Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_11-cv-02548/USCOURTS-caed-2_11-cv-02548-12/pdf.json

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

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UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

EDWARD LONG,

Plaintiff,

v.

D. MINER et al.,

Defendants.

No. 2:11-cv-2548 TLN DAD P

FINDINGS AND RECOMMENDATIONS

Plaintiff is a state prisoner proceeding pro se with a civil rights action seeking relief under 

42 U.S.C. § 1983. This matter is before the court on a motion for summary judgment brought 

pursuant to Rule 56 of the Federal Rules of Civil Procedure on behalf of defendants McLean, 

Martinez, Miner, and Williams. Plaintiff has filed an opposition to the motion, and defendants 

have filed a reply. 

For the reasons discussed below, the court will recommend that defendants‟ motion for 

summary judgment be granted.

BACKGROUND

Plaintiff is proceeding on an amended complaint against defendants McLean, Martinez, 

Miner, and Williams. Therein, plaintiff alleges that he suffers from rheumatoid arthritis and has 

not received adequate medical care for his condition. Plaintiff alleges that he complained about 

his lack of medical care, denial of pain medication, and prison officials‟ refusal to provide him

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with access to a specialist through the prison‟s administrative grievance process but received no 

appropriate relief. Plaintiff claims that the defendants, who were involved in scheduling medical 

appointments with outside specialists and/or reviewed plaintiff‟s administrative grievances, have 

violated his rights under the Eighth Amendment. In terms of relief, plaintiff requests an award of 

monetary damages (Am. Compl. & Attach. 1-14.)

SUMMARY JUDGMENT STANDARDS UNDER RULE 56

Summary judgment is appropriate when the moving party “shows that there is no genuine 

dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. 

Civ. P. 56(a).

Under summary judgment practice, the moving party “initially bears the burden of 

proving the absence of a genuine issue of material fact.” In re Oracle Corp. Securities Litigation, 

627 F.3d 376, 387 (9th Cir. 2010) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986)). 

The moving party may accomplish this by “citing to particular parts of materials in the record, 

including depositions, documents, electronically store information, affidavits or declarations, 

stipulations (including those made for purposes of the motion only), admission, interrogatory 

answers, or other materials” or by showing that such materials “do not establish the absence or 

presence of a genuine dispute, or that the adverse party cannot produce admissible evidence to 

support the fact.” Fed. R. Civ. P. 56(c)(1)(A), (B). 

When the non-moving party bears the burden of proof at trial, “the moving party need 

only prove that there is an absence of evidence to support the nonmoving party‟s case.” Oracle 

Corp., 627 F.3d at 387 (citing Celotex, 477 U.S. at 325.). See also Fed. R. Civ. P. 56(c)(1)(B). 

Indeed, summary judgment should be entered, after adequate time for discovery and upon motion, 

against a party who fails to make a showing sufficient to establish the existence of an element 

essential to that party‟s case, and on which that party will bear the burden of proof at trial. See

Celotex, 477 U.S. at 322. “[A] complete failure of proof concerning an essential element of the 

nonmoving party‟s case necessarily renders all other facts immaterial.” Id. In such a 

circumstance, summary judgment should be granted, “so long as whatever is before the district 

court demonstrates that the standard for entry of summary judgment, . . ., is satisfied.” Id. at 323. 

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If the moving party meets its initial responsibility, the burden then shifts to the opposing 

party to establish that a genuine issue as to any material fact actually does exist. See Matsushita 

Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). In attempting to establish the 

existence of this factual dispute, the opposing party may not rely upon the allegations or denials 

of its pleadings but is required to tender evidence of specific facts in the form of affidavits, and/or 

admissible discovery material, in support of its contention that the dispute exists. See Fed. R. 

Civ. P. 56(c)(1); Matsushita, 475 U.S. at 586 n.11. The opposing party must demonstrate that the 

fact in contention is material, i.e., a fact that might affect the outcome of the suit under the 

governing law, see Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986); T.W. Elec. Serv., 

Inc. v. Pacific Elec. Contractors Ass‟n, 809 F.2d 626, 630 (9th Cir. 1987), and that the dispute is 

genuine, i.e., the evidence is such that a reasonable jury could return a verdict for the nonmoving 

party, see Wool v. Tandem Computers, Inc., 818 F.2d 1433, 1436 (9th Cir. 1987).

In the endeavor to establish the existence of a factual dispute, the opposing party need not 

establish a material issue of fact conclusively in its favor. It is sufficient that “the claimed factual 

dispute be shown to require a jury or judge to resolve the parties‟ differing versions of the truth at 

trial.” T.W. Elec. Serv., 809 F.2d at 631. Thus, the “purpose of summary judgment is to „pierce 

the pleadings and to assess the proof in order to see whether there is a genuine need for trial.‟” 

Matsushita, 475 U.S. at 587 (citations omitted).

“In evaluating the evidence to determine whether there is a genuine issue of fact,” the 

court draws “all reasonable inferences supported by the evidence in favor of the non-moving 

party.” Walls v. Central Costa County Transit Authority, 653 F.3d 963, 966 (9th Cir. 2011). It is 

the opposing party‟s obligation to produce a factual predicate from which the inference may be 

drawn. See Richards v. Nielsen Freight Lines, 602 F. Supp. 1224, 1244-45 (E.D. Cal. 1985), 

aff‟d, 810 F.2d 898, 902 (9th Cir. 1987). Finally, to demonstrate a genuine issue, the opposing 

party “must do more than simply show that there is some metaphysical doubt as to the material 

facts . . . . Where the record taken as a whole could not lead a rational trier of fact to find for the 

nonmoving party, there is no „genuine issue for trial.‟” Matsushita, 475 U.S. at 587 (citation 

omitted).

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OTHER APPLICABLE LEGAL STANDARDS

I. Civil Rights Act Pursuant to 42 U.S.C. § 1983

The Civil Rights Act under which this action was filed provides as follows:

Every person who, under color of [state law] . . . subjects, or causes 

to be subjected, any citizen of the United States . . . to the 

deprivation of any rights, privileges, or immunities secured by the 

Constitution . . . shall be liable to the party injured in an action at 

law, suit in equity, or other proper proceeding for redress. 

42 U.S.C. § 1983. The statute requires that there be an actual connection or link between the 

actions of the defendants and the deprivation alleged to have been suffered by plaintiff. See 

Monell v. Department of Social Servs., 436 U.S. 658 (1978); Rizzo v. Goode, 423 U.S. 362 

(1976). “A person „subjects‟ another to the deprivation of a constitutional right, within the 

meaning of § 1983, if he does an affirmative act, participates in another‟s affirmative acts or 

omits to perform an act which he is legally required to do that causes the deprivation of which 

complaint is made.” Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978).

Moreover, supervisory personnel are generally not liable under § 1983 for the actions of 

their employees under a theory of respondeat superior and, therefore, when a named defendant 

holds a supervisorial position, the causal link between him and the claimed constitutional 

violation must be specifically alleged. See Fayle v. Stapley, 607 F.2d 858, 862 (9th Cir. 1979); 

Mosher v. Saalfeld, 589 F.2d 438, 441 (9th Cir. 1978). Vague and conclusory allegations 

concerning the involvement of official personnel in civil rights violations are not sufficient. See

Ivey v. Board of Regents, 673 F.2d 266, 268 (9th Cir. 1982).

II. The Eighth Amendment and Inadequate Medical Care

The unnecessary and wanton infliction of pain constitutes cruel and unusual punishment 

prohibited by the Eighth Amendment. Whitley v. Albers, 475 U.S. 312, 319 (1986); Ingraham v. 

Wright, 430 U.S. 651, 670 (1977); Estelle v. Gamble, 429 U.S. 97, 105-06 (1976). In order to 

prevail on a claim of cruel and unusual punishment, a prisoner must allege and prove that 

objectively he suffered a sufficiently serious deprivation and that subjectively prison officials 

acted with deliberate indifference in allowing or causing the deprivation to occur. Wilson v. 

Seiter, 501 U.S. 294, 298-99 (1991).

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If a prisoner‟s Eighth Amendment claim arises in the medical care context, the prisoner 

must allege and prove “acts or omissions sufficiently harmful to evidence deliberate indifference 

to serious medical needs.” Estelle, 429 U.S. at 106. An Eighth Amendment medical claim has 

two elements: “the seriousness of the prisoner‟s medical need and the nature of the defendant‟s 

response to that need.” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1991), overruled on 

other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997) (en banc).

A medical need is serious “if the failure to treat the prisoner‟s condition could result in 

further significant injury or the „unnecessary and wanton infliction of pain.‟” McGuckin, 974 

F.2d at 1059 (quoting Estelle, 429 U.S. at 104). Indications of a serious medical need include 

“the presence of a medical condition that significantly affects an individual‟s daily activities.” Id.

at 1059-60. By establishing the existence of a serious medical need, a prisoner satisfies the 

objective requirement for proving an Eighth Amendment violation. Farmer v. Brennan, 511 U.S. 

825, 834 (1994).

If a prisoner establishes the existence of a serious medical need, he must then show that 

prison officials responded to the serious medical need with deliberate indifference. See Farmer, 

511 U.S. at 834. In general, deliberate indifference may be shown when prison officials deny, 

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

prison officials provide medical care. Hutchinson v. United States, 838 F.2d 390, 393-94 (9th

Cir. 1988). Before it can be said that a prisoner‟s civil rights have been abridged with regard to 

medical care, however, “the indifference to his medical needs must be substantial. Mere 

„indifference,‟ „negligence,‟ or „medical malpractice‟ will not support this cause of action.” 

Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 1980) (citing Estelle, 429 U.S. at 

105-06). See also Toguchi v. Soon Hwang Chung, 391 F.3d 1051, 1057 (9th Cir. 2004) (“Mere

negligence in diagnosing or treating a medical condition, without more, does not violate a 

prisoner‟s Eighth Amendment rights.”); McGuckin, 974 F.2d at 1059 (same). Deliberate 

indifference is “a state of mind more blameworthy than negligence” and “requires „more than 

ordinary lack of due care for the prisoner‟s interests or safety.‟” Farmer, 511 U.S. at 835.

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Delays in providing medical care may manifest deliberate indifference. Estelle, 429 U.S. 

at 104-05. To establish a claim of deliberate indifference arising from delay in providing care, a 

plaintiff must show that the delay was harmful. See Hallett v. Morgan, 296 F.3d 732, 745-46 (9th 

Cir. 2002); Berry v. Bunnell, 39 F.3d 1056, 1057 (9th Cir. 1994); McGuckin, 974 F.2d at 1059; 

Wood v. Housewright, 900 F.2d 1332, 1335 (9th Cir. 1990); Hunt v. Dental Dep‟t, 865 F.2d 198, 

200 (9th Cir. 1989); Shapley v. Nevada Bd. of State Prison Comm‟rs, 766 F.2d 404, 407 (9th Cir. 

1985). In this regard, “[a] prisoner need not show his harm was substantial; however, such would 

provide additional support for the inmate‟s claim that the defendant was deliberately indifferent to 

his needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). 

Finally, mere differences of opinion between a prisoner and prison medical staff or 

between medical professionals as to the proper course of treatment for a medical condition do not 

give rise to a § 1983 claim. See Snow v. McDaniel, 681 F.3d 978, 988 (9th Cir. 2012); Toguchi, 

391 F.3d at 1058; Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996); Sanchez v. Vild, 891 

F.2d 240, 242 (9th Cir. 1989); Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981).

DEFENDANTS’ STATEMENT OF UNDISPUTED FACTS AND EVIDENCE 

Defense counsel has submitted a statement of undisputed facts supported by declarations

signed under penalty of perjury by defendants McLean, Martinez, Miner, and Williams as well as 

Mule Creek State Prison‟s Chief Physician and Surgeon Dr. Smith. That statement of undisputed 

facts is also supported by citations to copies of plaintiff‟s medical records and plaintiff‟s inmate 

appeals and prison officials‟ responses thereto. The evidence submitted by the defendants in 

support of the pending motion for summary judgment establishes the following.

At all relevant times, plaintiff was incarcerated at Mule Creek State Prison. Plaintiff 

commenced this action on September 28, 2011. Plaintiff filed his amended complaint on October 

26, 2011. Plaintiff alleges that the defendants were deliberately indifferent to his serious medical 

needs because they failed to schedule an appointment for him to see a Rheumatologist in violation

of the Eighth Amendment. (Defs.‟ SUDF 1-2, Pl.‟s Am. Compl.) 

Plaintiff has suffered from symptoms associated with rheumatoid arthritis (“RA”) since 

2005. RA is not a life-threatening medical condition. Diagnosis and treatment for RA is within 

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the scope and practice of Board Certified internists who served as plaintiff‟s primary care 

physicians. Between July 1, 2005, and August 30, 2007, medical care providers at MCSP 

evaluated and treated plaintiff‟s symptoms in a manner consistent with an RA diagnosis. This 

included taking x-rays of plaintiff‟s hands and wrists and prescribing him medication to manage 

symptoms associated with RA, including Naprosyn, Ibuprofen, Motrin, and glucosamine. The 

treatment plaintiff received between October 14, 2005, and August 30, 2007, was within the 

standard of care and skill ordinarily exercised by reputable members of the medical profession. 

(Defs.‟ SUDF 3-6, Smith Decl., Boyd Decl. Ex. B.)

On August 30, 2007, Physician‟s Assistant Todd evaluated plaintiff, reviewed his lab 

results and noted that his test for rheumatoid factor, which can indicate RA, was elevated. Todd 

completed a request for services to secure a routine, non-emergent Rheumatology consultation for 

plaintiff. The request was approved on September 4, 2007, and forwarded to defendant Martinez, 

a Registered Nurse, in early September 2007. (Defs.‟ SUDF 7-9, Smith Decl., Boyd Decl. Ex. B, 

Martinez Decl.) Defendant Martinez was the Medical and Return Outside Specialist Scheduler. 

In that capacity, she scheduled inmates for appointments with medical providers outside of 

CDCR. She did not schedule inmates for appointments with medical providers within CDCR. 

Once she received an approved request for services, she prepared a package to send to the outside 

provider to request that an appointment be scheduled. This package consisted of the request for 

services form indicating the type of service requested, a summary of the inmate‟s medical status 

and medical needs, and the inmate‟s relevant medical records. (Defs.‟ SUDF 10-11, Martinez 

Decl.) 

Once defendant Martinez received plaintiff‟s approved request for services, she 

immediately set about to schedule him for an appointment with a Rheumatologist at the 

University of California, Davis (“UCD”) by compiling the documents necessary to request an 

appointment and forwarding them to UCD. At that time, there was a long list of patients seeking 

routine, non-emergent services from a Rheumatologist. Because UCD received so many requests 

for services in the specialty of rheumatology, UCD could not schedule appointments for routine 

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services to occur sooner than six to nine months after they received the request. (Defs.‟ SUDF 

12-13, Martinez Decl.) 

There were often delays in scheduling inmates for appointments with Rheumatologists, 

who had the discretion to select and prioritize the patients they evaluated and treated. 

Rheumatology is a discrete medical specialty for which there was a small number of specialists. 

There was an even smaller number of Rheumatologists willing to accept prisoners as patients. It 

was not unusual for the few Rheumatologists to have substantial backlogs and thus not be 

available for many months to provide routine or non-emergency care when called by prisons for 

appointments. (Defs.‟ SUDF 14-16, McLean Decl., Williams Decl., Smith Decl.) 

Because of the delays UCD was experiencing, UCD declined to schedule plaintiff for an 

appointment. Defendant Martinez then requested that plaintiff be scheduled for an appointment 

to see a Rheumatologist at University of California, San Francisco (“UCSF”). Like UCD, UCSF 

was experiencing significant delays in scheduling appointments within the specialty of 

rheumatology, and UCSF declined to schedule an appointment for plaintiff. Defendant Martinez 

next requested that plaintiff be scheduled for an appointment to see a Rheumatologist at San 

Joaquin General Hospital (“SJGH”). SJGH placed plaintiff on a long waiting list, which 

defendant Martinez tracked in an attempt to ensure that plaintiff was not overlooked. Plaintiff

was subsequently scheduled with a Rheumatologist at SJGH on July 9, 2008. (Defs.‟ SUDF 17-

19, Martinez Decl., McLean Decl., Miner Decl., Williams Decl., Smith Decl.) 

Outside providers, not CDCR, determine and arrange appointment dates. CDCR staff 

does not have any control over when an outside provider is available for an appointment. 

Defendant Martinez used her best efforts to schedule plaintiff for an appointment with a 

Rheumatologist. She did not deliberately fail to schedule or delay plaintiff‟s Rheumatologist 

appointment. Despite her best efforts, there was a long waiting list to see a Rheumatologist 

through all of the outside providers she contacted, and plaintiff was scheduled for the first 

appointment that SJGH had to accommodate him. (Defs.‟ SUDF 20-21, Martinez Decl., McLean 

Decl., Miner Decl., Williams Decl., Smith Decl.) 

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On December 11, 2007, plaintiff submitted Appeal Log No. MCSP-08-000225, requesting

to see a physical therapist and a rheumatologist right away. Defendant Miner denied that inmate

appeal at the informal level of review. Defendant Miner was employed as an Office Technician 

and does not have any specialized training in the evaluation or treatment of medical conditions. 

Defendant Miner is not licensed to practice medicine of any kind and was not responsible for the 

delivery of medical care services to inmates. Defendant Miner did not schedule inmates for 

appointments with outside providers. Defendant Miner reviewed the Inmate Scheduling and 

Tracking System, a database that was used by CDCR to track the status of requests for services 

submitted by health care providers asking that an inmate receive medical evaluation and/or 

services from a provider outside of the prison, along with plaintiff‟s medical record, to determine 

whether plaintiff had been scheduled for an appointment to see a Rheumatologist. Defendant 

Miner determined that a request for services to have plaintiff seen by a Rheumatologist had 

already been submitted and approved and that plaintiff‟s appointment was pending based on the 

availability of the outside provider. Because an appointment was forthcoming, defendant Miner 

responded to plaintiff‟s inmate appeal in writing on January 7, 2008, and informed him that his

appointment to see a Rheumatologist was pending and that it would be scheduled based on the 

availability of the specialist. At no time did defendant Miner disregard either plaintiff‟s inmate 

appeal or his request to see a Rheumatologist. Defendant Miner did not purposefully attempt to 

delay plaintiff‟s receipt of any medical treatment. Defendant Miner never provided medical care 

to plaintiff. (Defs.‟ SUDF 22-28, Martinez Decl., Boyd Decl. Ex. A, McLean Decl., Miner Decl.) 

On January 31, 2008, plaintiff sought review of his inmate appeal at the first level of 

review. Defendant Martinez was assigned to review plaintiff‟s inmate appeal on February 5, 

2008. She reviewed the appeal and conducted an investigation regarding his claims and the 

remedy he sought. Using Med SATS, a database she used to track the scheduling of medical 

appointments with outside providers, plaintiff‟s medical record, and her recollection of the efforts 

she made to schedule an appointment for plaintiff, defendant Martinez confirmed that she had 

attempted to secure plaintiff an appointment with a Rheumatologist at both UCD and UCSF, but 

those requests had been declined. She also confirmed that she had attempted to secure plaintiff an 

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appointment with a Rheumatologist at SJGH, that plaintiff had been placed on a waiting list for 

an appointment there, and that he would be scheduled for an appointment as soon as one became 

available at SJGH. On February 13, 2007, defendant Martinez responded to plaintiff‟s inmate 

appeal in writing, and informed him that UCD and UCSF had declined to schedule him for an 

appointment and that he had been placed on a waiting list for an appointment with SJGH. 

Defendant Martinez also informed plaintiff that it could take six months before he saw a 

Rheumatologist. (Defs.‟ SUDF 29-31, Martinez Decl., Boyd Decl. Ex. A, McLean Decl.) 

Plaintiff sought review of his inmate appeal at the second level of review on March 10, 

2008. Defendant McLean, the Health Care Appeals Coordinator at MCSP, conducted an 

investigation into plaintiff‟s inmate appeal at the second level of review. Defendant McLean 

determined that a routine, non-urgent request for services to have plaintiff seen by a 

Rheumatologist was made on August 30, 2007. By the time plaintiff submitted his inmate appeal 

on December 11, 2007, significant efforts had already been made to schedule him for an outside 

appointment. Defendant McLean confirmed that defendant Martinez sent requests for 

appointments to UCD and UCSF but that those requests were denied by the providers. Defendant 

McLean also confirmed that plaintiff had been placed on a waiting list to see a Rheumatologist at 

SJGH and that he had an appointment scheduled at SJGH in mid-July 2008. Plaintiff would be 

referred to a physical therapist, if warranted, after he saw the Rheumatologist. By the time 

defendant McLean reviewed plaintiff‟s inmate appeal at the second level of review, plaintiff had 

already received the remedy he sought – namely, he be scheduled for an appointment with a 

Rheumatologist. Defendant McLean did not deliberately delay or fail to schedule plaintiff‟s 

appointment with a Rheumatologist. Defendant McLean drafted a written response to plaintiff‟s

inmate appeal at the second level of review. Defendant McLean‟s second level response was 

reviewed, approved, and signed by defendant Dr. Williams, the Health Care Manager at MCSP. 

(Defs.‟ SUDF 32-38, Martinez Decl., Boyd Decl. Ex. A, McLean Decl., Williams Decl.) 

By the time defendant Williams had reviewed the second level inmate appeal response, 

plaintiff had already been provided the remedy he sought – namely, he be scheduled to see a 

Rheumatologist. Defendant Williams did not provide plaintiff any treatment for RA. Defendant 

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Williams did not deliberately fail to schedule or otherwise delay plaintiff‟s appointment with a 

Rheumatologist. By the time defendant Williams learned that plaintiff was requesting an 

appointment through the inmate appeals process, an appointment for plaintiff to see a 

Rheumatologist had already been scheduled. Plaintiff was provided a copy of the second level 

response letter, dated April 21, 2008. (Defs.‟ SUDF 39-41, Williams Decl.) 

There were only a limited number of Rheumatologists with whom CDCR had contracts to 

provide medical services to inmates housed at MCSP. Effective June of 2006, all contracts with 

medical providers were negotiated and entered into by the Receiver‟s Office. (Defs.‟ SUDF 42, 

Martinez Decl., Smith Decl.) 

Plaintiff was scheduled for, and attended, an appointment with a Rheumatologist at SJGH 

on July 9, 2008. The Rheumatologist noted that plaintiff had RA since 2005 and had been treated 

with Ibuprofen, Naprosyn, Tylenol, topical salicylate, and glucosamine. The Rheumatologist 

assessed plaintiff with possible RA and suggested that plaintiff also be prescribed methotrexate. 

However, before plaintiff could be prescribed methotrexate, his Hepatitis C status had to be 

verified. Over the next six months, medical staff at MCSP saw plaintiff eight times to address the 

symptoms associated with RA. In addition to the treatment and medication he had previously 

been prescribed, plaintiff was also prescribed prednisone. Once his Hepatitis C blood tests were 

confirmed, plaintiff was also prescribed methotrexate three months after he saw the 

Rheumatologist at SJGH. (Defs.‟ SUDF 43-45, Boyd Decl. Ex. B, Smith Decl.) 

Dr. Smith, the Chief Physician and Surgeon at MCSP, has determined that while the 

approximate ten-month delay between the time plaintiff‟s request for services to be seen by a 

Rheumatologist outside of CDCR was approved and when plaintiff was actually seen by a 

Rheumatologist was regrettable, it did not cause him to suffer a progression in the severity of his 

RA or cause him to suffer a marked increase in the pain he experienced as a result of his 

condition. Based upon review of the medical records documenting plaintiff‟s encounters with 

health care providers between 2005 and January 2009, along with his professional training and

experience, Dr. Smith‟s medical opinion is that plaintiff received proper, continual medical care 

for his RA that complied with the standard of care and skill ordinarily exercised by reputable 

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members of the medical profession and that the delay in receiving a consultation with a 

Rheumatologist did not cause a progression in plaintiff‟s RA disease. Dr. Smith found no 

evidence in plaintiff‟s medical record indicating that the delay in being evaluated by a 

Rheumatologist caused plaintiff to suffer any increased pain or adverse consequences. While 

waiting for an appointment with a Rheumatologist to become available, plaintiff‟s health care 

providers continued to treat him for RA in an appropriate manner by performing x-rays of his 

hands and wrists, ordering periodic lab work, and prescribing medications that were indicated for 

the treatment of RA – namely, Naproxyn, non-steroridal anti-inflammatory medications, Tylenol, 

Ibuprofen, physical exercises, glucosamine, Motrin, and fish oil. (Defs.‟ SUDF 46-48, Boyd 

Decl. Ex. B, Smith Decl.) 

When the Rheumatologist at SJGH evaluated plaintiff on July 9, 2008, he did not 

recommend any change in the medications or care being provided to plaintiff up to that time. The 

Rheumatologist indicated that methotrexate should be prescribed, if plaintiff‟s blood test results 

permitted, and plaintiff was immediately prescribed the methotrexate once his blood test results

were confirmed. Even after plaintiff was evaluated by the Rheumatologist, it took several 

additional months for MCSP doctors to identify the most appropriate treatment/medication 

regimen to provide plaintiff the best possible relief from his symptoms associated with RA.

(Defs.‟ SUDF 49, Smith Decl.)

ANALYSIS

Based on the evidence submitted in connection with the pending motion, the undersigned 

finds that the defendants are entitled to summary judgment in their favor on the merits of 

plaintiff‟s Eighth Amendment deliberate indifference claim. As an initial matter, the undersigned 

finds that based on the evidence submitted on summary judgment and described above, the 

defendants have borne their initial burden of demonstrating that there is no genuine issue of 

material fact with respect to the adequacy of the medical care they provided to plaintiff in 

connection with the treatment of his rheumatoid arthritis.

Thus, given the evidence submitted by the defendants in support of the pending motion for 

summary judgment, the burden shifts to plaintiff to establish the existence of a genuine issue of 

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material fact with respect to his inadequate medical care claim. The court has reviewed plaintiff‟s 

verified complaint and his opposition to defendants‟ pending motion. Drawing all reasonable 

inferences from the evidence submitted in plaintiff‟s favor, the court concludes that plaintiff has 

not submitted sufficient evidence at the summary judgment stage to create a genuine issue of 

material fact with respect to his claim that the defendants violated his rights under the Eighth 

Amendment.

Specifically, the evidence presented by plaintiff fails to show that defendants responded to 

his serious medical needs1 with deliberate indifference. See Farmer, 511 U.S. at 834; Estelle, 429

U.S. at 106. For example, plaintiff contends that the nearly one-year delay he experienced in 

seeing a Rheumatologist constituted deliberate indifference on the part of the defendants. 

However, he has not presented any evidence to show that the defendants were responsible for that

delay. Where, as here, defendants‟ evidence establishes that they did not have control over 

outside medical appointments and/or outside resources, they cannot be held responsible for delays 

experienced in scheduling such an appointment. See, e.g., Gresham v. Williams, No. 2:08-cv00190 JMS BMK, 2010 WL 1644793 at *6 (E.D. Cal. Apr. 21, 2010), adopted by Dkt. No. 73 in 

No. 2:08-cv-00190 JMS BMK (May 18, 2010). 

In Gresham, a state prisoner injured his right knee while working in the prison‟s kitchen. 

2010 WL 1644793 at *1. A physician‟s assistant examined the prisoner-plaintiff‟s knee and 

diagnosed him as suffering with a torn meniscus. Id. She referred him to an outside orthopedic 

 

1

 The parties do not dispute, and undersigned finds, that based upon the evidence presented by 

the parties on summary judgment, a reasonable juror could conclude that plaintiff‟s rheumatoid 

arthritis constitutes an objective, serious medical need. See McGuckin, 974 F.2d at 1059-60 

(“The 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 are examples of 

indications that a prisoner has a „serious‟ need for medical treatment.”); see also Canell v. 

Bradshaw, 840 F. Supp. 1382, 1393 (D. Or. 1993) (the Eighth Amendment duty to provide 

medical care applies “to medical conditions that may result in pain and suffering which serve no 

legitimate penological purpose.”). Plaintiff‟s largely undisputed medical record, as well as the

observations and treatment recommendations by plaintiff‟s treating physicians and outside 

rheumatologist, compel the conclusion that plaintiff‟s medical condition, if left untreated, could 

result in “further significant injury” and the “unnecessary and wanton infliction of pain.” 

McGuckin, 974 F.2d at 1059.

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specialist for an appointment. Id. Two months later, the prisoner-plaintiff submitted an inmate 

request for interview because he still had not seen a specialist. Id. Prison officials responded that 

the scheduling nurse, defendant Martinez (the same defendant as in this instant case), was having 

trouble scheduling an appointment due to a new contract with a different outside hospital. Id. 

Prison officials also responded to the prisoner-plaintiff‟s administrative appeal by explaining that 

they had no control over the outside hospital‟s scheduling of appointments. Id. at *2. Nearly a 

year passed before the prisoner-plaintiff finally saw an outside orthopedic specialist. Id. Shortly 

thereafter, the plaintiff underwent elective reconstructive surgery. Id. 

The prisoner-plaintiff in Gresham sued defendant Martinez as well as various medical 

personnel and a prison official who had reviewed his administrative appeal, claiming that the 

defendants violated his rights under the Eighth Amendment. Id. This court granted summary 

judgment in favor of defendant Martinez because “while there was delay in scheduling plaintiff‟s 

appointment with an outside orthopedic specialist there was no evidence that the delay was within 

defendant Martinez‟s control.” Id. at *6. This court also granted summary judgment in favor of 

the prison official who reviewed the prisoner-plaintiff‟s inmate appeal in that case because, again, 

there was no evidence that any delay experienced by plaintiff in seeing the outside specialist was 

within the prison official‟s control. Id. at *7; see also, e.g., Tyler v. Smith, No. 1:04-cv-006638 

LJO BAM, 2013 WL 3991989 at *5 (E.D. Cal. Aug. 2, 2013) (although there was no dispute that 

plaintiff experienced pain due to delays in orthopedic treatment, plaintiff had not presented any 

evidence to show that defendant had any control over how long it would take for plaintiff to 

receive an orthopedic consult appointment or surgery); Fraher v. Suryadevara, No. 1:06-cv-1120 

AWI MJS, 2011 WL 831429 at *10 (E.D. Cal. Mar. 3, 2011) (plaintiff failed to establish 

existence of disputed fact because he produced no evidence showing that the defendant doctor 

was responsible for scheduling appointments or that defendant doctor had any control over 

whether the appointments took place in a timely manner); Davis v. Calvo, No. C03-4412 JSW 

(PR), 2006 WL 571357 (N.D. Cal. Mar. 3, 2006) (plaintiff presented no evidence to refute 

scheduling clerk‟s evidence that repeated re-scheduling of outside neurosurgical consultation was 

outside of clerk‟s control and that appointments were cancelled by outside doctor‟s office).

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Just as in Gresham, in this case, defendants‟ unrefuted evidence establishes that defendant 

Martinez (and the other named defendants) had no control over the delay in scheduling plaintiff‟s 

appointment with an outside Rheumatologist. Once defendant Martinez received plaintiff‟s 

approved request for services, she immediately set about to schedule him for an appointment with 

a Rheumatologist at UCD. UCD had received so many requests for services in the specialty of 

rheumatology that UCD could not schedule appointments for routine services to occur sooner 

than six to nine months after they received the request. UCD declined to schedule plaintiff for an 

appointment based on the delays they were experiencing in that regard. Defendant Martinez then 

requested that plaintiff be scheduled for an appointment to see a Rheumatologist at UCSF. Like 

UCD, UCSF was experiencing significant delays in scheduling appointments within the specialty 

of rheumatology, and UCSF also declined to schedule an appointment for plaintiff. Defendant 

Martinez next requested that plaintiff be scheduled for appointment to see a Rheumatologist at 

SJGH. SJGH placed plaintiff on a long waiting list, which defendant Martinez tracked in an 

attempt to ensure that he was not overlooked. SJGH subsequently scheduled plaintiff for an 

appointment with a Rheumatologist on July 9, 2008. (Martinez Decl., McLean Decl., Miner 

Decl., Williams Decl., Smith Decl.) 

Here, defendants‟ unrefuted evidence establishes the following. There were often delays 

in scheduling inmates for appointments with outside Rheumatologists, who had the discretion to 

select and prioritize the patients they evaluated and treated. Rheumatology is a discrete medical 

specialty for which there are a relatively small number of specialists. There was an even smaller 

number of Rheumatologists willing to accept prisoners as patients. It was not unusual for the few 

Rheumatologists to have substantial backlogs and thus not be available for many months to 

provide routine or non-emergency care when called by prisons for appointments. Outside 

providers, not CDCR, determine and arrange the appointment dates. CDCR staff does not have 

any control over when an outside medical care provider is available for an appointment with a 

prisoner patient. Defendant Martinez used her best efforts to schedule plaintiff for an 

appointment with a Rheumatologist as soon as possible, and she did not deliberately fail to 

schedule or delay his appointment. Despite her best efforts, there was a long waiting list to see a 

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Rheumatologist through all of the providers she contacted, and plaintiff was scheduled for the 

first appointment that SJGH had to accommodate him. (Martinez Decl., McLean Decl., Miner 

Decl., Williams Decl., Smith Decl.) 

The court observes that the Ninth Circuit recently held that the constraints under which an 

individual defendant operated may be considered in determining whether the defendant is liable 

for money damages because he or she was deliberately indifferent to a prisoner plaintiff‟s serious 

medical needs. See Peralta v. Dillard, 744 F.3d 1076, 1083-84 (9th Cir. 2014) (en banc); see also

Walker v. Benjamin, 293 F.3d 1030, 1038 (7th Cir. 2002) (defendant doctor entitled to summary 

judgment where the plaintiff presented no evidence that delays in his visit with a specialist were 

within the doctor‟s control). In Peralta, a state prisoner brought a § 1983 action against the 

prison‟s chief dental officer and chief medical officer as well as the staff dentist alleging that they 

were deliberately indifferent to his serious medical needs when he experienced a several-month 

delay in having his teeth cleaned and receiving treatment for associated pain. See id. The Ninth 

Circuit considered whether prison officials, being sued for damages, could assert a lack of 

available resources as a defense. The plaintiff had challenged a jury instruction that stated 

“[w]hether a dentist or doctor met his duties to Plaintiff Peralta under the Eighth Amendment 

must be considered in the context of the personnel, financial, and other resources available to him 

or her or which he or she could reasonably obtain.” Id. at 1082. The Ninth Circuit held that “[a] 

prison medical official who fails to provide needed treatment because he lacks the necessary 

resources can hardly be said to have intended to punish the inmate” for purposes of the Eighth 

Amendment‟s cruel and unusual punishment clause. The Ninth Circuit, reviewing Supreme 

Court precedent, explained:

[T]he Court has told us that prison officials aren‟t deliberately 

indifferent to a prisoner‟s medical needs unless they act wantonly,

and whether an official‟s conduct “can be characterized as „wanton‟ 

depends upon the constraints facing [him].” The Court has told us 

that, even if an official knows of a substantial risk, he‟s not liable 

“if [he] responded reasonably.” (internal citations omitted) 

Id. at 1082. The Ninth Circuit concluded that what resources were available to defendants is 

“highly relevant because they define the spectrum of choices that officials had at their disposal.” 

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Id. at 1083.

Moreover, in this case, plaintiff has not come forward with any evidence to show that the 

delay he experienced in seeing an outside Rheumatologist resulted in serious harm. See Wood, 

900 F.2d 1335 (delay of more than one month in referring a prisoner to an orthopedic specialist 

for a free-floating pin in his shoulder during which time the prisoner complained of pain was not 

actionable because no substantial harm resulted); Coyle v. Cambra, No. C 02-1810 SBA (PR), 

2005, WL 2397517 at *11 (N.D. Cal. Sept. 27, 2005) (delay of more than six months before a 

prisoner received an orthopedic consultation did not constitute deliberate indifference because the

plaintiff presented no evidence that his complaints of knee pain during the delay necessitated any 

further treatment than what he received). In contrast, defendants have submitted unrefuted expert 

testimony from Dr. Smith that the delay plaintiff experienced in receiving a consultation with a 

Rheumatologist did not cause a progression in his RA disease. (Smith Decl.) Dr. Smith found no 

evidence in the medical record indicating that the delay in plaintiff being evaluated by a 

Rheumatologist caused him to suffer any increased pain or adverse consequences. (Id.) In fact, 

while waiting for an appointment with a Rheumatologist to become available, plaintiff‟s health 

care providers continued to treat him for RA in an appropriate manner. (Id.) Plaintiff‟s medical 

records demonstrate that from 2005 through July 9, 2008, when plaintiff finally saw a 

Rheumatologist, medical personnel at MCSP regularly reviewed his case and monitored his 

complaints of pain and provided him appropriate medical care. (Id. & Boyd Decl. Ex. B.) For 

example, plaintiff‟s providers scheduled him for appointments every thirty to sixty days, ordered 

x-rays of his hands and wrists, and prescribed him medication to manage symptoms associated 

with RA, including Naprosyn, Ibuprofen, exercises, Motrin, and glucosamine. (Id.) In this 

regard, the evidence before the court on summary judgment establishes that prison medical 

personnel were aware of plaintiff‟s condition and complaints and sought to appropriately address 

them. The unrefuted evidence does not reflect deliberate indifference on the part of defendants. 

Insofar as plaintiff takes issue with the medical care he received and blames defendants 

for not providing or obtaining different or additional medical care for him, plaintiff‟s contentions

are without merit. As an initial matter, none of the named defendants in this action were 

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plaintiff‟s direct medical providers; rather, they were in charge of scheduling his outside medical 

appointments and/or reviewing his administrative appeals. Moreover, plaintiff has come forward 

with no evidence showing that the defendants, in scheduling his appointment with the 

Rheumatologist and/or responding to his administrative inmate appeals, intentionally failed to act 

in response to his serious medical needs resulting in his suffering and harm. See Jett, 439 F.3d at 

1096. 

At most, plaintiff has asserted a claim for negligence and/or a mere difference of opinion 

as to the appropriate course of medical treatment for his condition. It is well established, 

however, that mere „indifference,‟ „negligence,‟ or „medical malpractice‟ will not support this 

cause of action.” Broughton, 622 F.2d at 460 (9th Cir. 1980) (citing Estelle, 429 U.S. at 105-06). 

See also Wood, 900 F.2d at 1334 (“In determining deliberate indifference, we scrutinize the 

particular facts and look for substantial indifference in the individual case, indicating more than 

mere negligence or isolated occurrences of neglect.”). It is also well established that a mere 

difference of opinion between a prisoner and prison medical personnel as to the proper course of 

medical care does not give rise to a cognizable § 1983 claim. See Snow, 681 F.3d at 988; 

Jackson, 90 F.3d at 332; Sanchez, 891 F.2d at 242; Franklin, 662 F.2d at 1344; see also Fleming 

v. Lefevere, 423 F. Supp. 2d 1064, 1070 (C.D. Cal. 2006) (“Plaintiff‟s own opinion as to the 

appropriate course of care does not create a triable issue of fact because he has not shown that he 

has any medical training or expertise upon which to base such an opinion.”). Rather, to establish 

that a difference of medical opinion as to the appropriate course of treatment amounted to 

deliberate indifference, plaintiff must “show that the course of treatment the doctors chose was 

medically unacceptable under the circumstances” and that “they chose this course in conscious 

disregard of an excessive risk to [the prisoner‟s] health.” Jackson, 90 F.3d at 332. See also

Toguchi, 391 F.3d at 1058. 

In this case, plaintiff has not come forward with any evidence demonstrating that the 

course of treatment provided by his care providers and tacitly approved the defendants who 

reviewed his inmate appeals was medically unacceptable under the circumstances. Although the 

outside Rheumatologist plaintiff eventually saw prescribed him an additional medication in the 

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form of methotrexate, plaintiff has presented no evidence to indicate that the course of treatment 

he had been given by prison doctors up to that point was not medically acceptable. Nor has 

plaintiff submitted any evidence to cast doubt on defendants‟ unrefuted expert testimony from Dr. 

Smith which establishes that the medical care plaintiff received was medically appropriate under 

the circumstances and within the standard of care and skill ordinarily exercised by reputable 

/////

members of the medical profession at that time. Plaintiff has failed to raise a triable issue of fact 

that his complaints necessitated any further action on the part of the defendants. 

Plaintiff also has not come forward with any competent evidence demonstrating that 

defendants “chose” plaintiff‟s course of treatment in conscious disregard of an excessive risk to 

his health. By merely expressing his vague and speculative opinion in this regard, plaintiff fails 

to create a genuine issue of material fact. See, e.g., Hansen v. United States, 7 F.3d 137, 138 (9th 

Cir.1993) (“When the non-moving party relies on its own affidavits to oppose summary 

judgment, it cannot rely on conclusory allegations unsupported by factual data to create an issue 

of material fact.”); Fed. R. Civ. P. 56(c)(4) (“An affidavit or declaration used to support or oppose 

a motion must be made on personal knowledge, set out facts that would be admissible in 

evidence, and show that the affiant or declarant is competent to testify on the matters stated.”). 

In sum, there being no genuine dispute of material fact as to whether the defendants acted 

with deliberate indifference to plaintiff‟s serious medical needs, the undersigned will recommend 

that defendants‟ motion for summary judgment be granted.2 

OTHER MATTERS

Plaintiff also asserts a state law claim for negligence in his amended complaint. A district 

court may decline to exercise supplemental jurisdiction over state law claims if the district court 

has dismissed all claims over which it has original jurisdiction. 28 U.S.C. § 1367(c)(3). The 

court‟s discretion to decline jurisdiction over state law claims is informed by the values of judicial 

 

2

In light of the recommendation set forth in these findings and recommendations, the 

undersigned declines to address defendants‟ alternative argument that they are entitled to 

summary judgment in their favor based on the affirmative defense of qualified immunity.

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economy, fairness, convenience, and comity. Acri v. Varian Associates, 114 F.3d 999, 1001 (9th 

Cir. 1997) (en banc). In addition, “[t]he Supreme Court has stated, and [the Ninth Circuit] ha[s] 

often repeated, that „in the usual case in which all federal law claims are eliminated before trial, 

the balance of factors . . . will point toward declining to exercise jurisdiction over the remaining 

state law claims.‟” Id. (quoting Carnegie–Mellon Univ. v. Cohill, 484 U.S. 343, 350 n.7 (1988)).

///// 

Of course, “primary responsibility for developing and applying state law rests with the 

state courts.” Curiel v. Barclays Capital Real Estate, Civ. No. S–09–3074 FCD KJM, 2010 WL 

729499 at *1 (E.D. Cal. Mar. 2, 2010). Here, consideration of judicial economy, fairness, 

convenience, and comity all point toward declining to exercise supplemental jurisdiction. 

Therefore, the undersigned will recommend declining to exercise supplemental jurisdiction over 

plaintiff‟s state law claims.

CONCLUSION

IT IS HEREBY RECOMMENDED that:

1. Defendants‟ motion for summary judgment (Doc. No. 61) be granted; 

2. The court decline to exercise supplemental jurisdiction over any state law claims and 

dismiss any state law claims without prejudice to plaintiff re-filing them in state court; and

3. This action be closed.

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

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

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

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

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

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

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

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

Dated: April 17, 2015

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DAD:9

long2548.57

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