Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_04-cv-05919/USCOURTS-caed-1_04-cv-05919-8/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

MOISES I. FUENTES, JR., and

ANA P. FUENTES, by and through

their Guardian ad Litem,

BLANCA MARTINEZ

Plaintiffs,

v.

COUNTY OF MADERA, A Municipal

Corporation and Public Entity,

CORRECTIONAL MANAGED CARE

MEDICAL CORPORATION, and DOES

1 through 50, inclusive, 

Defendants.

1:04-CV-05919 OWW SMS

MEMORANDUM DECISION AND ORDER

GRANTING DEFENDANT

CORRECTIONAL MANAGED CARE

MEDICAL CORPORATION’S MOTION

FOR SUMMARY JUDGMENT

1. INTRODUCTION

Defendants Correctional Managed Care Medical Corporation

(“CMC”) move for summary judgment on Plaintiffs’ wrongful death

claim. (Doc. 50, Motion for Summary Judgment, Filed May 30,

2006.) Plaintiffs Moises I. Fuentes, Jr., and Ana Fuentes

through her guardian, Blanca Martinez have not opposed the

motion. This order is based entirely on arguments set forth in

CMC’s moving papers. 

2. PROCEDURAL BACKGROUND

Plaintiffs filed their original complaint on June 30, 2004,

invoking federal jurisdiction under the Civil Rights Act 42

U.S.C. § 1983. (Doc. 1, Complaint.) Plaintiffs filed a second

amended complaint on November 9, 2005. (Doc. 32, Second Amended

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 All facts are undisputed and based entirely on CMC’s 1

moving papers. 

2

Complaint “SAC”.) On February 2, 2005, Defendant County of

Madera (“the County”) filed a first amended cross-claim against

CMC for indemnification of the claims Plaintiffs asserted against

them. (Doc. 8, Cross-Claim For Indemnity.) Defendants filed

their answer to Plaintiffs’ SAC on December 9, 2005. (Doc. 35,

Answer to Amended Complaint by CMC.) On May 24, 2006 Plaintiffs’

attorney moved to withdraw as attorney on the grounds that her

clients have failed to respond to her attempts at communication

regarding their case. (Doc. 45, Motion to Withdraw as Attorney

of Record for Plaintiffs.) On June 30, 2006 Magistrate Judge

Sandra M. Snyder granted the motion to withdraw. (Doc. 67, Order

granting Motion to Withdraw as Attorney.) 

CMC filed a motion for summary judgment on May 30, 2006. 

(Doc. 50, Defendants Motion for Summary Judgment.) To date,

Plaintiffs’ have not filed opposition to the motion. 

3.FACTUAL BACKGROUND1

A. Background of Medical Treatment

Moises Fuentes (“Mr. Fuentes”) arrived at Madera County Jail

on July 22, 2003 after having been transferred there from Folsom

Prison. (DSUF, No. 1.) At the time of his transfer, Mr. Fuentes

was 29 years old. (Id.) No transfer information regarding any

previous weight loss, complaints of a sore throat were provided

to CMC. (Id.) The chart notes reflect he complained of a sore

throat and requested a medical evaluation on July 28, 2003. 

(DSUF, No. 2.) 

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He was seen and evaluated by CMC R.N. personnel on July 30,

2003. (Id.) At that time, he complained of a sore throat for

approximately one month, but denied fever, chest pain, shortness

of breath, or coughing of any blood. (Id.) His weight was 155

lbs. (Id.) His examination on July 30, 2003 was normal. (DSUF,

No. 3.) However, his tonsils were enlarged and showed evidence

of exudate. (Id.) He was diagnosed with pharyngitis and treated

accordingly with 10 days of antibiotics, acetaminophen for

discomfort, and advised to rinse with warm saline and to follow

up if there was no improvement. (Id.) Orders were countersigned

by Dr. Walters. (Id.) On August 19, 2003, Mr. Fuentes requested

another medical visit, complaining that while he had completed

his antibiotics, his throat was still sore and he was having

difficulty swallowing food. (DSUF, No. 4.) Mr. Fuentes was seen

that same day by nursing staff (FNP) who examined Mr. Fuentes and

found his left tympanic membrane ruptured, his nose runny and

inflamed, and his throat still inflamed. (DSUF, No. 5.) He was

prescribed Kenalog and antihistamines for what were presumed to

be ongoing allergies. (Id.) Orders were countersigned by Dr.

Walters. (Id.) There was no reason at this point to suspect a

more severe problem. (Id.) 

On August 22 and 29, 2003, Mr. Fuentes complained that he

still was not feeling better, and requested that a physician see

him. (DSUF, No. 6.) On September 3, 2003, Mr. Fuentes was seen

and evaluated by Dr. Walters. (DSUF, No. 7.) At this time, it

appeared his tonsils had resolved (were no longer swollen), but

his throat was still inflamed and it appeared he had a post nasal

drip. (Id.) Dr. Walters suspected an ongoing allergic rhinitis,

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or possibly an unresolved bacterial infection, and prescribed a

second allergy medication (CTM). (Id.) 

On September 7, 2003, Mr. Fuentes reported that he was

having some rectal bleeding. (DSUF, No. 8.) He was seen and

evaluated on September 8 and 9, 2003, by CMC nursing staff.

(DSUF, No. 9.) At this point, Mr. Fuentes reported his

swallowing was better after starting the second antihistamine. 

(Id.) However, his stool was black, tested positive for blood. 

(Id.) As a result, it was suspected that he had Gastritis. 

(Id.) At this point, he weighed 148 lbs. (Id.) A full liquid

diet was ordered and Mr. Fuentes was placed in the medical

department. (Id.) Previcid (a proton pump inhibitor used for

gastric acidity and/or reflux) was added to help with his

presumed gastritis. (Id.) Orders were countersigned by Dr.

Walters. He was checked on September 10 and 11, 2003, by CMC

nursing and then returned to the general population on September

12, 2003. (Id.) 

He was then seen by Dr. Walters on September 16, 2003,

complaining that his pain with swallowing was increasing. Dr.

Walters ordered a barium swallow in one week if his symptoms did

not improve. (DSUF, No. 10.) He was seen by CMC nursing

personnel (R.N.) on September 19, 2003, with ongoing complaints. 

(DSUF, No. 11.) However, he was refusing the prescribed liquid

diet. (Id.) A barium swallow was scheduled for September 25,

2003 at Madera Community Hospital. (Id.) On September 25, 2003,

he was transported to Madera Community Hospital, and the barium

swallow was performed. (DSUF, No. 12.) It revealed an area of

narrowing (stricture), which explained the difficulty in

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swallowing. (Id.) 

On September 26, 2003, he was scheduled for esophagoscopy

and esophageal biopsy with an outside specialist to take place at

Madera Community Hospital on October 8, 2003. (Id.) He was seen

on October 4 and October 6, 2003. (DSUF, No. 13.) He was

referred to the Madera Community Hospital emergency room on

October 6, 2003, for evaluation after a rectal examination was

positive for blood, and was sent back with a diagnosis of rectal

bleeding and constipation. (Id.) 

On October 8, 2003, he was transported to Madera Community

Hospital, and had an esophageal biopsy, which was interpreted by

the pathologist as demonstrating an adenocarcinoma in the distal

third of the esophagus. (DSUF, No. 14.) The pathology report

was received at the Madera Jail on October 13, 2003. (Id.) On

October 14, 2003, an appointment with a gasteroenterology

specialist, Dr. Akhtar, was scheduled for October 15, 2003, and

an appointment with an oncologist, Dr. Padmanabhan, was scheduled

for October 20, 2003. (Id.) 

On October 14, 2003, he was seen by Dr. Walters and informed

of the diagnosis of adenocarcinoma of the esophagus. (DSUF, No.

15.) After complaints of bloody vomitus were received, he was

seen by CMC nursing staff (FNP), and was moved to the medical

department for monitoring. (Id.) His vital signs were monitored

and determined to be stable. (Id.) He was scheduled to be

reevaluated again by Dr. Walters the next morning. (Id.) On

October 15, 2003, Mr. Fuentes was seen by CMC nursing personnel

and Dr. Walters with complaints of right flank pain and

midepigastric pain. (DSUF, No. 16.) Orders were received by Dr.

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Walters for a CBC, metabolic panel, CA 19-9, and for Vicoden and

Vistril (50mg) to be administered. (Id.) He was also seen by

gastroenterology specialist, Dr. Akhtar, x-rays were taken of the

chest, and an additional referral was requested for a consult

with an oncology specialist. (Id.) 

The CMC staff was able to schedule an appointment sooner

than the October 20, 2003 appointment previously made with Dr.

Padmanabhan, with oncologist, Dr. Shaikh, for October 16, 2003. 

(Id.) He was seen by oncology specialist, Dr. Shaikh, on October

16, 2003 who ordered CT scans of the chest, abdomen, and pelvis

in addition to whole body bone scans. (DSUF, No. 17.) 

Mr.Fuentes’ CEA and LDH levels were checked and Dr. Shaikh

arranged for placement of a PEG tube for nutrition and for mediport placement by interventional radiology for chemotherapy

delivery. (Id.) A Two-D echocardiogram was then requested for

assessment of baseline, wall motion and ejection fraction prior

to chemotherapy. (Id.) 

Dr. Shaikh’s plan was to treat Mr. Fuentes with combined

modality therapy with chemotherapy, radiation, and surgery. 

(DSUF, No. 18.) It is also likely that a complete metastatic

evaluation was done as well. (Id.) For pain control, he was

given a prescription of Duragesic 25 mcg patch. (Id.) Mr.

Fuentes was then returned to the clinic for follow-up. (Id.) 

On October 18, 2003, he began receiving Boost nutritional

supplement administered through the PEG tube. (DSUF, No. 19.) 

He continued to receive Vicodin, Duragesic patches, and Boost

every 4 hours thereafter. By the following day, he was feeding

himself through the tube demonstrating excellent technique and

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understanding of the tube. (Id.) 

On October 20, 2003, he was transferred from Madera County

Jail custody with the remaining Duragesic patches, Boost, and

feeding syringes, and was not seen again by CMC personnel. (Id.)

Although defendant does not have further information at this time

as to the nature of his subsequent medical course as it relates

to his esophageal cancer, CMC contends that the care and

treatment that the CMC staff provided to Mr. Fuentes while he was

housed at the Madera County Jail was reasonable, appropriate, and

within the standard of care. (DSUF, No. 20.) CMC further claims

that although Mr. Fuentes often refused his medications, the

infirmary staff was not deterred from going to great lengths to

ensure that he was given the best care possible under the

circumstances, including promptly scheduling necessary consults

and studies, which typically is a time consuming process. (Id.) 

Thus, CMC argues that the care given by the staff at CMC was

conscientious and with the best interests of the health and

welfare of Mr. Fuentes in mind. (Id.) Specifically, a two month

period of evaluation for Mr. Fuentes’ symptoms in the manner in

which they presented is well within what is seen commonly in the

community, especially considering how unlikely a diagnosis of

esophageal cancer is in a 29 year old. (DSUF, No. 21.) In fact

the time lapse is quite rapid. (Id.) CMC claims that it is not

unusual that scheduling the studies and consults take 2 to 4

weeks to schedule and complete when there does not appear to be a

medical urgency. (Id.) CMC further claims that it is

understandable that the diagnosis of cancer was not what the

health care workers were considering as the likely diagnosis when

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they scheduled these tests and consultations. (Id.) 

As for the result, and assuming Mr. Fuentes passed away from

adenocarcinoma of his esophagus, CMC claims that the time period

from July 28, 2003 to October 8, 2003, is unlikely to have

decreased his chance of survival or cure. (DSUF, No. 22.) 

CMC claims that they do not know what happened after Mr.

Fuentes left Madera Jail nor does it know the exact extent of his

esophageal cancer (length, thickness, metastatic evaluation), but

the months between initial presentation of symptoms and

histological diagnosis of his malignancy appears to have had no

effect on his recommended treatment or his likelihood of cure

insofar as different treatment would have been recommended had he

been considered unresectable. (Id.) Therefore, CMC claims that

there is no evidence of indifference or breach of duty by CMC

which led to Mr. Fuentes’ injuries. (DSUF, No. 23.) 

B. Plaintiffs’ Causes of Action 

In their SAC, Plaintiffs’ bring a 42 U.S.C. section 1983

cause of action against the County. (Doc. 1, Complaint, Paras.

23-28.) They also bring a state law claim for wrongful death

against CMC. (Doc. 1, Complaint, Paras. 29-30.) 

C. County of Madera’s First Amended Cross-Claim for

Indemnity

In their first amended cross-complaint, the County argues

that any damages alleged by Plaintiffs arose out of CMC’s

performance under an existing agreement between CMC and The

County to provide health care services for all inmates in the

custody of the Madera County Department of Corrections. (Doc. 8,

First Amended Cross-Claim, Paras. 3-6) The County thus asserts a

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claim for indemnification against CMC for any judgment entered

against them, for any attorneys fees and costs incurred, and for

any other such relief. (Doc. 8, First Amended Cross-Claim, Page

3, Paras. 1-3)

4. STANDARD OF REVIEW

Summary judgment is warranted only “if the pleadings,

depositions, answers to interrogatories, and admissions on file,

together with the affidavits, if any, show that there is no

genuine issue as to any material fact.” Fed. R. Civ. P. 56(c);

California v. Campbell, 138 F.3d 772, 780 (9th Cir. 1998). 

Therefore, to defeat a motion for summary judgment, the nonmoving party must show (1) that a genuine factual issue exists

and (2) that this factual issue is material. Id. A genuine

issue of fact exists when the non-moving party produces evidence

on which a reasonable trier of fact could find in its favor

viewing the record as a whole in light of the evidentiary burden

the law places on that party. See Triton Energy Corp. v. Square

D Co., 68 F.3d 1216, 1221 (9th Cir. 1995); see also Anderson v.

Liberty Lobby, Inc., 477 U.S. 242, 252-56 (1986). Facts are

“material” if they “might affect the outcome of the suit under

the governing law.” Campbell, 138 F.3d at 782 (quoting Anderson,

477 U.S. at 248). 

The nonmoving party cannot simply rest on its allegations

without any significant probative evidence tending to support the

complaint. Devereaux v. Abbey, 263 F.3d 1070, 1076 (9th Cir.

2001).

[T]he plain language of Rule 56(c) mandates the

entry of summary judgment, after adequate time

for discovery and upon motion, against a party

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who fails to make a showing sufficient to

establish the existence of an element essential

to the party's case, and on which that party

will bear the burden of proof at trial. In such

a situation, there can be “no genuine issue as

to any material fact,” 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. Catrell, 477 U.S. 317, 322-23 (1986). The more

implausible the claim or defense asserted by the nonmoving party,

the more persuasive its evidence must be to avoid summary

judgment. See United States ex rel. Anderson v. N. Telecom,

Inc., 52 F.3d 810, 815 (9th Cir. 1996). Nevertheless, the

evidence must be viewed in a light most favorable to the

nonmoving party. Anderson, 477 U.S. at 255. A court’s role on

summary judgment is not to weigh evidence or resolve issues;

rather, it is to determine whether there is a genuine issue for

trial. See Abdul-Jabbar v. G.M. Corp., 85 F.3d 407, 410 (9th

Cir. 1996).

5. DISCUSSION

A. Subject Matter Jurisdiction 

Federal courts are courts of limited jurisdiction and may

only preside over certain types of civil cases, as authorized by

Congress and the United States Constitution. Kokkonen v.

Guardian Life Ins. Co. of Am., 511 U.S. 375, 377 (1994). A court

has “federal question jurisdiction” over civil actions “arising

under the Constitution, laws, or treaties of the United States.” 

28 U.S.C. § 1331. Alternatively, federal district courts possess

“diversity jurisdiction” over civil suits where the parties are

citizens of different states and the dispute involves more than

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$75,000.00. 28 U.S.C. § 1332. 

B. Supplemental Jurisdiction 

Title 28 U.S.C. section 1367(a) provides in pertinent part:

“In any civil action of which the district courts have

original jurisdiction, the district court shall have

supplemental jurisdiction over all other claims that

are so related to the claims in the action within such

original jurisdiction that they form part of the same

case or controversy under Article III of the United

States Constitution.” 

Plaintiffs’ state law claims invoke supplemental

jurisdiction as they arise from the same controversy as their 42

U.S.C. section 1983 claim. 

In California, a person making a claim against a public

entity or a public employee must present such a claim in writing

to the clerk, auditor or secretary of the local public entity

within six months after the accrual of the cause of action. Cal.

Gov. Code § 911.2.; see also Javor v. Taggart, 98 Cal. App. 4th

795, 804 (Cal. Ct. App. 2002) (submission of a claim to a public

entity pursuant to the California Tort Claims Act is a condition

precedent to a civil action against the state or its employees

and failure to present the claim bars the action.) A person may

not maintain a cause of action against a public entity or public

employee without having first presented a claim as required by

California Statute. Cal. Gov. Code 945.4. Cal. Gov. Code

section 954.6 requires that a claimant file a civil action within

six months after the public agency issues its decision. Javor,

98 Cal. App. 4th at 804. Plaintiffs filed a claim against the

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County pursuant to Cal. Gov. Code § 911.2. 

C. Plaintiffs’ Standing 

Cal. Civ. Code section 377.60 sets forth three categories of

persons who may bring a wrongful death action:

1. The decedent’s surviving spouse,

domestic partner, children, and issue of

deceased children or, if there is no

surviving issue of the decedent, the

persons, including the surviving spouse

entitled to decedent’s property by

intestate succession

2. Whether qualified under the first

category or not, a putative spouse,

stepchildren, and parents, if they were

dependent on the decedent; and 

3. Whether or not qualified under the first

or second category, a minor who, at the

time of the decedent’s death, resided

for the previous 180 days in the

decedent’s household and depended on the

decedent for one half or more of this or

her support. 

Plaintiffs, as Mr. Fuentes’ children have standing to bring

a wrongful death claim under California law through a court

appointed guardian. 

D. Wrongful Death

A cause of action for wrongful death is a statutory claim in

California. Cal. Code Civ. Proc. sections 377.60-377.62; Quiroz

v. Seventh Ave. Center, 140 Cal. App. 4th 1256, 1263 (Cal. Ct.

App. 2006). Its purpose is to compensate heirs for the loss of

companionship and for other losses suffered as a result of a

decedent’s death. Id. The elements of the cause of action for

wrongful death by a health care provider are the (1) elements of

a tort for professional negligence, (2) the resulting death, and

(3) the damages, consisting of the pecuniary loss suffered by

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the heirs. Id. The elements of professional negligence are (1)

the duty of the professional to use such skill, prudence, and

diligence as other members of his profession commonly possess and

exercise; (2) a breach of that duty; (3) a proximate causal

connection between the negligent conduct and the resulting

injury; and (4) actual loss or damage resulting from the

professional negligence. Elcome v. Chin, 110 Cal. App. 4th 310,

317 (Cal. Ct. App. 2003). 

i. CMC’s Duty To Provide Mr. Fuentes with Medical

Care

A health care provider has a duty to use a reasonable degree

of skill, knowledge, and care in treating a patient, commensurate

with that possessed and exercised by others practicing within

that specialty in the professional community. Calderon v. Glick,

131 Cal. App. 4th 224, 234 (Cal. Ct. App. 2005). 

Defendants’ do not dispute that they owed a duty to Mr.

Fuentes to provide him with medical care. 

ii. Plaintiffs’ Fail to Provide Any Evidence to Show

That CMC Breached Their Duty of Care to Mr.

Fuentes

The standard of care against which the acts of a physician

are to be measured is a matter peculiarly within the knowledge of

experts; it presents a basic legal issue and can only be proven

by expert testimony, unless the conduct required by the

particular circumstances is within the common knowledge of a

layperson. Elcome, 110 Cal. App. at 317. Where the conduct

required of a medical professional is not within the common

knowledge of laypersons, a plaintiff must present expert witness

testimony to prove a breach of the standard of care. Bushling v.

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Fremont Medical Center, 117 Cal. App. 4th 493, 509 (Cal. Ct. App.

2004). 

The undisputed facts show that when Mr. Fuentes was

transferred to CMC, CMC was not provided with information

regarding any previous weight loss or complaints of a sore

throat. (DSUF, No. 1.) Upon his transfer, Mr. Fuentes was 29

years old. (Id.) After he was examined on July 30, 2003, Mr.

Fuentes was determined to have symptoms of a throat infection, a

common condition. (DSUF, No. 3.) Mr. Fuentes was again seen the

following month on August 19, 2003 after he continued to complain

of a sore throat and difficulty swallowing his food. (DSUF, No.

4.) He was seen that same day by nursing staff who diagnosed his

problem to be the result of ongoing allergies and was prescribed

antibiotics accordingly. (DSUF, No. 5.) The undisputed facts

show that there was no reason at this point to suspect a more

severe problem. (Id.) 

After continuing to complain that he was not feeling well,

Mr. Fuentes was again treated on September 3, 2003 by Dr. Walters

who determined that his throat was still inflamed and suspected

an ongoing allergic rhinitis or unresolved bacterial infection. 

(DSUF, No. 7.) Subsequent to this check up, Mr. Fuentes was

diagnosed with Gastritis after his stool tested positive for

blood. (DSUF, No. 9.) After several more complaints that he was

having trouble swallowing, Mr. Fuentes was transported to Madera

Community Hospital where a barium swallow was performed. (DSUF,

No. 12.) On October 8, 2003 an esophageal biopsy was performed

and a pathologist at Madera Community Hospital determined that

Mr. Fuentes had adenocarcinoma. (DSUF, No. 14.) CMC received

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the pathology report on October 13, 2003 and Dr. Walters informed

Mr. Fuentes on October 14, 2003. (DSUF, No. 15.) Mr. Fuentes

was subsequently moved to the medical department where his vital

signs were monitored. (Id.) During this time he was provided

with the following treatment: 

1. Mr. Fuentes was given a CBC, metabolic

panel, CA 19-19, and given Vicoden and

Vistril (50 mg) 

2. Mr. Fuentes was seen by a gastroenterology

specialist

3. X-rays of his chest were taken. 

(DSUF, No. 16.) On October 16, 2003 he was treated by an

oncology specialist who ordered CT scans of his chest, abdomen,

and pelvis, in addition to whole body bone scans. (DSUF, No.

17.) At this time his CEA and LDH levels were checked and the

treating doctor, Dr. Shaikh, arranged for placement of a PEG tube

for nutrition and for medi-port placement by interventional

radiology for chemotherapy delivery. (Id.) Dr. Shaikh’s plan

was to treat Mr. Fuentes with combined modality therapy with

chemotherapy, radiation, and surgery. (DSUF, No. 18.) On

October 20, 2003 he was transferred from Madera County Jail

custody with Duragesic patches for his pain, Boost, and feeding

syringes. (DSUF, No. 19.) He was not seen again by CMC

personnel. (Id.) CMC has no further information as to the

nature of his subsequent medical course as it relates to his

esophageal cancer. (DSUF, No. 20.)

Plaintiffs’ have not filed any response to CMC’s motion for

summary judgment. Plaintiffs have not provided any evidence or

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expert testimony to show that CMC’s conduct fell below the

standard of care required from a health care provider in such

circumstances. 

iii. Plaintiffs Fail to Show that CMC’s Actions Were the

Actual or Proximate Cause of Mr. Fuentes’ Death

Cal. Civ. Code section 1714.8 provides: 

No health care provider shall be liable

for professional negligence or malpractice

for any occurrence or result solely on the

basis that the occurrence or result was

caused by the natural course of a disease or

condition, or was the natural or expected

result of reasonable treatment rendered for

the disease or condition. This section shall

not be construed so as to limit liability for

the failure to inform of the risks of

treatment or failure to accept treatment, or

for negligent diagnosis or treatment or the

negligent failure to diagnose or treat. 

Professional negligence is defined as a negligent act or

omission by a health care provider in rendering professional

services, which act or omission is the proximate cause of a

personal injury or wrongful death, provided that such services

are within the scope of services for which the provider is

licensed and which are not within any restriction imposed by the

licensing agency or licensed hospital. Cal. Civ. Code section

3333.2(c)(2). Plaintiffs must prove that CMC’s negligence was a

cause in fact of Mr. Fuentes’ injury. Jennings v. Palomar

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Pomerado Health Systems, Inc., 114 Cal App. 4th 1108, 1118 (Cal

Ct. App. 2003). 

In any personal injury action causation must be proven

within a reasonable medical probability based on competent expert

testimony. (Id.) Mere possibility alone is insufficient to

establish a prima facie case. (Id.) There can be many possible

“causes,” indeed, an infinite number of circumstances that can

produce an injury or disease. (Id.) A possible cause only

becomes probable when, in the absence of other reasonable causal

explanations, it becomes more likely than not that the injury was

a result of its action. (Id.) To establish causation the

Plaintiff must offer expert opinion that contains a reasoned

explanation illuminating why the facts have convinced the expert,

and therefore should convince the jury, that it is more probable

than not the negligent act was a cause in fact of the plaintiff’s

injury. 

In failing to respond to CMC’s motion, Plaintiffs have not

shown that any action on the part of CMC was a substantial factor

in causing Mr. Fuentes’ injuries or death. Plaintiffs’ offer no

facts to show failure to diagnose or treat Mr. Fuentes. 

Plaintiffs also fail to show that CMC’s actions were more likely

than not the cause of Mr. Fuentes’ death. 

CMC’s motion for summary judgment as to Plaintiffs’ wrongful

death claim is GRANTED. 

E. The County Has Failed to Show That They Are Entitled to

Indemnity from CMC

A party seeking indemnity, without a judgment ordering it to

pay, has the burden of demonstrating that it is actually or at

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least potentially liable on the underlying claim and that the

settlement amount is reasonable. Cossu v. Jefferson Pilot Sec.

Corp. (In re Cossu), 410 F.3d 591, 595 (9th Cir. 2005). 

The County has not responded to CMC’s motion for summary

judgment as to their first amended cross-claim for

indemnification. In a related motion, the County has sought

dismissal of Plaintiffs’ 42 U.S.C. section 1983 claim against

them and that dismissal has been granted. The County is unable

to show that CMC is at least potentially liable on the underlying

claim or that the County is entitled to indemnification from CMC. 

CMC’s motion for summary judgment as to the County’s first

amended cross-claim for indemnification is GRANTED. 

6. CONCLUSION

For the reasons set forth above Defendant CMC’s motion for

summary judgment as to Plaintiffs’ wrongful death claim is

GRANTED. 

CMC’s motion for summary judgment as to County of Madera’s

first amended cross-claim for indemnification is GRANTED.

IT IS SO ORDERED.

Dated: October 30, 2006 /s/ Oliver W. Wanger 

dd0l0 UNITED STATES DISTRICT JUDGE

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