Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_14-cv-00414/USCOURTS-casd-3_14-cv-00414-1/pdf.json

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

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

DAVID CODELL PRIDE, JR., 

Plaintiff,

v.

DR. STRAGA,

Defendant.

Case No.: 14-CV-414 JLS (DHB)

ORDER GRANTING DEFENDANT’S 

MOTION TO DISMISS

(ECF No. 45)

Presently before the Court is Defendant Dr. Straga’s Motion to Dismiss Third

Amended Complaint, (“MTD,” ECF No. 45). Also before the Court are Plaintiff David 

Codell Pride Jr.’s Response in Opposition to, (“Opp’n,” ECF No. 46), and Defendant’s 

Reply in Support of, (“Reply,” ECF No. 47), Defendant’s MTD. The Court vacated the 

hearing on the motion and took the matter under submission pursuant to Civil Local Rule 

7.1(d)(1). (ECF No. 40.) After considering the parties’ arguments and the law, the Court 

GRANTS Defendant’s MTD, (ECF No. 45), and DISMISSES WITHOUT

PREJUDICE Plaintiff’s Third Amended Complaint.

/ / /

/ / /

/ / /

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BACKGROUND

Plaintiff is currently an inmate at Richard J. Donovan Correctional Facility in 

California. (First Am. Compl. (“FAC”) 1, ECF No. 6.)1 The events underlying this 

claim occurred while Plaintiff was an inmate at Calipatria State Prison (“CSP”), also in 

California. (Id.) In 2009, Plaintiff was taking Tramadol prescribed to him by his primary 

care physician at CSP for chronic knee, neck, back, and shoulder pain. (Id. at 3.) On 

February 24, 2009, Plaintiff was taken off Tramadol and prescribed Neurontin by 

Defendant, a neurologist treating Plaintiff. (Third Am. Compl. (“TAC”) ¶ 6, ECF No. 

44.)2

After the initial appointment, Plaintiff had several more primary care appointments 

with Dr. Straga between February 2009 and July 2010. (Id. ¶ 7.) Plaintiff informed Dr. 

Straga during these visits that the Neurontin was not relieving his chronic pain. (Id. ¶ 8.) 

There are no further factual allegations that illuminate what happened concerning 

Plaintiff’s treatment after July 2010. From those factual allegations, Plaintiff concludes

that Defendant knew the Neurontin treatment regimen provided Plaintiff no relief. (Id.

¶ 11.) Plaintiff also alleges that Defendant failed to provide treatment, “[d]espite the 

diagnose [sic] of central neuropathic pain, and repeated complaints by plaintiff and 

request [sic] for a different method of treatment which would have brought his pain and 

treatment needs to an acceptable level of care.” (Id. ¶¶ 12–13.)

Plaintiff now brings a claim under 42 U.S.C. § 1983 alleging that Defendant 

violated his Eighth Amendment right. (Id. ¶ 18.)

/ / /

/ / /

 

1 The Court recites these background facts from Plaintiff’s First Amended Complaint, rather than his 

present Third Amended Complaint, because he omits these details from his Third Amended Complaint.

2

It does not appear that Plaintiff filed a Second Amended Complaint. He labeled his most recent 

complaint: “Third Amended Complaint for Damages.” (ECF No. 44.) The Court will refer to the 

complaint currently pending as Plaintiff’s Third Amended Complaint, or TAC, even though it is only the 

second amended complaint.

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LEGAL STANDARD

Federal Rule of Civil Procedure 12(b)(6) permits a party to raise by motion the 

defense that the complaint “fail[s] to state a claim upon which relief can be granted,” 

generally referred to as a motion to dismiss. The Court evaluates whether a complaint 

states a cognizable legal theory and sufficient facts in light of Federal Rule of Civil 

Procedure 8(a), which requires a “short and plain statement of the claim showing that the 

pleader is entitled to relief.” Although Rule 8 “does not require ‘detailed factual 

allegations,’ . . . it [does] demand more than an unadorned, the-defendant-unlawfullyharmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. 

Corp. v. Twombly, 550 U.S. 544, 555 (2007)). In other words, “a plaintiff’s obligation to 

provide the ‘grounds’ of his ‘entitle[ment] to relief’ requires more than labels and 

conclusions, and a formulaic recitation of the elements of a cause of action will not do.”

Twombly, 550 U.S. at 555 (citing Papasan v. Allain, 478 U.S. 265, 286 (1986)). A 

complaint will not suffice “if it tenders ‘naked assertion[s]’ devoid of ‘further factual 

enhancement.’” Iqbal, 556 U.S. at 677 (citing Twombly, 550 U.S. at 557).

In order to survive a motion to dismiss, “a complaint must contain sufficient 

factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” 

Id. (quoting Twombly, 550 U.S. at 570); see also Fed. R. Civ. P. 12(b)(6). A claim is 

facially plausible when the facts pled “allow the court to draw the reasonable inference 

that the defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 677 (citing 

Twombly, 550 U.S. at 556). That is not to say that the claim must be probable, but there 

must be “more than a sheer possibility that a defendant has acted unlawfully.” Id. Facts 

“‘merely consistent with’ a defendant’s liability” fall short of a plausible entitlement to 

relief. Id. (quoting Twombly, 550 U.S. at 557). Further, the Court need not accept as true 

“legal conclusions” contained in the complaint. Id. This review requires context-specific 

analysis involving the Court’s “judicial experience and common sense.” Id. at 679 

(citation omitted). “[W]here the well-pleaded facts do not permit the court to infer more 

than the mere possibility of misconduct, the complaint has alleged—but it has not 

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‘show[n]’—‘that the pleader is entitled to relief.’” Id.

In the wake of the heightened pleading standard announced in Twombly and 

affirmed in Iqbal, the Court remains obligated, “where the petitioner is pro se, 

particularly in civil rights cases, to construe the pleadings liberally and to afford the 

petitioner the benefit of any doubt.” Hebbe v. Pliler, 627 F.3d 338, 342 (9th Cir. 2010) 

(quoting Bretz v. Kelman, 773 F.2d 1026, 1027 n.1 (9th Cir. 1985) (en banc)). However, 

the Court may not “supply essential elements of claims that were not initially pled.” Ivey 

v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982). And “vague 

and conclusory allegations of official participation in civil rights violations” are not 

“sufficient to withstand a motion to dismiss.” Id.

Where a complaint does not survive 12(b)(6) analysis, the Court will grant leave to 

amend unless it determines that no modified contention “consistent with the challenged 

pleading . . . [will] cure the deficiency.” DeSoto v. Yellow Freight Sys., Inc., 957 F.2d 

655, 658 (9th Cir. 1992) (quoting Schriber Distrib. Co. v. Serv-Well Furniture Co., 806 

F.2d 1393, 1401 (9th Cir. 1986)).

ANALYSIS

I. Eighth Amendment Standard

An inmate has an Eighth Amendment right to adequate physical and mental health 

care. Doty v. Cnty. of Lassen, 37 F.3d 540, 546 (9th Cir. 1994). “To establish 

unconstitutional treatment of a medical condition . . . a prisoner must show deliberate 

indifference to a “serious” medical need. Id. (citing McGuckin v. Smith, 974 F.2d 1050, 

1059 (9th Cir. 1992)). Deliberate indifference to the serious medical needs of an inmate 

is inconsistent with the basic standards of human decency and antithetical to the Eighth 

Amendment’s proscription of “unnecessary and wanton infliction of pain.” Gregg v. 

Georgia, 428 U.S. 153, 173 (1976).

A determination of deliberate indifference to a serious medical need involves a 

two-step analysis consisting of both objective and subjective inquiries. Farmer v. 

Brennan, 511 U.S. 825, 837 (1994). First, the plaintiff must demonstrate a serious 

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medical need such that failure to provide treatment could “result in further significant 

injury” or “unnecessary and wanton infliction of pain.” Jett v. Penner, 439 F.3d 1091, 

1096 (9th Cir. 2006) (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)). Second, the 

plaintiff must show that the defendant’s response to the medical need was deliberately 

indifferent. Id. (citing McGuckin, 974 F.2d at 1059–60).

Deliberate indifference consists of (1) a purposeful act or failure to respond to a 

prisoner’s pain or possible medical need and (2) harm caused by the indifference. Id.

Such indifference may be manifested when “prison officials deny, delay[,] or 

intentionally interfere with medical treatment, or it may be shown by the way in which 

prison physicians provide medical care.” Hutchinson v. United States, 838 F.2d 390, 394 

(9th Cir. 1988). This standard is one of subjective recklessness. Farmer, 511 U.S. at 

839–40. “To satisfy this subjective component of deliberate indifference, the inmate 

must show that prison officials ‘kn[e]w [ ] of and disregard[ed]’ the substantial risk of 

harm, but the officials need not have intended any harm to befall the inmate; ‘it is enough 

that the official acted or failed to act despite his knowledge of a substantial risk of serious 

harm.’” Lemire v. Cal. Dep’t of Corr. & Rehab., 726 F.3d 1062, 1074 (9th Cir. 2013) 

(alterations in original) (quoting Farmer, 511 U.S. at 837, 842). “Deliberate indifference 

is a high legal standard. A showing of medical malpractice or negligence is insufficient 

to establish a constitutional deprivation under the Eighth Amendment.” Hamby v. 

Hammond, 821 F.3d 1085, 1092 (9th Cir. 2016) (quoting Toguchi v. Chung, 391 F.3d 

1051, 1060 (9th Cir. 2004)); see Estelle, 429 U.S. at 106.

II. Application

A. Serious Medical Need

Accepting his factual allegations as true, Plaintiff sufficiently pleads a serious medical 

need. Plaintiff alleges he suffered from chronic pain throughout his body, bulging and 

ruptured discs, and nerve pain, among other maladies. (TAC ¶ 4.)

/ / /

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B. Deliberate Indifference

The Court turns to the second element, deliberate indifference. Plaintiff alleges 

that during his appointments with Defendant he complained to Defendant that she 

“purposefully failed to provide plaintiff with treatment that was effective in meeting his 

treatment needs with a regiment [sic] of care that was adequate in treating his medical 

needs and relieving his chronic pain, and which met community standards.” (Id. ¶ 8.) In 

sum, Plaintiff believes his treatment was ineffective, (see id. ¶ 11 (“Defendant Straga 

failed to afford plaintiff with treatment that was effective.”)), and inadequate to relieve 

his chronic pain, (see id. ¶ 12 (“[Defendant] failed to provide treatment which reduced or 

relived [sic] plaintiff’s medical needs.”)).

Defendant argues that her decision to discontinue Tramadol in favor of Neurontin 

is simply a difference of opinion and is not actionable.3 (MTD 5.) Defendant states that 

Plaintiff does not allege that Dr. Straga refused to provide any pain medication, but rather 

Plaintiff was critical of the specific medication prescribed, i.e., he did not want 

Neurontin, but did want a different drug. (Id.)

Generally, difference of medical opinion . . . [is] insufficient, as a matter of law, to 

establish deliberate indifference.” Toguchi, 391 F.3d at 1058 (alteration in original) 

(quoting Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996)). However, the choice to 

pursue one treatment among alternatives may support a deliberate indifference claim if 

the elected course of treatment “was medically unacceptable under the circumstances” 

and was chosen in “conscious disregard of an excessive risk to the prisoner’s health.” 

Jackson, 90 F.3d at 332 (declining to grant summary judgment for doctors where the 

 

3 Defendant also argues Plaintiff’s Third Amended Complaint omits several critical allegations, 

previously included in the First Amended Complaint, that are important to the context of Plaintiff’s 

claims. (MTD 2.) For example, the TAC omits Plaintiff’s previous factual allegation that his Neurontin 

prescription was discontinued in July 2010 due to patient compliance issues. (Id.; FAC 29.) Nor did 

Defendant’s care end in July 2010—Plaintiff previously alleged that he had follow up visits with 

Defendant and was prescribed other treatment regimes by Defendant. (MTD 2–3; FAC 29–31.) The 

Court understands Defendant’s concern, but concludes that Plaintiff’s claim fails as a matter of law 

without considering the omitted context between Plaintiff’s First and Third Amended Complaints.

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plaintiff alleged they denied him a kidney transplant out of personal animosity). 

1. Whether the Elected Course of Treatment Was Medically Unacceptable

Plaintiff argues that he will be able to show that the FDA did not approve 

prescribing Neurontin for treatment of symptoms associated with central neuropathic pain 

and thus his treatment was medically unacceptable. (Opp’n 7.) His theory is predicated 

on a district court opinion in In re Neurontin Mktg. & Sales Practices Litig., 799 F. Supp. 

2d 110 (D. Mass. 2011), which purportedly held that Neurontin is not effective at 

relieving nerve pain. (Opp’n 8.) 

That case concerned Pfizer’s fraudulent marketing of Neurontin for off-label uses. 

See In re Neurontin, 799 F. Supp. 2d at 112. As part of its finding of fact, the district 

court made several findings concerning Neurontin’s efficacy for off-label uses, including 

neuropathic pain. See In re Neurontin Mktg. & Sales Practices Litig., No. 04-cv-10739-

FBS, 2011 WL 3852254, at *34 (D. Mass. Aug. 31, 2011). Specifically, the court found 

that 

there is no reliable scientific evidence that Neurontin is 

effective for bipolar disorder, migraine, or at high doses. With 

respect to some kinds of neuropathic pain, there is some 

scientific evidence of efficacy. However, as the FDA found, 

there is no reliable scientific evidence to support a broad 

indication of neuropathic pain.

Id. The court went on to discuss several double-blind, randomized, control trials 

assessing Neurontin’s off-label efficacy for neuropathic pain. The court found:

After a review of 12 [double blind trials] studying the use of 

Neurontin in the treatment of neuropathic pain, and a careful 

consideration of the expert testimony, the Court finds that there 

is no generally accepted scientific evidence that Neurontin is 

effective in the treatment of neuropathic pain as a broad 

category or indication. This is a closer call because, unlike 

migraine and bipolar disorder, there are four [double-blind 

trials] that concluded that Neurontin was better than placebo for 

treating certain narrow indications like postamputation phantom 

limb pain, neuropathic pain after spinal cord injury, and 

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Complex Regional Pain Syndrome I. . . . However, using the 

generally accepted standard of scientific efficacy followed by 

the FDA and the scientific community (requiring two [doubleblind trials] that demonstrate efficacy), the Court is persuaded 

that there is insufficient reliable evidence of the efficacy of 

Neurontin with respect to the broad indication of neuropathic 

pain.

Id. at *43. 

The findings of fact in In re Neurontin Marketing & Sales Practices Litigation do 

suggest that Plaintiff has a point that Neurontin’s off-label efficacy is not conclusive. 

However, Plaintiff’s reliance on this one case sweeps too broadly. The finding of fact 

was made with respect to a “broad indication of neuropathic pain.” Id. This does not 

speak to the circumstances as they apply to Plaintiff’s own medical situation. 

Further, the district court did note that Neurontin did have some efficacy with 

respect to some kinds of neuropathic pain. Id. at *34. The court stated that its finding

was a close call because there were four double-blind trials that concluded “Neurontin 

was better than placebo for treating certain narrow indications like postamputation 

phantom limb pain, neuropathic pain after spinal cord injury, and Complex Regional Pain 

Syndrome I.”

4

 Id. at *43. The primary issue with relying on a case like In re Neurontin 

Marketing & Sales Practices Litigation is that the district court’s conclusions speak to the 

broad contours of Neurontin efficacy (or lack thereof) but those conclusions do not take 

into account the particulars of Plaintiff’s medical situation. The Court finds Plaintiff has 

not alleged sufficient facts to show how the elected course of treatment was medically 

unacceptable.

/ / /

 

4 Further, it appears that at the time of Plaintiff’s treatment Neurontin was approved by the California 

Department of Corrections and Rehabilitation (“CDCR”), but removed from CDCR’s formulary after 

2011. See Haney v. Nangalama, No. 11-cv-1218-MCE-CMK-P, 2013 WL 4482866, at *1 (E.D. Cal. 

Aug. 20, 2013); Johnson v. Sepulveda, No. 11-cv-6693-JST (PR), 2013 WL 5313133, at *1–2 (N.D. 

Cal. Sept. 23, 2013). While this does undercut the scientific argument for Neurontin’s efficacy, it 

bolsters Defendant’s position because Defendant was prescribing a course of treatment approved by 

CDCR at the time of Plaintiff’s allegations.

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2. Whether Defendant Consciously Disregarded Excessive Risk to Plaintiff’s 

Health

“To satisfy this subjective component of deliberate indifference, the inmate must 

show that prison officials ‘kn[e]w [ ] of and disregard[ed]’ the substantial risk of harm, 

but the officials need not have intended any harm to befall the inmate; ‘it is enough that 

the official acted or failed to act despite his knowledge of a substantial risk of serious 

harm.’” Lemire, 726 F.3d at 1074 (alteration in original) (quoting Farmer, 511 U.S. at 

837, 842). In Farmer, the Supreme Court held that 

a prison official cannot be found liable under the Eighth 

Amendment for denying an inmate humane conditions of 

confinement unless the official knows of and disregards an 

excessive risk to inmate health or safety; the 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.

511 U.S. at 837.

Here, the only allegation Plaintiff puts forward is that during his appointments with 

Defendant he complained to her about the treatment. (See TAC ¶ 8.) There are no 

factual allegations that Defendant knew of an excessive risk. There are no factual 

allegations that, with the knowledge of the excessive risk to Plaintiff, Defendant 

disregarded that risk. For example, in his TAC Plaintiff fails to allege any facts as to 

what happened after July 2010. (See id. ¶ 7.) Even assuming, for the sake of argument, 

Defendant knew Neurontin constituted an excessive risk to Plaintiff’s medical condition, 

Plaintiff omits any factual allegations as to what Defendant did or did not do after 

receiving his complaints. 

In his opposition, Plaintiff seems to suggest that Defendant’s action was punitive

because Defendant viewed Plaintiff as a “Complainer.” (Opp’n 7 (“Plaintiff will offer 

evidence that Dr. Straga often labelled [sic] plaintiff as a “Complainer” and because she 

viewed plaintiff as a “Complainer,” she deliberately prescribed a Treatment Plan that 

provided ineffective treatment for his chronic pain.”).) This argument fails for two 

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reasons. First, factual allegations must be included in a complaint and not contained in 

an opposition brief. Schneider v. Cal. Dep’t of Corr., 151 F.3d 1194, 1197 n.1 (9th Cir. 

1998) (“[I]n determining the propriety of a Rule 12(b)(6) dismissal, a court may not look 

beyond the complaint to a plaintiff’s moving papers, such as a memorandum in 

opposition to a defendant’s motion to dismiss.”). Second, there are no allegations 

connecting Defendant purportedly labeling Plaintiff a “complainer” to his allegedly 

deficient medical treatment. 

Thus, Plaintiff has not alleged sufficient facts to allow the Court to infer that 

Defendant consciously disregarded an excessive risk to Plaintiff.

In sum, this is a difference of opinion between a physician and a prisoner, which is 

insufficient as a matter of law to establish deliberate indifference. The crux of Plaintiff’s 

complaint is that Defendant substituted Neurontin for his previously subscribed Tramadol

and then he was treated with Neurontin from February 2009 to July 2010. (TAC ¶¶ 6–7.) 

There are no further factual allegations, only conclusory statements like Defendant 

“failed to provide treatment which reduced or relived [sic] plaintiff’s medical needs.” 

(Id. ¶ 11.) Plaintiff previously alleged more detailed factual allegations, (see generally

FAC), but chose to include significantly less detail in his TAC. Accordingly, the Court 

GRANTS Defendant’s MTD, (ECF No. 45).

CONCLUSION

For the reasons stated above, the Court GRANTS Defendant’s MTD (ECF No. 

45). The Court continues to harbor serious doubts that Plaintiff will be able to adequately 

re-plead his claims against Defendant. However, because Plaintiff is a prisoner, 

proceeding pro se, and alleging a civil rights claim the Court will allow amendment. See

Hebbe, 627 F.3d at 342; DeSoto, 957 F.2d at 658. Accordingly, the Court DISMISSES 

WITHOUT PREJUDICE Plaintiff’s Third Amended Complaint. 

/ / /

/ / /

/ / /

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Plaintiff SHALL FILE an amended complaint, if any, on or before thirty (30) days on 

the date this Order is electronically docketed. Failure to file an amended complaint by 

this date may result in Plaintiff’s Eighth Amendment claims being dismissed with 

prejudice.

IT IS SO ORDERED.

Dated: April 10, 2018

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