Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_08-cv-02856/USCOURTS-caed-2_08-cv-02856-4/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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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

LEON COOPER,

Plaintiff, No. CIV S-08-2856 GGH P

vs.

DR. McALPINE, et al., ORDER AND

Defendants. FINDINGS & RECOMMENDATIONS

 /

I. Introduction

Plaintiff is a state prisoner proceeding pro se with a civil rights action pursuant to

42 U.S.C. § 1983. Plaintiff alleges that defendants acted with deliberate indifference to his

serious medical needs.

On September 1, 2009, plaintiff filed a summary judgment motion. On October

16, 2009, defendants filed an opposition to plaintiff’s motion and a cross-motion for summary

judgment. Plaintiff did not file an opposition to defendants’ cross-motion. Accordingly, on

January 11, 2009, the court ordered plaintiff to show cause for his failure to oppose defendants’

motion within fourteen days. Fourteen days passed and plaintiff did not respond to the January

11, 2009, order. Nevertheless, the court construes plaintiff’s summary judgment motion as an

opposition to defendants’ motion.

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After carefully reviewing the record, the court recommends that plaintiff’s motion

be denied and defendants’ motion be granted in part and denied in part.

II. Summary Judgment Standards Under Rule 56

Summary judgment is appropriate when it is demonstrated that there exists “no

genuine issue as to any material fact and that the moving party is entitled to a judgment as a

matter of law.” Fed. R. Civ. P. 56(c).

Under summary judgment practice, the moving party 

always bears the initial responsibility of informing the district court

of the basis for its motion, and identifying those portions of “the

pleadings, depositions, answers to interrogatories, and admissions

on file, together with the affidavits, if any,” which it believes

demonstrate the absence of a genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S. Ct. 2548, 2553 (1986) (quoting Fed. R. Civ.

P. 56(c)). “[W]here the nonmoving party will bear the burden of proof at trial on a dispositive

issue, a summary judgment motion may properly be made in reliance solely on the ‘pleadings,

depositions, answers to interrogatories, and admissions on file.’” Id. 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 id. at 322, 106 S. Ct. at 2552. 

“[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, as set forth in Rule 56(c), is satisfied.” Id. at 323, 106 S. Ct. at

2553.

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, 106 S. Ct. 1348, 1356

(1986). In attempting to establish the existence of this factual dispute, the opposing party may

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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(e); Matsushita, 475 U.S. at 586 n.11,

106 S. Ct. at 1356 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, 106 S. Ct. 2505, 2510 (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, 106 S. Ct. at 1356 (quoting Fed. R. Civ. P.

56(e) advisory committee’s note on 1963 amendments).

In resolving the summary judgment motion, the court examines the pleadings,

depositions, answers to interrogatories, and admissions on file, together with the affidavits, if

any. Fed. R. Civ. P. 56(c). The evidence of the opposing party is to be believed. See Anderson,

477 U.S. at 255. All reasonable inferences that may be drawn from the facts placed before the

court must be drawn in favor of the opposing party. See Matsushita, 475 U.S. at 587, 106 S. Ct.

at 1356. Nevertheless, inferences are not drawn out of the air, and 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

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 Plaintiff claims that on March 25, 2009, his rash was wrongly diagnosed as having been 1

caused by a spider bite. Defendants dispute this claim. Because there is no claim by plaintiff

that any defendant was involved in this alleged misdiagnosis, it is not a material fact. 

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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, 106 S. Ct. at 1356 (citation omitted).

On February 3, 2009, the court advised plaintiff of the requirements for opposing

a motion pursuant to Rule 56 of the Federal Rules of Civil Procedure. See Rand v. Rowland, 154

F.3d 952, 957 (9th Cir. 1998) (en banc); Klingele v. Eikenberry, 849 F.2d 409, 411-12 (9th Cir.

1988).

III. Undisputed Facts

At all relevant times, plaintiff was a state prisoner at California State PrisonSacramento (CSP-Sac). At all relevant times, defendants Brown and Hartwell were employed at

CSP-Sac as Licensed Vocational Nurses (LVN). At all relevant times, defendant Bal was the

Chief Medical Officer at CSP-Sac. At all relevant times, defendant McAlpine was a medical

doctor employed at CSP-Sac.

On March 30, 2008, plaintiff was seen at A Facility Treatment and Triage with

complaints of a skin rash that had started three days earlier. Plaintiff’s thigh, abdomen and right 1

arm pit were red and swollen. The right thigh had an open area. Dr. Reddy ordered Bactrim, two

tablets to be taken two times a day for ten days, and Ibuprofen to be taken two times a day for

five days for pain. These drugs were given to plaintiff to take as prescribed. 

On April 4, 2008, plaintiff returned to the Medical Facility complaining about the

wounds on his abdomen, thigh and armpit. Dr. McAlpine examined plaintiff’s wounds and

determined that he needed to have the stomach and thigh wounds incised and drained. He

scheduled plaintiff for surgery immediately.

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 /////

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 Plaintiff claims that his diagnosis was confirmed on April 4, 2008. However, the 2

records from Quest Diagnostic indicate that the culture was collected on April 4, 2008, and tested

on April 7, 2008. Defendants’ Exhibit A, p. 63. 

 In his summary judgment motion, plaintiff alleges that Dr. Wedell saw him on April 18, 3

2008, and reordered his treatment plan after seeing that it had been discontinued by defendants

McAlpine, Brown and Harwell. However, the entry in plaintiff’s medical records from that date

is signed by defendant McAlpine. See Plaintiff’s Summary Judgment Motion, Exhibit E. 

Plaintiff’s claim that Dr. Wedell examined him on April 18, 2008, and reinstated his treatment

plan is not supported by the evidence. 

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On April 4, 2008, Dr. Wedell performed an incision and drain of plaintiff’s left

abdomen wall and right thigh. The wounds were packed with gauze and he took a wound

culture. Dr. Wedell prescribed Rifampin 600 mg double strength to be taken two times a day for

fourteen days and Tylenol 974 mg three times a day for fourteen days as needed for pain. 

Plaintiff was to keep these medications on his person. Dr. Wedell also prescribed daily wound

dressings by a Registered Nurse in B Facility. An entry in plaintiff’s medical records on April 4,

2008, by someone unknown states that plaintiff’s wound dressings were to be changed until

healed.

On April 4, 2008, at 6:15 p.m. plaintiff was seen at B Facility for a dressing

change.

On April 7 2008, the culture of plaintiff’s wounds were confirmed as

staphylococcus aureus resistant, i.e. MRSA.2

On April, 9, 2008, defendant McAlpine ordered that plaintiff could do self-applied

dry dressing changes to his abdomen and right thigh wounds for the next five days.

On April 18, 2009, defendant McAlpine examined plaintiff. Plaintiff told 3

defendant McAlpine that he had not taken his Bactrim because a LVN had told him to stop

taking it. Defendant McAlpine wrote in the entry for that date, “the inmate was not aware that

both drugs are to be taken concomitantly.” Defendant observed that plaintiff’s right arm pit had

healed. The abdomen wall still had loculation (small cavity with fluid) and drainage, and the

right thigh had one centimeter of loculation. The wounds were still active so defendant

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McAlpine refilled plaintiff’s prescriptions for Rifampin and Bactrim for seven days. Plaintiff

was told to return in ten days for nasal swabs to assess MRSA colonization.

On April 24, 2008, defendant McAlpine saw plaintiff. Plaintiff had no new sores. 

His right armpit and right thigh were healed. There was no drainage from the abdomen wound. 

Defendant McAlpine determined that the MSRA had been resolved. Defendant took a nasal

swab to assess MSRA colonization. 

On May 12, 2008, defendant McAlpine saw plaintiff. He reported no new sores

and that the MSRA swab was negative. Defendant wrote in plaintiff’s records that the MSRA

was resolved. 

IV. Legal Standard for Eighth Amendment Claim

In order to state a § 1983 claim for violation of the Eighth Amendment based on

inadequate medical care, plaintiff must allege “acts or omissions sufficiently harmful to evidence

deliberate indifference to serious medical needs.” Estelle v. Gamble, 429 U.S. 97, 106, 97 S. Ct.

285, 292 (1976). To prevail, plaintiff must show both that his medical needs were objectively

serious, and that defendants possessed a sufficiently culpable state of mind. Wilson v. Seiter,

501 U.S. 294, 299, 111 S. Ct. 2321, 2324 (1991); McKinney v. Anderson, 959 F.2d 853 (9th Cir.

1992) (on remand). The requisite state of mind for a medical claim is “deliberate indifference.” 

Hudson v. McMillian, 503 U.S. 1, 4, 112 S. Ct. 995, 998 (1992). 

A serious medical need exists if the failure to treat a prisoner’s condition could

result in further significant injury or the unnecessary and wanton infliction of pain. Indications

that a prisoner has a serious need for medical treatment are the following: 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. See, e.g., Wood v. Housewright, 900

F. 2d 1332, 1337-41 (9th Cir. 1990) (citing cases); Hunt v. Dental Dept., 865 F.2d 198, 200-01

(9th Cir. 1989). McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992), overruled on other

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grounds, WMX Technologies v. Miller, 104 F.3d 1133 (9th Cir. 1997) (en banc).

In Farmer v. Brennan, 511 U.S. 825, 114 S. Ct. 1970 (1994) the Supreme Court

defined a very strict standard which a plaintiff must meet in order to establish “deliberate

indifference.” Of course, negligence is insufficient. Farmer, 511 U.S. at 835, 114 S. Ct. at 1978. 

However, even civil recklessness (failure to act in the face of an unjustifiably high risk of harm

which is so obvious that it should be known) is insufficient. Id. at 836-37, 114 S. Ct. at 1979. 

Neither is it sufficient that a reasonable person would have known of the risk or that a defendant

should have known of the risk. Id. at 842, 114 S. Ct. at 1981.

It is nothing less than recklessness in the criminal sense – subjective standard –

disregard of a risk of harm of which the actor is actually aware. Id. at 838-842, 114 S. Ct. at

1979-1981. “[T]he official must both be aware of facts from which the inference could be drawn

that a substantial risk of serious harm exists, and he must also draw the inference.” Id. at 837,

114 S. Ct. at 1979. Thus, a defendant is liable if he knows that plaintiff faces “a substantial risk

of serious harm and disregards that risk by failing to take reasonable measures to abate it.” Id. at

847, 114 S. Ct. at 1984. “[I]t is enough that the official acted or failed to act despite his

knowledge of a substantial risk of serious harm.” Id. at 842, 114 S. Ct. at 1981. If the risk was

obvious, the trier of fact may infer that a defendant knew of the risk. Id. at 840-42, 114 S. Ct. at

1981. However, obviousness per se will not impart knowledge as a matter of law. 

Also significant to the analysis is the well established principle that mere

differences of opinion concerning the appropriate treatment cannot be the basis of an Eighth

Amendment violation. Jackson v. McIntosh, 90 F.3d 330 (9th Cir. 1996); Franklin v. Oregon,

662 F.2d 1337, 1344 (9th Cir. 1981).

Moreover, a physician need not fail to treat an inmate altogether in order to violate

that inmate’s Eighth Amendment rights. Ortiz v. City of Imperial, 884 F.2d 1312, 1314 (9th Cir.

1989). A failure to competently treat a serious medical condition, even if some treatment is

prescribed, may constitute deliberate indifference in a particular case. Id.

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Additionally, mere delay in medical treatment without more is insufficient to state

a claim of deliberate medical indifference. Shapley v. Nevada Bd. of State Prison Com’rs, 766

F.2d 404, 408 (9th Cir. 1985). Although the delay in medical treatment must be harmful, there is

no requirement that the delay cause “substantial” harm. McGuckin, 974 F.2d at 1060, citing

Wood v. Housewright, 900 F.2d 1332, 1339-1340 (9th Cir. 1990) and Hudson, 112 S. Ct. at 998-

1000. A finding that an inmate was seriously harmed by the defendant’s action or inaction tends

to provide additional support for a claim of deliberate indifference; however, it does not end the

inquiry. McGuckin, 974 F.2d 1050, 1060 (9th Cir. 1992). In summary, “the more serious the

medical needs of the prisoner, and the more unwarranted the defendant’s actions in light of those

needs, the more likely it is that a plaintiff has established deliberate indifference on the part of

the defendant.” McGuckin, 974 F.2d at 1061. 

Superimposed on these Eighth Amendment standards is the fact that in cases

involving complex medical issues where plaintiff contests the type of treatment he received,

expert opinion will almost always be necessary to establish the necessary level of deliberate

indifference. Hutchinson v. United States, 838 F.2d 390 (9th Cir. 1988). Thus, although there

may be subsidiary issues of fact in dispute, unless plaintiff can provide expert evidence that the

treatment he received equated with deliberate indifference thereby creating a material issue of

fact, summary judgment should be entered for defendants. The dispositive question on this

summary judgment motion is ultimately not what was the most appropriate course of treatment

for plaintiff, but whether the failure to timely give a certain type of treatment was, in essence,

criminally reckless.

V. Discussion

This action is proceeding on the first amended complaint filed December 23,

2008. Plaintiff alleges that defendants Brown and Harwell acted with deliberate indifference on

April 7, 2008, by informing him that that day would be his last dressing change. Plaintiff alleges

that he showed defendants that his wounds had not healed but they prevented him from returning

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to the clinic. Plaintiff also alleges that defendants told him to stop taking his Bactrim. Plaintiff

alleges that on April 9, 2008, without examining him, defendant McAlpine acted with deliberate

indifference by ordering that plaintiff could do self-applied dry dressing changes to his abdomen

and right thigh wound. 

Plaintiff alleges that after defendants changed Dr. Wedell’s orders regarding

wound changes and Bactrim, his infection became painful and worsened. Plaintiff also alleges

that his infection began showing signs of scarring. Plaintiff alleges that on April 18, 2008,

defendant Wedell became aware that his orders had been changed and ordered them reinstated. 

Plaintiff alleges that defendant Bal improperly denied his administrative appeals regarding the

conduct of the other defendants. As relief, plaintiff seeks money damages only.

Defendants argue that they are entitled to summary judgment based on qualified

immunity. They do not dispute that plaintiff had a serious medical need. They instead argue that

they not act with deliberate indifference.

In resolving a claim for qualified immunity the court addresses two questions: (1)

whether the facts, when taken in the light most favorable to plaintiff, demonstrate that the

officer's actions violated a constitutional right and (2) whether a reasonable officer could have

believed that his conduct was lawful, in light of clearly established law and the information the

officer possessed. Anderson v. Creighton, 483 U.S. 635, 107 S.Ct. 3034 (1987). Although the

Supreme Court at one time mandated that lower courts consider these two questions in the order

just presented, more recently the Supreme Court announced that it is within the lower courts’

discretion to address these questions in the order that makes the most sense given the

circumstances of the case. Pearson v. Callahan, --- U.S. ---, 129 S.Ct. 808, --- L.Ed.2d ----, 2009

WL 128768 (January 21, 2009).

The undersigned first considers the first qualified immunity prong, i.e. whether

the facts, taken in the light most favorable to plaintiff, demonstrate that defendants violated his

constitutional rights. 

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Whether defendants Brown and Harwell told plaintiff to stop taking his Bactrim is

a materially disputed fact. In their declarations submitted in support of defendants’ summary

judgment motion, both defendants deny telling plaintiff to stop taking his Bactrim. At his

deposition, plaintiff testified otherwise. If plaintiff’s version of facts is true, the undersigned

would find that defendants acted with deliberate indifference to his medical needs because

defendants were not authorized and had no grounds to overturn the orders of a medical doctor. 

The undersigned now turns to the issues of the dressing of plaintiff’s wounds.

Whether on April 7, 2008, defendants Brown and Harwell told plaintiff that his wounds would

no longer be changed is a materially disputed fact. In their declarations submitted in support of

the summary judgment motion, defendants deny telling plaintiff that April 7, 2008, would be the

last day his wounds were changed. At his deposition, plaintiff testified that defendants made this

statement to him. The fact that there is no medical record showing a dressing change for plaintiff

on April 7, 2008, or April 8, 2008, supports plaintiff’s version of events. If plaintiff’s version of

facts is true, the undersigned would find that defendants Brown and Harwell acted with

deliberate indifference to plaintiff’s serious medical needs as there were apparently no medical

grounds for such an order. 

Whether on April 9, 2009, defendant McAlpine ordered plaintiff to change his

own dressing without examining plaintiff is also a materially disputed fact. Plaintiff alleges that

defendant did not examine him that day. In his declaration submitted in support of the pending

motion, defendant states that he examined plaintiff on April 9, 2009, before ordering the selfdressing. The entry in plaintiff’s medical records from that day is not clear regarding this issue. 

See defendants’ Brodbeck declaration, exhibit A, p. 13. The notation for self-applied dressing is

written by someone other than defendant McAlpine, although it is signed by him. The

undersigned cannot determine from this record whether defendant actually examined plaintiff

that day. 

/////

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Whether plaintiff’s wounds had sufficiently healed to warrant self-dressing is also

a materially disputed fact. At his deposition, plaintiff testified that on April 9, 2008, his wounds

were draining and “it was bad man. It was bad.” See Brodbeck declaration, exhibit B, p. 72: 2-

12. Plaintiff also testified that on April 9, 2008, he was not given anything to change his

wounds. Id., p. 78:20-22. Plaintiff testified that he was not given anything to change his wounds

until April 18, 2008. Id. at 78: 23-25, 79: 1-3. In his declaration, defendant McAlpine states that

on April 9, 2008, he saw plaintiff in triage and observed that the wounds were healing. 

McAlpine declaration, ¶ 14. For that reason, defendant ordered that plaintiff apply self-dressing

to his abdomen and thigh for five days. Id. 

If plaintiff’s version of facts is true, the trier of fact could find that defendant

McAlpine acted with deliberate indifference to plaintiff’s serious medical needs by ordering him

to self-dress his wounds that he did not personally examine and that were not healing.

Because of the materially disputed facts, neither plaintiff nor defendants

McAlpine, Brown or Harwell should be granted summary judgment.

The undersigned observes that neither party has addressed the issue of causation,

i.e. whether defendants’ conduct caused a delay in the healing of plaintiff’s wounds and whether

this delay caused the injuries he alleges, additional pain and scarring. See Harper v. City of Los

Angeles, 533 F.3d 1010, 1026 (9th Cir. 2008), citing Arnold v. IBM Corp., 637 F.2d 1350, 1355

(9th Cir.1981) (in addition to demonstrating deliberate indifference, in a § 1983 action, the

plaintiff must also demonstrate that the defendants’ conduct was the actionable cause of the

claimed injury.)

Regarding the temporary discontinuation of Bactrim, as discussed above, on April

18, 2009, defendant McAlpine told plaintiff that he had to take the Bactrim concomitantly with

the other drugs he was prescribed in order for them to work. A reasonable inference from this

comment is that the alleged temporary discontinuance of plaintiff’s Bactrim by defendants

Brown and Halwell caused a delay, albeit not significant, in the healing of plaintiff’s wounds. 

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The record contains no evidence regarding whether the alleged orders by defendants regarding

the cleaning of plaintiff’s wounds caused a delay in the healing of plaintiff’s wounds. 

Regarding plaintiff’s claim of additional pain, on April 4, 2007, plaintiff was

prescribed Tylenol 975 mg, to keep on his person, three times a day for fourteen days. Plaintiff is

apparently claiming that this prescription did not adequately address his pain. Defendants do not

address this issue. 

Regarding the issue of scarring, defendants do not dispute that plaintiff had scars

on his body as a result of the MRSA. See McAlpine declaration, ¶ 21. According to defendant

McAlpine, scars are a normal result from a breach of skin integrity which includes sores or an I

& D procedure. Id. Defendant McAlpine observed hyper pigmented changes at the left lower

quadrant of the abdomen, right interior thigh and right axilla. Id. 

Plaintiff is apparently claiming that he would have had fewer scars on his body

had the MSRA healed more quickly. Neither party has adequately addressed this issue. 

The undersigned now turns to the second prong of the qualified immunity

analysis: whether a reasonable officer could have believed that his conduct was lawful, in light

of clearly established law and the information the officer possessed. Any idea that qualified

immunity can exist in the context of a deliberate indifference to medical needs claim has been

wiped away by Conn v. City of Reno, 591 F.3d 1081, 1102 (9th Cir. 2010). While the doctrine

may yet exist in some sort of extraordinary or bizarre medical context, the present situation

presents the run of the mill situation where a prisoner complains of not receiving medical care

that might have helped his problem. If the trier of fact were to find defendants to have been

deliberately indifferent in not providing that care or in interfering with that care, by definition

they could not have been reasonable in believing their actions did not violate clearly established

law. 

Regarding the claims against defendants Harwell and Brown, the undersigned

does not find that based on the facts of this case, a reasonable LPN would have believed that it

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was lawful to tell plaintiff that he no longer needed to take Bactrim and that the dressing on his

wounds would no longer be changed. These orders directly contradicted those made by medical

doctors. 

Regarding defendant McAlpine, the court cannot find on this record that a

reasonable doctor would believe that ordering self-dressing of a wound without examining the

patient was reasonable. 

For these reasons, defendants Harwell, Brown and McAlpine are not entitled to

qualified immunity. Because of the disputed material facts, both plaintiff and defendants

Harwell, Brown and McAlpine should be denied summary judgment as to the claims made

against these defendants.

Plaintiff alleges that defendant Bal acted with deliberate indifference when he

denied plaintiff’s second level appeal regarding the conduct of defendants Brown, Harwell and

McAlpine. A copy of this appeal is attached to the first amended complaint, court file no. 7, p.

28-30 of 52. This presents a difficult situation in the deliberate indifference context.

In the appeal response dated June 26, 2008, defendant Bal summarized plaintiff’s

complaint as follows:

You contend on March 25, 2008, you were treated for what was diagnosed as

“spider bites,” and were prescribed antibiotics. You sought further health care

when the “spider bites” did not go away. You contend California Department of

Corrections and Rehabilitation (CDCR) medical staff was aware that some

inmates were incorrectly diagnosed with “spider bites,” when in fact they had

Methicillin-Resistant Staphylococcus Aureus (MRSA) infection. You were

diagnosed and on April 4, 2008, had surgery for MRSA infection. A physician

ordered dressing changes until the wound healed. On April 7, 2008, a nurse told

you that that day would be the last time your dressing was to be changed. You

showed her a copy of the physician’s order, but the dressing has not been changed

since that day. The actions or non-actions by medical staff are a violation of your

eighth amendment rights and have caused additional stress, pain, and suffering in

your postoperative condition.

You request 1) adequate medical care, including following all doctor’s orders,

daily change of dressing, and follow-up care; and 2) you further request $50,000

for distress and pain caused by the medical staff’s deliberate indifference in

refusing you follow-up treatment.

Id.

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The appeal response states, in relevant part,

Your appeal was PARTIALLY GRANTED at the FLR. The first level reviewer

responded as follows:

On March 30, 2008, nursing assessment for your skin condition. Dr. Reddy, oncall physician, ordered Bactrim DS one by mouth, twice per day for ten (10) days;

Ibuprofen 600 mg by mouth three (3) per day, as needed for five (5) days, and Dr.

Wedell saw you April 4, 2008, and diagnosed multiple abscesses. The right thigh

wound was cultured and you were started on Rifampin 600 mg by mouth twice

per day for fourteen (14) days. One nursing note on April 4, 2008, documents

dressing changes. The next documentation is April 18, 2008, in my clinic where

the right axilla abscess was found to be healed with active drainage on the anterior

abdominal wall and right thigh area. Hibiclens was given for cleansing of your

cell. Re-evaluation on April 24, 2008, showed all lesions healed. Nasal swab for

colonization was taken. You were seen again on May 2, 2008, and appraised that

the swab for colonization was negative. You have been receiving adequate

medical care.

Your request for monetary compensation is beyond the scope of the appeals

process, therefore denied.

In requesting a Second Level Review, you state “it is my contention that doctor’s

orders were not followed-dressing being changed daily–resulting in a medical

refusal, denial of care known as deliberate indifference. There is also the matter

of compensation that needs to be resolved.”

SECOND LEVEL APPEAL RESPONSE: Nursing staff follows the doctor’s order

of dressing change of infected skin lesions daily until needed. On April 9, 2008,

Dr. McAlpine ordered self-applicable dry dressing change daily to abdomen and

legs. This is a useful step to allow you to participate in your own care and

promote better healing. There was no refusal, denial of care, or deliberate

indifference. As stated on the First Level Review (FLR) by Dr. McAlpine, you

were given adequate medical care.

Again, monetary compensation is beyond the scope of the appeals process.

Id.

Defendants sued in their individual capacity must be alleged to have: personally

participated in the alleged deprivation of constitutional rights; known of the violations and failed

to act to prevent them; or implemented a policy that repudiates constitutional rights and was the

moving force behind the alleged violations. Larez v. City of Los Angeles, 946 F.2d 630, 646 (9th

Cir. 1991); Hansen v. Black, 885 F.2d 642 (9 Cir. 1989); Taylor v. List, 880 F.2d 1040 (9 Cir. th th

1989). “Although a § 1983 claim has been described as ‘a species of tort liability,’ Imbler v.

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Pachtman, 424 U.S. 409, 417, 96 S. Ct. 984, 988, 47 L.Ed.2d 128, it is perfectly clear that not

every injury in which a state official has played some part is actionable under that statute.” 

Martinez v. State of California, 444 U.S. 277, 285, 100 S. Ct. 553, 559 (1980). “Without

proximate cause, there is no § 1983 liability.” Van Ort v. Estate of Stanewich, 92 F.3d 831, 837

(9 Cir. 1996). th

The search, which was performed in accordance with this constitutionally valid 

strip search policy, was subsequently ratified by the School Board when Mr. 

Williams filed a grievance. Therefore, Williams’ only grasp at evoking municipal

liability under § 1983 is to show that this subsequent ratification is sufficient to 

establish the necessary causation requirements. Based on the facts, the Board 

believed Ellington and his colleagues were justified in conducting the search of 

Williams. There was no history that the policy had been repeatedly or even 

sporadically misapplied by school board officials in the past. Consequently, the 

School Board cannot be held liable for the ratification of the search in question, 

because this single, isolated decision can hardly constitute the “moving force” 

behind the alleged constitutional deprivation.

Williams v. Ellington, 936 F.2d 881, 884-885 (9 Cir. 1991). th

This court is unwilling to adopt a rule that anyone involved in adjudicating

grievances after the fact is per se potentially liable under a ratification theory. However, this is

not to say that persons involved in adjudicating administrative disputes, or persons to whom

complaints are sometimes made, can never be liable under a ratification theory. If, for example,

a reviewing official’s rejections of administrative grievances can be construed as an automatic

whitewash, which may have led other prison officials to have no concern of ever being

reprimanded, a ratifying official may be liable for having put a defective policy in place. 

The undersigned does not find that defendant Bal’s response to plaintiff’s

grievance constituted a whitewash which would have led the defendants to have no concern for

being reprimanded regarding their treatment of plaintiff. By the time defendant Bal reviewed the

grievance, plaintiff had been successfully treated for MRSA and his wounds had healed. 

Defendant Bal did not act with deliberate indifference in responding to this grievance. 

Accordingly, defendant Bal should be granted summary judgment. 

\\\\\

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Accordingly, IT IS HEREBY ORDERED that the Clerk of the Court shall assign

a district judge to this action; 

IT IS HEREBY RECOMMENDED that:

1. Plaintiff’s September 1, 2009, summary judgment motion (no. 18) be denied;

2. Defendants’ October 16, 2009, summary judgment motion (no. 22) be granted

as to defendant Bal but denied as to defendants McAlpine, Brown and Harwell. 

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 twentyone (21) 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 reply to the

objections shall be served and filed within seven (7) 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: 03/04/2010

/s/ Gregory G. Hollows

 

UNITED STATES MAGISTRATE JUDGE

coo2856.sj

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