Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_14-cv-01297/USCOURTS-casd-3_14-cv-01297-1/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 

Juan Marcette Davis, 

Plaintiff,

v. 

R. Walker, Chief Physician and Surgeon; 

G. Casian, Primary Care Physician; 

Sergeant Flores; C. Clark, Correctional 

Officer; and Does 1-10, 

Defendants.

 14cv1297 BAS (NLS) 

REPORT AND 

RECOMMENDATION FOR ORDER 

GRANTING IN PART AND 

DENYING IN PART DEFENDANTS’ 

MOTION FOR SUMMARY 

JUDGMENT 

[Dkt. No. 32] 

I. Introduction and Procedural Background. 

Plaintiff Juan Marcette Davis, a prisoner formerly incarcerated in the California 

state prison system, is proceeding in forma pauperis in this civil rights action filed under 

42 U.S.C. § 1983. He alleges that while housed at RJ Donovan State Prison (Donovan), 

Defendants were deliberately indifferent to his serious medical needs stemming from a 

painful callous on the in-step of his left foot that required repeated treatment. Davis 

alleges eighth amendment claims due to Defendants’ alleged failure to appropriately treat 

the callous and accommodate him in a lower bunk on the lower tier of the prison, which 

caused Davis to suffer further serious injuries. 

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 The court screened the complaint and directed the clerk to issue summons for 

defendants Walker, Casian, Flores and Clark. The Marshal served the complaint on 

Walker, Casian and Flores. The summons as to Clark was returned unexecuted because 

per the litigation coordinator at Donovan, there was no Correctional Officer Clark 

employed there. Dkt. No. 10. 

Before the court is a Motion for Summary Judgment filed on behalf of appearing 

defendants Casian, Flores and Walker. Defendants, and the court, notified Davis of the 

requirements for opposing summary judgment pursuant to Klingele v. Eikenberry, 849 

F.2d 409 (9th Cir. 1988) and Rand v. Rowland, 154 F.3d 952 (9th Cir. 1998 (en banc)).1

 

After the court issued the notice, Davis—with defense counsel’s consent—filed motions 

to continue the summary judgment hearing date, reopen discovery and continue pretrial 

dates for two months, because Davis had procured counsel. The court granted the 

motions. Davis, after having had counsel conduct follow-up discovery, filed an 

opposition to the summary judgment motion. Defendants filed a reply. 

 For the following reasons, the court RECOMMENDS that the district judge 

GRANT in part and DENY in part Defendants’ motion for summary judgment. 

II. Factual Background. 

Davis transferred to Donovan from Wasco State Prison on March 24, 2010. 

Compl., p.12.2

 At that time he had a “chrono” ordering that he be placed in a lower bunk 

due to the presence of a callous on the bottom of his left foot.3

 Id. The callous had 

                                                                

1 Klingele and Rand require the district court to ensure that a pro se prisoner has been 

given “fair notice ... of the requirements and consequences of a summary judgment 

motion.” County of Los Angeles v. Beltran, 514 F.3d 946, 952 (9th Cir. 2008).

2

 Unless otherwise noted, the page numbers reference the CM/ECF filing page numbers. 

3 A “chrono” notes an accommodation made for a medical condition for an inmate. 

Walker Decl. ¶ 6. They are classified as “temporary” or “permanent.” Id. A 

“temporary” chrono has a specific end-date upon which the accommodation 

automatically terminates (e.g., accommodation in a lower bunk for 90 days). Id. A 

“permanent” chrono has no specific designated end date but can terminate at any time, 

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developed after removal of a plantar mass on the arch his left foot in 2005, when he was 

at Wasco. Davis Decl. ¶ 2; Walker Decl. Ex. B, p.10. It measured half a centimeter by 

two centimeters. Casian Decl. ¶ 4. The pain from this condition varied based on the size 

of the callous, the degree to which it was protruding, and the amount of pressure on his 

left foot. Davis Decl. ¶ 2. 

When he arrived at Donovan in March 2010, Davis says that the prison honored his 

existing chrono and placed him in a lower bunk on the lower tier. Davis Decl. ¶ 3. He 

had appointments with Dr. Campbell, his primary care physician with the California 

Department of Corrections and Rehabilitation (CDCR), several times over the next 16 

months, who cared for his foot and referred him to a podiatrist when his condition did not 

improve. Id. at ¶ 4. On August 29, 2011 Dr. Campbell noted that Davis still had not seen 

a podiatrist, and sent a second request for one. Frieder Decl. Ex. C, p.2. She also noted 

that there was a podiatry backlog due to the “recent loss of contract.” Id.

Dr. Wagers, a contract podiatrist, saw Davis on September 1 and 22, 2011. Walker 

Decl. Ex. B, Dkt. No. 32-5, pp.11-13. He noted that Davis had a “chronic foot problem 

[that would last] most likely the rest of the patient’s life.” Id. Dr. Wagers performed 

“debridement” (removal of tissue) surgery on the callous, ordered orthopedic shoes, and 

recommended a “permanent lower bunk, lower tier [chrono] – not too [sic] change.” Id.

at 13. Dr. Campbell examined Davis again on October 6, 2011 and reviewed the request 

for a permanent lower bunk chrono. Id. at 11, 14-15. She granted the request and issued 

the “permanent” chrono the same day. Id. at 11. The chrono itself states that “[c]hronos 

indicating permanent accommodations shall be reviewed annually.” Id. at 11. 

In the complaint, Davis alleges that he did not receive any treatment for his callous 

for over 18 months, from the time of his last podiatrist appointment in fall 2011 until he 

left Donovan on April 18, 2013. Compl., p.13. Also, his orthopedic shoes were taken 

                                                                

based on a medical review. Id. As Dr. Walker of the CDCR explains, “an inmate will 

never receive a ‘permanent’ chrono that can never be reviewed or changed.” Id.

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from him in a random, prison-wide raid, and never replaced. Davis Decl. ¶ 8. 

Meanwhile, Defendants say that Davis’ foot problem was treated because he had “twenty 

medical visits for his foot between September 1, 2011 and April 15, 2013.” Mem. 

Ps&As, p.5 (citing Walker Decl. Ex. B). In sum, the parties disagree as to whether nurse 

evaluations for eligibility of medical services for the specific foot problem amount to 

treatment of that problem.4

 A review of the exhibit reveals these details: 

 October 6, 2011: Comprehensive Accommodation Chrono written by Dr. 

Campbell permanently placing Davis in a bottom bunk. This was based on 

two visits (September 1 and 22, 2011) with Dr. Wagers, a podiatrist, who 

diagnosed Davis with a chronic foot problem that would likely last the rest 

of his life, as well as an October 6, 2011 visit with Dr. Campbell (Dkt. No. 

32-5, pp.11-15). 

 October 13, 2011: Follow-up visit with podiatrist Dr. Wagers (Id. at 16). [In 

his declaration Davis says that this appointment never occurred.] 

 January 12, 2012: Davis saw a nurse practitioner regarding other ailments, 

no mention of the callous (Id. at 17). 

 January 25, 2012: Medical visit with RN Oliveros concerning blood tests 

for other ailments, no mention of the callous (Id. at 18). 

 February 20, 2012: Dr. Campbell requested replacement of Davis’ 

orthopedic shoes as well podiatry services for him. Dr. Choo denied both 

requests on February 23, 2012 (Id. at 19-20). 

 June 13, 2012: Medical visit with Dr. Campbell, where she noted that (1) 

Davis was last seen on March 16, 2012; (2) the foot pain was likely to be a 

chronic condition; (3) she recommended a lower bunk; and (4) and noted an 

accommodation chrono issued on October 6, 2011 (Id. at 21-23). 

 August 2012: Medical Classification Chrono saying that Davis’ chrono 

would be reviewed in October 2012 (Id. at 10). 

                                                                

4

 Davis does not complain about the treatment he received by Dr. Campbell, his CDCR 

primary care physician until June 2012, after which Dr. Casian took over. 

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 August 31, 2012: Davis filled out a Health Care Services Request Form to 

ask that his lower bunk accommodation be “updated.” Nurse Perez saw 

Davis on September 11, 2012 and set doctor appointment for September 14, 

2012. (Id. at 24). 

 September 17, 2012: Davis filled out a Reasonable Modification or 

Accommodation Request, asking for a mobility impaired vest, orthopedic 

shoes and that his chrono be placed in the computer for medical staff and 

officers because his chrono was not “logged in the computer.” Frieder 

Decl., Ex. A, p.14. 

 September 25, 2012: Davis filled out a Health Care Services Request Form 

to ask to see a podiatrist. On September 27, 2012 RN Gines evaluated him. 

(Dkt. No. 32-5, p.25). 

 October 3 and 4, 2012: Medical visits with nurses regarding foot pain, acne, 

and request that bottom bunk accommodation be renewed. The requests 

were denied. (Id. at 26-28). 

 October 15, 2012: Davis filled out a Health Care Services Request Form 

asking for pain relief for his foot. On October 17, 2012 RN Vazquez noted 

that Davis was seen on October 4 and 10, 2012 and that he did not meet 

criteria for a lower bunk chrono and was encouraged to buy new tennis 

shoes through the inmate catalog. (Id. at 29-32). 

 October 29, 2012: Davis filed a 602 Health Care Appeal based on the 

medical staff’s denials for (1) a low bunk/low tier chrono renewal; and (2) a 

referral to podiatry. Walker Decl. Ex. A. 

 November 7, 2012: Davis filled out a Health Care Services Request Form to 

ask to see a podiatrist. On November 9, 2012 Davis refused to see a nurse as 

an alternative to a podiatrist. (Id. at 33-34). 

 November 19, 2012: In response to the 602 appeal filed on October 29, 

2012, Davis had an evaluation with Dr. Casian for foot pain where Dr. 

Casian found no medical necessity for a lower bunk chrono (Id. at 35-36). 

 January 21, 2013: Davis saw the on-call doctor after he fell from an upper 

bunk and injured his back; he was given a lower bunk chrono for three 

months (Id. at 37-40, Dkt. No. 32-6, p.1). 

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 January 24, 2013: Davis was evaluated for his back pain, and noted that he 

had not seen a podiatrist since September 22, 2011 (Dkt. No. 32-6, pp.2-5). 

 January 25, 2013: Davis’ foot was examined and he was advised to resubmit 

a Health Services Request Form if his persistent foot pain did not resolve in 

14 days (Id. at 6). 

 February 1, 2013: Davis had a follow up visit for his back injury (Id. at 7-9). 

 February 8, 2013: Davis was evaluated by a Nurse Practitioner Velardi for 

his continued back pain (Id. at 10-11). 

 February 13, 2013: Davis examined by RN Steadman for back pain, who 

refused his request for stronger pain medication (Id. at 12-15). 

 February 25 and March 5, 11, 18 and 28, 2013: Davis examined by different 

nurses for back and foot pain (Id. at 16-28). 

 April 3, 2013: Dr. Chau examined Davis’ foot, and referred him to a 

podiatrist (Id. at 29-32). 

 April 11, 2013: A nurse examined Davis for his back pain (Id. at 33-36). 

 April 12, 2013: Dr. Seeley approved Dr. Chau’s request for a podiatrist 

appointment for Davis, and one was set for June 25, 2013 (Id. at 37). 

 April 15, 2013: Dr. Casian examined Davis for his foot and other ailments, 

where she noted he had a pending referral to podiatry for June 2013 (Id. at 

38-40). She also wrote a Comprehensive Accommodation Chrono placing 

Davis temporarily in a bottom bunk for three months (Dkt. No. 32-5, p.9). 

In sum, these visits show that Davis was seen by general practice doctors, nurse 

practitioners, registered nurses or nurses more than 20 times from October 6, 2011 to 

April 15, 2013. Davis received medical accommodations that included orthotic insoles, a 

cane, and a temporary lower bunk bed assignment after he injured his back. But Davis 

did not receive any consultations with a podiatrist, any debridement surgeries, or any 

orthopedic shoes during this time. Starting in September 2012, Davis’ repeated requests 

for a lower bunk, lower tier chrono renewal based on his foot injury were all denied. 

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Specifically, starting with RN Gines on September 27, 2012, and continuing with 

NP Denbela on October 3, NP Velardi on October 4, Nurse Perez on October 11, and RN 

Vasquez on October 17, 2012, all the nurses told Davis that he did not meet the criteria 

for a lower bunk chrono based on his foot problem. On November 9, 2012, Davis 

refused to see a nurse as an alternative to a podiatrist. Dr. Casian then examined Davis 

on November 19, where she noted there was no medical necessity for a lower bunk 

chrono or for referral to a podiatrist. 

During these visits Davis told the medical staff that he was in severe pain and his 

condition made it difficult for him to jump up to, and down from, a top bunk, and that he 

experienced pain while standing and working. Davis Decl. ¶ 10. He also told them that 

orthopedic shoes and debridement surgeries helped his condition, and that a lower bunk 

was necessary to control his pain and prevent further injury. Id. 

On December 10, 2012, Davis alleges that defendant Flores saw Davis’ permanent 

chrono on the computer, yet stripped him of the lower bunk, stating that there were no 

more lower bunks for him to have. Compl., p.2; Davis Decl. ¶ 15. Flores says that on 

December 10 an inmate with a valid medical chrono needed a lower bunk but none were 

available. Flores Decl. ¶ 4. So Flores asked Davis if he had a valid medical chrono. Id. 

Davis did not have a paper copy of the chrono, so Flores checked the computer. Id. 

Flores said that there was no valid medical chrono or other accommodation for Davis 

noted on the computer, so he moved Davis to an upper bunk. Id.

Davis was then forced to use the sink to climb up onto, and down from, the top 

bunk. Davis Decl. ¶¶ 15, 16. This climbing action required Davis to use the sensitive 

part of his foot to step onto the sink, or a desk, to get up and down from the top bunk. 

Davis Decl. ¶ 17. 

On January 21, 2013, while trying to descend from the upper bunk, Davis slipped 

off the sink in his cell and fell to the floor, injuring his back. Compl., p.10; Davis Decl. ¶ 

17. Davis says his pain was so severe that he could not attend mental health depression 

groups and that he needs other inmates help to go to the “chow hall, laundry, [and] 

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downstairs.” Compl. pp.8, 10. 

Davis left Donovan on April 18, 2013. Compl. p.13; Davis Decl. ¶ 2. Once he 

transferred out of Donovan into a different penal institution, Davis saw a podiatrist and 

received orthopedic shoes and a permanent lower bunk, lower tier chrono. Davis Decl. 

¶¶ 20-21. He received debridement surgeries approximately once every three months and 

physical therapy for his back twice a week, for the duration of his incarceration. Id.

Davis points out that on March 18, 2013, court medical experts issued a report in a 

different federal case that found that Donovan had inadequate health care facilities and 

“serious problems related to access, timeliness, and quality of care.” Frieder Decl. Ex. F. 

Finally, Dr. Walker never personally examined or treated Davis. Walker Decl. ¶ 2. 

He only reviewed two inmate appeals that Davis filed regarding his medical treatment. 

Walker Decl. Ex. A. 

III. Legal Standards. 

A. Summary Judgment. 

Summary judgment is appropriate when there is no genuine issue as to any 

material fact. Fed. R. Civ. P. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). 

A fact is “material” when it could affect the outcome of the case. Anderson v. Liberty 

Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute about a material fact is “genuine” if 

“the evidence is such that a reasonable jury could return a verdict for the nonmoving 

party.” Id. at 248. 

 The moving party can establish an absence of a genuine issue of material fact by 

(1) presenting evidence that negates an essential element of the non-moving party’s case; 

or (2) demonstrating that the nonmoving party failed to establish an essential element of 

that party’s case. Celotex, 477 U.S. at 322-323. The moving party must identify the 

pleadings, depositions, affidavits or other evidence that the party “believes demonstrates 

the absence of a genuine issue of material fact.” Id. at 323. 

 If the moving party meets this burden, the non-moving party must do more than 

demonstrate a mere “metaphysical doubt as to the material facts.” Scott v. Harris, 550 

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U.S.372, 380 (2007) (quoting Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 

475 U.S. 574, 586 (1986)). It must “go beyond the pleadings and by her own affidavits, 

or by ‘the depositions, answers to interrogatories, and admissions on file,’ designate 

‘specific facts showing that there is a genuine issue for trial.’” Celotex, 477 U.S. at 324 

(quoting Fed. R. Civ. P. 56(e)). 

The court must view the underlying facts in the light most favorable to the party 

opposing the motion. See Matsushita, 475 U.S. at 587. 

B. Section 1983. 

“[Section] 1983 ‘is not itself a source of substantive rights,’ but merely provides ‘a 

method for vindicating federal rights elsewhere conferred.’” Graham v. Connor, 490 

U.S. 386, 393-394 (1989) (citation omitted). To prevail on a section 1983 claim, a 

claimant must prove that: (1) a person acting under color of state law committed the 

conduct at issue; and (2) the conduct deprived the claimant of some right, privilege, or 

immunity protected by the Constitution or laws of the United States. 42 U.S.C. § 1983; 

Parratt v. Taylor, 451 U.S. 527, 535 (1981), overruled on other grounds by Daniels v. 

Williams, 474 U.S. 327, 328 (1986); Haygood v. Younger, 769 F.2d 1350, 1354 (9th Cir. 

1985) (en banc). 

Defendants do not dispute that they were acting under color of state law. Rather, 

they argue that there are no triable issues of fact as to whether they violated any of Davis’ 

rights protected by the Constitution. 

IV. Eighth Amendment Deliberate Indifference Claim. 

 The eighth amendment protects prisoners from “inhumane conditions of 

confinement.” Morgan v. Morgensen, 465 F.3d 1041, 1045 (9th Cir. 2006). 

Consequently, the government must “provide medical care for those whom it is punishing 

by incarceration,” and cannot act with deliberate indifference to a prisoner’s serious 

medical needs. Estelle v. Gamble, 429 U.S. 97, 106 (1976). A prison official acts with 

deliberate indifference if the official “knows of and disregards an excessive risk to inmate 

health or safety.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). Deliberate indifference 

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is also known as the “unnecessary and wanton infliction of pain.” Estelle, 429 U.S. at 

104 (internal quotations omitted). 

To prevail, a plaintiff must make (1) an objective showing that he had a serious 

medical need; and (2) a subjective showing that the specific defendants were deliberately 

indifferent to that need. Id.; Farmer, 511 U.S. at 837; Colwell v. Bannister, 763 F.3d 

1060, 1066 (9th Cir. 2014). 

A. Objective Standard: Davis’ Serious Medical Need. 

A medical need is serious if it “result[s] in pain and suffering.” Estelle, 429 U.S. at 

103. The “suffering” test under Estelle can be met where an inmate suffers injuries 

caused by falling. Colwell, 763 F.3d at 1067. A serious medical need can also exist 

where “failure to treat the injury or condition ‘could result in further significant 

injury[.]’” Id. at 1066 (quoting Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir.2006). 

Other indications include “‘[t]he existence of an injury that a reasonable doctor or patient 

would find important and worthy of comment or treatment; the presence of a medical 

condition that significantly affects an individual's daily activities; or the existence of 

chronic and substantial pain.’” Colwell, 763 F.3d at 1067 (quoting McGuckin v. Smith, 

974 F.2d 1050, 1059-60 (9th Cir.1992)). 

Here, Davis had a recurring, protruding callous that caused him problems since 

2005. He received a lower tier, lower bunk medical accommodation for that callous 

while incarcerated at Wasco, for one of his years at Donovan, and for the rest of his 

incarceration after he transferred out of Donovan. For the approximate 18 months in 

question in this case, Davis had repeated medical visits where he almost always 

complained of foot pain and asked for treatment and relief for the callous. A podiatrist at 

Donovan diagnosed him with a chronic foot condition likely to last the rest of his life. 

Davis says that in his appeal he told Defendants that he felt unsafe climbing to the top 

bunk, worried about falling, and was in constant pain. Davis Decl. ¶ 16. Davis in fact 

fell while trying to descend from the top bunk, injuring his back. 

Considering that at least two doctors at Donovan and doctors at other CDCR 

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institutions found Davis’ foot injury worthy of comment and treatment, his foot pain 

affected his ability to get in and out of an upper bunk bed, and he suffered from chronic 

foot pain as documented in the medical records, the court finds that Davis satisfied the 

objective standard and demonstrated a serious medical need based on the recurring, 

protruding callous on his foot. 

B. Subjective Showing: Defendants’ Deliberate Indifference. 

1. Dr. Casian 

Dr. Casian first examined Davis on November 19, 2012, approximately two and 

half months after Davis first requested a renewal of his chrono. She examined him in 

response to a 602 appeal form that Davis filed for failure to renew his lower bunk chrono 

or to refer him to a podiatrist. Those chrono and podiatry requests were denied by 

several different nurses. 

Dr. Casian said that before the November 19 exam, she reviewed Davis’ medical 

file from Donovan from 2011 to the time of the exam. Frieder Decl., Ex. E, Casian Depo 

23:8-18. While she did not review the records from the podiatrist, Dr. Wagers, she 

“knew he had chronic foot pain” and “knew he was evaluated by podiatry.” Casian Depo 

24:8-25:8. In her treatment notes from that day, Dr. Casian said that Davis complained of 

“intermittent foot pain with prolonged walking and standing.” Walker Decl., Ex. B, Dkt. 

No. 32-5, pp.35-36. She also noted that it was moderately tender. Id. After her exam 

Dr. Casian denied Davis’ request to renew his chrono and to see a podiatrist. Id. In 

coming to that decision, Dr. Casian did not consult a podiatrist, and based her decision 

solely on her assessment and apparent incomplete review of Davis’ medical record. 

Casian Depo 49:8-16. 

Dr. Casian’s treatment notes as to “intermittent pain” contrast with what Davis 

noted on his health care services request forms that formed the basis of his 602, as well as 

with some of the examining nurses’ notes: 

/ / / 

/ / / 

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 September 25, 2012: “I have pain in the sole of foot from prior surgery.” 

On September 27 RN Gines noted that on a 1-10 pain scale Davis had a “9” 

for pain on the sole of his foot. (Walker Decl. Ex. B, Dkt. No. 32-5, p.25). 

 October 3, 2012: “I cannot climb up and jump down from upper bunk.” (Id.

at 26). 

 October 3, 2012: “I spoke with Dr. [sic] Denbela who have [sic] no 

knowledge of my foot surgery and my chrono....The doctor’s assessment is 

no[t] accurate with my medical problem.” (Id. at 28). 

 October 15, 2012: “I had surgery while at Wasco State Prison. My foot is in 

pain. I’m in need of some kind of pain relief.” (Id. at 29). 

 October 17, 2012: RN Vasquez noted that Davis was in “extreme pain” and 

said that Davis explained that a “podiatrist used to file down calloused area 

of foot and [he] wants to see podiatry.” (Id. at 32). 

 November 7, 2012: “I have a need to see podiatry. (A.S.A.P.). I’ve been 

having this foot pain for 5 to 6 years of my incarceration and I still have pain 

in my left foot daily.” (Id. at 29). 

Admittedly, Dr. Casian did not review Davis’ subjective complaints that formed 

the basis of his 602. Casian Depo 27:5-17. But she said she interviewed Davis and 

obtained his history and the basis for the 602 medical appeal in person. Casian Depo 

27:18-28:11. 

In contrast to Dr. Casian’s note of “intermittent pain,” in his sworn declaration, 

Davis says that he reported to Dr. Casian throbbing pain that impacted his ability to work 

and sleep. Davis Decl. ¶ 14. He explained that seeing a podiatrist for debridement and 

wearing orthopedic shoes helped his condition, and that using an upper bunk caused him 

pain and discomfort. Id. Davis says that Dr. Casian responded, “you look healthy 

enough to climb,” and noted that he did not have a chronic condition (in contrast to Dr. 

Wagers’ assessment) and that other people needed lower bunks. Id. 

Comparing Dr. Casian’s treatment notes from November 19 with the medical 

requests and records that form the basis of the 602, as well as with Davis’ sworn 

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declaration, Dr. Casian’s note of only “intermittent foot pain with prolonged walking and 

standing” contradicts the statements of pain and trouble with daily activities that were 

documented before the November 19 appointment. The court finds this difference in the 

reporting and recording of Davis’ pain and abilities to be a genuine issue of material fact 

as to whether Dr. Casian was deliberately indifferent to Davis’ medical needs. 

Dr. Casian further argues that her determination that there was no medical need to 

renew the lower bunk chrono and podiatrist referral is merely a difference of medical 

opinion from that of other doctors. With regard to medical treatment, a difference of 

opinion—even if it constitutes malpractice—does not amount to deliberate indifference to 

medical needs. Estelle, 429 U.S. at 106; Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 

1989). The plaintiff must show that the chosen course of treatment was medically 

unacceptable under the circumstances, and that it was chosen in conscious disregard of an 

excessive risk to the plaintiff’s health. Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 

1996). 

Here, Davis has gone beyond the pleadings to deposition testimony and medical 

records to show that there is a genuine issue of material fact as to whether Dr. Casian 

chose a course of treatment that was medically unacceptable under the circumstances. In 

deposition she admitted that she reviewed the medical records and knew of the chronic 

foot pain. She also said that she knew the basis of Davis’ 602 complaint, which included 

worsening foot pain that went untreated for 13 months, difficulty accessing a top bunk, 

and that regular debridement and orthopedic shoes helped Davis’ condition. But Dr. 

Casian ignored the prior diagnosis of chronic foot pain, the previous “permanent” 

medical chrono ordered by a podiatrist, and the documented complaint history when she 

relied on her single examination to deny the chrono renewal. There is a legitimate 

question of fact as to whether Dr. Casian’s chosen course of treatment was unacceptable 

under the circumstances when there was a podiatrist readily available—visiting Donovan 

approximately once per week—to examine patients. Frieder Decl., Ex. D, Walker Depo 

68:10-19. 

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Davis also raises a question of fact as to whether a decision to deny referral to a 

podiatrist was based on non-medical factors. As Dr. Campbell noted, at some point 

during Davis’ incarceration Donovan “lost the contract” with podiatry and there was a 

“podiatry backlog.” Frieder Decl. Ex. C, p.2. Further, Donovan was determined to have 

“systemic issues that present ongoing serious risk of harm to patients and result in 

preventable morbidity and mortality.” Frieder Decl., Ex. F, pp.5-6. 

Dr. Casian’s denial to renew the chrono—or even to renew it temporarily pending 

a referral to podiatry—may have caused Davis further injury when his foot allegedly shot 

in pain as he tried to descend from the top bunk, injuring his back. Based on the 

questions of fact material to Dr. Casian’s subjective knowledge and actions in this case, 

this court recommends that the district judge deny summary judgment as to Dr. Casian. 

2. Dr. Walker 

Davis alleges that Dr. Walker worked to void the medical chronos of the inmate 

population in general, and in particular worked to void Davis’ chrono. Compl., p.13. 

Davis also alleges that Dr. Walker was deliberately indifferent to his medical needs 

regarding renewal of his lower bunk chrono and a referral to podiatry. 

Dr. Walker argues that he is entitled to summary judgment because he never 

personally treated Davis and was not involved in his medical treatment. Walker Decl. ¶ 

3. He argues that as to Davis, his only involvement with him was that he reviewed 

Davis’ two inmate appeals. Walker Decl. ¶ 4; Ex. A. Finally, Dr. Walker argues that he 

did not set, enact or enforce a policy to arbitrarily deny or revoke medical chronos for 

any inmate, including Davis. Walker Decl. ¶ 5. 

Dr. Walker is the Chief Surgeon and Physician at Donovan. Walker Decl., Ex. A. 

He also sat on the Institutional Utilization Management Committee (IUMC) when Dr. 

Campbell submitted a request for services (RFS) for Davis to see a podiatrist. Frieder 

Decl., Ex. D, Walker Depo 55:4-13. The IUMC “review and manage referrals for 

specialty medical services” and “review and manage institutional...bed usage.” Frieder 

Decl., Ex. B, §3352(a). Thus, Dr. Walker was aware of the IUMC’s prior approval of 

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Davis’ “permanent” chrono for a lower bunk, as well as Dr. Campbell’s requests for 

Davis to see a podiatrist. Therefore, Dr. Walker had actual knowledge of Davis’ chronic 

foot pain and his previous accommodation. 

Dr. Walker testified that in reviewing Davis’ 602 form, he reviewed Davis’ 

complaint, Dr. Casian’s progress note, and nothing else. Walker Depo 38:10-39:7. But 

in response to the 602 form, Dr. Walker said he also reviewed the “electronic Unit Health 

Record” for Davis, which presumably would have included Davis’ subjective complaints 

and treatment history. Walker Decl., Ex. A. Dr. Walker also knew that Davis 

complained the “treating” nurses failed to appreciate his condition. Walker Depo 37:1-

15. 

Just because Dr. Walker was presented with Davis’ concerns during the appeals 

process as opposed to during a personal medical examination does not relieve him from 

potential eighth amendment liability. See Keller v. Faecher, 44 Fed.Appx. 828, 831-832 

(9th Cir. 2002) (finding deliberate indifference claim against a doctor for denying an 

inmate appeal was not actionable only where the denial “did not constitute a denial, 

delay, or intentional interference with medical treatment”). Here, Davis points to 

deposition testimony, the first 602 grievance response, and medical records that indicate 

Dr. Walker’s subjective knowledge of Davis’ condition and the risk of harm Davis faced. 

Dr. Walker received further information when Davis drafted his second 602 on December 

12, 2012, stating: “I had surgery on the step of my left foot, I’m always in pain with my 

step, my left foot will always be vulnerable due to that surgery....I am currently in pain 

and on the top bunk. Please review my podiatry records.” Frieder Decl., Ex. A, p.16. 

Based on Dr. Walker’s knowledge of Davis and his treatment history and diagnosis by a 

podiatrist, this court finds a question of material fact as to whether Dr. Walker 

intentionally interfered with Davis’ medical treatment by denying him a podiatry referral 

and lower bunk chrono. 

As explained for Dr. Casian, there is also a question of material fact as to whether 

the decision to deny referral to a podiatrist was based on non-medical factors. See 

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Frieder Decl., Ex. F, pp.5-6 (“Donovan Health Care Evaluation”). 

Finally, Dr. Walker’s denial of the appeal that prevented Davis from seeing a 

podiatrist or getting a lower bunk chrono may have caused Davis further injury when his 

foot allegedly shot in pain as he tried to descend from the top bunk, injuring his back. 

Based on the questions of fact material to Dr. Walker’s subjective knowledge and actions 

in this case, this court recommends that the district judge deny summary judgment as to 

Dr. Walker. 

3. Correctional Officer Flores 

Flores says that on December 10 an inmate with a valid medical chrono needed a 

lower bunk but none were available. Flores Decl. ¶ 4. So Flores asked Davis if he had a 

valid medical chrono. Id. Davis did not have a paper copy of the chrono, so Flores 

checked the computer. Id. Flores said that there was no valid medical chrono or other 

accommodation for Davis noted on the computer, so he moved Davis to an upper bunk. 

Id. In his declaration, Davis says that Flores actually saw Davis’ permanent chrono on 

the computer, yet stripped him of the lower bunk anyway. Davis Decl. ¶ 15. But Davis’ 

declaration belies what he pleaded in his medical evaluation requests and 602s, arguing 

that he needed his chrono renewed because it was not logged into the computer. 

Specifically, on September 17, 2012, Davis filled out a Reasonable Modification or 

Accommodation Request, and asked that his chrono be placed in the computer for 

medical staff and officers because his chrono was not “logged in the computer.” Frieder 

Decl., Ex. A, p.14. 

By Davis’ own admission, defendant Flores did not have subjective knowledge of 

a lower bunk chrono, so he could not have been deliberately indifferent to Davis’ serious 

medical needs. The court, therefore, finds no question of fact material to Flores’ 

subjective knowledge and actions in this case, and thus recommends that the district 

judge grant summary judgment as to defendant Flores. 

/ / / 

/ / / 

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V. Conclusion. 

For the foregoing reasons, this court RECOMMENDS that Defendants’ motion 

for summary judgment be GRANTED in part and DENIED in part as follows: 

1. DENY as to Dr. Casian; 

2. DENY as to Dr. Walker; and 

3. GRANT as to Correctional Officer Flores. 

This report and recommendation is submitted to the United States District Judge 

assigned to this case pursuant to 28 U.S.C. § 636(b)(1). 

IT IS ORDERED that no later than January 29, 2016, any party to this action 

may file written objections and serve a copy on all parties. The document should be 

captioned “Objections to Report and Recommendation.” 

 IT IS FURTHER ORDERED that any reply to the objections must be filed and 

served on all parties no later than February 5, 2016. The parties are advised that failure 

to file objections within the specified time may waive the right to raise those objections 

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

IT IS SO ORDERED. 

Dated: January 15, 2016 

 

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