Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_02-cv-05919/USCOURTS-caed-1_02-cv-05919-0/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

 EASTERN DISTRICT OF CALIFORNIA

EVERETT PARKER,

Plaintiff,

v.

LIEUTENANT BIRD, et al., 

Defendants.

CIV-F-02-5919 OWW WMW P

ORDER ON DEFENDANTS’

OBJECTIONS TO MAGISTRATE

JUDGE’S FINDINGS AND

RECOMMENDATIONS (Doc. 25)

Plaintiff, a state prisoner proceeding pro se in this civil

rights action, seeks relief pursuant to 42 U.S.C. § 1983. 

Plaintiff alleges that prison officials at the Sierra

Conservation Center (“SCC”) of the California Department of

Corrections refused to give him his diabetic medication. Before

the court is Defendants’ Opposition to the Magistrate Judge’s

Findings and Recommendations (“F & R”) recommending the denial of

Defendant’s Motion for Summary Judgment.

I. BACKGROUND FACTS

Plaintiff is a Type I “brittle” diabetic, whose erratic

blood sugar levels must be frequently adjusted with medication. 

Because Plaintiff’s pancreas no longer produces insulin, he must

receive insulin injections in order for his body to use glucose

obtained from his meals. Iannone Decl. at ¶3, Doc. 20, Ex. 1. 

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Approximately two weeks before October 16, 2001, Plaintiff

received smaller doses of insulin as part of a new control

regimen that included a new type of insulin, Lantus. During the

night of October 15, 2001, Plaintiff experienced vomiting and

dehydration for ten or twelve hours. Iannone Decl. at ¶5 ;

Parker Depo. at 6, Doc. 20, Ex. 3. On October 16, 2001,

officials released Plaintiff from his cell at 5:45 a.m. Parker

Depo. at 8. Plaintiff walked to the medical clinic and tried to

obtain his insulin injection and fasting glucose test, but no

Medical Technical Assistant (“MTA”) was available. Because of a

recent security problem, the prison was on lockdown. Among other

restrictions imposed during a lockdown, prison officials imposed

“controlled feeding” for breakfast on October 16, 2001. Bird

Decl. at ¶3, Doc. 20, Ex. 2. During controlled feeding, inmates

are released to the dining hall by racial or ethnic groups in

order to minimize disruptions. Id. At approximately 6:00 a.m.,

Corrections Officer (“C/O”) Cruz told Plaintiff to go to

breakfast. Parker Depo, at 9. Plaintiff complied with this

order and went to the dining hall, but he did not eat. Id.

After Plaintiff left the dining hall, he asked C/O Woods if

he could see the MTA on duty. Woods granted him permission, and

Plaintiff went to the medical office. When MTA Dunbar came out

of the clinic, C/O Cruz said “no one is allowed medication.” 

Plaintiff told C/O Cruz he needed his insulin shot, but she

replied that “there [was] nothing she could do” because Lt. Bird

had instructed that no medication was to be dispensed during

controlled feeding. Id. at 9. Plaintiff went to Lt. Bird and

told him he was “feeling ill,” “wasn’t feeling right,” and

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“needed to check his insulin, fasting glucose, and blood

glucose.” Lt. Bird “said he didn’t care” and told Plaintiff that

there was a controlled feeding. Plaintiff repeated that he

“needed to take insulin”, but C/O Nall told Plaintiff he would be

placed in Administrative Segregation unless he returned to his

cell. Id. at 9-10. 

Plaintiff went to his cell and experienced “blurred vision,

vomiting, and a burning sensation in his stomach.” About 8:45

a.m., prison officials released Plaintiff from his cell to the

medical clinic. MTA Dunbar checked Plaintiff’s blood sugar level

and gave him an insulin shot. Plaintiff’s blood test revealed a

high blood sugar level of 481 mg/dl. Plaintiff told Dunbar he

“wasn’t feeling well.” Dunbar told him, “go back to the building

and if you are not feeling well, notify them and we’ll come over

to your building.” Id. at 11. This evidences that MTA Dunbar

gave plaintiff insulin and expressed concern that if Plaintiff

was not feeling well after returning to Plaintiff’s building that

MTA Dunbar could come to Plaintiff’s building to see him. There

is no evidence of deliberate indifference or wanton infliction of

pain, rather only a quarrel over whether MTA Dunbar used the

“best” medical judgment in treating Plaintiff’s insulin

deficiency.

While Plaintiff’s walked back to his cell, he became dizzy

and vomited. Plaintiff returned to the medical clinic, where he

lay down and passed out. Dr. Iannone examined Plaintiff and

transported him to a local hospital at 9:45 a.m. to stabilize his

blood sugar levels. Plaintiff was not in a state of

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1Ketoacidosis is a state of insulin deficiency with

catabolism of body fats and acid accumulation. Catabolism is the

destructive phase of metabolism and includes all the processes in

which complex substances are converted into simpler substances,

usually with the release of energy. Taber’s Cyclopedic Medical

Dictionary, 14th Edition.

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ketoacidosis1 when he was transported. After his

hospitalization, Plaintiff returned to prison that day. Id. at

12; Iannone Decl., at 2.

II. PROCEDURAL HISTORY

On October 28, 2001, Plaintiff filed a “Reasonable

Modification or Accommodation Request” with SCC for “specific

procedures whereby diabetics can receive their insulin injections

and fasting glucose test prior to their meals.” On November 6,

2001, an associate warden approved this request. 

On October 28, 2001, Plaintiff also filed an administrative

appeal with SCC, requesting (1) a “policy that all insulin

dependent diabetics receive their medication prior to eating

their meals, and at any such other time needed” and (2)

“compensation for the pain and suffering” that resulted from his

hospitalization “due to the tardiness of [his] insulin

injection.” The director denied this request because prison

officials had already modified the controlled feeding program to

ensure more timely delivery of medication. SCC instructed their

staff that inmates could receive insulin or glucose checks on the

way to the dining hall or in their cells. The director also

denied Plaintiff’s request for monetary compensation because it

was beyond the scope of the appeals process. The director’s

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decision letter also stated that the decision “exhausts the

administrative remedy [sic] available to the appellant within the

California Department of Corrections.” Doc 15, Ex. A-1.

On June 28, 2002, Plaintiff filed a complaint in federal

court, claiming that Defendants deprived him of access to medical

care and violated the Eighth Amendment’s prohibition on cruel and

unusual punishment. On April 22, 2003, Defendants moved for

summary judgment on the grounds that (1) Defendant’s delay did

not cause Parker’s problems and (2) MTA Dunbar is entitled to

qualified immunity. On March 3, 2005, the Magistrate Judge

issued findings and recommendations denying Defendant’s motion

for summary judgment. On March 17, 2005, Defendants filed timely

objections to the Report and Recommendation. 

III. STANDARD OF REVIEW

Petitioner’s case is reviewed de novo under 28 U.S.C. 

§ 636(b)(1)(B).

The General Summary Judgment Standard

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). To

defeat a motion for summary judgment, the non-moving 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

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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 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).

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IV. ANALYSIS

“The government has an obligation to provide medical care

for those whom it punishes by incarceration.” Hutchinson v.

United States, 838 F.2d 390 (9th Cir. 1998). “An inmate’s

complaint of inadequate medical care amounts to a constitutional

violation if the inmate alleges acts or omissions sufficiently

harmful to evidence deliberate indifference to serious medical

needs.” Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990)

(citing Estelle v. Gamble, 429 U.S. 97, 106 (1976) (emphasis

added). 

A. Deliberate Indifference

 Prison officials are “deliberately indifferent” when they

“deny, delay or intentionally interfere with medical treatment.” 

Hutchinson, 838 F.2d at 394. 

The indifference to the prisoner’s medical needs, however,

must be substantial. “Mere indifference, negligence, or medical

malpractice will not support this cause of action.” Broughton v.

Cutter Labs., 622 F.2d 458 (9th Cir. 1980). Even gross

negligence is insufficient to establish deliberate indifference

to serious medical needs. See Wood v. Housewright, 900 F.2d at

1334. “Deliberate indifference to serious medical needs of

prisoners constitutes the ‘unnecessary and wanton infliction of

pain’ proscribed by the Eight Amendment.” Estelle, 429 U.S. at

104. 

The Ninth Circuit has applied the deliberate indifference

standard in a number of cases. In Ortiz v. City of Imperial, 884

F.2d 1312 (9th Cir. 1989), defendants acted with deliberate

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indifference when they knew of a prisoner’s head injury but

totally failed to treat it competently. Also, in Hoptowit v.

Ray, 682 F.2d 1237 (9th Cir. 1982), prison officials showed

deliberate indifference to serious medical needs when prisoners

could not make their medical problems known to the medical staff.

 Here, Lt. Bird’s alleged actions rose to the level of

“deliberate indifference.” It is undisputed that Lt. Bird’s

actions took place during controlled feeding, a safety measure

used to prevent disruption among inmates. In this case, however,

there was no imminent danger associated with a prison riot or

uprising. Compare Whitley v. Albers, 475 U.S. 312 (1986) (where

a guard’s shooting of a prisoner in the leg during a prison riot

did not violate the prisoner’s right to be free from cruel and

unusual punishment). It is also undisputed that Lt. Bird ordered

that diabetic inmates were not permitted to go to the medical

office until breakfast was finished. As in Ortiz and Hoptowit,

Lt. Bird’s order prevented Plaintiff from seeking medical help

from MTA Dunbar at the clinic. According to Plaintiff, Lt. Bird

knew that Plaintiff was ill and needed to check his insulin,

fasting glucose, and blood glucose. Plaintiff also alleges that

Lt. Bird said “he didn’t care” when Plaintiff told him that he

needed his insulin injection. Parker Depo., at 20. Lt. Bird’s

statement remains a disputed fact, but must be viewed in the

light most favorable to Plaintiff for the purposes of this

summary judgment motion. Taking all these facts into

consideration, Lt. Bird’s actions could support the inference

that he acted with knowledge that failure to provide medication

Plaintiff would cause the “unnecessary and wanton” infliction of

pain.

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2Plaintiff attaches a letter from the American Diabetes

Association which states, “Specifically, you asked would a blood

glucose level of 481 be considered highly dangerous? The

American Diabetes Association’s listed goal for a blood glucose

level is 90-130 mg/dl. Cause for concern should arise when

levels reach 250-300 mg/dl. Doc. 21, Ex. A.

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B. “Sufficiently Harmful”

“In order to state a cognizable claim [under the Eighth

Amendment], a prisoner must allege acts or omissions sufficiently

harmful to evidence deliberate indifference.” Estelle, 429 U.S.

at 104 (emphasis added). When a prisoner alleges a delay in

receiving medical treatment, the prisoner must allege that the

delay led to further injury. See Shapley v. Nevada Bd. of State

Prison Commrs., 766 F.2d 404, 407 (9th Cir. 1985) (emphasis

added). Here, Plaintiff offers evidence that the two-hour delay

resulted in two harms: (1) a high sugar level of 481 mg/dl and

(2) his hospitalization. It is undisputed that Plaintiff had a

high sugar level of 481 mg/dl and that he was hospitalized. 

Although a blood sugar level of 481 mg/dl is high2, the twohour delay may not have caused Plaintiff’s high blood sugar

level. Instead, Dr. Iannone opines that the probable cause of

Plaintiff’s high blood sugar level was a new control regimen that

included a new type of insulin. Iannone Decl., at ¶6. Even if

the delay contributed to Plaintiff’s high blood sugar level,

Plaintiff’s attachment, an American Diabetes Association

pamphlet, states that prolonged elevation of blood sugar levels

“over many years” can harm the eyes, kidneys, and nerves. Doc.

21, Ex. B. In this case, Lt. Bird’s actions, mandated by

controlled feeding procedures, resulted in a two hour delay of

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3Ketoacidosis occurs when blood sugar levels are too high

and insulin levels are too low. During ketoacidosis, the body

starts breaking down fat for energy and produces harmful

chemicals called ketones. Ketoacidosis may result in vomiting,

thirst, and even coma.

4It is undisputed that Plaintiff experienced vomiting and

dehydration the night before his hospitalization. Parker Decl.,

at 6. 

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medical treatment which did not result in ketoacidosis.3 Iannone

Decl., at ¶5. 

This case turns on medical causation. The two-hour delay

also did not cause Plaintiff’s hospitalization. Dr. Iannone’s

medical opinion is: “I do not attribute [Plaintiff’s]

hospitalization on October 16, 2001 to receiving his insulin

injection at 9:00 a.m. on that date.” Id. at ¶6. Dr. Iannone

also opined: “had [Plaintiff] received his insulin shot two hours

earlier, it probably would not have prevented his

hospitalization. By 9:00 a.m. on October 16, 2001, he had been

ill with vomiting and dehydration for the preceding ten or twelve

hours, so the likelihood that he would require hospitalization

was already high.”4 Id. at 3:5-12. The probable major cause of

Parker’s high blood sugar level, and subsequent hospitalization,

on October 16, 2001, was that he was receiving smaller doses of

insulin as part of a new control regimen that included the use of

a new type of insulin, Lantus (insulin glargine). Id. at 3:10-

13. Plaintiff presents no medical evidence to counter Dr.

Iannone’s conclusion that the delayed treatment of insulin was

not the efficient proximate cause of Plaintiff’s hospitalization. 

The two hour delay did not cause Plaintiff’s hospitalization or

the blood sugar level that caused his symptoms. Defendant’s

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actions were not “sufficiently harmful.” They were undertaken as

part of legitimate institutional concerns. Finally, the

magistrate judge misread Dr. Iannone’s opinion in concluding that

“had [Plaintiff] received a timely injection, he probably ‘would

not have been sent to the hospital.’” F&Rs, at 7:17-18. This is

a transposition of Dr. Iannone’s stated opinion that the delayed

insulin injection was “likely a minor cause of elevated sugar

level,” but receiving the shot two hours earlier “probably would

not have prevented his hospitalization.” Id. at 7:13-14, 7:17. 

V. CONCLUSION

Even if Lt. Bird acted with “deliberate indifference,” the

resulting hospitalization of to Plaintiff was not legally caused

by constitutionally inadequate medical care administered to

plaintiff. Plaintiff has submitted no evidence that the two hour

delay caused him unnecessary or exacerbated pain or suffering. 

At most, his already elevated blood sugar level was heightened. 

However, there is no medical evidence as to identifiable symptoms

or physical harm that resulted from the delay. 

The F&Rs of the Magistrate Judge are NOT ADOPTED.

Defendant’s Motion for Summary Judgment 

(Doc. 19) is GRANTED. Judgment shall be entered by the clerk of

court for Defendants and against Plaintiff. 

SO ORDERED.

Dated: May 11, 2005

 /s/ Oliver W. Wanger 

 Oliver W. Wanger

UNITED STATES DISTRICT JUDGE

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