Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_09-cv-01195/USCOURTS-azd-2_09-cv-01195-1/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

 James A. Payne, an individual, 

Plaintiff, 

vs.

State of Arizona; Arizona Department of

Corrections, a state agency; and Does 1

through 100,

Defendants. 

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No. CV-09-1195-PHX-NVW

ORDER

Before the Court is Defendant State of Arizona’s Motion to Dismiss II (doc. # 89),

treated as a motion for judgment on the pleadings pursuant to Fed. R. Civ. P. 12(c). 

I. Legal Standard

A motion for judgment on the pleadings is assessed under the standard applicable

to a motion to dismiss for failure to state a claim upon which relief may be granted under

Rule 12(b)(6) of the Federal Rules of Civil Procedure. See Aldabe v. Aldabe, 616 F.2d

1089, 1093 (9th Cir. 1980). Generally, only the face of the complaint and any attached

exhibits may be considered. Knievel v. ESPN, 393 F.3d 1068, 1076 (9th Cir. 2005). 

However, under the incorporation by reference doctrine, any documents “whose contents

are alleged in [the] complaint and whose authenticity no party questions” may also be

considered. Id. All of the plaintiff’s factual allegations are accepted as true and the

pleadings are construed in the light most favorable to the plaintiff. Id. at 1072; Hal Roach

Case 2:09-cv-01195-NVW Document 96 Filed 04/26/10 Page 1 of 8
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Studios, Inc. v. Richard Feiner & Co., 896 F.2d 1542, 1550 (9th Cir. 1989). Judgment on

the pleadings is appropriate only where the moving party “clearly establishes on the face

of the pleadings that no material issue of fact remains to be resolved and that it is entitled

to judgment as a matter of law.” Id.

II. Factual Allegations

The following allegations are derived from the Complaint (doc. # 1) and the Notice

of Claim (doc. # 1-1), attached to the Complaint as an exhibit. In 1983, Plaintiff James

Payne was diagnosed with Type I diabetes, treatment of which requires a consistent

insulin dosage and food regimen to maintain a healthy blood-sugar level. This includes a

particular dosage of insulin and the opportunity to eat a special diet within thirty minutes

of receiving the insulin. Short-term failure to maintain a healthy blood-sugar level causes

Payne to experience severe hypoglycemic and hyperglycemic episodes, during which he

lapses into states of incoherence or even unconsciousness. Long-term failure to maintain

a healthy blood-sugar level can cause severe and permanent physical deterioration and

disability. 

Payne was incarcerated in the Arizona State Prison Complex in Florence, Arizona

(“Florence prison facility”) in April 2002, where he remained until September 2002. In

September 2003, he received a second sentence based on the incident that resulted in his

first sentence, and was again incarcerated in the Florence prison facility, where he

remained until his release in September 2007. 

 The State of Arizona and the Arizona Department of Corrections were aware of

Payne’s disability but were deliberately indifferent to accommodating his needs and

disregarded the high risk that Payne would develop long-term complications related to his

diabetes. Upon arrival at the Florence prison facility, Payne received a physical exam in

which the examiner initially failed to diagnose his diabetes. He was also denied a

“diabetic meal card” for approximately a year and received insulin and food at irregular

intervals, preventing him from coordinating his insulin and food intake. When he was

able to coordinate the two, the food-to-insulin ratio was unhealthy and the food fluctuated

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in carbohydrate content, rendering control of his disease near impossible. His requests

for glucose tablets were often unmet due to lack of supply and when he did receive them,

the dosage was usually insufficient. As a result of these practices, Payne’s blood sugar

level was rarely within medically acceptable ranges. He often suffered severe

hypoglycemic and hyperglycemic episodes, during which he experienced incoherence or

sometimes even unconsciousness. During one episode, he suffered a seizure and

sustained a serious shoulder injury. 

 In August and September 2008, after his release from the Florence prison facility,

Payne sought medical care and was diagnosed with severe hypoglycemia, possible

gastroparesis, mild verbal recall deficit, peripheral and autonomic neuropathy, and a

shoulder injury that requires surgery. All of these conditions were caused by Payne’s

inability to maintain his blood-sugar levels during his incarceration.

On June 3, 2009, Payne sued Defendants State of Arizona and Arizona Department

of Corrections for negligence and for violating the Americans with Disabilities Act

(“ADA”), 42 U.S.C. § 12132, by failing to reasonably accommodate his diabetes while he

was incarcerated. On February 18, 2010, the Court dismissed both claims against

Defendant Arizona Department of Corrections for lack of jural status and dismissed the

negligence claim against the State as time-barred. (Doc. # 88.) The State now seeks

dismissal of the remaining ADA claim for failure to state a claim upon which relief can

be granted. 

III. Analysis

Pursuant to Title II of the ADA, “no qualified individual with a disability shall, by

reason of such disability, be excluded from participation in or be denied the benefits of

the services, programs, or activities of a public entity, or be subjected to discrimination by

any such entity.” 42 U.S.C. § 12132. To state a claim under 42 U.S.C. § 12132, a

plaintiff must allege that (1) he is “an individual with a disability,” (2) he is “otherwise

qualified to participate in or receive the benefits of some public entity’s services,

programs, or activities,” (3) he was “either excluded from participation in or denied the

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benefits of the public entity’s services, programs, or activities, or was otherwise

discriminated against by the public entity,” and (4) the exclusion, denial, or

discrimination was “by reason of” his disability. See McGary v. City of Portland, 386

F.3d 1259, 1265 (9th Cir. 2004) (quoting Thompson v. Davis, 295 F.3d 890, 895 (9th Cir.

2002)) (internal quotes omitted). 

Discrimination under the ADA includes a public entity’s failure to “make

reasonable modifications in policies, practices, or procedures when the modifications are

necessary to avoid discrimination on the basis of disability, unless . . . the modifications

would fundamentally alter the nature of the service, program, or activity.” 28 C.F.R. §

35.130(b)(7); see also Pierce v. County of Orange, 526 F.3d 1190, 1214 n.25 (9th Cir.

2007) (because Congress authorized the Attorney General to promulgate regulations

under the ADA, the regulations are given legislative weight unless “arbitrary, capricious,

or plainly contrary to the statute.”). When a public entity’s uniformly enforced policy or

program burdens a disabled person in a manner different from and greater than nondisabled persons, and the entity fails to reasonably accommodate the disability, the entity

discriminates against the disabled person “by reason of” his disability. McGary, 386 F.3d

at 1265. 

The State neither challenges the sufficiency of Payne’s allegation that he is

disabled within the meaning of the ADA nor argues that Payne has failed to plead facts

indicating he was qualified to receive the benefits of the prison’s services and programs. 

Instead, it attacks the claim on grounds that (1) Payne has failed to allege that other nondisabled prisoners received the same benefits he was denied, (2) the claim is improper

because it is no more than a disguised Eighth Amendment deliberate indifference claim,

and (3) claims challenging medical care in prisons are not cognizable under Title II of the

ADA.

The State’s first argument fails for two reasons. First, it has been foreclosed by the

Supreme Court. See Olmstead v. Zimring, 527 U.S. 581, 598 (1999) (declining to read

into the ADA a requirement that non-disabled individuals received preferential

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treatment); see also McGary, 386 F.3d at 1266. Second, as it relates specifically to

Payne’s ADA claim, it ignores the allegation that the State refused to reasonably modify

its meal and medication practices and procedures to accommodate Payne’s diabetes. 

When an ADA discrimination claim is predicated on denial of reasonable modifications

or accommodations to the entity’s practices and procedures, the plaintiff need not

demonstrate that other non-disabled individuals received the same benefits he or she was

denied. McGary, 386 F.3d at 1265-66. 

The State’s second argument is unsupported. This Court is aware of no authority

indicating that a plaintiff is precluded from asserting an ADA reasonable accommodation

claim merely because the factual allegations may support an Eighth Amendment

deliberate indifference claim. Both may be asserted simultaneously. See United States v.

Georgia, 546 U.S. 151, 157-59 (2006) (Title II of the ADA abrogates state sovereign

immunity to the extent the conduct complained of actually violates the Eight Amendment

right against cruel and unusual punishment). Moreover, to recover monetary damages

under Title II of the ADA, proof of intentional discrimination is required. Duvall v.

County of Kitsap, 260 F.3d 1124, 1138 (9th Cir. 2001). A plaintiff may prove intentional

discrimination by establishing that the defendant was deliberately indifferent. Id. 

Therefore, if anything, Payne’s references to deliberate indifference support rather than

undermine his ADA claim. 

The State’s third argument deserves closer scrutiny. While Title II undoubtedly

extends to the state prison context, Pennsylvania Dep’t of Corr. v. Yeskey, 524 U.S. 206,

213 (1998), there is disagreement among courts as to whether and when it supports

challenges to a prison’s medical and nutritional services. The Seventh Circuit, in

declining to recognize a plaintiff’s Title II challenge to a prison’s failure to accommodate

his paraplegia, has held that Title II of the ADA “does not create a remedy for medical

malpractice.” Bryant v. Madigan, 84 F.3d 246, 249 (7th Cir. 1996). The court

emphasized that “courts have labored mightily to prevent the transformation of the Eighth

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Amendment’s cruel and unusual punishments clause into a medical malpractice statute for

prisoners.” Id. 

Several district courts, relying on Bryant and other cases citing Bryant, have

similarly declined to recognize Title II claims challenging inadequate medical care. See,

e.g., Farid v. Demars, No. 06-CV-1545 (TJM/GJD), 2009 WL 455450, at *4-5, 2009

U.S. Dist. LEXIS 13949, at * 13-14 (N.D.N.Y. Feb. 23, 2009) (declining to apply Title II

to a plaintiff’s reasonable accommodations claim that prison officials denied him lowsugar food items); Rosado v. Alameida, No. 03CV1110J (LSP), 2005 WL 892120, at *2,

2005 U.S. Dist. LEXIS 3341, at *6-7 (S.D. Cal. Feb. 9, 2005) (declining to apply Title II

to a plaintiff’s claim that prison officials failed to have him evaluated for a liver

transplant, failed to place him on the liver transplant list, and failed to provide him with a

modified diet); Olson v. Meyers, No. 01 C 50023, 2004 WL 1280353, at *2, 2004 U.S.

Dist. LEXIS 10440, at *6 (N.D. Ill. June 7, 2004) (declining to apply Title II to a

plaintiff’s claim that a prison official denied him a diabetic snack on one occasion and

insulin on another).

However, subsequent Supreme Court authority suggests the ADA supports claims

alleging failure to accommodate disability-related needs in the provision of medical

services where the failure is deliberate. In Yeskey, the Supreme Court expressly noted

that the phrase “services, programs, or activities of a public entity” in 42 U.S.C. § 12132

encompasses medical services offered in prisons. 524 U.S. at 210. In a more recent

decision on the constitutionality of Title II’s abrogation of state sovereign immunity, the

Supreme Court stated, in dictum, that “it is quite plausible that the alleged deliberate

refusal of prison officials to accommodate . . . disability-related needs in such

fundamentals as . . . medical care” constitutes exclusion from or denial of the benefits of

the prison’s “services, programs, or activities” for purposes of Title II of the ADA. 

Georgia, 546 U.S. at 157 (citing Yeskey, 524 U.S. at 210) (emphasis added). 

Since Georgia, the First Circuit has recognized a Title II challenge to medical care

in a prison setting. See Kiman v. New Hampshire Dep’t of Corr., 451 F.3d 274 (1st Cir.

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2006). Relying on Georgia, the court acknowledged that “[m]edical care is one of the

‘services, programs, or activities’ covered by the ADA” but also noted that courts have

“differentiated ADA claims based on negligent medical care from those based on

discriminatory medical care.” Id. at 284. Where the challenged care is “simply a

reasoned medical judgment with which the patient disagreed,” state medical malpractice

law rather than the ADA is the appropriate vehicle in which to bring a claim. Id. at 285. 

However, where the challenged practice constitutes “outright denial of medical services,”

an ADA claim may lie. Id. at 287. Under those principles, the plaintiff’s challenge to the

prison’s diagnosis and treatment of his amyotrophic lateral sclerosis was not cognizable

under Title II of the ADA. Id. at 284-85. However, his challenge to corrections officers’ 

denial of access to his prescription medications was cognizable. Id. at 286-87.

At least one district court has taken a similar approach. See Hughes v. Colorado

Dep’t of Corr., 594 F. Supp. 2d 1226, 1241-42 (D. Colo. 2009). In Hughes, the plaintiff

alleged that the Colorado Department of Corrections violated Title II of the ADA by

denying him access to medical treatment for his mental disability. Id. at 1241. After

acknowledging Georgia’s dictum and the different treatment accorded challenges to

negligent medical care and challenges to outright denial of medical care, the court found

the plaintiff’s allegations sufficient to state a claim under Title II of the ADA. Id. at

1241-42.

 This Court finds that approach persuasive. Therefore, where a plaintiff’s factual

allegations paint a picture of mere negligence in the provision of medical services, a Title

II ADA claim cannot lie. On the other hand, where they indicate an outright and

deliberate denial or refusal of access to medical care for a qualifying disability, a plaintiff

may proceed under Title II. Here the factual allegations are insufficient because they do

no more than state a claim for negligence. That the State initially failed to diagnose

Payne’s diabetes amounts to no more than a negligent medical judgment. Furthermore,

that Payne received any glucose tablets, insulin, and food, albeit sporadically, indicates

that there was no outright and deliberate denial of access to care. Finally, the State’s

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“denial” of a diabetic meal card does not state a claim absent some indication that the

denial was deliberate and intentional. However, because this last deficiency may be

cured, the Complaint will be dismissed with leave to amend. See Doe v. United States, 58

F.3d 494, 497 (9th Cir. 1995) (court should grant leave to amend unless the pleading

cannot be cured by the allegation of other facts). 

IT IS THEREFORE ORDERED that the State’s Motion to Dismiss II (doc. # 89),

treated as a motion for judgment on the pleadings pursuant to Fed. R. Civ. P. 12(c), is

granted.

IT IS FURTHER ORDERED that the Complaint is dismissed with leave to amend

by May 10, 2010. If no amended complaint is filed by May 10, 2010, the Clerk shall

enter judgment dismissing this action with prejudice as to all Defendants.

 DATED this 26th day of April, 2010.

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