Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-02529/USCOURTS-azd-2_13-cv-02529-0/pdf.json

Nature of Suit Code: 360
Nature of Suit: Other Personal Injury
Cause of Action: 42:1983 Civil Rights Act

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Sharon L. Dixon, 

Plaintiff, 

v. 

Arizona Department of Corrections, et al., 

Defendants.

No. CV-13-02529-PHX-DLR

ORDER 

 Before the Court are the summary judgment motions filed on behalf of Defendant 

Wexford Health Sources, Inc. (“Wexford”) and Defendants State of Arizona (“State”), 

Former Arizona Department of Corrections (“ADOC”) Health Services Division Director 

Michael Adu-Tutu, ADOC Health Services Contract Monitoring Bureau Assistant 

Director Arthur Gross, ADOC Inspector General Greg Lauchner, ADOC Health Services 

Division Interim Director Richard Pratt, and ADOC Director Charles Ryan (collectively 

“Named State Defendants”). (Docs. 158, 160.) The motions are fully briefed.1

 For the 

following reasons, the motions are granted. 

BACKGROUND 

 Gary Dixon was an inmate at the ADOC Eyman Facility. (Doc. 159, ¶ 2; Doc. 

161, ¶ 1.) On January 13, 2010, upon intake screening and evaluation, it was noted that 

 

1

 The parties’ requests for oral argument are denied because the issues are 

adequately briefed and oral argument will not aid the Court’s resolution of the motions. See Fed. R. Civ. P. 78(b); LRCiv. 7.2(f). 

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Dixon had numerous health conditions, including hepatitis C, a supraumbilical hernia, 

and cirrhosis. (Doc. 159, ¶¶ 2, 12; Doc. 161, ¶ 1.) Throughout his incarceration, Dixon 

received medical treatment for his conditions—including blood tests, abdominal 

sonograms and ultrasounds, and esophagogastroduodenoscopies—from both in-house 

and outside medical providers. (Doc. 159, ¶ 37; Doc. 161, ¶¶ 2-10.) 

 Beginning July 1, 2012, ADOC contracted with Wexford to provide medical 

services to state prison complexes. (Doc. 159, ¶ 32.) The contract required Wexford to 

follow ADOC’s policies regarding inmate medical care. (Doc. 159, ¶¶ 33-34.) During 

the relevant time period, it was ADOC’s policy to “consider organ transplantation as a 

medical treatment option for inmates if it is determined to be medically necessary.” 

(Doc. 159, ¶ 35; Doc. 161, ¶ 12.) Dixon’s in-house and outside medical providers were 

responsible for determining whether organ transplantation was necessary, and none 

recommended that he be evaluated for a liver transplant. (Doc. 159, ¶¶ 36-37; Doc. 161, 

¶ 11.) 

 On January 22, 2013, Dixon had a sudden decompensation from sepsis, likely 

related to a urinary tract infection. (Doc. 161, ¶ 26.) He was admitted to the hospital, but 

his condition deteriorated rapidly and he died on January 28, 2013. (Id.) 

 Plaintiff Sharon Dixon brought this action in her capacity as Dixon’s spouse and 

personal representative of his estate, alleging violations of 42 U.S.C. § 1983 and 

Arizona’s Adult Protective Services Act (“APSA”), A.R.S. § 46-451, et seq., and a claim 

for wrongful death. (Doc. 159, ¶ 1; Doc. 55 at 16-18.) Plaintiff alleges that liver 

transplantation was the only definitive treatment for Dixon’s end-stage liver disease, that 

he died because he was not evaluated for and did not receive a liver transplant, and that 

liver transplantation would have reduced the discomfort caused by Dixon’s hernias. 

(Doc. 55, ¶¶ 70-72.) Defendants move for summary judgment on all counts. 

LEGAL STANDARD 

 Summary judgment is appropriate if the evidence, viewed in the light most 

favorable to the nonmoving party, demonstrates “that there is no genuine dispute as to 

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

P. 56(a). “[A] party seeking summary judgment always bears the initial responsibility of 

informing the district court of the basis for its motion, and identifying those portions of 

[the record] which it believes demonstrate the absence of a genuine issue of material 

fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). 

 Substantive law determines which facts are material and “[o]nly disputes over 

facts that might affect the outcome of the suit under the governing law will properly 

preclude the entry of summary judgment.” Anderson v. Liberty Lobby, Inc., 477 U.S. 

242, 248 (1986). “A fact issue is genuine ‘if the evidence is such that a reasonable jury 

could return a verdict for the nonmoving party.’” Villiarimo v. Aloha Island Air, Inc., 

281 F.3d 1054, 1061 (9th Cir. 2002) (quoting Anderson, 477 U.S. at 248). Thus, the 

nonmoving party must show that the genuine factual issues “‘can be resolved only by a 

finder of fact because they may reasonably be resolved in favor of either party.’” Cal. 

Architectural Bldg. Prods., Inc. v. Franciscan Ceramics, Inc., 818 F.2d 1466, 1468 (9th 

Cir. 1987) (quoting Anderson, 477 U.S. at 250). Furthermore, the party opposing 

summary judgment “may not rest upon mere allegations of denials of pleadings, but . . . 

must set forth specific facts showing that there is a genuine issue for trial.” Brinson v. 

Linda Rose Joint Venture, 53 F.3d 1044, 1049 (9th Cir. 1995); see also Fed. R. Civ. P. 

56(e); Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986). 

If the nonmoving party’s opposition fails to specifically cite to materials either in the 

court’s record or not in the record, the court is not required to either search the entire 

record for evidence establishing a genuine issue of material fact or obtain the missing 

materials. See Carmen v. S.F. Unified Sch. Dist., 237 F.3d 1026, 1028-29 (9th Cir. 

2001); Forsberg v. Pac. N.W. Bell Tel. Co., 840 F.2d 1409, 1417-18 (9th Cir. 1988). 

DISCUSSION 

 Preliminarily, Plaintiff’s response brief, separate statement of facts, and 

controverting statement of facts do not comply with LRCiv 56.1. Plaintiff fails to support 

many statements of fact with citations to admissible portions of the record. LRCiv 

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56.1(a)-(b). Further, Plaintiff fails to support the vast majority of assertions made in her 

response memorandum with citations to the specific paragraphs in her statement of facts. 

LRCiv 56.1(e). Accordingly, for purposes of this order the Court deems admitted any 

assertion not appropriately denied by Plaintiff, and disregards all assertions that are not 

supported by citation to admissible portions of the record. See Szaley v. Pima Cty., 371 

F. App’x 734, 735 (9th Cir. 2010). 

I. Section 1983 

 Section 1983 provides a cause of action for those who have been deprived of their 

constitutional rights by persons acting under color of law. 42 U.S.C. § 1983. It is a 

mechanism “for vindicating federal rights elsewhere conferred,” and Ais not itself a 

source of substantive rights.@ Thornton v. City of St. Helens, 425 F.3d 1158, 1164 (9th 

Cir. 2005) (internal quotations and citation omitted). To succeed on a claim under § 

1983, a plaintiff must show “(1) that a right secured by the Constitution or the laws of the 

United States was violated, and (2) that the alleged violation was committed by a person 

acting under color of State law.” Long v. Cty. of L.A., 442 F.3d 1178, 1185 (9th Cir. 

2006). 

 “[T]o maintain an Eighth Amendment claim based on prison medical treatment, 

an inmate must show ‘deliberate indifference to serious medical needs.’” Jett v. Penner, 

439 F.3d 1091, 1096 (9th Cir. 2006) (quoting Estelle v. Gamble, 429 U.S. 97, 104 

(1976)). This is a two-part inquiry: 

First, the plaintiff must show a “serious medical need” by demonstrating that “failure to treat a prisoner’s condition could result in further significant injury or the ‘unnecessary and wanton infliction of pain.’” Second, the 

plaintiff must show the defendant’s response to the need was deliberately indifferent. This second prong . . . is satisfied by showing (a) a purposeful act or failure to respond to a prisoner’s pain or possible medical need and (b) harm caused by the indifference. Indifference “may appear when prison officials deny, delay, or intentionally interfere with medical treatment, or it 

may be shown by the way in which prison physicians provide medical care.” 

Id. (quoting McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1991), overruled on 

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

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indifference is a higher standard than mere negligence; “medical malpractice does not 

become a constitutional violation merely because the victim is a prisoner.” Estelle, 429 

U.S. at 106. 

 Plaintiff brings her § 1983 claim against Wexford and the Named State 

Defendants. She alleges that the failure to evaluate Dixon for a liver transplant rises to 

the level of deliberate indifference. 

A. Named State Defendants 

Plaintiff seeks to hold the Named State Defendants responsible in their individual, 

supervisory capacities. (Doc. 169 at 8-9; Doc. 43 at 7-9.) “Respondeat superior or 

vicarious liability will not attach under § 1983.” City of Canton, Ohio v. Harris, 489 U.S. 

378, 385 (1989). Instead, a plaintiff must show “that each Government-official 

defendant, through the official’s own individual actions, has violated the Constitution.” 

Ashcroft v. Iqbal, 556 U.S. 662, 676 (2009). A supervisory official may be held liable for 

the acts of his subordinates by participating in or directing the violations, failing to 

prevent violations of which the supervisor is aware, or by “set[ting] in motion a series of 

acts by others which the actor knows or reasonably should know would cause others to 

inflict constitutional harms.” Corales v. Bennett, 567 F.3d 554, 570 (9th Cir. 2009) 

(internal quotations and citations omitted). 

 Plaintiff provides no evidence that any of the Named State Defendants had direct 

involvement or knowledge of Dixon’s medical care, nor does she provide evidence that 

any of the Named State Defendants set in motion a series of acts that they should have 

known would cause those who were directly involved in Dixon’s care to engage in 

unconstitutional behavior. Instead, Plaintiff’s claim rests on allegations that the Named 

State Defendants had a policy, practice, or custom of providing inmates inadequate health 

care. (See Doc. 169 at 10 (“The evidence disclosed and developed in discovery shows a 

pattern and practice of not meeting the medical needs of inmates, including Mr. 

Dixon.”).) Such allegations are relevant only to a claim against local government 

officials acting in their official capacities. See Cortez v. Cty. of L.A., 294 F.3d 1186, 

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1188 (9th Cir. 2001) (“A municipality or other local government entity . . . may be sued 

for constitutional torts committed by its officials according to an official policy, practice, 

or custom.” (citing Monell v. N.Y. Dep’t of Soc. Servs., 436 U.S. 658, 690-91 (1978)). 

However, “a state and its officials sued in their official capacity are not considered 

‘persons’ within the meaning of § 1983, due to the sovereign immunity generally 

afforded states by the Eleventh Amendment.” Id. Although there is an exception to this 

general rule for claims seeking prospective injunctive relief, Will v. Michigan Dep’t of 

State Police, 491 U.S. 58, 71 (1989), Plaintiff seeks only monetary damages for her 

claims.2

 Accordingly, the Named State Defendants are entitled to summary judgment on 

Plaintiff’s § 1983 claim because Plaintiff has not supplied evidence that any of the 

Named State Defendants had direct involvement in or knowledge of Dixon’s care. 

B. Wexford 

 The liability of private entities acting under color of state law is assessed by the 

same legal standards applicable to municipalities. See Tsao v. Desert Palace, Inc., 698 

F.3d 1128, 1139 (9th Cir. 2012) (“[W]e see no basis in the reasoning underlying Monell

to distinguish between municipalities and private entities acting under color of state 

law.”) Thus, to succeed on her § 1983 claim against Wexford, Plaintiff must show that 

Wexford had a policy, practice, or custom that was the moving force behind the alleged 

violation of Dixon’s Eighth Amendment rights. Dougherty v. City of Covina, 654 F.3d 

892, 900 (9th Cir. 2011). Wexford cannot be liable under a respondeat superior theory. 

See Tsao, 698 F.3d at 1139 (citing Monell, 436 U.S. at 691). 

 Wexford’s contract required it to follow ADOC’s policies regarding medical care. 

During the relevant time period, ADOC’s official policy was to “consider organ 

transplantation as a medical treatment option for inmates if it is determined to be 

medically necessary.” (Doc. 159, ¶ 35.) Plaintiff does not argue that this policy is 

 

2

 To the extent Plaintiff is attempting to pursue a claim for monetary damages against the Named State Defendants in their official capacities based on an allegedly unconstitutional policy, practice, or custom, her claim is barred by the Eleventh Amendment. (See Doc. 139 at 4 n.3.) 

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unconstitutional. Instead, without citing any factual support in the record, Plaintiff 

argues that Wexford “had a custom and practice of ignoring its own policy.” (Doc. 169 

at 2.) 

 Throughout his incarceration, Dixon was treated by both in-house and outside 

medical providers, none of whom recommended that Dixon be evaluated for a liver 

transplant. These medical providers were responsible for determining whether organ 

transplantation was medically necessary. Plaintiff points to no ADOC or Wexford policy 

that was the moving force behind these providers’ decisions. Instead, Plaintiff offers 

slides prepared by Wexford for a meeting with ADOC in November 2012 in which 

Wexford expressed concerns about the adequacy of inmate health care generally. (Doc. 

168, ¶ 16.) In essence, Plaintiff argues that, because Wexford believed ADOC was not 

providing constitutionally adequate inmate care, Dixon’s death must have been a direct 

result of these deficiencies. But she offers no evidence connecting any particular policy, 

practice, or custom to the decision of Dixon’s in-house and outside medical providers to 

not recommend him for a liver transplant evaluation. Plaintiff might disagree with 

Dixon’s medical providers about the medical necessity of a liver transplant, but it does 

not follow that the decision not to recommend Dixon for a liver transplant was the result 

of an unconstitutional policy, practice, or custom. See Jackson v. McIntosh, 90 F.3d 330, 

332 (9th Cir. 1996) (“[A] difference of medical opinion as to the need to pursue one 

course of treatment over another [is] insufficient, as a matter of law, to establish 

deliberate indifference.” (internal quotations and citation omitted)). Accordingly, 

Wexford is entitled to summary judgment on Plaintiff’s § 1983 claim because Plaintiff 

has not offered evidence that the treatment recommendations of Dixon’s health care 

providers were the result of an unconstitutional policy, practice, or custom of Wexford. 

II. Wrongful Death 

Pursuant to A.R.S. § 12-611, Plaintiff brings her wrongful death claim against the 

State and Wexford based on a theory of medical negligence. To succeed, Plaintiff must 

prove:

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1. The health care provider failed to exercise that degree of care, skill and learning expected of a reasonable, prudent health care provider in the profession or class to which he belongs within the state acting in the same or similar circumstances. 

2. Such failure was a proximate cause of the injury. 

A.R.S. § 12-563. The State and Wexford are not, themselves, health care providers. 

Instead, they employed the clinicians responsible for Dixon’s health care. Thus, Plaintiff 

must demonstrate that the State and Wexford are vicariously liable for the alleged 

medical negligence of their employee health care providers. See A.R.S. § 12-2604(B) 

(“If the defendant is a health care institution that employs a health professional against 

whom or on whose behalf the [standard of care] testimony is offered, the provisions 

[A.R.S. § 12-2604(A)] apply as if the health professional were the party or defendant 

against whom or on whose behalf the testimony is offered.”)

 However, Plaintiff identifies no specific clinician(s) whose care allegedly fell 

below acceptable medical standards. Her Second Amended Complaint names “John and 

Jane Doe Health Care Providers” and states that she will replace the fictional defendants 

“once such names and identities are known to Plaintiff.” (Doc. 55, ¶ 15.) Despite 

possessing medical records disclosing the identities of forty-one of Dixon’s medical 

providers, Plaintiff never amended her complaint to add the names of the allegedly 

negligent medical providers, nor has she provided this information in her response to 

Defendants’ summary judgment motions. (Doc. 159, ¶ 10.) 

 Plaintiff’s omission is problematic for many reasons. For example, her failure to 

identify specific clinicians whose treatment she believes fell below the standard of care 

makes it impossible to determine whether Dr. Leff is qualified to offer standard of care 

opinions. Under Arizona law: 

In an action alleging medical malpractice, a person shall not give expert testimony on the appropriate standard of practice or care unless the person is licensed as a health professional in this state or another state and the 

person meets the following criteria: 

1. If the party against whom or on whose behalf the testimony is offered is or claims to be a specialist, specializes at the time of the occurrence that is the basis for the action in the same specialty or claimed specialty as the 

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party against whom or on whose behalf the testimony is offered. If the party against whom or on whose behalf the testimony is offered is or claims to be a specialist who is board certified, the expert witness shall be a specialist who is board certified in that specialty or claimed specialty. 

2. During the year immediately preceding the occurrence giving rise to the lawsuit, devoted a majority of the person's professional time to either or both of the following: 

(a) The active clinical practice of the same health profession as the defendant and, if the defendant is or claims to be a specialist, in the same specialty or claimed specialty. 

(b) The instruction of students in an accredited health professional school or accredited residency or clinical research program in the same health 

profession as the defendant and, if the defendant is or claims to be a specialist, in an accredited health professional school or accredited 

residency or clinical research program in the same specialty or claimed specialty. 

3. If the defendant is a general practitioner, the witness has devoted a 

majority of the witness's professional time in the year preceding the occurrence giving rise to the lawsuit to either or both of the following: 

(a) Active clinical practice as a general practitioner. 

(b) Instruction of students in an accredited health professional school or accredited residency or clinical research program in the same health care 

profession as the defendant.

A.R.S. § 12-2604(A) (emphasis added). Defendants and the Court cannot evaluate 

whether Dr. Leff shares the same profession, specialty, or board certification(s) as the 

clinicians who Plaintiff claims provided substandard medical care because Plaintiff has 

not identified them. 

 More importantly, however, Plaintiff’s omission is fatal to her claim because she 

is required to prove that Dixon’s health care provider(s) “failed to exercise that degree of 

care, skill and learning expected of a reasonable, prudent health care provider in the 

profession or class to which he belongs . . . acting in the same or similar circumstances.” 

A.R.S. § 12-563 (emphasis added). Plaintiff cannot establish this element without 

identifying the profession or class of the allegedly negligent health care provider(s), or 

the circumstances under which the provider(s) administered care. Further, and on a more 

fundamental level, Plaintiff has not identified specific tortfeasors for whose alleged 

negligence either the State or Wexford may be vicariously liable. Accordingly, the State 

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and Wexford are entitled to summary judgment on Plaintiff’s wrongful death claim. 

III. APSA 

Plaintiff alleges that Wexford violated APSA, which creates a civil cause of action 

for: 

[a] vulnerable adult whose life or health is being or has been endangered or injured by neglect, abuse or exploitation . . . against any person or enterprise that has been employed to provide care, that has assumed a legal duty to provide care or that has been appointed by a court to provide care to such vulnerable adult . . . . 

A.R.S. § 46-455(B). A vulnerable adult is someone “who is unable to protect himself 

from abuse, neglect or exploitation by others because of a physical or mental 

impairment,” or who is incapacitated “by reason of mental illness, mental deficiency, 

mental disorder, physical illness or disability, chronic use of drugs, chronic intoxication 

or other cause . . . to the extent that he lack sufficient understanding or capacity to make 

or communicate responsible decisions concerning his person.” A.R.S. §§ 46-451(A)(9), 

14-5101(1). 

[T]o be actionable abuse under APSA, the negligent act or acts (1) must 

arise from the relationship of caregiver and recipient, (2) must be closely connected to that relationship, (3) must be linked to the service the 

caregiver undertook because of the recipient’s incapacity, and (4) must be related to the problem or problems that caused the incapacity. 

Estate of McGill ex rel. McGill v. Albrecht, 57 P.3d 384, 389 (Ariz. 2002). In enacting 

APSA, “the legislature’s obvious intent to protect a class of mostly elderly or mentally ill 

citizens from harm caused by those who have undertaken to give them the care they 

cannot provide for themselves.” Id. at 388. 

 Although it is undisputed that Dixon had many physical impairments,3

 (Doc. 159, 

¶ 12), Plaintiff provides no evidence that these impairments rendered him incapable of 

protecting himself from abuse, neglect, or exploitation, or that he lacked the 

understanding or capacity to communicate regarding his medical care. Indeed, Dixon’s 

 

3

 Plaintiff argues that Dixon was mentally impaired, but it is undisputed that Dixon required no mental health services while incarcerated. (Doc. 159, ¶¶ 13-16.) 

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cellmate, Darren Stanely, testified that Dixon was coherent and able to communicate 

effectively until the day he died. (Id., ¶ 16.) Plaintiff argues that Dixon was incapable of 

making his own medical decisions because “he was totally dependent on Defendants for 

his daily needs and medical care and, as such, was physically impaired to such an extent 

that he was unable to protect himself from abuse and neglect.”4

 (Doc. 169 at 13.) But 

incarceration is not synonymous with incapacitation as described in A.R.S. § 14-5101(1). 

Nor does the fact that a person might rely on prison officials for daily needs and medical 

care mean that he is unable to protect himself due to physical or mental impairments as 

required by A.R.S. § 46-451(A)(9). Wexford is entitled to summary judgment on 

Plaintiff’s APSA claim because Plaintiff has not offered evidence that Dixon was a 

vulnerable adult as defined by Arizona law. 

IV. Causation 

In addition to the reasons explained above, Defendants are entitled to summary 

judgement on all claims because Plaintiff will be unable to prove that Defendants’ actions 

or inaction caused Dixon’s death. Proximate causation is an element of all of Plaintiff’s 

claims. See City of Canton, 489 U.S. at 385 (“The first inquiry in any case alleging 

municipal liability under § 1983 is the question whether there is a direct causal link 

between a municipal policy or custom and the alleged constitutional deprivation.”); 

A.R.S. § 12-563 (stating that proximate cause is a required element of a medical 

negligence claim); A.R.S. § 46-455(B) (creating cause of action against caregiver who 

causes endangerment or injury). The crux of Plaintiff’s case is that Defendants should 

have evaluated Dixon for a liver transplant. However, it is undisputed that Dixon was not 

eligible to receive a cadaveric liver transplant. (Doc. 159, ¶¶ 19-23.) 

 Dr. Leff opined that Dixon should have had the opportunity to be assessed by a 

transplant team for a partial liver transplant from a living donor. (Doc. 161-12 at 40.) 

Plaintiff’s causation expert, Dr. Mario Chojkier, opined that Dixon theoretically could 

 

4

 Plaintiff uses the plural “Defendants,” but her APSA claim is against Wexford only. There is no evidence that Wexford contracted to provide ADOC inmates with their “daily needs.” 

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have had a living donor transplant. (Doc. 159, ¶ 24.) However, the only known and 

potentially willing living donor identified by Plaintiff is herself. (Doc. 159, ¶ 29.) None 

of Plaintiff’s medical experts examined her or reviewed her medical history to determine 

whether she was a suitable donor. (Id., ¶ 30.) Although Dr. Chojkier testified that a 

living donor could be “friends, relatives, neighbors, and good Samaritans,” (Doc. 168 at 

12, ¶ 26), Plaintiff offers no evidence of any known friends, relatives, neighbors, or good 

Samaritans willing and suitable to donate part of their liver to Dixon. Accordingly, 

Plaintiff will be unable to show at trial that Dixon would have received a partial liver 

from a living donor had he been evaluated for one. 

 Plaintiff argues that the evidence is sufficient to have a jury determine causation 

based on a “loss of chance theory.” (Doc. 169 at 14-15.) She relies on Thompson v. Sun 

City Community Hospital, in which the Arizona Supreme Court adopted the rule from the 

Restatement (Second) of Torts § 323 that: 

One who undertakes, . . . to render services to another which he should 

recognize as necessary for the protection of the other’s person or things, is subject to liability to the other for physical harm resulting from his failure to exercise reasonable care to perform his undertaking, if (a) his failure to exercise such care increases the risk of such harm . . . . 

688 P.2d 605, 616 (Ariz. 1984). Plaintiff contends that Defendants increased Dixon’s 

risk of harm by failing to evaluate him for a partial liver transplant from a living donor. 

Thompson involved delayed treatment. In that case, the plaintiff suffered a 

transected femoral artery and was taken to the emergency room, where it was determined 

that he required surgery. Id. at 607-08. The plaintiff’s insurance did not satisfy the 

hospital’s financial requirements for admission, so he was transferred to a different 

hospital when his condition stabilized. Id. at 608. Although he underwent and survived 

surgery, he experienced residual impairment in his left leg. Id. He sued the transferor 

hospital for medical negligence, and appealed the trial court’s refusal to instruct that jury 

that causation could be established by proof that the defendant’s acts or omissions had 

increased his risk of harm. Id. at 613. 

 The Arizona Supreme Court reversed the trial court, concluding that causation is a 

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jury question “[e]ven if the evidence permits only a finding that the defendant’s 

negligence increased the risk of harm or deprived plaintiff of some significant chance of 

survival or better recovery . . . .” Id. at 614-16 (emphasis added). However, the court 

noted that its decision applies to a “limited class of cases in which [a] defendant 

undertook to protect [a] plaintiff from a particular harm and negligently interrupted the 

chain of events, thus increasing the risk of that harm,” and cautioned that “this rule fits 

only in those situations where the courts traditionally have allowed juries to deal more 

loosely with causation . . . .” Id. at 616. The Arizona Court of Appeals later interpreted 

Thompson to require evidence that a defendant deprived a plaintiff of a substantial

chance of survival or a better outcome. Lohse v. Faultner, 860 P.2d 1306, 1316 (Ariz. 

Ct. App. 1992). 

 Here, Plaintiff has not shown that “loss of chance” causation is applicable to this 

case. This is not a situation in which Defendants “negligently interrupted the chain of 

events, thus increasing the risk of . . . harm” to Dixon. Thompson, 688 P.2d at 616. 

Instead, Plaintiff and Dr. Leff merely disagree with the conservative treatment provided 

to Dixon by his medical providers. Nor has Plaintiff provided any authority that 

Thompson applies outside the medical malpractice context. 

 Moreover, assuming Thompson applies, Plaintiff has not provided evidence 

“ris[ing] to the level of substantiality.” Lohse, 860 P.2d at 1316. There is no evidence 

that any suitable living donors would have been willing to donate part of their liver to 

Dixon had he been evaluated for a transplant. Dr. Chojkier does not opine to any degree 

of probability that Dixon would have found a suitable donor and received a partial liver 

transplant. It is undisputed that less than 10 percent of liver transplants are from living 

donors, and that most people who are willing to donate cannot be donors because of 

health issues, psychosocial factors, or other technical issues unique to live donation. 

(Doc. 161, ¶ 27; Doc. 170, ¶ 29.) On this issue, Plaintiff’s medical experts offer only 

speculation, and no reasonable jury could conclude that Defendants deprived Dixon of a 

substantial possibility of survival. See Lohse, 860 P.2d at 1316 (upholding summary 

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judgment where “it was wholly speculative” whether harm could have been prevented 

absent alleged medical negligence). 

CONCLUSION 

 For the foregoing reasons, Plaintiff will be unable to carry her burden of proof at 

trial for any of her claims. Accordingly, 

IT IS ORDERED that Defendants’ motions for summary judgment, (Docs. 158, 

160), are GRANTED. The Clerk shall terminate all remaining motions, enter judgment 

accordingly, and terminate this case. 

 Dated this 11th day of March, 2016. 

Douglas L. Rayes 

United States District Judge

Case 2:13-cv-02529-DLR Document 177 Filed 03/14/16 Page 14 of 14