Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_08-cv-01279/USCOURTS-azd-2_08-cv-01279-9/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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Upon screening, the Court dismissed Thompson, Berger, Palosaari, Doe, Breummer,

Johnson, Kingsland, Herman, Linderman, Hatfield, Webb, Cooper, Butryn, Smith, Rios,

Kocho, Parsons, Mendoza, Sikes, Curran, Zavala, and Coleman as Defendants (Doc. #13).

WO JDN

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Karl Louis Guillen, 

Plaintiff, 

vs.

Gerald Thompson, et al., 

Defendants.

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No. CV 08-1279-PHX-MHM (LOA)

ORDER

Plaintiff Karl Louis Guillen brought this civil rights action under 42 U.S.C. § 1983

against Dora Schriro, Arizona Department of Corrections (ADC) Director, and Ronolfo

Macabuhay, Lewis Complex physician (Doc. #11).1

 Before the Court are the following

motions:

(1) Defendants’ Motion for Summary Judgment (Doc. #135);

(2) Plaintiff’s Motion to Strike (Doc. #151);

(3) Plaintiff’s Cross-Motion for Summary Judgment (Doc. #160); 

(4) Plaintiff’s Motion for Temporary Restraining Order (TRO) and Preliminary

Injunction (PI) (Doc. #178); and

(5) Plaintiff’s Motion for Emergency Examination (Doc. #183). 

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In July 2009, Plaintiff was transferred to Eyman-Special Management Unit (SMU) I

in Florence, Arizona (Doc. #76).

3

Allodynia is a condition in which ordinarily nonpainful stimuli evoke pain, and

hyperalgesia is extreme sensitivity to painful stimuli. Stedman’s Medical Dictionary

allodynia and hyperalgesia (27th ed. 2000).

4

Neuralgia is defined as “pain of a severe, throbbing, or stabbing character in the

course of distribution of a nerve.” Stedman’s Medical Dictionary neuralgia (27th ed. 2000).

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The Court will grant Defendants’ summary judgment motion, deny Plaintiff’s

motions, and terminate the action.

I. Background

Plaintiff initiated this action in July 2008 (Doc. #1), and he submitted his First

Amended Complaint on September 8, 2008 (Doc. #11). His claims stem from his

confinement in the Arizona State Prison Complex (ASPC)-Lewis, Rast Unit in Buckeye,

Arizona (id. at 1).2

 Plaintiff alleged that in April 2008, he began to suffer pain, allodynia,

and hyperalgesia (id. at 3).3

 He alleged that from May 10 to May 18, he submitted 14 Health

Needs Requests (HNRs) for treatment of his extreme pain from postherpetic neuralgia

(PHN), which Plaintiff described as “constant and unrelenting pain” and “the worst type of

pain known to mankind” (id.).4

 Plaintiff claimed that this pain interfered with his ability to

sleep, eat, exercise, and function. Plaintiff averred that when he was finally seen on May 18,

Macabuhay informed him that treatment could only be provided for up to 7 days because

there was no long-term treatment available (id. at 3-3(A)).

Plaintiff alleged that Defendants were aware that he was experiencing tachycardia,

high blood pressure, and severe weight loss due to the pain (id. at 3(A)). Plaintiff further

alleged that Defendants were aware that in 2005, Plaintiff was taken to the University of

Arizona Pain Clinic for an epidural spinal injection to alleviate pain caused by a prior flareup. Plaintiff contended that Schriro restricted Macabuhay’s ability to effectively treat

Plaintiff’s condition in part by reducing the medical care contract, which cut medical staff,

and by eliminating the majority of pharmacies that provided medication. Plaintiff alleged

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This claim was set forth in Count I of Plaintiff’s Complaint (Doc. #11 at 3-3(A)).

Plaintiff’s nine other counts were dismissed for failure to state a claim (Doc. #13).

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that both Defendants were deliberately indifferent to his serious medical condition (id.).5

On December 22, 2008, the Court screened the amended pleading and ordered service

on Defendants (Doc. #13). Service was executed in February 2009 (Doc. ##14-15). The

following month, Defendants submitted their Answer (Doc. #22), and the Court issued a

Scheduling Order (Doc. #23). Since that time, Plaintiff has filed at least 11 motions for

injunctive relief, primarily concerning his ongoing medical care, none of which have been

granted (see Doc. ##28-29, 47, 55-56, 58-59, 108, 143, 154, 166). 

Defendants have now moved for summary judgment (Doc. #135). 

II. Parties’ Contentions

A. Defendants’ Motion

1. Facts

In support of their motion, Defendants submit a separate Statement of Facts (DSOF)

(Doc. #136). DSOF are supported by Macabuhay’s declaration (id., Ex. B), which in turn

is supported by various attachments, including a copy of ADC’s Pharmacy Technical

Manual; copies of Plaintiff’s medical records; and a copy of ADC’s Health Services Manual

on Outside (Speciality) Care and Clinics (id., Attachs. 3-5). Defendants also submit the

declarations of Paulette Boothby, an ADC pharmacist (id., Ex. C) and Schriro (id., Ex. D).

The relevant portion of DSOF sets out the following facts:

Macabuhay did not see Plaintiff on May 18, 2008 (DSOF ¶ 50). Rather, he saw

Plaintiff on May 29, 2008, in response to Plaintiff’s complaint of extreme pain in the right

side of his chest from PHN (id.). Macabuhay noted Plaintiff’s PHN history and ordered that

he receive an injection of 20 mg of Nubain, a potent analgesic equivalent to morphine that

helps reduce pain, and an injection of 25 mg of Phenergan, an antihistamine that helps reduce

itching (id. ¶ 51). Macabuhay also recommended that the Medical Review Committee refer

Plaintiff to an outside consultant for epidural injections (which are provided at a pain

management clinic), completed a request for lidocaine patches, and wrote prescriptions for

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an analgesic balm and Tylenol with Codeine (id.). 

To fill prescriptions, the ADC maintains pharmacies within each ADC unit that are

independent of the ADC physicians (id. ¶ 25). The ADC pharmacies operate on a drug

formulary system (id. ¶ 31). When a physician writes a prescription, it is transmitted to the

pharmacy, which fills the prescription and contacts the inmate for pick-up or other

arrangements based on any existing security concerns (id. ¶ 26). Any prescription for a

Brand name is dispensed by the Generic substitution (id. ¶ 29). Physicians do have the

ability to request non-formulary drugs; however, they have no authority or control over how

or when the ADC pharmacy fills prescriptions (id. ¶¶ 31, 27). 

Pursuant to a mandate issued by the state legislature, the ADC began consolidating

and automating prison pharmacies in 2005 (id. ¶ 34). This consolidation plan served to

reduce costs and increase accuracy through bar-code driven automation of prescription fills,

inventory control process, and a reduction in sites required for specialized pharmaceutical

support (id.). Various prison pharmacies were closed; however, the pharmacies at Lewis,

Eyman, Perryville, Phoenix, and Tucson remained opened and provided services to those

prison complexes that lost pharmacies (id. ¶¶ 36-41). 

Except for the lidocaine patches, the prescriptions written by Macabuhay following

the May 29, 2008 appointment were filled the next day (id. ¶ 51).

As to Macabuhay’s request for an outside consultant for epidural injections, the

Medical Review Committee does not refer inmates directly to the University of Arizona pain

management clinic; rather, the Review Committee refers inmates to an outside neurologist

for evaluation and treatment, which may include a referral for injections at a pain

management clinic (id. ¶ 52). 

Macabuhay saw Plaintiff again on June 12, 2008, in response to complaints of

worsening pain and that the analgesics were not working (id. ¶ 53). Macabuhay ordered that

Plaintiff receive an injection of 20 mg of Nubain and 25 mg of Phenergan, discontinued the

analgesic balm prescription, and requested the status on the drug request for lidocaine

patches and the outside consultant request for epidural injections (id.). Nurse Hoffman gave

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Plaintiff an injection of 20 mg of Nalbuphine HCL, a generic equivalent for Nubain, and 25

mg of Phenergan (id.). 

On June 19, 2008, Macabuhay saw Plaintiff and ordered another 20 mg of Nubain and

25 mg of Phenergan (id. ¶ 54). Hoffman gave Plaintiff 20 mg of Nalbuphine HCL and 25

mg of Phenergan (id.). 

On July 10, 2008, Macabuhay saw Plaintiff again and noted acute exacerbation of

PHN (id. ¶ 55). Macabuhay ordered that Plaintiff receive medical ice for eight days, lay-in

(no work and meals in cell) for eight days, and he requested a check of the status on the

lidocaine patches (id.). Macabuhay also ordered that Plaintiff receive 20 mg of Nubain and

25 mg of Phenergan daily for ten days (id.). Hoffman administered the injections (id.).

Macabuhay then saw Plaintiff on July 31, 2008, in response to Plaintiff’s increasing

pain in the right side of his chest (id. ¶ 56). Macabuhay again ordered follow-up on the

request for lidocaine patches, and he ordered another 20 mg of Nubain and 25 mg of

Phenergan, which were administered by Hoffman (id. ¶ 56). 

Macabuhay saw Plaintiff again on August 14, 2008, at which time Plaintiff

complained of right-side pain but said that the Nalbuphine and Phenergan injections helped

(id. ¶ 57). Macabuhay submitted a drug request for Methadone and ordered that the

Nalbuphine and Phenergan injections continue for 7 more days, and he increased the

Phenergan from 25 mg to 50 mg (id.). Macabuhay also re-submitted the outside consultant

request for a referral to a pain management clinic (id.). 

On August 26, 2008, Central Office approved the request for non-formularly

Neurontin (substitute for Methadone) (id. ¶ 58). On September 11, 2008, Macabuhay noted

in Plaintiff’s medical record that the request for a referral to a pain management clinic was

denied by Central Office, which instead recommended up to 900 mg of Neurontin a day; up

to 100 mg of Elavil every night; lidocaine ointment; and capsaicin, a nonsteroidal antiflammatory drug, or Tylenol (id. ¶ 59). Meanwhile, Plaintiff continued to take 300 mg of

Gabapentin (a generic equivalent for Neurontin), three times a day, with a seven-day supply

provided every Wednesday (id. ¶¶ 59-60). 

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On September 25, 2008, Macabuhay saw Plaintiff, who reported that the

Neurontin/Gabapentin appeared to decrease his pain slightly (id. ¶60). Macabuhay noted that

Plaintiff was ambulatory and did not appear to be in much distress; however, he did appear

more depressed, and he was not responding to the current PHN treatment (id.). Macabuhay

increased the Neurontin/Gabapentin from 300 to 600 mg 3 times a day for 30 days and from

600 to 900 mg 3 times a day for 6 months thereafter (id.). Macabuhay also submitted another

drug request for lidocaine patches and ordered a Nubain injection. Hoffman administered

the injection, and the pharmacy filled Plaintiff’s prescription for 90 60-mg tablets of

Gabapentin with a seven-day supply provided each Wednesday (id.). Macabuhay renewed

the Gabapentin prescription on November 5, 2008 (id.).

On November 12, 2008, Macabuhay noted in Plaintiff’s medical record that the May

29 and September 25, 2008 requests for lidocaine patches were disapproved, as was the

request to increase Plaintiff’s dosage of Neurontin/Gabapentin and the request for an outside

consultant/referral to a pain management clinic (id. ¶ 61). Macabuhay documented his

recommendation to treat Plaintiff with lidocaine patches, nonsteroidal anti-inflammatory

drugs, and to increase Neurontin/Gabapentin, which Plaintiff was currently taking at a dosage

of 900 mg three times a day (id.). Macabuhay also ordered a check to see if Plaintiff had

ever taken Elavil (id.).

On November 13, 2008, Macabuhay saw Plaintiff and determined that there were no

side effects from the Neurontin/Gabapentin, noted that Plaintiff could not take Elavil, and

found that his PHN was under control (id. ¶ 62). 

Macabuhay did not see Plaintiff again until June 23, 2009, at which time Plaintiff

appeared in acute distress when his right side was touched (id. ¶ 63). Macabuhay ordered

that Plaintiff receive 20 mg of Nubain and 25 mg of Phenergan; Hoffman administered the

injections. And Macabuhay submitted a request to the Medical Review Committee for an

outside consultation with a pain management clinic for epidural injections (id.)

On July 21, 2009, Plaintiff was transferred from the Lewis complex to ASPC-Eyman

SMU I, where he was moved to the care of another physician at that facility (id.).

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Since his transfer, Plaintiff has been seen by a neurologist, who referred Plaintiff to

a pain management clinic (id. ¶ 76). The record reflects that Plaintiff received epidural

injections at a pain management clinic in January and February 2010 (Doc. #176 at 1).

2. Legal Arguments

Defendants move for summary judgment on the grounds that they were not

deliberately indifferent to Plaintiff’s medical needs and they are entitled to qualified

immunity (Doc. #135). Defendants argue that the facts show that ADC has expended

considerable time and resources providing medical care to Plaintiff for his PHN (id. at 12).

They maintain that although there was a reduction in the number of prison pharmacies, that

reduction did not affect Plaintiff’s care or prescriptions because the pharmacies at the Lewis

Complex—where he was housed when his claim arose—and at the Eyman Complex—where

he was subsequently housed, were not closed or changed (id. at 13). Defendants assert that

the restrictions on Plaintiff’s prescriptions were due to his failure to follow prescribed time

and dosage requirements, which left him unable to possess a large quantity of his medication

(id.). Defendants acknowledge that there were isolated instances of delay in filling Plaintiff’s

prescriptions, but they note that ADC pharmacies filled 670,193 inmate prescriptions in 2008

and even more in 2009 (id.). 

Defendants contend that Macabuhay timely responded to Plaintiff’s medical needs

and, in fact, provided care beyond constitutional standards (id.). They further contend that

there is no evidence that Schriro violated Plaintiff’s right to treatment or sanctioned a

constitutionally deficient health care program for inmates (id.). 

Defendants next argue that even if there were sufficient facts to establish a

constitutional violation, they are entitled to qualified immunity (id. at 14). They assert that

Schriro has no medical training and no involvement in establishing medical protocols or

prescribing treatment; thus, it would not be clear that her actions violated Plaintiff’s Eighth

Amendment rights (id.). As to Macabuhay, Defendants contend that Macabuhay had no

authority to send Plaintiff to outside providers absent further authorization, so it would not

be clear to him that his actions in treating Plaintiff were unlawful (id. at 14-15). 

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The Court issued a Notice pursuant to Rand v. Rowland, 154 F.3d 952, 962 (9th Cir.

1998) (en banc), informing Plaintiff of his obligation to respond (Doc. #137). 

7

The remaining attachments and exhibits, which are not directly related to the issues

in this suit, include the following: copies of reviews of Plaintiff’s book, copies of certificates

of completion or achievement he has earned in prison, ADC policies governing placement

in maximum security and Plaintiff’s grievances and appeals related to his placement (Doc.

#160, Attach. 1-6); excerpts from various publications on high blood pressure, Gabapentin,

chronic pain, and space research (Attachs. 9-11); a copy of ADC’s policy on protective

segregation (id., Ex. 1, Attach. 13; Ex. T); copies of some of Plaintiff’s previously filed

motions for injunctive relief (id., (second) Attach. 3); copies of ADC’s Fiscal Year

Appropriations Reports from 2005-2009 (id., Ex. F); the declarations and copies of Health

Needs Requests from inmates Edward Valenzuela, Abel Trujillo, Robert Martinez, and

Aaron Kraft (id., Exs. K, M-N, Q); excerpt from “Rights of Prisoners,” third edition (id., Ex.

L); and the copy of a stipulation for injunctive relief in a 2001 case in the United States

District Court for the Northern District of Ohio (id., Ex. U).

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B. Plaintiff’s Response6

Plaintiff’s initial response to Defendants’ motion was his own Motion to Strike

specific portions of DSOF (Doc. #151). Plaintiff contends that various paragraphs within

DSOF are misrepresentations, based upon fraud, and constitute hearsay (id. at 1). 

Plaintiff then filed a combined Motion for Summary Judgment and Response to

Defendants’ motion and his own separate Statement of Facts (PSOF) (Doc. ##160, 162). 

1. Facts

Plaintiff’s response memorandum and PSOF are supported by approximately 370

pages of exhibits that include his own affidavit with attached medical records (Doc. #160,

Ex. A, Attach. 7); copies of grievance appeals to Schriro related to his medical care (id.,

(second) Attach. 1); Macabuhay’s responses to interrogatories (id., Ex. D); Schriro’s

responses to requests for admissions (id., Ex. O); and a copy of ADC’s Manual on NonFormulary Drug Requests (id., Ex. R).7

 The relevant portion of PSOF presents the following

facts:

On May 12, 2008, Plaintiff filed an emergency HNR for PHN pain; however, he was

not seen by Macabuhay until May 29, 2008 (Doc. #162, PSOF ¶ 23). Macabuhay was aware

of Plaintiff’s chronic condition, which required specific treatment (id. ¶ 24). Plaintiff

suffered in pain from approximately June 8 until September 25, 2008, and from June 20 to

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Plaintiff was placed into detention for disciplinary reasons in response to a charge of

gambling (Doc. #45 at 3). Plaintiff filed motions for a TRO and an injunction related to his

detention placement (Doc. ##28-29). The Court ordered briefing and subsequently denied

Plaintiff’s motions on the ground that the evidence showed that Plaintiff went without

medications for just four days, that he received treatment—including a pain shot and

medications—on May 12, 2008, and that thereafter he maintained possession of allergy

medications and medicine for his PHN (Doc. #91 at 11-12).

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July 9, he had no medication (id. ¶¶ 25-29, 31). Although Macabuhay wrote prescriptions

in August 2008 for Lidocaine, Methadone, and Gabapentin, “[o]nly a low dose of Gabapentin

arrived” (id. ¶ 30). 

From late September to mid-November, 2008, Plaintiff’s pain level was reduced

slightly; however, Macabuhay noted that Plaintiff was not responding to treatment, and

Macabuhay was informed by Central Office that multiple medications would be necessary

to treat Plaintiff’s PHN (id. ¶ 32). Plaintiff suffered in extreme pain from mid-November,

2008 to May 12, 2009 (id. ¶ 33). 

On May 8, 2009, Macabuhay and Director Ryan permitted Plaintiff to be placed into

a “hot cell” in the Rast detention unit without medications, bedding, or toiletries; these

conditions increased Plaintiff’s pain and led to his transport to the Complex emergency room

on May 12, 2009 (id. ¶ 34).8

 On June 23, 2009, Macabuhay noted that Plaintiff was in acute

distress and gave Plaintiff a pain shot but sent him back to the detention unit cell (id. ¶ 36).

In July 2009, Plaintiff was transferred to SMU I. Upon his arrival to SMU I, Plaintiff

was taken via ambulance to St. Mary’s hospital for treatment (id. ¶ 37). 

On each of the nine occasions that Macabuhay examined Plaintiff from May 2008

through July 2009, Plaintiff’s blood pressure was extremely high (id. ¶ 40).

2. Legal Arguments

Plaintiff argues that he has suffered from an ongoing denial of adequate medical

treatment and that Defendants have been deliberately indifferent to his serious medical

condition (Doc. #160 at 4). 

Plaintiff asserts that beginning in May 2008, Macabuhay issued temporary relief in

the form of pain shots; however, prescriptions for other medications were never filled or

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issued (id. at 6). Plaintiff claims that as a result, he suffered extreme pain regularly between

pain shots (id.). Plaintiff also asserts that Macabuhay merely issued a pain shot in response

to Plaintiff’s suffering after he was placed in a “hot cell” in May 2009, and Macabuhay even

returned him to the “hot cell” despite the exacerbating effect of the heat and stress from the

housing conditions (id. at 7). And Plaintiff claims that Macabuhay failed to address

Plaintiff’s high blood pressure, which has resulted in extreme pain, the inability to function,

stage 3 high blood pressure, and cardiovascular pain (id. at 8). Plaintiff concludes that

Macabuhay’s actions constitute deliberate indifference (id.).

As to Schriro, Plaintiff asserts that her budget reductions for outside services and

pharmacy “reduction” since 2006 have effectively denied Plaintiff adequate medical

treatment and that ADC policies restricted Macabuhay from providing adequate medical

treatment (id. at 4-5). Plaintiff states that the outside services budget was consistently around

$70-85 million per year from 2003 to 2006, but in 2006, Schriro cut that budget by $52

million (id. at 9). Plaintiff maintains that he was unable to see a physician every month, even

for emergency chronic care and extreme pain, because there was insufficient staffing at the

Lewis Complex (id. at 9). He states that he was on a 6 1/2 month waiting list at SMU I to

see a doctor for an emergency HNR (id.).

Plaintiff argues that the ADC pharmacy formulary does not contain appropriate

analgesic agents to manage his PHN, and, consequently, ADC has over-dosed Plaintiff on

Gabapentin despite Plaintiff’s medical history showing that he would suffer side-effects from

Gabapentin (id. at 5). He also states that there is no ADC protocol for treating PHN (id. at

10). Plaintiff asserts that under ADC policy, the treating physician has no final determination

in Plaintiff’s treatment because there are administrative restrictions—Technical Manuals

governing non-formulary drugs, algorithms, and the Medical Review Committee—that

restrict treatment (id.). Plaintiff contends that these restrictions were not present prior to

Schriro’s budget cuts (id.).

Plaintiff alleges that Ryan, as the current ADC Director, is also liable individually

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because he was put on notice of the emergency nature of Plaintiff’s condition but disregarded

the risk to Plaintiff (id. at 11). 

With respect to Defendants’ claim of qualified immunity, Plaintiff notes that

Defendants do not contest that his medical condition was sufficiently serious to constitute

a serious medical need, and he asserts that the facts clearly demonstrate that Defendants were

well aware of the risk to Plaintiff (id. at 11-12). 

Plaintiff concludes by requesting summary judgment against both Macabuhay and

Schriro, and he requests that the Court convene a 3-Judge Panel for Release Order and place

ADC’s health care services under Federal Receivership (id. at 15). 

C. Defendants’ Reply

In response to Plaintiff’s Motion to Strike, Defendants note that most of Plaintiff’s

objections to certain paragraphs within DSOF are not supported by a reference to the record

or any other evidence (Doc. #173). Defendants argue that to the extent that Plaintiff cites to

evidence to support his motion, those citations fail to support his objections (id. at 4). They

submit that Plaintiff’s motion is based on his own conclusory statements or inappropriate

references to the record (id. at 4-5).

As to Plaintiff’s evidence submitted with his motion/response, Defendants contend

that much of the affidavit testimony fails to meet the prerequisites of admissibility—based

upon personal knowledge, admissible at trial, and offered by a competent affiant (id. at 5-7).

They further contend that PSOF are compound, conclusory, and argumentative (id. at 7).

Defendants note that PSOF protests his current custody assignment and alleges deprivation

of due process; issues unrelated to this action (id.). Defendants argue that references Plaintiff

cites in support of his PSOF are themselves conclusory statements from Plaintiff’s affidavit

(id.). And Defendants assert that Plaintiff is not competent to make the numerous medical

observations and conclusions that he makes throughout his affidavit and response (id.). They

also assert that Plaintiff likewise does not have the competence to testify to matters regarding

state-agency funding, pharmacy funding, staffing and protocols, or the ADC heath care

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delivery system (id. at 7-8). Defendants submit that PSOF should be disregarded in its

entirety (id. at 8).

In reply in support of their summary judgment motion, Defendants argue that Plaintiff

does not dispute that Macabuhay examined him numerous times and provided treatment, nor

does Plaintiff proffer evidence to support that Macabuhay was deliberately indifferent (id.

at 9). Defendants contend that Plaintiff’s claim against Schriro is supported only by isolated

incidents where he did not receive timely prescriptions, which they claim is insufficient to

defeat summary judgment (id. at 10). And they maintain that there are no grounds for

granting Plaintiff’s request for mandatory injunctive relief. Defendants note that the

Court—in addressing a prior preliminary injunctive motion—has already found that Plaintiff

is receiving “treatments considered to have the best efficacy in treating post-herpetic

neuralgia” (id. at 11, citing Doc. #127 at 7).

III. Legal Standards

A. Summary Judgment

A court must grant summary judgment “if the pleadings, the discovery and disclosure

materials on file, and any affidavits show that there is no genuine issue as to any material fact

and that the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(c); see

also Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). Under summary judgment

practice, the movant bears the initial responsibility of presenting the basis for its motion and

identifying those portions of the record, together with affidavits, that it believes demonstrate

the absence of a genuine issue of material fact. Celotex, 477 U.S. at 323; Devereaux v.

Abbey, 263 F.3d 1070, 1076 (9th Cir. 2001) (en banc). 

If the movant meets its burden with a properly supported motion, the burden then

shifts to the nonmovant to present specific facts that show there is a genuine issue for trial.

Fed. R. Civ. P. 56(e); Auvil v. CBS “60 Minutes”, 67 F.3d 816, 819 (9th Cir. 1995); see

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The nonmovant need not

establish a material issue of fact conclusively in its favor; it is sufficient that “the claimed

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factual dispute be shown to require a jury or judge to resolve the parties’ differing versions

of the truth at trial.” First Nat’l Bank of Ariz. v. Cities Serv. Co., 391 U.S. 253, 288-89

(1968). By affidavit or as otherwise provided by Rule 56, the nonmovant must designate

specific facts that show there is a genuine issue for trial. Anderson, 477 U.S. at 249;

Devereaux, 263 F.3d at 1076. The nonmovant may not rest upon the pleadings’ mere

allegations and denials, but must present evidence of specific disputed facts. See Anderson,

477 U.S. at 248. 

At summary judgment, the judge’s function is not to weigh the evidence and

determine the truth but to determine whether there is a genuine issue for trial. Id. at 249. In

its analysis, the court must believe the nonmovant’s evidence, and draw all inferences in the

nonmovant’s favor. Id. at 255.

B. Eighth Amendment

To prevail on an Eighth Amendment medical-care claim, a prisoner must demonstrate

“deliberate indifference to serious medical needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th

Cir. 2006) (citing Estelle v. Gamble, 429 U.S. 97, 104 (1976)). A plaintiff must show (1) a

“serious medical need” and (2) that the defendant’s response was deliberately indifferent.

Jett, 439 F.3d at 1096 (citations omitted).

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.’”

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

Techs., Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc) (internal citation

omitted). 

To act with deliberate indifference, a prison official must both know of and disregard

an excessive risk to inmate health; the 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. Farmer v. Brennan, 511 U.S. 825, 837 (1994). In the medical context,

deliberate indifference may be shown by a purposeful act or failure to respond to a prisoner’s

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pain or possible medical need and harm caused by the indifference. Jett, 439 F.3d at 1096.

Prison officials are deliberately indifferent to a prisoner’s serious medical needs if they deny,

delay, or intentionally interfere with medical treatment. Wood v. Housewright, 900 F.2d

1332, 1334 (9th Cir. 1990). But a delay in providing medical treatment does not constitute

an Eighth Amendment violation unless the delay was harmful. Hunt v. Dental Dep’t, 865

F.2d 198, 200 (9th Cir. 1989) (citing Shapley v. Nevada Bd. of State Prison Comm’rs, 766

F.2d 404, 407 (9th Cir. 1985) (per curiam)). 

“[A] mere ‘difference of medical opinion . . . [is] insufficient, as a matter of law, to

establish deliberate indifference.’” Toguchi v. Chung, 391 F.3d 1051, 1058 (9th Cir. 2004)

(citation omitted). Therefore, to prevail on a claim involving choices between alternative

courses of treatment, a prisoner must show that the course of treatment the doctors chose was

medically unacceptable in light of the circumstances and that it was chosen in conscious

disregard of an excessive risk to plaintiff’s health. Jackson v. McIntosh, 90 F.3d 330, 332

(9th Cir. 1996).

IV. Analysis

A. Plaintiff’s Motion to Strike

The Court finds that many of Plaintiff’s objections to DSOF concern facts that are not

relevant. Further, as argued by Defendants, some of Plaintiff’s objections are completely

unsupported or not adequately supported by the referenced citations (see Doc. #173 at 4).

As to any pertinent remaining objections, the Court confirms that it may not consider

inadmissible or unsupported facts in its summary judgment analysis and therefore has not

relied on any evidence that would not be admissible at trial. See Fed. R. Civ. P. 56(e); Orr

v. Bank of Am., 285 F.3d 764, 773 (9th Cir. 2002). Plaintiff’s Motion to Strike will therefore

be denied, as will Defendants’ request that PSOF be disregarded in its entirety.

B. Macabuhay

Defendants do not dispute that Plaintiff’s PHN condition constituted a serious medical

need, thereby satisfying the first prong of the deliberate indifference test. Estelle, 429 U.S.

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at 104. Thus, the summary judgment analysis on Macabuhay’s liability turns on whether his

response to Plaintiff’s serious medical need was deliberately indifferent. See Jett, 439 F.3d

at 1096.

Macabuhay maintains that he was not deliberately indifferent to Plaintiff’s serious

medical need. In his declaration, Macabuhay describes his examinations of Plaintiff from

June 2007 through June 2009, during which time he saw Plaintiff approximately 14 times and

conducted at least two reviews of Plaintiff’s medical records independent of those office

visits (Doc. #136, Ex. B, Macabuhay Decl. ¶¶ 27-29, 32-36, 38-42). Macabuhay’s averments

and the attached medical records reflect that Macabuhay responded to Plaintiff’s complaints,

prescribed various medications and changed the dosages according to Plaintiff’s responses,

and submitted requests for additional treatment to the Medical Review Committee (see id.).

Macabuhay explains that he has no control over the pharmacy’s handling of

prescriptions and that the process is similar to the civilian sector’s physician/pharmacy

relationship; he writes the prescription and the pharmacy fills it and provides it to the inmate

(id. ¶¶ 18-20). Defendants’ evidence includes the copies of the policies governing nonformulary drug requests, which Plaintiff claims most of his required medication constituted

(id., Attach. 6). According to the Technical Manual on non-formulary drug requests, the

request is submitted to the Key Contact Pharmacist, who either approves the request or

suggests alternative therapies and then forwards the request to the Central Office and the

ADC Clinical Pharmacist (id. at 2, §§ 3.0, 3.2). According to the Manual, the request is then

sent to the Medical Program Manager or Health Services Bureau Administrator for approval

(id. § 3.2). This evidence demonstrates that once Macabuhay wrote prescriptions for various

medications, the ultimate provision of those medications—whether they were on the ADC

formulary or were non-formulary drugs—was through the ADC pharmacy, which was out

of Macabuhay’s authority and control. 

Plaintiff does not dispute that he saw Macabuhay regularly from 2007-2009, or that

Macabuhay provided the treatment described in his declaration (see Doc. #160, Ex. 1, Pl.

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Aff. ¶¶ 9, 11). Also, Plaintiff acknowledges that Macabuhay’s prescriptions are subject to

approval by the pharmacist and that some treatment protocols are subject to approval by the

Medical Review Committee (id. ¶¶ 11-12). Much of Plaintiff’s affidavit concerns his

complaint over the inability to see Macabuhay or another ADC physician immediately in

response to his HNRs seeking treatment (see ¶¶ 9-10). But as Macabuhay explains, the

HNRs are reviewed by a nurse who determines whether a physician’s involvement is

required and if so, schedules an appointment (Doc. #136, Ex. B, Macabuhay Decl. ¶ 15).

Thus, like the provision of prescription medication, this is an aspect of the health care system

beyond Macabuhay’s control.

Plaintiff asserts that Macabuhay was deliberately indifferent because he failed to

address Plaintiff’s high blood pressure. The evidence Plaintiff relies on in support of this

claim is his affidavit, and in the respective paragraphs in his affidavit, Plaintiff’s only citation

is to an article from the Mayo Clinic Family Health Book on high blood pressure (Doc. #160,

Ex. A, Pl. Aff. ¶ 10, citing Attach. 9). This is not competent evidence to show deliberate

indifference by Macabuhay. Standing alone, Plaintiff’s conclusory allegations that

Macabuhay failed to adequately treat his high blood pressure are insufficient to prevent

summary judgment. See Leer v. Murphy, 844 F.2d 628, 634 (9th Cir. 1988); see also

Hutchinson v. United States, 838 F.2d 390, 393 (9th Cir. 1988) (granting summary judgment

against a plaintiff who relied only on her own allegations and conclusory statements that

defendants had been negligent and who failed to provide affidavits or depositions of experts).

When a prisoner attempts to hold a prison employee responsible for deliberate

indifference, the prisoner must establish individual fault. Leer, 844 F.2d at 634. Plaintiff has

failed to do so here. Indeed, Plaintiff’s own evidence and admissions support the conclusion

that in his capacity as an ADC physician, Macabuhay provided adequate treatment for

Plaintiff’s PHN. At the most, Plaintiff establishes a disagreement with some of the decisions

regarding his health care and prescribed medications. But in the absence of any competent

evidence to show that Macabuhay’s decisions or course of treatment were medically

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unacceptable under the circumstances, Plaintiff cannot demonstrate a material factual dispute

that Macabuhay disregarded an excessive risk to Plaintiff’s health and was deliberately

indifferent. See Toguchi, 391 F. 3d at 1058; Jackson, 90 F.3d at 332. The Court will

therefore grant summary judgment to Macabuhay, and deny Plaintiff’s request for summary

judgment on this claim.

C. Schriro 

Next, the Court addresses Plaintiff’s claim that Schriro is liable for deliberate

indifference based on budget cuts made during her tenure as ADC Director; Plaintiff alleges

that those cuts affected staffing and access to prescription medication to such a degree that

his care fell below Eighth Amendment standards (Doc. #160 at 9-10). Plaintiff also claims

that in a July 2008 grievance appeal, Schriro was put on notice that he was denied medical

treatment (Doc. #162, PSOF ¶ 47).

Plaintiff’s claim against Schriro alleges both individual and official-capacity liability.

To establish individual-capacity liability, Plaintiff must show that Schriro personally

participated in the violation of Plaintiff’s constitutional rights, acted with deliberate

indifference to Plaintiff’s constitutional rights, or failed to take action to prevent further

misconduct. King v. Atiyeh, 814 F.2d 565, 568 (9th Cir. 1987). To show official-capacity

liability, Plaintiff must demonstrate that action taken pursuant to an official government

policy or custom caused a constitutional violation. Berry v. Baca, 379 F.3d 764, 767 (9th

Cir. 2004) (citing Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 694 (1978) (if the defendant

is sued in her official capacity, the plaintiff must set fourth facts to support that the defendant

either created the harm or acted pursuant to an official policy of custom that caused the

constitutional injury).

Schriro avers that she does not have a medical degree, did not create medical

treatment protocols, and was not involved in providing or denying treatment to inmates (Doc.

#136, Ex. D, Schriro Decl. ¶¶ 4-5). She further avers that she delegated the management of

inmate health services to the Health Services Bureau Administrator, who in turn assigned the

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Medical Programs Manager to develop healthcare policies and procedure (id. ¶ 3). Plaintiff

submits that his only contact with Schriro was through a grievance appeal, which he notes

was signed by another officer on her behalf (Doc. #162, PSOF ¶ 47). Thus, there is no

evidence that Schriro was aware of Plaintiff’s treatment or any delays and failed to act in

disregard to the risk to Plaintiff’s health. See May v. Enomoto, 633 F.2d 164, 167 (9th Cir.

1980) (the prison director “could not be charged with responsibility for the neglect or delay,

if any, of his subordinates in the absence of his direction or participation therein”). 

To support his official-capacity claim against Schriro, Plaintiff asserts that cuts to

staffing left him and other inmates unable to see physicians weekly or monthly, even for

emergency care (Doc. #160 at 9). He further asserts that Schriro’s changes to health care

policies meant that physicians could no longer provide direct treatment to inmates (Doc.

#162, PSOF ¶ 12). But, as discussed above, there is no evidence to support a finding that

Plaintiff’s medical care fell below Eighth Amendment standards or otherwise violated federal

law. The record shows that from June 2007-June 2009, Plaintiff saw Macabuhay

approximately 14 times (Doc. #136, Ex. B, Macabuhay Decl. ¶¶ 27-29, 32-36, 39, 41-42).

The record further shows that since July 2009, Plaintiff has been seen by either ADC

physicians or outside consultant physicians on at least 7 occasions (id., DSOF ¶¶ 65-66 (July

21, 2009), ¶ 70 (July 31, 2009), ¶ 76 (Oct. 27, 2009); Doc. #180, Ex. A (Jan. 12, 29, Feb.

5, 12)). 

Plaintiff’s declarations from other inmates also fail to support his claim that inmates

are forced to wait months for medical care because there is insufficient documentary

evidence to support the declarations, and the evidence that is attached does not support that

there were delays in medical care. For example, the HNRs accompanying Valenzuela’s

affidavit show that when he sought mental health care for hearing voices, he saw a

psychiatrist within two weeks (Doc. #160, Ex. K, Attach. at 1 (Sept. 7, 2009 HNR) and 4

(Sept. 19, 2009 HNR—complaining about the psychiatrist he saw)). And Martinez avers that

he submitted several HNRs in June/July 2009, but was not seen until an emergency medical

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service was activated; however, he does not indicate when that emergency medical service

was activated, and there are no medical records attached to the declaration (id., Ex. N). 

To the extent that Plaintiff or another inmate may have experienced an isolated delay

in medical care, Plaintiff submits no evidence to demonstrate that any such delays were

attributable to policy changes caused by budget cuts made by Schriro’s administration.

“Liability for improper custom may not be predicated on isolated or sporadic incidents; it

must be founded upon practices of sufficient duration, frequency, and consistency that the

conduct has become a traditional method of carrying out policy.” Trevino v. Gates, 99 F.3d

911, 918 (9th Cir. 1996) (citation omitted); see Monell, 436 U.S. at 692 (the practice or

custom must be so “persistent and widespread” that it constitutes a “permanent and well

settled policy”).

Plaintiff next alleges that the consolidation of ADC pharmacies resulted in restrictions

to non-formulary drugs, which he needed to control his PHN (Doc. #160 at 10; see Doc. #151

at 2 par 5 (Pl. identifying Gabapentin and Lidocaine as non-formulary drugs)). But

Plaintiff’s allegations regarding receipt of his non-formulary medications are contradictory.

He asserts that his prescriptions were often never filled (see Doc. #151 at 2 ¶¶ 9, 11); yet, he

also states that his Gabapentin prescription dosage has not been increased, that he now

suffers side-effects from taking Gabapentin, and that the lidocaine patches do not provide

sufficient relief (Doc. #162, PSOF ¶¶ 42-43, 45). These claims demonstrate that Plaintiff

has, in fact, received his medications. 

As to the efficiency of the ADC pharmacies following consolidation, Macabuhay

avers that he observed minimal to no disruption on inmates’ ability to timely receive

prescriptions and there have been no notable changes in the pharmaceuticals available for

prescriptions (Doc. #136, Ex. B, Macabuhay Decl. ¶¶ 24-25). According to the ADC

Pharmacy Program Manager, the consolidated prison pharmacy system filled 670,000

prescriptions in 2008 and 688,000 prescriptions in 2009 (id., Ex. C, Boothby Decl. ¶¶ 2, 17).

This evidence reflects that the consolidated pharmacy system has maintained the ability to

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meet the high prescription demands of the prison population. Regardless, Plaintiff does not

dispute that the consolidation of pharmacies was pursuant to a mandate from the state

legislature, not the result of any policy or order from Schriro or ADC officials (Doc. #136,

DSOF ¶ 34).

In sum, absent evidence of a constitutional deprivation, Plaintiff cannot demonstrate

a material fact that Schriro is liable in either her individual or official capacity. See Jackson

v. City of Bremerton, 268 F.3d 646, 653-654 (9th Cir. 2001) (a supervisor cannot be held

liable under § 1983 where no constitutional violation has occurred). The Court will grant

summary judgment to Schriro and deny Plaintiff’s request for summary judgment. 

Defendants’ qualified immunity arguments need not be addressed.

V. Plaintiff’s Motions for Injunctive Relief

In his Emergency Motion for TRO and PI, Plaintiff alleges that since February 2010,

he has lost feeling in his left foot and is unable to walk normally (Doc. #178). Plaintiff states

that there is a 6-month waiting list to see a physician and therefore seeks injunctive relief in

the form of an immediate examination by ADC physicians and an outside specialist and a

show cause hearing why Plaintiff should not be released on a medical furlough (id. at 7). The

motion is supported by Plaintiff’s attached declaration; there are no medical records attached

(id., Attach.).

Plaintiff’s Motion for an Emergency Examination repeats the allegations concerning

the loss of feeling in his foot and inability to see a physician (Doc. #183). Plaintiff cites to

various passages from an attached excerpt of an article on strokes (id. at 2-3, Attach.).

Defendants oppose the motions and submit copies of medical records documenting

Dr. Brian Page’s examinations of Plaintiff on January 12 and 29 and February 5 and12, 2010;

these records reflect that Plaintiff’s vital signs were consistently stable (Doc. #180, Ex. A;

Doc. #184).

To obtain a preliminary injunction, the movant must show “that he is likely to succeed

on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief,

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that the balance of equities tips in his favor, and that an injunction is in the public interest.”

Winter v. Natural Res. Def. Council, Inc., 129 S. Ct. 365, 374 (2008). The Court finds that

Plaintiff falls short of establishing eligibility for injunctive relief. More importantly, because

the Court is granting Defendants’ summary judgment motion, Plaintiff’s motions for

injunctive relief are moot. Accordingly, both motions will be denied.

IT IS ORDERED:

(1) The reference to the Magistrate is withdrawn as to Defendants’ Motion for

Summary Judgment (Doc. #135), Plaintiff’s Motion to Strike (Doc. #151), Plaintiff’s CrossMotion for Summary Judgment (Doc. #160), Plaintiff’s Motion for TRO and PI (Doc. #178),

and Plaintiff’s Motion for Emergency Examination (Doc. #183). 

(2) Plaintiff’s Motion to Strike (Doc. #151) is denied.

(3) Defendants’ Motion for Summary Judgment (Doc. #135) is granted.

(4) Plaintiff’s Cross-Motion for Summary Judgment (Doc. #160) is denied.

(5) Plaintiff’s Motion for TRO and PI (Doc. #178) and Motion for Emergency

Examination (Doc. #183) are denied.

(6) The Clerk of Court must dismiss this action and enter judgment accordingly.

DATED this 23rd day of June, 2010.

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