Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_15-cv-01861/USCOURTS-caed-2_15-cv-01861-2/pdf.json

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

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UNITED STATES DISTRICT COURT 

FOR THE EASTERN DISTRICT OF CALIFORNIA 

ALBERTO VILLESCAS,

Plaintiff,

v.

RAFAEL MIRANDA, et al.,

Defendants.

No. 2:15-cv-1861 TLN KJN P 

ORDER AND FINDINGS AND

RECOMMENDATIONS

Introduction 

 Plaintiff is a state prisoner, proceeding without counsel, with a civil rights action pursuant 

to 42 U.S.C. § 1983. Pending before the court is plaintiff’s motion for injunctive relief (ECF No. 

11) and plaintiff’s motion to supplement the motion for injunctive relief (ECF No. 17). Plaintiff 

alleges that he has received inadequate medical care. For the following reasons, these motions 

should be denied. 

Legal Standard for Injunctive Relief 

 The party requesting preliminary injunctive relief must show that “he is likely to succeed 

on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that 

the balance of equities tips in his favor, and that an injunction is in the public interest.” Winter v. 

Natural Resources Defense Council, 555 U.S. 7, 20 (2008); Stormans, Inc. v. Selecky, 586 F.3d 

1109, 1127 (9th Cir. 2009) (quoting Winter). The propriety of a request for injunctive relief 

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hinges on a significant threat of irreparable injury that must be imminent in nature. Caribbean 

Marine Serv. Co. v. Baldridge, 844 F.2d 668, 674 (9th Cir. 1988). 

 Alternatively, under the so-called sliding scale approach, as long as the plaintiff 

demonstrates the requisite likelihood of irreparable harm and can show that an injunction is in the 

public interest, a preliminary injunction may issue so long as serious questions going to the merits 

of the case are raised and the balance of hardships tips sharply in plaintiff’s favor. Alliance for 

Wild Rockies v. Cottrell, 632 F.3d 1127, 1131-36 (9th Cir. 2011) (concluding that the “serious 

questions” version of the sliding scale test for preliminary injunctions remains viable after 

Winter).

 The principal purpose of preliminary injunctive relief is to preserve the court’s power to 

render a meaningful decision after a trial on the merits. See 11A Charles Alan Wright & Arthur 

R. Miller, Federal Practice and Procedure, § 2947 (2d ed. 2010). As noted above, in addition to 

demonstrating that he will suffer irreparable harm if the court fails to grant the preliminary 

injunction, plaintiff must show a “fair chance of success on the merits” of his claim. Sports 

Form, Inc. v. United Press International, Inc., 686 F.2d 750, 754 (9th Cir. 1982) (internal citation 

omitted). Implicit in this required showing is that the relief awarded is only temporary and there 

will be a full hearing on the merits of the claims raised in the injunction when the action is 

brought to trial. In cases brought by prisoners involving conditions of confinement, any 

preliminary injunction “must be narrowly drawn, extend no further than necessary to correct the 

harm the court finds requires preliminary relief, and be the least intrusive means necessary to 

correct the harm.” 18 U.S.C. § 3626(a)(2). 

Legal Standard for Claim Alleging Inadequate Medical Care 

 To succeed on an Eighth Amendment claim predicated on the denial of medical care, a 

plaintiff must establish that he had a serious medical need and that the defendant’s response to 

that need was deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006); see 

also Estelle v. Gamble, 429 U.S. 97, 106 (1976). A serious medical need exists if the failure to 

treat the condition could result in further significant injury or the unnecessary and wanton 

infliction of pain. Jett, 439 F.3d at 1096. Deliberate indifference may be shown by the denial, 

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delay, or intentional interference with medical treatment, or by the way in which medical care is 

provided. Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir. 1988). 

 To act with deliberate indifference, a prison official must both be aware of facts from 

which the inference could be drawn that a substantial risk of serious harm exists, and he must also 

draw the inference. Farmer v. Brennan, 511 U.S. 825, 837 (1994). Thus, a defendant is liable if 

he knows that plaintiff faces “a substantial risk of serious harm and disregards that risk by failing 

to take reasonable measures to abate it.” Id. at 847. A physician need not fail to treat an inmate 

altogether in order to violate that inmate’s Eighth Amendment rights. Ortiz v. City of Imperial, 

884 F.2d 1312, 1314 (9th Cir. 1989) (per curiam). A failure to competently treat a serious 

medical condition, even if some treatment is prescribed, may constitute deliberate indifference in 

a particular case. Id. 

 It is important to differentiate common law negligence claims of malpractice from claims 

predicated on violations of the Eighth Amendment’s prohibition of cruel and unusual punishment. 

In asserting the latter, “[m]ere ‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not 

support this cause of action.” Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 

1980) (citing Estelle, 429 U.S. at 105–06); see also Toguchi, 391 F.3d at 1057. 

Analysis 

 On September 2, 2015, plaintiff filed a complaint alleging that he had received inadequate 

medical care at High Desert State Prison (“HDSP”). (ECF No. 1.) On October 8, 2015, plaintiff 

filed the pending motion for injunctive relief. (ECF No. 11.) On October 9, 2015, the 

undersigned ordered service of his complaint on defendants. (ECF No. 12.) 

 Although no defendants had yet appeared in this action, on October 9, 2015, the 

undersigned also ordered Supervising Deputy Attorney General Monica Anderson to file a 

response to plaintiff’s motion for injunctive relief. (ECF No. 14.) On October 22, 2015, plaintiff 

filed further briefing in support of his motion for injunctive relief. (ECF No. 17.) On October 23, 

2015, the Office of the Attorney General filed an opposition to plaintiff’s motion for injunctive 

relief. (ECF No. 16.) 

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 The undersigned herein sets forth plaintiff’s allegations in support of his request for 

injunctive relief. 

Plaintiff is a T12 paraplegic with chronic decubitus ulcers. (ECF No. 1 at 4; 11 at 23.) 

The instant action proceeds on plaintiff’s Eighth Amendment claims that defendants have 

intentionally denied, and interfered with plaintiff’s medical care by, inter alia, depriving him of 

his air mattress, Lumbar Sacral Orthosis (“LSO”), and narcotic pain medications, despite prior 

medical orders from pain management specialists and neurosurgeons. Prior to his transfer to 

High Desert State Prison (“HDSP”) on August 29, 2013, plaintiff claims that he was “almost 

continuously prescribed” pain medication for his chronic and substantial pain, including Fentanyl 

patches, Vicodin, and Morphine. (ECF No. 1 at 4.) On August 29, 2013, plaintiff alleges that 

defendant Miranda “falsely documented ‘no medical need’ for Methadone and ‘not medically 

necessary’ for Lumbar Corset [LSO]” without examining plaintiff or his medical records. (Id. at 

5-6.) 

 In the motion for injunctive relief, plaintiff claims he continues to suffer severe pain 

because of the denial of his lumbar orthosis and proper pain medications as well as not having his 

personal, custom-fitted wheelchair. (ECF No. 11 at 3.) In addition, plaintiff contends that he was 

recently told that because he “made all CTC custody and medical staff extremely mad [at him] for 

complaining,” the yogurt and Boost supplements will be rescinded as not medically needed. (Id.

at 2.) Plaintiff states he was told his custom wheelchair will not be returned because of “contract 

issues and replacement parts being too expensive, as a result of plaintiff filing [a request for] an 

accommodation.” (Id. at 2.) Plaintiff seeks return of his custom wheelchair, a prescription and 

return of his LOS, examination by a pain management specialist and medications or treatment as 

recommended, and immediate transfer to a facility in Los Angeles. 

 In his further briefing filed in support of the pending motion, plaintiff requests immediate 

return of his personal wheelchair and to be transferred to an “OHU or CTC” near Los Angeles or 

Sacramento. (ECF No. 17.) 

 In the opposition, the Office of the Attorney General provided the declaration of Dr. 

Greenleaf, plaintiff’s primary treating physician. (ECF No. 16-1.) Dr. Greenleaf states, in 

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relevant part, 

2. I have been employed by the California Department of 

Corrections and Rehabilitation (CDCR) since 2008. I currently 

work as a physician and surgeon at High Desert State Prison 

(HDSP). 

3. I am inmate Alberto Villescas’ (P-16275) primary treating 

physician. This declaration is based on my education and training 

as a physician, my review of Mr. Villescas’ Unit Health Record 

(UHR), and my involvement with Mr. Villescas’ care and treating 

during his time at HDSP. 

4. I generally meet with Mr. Villescas approximately two to three 

times per week, and more often as his treatment dictates.

5. Mr. Villescas arrived at HDSP on August 29, 2013. He was 

previously housed at Pleasant Valley State Prison. 

6. Mr. Villescas is currently being treated at HDSP in the 

Correctional Treatment Center (CTC). He was admitted to the CTC 

on October 7, 2014, due to recurrent decubitis ulcers (bed sores) in 

his sacral area, located at the base of his spine. 

7. The CTC at HDSP is designed to provide for the health care 

needs of inmates. The CTC can accommodate inmates who qualify 

as disabled under the Americans with Disabilities Act (ADA). Staff 

members in the CTC include doctors and registered nurses, as well 

as other clinical and administrative staff. 

8. Mr. Villescas is paraplegic and requires a wheelchair, ankle 

braces, and orthotic boots. Because he has lost sensation in his 

lower extremities, he also requires frequent monitoring to prevent 

bed sores. 

9. While housed in the CTC, Mr. Villescas has access to a 

treatment team that includes myself, other licensed physicians, and 

registered nurses. He receives frequent nursing care to monitor and 

manage any skin breakdown, and has been prescribed daily 

showers. 

10. Mr. Villescas’ room in the CTC is wheelchair-accessible and 

has a shower that is outfitted to meet his needs and minimize sores. 

A trapeze device is attached to his bed. He may use the trapeze to 

move into and out of his bed using his upper body. Mr. Villescas 

has been issued an airflow mattress for more than a year. 

11. Mr. Villescas has been provided with a Jetstream Pro Back and 

a transfer board. The Jetsteam Pro Back is a contoured support 

cushion that attaches to Mr. Villescas’ wheelchair to reduce 

pressure on his sacral area, and the transfer board is used to avoid 

abrasions to the sacral area when he moves into and out of his 

wheelchair. 

12. Mr. Villescas informed me that he experiences upper-back pain 

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with some regularity. Accordingly, I have prescribed him 

medication and implemented a treatment regimen that includes 

acetaminophen and morphine for pain, which is administered on an 

as-needed basis. In my medical opinion, Mr. Villescas does not 

have a current need for methadone, and his pain is being 

appropriately managed and treated. 

13. When I examined Mr. Villescas on October 19, 2015, he 

appeared stable and in good health. He did not request additional 

pain medication. 

14. In my medical opinion, Mr. Villescas does not have a current 

medical need for a lumbar corset. For individuals with Mr. 

Villescas’ condition, such devices expose patients to the risk of 

additional muscle atrophy. 

15. Mr. Villescas has been issued one pair of orthotic boots. In the 

past, he expressed to me that he wanted an extra pair of boots so 

that his boots did not wear out so quickly, but in my judgment, 

there is no medical need for a second pair of boots. When I meet 

with Mr. Villescas, he did not indicate that his current pair was in 

need of replacement. 

16. On September 1, 2015, Mr. Villescas was issued a medical 

order for yogurt and Boost, a nutritional supplement. That order 

was renewed for thirty days on September 25, 2015. 

17. Mr. Villescas has been placed on a waitlist for transfer to an 

Outpatient Housing Unit since approximately October 6, 2014. I do 

not have the authority to expedite his transfer. 

18. In my opinion, Mr. Villescas’ medical needs are being 

appropriately addressed in the CTC. His treatment team is actively 

monitoring his care and responding to his treatment needs. 

(Id. at 1-3.) 

 With regard to plaintiff’s claim that he is being denied access to his wheelchair, the 

Officer of the Attorney General provided the declaration of HDSP Materials and Stores Specialist 

II, H. Mueller. (ECF No. 16-2.) H. Mueller states, in relevant part, 

2. In my capacity as M & SS II, I facilitate the receipt, storage, 

issuance, and shipping of a variety of medical supplies ordered for 

inmates at HDSP, as well as repairs of durable medical equipment, 

such as wheelchairs. This declaration is based on my involvement 

with the recent repair order for the personal wheelchair of inmate 

Villescas (P-16275). 

3. CDCR has contracted with MultiMedical Systems 

(MultiMedical), a service contractor, to provide wheelchair repair. 

4. In August of 2015, my office received a repair request form 

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from Mr. Villescas for a T-Lite ZRA wheelchair. This is Mr. 

Villescas’ personal wheelchair, and was not issued by CDCR. The 

wheelchair was sent to MultiMedical for repairs on September 1, 

2015. In the interim, while awaiting return of his chair, Mr. 

Villescas was loaned a standard wheelchair. 

5. MultiMedical has evaluated the wheelchair and indicated that 

the chair’s axles, tires, and brakes need repair in order to make the 

chair safe for operation. 

6. It is estimated that the repaired wheelchair will be returned to 

Mr. Villescas on or around October 30, 2015. 

7. My records indicate that Mr. Villescas still has the standard 

wheelchair that was loaned to him while he awaits the completion 

of repairs. 

(Id. at 1-2.) 

 In his declaration, Dr. Greenleaf addresses the claims raised by plaintiff in his pending 

motion. While plaintiff alleges that he has been denied an air mattress, Dr. Greenleaf states that 

plaintiff has been issued an air mattress for over one year. While plaintiff alleges that he has been 

denied narcotic pain medication, Dr. Greenleaf states that plaintiff has been prescribed 

acetaminophen and morphine for pain. While plaintiff alleges that he has been denied 

methadone, Dr. Greenleaf states that plaintiff does not have a current need for methadone. While 

plaintiff alleges that he has been denied a medically necessary lumbar corset, Dr. Greenleaf states 

that plaintiff does not have a current medical need for this device.1 While plaintiff alleges that he 

was denied Boost and yogurt, Dr. Greenleaf states that plaintiff’s medical order for Boost and 

yogurt was renewed for thirty days on September 25, 2015. 

 With regard to plaintiff’s request to be transferred to an Outpatient Housing Unit 

(“OHU”), Dr. Greenleaf acknowledges that plaintiff has been on an OHU waitlist for transfer for 

one year. Dr. Greenleaf states that in his opinion, plaintiff’s medical needs are being addressed 

appropriately in the CTC. 

 With regard to plaintiff’s request for his personal wheelchair, according to the declaration 

of H. Mueller, plaintiff should have possession of his personal wheelchair by the time he receives 

 

1

 Plaintiff also alleges that he has been denied a lumbar orthosis. The undersigned understands a 

lumbar orthosis and a lumbar corset to be similar devices. They are both back braces. 

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these findings and recommendations. 

Based on the information contained in the declarations of Dr. Greenleaf and H. Mueller, 

the undersigned finds that plaintiff has not demonstrated that he will likely suffer irreparable 

harm if injunctive relief is not granted. Plaintiff has not provided expert evidence countering the 

expert evidence presented by the Office of the Attorney General demonstrating that plaintiff is 

receiving adequate medical care. However, if plaintiff’s wheelchair has not been returned to him 

by the time he receives these findings and recommendations, he shall notify the court. In 

addition, Dr. Greenleaf states that plaintiff’s medical needs are being appropriately addressed in 

the CTC. If plaintiff is removed from the CTC, he may refile his motion for injunctive relief 

alleging inadequate medical care. 

Accordingly, IT IS HEREBY ORDERED that the Clerk of the Court shall serve these 

findings and recommendations on Deputy Attorney General Martha Ehlenbach; and 

 IT IS HEREBY RECOMMENDED that plaintiff’s motion for a temporary restraining 

order (ECF No. 11), and plaintiff’s supplemental briefing in support of this motion (ECF No. 17), 

be denied without prejudice. 

 These findings and recommendations are submitted to the United States District Judge 

assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within fourteen days 

after being served with these findings and recommendations, any party may file written 

objections with the court and serve a copy on all parties. Such a document should be captioned 

“Objections to Magistrate Judge’s Findings and Recommendations.” Any response to the 

objections shall be filed and served within fourteen days after service of the objections. The 

parties are advised that failure to file objections within the specified time may waive the right to 

appeal the District Court’s order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991). 

Dated: October 30, 2015 

Vill1861.tro

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