Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_18-cv-06386/USCOURTS-cand-3_18-cv-06386-3/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

JAMES CARL KELLY,

Plaintiff,

v.

P. SULLIVAN, et al.,

Defendants.

Case No. 18-cv-06386-SI 

ORDER OF DISMISSAL

Re: Dkt. Nos. 15, 16

James Carl Kelly, an inmate currently housed at the California State Prison - Sacramento, 

filed this pro se prisoner's civil rights action under 42 U.S.C. § 1983. The court reviewed the 

complaint and dismissed it with leave to amend. The amended complaint is now before the court 

for review pursuant to 28 U.S.C. § 1915A. Kelly’s motion for appointment of counsel also is before 

the court for consideration.

BACKGROUND

Understanding Kelly’s amended complaint is aided by some very basic information about 

anticoagulant medications. According to “A Patient’s Guide to Taking Warfarin” available on the 

American Heart Association’s website (www.heart.org), “[w]arfarin (brand names Coumadin and 

Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing 

larger.” The guide also explains: “The goal of warfarin therapy is to decrease the clotting tendency 

of blood, not to prevent clotting completely. Therefore, the effect of warfarin must be monitored 

carefully with blood testing. On the basis of the results of the blood test, [the patient’s] daily dose

of warfarin will be adjusted to keep [his or her] clotting time within a target range.” The blood test

result is reported as the International Normalized Ratio (INR), a standardized way of expressing the 

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prothrombin time value. Id. Lovenox is another anticoagulant used to prevent blood clots. 

The amended complaint alleges the following:

On about October 30, 2012, Kelly was told by five doctors at a hospital in Bakersfield that, 

“since I already had ‘tiny nodules’ on left lung and ‘hepetities C’ I could only take Coumadin at 7.5 

mg. and only Coumadin and if my I.N.R. is low or high I should get Lovenox injection 80 mg. If I 

don’t the tiny nodules will leave left lung, and go to right lung which would cause me ‘lung cancer.’” 

Docket No. 15-1 at 5-7 (errors in source). Kelly has been repeating this information to doctors ever 

since then. Id. at 7. 

Almost six years later, in about June through August 2018, and while incarcerated at Salinas 

Valley State Prison, Kelly saw Dr. Bright because his INR level was low and he was a high-risk 

heart patient. Dr. Bright prescribed too high a dose of Coumadin for Kelly. Docket No. 15-1 at 5. 

Kelly became dizzy when taking the medication at the higher dose. He tried to explain to Dr. Bright 

the information he had received in 2012 from other doctors, i.e., that he was only to receive 7.5 mg. 

Coumadin and, if his INR level was too high or low, he was to receive an 80 mg. injection of 

Lovenox. Id. at 5-9. Dr. Bright did not believe Kelly. Id. at 5, 9. 

In about July 2018, Dr. Lawrence Gamboa became Kelly’s doctor. Like Dr. Bright, Dr. 

Gamboa did not believe Kelly’s statement that, per the orders from the Bakersfield doctors in 2012, 

Kelly was only to receive 7.5 mg. of Coumadin. Id. at 7. Dr. Gamboa prescribed a higher dose of 

Coumadin for several months and then reduced the dose to 7.5 mg. Id.

Although Kelly alleges that the doctors in 2012 told him that he should receive an 80 mg. 

injection of Lovenox if his INR level was too “high or low,” id. at 7, he also faults Dr. Bright and 

Dr. Gamboa for not adjusting the Lovenox dose to avoid adjusting the Coumadin dose, id. at 9. 

In addition to Dr. Bright and Dr. Gamboa, Kelly names as a defendant P. Sullivan, the 

Salinas Valley State Prison associate warden. Sullivan apparently is sued on the theory that he is in 

charge of the other two defendants. See id. at 5. 

Although Kelly’s theory of relief here is that Drs. Bright and Gamboa are liable because they 

did not adhere to the medication orders given to Kelly six years earlier by doctors at a Bakersfield 

hospital, he pursued a contradictory theory in an earlier action where he claimed that the Bakersfield 

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doctors gave him bad medication advice. In a complaint signed under penalty of perjury, Kelly sued

the Bakersfield doctors for, among other things, causing him to have a “blood disease” and telling 

him that he could “only take one kind of blood thinner medication, called Coumadin at 7.5 mg. 

because of the anemia, hepetities C and the tiny nodules I have on left lung, which now today is 

proved to be a lie.” Kelly v. Islam, E. D. Cal. No. 18-cv-0018 DAD JDP, Docket No. 1 at 3. He 

further alleged in that action that, as a result of the Bakersfield doctors’ statement that he was only 

to take a specific dose of Coumadin, he experienced a mental breakdown and attempted to commit 

suicide when other doctors ordered different doses of Coumadin. Id. at 5. The court takes judicial 

notice that Kelly filed a complaint with these allegations in the U.S. District Court for the Eastern 

District of California. See Fed. R. Evid. 201(b)(2).

DISCUSSION

A. Review of Amended Complaint

A federal court must engage in a preliminary screening of any case in which a prisoner seeks 

redress from a governmental entity or officer or employee of a governmental entity. See 28 U.S.C. 

§ 1915A(a). The court must identify any cognizable claims, and dismiss any claims which are 

frivolous, malicious, fail to state a claim upon which relief may be granted, or seek monetary relief 

from a defendant who is immune from such relief. See id. at § 1915A(b)(1),(2). Pro se complaints 

must be liberally construed. See Hebbe v. Pliler, 627 F.3d 338, 342 (9th Cir. 2010). 

Federal Rule of Civil Procedure 8(a)(2) requires that the complaint set forth “a short and 

plain statement of the claim showing that the pleader is entitled to relief.” Although a complaint 

“does not need detailed factual allegations, . . . 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. . . . Factual allegations must be enough to raise a right 

to relief above the speculative level.” Bell Atlantic Corp. v. Twombly, 550 U.S. at 544 (citations 

omitted). A court may dismiss a complaint when it does not contain enough facts to state a claim 

to relief that is plausible on its face. See id. at 570. “A claim has facial plausibility when the plaintiff 

pleads factual content that allows the court to draw the reasonable inference that the defendant is 

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liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). “The plausibility 

standard is not akin to a ‘probability requirement,’ but it asks for more than a sheer possibility that 

a defendant has acted unlawfully.” Id. (quoting Twombly, 550 U.S. at 557). 

To state a claim under 42 U.S.C. § 1983, a plaintiff must allege two elements: (1) that a 

right secured by the Constitution or laws of the United States was violated, and (2) that the violation 

was committed by a person acting under the color of state law. See West v. Atkins, 487 U.S. 42, 48 

(1988).

Deliberate indifference to a prisoner’s serious medical needs violates the Eighth 

Amendment’s prohibition of 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 based on inadequate medical care, a prisoner-plaintiff must show: (1) a serious 

medical need, and (2) deliberate indifference thereto by a defendant. 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), overruled on other grounds by WMX Techs., Inc. v. 

Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc). Deliberate indifference is not shown by a

mere difference of opinion between doctors or by mere negligence. Toguchi, 391 F.3d at 1058, 

1060-61. 

The amended complaint fails to state a claim upon which relief may be granted. Kelly

alleges that Dr. Bright and Dr. Gamboa failed to follow a medication regimen that other doctors had 

ordered six years earlier. The allegations of the amended complaint do not state a deliberateindifference claim that is plausible on its face. First, it is not plausible that the 2012 medication 

order was set in stone and never to be changed regardless of what happens to the patient. But that 

is just what Kelly’s amended complaint suggests, i.e., that no doctor could ever stray from the 2012 

order for 7.5 mg. of Coumadin. Second, it is not plausible that Drs. Bright and Gamboa erred in not 

following the alleged instructions from the Bakersfield doctors to administer 80 mg. of Lovenox if 

Kelly’s INR level was too “low or high.” Docket No. 15-1 at 7. Although Lovenox might be right 

for one of these conditions, it defies common sense to say that the same solution is right for both of 

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these conditions. Kelly’s allegation is akin to saying that insulin should be administered when blood 

sugar either plummets or spikes, or that an anti-hypertension medication should be administered 

when the patient’s blood pressure is either low or high. Third, the allegations in the amended 

complaint are incompatible with the statements Kelly made under penalty of perjury in the action 

filed earlier in the Eastern District of California: whereas he alleges in this action that Drs. Bright 

and Gamboa improperly failed to follow the 2012 orders from Bakersfield doctors, Kelly stated 

under penalty of perjury in the earlier action that those very orders from the Bakersfield doctors 

were wrong. The amended complaint does not allege facts that plausibly suggest Dr. Gamboa and 

Dr. Bright were deliberately indifferent to Kelly’s medical needs when they adjusted the dose of 

Coumadin to be administered to Kelly instead of blindly following the directions given six years 

earlier. At the very most, he has identified a difference of opinion between doctors, but that is 

insufficient to state a claim for deliberate indifference to medical needs. See Toguchi, 391 F.3d at 

1058.

The amended complaint also does not state a claim against associate warden Sullivan. No 

facts are alleged suggesting that Sullivan played any personal role in Kelly’s medical care. Sullivan 

apparently was sued on a theory that he was in charge of the two doctor-defendants. There is no 

respondeat superior liability under § 1983, i.e., no liability under the theory that one is liable simply 

because he employs a person who has violated a plaintiff's rights. See Monell v. Dep't of Social 

Servs.,436 U.S. 658, 691 (1978); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989). 

Further leave to amend will not be granted because it would be futile. In the order of 

dismissal with leave to amend, the court explained the requirements for stating an Eighth 

Amendment deliberate indifference to medical needs claim and explained that Kelly needed to link 

each individual defendant by alleging what that person did or failed to do that caused a violation of 

his rights. Docket No. 8 at 2-3. Kelly was unable or unwilling to allege an Eighth Amendment 

claim. 

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B. Miscellaneous Motions

Kelly’s motion to file an amended complaint is DISMISSED as unnecessary. Docket No. 

15. When the court orders a party to file an amended complaint, as occurred here, there is no need 

for that party to file a motion to amend when he files his amended complaint.

Kelly requests that counsel be appointed to represent him in this action. Docket No. 16. A 

district court has the discretion under 28 U.S.C. §1915(e)(1) to designate counsel to represent an 

indigent civil litigant in exceptional circumstances. See Wilborn v. Escalderon, 789 F.2d 1328, 

1331 (9th Cir. 1986). This requires an evaluation of both the likelihood of success on the merits 

and the ability of the plaintiff to articulate his claims pro se in light of the complexity of the legal 

issues involved. See id. Neither of these factors is dispositive and both must be viewed together 

before deciding on a request for counsel under § 1915(e)(1). Here, exceptional circumstances 

requiring the appointment of counsel are not present because the amended complaint does not state 

a claim upon which relief may be granted. There is no chance of success on the merits of this action. 

The request for appointment of counsel therefore is DENIED. Docket No. 16.

CONCLUSION

This action is dismissed because the amended complaint fails to state a claim upon which 

relief may be granted. 

IT IS SO ORDERED.

Dated: August 9, 2019

______________________________________

SUSAN ILLSTON

United States District Judge

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