary judgment or summary

adjudication when “the pleadings, depositions, answers to interrogatories, and admissions on file,

together with affidavits, if any, show that there is no genuine issue as to any material fact and that

the moving party is entitled to a judgment as a matter of law.” Fed. R. Civ. P. 56(a). The

standard for summary judgment and summary adjudication is the same. See Fed. R. Civ. P.

56(a), 56(c); see also Mora v. ChemTronics, 16 F. Supp. 2d. 1192, 1200 (S.D. Cal. 1998). One

of the principal purposes of Rule 56 is to dispose of factually unsupported claims or defenses. 

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See Celotex Corp. v. Catrett, 477 U.S. 317, 325 (1986). Under summary judgment practice, the

moving party

always bears the initial responsibility of informing the district court of the

basis for its motion, and identifying those portions of “the pleadings,

depositions, answers to interrogatories, and admissions on file, together

with the affidavits, if any,” which it believes demonstrate the absence of a

genuine issue of material fact.

Id. at 323 (quoting former Fed. R. Civ. P. 56(c)); see also Fed. R. Civ. P. 56(c)(1). 

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 admissible discovery material, in support of its contention that the

dispute exists. See Fed. R. Civ. P. 56(c)(1); see also Matsushita, 475 U.S. at 586 n.11. 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, Anderson v. Liberty Lobby, Inc., 477 U.S.

242, 248 (1986); T.W. Elec. Serv., Inc. v. Pacific Elec. Contractors Ass’n, 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, Wool v. Tandem Computers, Inc., 818 F.2d 1433,

1436 (9th Cir. 1987). To demonstrate that an issue is genuine, 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 fact to find for the non-moving party,

there is no ‘genuine issue for trial.’” Matsushita, 475 U.S. at 587 (citation omitted). It is

sufficient that “the claimed factual dispute be shown to require a trier of fact to resolve the

parties’ differing versions of the truth at trial.” T.W. Elec. Serv., 809 F.2d at 631. 

In resolving the summary judgment motion, the court examines the pleadings,

depositions, answers to interrogatories, and admissions on file, together with the affidavits, if

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any. See Fed. R. Civ. P. 56(c). The evidence of the opposing party is to be believed, see

Anderson, 477 U.S. at 255, and all reasonable inferences that may be drawn from the facts placed

before the court must be drawn in favor of the opposing party, see Matsushita, 475 U.S. at 587. 

Nevertheless, inferences are not drawn out of the air, and 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). Ultimately, “[b]efore the evidence is left to the jury, there is a preliminary question for

the judge, not whether there is literally no evidence, but whether there is any upon which a jury

could properly proceed to find a verdict for the party producing it, upon whom the onus of proof

is imposed.” Anderson, 477 U.S. at 251.

III. DISCUSSION

A. Eighth Amendment

Plaintiff alleges the defendant violated his Eighth Amendment rights by

cancelling the treatment which was prescribed him by another doctor. Specifically, plaintiff

contends that treatment of his Hepatitis C, including Interferon and Ribavirin, was ordered and

began. However, after not even half of the treatments, and no Interferon treatment at all,

defendant Fox ordered the cancellation of the treatment, both Interferon and Ribavirin. He

argues defendant Fox’s involvement and authorization of the cancellation order is evidenced by

the pharmacy records. 

Defendant counters that he did not approve any discontinuation order for

Interferon and Ribavirin, that any such orders came from Dr. Imperial. He contends his name is

on the pharmacy records, not because he gave the order but due to his position as Chief Medical

Officer. In addition, while not clear, defendant seems to be arguing that even if he had ordered

the discontinuation of treatment, the treatment plaintiff received was sufficient and did not

violate his Eighth Amendment rights.

/ / / 

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The treatment a prisoner receives in prison and the conditions under which the

prisoner is confined are subject to scrutiny under the Eighth Amendment, which prohibits cruel

and unusual punishment. See Helling v. McKinney, 509 U.S. 25, 31 (1993); Farmer v. Brennan,

511 U.S. 825, 832 (1994). The Eighth Amendment “embodies broad and idealistic concepts of

dignity, civilized standards, humanity, and decency.” Estelle v. Gamble, 429 U.S. 97, 102

(1976). Conditions of confinement may, however, be harsh and restrictive. See Rhodes v.

Chapman, 452 U.S. 337, 347 (1981). Nonetheless, prison officials must provide prisoners with

“food, clothing, shelter, sanitation, medical care, and personal safety.” Toussaint v. McCarthy,

801 F.2d 1080, 1107 (9th Cir. 1986). A prison official violates the Eighth Amendment only

when two requirements are met: (1) objectively, the official’s act or omission must be so serious

such that it results in the denial of the minimal civilized measure of life’s necessities; and (2)

subjectively, the prison official must have acted unnecessarily and wantonly for the purpose of

inflicting harm. See Farmer, 511 U.S. at 834. Thus, to violate the Eighth Amendment, a prison

official must have a “sufficiently culpable mind.” See id. 

Deliberate indifference to a prisoner’s serious illness or injury, or risks of serious

injury or illness, gives rise to a claim under the Eighth Amendment. See Estelle, 429 U.S. at

105; see also Farmer, 511 U.S. at 837. This applies to physical as well as dental and mental

health needs. See Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982). An injury or illness is

sufficiently serious if the failure to treat a prisoner’s condition could result in further significant

injury or the “unnecessary and wanton infliction of pain.” McGuckin v. Smith, 974 F.2d 1050,

1059 (9th Cir. 1992); see also Doty v. County of Lassen, 37 F.3d 540, 546 (9th Cir. 1994). 

Factors indicating seriousness are: (1) whether a reasonable doctor would think that the condition

is worthy of comment; (2) whether the condition significantly impacts the prisoner’s daily

activities; and (3) whether the condition is chronic and accompanied by substantial pain. See

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

/ / / 

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The requirement of deliberate indifference is less stringent in medical needs cases

than in other Eighth Amendment contexts because the responsibility to provide inmates with

medical care does not generally conflict with competing penological concerns. See McGuckin,

974 F.2d at 1060. Thus, deference need not be given to the judgment of prison officials as to

decisions concerning medical needs. See Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir.

1989). The complete denial of medical attention may constitute deliberate indifference. See

Toussaint v. McCarthy, 801 F.2d 1080, 1111 (9th Cir. 1986). Delay in providing medical

treatment, or interference with medical treatment, may also constitute deliberate indifference. 

See Lopez, 203 F.3d at 1131. Where delay is alleged, however, the prisoner must also

demonstrate that the delay led to further injury. See McGuckin, 974 F.2d at 1060.

Negligence in diagnosing or treating a medical condition does not, however, give

rise to a claim under the Eighth Amendment. See Estelle, 429 U.S. at 106. Moreover, a

difference of opinion between the prisoner and medical providers concerning the appropriate

course of treatment does not give rise to an Eighth Amendment claim. See Jackson v. McIntosh,

90 F.3d 330, 332 (9th Cir. 1996). Similarly, a difference of opinion between medical

professional does not amount to deliberate indifference. See Snow v. McDaniel, 681 F.2d 978,

987 (9th Cir. 2012) (citing Sanches v. Vild, 894 F.2d 240, 242 (9th Cir. 1989)). “To show

deliberate indifference, the plaintiff ‘must show that the course of treatment the doctors chose

was medically unacceptable under the circumstances’ and that the defendants ‘chose this course

in conscious disregard of an excessive risk to plaintiff’s health.’” Id. (Citing Jackson v.

McIntosh, 90 F.3d 330, 332 (9th Cir. 1996)). 

Here, defendant contends he was not involved in plaintiff’s treatment and did not

order the discontinuation of treatment. However, the evidence he supplies in support of that

contention is inconclusive at best. Defendant attempts to explain why his name is on relevant

medical records, indicating that as Chief Medical Officer his name is sometimes substituted for

the ordering doctor. However, other than his own declaration, he provides no supporting

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evidence. For instance, there is no declaration from the custodian of records indicating that the

computer generates such a record and that is the normal course of action in such circumstance. 

Even if there was such a declaration, given the medical records plaintiff has supplied indicating

that at least to some extent Dr. Fox appears to have been directly involved in his treatment for

Hepatitis C, whether or not the explanation for Dr. Fox’s name on the pharmacy records is

sufficient to overcome the inference would be a judgment call for a jury to determine. 

Next, defendant appears to contend that even if he was to have ordered the

discontinuation of plaintiff’s treatment, such action was not a violation of plaintiff’s rights as

there was no damage resulting therefrom. Whether or not there was damage resulting from the

discontinuation of treatment would be a question for a jury. Such a determination is not

dispositive of the claim of deliberate indifference, and would require a finding of fact.

It is clear from the evidence submitted, that plaintiff suffers from Hepatitis C. 

Treatment for plaintiff’s Hepatitis C was ordered and started, but was then discontinued prior to

the full treatment being received. There is no explanation as to why treatment was discontinued. 

It is questionable whether evidence produced by defendant Fox is sufficient to meet his burden of

demonstrating the absence of a genuine issue of material fact. Even if the evidence is sufficient,

plaintiff has produced sufficient evidence to establish that a genuine issue as to any material fact

actually does exist as to whether or not Dr. Fox was involved in the decision to discontinue

plaintiff’s treatment. It is certainly conceivable that a jury could determine that based on Dr.

Fox’s apparent involvement in plaintiff’s treatment, he could have ordered the treatment stopped

either directly or through plaintiff’s treating physician. But that is a question of fact for a jury to

determine. The court, upon a motion for summary judgment, does not resolve questions of fact. 

B. Qualified Immunity

Defendant Fox also contends that he should be granted qualified immunity. 

Government officials enjoy qualified immunity from civil damages unless their

conduct violates “clearly established statutory or constitutional rights of which a reasonable

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person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). In general,

qualified immunity protects “all but the plainly incompetent or those who knowingly violate the

law.” Malley v. Briggs, 475 U.S. 335, 341 (1986). In ruling upon the issue of qualified

immunity, the initial inquiry is whether, taken in the light most favorable to the party asserting

the injury, the facts alleged show the defendant’s conduct violated a constitutional right. See

Saucier v. Katz, 533 U.S. 194, 201 (2001). If a violation can be made out, the next step is to ask

whether the right was clearly established. See id. This inquiry “must be undertaken in light of

the specific context of the case, not as a broad general proposition . . . .” Id. “[T]he right the

official is alleged to have violated must have been ‘clearly established’ in a more particularized,

and hence more relevant, sense: The contours of the right must be sufficiently clear that a

reasonable official would understand that what he is doing violates that right.” Id. at 202

(citation omitted). Thus, the final step in the analysis is to determine whether a reasonable

officer in similar circumstances would have thought his conduct violated the alleged right. See

id. at 205. 

When identifying the right allegedly violated, the court must define the right more

narrowly than the constitutional provision guaranteeing the right, but more broadly than the

factual circumstances surrounding the alleged violation. See Kelly v. Borg, 60 F.3d 664, 667

(9th Cir. 1995). For a right to be clearly established, “[t]he contours of the right must be

sufficiently clear that a reasonable official would understand [that] what [the official] is doing

violates the right.” See Anderson v. Creighton, 483 U.S. 635, 640 (1987). Ordinarily, once the

court concludes that a right was clearly established, an officer is not entitled to qualified

immunity because a reasonably competent public official is charged with knowing the law

governing his conduct. See Harlow v. Fitzgerald, 457 U.S. 800, 818-19 (1982). However, even

if the plaintiff has alleged a violation of a clearly established right, the government official is

entitled to qualified immunity if he could have “. . . reasonably but mistakenly believed that his .

. . conduct did not violate the right.” Jackson v. City of Bremerton, 268 F.3d 646, 651 (9th Cir.

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2001); see also Saucier, 533 U.S. at 205. 

The first factors in the qualified immunity analysis involve purely legal questions. 

See Trevino v. Gates, 99 F.3d 911, 917 (9th Cir. 1996). The third inquiry involves a legal

determination based on a prior factual finding as to the reasonableness of the government

official’s conduct. See Neely v. Feinstein, 50 F.3d 1502, 1509 (9th Cir. 1995). The district court

has discretion to determine which of the Saucier factors to analyze first. See Pearson v.

Callahan, 555 U.S. 223, 236 (2009). In resolving these issues, the court must view the evidence

in the light most favorable to plaintiff and resolve all material factual disputes in favor of

plaintiff. Martinez v. Stanford, 323 F.3d 1178, 1184 (9th Cir. 2003). 

Here, defendant argues no constitutional rights were violated, therefore he is

entitled to qualified immunity. He also contends that a reasonable person in is position could

have believed his conduct was lawful because it was medically appropriate to cancel plaintiff’s

treatment.

The issue is whether the defendant was deliberately indifferent to plaintiff’s

medical needs by the termination of treatment. The Eighth Amendment’s right to adequate

medical care is clearly established. See Estelle, 429 U.S. at 105. Taken in the light most

favorable to plaintiff, the court cannot find that it is undisputed that defendant Fox was not

personally involved in plaintiff’s treatment, or the discontinuation thereof. That is a factual

determination for the jury. If plaintiff’s condition required treatment, and such treatment was

prescribed then prematurely terminated, there is no basis for the court to determine the

defendant’s conduct did not violate plaintiff’s Eighth Amendment rights. In addition, again in

the light most favorable to plaintiff, the court cannot say that a reasonable doctor in similar

circumstances would not have thought his conduct violated the alleged right. Providing inmates

with appropriate and necessary medical care is required under the Eighth Amendment. Whether

or not the treatment prescribed plaintiff was appropriate and necessary is a factual determination

for the jury to make. As to defendant’s claim for qualified immunity, the court finds it likely that

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a reasonable doctor in a similar circumstance would have known or realized terminating

treatment could have violated plaintiff’s Eighth Amendment rights by denying plaintiff necessary

treatment under these circumstances. Thus, defendant Fox is not entitled to qualified immunity.

IV. CONCLUSION

The undersigned finds a genuine issue as to material facts remain which must be

resolved by a jury. Defendant fails to meet his burden to show no undisputed material facts exist. 

It is for a finder of fact to determine whether the evidence sufficiently shows Dr. Fox was

personally involved in the decision to discontinue plaintiff’s treatment. As such, the motion for

summary judgment must be denied. 

Accordingly, IT IS HEREBY ORDERED that defendant’s motion for summary

judgment (Doc. 53) is denied.

DATED: September 29, 2014

______________________________________

CRAIG M. KELLISON

UNITED STATES MAGISTRATE JUDGE

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