Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_05-cv-01701/USCOURTS-caed-2_05-cv-01701-9/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

SAM CONSIGLIO,

Plaintiff, No. CIV S-05-1701 GEB GGH P

vs.

JEANNE WOODFORD, Director of

the California Department of Corrections, ORDER &

Defendants. FINDINGS AND RECOMMENDATIONS

 /

Background

 Plaintiff, a state prisoner proceeding pro se and in forma pauperis, seeks relief

pursuant to 42 U.S.C. § 1983. Presently pending before the court is plaintiff’s motion for a

preliminary injunction (entitled a “motion for permanent or temporary injunction....”) to enjoin

defendants from transferring him from Mule Creek State Prison (MCSP) to Salinas Valley State

Prison (SVSP), or any other prison facility, until he receives currently scheduled medical care. 

By order filed on October 20, 2005, the court has directed service of plaintiff’s amended

complaint upon Jeanne Woodford and seven additional defendants. Service upon defendant

Woodford was ordered on September 2, 2005, and defendant Woodford was granted ten days to

respond to plaintiff’s request for a TRO to prevent his transfer because plaintiff threatened

suicide should an anticipated immediate transfer from MCSP occur before he received adequate

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 In a supplemental filing on October 7, 2005, defendant Woodford’s counsel indicated

that after defendant’s response was filed on September 16, 2005, the classification staff

representative (CSR) did, in fact, endorse the transfer but a hold was placed on the transfer upon

the filing of the Order and Findings and Recommendations on September 20, 2005. Based on the

scheduling order of the motion for preliminary injunction, it appears that at least an unofficial

hold has been placed on the transfer pending adjudication of the motion for preliminary

injunction, but that is not entirely clear. See defendant’s supplement filed on October 7, 2005.

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medical treatment for painful injuries from which he claimed to have been suffering for many

years. 

On September 20, 2005, the undersigned recommended issuance of a TRO

prohibiting plaintiff’s transfer from MCSP pending adjudication of a motion for preliminary

injunction. Judge Burrell denied the TRO, finding that there was no evidence in the record

indicating that plaintiff was subject to “a significant threat of being transferred during the time

that the TRO plaintiff requests would be in effect.” Order, filed on September 30, 2005, p. 2.1 

The district judge also found that “plaintiff’s concern about a possible transfer has not been

shown to constitute a significant threat of irreparable harm.” Id., p. 3. Judge Burrell affirmed the

order upon plaintiff’s request for reconsideration by order filed on October 13, 2005. The district

judge, however, did not reference plaintiff’s motion for preliminary injunction for which this

court had set the schedule in the order filed on September 20, 2005.

Amended Complaint

Included here are the allegations of the amended complaint as set forth previously

by the court: 

[P]laintiff alleges that in January 2000, he suffered a serious knee

injury in the prison laundry that has never been treated properly. 

First Amended Complaint (FAC), p. 3. Due to the defendants’

deliberate indifference to, and long delay in, treating this serious

injury, plaintiff now needs an artificial joint replacement in that

knee. Id. 

In November of 2001, plaintiff suffered a serious back injury in the

prison laundry while at work, which has never been properly

treated primarily because defendant Hernandez, Warden at R. J.

Donovan Correctional Facility, had plaintiff transferred “illegally”

in 2004 despite a medical hold placed on plaintiff. FAC, p. 4. The

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transfer was in retaliation for plaintiff’s having exposed the

physical and sexual abuse of mentally ill inmates. Id. Defendant

Hernandez placed plaintiff in administrative segregation for over

three months on false charges that were never adjudicated and had

plaintiff transferred without a hearing in violation of due process. 

Id. 

On April 15, 2002, plaintiff sustained a third injury in the prison

laundry, tearing the rotator cuff in his right shoulder, an injury

which has never been treated. Defendant Dr. Bradley Williams, a

doctor at Doctor’s Hospital at Manteca, under contract with Mule

Creek State Prison (MCSP), delayed, and ultimately denied,

treatment, ordering in the interim costly and unnecessary tests. Id. 

 

Following plaintiff’s “illegal” transfer, on January 26, 2004, to

Folsom State Prison, he was transferred by the end of March, 2004

to CMC-E, a “supposed” medical treatment facility, when

authorities at Folsom realized how much medical treatment

plaintiff needed. Id. Defendant Marshall, Warden of CMC-E, had

plaintiff transferred “illegally” to MCSP on August 11, 2004, by

“falsifying” a CDC 1845 form. Id. 

In the year plaintiff has been transferred to MCSP, plaintiff has

received constant threats of a retaliatory transfer for continuing to

complain about not receiving adequate medical care. Id. As of

August 2005, five surgical procedures have been approved and

scheduled for plaintiff. Id. On August 2, 2005, when plaintiff

appeared before the Unit Classification Committee (UCC), he was

told he would remain at MCSP for another year; shortly thereafter,

defendants Arnold, Reyes, Smith and Brett Williams “decided to

get rid of plaintiff” despite his pending surgical procedures. Id. 

Defendant Campbell, Warden of MCSP, has failed to protect

plaintiff from this retaliatory action. Id. The anticipated transfer

is also an effort by MCSP to avoid spending the $100,000 cost for

all of plaintiff’s surgeries. Id. Defendant Woodford has approved

all of plaintiff’s transfers. FAC, p. 5. Plaintiff seeks both

injunctive relief and monetary damages. 

See Order and Findings and Recommendations, filed on September 20, 2005, pp. 2-3. 

Preliminary Injunction Standard

The legal principles applicable to a request for preliminary injunctive relief are

well established. “The traditional equitable criteria for granting preliminary injunctive relief are:

1) a strong likelihood of success on the merits, 2) the possibility of irreparable injury to plaintiff

if the preliminary relief is not granted, 3) a balance of hardships favoring the plaintiff, and 4)

advancement of the public interest (in certain cases).” Dollar Rent A Car v. Travelers Indem.

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Co., 774 F.2d 1371, 1374 (9th Cir. 1985). The criteria are traditionally treated as alternative

tests. “Alternatively, a court may issue a preliminary injunction if the moving party demonstrates

‘either a combination of probable success on the merits and the possibility of irreparable injury or

that serious questions are raised and the balance of hardships tips sharply in his favor.’” Martin

v. International Olympic Comm., 740 F.2d 670, 675 (9th Cir. 1984) (quoting William Inglis &

Sons Baking Co. v. ITT Continental Baking Co., 526 F.2d 86, 88 (9th Cir. 1975)). The Ninth

Circuit has reiterated that under either formulation of the principles, if the probability of success

on the merits is low, preliminary injunctive relief should be denied:

Martin explicitly teaches that “[u]nder this last part of the

alternative test, even if the balance of hardships tips decidedly in

favor of the moving party, it must be shown as an irreducible

minimum that there is a fair chance of success on the merits.”

Johnson v. California State Bd. of Accountancy, 72 F.3d 1427, 1430 (9th Cir. 1995) (quoting

Martin, 740 F.2d at 675).

In cases brought by prisoners involving conditions of confinement, any

preliminary injunction “must be narrowly drawn, extend no further than necessary to correct the

harm the court finds requires preliminary relief, and be the least intrusive means necessary to

correct the harm.” 18 U.S.C. § 3626(a)(2).

Plaintiff’s Motion

Plaintiff seeks a preliminary injunction against defendants preventing his transfer

to another prison until his current medical complaints are addressed and until Dr. White, MCSP

Chief Psychologist (not a defendant), or his subordinates clear plaintiff for the transfer

psychologically or until full adjudication of this case. Plaintiff states that his mental state is

“very fragile” because of the constant threat of transfer over the past year and that a further

transfer would constitute the fourth transfer in eighteen months. Plaintiff claims that all transfers

since January 26, 2004 have been retaliatory. He further claims that defendant’s counsel in her

\\\\\

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September 16, 2005 response to plaintiff’s TRO request claimed falsely that Dr. White endorsed

a transfer. Motion, pp. 1-2.

Plaintiff was apparently not able to secure an affidavit from Dr. White, and now

seeks an evidentiary hearing to demonstrate whether he approves plaintiff’s transfer or not. See

plaintiff’s filings on October 20, 2005 and October 21, 2005. Plaintiff has included as exhibits

after the filing of his motion, chronological interdisciplinary progress notes (hereafter

abbreviated as “progress notes”) of Dr. W. J. White with entries on September 2, 2005 and

October 4, 2005. On September 2, 2005, Dr. White recommended plaintiff’s “short-term readmission as medical necessity to CCCMS (California Correctional Case Management) to

provide him brief supportive counseling and monitoring while the transfer issues are being

resolved.” In a later entry, after plaintiff has been admitted, at least as an outpatient to CCCMS,

Dr. White states that he has not served as a direct provider of mental health services for plaintiff,

but sets forth, inter alia, the following:

“Mr. Consiglio is...known to me in my capacity as Chief

Psychologist. This includes a review of his Unit Health Record,

inquiries of his former Case Manager, multiple face-to-face

contacts and correspondence received from him... Currently

inmate-patient Consiglio is being considered for a transfer to

another institution. He has multiple medical problems in various

stages of workup and treatment that he fears will be delayed or

disrupted. Likewise, he fears for his safety should he transferred. 

He perceives any transfer as distinctly adverse and inimical to his

interests and construes it as deliberate and punitive...

Should Mr. Consiglio’s transfer proceed at this time, it is my

opinion it will likely precipitate a major psychological crisis, a

crisis that will or can result in significant destabilization and

increased risk of self-harm or suicide. Any such crisis will require

specific mental health interventions such as MHCB admission,

suicide watch or precautions, change of level-of-care and/or

psycho-pharmacological management. 

Plaintiff’s exhibit, filed on October 20, 2005, from progress notes of Dr. White on 10/04/05.

On October 5, 2005, (non-defendant) Senior Psychologist Supervisor K. Powell,

also relied on by defendant (see below), stated that he is not plaintiff’s case manager, but

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observed that plaintiff “has a well thought out and detailed suicide plan which in reality, he could

carry out.” Plaintiff’s exhibit, filed on October 20, 2005, from progress notes of Senior

Psychologist Supervisor K. Powell on 10/5/05. Dr. Powell notes that plaintiff “is generally stable

until he talks about his pending transfer and medical problems.” Id. Even being taken away

from MCSP overnight to a hospital apparently causes plaintiff concern for his safety. Id. Dr.

Powell concludes:

It is my opinion that this inmate will not be able to tolerate the

anxiety and fear a transfer can bring about. He continues to be a

high risk to attempt suicide if his situation is destabilized. This

inmate has thought about his situation and how he will respond for

a long time. His statements should be taken seriously. 

Id. 

Plaintiff claims that after waiting for almost two years since cortizone epidural

injections were ordered for his “severe back pain,” he has had two of the three injections: one on

July 14, 2005 and one on September 15, 2005. If a third is necessary, it should be given in about

three or four months. Plaintiff believes that to transfer him in the middle of “neurological

treatments” is tantamount to trying to transferring an inmate while he is on the operating table. 

Plaintiff claims that the two injections have reduced his back pain by 60% and expresses

confidence that after the final injection, he will not need the second surgery recommended by

non-defendant Dr. Barba nearly three years ago. Motion, pp. 2-3. 

Plaintiff also claims that he was seen by Dr. Tran, a gastro-intestinal specialist at

Doctor’s Hospital in Manteca (not a defendant), on September 20, 3005, who ordered a

colonoscopy that should be completed in two to three months. Plaintiff had polyps removed in

1974 and 2003 and Dr. Tran has told him that after the colonoscopy, he can determine whether or

not he will perform hemorrhoid surgery. Due to retaliatory transfers, plaintiff was unable to

receive the colonoscopy in 2004, when it was supposed to have been done. He believes that both

the potential third injection of cortizone and for his back and his pending colonoscopy militates

against transferring him or these procedures may not be completed as planned. Motion, p. 3.

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Plaintiff states that he has waited for more than three and a half years for shoulder

surgery to repair a torn rotator cuff and over five and a half years for knee surgery. Had he not

been subject to an “illegal retaliatory transfer” on January 26, 2004, both surgeries would have

been completed as early as 2004 by an orthopedic specialist named Dr. D. Smith (not a

defendant). Plaintiff alleges that defendant Warden Hernandez fabricated a safety concern to

transfer him from R.J. Donovan so that he could be transferred despite a medical hold. Plaintiff

encloses an April 8, 2004 CDC 128 chrono as an exhibit wherein non-defendant CMC Chief

Physician Ellen Greenman, recommends transfer back to RJD so that the same neurosurgeon

who performed the first surgery could complete his treatment. Even though Dr. Greemman’s

recommendation was not followed, plaintiff has been well-treated by a Dr. Min Zheng for his

back injury, but still complains that he was forced to endure three years of unnecessary intense

pain. Motion, pp. 4-5. Although plaintiff’s next orthopedic appointment is sent for March 2006

at UC Davis Outpatient Orthopedic Clinic, he is satisfied that relief is in sight. Motion, p. 5. 

Plaintiff argues that there is no reason to transfer a Level II inmate, which he is, to

a Level III prison and that the authorization of the involuntary transfer is purely retaliatory

because he has attempted to obtain adequate medical care and because he has written letters to

defendant Campbell complaining of staff misconduct. Plaintiff also asserts that there are several

false statements in defendant’s counsel’s declaration, filed in response to the TRO, for which he

does not generally fault her because he believes she has been misled. Motion, p. 5.

He already asserted that Dr. White did not support his transfer, as was represented

by counsel. He claims not to have refused a medical appointment on December 21, 2004 or any

other medical treatment and challenges non-defendant T. Weinhold to produce any record of

such a refusal. Motion, pp. 5-6. He argues that a second M.R.I. of his right shoulder was

unnecessary after one had been done in 2002. He contends that his counselor Ms. Sells (not a

defendant) did not put him up for transfer but that defendant K. Reyes, who is not his counselor

and knows nothing of his medical needs, did. Motion, pp. 6-7. In opposition, in defendant’s

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 Plaintiff spells the name as “Nachay,” but defendant’s filings indicate that the name is

spelled “Nechay.” See defendant’s Exhibit E, Declaration of Dr. K. Powell, p. 2.

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Exhibit B, CC-1 K. Reyes’ declaration, p. 2, defendant Reyes states that she is the backup

counselor when plaintiff’s assigned counselor is absent and has met with and interviewed

plaintiff several times. 

Plaintiff contends that the prison staff’s assertion that his transfer was solely

intended to address his medical needs is patently false since five surgical procedures have been

approved and scheduled by MCSP medical staff. He claims that he never told a clinical social

worker, Ms. Nechay2 (not a defendant), as was wrongly asserted in the CDC 128G chrono before

the Unit Classification Committee which defendant’s counsel included with her declaration in

response to plaintiff’s TRO request (and here in the opposition as Attachment 1 to defendant’s

Exhibit B), that he wished to remain at MCSP so his mother could visit him as she has been

deceased since 1991, a fact documented in his prison file and an assertion Ms. Nechay denies

ever having made to the UCC. Motion, p. 7. Despite his many complaints about inadequate

medical treatment, MCSP is the prison at which he has felt the safest in fourteen years. Motion,

pp. 7-8.

Nevertheless, plaintiff claims, since August 2005, he has also been harassed by

unnamed individuals of the MCSP mailroom staff with respect to his legal mail, in part in the

form of not receiving the Daily Appellate Reports he is supposed to receive every day. He also

claims that his outgoing legal mail is constantly returned and he is told that he is limited to five

pieces of legal mail per week. He states that the mail staff has refused to supply him with paper

and envelopes for his legal work and contends the “recent harassment” is a retaliatory result of

his pending litigation. Motion, p. 8.

Plaintiff includes a declaration which reiterates or clarifies many of the allegations

of his underlying amended complaint, including claims that he was transferred from both Folsom

and California Men’s Colony, following his retaliatory transfer from RJ Donovan, because he

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had too many unresolved medical issues. Plaintiff’s Declaration, pp. 1-2. He claims that he was

assured that his medical needs would be immediately addressed at MCSP when he was

transferred there on August 11, 2004. Id., pp. 2-3. On August 2, 2005, he was told by his

counselor, Ms. Sells, that the UCC had agreed to retain him at MCSP for another year, but that

on August 29, 2005, defendant Reyes, who has nothing to do with his case, told him that the

promise was being rescinded and he was being put up for transfer to SVSP. Id., p. 3. Dr. White,

widely recognized “as one of the most honest staffmembers at MCSP,” told plaintiff on

September 1, 2005, that he had sent a memo to defendant Brett Williams, MCSP Chief Medical

Officer, recommending that a medical hold be placed on plaintiff due to his many unresolved

medical issues. Id., p. 4. On September 20, 2005, Dr. White reassured plaintiff that he had never

recommended a transfer and had even called defense counsel to make sure she was not confused

on this point. Id., p. 5. Ms. Nechay told plaintiff she not only never told the UCC that he had

claimed to need to stay at MCSP so his mother could visit him, but asserted that he had never

discussed his mother with her at any therapy session. Id. 

Opposition

Defendant Woodford avers that plaintiff is classified as an “R” suffix inmate,

requiring sensitive needs yard (SNY) placement. SNY placement allows inmates who may have

enemy concerns to be housed safely and to participate in normal programming without fear of

inmate assault. Plaintiff has been housed in a sensitive needs yard facility at MCSP since his

transfer on August 11, 2004. Plaintiff is a level II inmate who nevertheless has close custody

status requiring that he be housed in a cell. Opposition (Opp.), p. 3, Exhibit A, Declaration of S.

Winkler, MCSP Correctional Counselor I, pp. 1-3. CC-I Winkler is a nineteen-year employee of

the California Department of Corrections and Rehabilitation (CDCR), formerly the California

Dept. of Corrections, and has held his current position for about five years; he is responsible for

classifying inmates assigned to him on Facility B at MCSP. Winkler Dec., p. 1. According to

CC-1 Winkler, CDCR is seriously considering a proposal to switch the SNY population with the

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general population at Folsom State Prison, converting MCSP wholly to a general population

facility. Id., p. 3. CC-1 Winkler states that his review of plaintiff’s central file indicates that, on

September 7, 2005, plaintiff’s Facility B UCC review resulted in the UCC rescinding the August

2, 2005 classification staff representative’s (CSR’s) August 2, 2005 referral to retain plaintiff at

MCSP III SNY due to the conversion of MCSP to a general population facility. Id. In any

event, CC-I Winkler adds that it was noted that SVSP had a specialist under contract who could

treat plaintiff’s medical needs while MCSP does not and that the UCC recommended plaintiff’s

transfer to SVSP Level III SNY; a 9/19/05 chrono indicates that the CSR endorsed the transfer

with a “time override” (a term which is unexplained). Id. A hold was placed on the transfer on

September 20, 2005, as a result of [this] litigation. Id., and attachment. CC-I Winkler maintains

that if plaintiff is not transferred to SVSP, he would have to be transferred to a SNY at another

facility if the contemplated conversion goes through as plaintiff cannot be transferred to Folsom

State Prison because it does not have the level terrain required by plaintiff according to his most

recent CDC 1845 dated 4-05-05. Id., p. 4. The court notes that in a filing dated October 20,

2005, plaintiff endorses CC-I Winkler as “one of the best and most honest counselors here” and

his “statement” as “pretty accurate.”

According to defendant, plaintiff has received a significant degree of medical

treatment while in prison. Opp., p. 3, citing defendant Smith’s Decl., p. 2. Defendant Dr. C.

Smith is the Chief Physician and Surgeon at MCSP. Exhibit C, Smith Decl., p. 1. Defendant

Smith states that he has reviewed plaintiff’s voluminous medical records. 

Left Knee

Defendant Smith reviews the history of plaintiff’s knee injury, beginning with his

having provided a medical history on May 19, 1993, including a report of an on-the-job truck

accident injury, wherein plaintiff sustained injuries to his left knee and back. Smith Decl., p. 2. 

Defendant Smith goes on to state that plaintiff “subsequently” had surgery to his left knee “in the

early 1980's.” Id. 

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As far as his treatment in prison, plaintiff was seen in the outpatient clinic for his

left knee condition on 6/18/92, 5/19/93, 7/25/94, and 9/8/94; recommendations were made for

Motrin and proper exercise and weight loss. Id. In March, 1995, plaintiff, who was then 43, told

an orthopedist, Dr. Lai (a non-defendant), that he had had arthroscopic surgery on his left knee in

1983 and had thereafter had difficulties with the knee; plaintiff wished to continue with

Ibuprofen and asked for a total knee replacement. Smith Decl., pp. 2-3. Dr. Lai found that

plaintiff was too young and obese for a total knee replacement. Id., p. 3. Plaintiff was seen on

April 19, 1995 in the orthopedic clinic by Dr. Lai, as well as in the outpatient clinic for his left

knee on August 9, 1996, September 13, 1996, and October 21, 1996. Id. On July 9, 1997, Dr.

Lai saw plaintiff for his left knee; his weight had increased; x-rays confirmed advanced

osteoarthritis in his left knee and Motrin and a knee brace were recommended. Id. Medication

renewal outpatient visits occurred on April 19, 1999 and July 26, 1999, according to plaintiff’s

medical records. Id. 

Dr. David Smith (not a defendant) saw plaintiff on September 15, 1999 for

chronic left knee pain and lower back pain. C. Smith Dec., p. 4. X-rays again showed

degenerative joint disease; plaintiff was prescribed a muscle relaxer and Motrin and given a twoday lay in. Id. On September 28, 1999, plaintiff had an outpatient visit. Id. 

On January 5, 2000, plaintiff reported that he had tripped on a floor mat and

twisted his left knee. Id. It is this injury to his knee that is one of the three injuries for which he

alleges inadequate medical treatment in his complaint. Defendant asserts that plaintiff had a preexisting arthritic knee as shown by x-rays on March 14, 1995 and the history recounted above. 

Id. Defendant C. Smith records that Dr. D. Smith saw plaintiff in the orthopedic clinic for his

left knee on January 12, 2000, January 26, 2000, and on March 1, 2000. At the first visit,

plaintiff was placed on a Prednisone taper, giving one Tylenol with Codeine, and was allowed an

extra mattress. Id. On the follow-up, plaintiff’s symptoms appeared to be returning with the

tapering of the Prednisone dosage; plaintiff was prescribed an anti-inflammatory. Id. At his

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third visit following his left knee injury, Dr. D. Smith was found to have joint swelling and xrays were ordered. Id. On March 16, 2000, plaintiff was approved for left knee arthroscopy,

which he had on April 4, 2000. Id. Dr. D. Smith saw plaintiff on May 17, 2000, when he was

reportedly doing well and apparently virtually pain free with an increased range of motion and

decreased swelling. Id., p. 5. Plaintiff was given Indocin and Robaxin, a muscle relaxant, and a

chrono for an extra mattress for a year. Id. 

Dr. D. Smith saw plaintiff again on March 21, 2001, July 18, 2001, October 17,

2001, September 4, 2002 for his knee. Id. Plaintiff was given a cortisone injection into his left

knee on the first of this series of visits for his pain and referred for consideration for soft shoes. 

Id. On the second, he was prescribed a Prednisone taper; plaintiff was seen for pain on the third

visit, with no treatment reported. Id. On the last visit, plaintiff was prescribed Indocin for pain

and as an anti-inflammatory; Dr. D. Smith believed a total knee replacement would be needed

eventually. Id. No further treatment for, or evaluation specifically of, plaintiff’s left knee is set

forth, until October 13, 2004, after plaintiff had arrived at MCSP and consulted with an

orthopedist, defendant Dr. Williams, at which time plaintiff apparently told that defendant that

his left knee was not nearly as bad as his right shoulder, for which he sought help; nevertheless,

plaintiff was given a steroid injection to his left knee on that day. Id. 

Right Shoulder

As for his right shoulder, defendant Smith indicates that plaintiff first complained

of discomfort there on October 23, 2000 (Smith Dec., p. 6), a date which, the court notes,

predates the right shoulder injury which is alleged to have occurred in April of 2002, but is the

first and only record defendant could find for any complaint by plaintiff about that area preceding

the shoulder injury complained of by plaintiff herein. On September 9, 2002 (a date several

months after the alleged injury), plaintiff’s MRI showed a complete rotator cuff tear and

osteroarthritis of the AC joint. C. Smith Dec., p. 6. Dr. D. Smith recommended right shoulder

arthroscopy; on December 3, 2002, plaintiff was admitted to Alvarado Hospital, where he

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underwent arthroscopic surgery performed by Dr. D. Smith. Id. Plaintiff, in his October 20,

2005, disputes defendant C. Smith’s assertion in his review of plaintiff’s medical record, stating

that he never had any surgery to his right shoulder, a dispute which the court cannot resolve on

this showing, without the record evidence. On January 27, 2003, Dr. D. Smith saw plaintiff for a

follow-up, according to defendant Smith, at which time, plaintiff exhibited an increased range of

motion, but complained of residual pain at night. Smith Dec., p. 6. 

Although another follow-up was scheduled for a month later, defendant Smith

does not reference any further medical attention in plaintiff’s medical records to plaintiff’s right

shoulder until September 22, 2004 (well over a year and a half later), when plaintiff, then housed

at MCSP, saw defendant Williams for an orthopedic consultation for his right shoulder

discomfort. Smith Dec., p. 6. Although not stated here, in defendant’s response to plaintiff’s

TRO, counsel set forth that defendant Dr. Bradley Williams ordered an MRI of plaintiff’s right

shoulder. Plaintiff returned to see him on October 13, 2004 for his shoulder injury and to have

his left knee examined. As noted, although plaintiff sought treatment more for his right shoulder,

he was given a steroid injection for his left knee on October 13, 2004. Id. Defendant Bradley

Williams upon reviewing the MRI taken on November 4, 2005, before recommending surgery,

due to plaintiff’s cardiac history, required plaintiff to see a cardiologist to be cleared for shoulder

surgery. Id. Plaintiff saw a cardiologist, Dr. Baluyat (not a defendant), at Doctor’s Hospital in

Modesto/Manteca, who, on June 20, 2005, cleared him for surgery. Smith Dec., p. 7. Although

defendant Smith does not comment on it, this amounted to a delay of more than seven months

before plaintiff was seen by the cardiologist following defendant Bradley Williams’ review of the

11/4/05 MRI. 

Defendant Bradley Williams, thereafter, on June 29, 2005, recommended the

shoulder surgery but his contract had expired. Smith Dec., p. 7. A recommendation for

expedited surgery was made due to the recent cardiac clearance, but the orthopedist at Queen of

the Valley Hospital, Dr. Schifflet, to whom plaintiff was referred on August 15, 2005, refused to

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do the surgery. Smith Dec., p. 7. 

UC Davis Medical Center was then sent plaintiff’s medical records for review. Id.

In the meantime, plaintiff’s records were sent to Dr. Lee (not a defendant), a Health Care

Manager at SVSP, when defendant Smith was informed that SVSP had an orthopedist under

contract. Id. On September 12, 2005, UC Davis notified MCSP that they would see plaintiff in

their clinic on March 27, 2006 for an orthopedic consultation. Id. Because the consultation

would not be for another six months and in light of the cardiac clearance, defendant C. Smith

states that it was still necessary to consider whether the SVSP orthopedist could treat plaintiff on

a more expedited basis. Id. Defendant Smith states that he has communicated with Dr. Lee who

has informed him that SVSP can address plaintiff’s right shoulder complaints on a more

expedited basis than can be done at UC Davis. Smith Dec., p. 16. Moreover, Dr. Lee has

informed him that SVSP has other specialty consultants who can treat plaintiff’s other medical

conditions. Id. Plaintiff, for his part, is apparently willing to wait for the scheduled consultation

at the UC Davis Medical Clinic rather than be transferred.

Back

Defendant Smith states that the September 15, 1999 x-rays, which pre-exist

plaintiff’s claimed back injury while working in the laundry room on November 12, 2001, show

that plaintiff has a prior lumbar fusion of the L4-L-5 spine. Smith Dec., p. 8. In any event,

defendant Smith makes no reference to any treatment for plaintiff’s November, 2001 back injury

until February of 2002 when plaintiff underwent lower back surgery performed by non-defendant

Dr. Soumekh. Id. Plaintiff had several medical conditions on discharge involving L4 and L5. 

Id. Plaintiff was discharged from Alvarado Hospital after his February surgery on March 6,

2002; he was seen for a follow-up appointment by Dr. Soumekh on November 13, 2002, at which

time plaintiff claimed to be doing well until he fell. Id. An exam showed normal results but

plaintiff claimed mild discomfort in the lumbar spine and was asked to return in about a month. 

Id. Nothing is reported by defendant Smith from his review of the plaintiff’s medical records to

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indicate that plaintiff was returned at that time.

On May 6, 2003, plaintiff was seen by Dr. Barba (as noted, not a defendant), a

UCSD neurological consultant, who believed plaintiff had bilateral lower extremity numbness;

plaintiff did not describe back pain. Id. Dr. Barba recommended routine x-rays and an EMG to

look for pinching of the nerves; he would only consider surgery if there were a complication

from plaintiff’s prior surgery, since plaintiff did not have back pain. Id. The July 18, 2003 EMG

of the left leg was normal, but the right leg showed changes consistent with a chronic lesion of

the L5 and S1 nerve roots. Smith Dec., p. 9. The lower extremity did not show peripheral

neuropathy. Id. In a September 2, 2003 follow-up visit, Dr. Barba saw plaintiff who

recommended a follow-up with his prior neurosurgeon to evaluate symptoms that suggested

recurrent lumbar spinal stenosis. Id. Defendant Smith does not indicate that this

recommendation was followed.

Almost a year later, on July 16, 2004, a lumbar MRI was done, which did not

identify evidence of central stenosis. Id. On October 25, 2004, non-defendant Dr. Farr, an

orthopedic consultant at Doctors Hospital of Manteca, evaluated plaintiff and suggested that

epidural injections might help to relieve plaintiff’s symptoms. Id. On December 14, 2005,

plaintiff was referred to Dr. Zheng, not a defendant, about his chronic low back pain, a referral

that was made because Dr. Farr does not accept inmate patients. Id. Dr. Zheng also

recommended epidural injections. Id. 

According to defendant Smith, plaintiff received three caudal epidural injections

of the back, one on 4/5/2005, a second on 7/14/05, and a third on 9/15/05. Smith Dec., pp. 9, 15.

Plaintiff, in an October 20, 2005 filing, takes issue with this, stating that he has had only two

epidural injections to date, the first one on July 14, 2005. Although defendant does not note the

discrepancy, the court observes that in her declaration opposing plaintiff’s TRO, defendant’s

counsel states that she had been informed by plaintiff’s medical return coordinator, T. Weinhold,

that Dr. Zheng recommended the epidural steroid injections and that plaintiff at that time had

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received one on July 14, 2005 and was due for a second in mid-September, an assertion that

comports with plaintiff’s representation, rather than that of defendant Smith. See, 9/16/05

declaration of Jodie Scwab, p. 4. In any event, at the time of his writing, according to defendant

Smith, plaintiff was due for a follow-up with Dr. Zheng for any continued low back pain and

chronic left knee discomfort on October 18, 2005. Smith Dec., p. 10. 

Other Medical Conditions

Defendant Smith also includes the medical history and treatment for other

conditions of the plaintiff, including coronary artery disease, hypertension, and hemorrhoids,

noting an acute heart attack plaintiff apparently suffered on July 5, 1988. Smith Dec., pp. 2, 10-

14. Relying on defendant Smith’s review of plaintiff’s medical records, defendant contends that

plaintiff’s complaints of severe knee, shoulder, and back pain are belied by the history he has

provided to his treating physicians. Opp., p. 4. 

Further Declarations

Dr. Lee, Chief Medical Officer, as well as Health Care Manager at Salinas Valley

State Prison, declares that he oversees all medical and mental health care for inmates at SVSP, is

familiar with plaintiff’s medical history and conditions, and is aware of the solutions to his

medical problems. Opp., p. 4, Exhibit D, Lee Dec., pp. 1-2. He states that SVSP has an

orthopedic doctor under contract, who can examine and treat plaintiff for his right shoulder, left

knee and lower back conditions. Lee Dec., p. 2. Specifically, he states, under penalty of perjury,

that he has agreed to place plaintiff in a priority position for an orthopedic consultation,

anticipating that plaintiff can be seen for a consultation for right shoulder within one (1) month

of his arrival at SVSP, should he be transferred. Id. He further represents that it is more likely

that plaintiff will be able to be seen by the SVSP orthopedist before he can be seen at his

currently scheduled consultation at UC Davis, but, as a precaution, that consultation will not be

cancelled. Lee Dec., pp. 2-3. 

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In addition, Dr. Lee asserts that SVSP has a doctor of internal medicine who can

monitor and continue to treat plaintiff for his other medical conditions, including evaluating his

need for a colonoscopy. Lee Dec., p. 3. Dr. Lee also states that if plaintiff does have any outside

scheduled medical appointments at the time of his transfer, “upon timely notification,” SVSP

will ensure that he keeps any such appointments by transporting him for the appointments. Id. 

Dr. Lee also is aware of plaintiff’s suicide threats and provides assurances that

MCSP will provide notice to him prior to plaintiff’s transfer and a discharge summary to himself

and the SVSP Chief Psychologist, Dr. Kahle, (a non-defendant) as to plaintiff’s mental condition

and treatment, and that he will have plaintiff, immediately upon his arrival at SVSP evaluated

and monitored by the mental health department. Lee Dec., p. 3. If necessary, arrangements will

be made for a crisis management bed admission for plaintiff upon his transfer. Id. 

Defendant includes the declaration of Dr. K. Powell, the Senior Staff

Psychological Supervisor, who supervises all clinical case management programs involving the

mental care of inmates at MCSP, and whose progress notes were quoted in part above as part of

plaintiff’s exhibits. Opp., pp. 4-5, Exhibit E, Powell Dec., pp. 1-2. Dr. Powell reviewed

plaintiff’s mental health file, met with and evaluated plaintiff following his UCC hearing on

September 7, 2005, diagnosing him as having a generalized anxiety disorder. Powell Dec., p. 2. 

Plaintiff had been in the CCCMS program from 2003 to May 5, 2005, and Dr. Powell returned

him to the program on September 7, 2005 as a precaution, although he did not think him suicidal

at the time. Id. In CCCMS, to which treatment plan plaintiff agreed, plaintiff is monitored and

meets with a case manager every week or as needed. Id. Dr. Powell states that plaintiff is not

taking any medication for mental health purposes. Id. Upon his October 5, 2005 re-evaluation of

plaintiff, Dr. Powell did not find him at that time to be suicidal, but he states that any change in

his environment plaintiff perceives as a safety threat can destabilize him and that, while at MCSP

when he evaluated him, plaintiff was not suicidal, plaintiff is at risk to himself if he interprets a

new environment as hostile to him. Powell Dec., p. 3. 

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Dr. R. Lipon, Acting Chief Psychiatrist at MCSP (not a defendant), also reviewed

plaintiff’s mental health records, met with, evaluated, and diagnosed him. Opp., p. 5, Exhibit F,

Lipon Dec., pp. 1-2. Dr. Lipon states that he could not rule out an Axis I diagnosis for

generalized anxiety disorder, noting a poly-substance abuse history with an institutional

remission. Lipon Dec., p. 2. On Axis II, Dr. Lipon assesses plaintiff as having a personality

disorder with histrionic borderline and antisocial traits. Id. Dr. Lipon opined that plaintiff is

very unpredictable and changes in his environment place him at risk for suicide, a risk he

characterizes as “mild-to-moderate.” Id. However, the doctor does not believe the risk is limited

to a transfer to another institution and could include even changes such as a cell move or change

of a cellmate at MCSP. Id. Dr. Lipon believes that it is not unusual to transport and transfer a

plaintiff with suicidal ideation and that plaintiff could be transferred from MCSP to SVSP

through a doctor-to-doctor contact. Id. Dr. Lipon outlines the steps he would personally take or

make certain would be taken once plaintiff’s transfer was approved, including placing plaintiff

immediately in the MCSP infirmary in a crisis bed, preparing an admission evaluation, treatment

plan and assembling of an interdisciplinary treatment team. Lipon Dec., p. 3.

Plaintiff’s mental health would be monitored and documented daily; contact

would be initiated with the Chief Medical and Mental Health Officers at SVSP and a discharge

summary transmitted to SVSP before plaintiff’s arrival there. Id. In addition, a discharge

summary would also accompany plaintiff upon his transfer. Id. Plaintiff would be given special

transport to SVSP, whereupon plaintiff would be transported directly to the infirmary and

assessed by a mental health doctor to determine his mental health needs. Id. If plaintiff were

determined to be suicidal, SVSP could place him in the Department of Mental Health, located

next to SVSP. Id. 

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Discussion

Serious Questions/Irreparable Harm

Given the evaluation of defendant’s own experts, there is little doubt that

plaintiff’s threats of suicide, should he be transferred again without, at the least, receiving the

medical treatment for which he is currently scheduled, raise a serious question. That his threats

may to some degree be characterized as manipulative and histrionic does not sufficiently mitigate

the risk or diminish plaintiff’s apparent sense, well-grounded or not, of desperation. Defendant

maintains that plaintiff has not adequately made a showing of irreparable harm because of either

his perception of past harms done him, that he has been transferred in the past so that CDCR can

avoid treating him, or on the basis that he is currently subject to deliberate indifference as to his

medical care. Opp., p. 8. However, the irreparable harm that plaintiff seeks to demonstrate is his

own suicide should he be transferred, and it goes without saying that carrying out that threat, for

which defendant’s own experts state that he as at risk, would constitute irreparable harm. 

As to evaluating the likelihood of plaintiff’s success on the merits of his amended

complaint, the court must set forth the applicable legal standard. 

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

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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

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))a 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

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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.

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, plaintiff must, in the end, provide expert evidence

that the treatment he received equated with deliberate indifference thereby creating a material

issue of fact. The dispositive question 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.

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3

 Defendant Smith states that plaintiff has three volumes of medical records. Smith Dec.,

p. 2.

22

Likelihood of Success on the Merits

Although defendant maintains no deliberate indifference to plaintiff’s medical

care has been shown in the treatment of his various injuries, beginning in 2000, to his left knee,

back, and right shoulder, and presents some evidence of the extensiveness of his medical record,3

there appear to be have been arguably significant gaps in his treatment, not only based on

plaintiff’s allegations, as observed earlier, but also on defendant Smith’s own review, also noted

above. 

For example, from September 4, 2002 until October 13, 2004, there does not

appear to have been any medical attention to plaintiff’s left knee injury, even though on 9/4/02,

the treating physician apparently concluded that plaintiff would eventually need a total knee

replacement. After the October 13, 2004 steroid injection, no further mention of treatment of the

left knee at MCSP is set forth by defendant. On the other hand, defendant maintains that plaintiff

at the time was more concerned about treatment of his right shoulder at MCSP. As to the

treatment of the right shoulder, plaintiff maintains he never received any surgery, although

defendant’s records apparently indicate otherwise. And as to that injury, even in defendant

Smith’s recounting, it appears that at least one follow-up was scheduled for which occurrence no

evidence is set forth, and there is a gap of time of over a year and a half, from January 27, 2003

to September, 2004, before plaintiff received any further treatment for that condition. 

Moreover, on October 13, 2004, when defendant Smith avers that plaintiff indicated that the pain

in his right shoulder was much worse than the problem in his left knee, he was given a steroid

injection in the knee and the rotator cuff injury has yet to receive the surgical intervention,

apparently recommended by defendant Bradley Williams. 

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4

 One of plaintiff’s exhibits indicates that a CMC physician, Dr. Greenman, not

mentioned by defendant Smith, also recommended plaintiff’s transfer from CMC so that plaintiff

could be followed up with by the same earlier surgeon.

23

As for his back, plaintiff apparently never received the follow-up treatment by his

prior neurosurgeon recommended by Dr. Barba4 and, although plaintiff has apparently

experienced relief from the epidural injections he has recently received, defendant Smith states

that he has received three of them, while plaintiff is adamant that he has received only two to

date and there is support in the record provided by defendant that substantiates plaintiff’s claim

(the third one to be administered, if necessary, within the next three or four months). It may be

that plaintiff is exaggerating the level of his pain and that he has received adequate medical care,

but that can by no means be resolved by defendant’s present showing. Nevertheless, it is

plaintiff’s burden to show a likelihood of success on the merits of his underlying allegations and,

although it is by no means an easy question, the court does not find that he has demonstrated

such a likelihood at this stage. Even so, plaintiff’s threat to himself upon any transfer to SVSP

cannot be ignored and the court will require that if such a transfer is effected that defendant must

comply with representations herein of steps to be taken to protect plaintiff and to provide for his

expedited medical treatment.

As to his unrelated claims that his outgoing mail is being interfered and the

mailroom is not allowing him the paper and envelopes he needs for his legal work, the evidence

of his frequent filings in this case belies such a claim, as does the mail log submitted by

defendants. Opp., p. 12, Exhibit G, declaration of MCSP mail room supervisor Holtorf and

attachment; Exhibit H, declaration of MCSP Senior Librarian L. Robinson. Plaintiff’s complaint

as to not receiving Daily Appellate Reports on a daily basis is not a supportable claim. 

This court will recommend denial of plaintiff’s motion for a preliminary

injunction to enjoin the defendants from transferring him from MCSP to SVSP prior to his

having received all of the medical treatment for which he is currently scheduled, but the court

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will also require defendant Woodford and all of the defendants named in the first amended

complaint, as well as non-defendants Dr. Lipon and Dr. Lee, under the auspices of the CDCR

director defendant, to strictly comply with all of the steps they have set forth that they would take

should plaintiff be approved for transfer to SVSP. No scheduled medical appointment will be

vacated. Given the realities of a prison context, every reasonable precaution for plaintiff’s safety

must be taken and each commitment to expedite plaintiff’s medical care will be met. 

Accordingly, IT IS ORDERED that:

1. Plaintiff’s multiple requests for an evidentiary hearing, made on October 12,

2005, October 20, 2005 and October 21, 2005, are denied as unnecessary;

2. If plaintiff is transferred from MCSP to SVSP, defendants must file a

declaration, within sixty days, ascertaining that each step set forth by Drs. Lipon and Lee for

plaintiff’s safe transfer has been effected and that no currently scheduled medical

appointment/evaluation/procedure for plaintiff is vacated or cancelled, absent extraordinary

cause. Plaintiff’s mental condition must be monitored and defendants must include with the

affidavit a status report on his transfer, on his safe housing at SVSP, and on the progress of his

expedited medical treatment. There will be no extension of time. Failure to comply with this

order will result in the imposition of sanctions against defendants. 

IT IS RECOMMENDED that plaintiff’s October 3, 2005 “motion for permanent

or temporary injunction....,” construed as a motion for preliminary injunction, be denied.

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 twenty

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 ten days after service of the objections. The parties are advised 

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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: 10/26/05

/s/ Gregory G. Hollows

____________________________________

GREGORY G. HOLLOWS

UNITED STATES MAGISTRATE JUDGE

ggh:009

cons1701.pi

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