Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_15-cv-00861/USCOURTS-caed-1_15-cv-00861-3/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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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

HORACE M. WILLIAMS,

Plaintiff,

vs.

WINFRED KOKOR M.D., et al,

Defendants.

Case No. 1:15-cv-00861-RRB

SECOND DISMISSAL ORDER

Plaintiff Horace M. Williams, a state prisoner appearing pro se and in forma

pauperis, filed an Amended Complaint under the Civil Rights Act, 28 U.S.C. § 1983,

against various employees of the California Department of Corrections and Rehabilitation.1

Williams is currently incarcerated at the California Substance Abuse Treatment Facility

(“SATF”), Corcoran, California, where the acts underlying this action occurred. 

I. SCREENING REQUIREMENT

This Court is required to screen complaints brought by prisoners seeking relief

against a governmental entity or officer or employee of a governmental entity.

2 The Court

having set forth the screening standards in dismissing the original Complaint, they are not

repeated herein.

1

 In addition to Winfred Kokor, M.D., Williams names as defendants: C. Nyenke,

M.D.; Goodwin Ugwueeze, M.D.; C. Nyenke, M.D.; Rosenblatt, M.D.; Clement Ogbuehi,

P.A.; Whiting, R.N.; L. Merritt, N.P.; and Powell, R.N. 

2

 28 U.S.C. § 1915A(a).

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 1

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 1 of 23
II. GRAVAMEN OF COMPLAINT

It appears from the Complaint that, at a result of prior surgery, Williams suffers from

back problems at levels C5–C6 and is wheelchair bound. In his Amended Complaint

Williams alleges deliberate medical indifference and retaliation claims against the

Defendants while incarcerated at SATF during the period beginning in March 2010

extending to some point after August 2012 when Williams was transferred to Pleasant

Valley State Prison. Williams was transferred back to SATF in August 2013 where he was

housed through the date the Complaint was filed. Although pleaded as a single claim and

difficult to follow, the Amended Complaint appears to plead several separate claims.

First Claim. Dr. Nyenke and RN Powell refused to timely schedule Williams for a

new arrival appointment or renew Williams medications as a result of which Williams was

without his medication for a period of 27 days. It does not appear from the record that

Williams exhausted this claim. Furthermore, it appears more likely than not that the acts

complained of occurred prior to June 1, 2010, and are barred by the limitations period.3

Second Claim. Dr. Ugweeze failed to provide proper oversight of facility medical

personnel.

Third Claim. During the period March through July 2011 the medication prescribed

by Dr. Nyenke (Naproxen) did not alleviate Williams’ pain and Dr. Nyenke refused to renew

Williams’ prescription for Hydroxyzine. Williams further alleges that Dr. Nyenke refused to

3 See Cal. Civ. Proc. Code §§ 335.1, 352.1(a) (providing a two-year statute of

limitations for personal injury claims, which may be tolled for an additional two years for

prisoners).

SECOND DISMISSAL ORDER

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Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 2 of 23
follow the recommendation of one outside physician that surgery was necessary on his

lumbar area and another outside physician that Williams receive an epidural.

Fourth Claim. Appears to allege that in December 2011 RN Merritt deprived

Williams of appropriate pain medication ostensibly to intimidate Williams from filing his

medical care complaints.

Fifth Claim. In or about December 2011 Williams was again examined by an outside

neurosurgeon who recommended a different pain medication. Williams alleges that

Dr. Nyenke, Dr. Ugwueeze, and RN Merritt deliberately ignored this recommendation in

retaliation for Williams having exercised his First Amendment right to petition for redress

of his grievances.

Sixth Claim. Alleges that, although Williams was suffering serious side effects from

its use, PA Ogbuehi refused to discontinue a prescription for Methadone in retaliation for

the complaints Williams had filed against PA Ogbuehi’s co-workers.

Seventh Claim. In March 2012 Dr. Rosenblatt indifferently ignored Williams’

requests that Gabapentin be dispensed resulting in Williams suffering extreme pain for a

period of 19 days.

Eighth Claim. Although somewhat unclear, this claim involves an incident on

September 9, 2013, where Williams fell while transferring from his wheelchair to the toilet

injuring his lower back, tail-bone, and back of his head. He claims that during the period

from the time of his accident through September 25, 2013, RN Powell deliberately delayed

providing Williams appropriate treatment for his injuries.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 3

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 3 of 23
Ninth Claim. This claim, spanning the period January through February 2015,

alleges that, although Dr. Kokor approved that Williams be issued an egg crate mattress

and cervical pillow, RN Whiting deliberately prolonged or failed to order those items. 

Williams seeks declaratory and injunctive relief, and compensatory and punitive

damages in various amounts from each of the Defendants.

III. ADMINISTRATIVE APPEALS

Attached as exhibits to the First Amended Complaint are ten administrative appeals

processed at SATF in each of which Williams was denied relief. To the extent relevant to

the issues presented by the Amended Complaint the holdings are summarized below.

SATF-33-11-11351 (November 21, 2011).Brought against Dr. Nyenke for neglecting

to renew hydroxyzine and artificial tears and continued dispensation of naproxen.

INSTITUTION DECISION:

The Second Level Response (SLR) stated your appeal was partially granted

indicating:

• On March 12, 201 l, you were sent to an outside facility for evaluation

of chest pain and to rule out acute coronary syndrome (ACS), you

were discharged the next day and returned to California Substance

Abuse Treatment Facility (SATF);

• Discharge notes indicated your angiogram was within normal limits

and your cardiac troponin levels were negative;

• On March 15, 2011, you were seen and examined by your Primary

Care Provider (PCP), your plan of care was developed and reviewed

with you and you were prescribed Tylenol and naproxen;

• There was no indication that you informed the PCP that taking

naproxen caused you to experience chest pain nor was there record

of a Health Care Services Request Forms (CDC 7362) to inform staff

of this problem;

• On March 29, 2011, you were see for your follow up appointment with

the PCP, you did not indicate chest pains from naproxen;

• On May 23, 2011, you submitted a CDC 7362, stating you were

experiencing severe back, neck, shoulder and arm pain, an ear

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 4

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 4 of 23
infection, you requested hydroxyzine, nunisolide and eye drops, and

that you needed alternate pain medication because naproxen gave

you chest pain (first document in your unit health record [UHR]);

• On May 25, 2011, you were seen by the Registered Nurse (RN), who

contacted the PCP and obtained an order for hydroxyzine, and

artificial tears;

• On May 30,2011, your naproxen was discontinued; and

• During your interview your neck, arms, and legs were assessed and

you agreed there were no significant findings that would warrant

photos for these areas.

BASIS FOR DIRECTOR'S LEVEL DECISION:

At the Director's Level of Review (DLR), submitted on August 14, 2011, you

restate your issues and concerns as noted above.

At the DLR, your appeal file and documents obtained from your UHR were

reviewed and revealed the following:

• It was determined your care related to your appeal issues was

adequate, as you received medical treatment, medication was

provided and your concerns were appropriately addressed at the FLR

and SLR;

• For your request to be ordered pain medication, hydroxyzine, and

artificial tears, according to your medication profile you are prescribed

the following medications, amlopipine, aspirin, cetirizine HCL,

nunisolide spray, gabapentin, hydroxyzine, lisinopril, salsalate as

prescribed by your PCP;

• For your request to discontinue naproxen, this medication was

discontinued on May 30, 2011; and

• For your request to have photos been taken of your neck, arms, back,

and legs, during your assessment with your PCP you agreed there

were no significant findings that would warrant photos for these areas.

Please be advised medications are prescribed on the basis of your

current medical needs. However, it is your responsibility to

communicate with the doctor regarding the effect of the pain

medication prescribed. If you feel the medication is not effective or is

giving your side effects, you are encouraged to submit a CDCR 7362

to discuss the medication with your PCP.4

4

 Docket 24, pp. 31–32.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 5

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 5 of 23
SATF SC 11001200 (July 9, 2012). Staff Complaint brought against Dr. Nyenke,

NP Merrit, RN Powell, and LVN Gonzales for allegedly collaborating and conspiring to

retaliate for submitting the appeal against Dr. Nyenke.

INSTITUTION'S DECISION:

The institution partially granted your appeal indicating your appeal was

processed as a staff complaint wherein a Confidential Inquiry was

completed. Your allegations were related as stated in your appeal document. 

You were interviewed on February 13, 2012, by Chief Physician and Surgeon

Ugwueze and were advised your health care issues would not be addressed

in this appeal, but were split with appeal number SATF HC 11053921. A

confidential inquiry was conducted and LVN Gonzales, RN Powell, NP Merrit

and Dr. Nyenke were interviewed. Conclusions indicated there was no

violation of California Department of Corrections and Rehabilitation (CDCR)

policy.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal was deemed a staff complaint by the institution's hiring

authority. The Director's Level Examiner reviewed the Confidential Inquiry,

supporting documents and your appeal documents. Complaints against staff

are taken seriously and al I efforts are made to ensure these matters are

thoroughly researched and responded to in accordance with governing laws,

rules and policies. Any report generated or action taken regarding a staff

complaint is confidential. As such, no matters related to staff shall be shared

with other staff, inmates or the public.

Your complaint was referred for a Staff Complaint Inquiry. The supervisor's

inquiry into the matter concluded staff did not violate CDCR policy. Review

of the inquiry documents and all supporting documents demonstrated you

were interviewed on February 13, 2012, Dr. Nyenke was interviewed on

January 13, 2012, NP Merritt was interviewed on January 4, 2012,

RN Powell was interviewed on January 4, 2012, and LVN Gonzales was

interviewed on January 20, 2012. Your Electronic Unified Health Record was

reviewed. The content of the inquiry supported the conclusions determined.

You were informed in your interview with Dr. Ugwueze that your health care

requests would not be addressed in this appeal as this appeal is a staff

complaint. The first initial of R.N. Powell is "K" and of LVN Gonzales is "L."

It is noted you added additional issues at the Director's Level of Review,

specifically your allegation that Dr. Nyenke and NP Merritt conspired to

change your pain medications as part of their function in the Pain

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 6

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 6 of 23
Management Committee. These issues will not be addressed, as you have

not provided evidence that you attempted to address these issues at the

institution, per the California Code of Regulations (CCR), Title 15, Section

3084.2.5

SATF HC 12054498 (November 5, 2012). Staff Complaint against the pharmacy

supervisor alleging that the auto refill for Williams’ gabapentin prescription was not refilled.

INSTITUTION DECISION:

The institution's response stated your appeal was partially granted and

indicated the following:

• You were provided the pharmacy supervisor's name at the First Level

of Review.

• Due to an administrative error, the auto refill of gabapentin was not

''turned on." The error was corrected and your prescription for

gabapentin was renewed and issued to you starting on March 12,

2012.

• Monetary compensation was beyond the scope of the appeals

process.

BASIS FOR DIRECTOR'S LEVEL DECISION:

At the Director's Level of Review (DLR), received on July 16, 2012, you

restate your issues and concerns as noted above.

At the DLR, your appeal file and documents obtained from your Unit Health

Record (UHR) were reviewed by licensed clinical staff and revealed the

following:

Documentation is supportive of you receiving ongoing Primary Care Provider

(PCP) evaluation and treatment to October 31, 2012, as detemined medically

indicated for chronic neck/back pain including historical and current order for

pain medications including gabapentin. As described in the institution's

response, you were provided the name of the pharmacy supervisor, and the

March 2012, Medication Administration Record shows gabapentin was

resumed on March 12, 2012. Institution staff acknowledged an administrative

error caused the lapse and the error was corrected.6

5

 Docket 24, pp. 38–39.

6

 Docket 24, pp. 46–47.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 7

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 7 of 23
SATF HC 12054962 (November 15, 2012).Alleges thatPAOgbuehi misrepresented

himself as a medical doctor and made misrepresentations in the medical report.

INSTITUTION DECISION:

The institution's response stated your appeal was partially granted and

indicated the following:

• There was no medical indication for you to meet with Dr. Uguweze.

• Your case was reviewed by the Pain Management Committee,

Medical Authorization Review (MAR) Committee, who recommended

and prescribed medication appropriate for your needs; however, your

continued refusal to take the medications prescribed to you resulted

in this medication being stopped.

• You continued to receive the medications gabapentin and baclofen.

• Notes of March 15, 2012, reflected the PA's assessment.

• You were seen and examined regularly by licensed professionals in

accordance with policy and procedure.

BASIS FOR DIRECTOR'S LEVEL DECISION:

At the Director's Level of Review (DLR), received on July 30, 2012, you

restate your issues and concerns as noted above.

At the DLR, your appeal file and documents obtained from your Unit Health

Record (UHR) were reviewed by licensed clinical staff and revealed the

following:

Documentation is supportive of you receiving ongoing Primary Care Provider

(PCP) evaluation and treatment to October 31, 2012, as determined

medically indicated for chronic neck/back pain including MAR Committee

evaluation concerning pain management in April 2012, and active orders for

the medications amitriptyline, baclofen, gabapentin, and tramadol. While you

may refuse care, you may not be selective in the choice of providers. 

Provider assignments are determined by health care management based on

the institution's needs.

Although you have the right to submit an appeal as a staff complaint, it is not

in the purview of the inmates to request specific disciplinary action against

personnel and any action taken by the Department is confidential. As such,

no matters related to personnel shall be shared with inmates or the public. 

It should be noted your appeal was reviewed and evaluated by the Hiring

Authority and the issue was deemed not to meet staff complaint criteria.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 8

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 8 of 23
Treatment is provided based on your current medical needs and the

judgment of your current provider, not on the basis of previous orders of

other medical facilities or staff, in accordance with departmental policy and

procedures. The professional judgment of your current provider is not

rendered as inadequate medical care or deliberate indifference just because

another provider may have had a different opinion.

The Inmate Medical Services Policy and Procedures state it is the policy of

California Department of Corrections (CDCR) California Correctional Prison

Health Care Services (CCHCS) to integrate Physician Assistants (PA-Cs)

and Nurse Practitioners (FNPs) into the health care delivery system as

PCPs. Authority for the use of PA-Cs and FNPs is derived from Business

and Professions Code Chapter 7.7, Article 1, Sections 3500-3503.5, for PACs, and from Business and Professions Code, Nursing Practice Act, Section

2725 (b)(4) for FNPs. While you have a right to refuse treatment, you do not

have the right to choose the type, specialty, or credential of your provider.

Provider assignments are made by institution health care management

based upon institution needs.

* * * *

The Department shall provide only medical services for patient-inmates that

are based on medical necessity and supported by outcome data as effective

medical care. In the absence of available outcome data for a specific case,

treatment will be based on the judgment of the physician that the treatment

is considered effective for the purpose and is supported by diagnostic

information and consultations with appropriate specialists. Your contention

that you have not received adequate medical care is refuted by professional

health care staff familiar with your medical history, as well as a review of your

medical records.7

SATF HC 13058187 (April 1, 2014). Requested to see an MD immediately, receive

a CAT scan or MRI, stop gross delays in medical treatment, and be processed as an

emergency. This complaint appears to be directed against RN Powell.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal file and documents obtained from your Unit Health Record were

reviewed. These records indicate: 

• You have a history of chronic cervical lumbar spine condition prior to

your fall in September of 2013; you have received post fall evaluation

7

 Docket 24, pp. 51–52.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 9

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 9 of 23
including nurse and provider evaluations, acute hospital evaluation

with findings including right hip traumatic bruise; CT scan revealed no

acute fracture of your right hip.

• Furthermore, you have received provider follow up evaluation

including medically indicated accommodation, analgesics/muscle

relaxant and referral for neurosurgery consultation related to your

spine condition that existed prior to the September 2013 fall incident.

• Names of medical staff that treated you in the rrA on September 15,

2013, were provided to you in the Second Level Response.

Per the Inmate Medical Services Policies andProcedures (IMSP&P), Volume

4, Chapter 4, the California Department of Corrections and Rehabilitation

(CDCR) health care staff shall provide inmate-patients access to primary

health care services. California Correctional Health Care Services (CCHCS)

makes every effort to ensure that patient-inmates receive quality medical

care; however, in some cases an appointment will need to be delayed. 

Physician requests to cancel clinic sessions or individual medical

appointments shall only be canceled with the approval of the Health Care

Manager (HCM) or Chief Medical Officer (CMO). As noted in the institution's

response, there are procedures in place to address canceled or rescheduled

appointments.

You indicated your appeal warranted emergency consideration. Following

a review of the appeal issue(s), your appeal was found not to have met

emergency criteria as described in the California Code of Regulations (CCR),

Title 15, Section 3084.9(a)(l). Therefore, your appeal was processed as a

routine matter.

While the health care administrative appeals process is an important means

of setting forth your health care concerns, it is not a substitute for direct

communication about your health with your medical care providers. You are

encouraged to continue your care with your assigned medical care providers

and share with them new or additional clinical information about your

conditions that you believe may affect your care. However, California law

directs your medical care providers to offer and provide only the care they

determine to be currently medically necessary for you, in accordance with

appropriate policies and procedures. Previous orders from other medical

facilities or staff, input from medical consultants, and/or your own personal

preferences may be considered, but do not control the professional judgment

of your current medical care providers.

It is noted you have added a new issue and/or request to your appeal at the

Director's Level of Review (DLR), "Dr. Jackson never reviewed my chart

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 10

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 10 of 23
regarding neurosurgery. They have refused to give recommended treatment

and refused to let me see the neurosurgeon. I am still left to suffer. I plan to

file suit." It is not appropriate to expand the appeal beyond the initial

problem and or requests. This issue will not he addressed, as you have not

provided evidence you attempted to address it at the lower level, per the

California Code of Regulations (CCR), Title 15, Section 3084.l(b).

After review, no intervention at the Director's Level of Review is necessary

as your medical condition has been evaluated and you are receiving

treatment deemed medically necessary.

8

SATF HC 14058949 (July 24, 2014). Alleges retaliation by PA Oguehi for the filing

of appeals cease and desist by refusing to allow Williams to be seen by a doctor, referring

him to a neurologist, and to increase his pain medication.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal file and documents obtained from your Unit Health Record were

reviewed by licensed clinical staff. These records indicate:

• Your requests to be seen by a doctor, referred to a neurologist and an

increase in your pain medication are being addressed in appeal SATF

HC 14058945.

The Department takes your complaint against any personnel seriously and

all efforts are made to ensure these matters are thoroughly researched and

responded to accordingly. However, it is not in the purview of the inmates to

request specific disciplinary action against personnel and any action taken

by the Department is confidential. As such, no matters related to personnel

shall be shared with inmates or the public. It should be noted the appeal was

reviewed and evaluated by the hiring authority and the issue was deemed

not to meet staff complaint criteria.

* * * *

While the health care administrative appeals process is an important means

of setting forth your health care concerns, it is not a substitute for direct

communication about your health with your medical care providers. You are

encouraged to continue your care with your assigned medical care providers

and share with them new or additional clinical information about your

conditions that you believe may affect your care. However, California law

directs your medical care providers to offer and provide only the care they

8

 Docket 24, pp. 57–58.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 11

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 11 of 23
determine to be currently medically necessary for you, in accordance with

appropriate policies and procedures. Previous orders from other medical

facilities or staff, input from medical consultants, and/or your own personal

preferences may be considered, but do not control the professional judgment

of your current medical care providers.

After review, no intervention at the Director's Level of Review is necessary

as your medical condition has been evaluated and you arc receiving

treatment deemed medically necessary.

9

SATF HC 14058945 (July 24, 2014). A retaliation claim against RN Powell, and

requesting an order to cease and desist.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal file and documents obtained from your Unit Health Record were

reviewed by licensed clinical staff. These records indicate:

• You are receiving ongoing evaluation and treatment as determined to

be medically indicated by your providers, to July 11, 2014, and you

are being monitored in the chronic care program.

• Your current CDC 7410. Comprehensive Accommodation Chrono,

dated October 31, 2013, authorizes you barrier free/wheelchair

access, ground floor cell, bottom bunk, wrist brace, back brace,

manual wheelchair, hearing aids, wheelchair cushion, wheelchair

gloves, extra mattress, wedge, pillow, wheelchair accessible table,

transport vehicle with lift, daily shower and work restrictions.

• On April 4, 2014, you were seen for a neurosurgical consult via

telemedicine, where treatment recommendations were made.

• On April 10, 2014, you were seen by your Primary Care Provider

(PCP) for follow up, your treatment plan was discussed, your

medications were reviewed, and referrals for Physical Therapy (PT)

and an epidural injection were submitted. Your PCP noted that there

was no medical indication of neuropathy and you would need to be

tapered off of gabapentin.

• On May 29, 2014, a non-formulary request was approved for tramadol

for chronic low back pain.

• On June 10, 2014, you were seen by your PCP for follow up, where

your medication was reviewed and your treatment plan was

discussed. Your PCP noted he would start you on Trileptal, your PT

9

 Docket 24, pp. 62–63.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 12

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 12 of 23
and epidural injections had to be cancelled and rescheduled, due to

non compliance with the pre-operative procedures.

• On June 12, 2014, you were seen and evaluated for PT, where

treatment recommendations were made.

• On June 18, 2014, your PT was completed; you were advised of

strengthening exercises lo perform on your own time.

• On July 11, 2014, you were seen by your PCP, for follow up and

review of your chronic conditions; Trileptal was discontinued per your

request and your PCP submitted a referral for a Magnetic Resonance

Imaging (MRI) of your cervical spine, this referral is pending.

• Your pharmacy profile indicates active orders for amitriptylinc,

baclofen, and tramadol for pain management as of July 18, 2014.

Effective May 9, 2011, all prescriptions for gabapentin require non-formulary

approval and are restricted to adjunctive therapy for partial complex seizures,

post herpetic neuralgia, and objective evidence of severe disease. Per

policy, you do not meet the criteria for non-formulary use of gabapentin.10

SATF HC 14058947 (July 24, 2014). Staff Complaint PA Oguehi alleging retaliation

and seeking a cease and desist order, to be seen by Dr. Jackson, referral to a neurologist,

and an increase in pain medication.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal file and documents obtained from your Unit Health Record were

reviewed by licensed clinical staff. These records indicate:

• Your requests to be referred lo a neurologist and an increase in your

pain medication are being addressed in appeal SATF HC 14058945.

• While you may refuse care, you may not be selective in the choice of

providers. Provider assignments are determined by health care

management based on the institution's needs. 

The Department takes your complaint against any personnel seriously and

all efforts are made lo ensure these matters arc thoroughly researched and

responded to accordingly. However, it is not in the purview of the inmates to

request specific disciplinary action against personnel and any action taken

by the Department is confidential. As such, no matters related to personnel

shall be shared with inmates or the public. lt should b e noted the appeal was

10

 Docket 24, pp. 67–68.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 13

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 13 of 23
reviewed and evaluated by the hiring authority and the issue was deemed

not to meet staff complaint criteria.11

SATF HC 14059867 (December 30, 2014). A staff Complaint against Dr. Kokor

requesting reinstatement of gabapentin and that trileptal be discontinued; and that Williams

be given a face-to-face consultation with a neurologist instead of by telemedicine.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal file and documents obtained from your Unit Health Record were

reviewed by licensed clinical staff. These records indicate:

• You are receiving ongoing evaluation and treatment as determined to

be medically indicated by your providers, to December 10, 2014, and

you are being monitored in the chronic care program.

• As stated in the Second Level response, on July 11, 2014, your

prescription for oxcarbazepine was discontinued.

• On October 3, 2014, you received lumbar spine fusion surgery.

• On October 8, 2014, you were seen by your Primary Care Provider

(PCP) for follow up, where your PCP advised you to continue physical

therapy, and to continue your pain medication as prescribed.

• On October 8, 9, 10, 13, 20, and 28, 2014, you were seen by physical

therapy; you were discharged from physical therapy on October 28,

2014, at your request.

• On October 9, 10, and 12, 2014, you were seen by your PCP for

follow up, where your treatment plan was discussed and your

medications were reviewed.

• On October 13, 2014, documentation indicates you refused to have

your staples removed.

• On October 14, 2014, you were seen by your PCP for follow up,

where your staples were removed and you were advised you would

be transferred to the yard when a bed is available.

• On October 16, 2014, you received x-rays of your lumbar spine.

• On October 20, 2014, you were seen by your PCP for follow up,

where your x-rays and pain medications were reviewed and

discussed. Your PCP noted your wound had completely healed, and

you were advised of the goals of pain management. Your PCP

advised you to continue with physical therapy and pain medications.

• On November 5, 2014, your case was reviewed by the pain

management committee, where it was recommended to continue pain

11

 Docket 24, p. 73.

SECOND DISMISSAL ORDER

Williams v. Kokor, 1:15-cv-00861-RRB – 14

Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 14 of 23
medications as prescribed, follow up with the neurosurgeon, and

encourage you to ambulate.

• On November 24, 2014, you were seen by neurosurgery for follow up,

where it was recommended to continue using the lumbar brace,

referral to orthotics for a right foot drop, continue physical therapy,

and follow up with neurosurgery in three months.

• On November 26, 2014, you were seen by your PCP for follow up,

where the neurosurgeon's recommendations were reviewed and

discussed with you. It was noted you did not want to go back to

physical therapy and you are doing the exercises on your own. Your

PCP submitted referrals to orthotics and neurosurgery.

• On December 4, 2014, your case was reviewed by the pain

management committee, where it was recommended to start

methadone, tapper off morphine and Lyrica; then start on gabapentin

and increase Elavil. You may also need to be tapered off baclofen. 

• On December 10, 2014, you were seen by your PCP for follow up,

where your medications were reviewed and your treatment plan was

discussed.

• Your pharmacy profile indicates active orders for acetaminophen,

amitriptyline, morphine and Lyrica for pain management as of

December 29, 2014.

• An orthotics consult and neurosurgery follow up are to be scheduled

prior to February 24, 2015.

• If you believe your condition has changed and further evaluation is

needed prior to your follow up appointment you are advised to submit

a CDCR 7362, Health Care Services Request Form, to your facility

clinic to further discuss this issue with your PCP.

You are considered an active partner and participant in the health care

delivery system. You are encouraged to cooperate with your clinicians in

order to receive the proper care and management of your condition. You will

continue to be evaluated and treatment will be provided based on your

clinician's evaluation, diagnosis, and recommended treatment plan, in

accordance with appropriate policies and procedures.

* * * *

While the health care administrative appeals process is an important means

of setting forth your health care concerns, it is not a substitute for direct

communication about your health with your medical care providers. You are

encouraged to continue your care with your assigned medical care providers

and share with them new or additional clinical information about your

conditions that you believe may affect your care. However, California law

directs your medical care providers to offer and provide only the care they

determine to be currently medically necessary for you, in accordance with

SECOND DISMISSAL ORDER

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appropriate policies and procedures. Previous orders from other medical

facilities or staff, input from medical consultants, and/or your own personal

preferences may be considered, but do not control the professional judgment

of your current medical care providers.12

SATF HC 15061160 (June 10, 2015). A retaliation complaint against Dr. Kokor for

failing to include a wedge pillow and extra mattress on an equipment request, and RN

Whiting for failing to timely provide the wedge pillow, egg crate mattress, cervical pillow,

and extra mattress.

BASIS FOR DIRECTOR'S LEVEL DECISION:

Your appeal file and documents obtained from your Unit Health Record were

reviewed by licensed clinical staff. These records indicate:

• You continue to be evaluated and monitored by health care providers

regarding your pain conditions to June 8, 2015; including review and

adjustment of your current pain medications.

• California Correctional Health Care Services shall provide Durable

Medical Equipment (DME) and medical supplies to California

Department of Corrections and Rehabilitation patient-inmates as

medically necessary to ensure equal access to prison services,

programs, or activities. The DME policy was developed lo standardize

all aspects of prescribing, ordering, distribution, and management of

DME to ensure the DME needs of the patient-inmate arc met while

maintaining institution safety and security by working with and

advising custody staff.

• The DME policy specifics that certain miscellaneous supplies or

property, such as blankets, extra state issued mattresses, egg crate

mattresses (foam pads), extra pillows, shower chairs, clothing (boxer

shorts, brassieres, shoes, and hats) shall not be considered medical

supplies or DME and are not prescribed by health care staff.

• If you believe your condition has changed and further evaluation is

needed prior to your follow up appointment you are advised to submit

a CDCR 7362, Health Care Services Request Form, to your facility

clinic to further discuss this issue with your primary care provider.

You have the right to be treated respectfully, impartially, and fairly by all

employees. If you should have evidence to support your claim of retaliation

12

 Docket 24, pp. 79–81.

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Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 16 of 23
by health care staff you should bring this to the attention of the Chief Medical

Executive al your institution.

While the health care administrative appeals process is an important means

of setting forth your health care concerns, it is not a substitute for direct

communication about your health with your medical care providers. You are

encouraged to continue your care with your assigned medical care providers

and share with them new or additional clinical information about your

conditions that you believe may affect your care. However, California law

directs your medical care providers to offer and provide only the care they

determine to be currently medically necessary for you, in accordance with

appropriate policies and procedures. Previous orders from other medical

facilities or staff, input from medical consultants, and/or your own personal

preferences may be considered, but do not control the professional judgment

of your current medical care providers.13

IV. DISCUSSION

As presently constituted, Williams Amended Complaint is deficient severalrespects.

It appears that Dr. Ugwueeze is being sued solely in his supervisory capacity. 

Section 1983, standing alone, does not support vicarious liability - a plaintiff must

demonstrate that each defendant personally participated in the deprivation of his or her

rights.14 On the other hand, however “[i]f state law imposes liability upon a public official for

13

 Docket 24, pp. 87–88.

14 Ashcroft v. Iqbal, 556 U.S. 662, 677 (2009); OSU Student Alliance v. Ray, 699

F.3d 1053, 1069 (9th Cir. 2012); Jones v. Williams, 297 F.3d 930, 934 (9th Cir. 2002); see

Monell v. Dep’t of Soc. Svcs. of N. Y. City, 436 U.S. 658, 691–95 (1978) (rejecting the

concept of respondeat superior in the context of § 1983, instead requiring individual liability

for the violation); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989) (“Liability under [§]

1983 arises only upon a showing of personal participation by the defendant. A supervisor

is only liable for the constitutional violations of . . . subordinates if the supervisor

participated in or directed the violations, or knew of the violations and failed to act to

prevent them.” (Citations omitted)).

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the acts of his subordinates, vicarious liability can be imposed on him under section

1983.”15

To impose liability on a supervisor, the supervisor’s wrongful conduct must be

sufficiently causally connected to the constitutional violation.16 That is, the official must

“implement a policy so deficient that the policy itself is a repudiation of constitutional rights

and is the moving force of the constitutional violation.”17

A person deprives another “of a constitutional right, within the

meaning of section 1983, if he does an affirmative act, participates in

another's affirmative acts, or omits to perform an act which he is legally

required to do that causes the deprivation of which [the plaintiff complains].” 

Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir.1978) (Johnson) (emphasis

added). The inquiry into causation must be individualized and focus on the

duties and responsibilities of each individual defendant whose acts or

omissions are alleged to have caused a constitutional deprivation. [Citations

omitted.]18

Williams’ claims against Dr. Ugwueeze fall far short of meeting the requirements for

supervisor liability. To the extent that Williams attempts to include Dr. Ugwueeze in several

of the claims, Williams simply alleges that Dr. Ugwueeze is somehow responsible in purely

conclusory terms without specifying how or the extent to which Dr. Ugwueeze was

somehow directly involved. In addition, even if Dr. Ugwueeze were directly involved, any

15

 Johnson v. Duffy, 588 F.3d 740, 744 (9th Cir. 1978).

16 See Redman v. County of San Diego, 942 F.2d 1435, 1446 (9th Cir. 1991) (en

banc) (abrogated in part on other grounds by Farmer v. Brennan, 511 U.S. 825 (1994)).

17

 Id. (internal quotation marks and citations omitted).

18

Leer v. Murphy, 844 F.2d 628, 633 (9th Cir. 1988) (quoted with approval in

Tennison v. City and County of San Francisco., 570 F.3d 1078, 1096 (9th Cir. 2009)).

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Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 18 of 23
claim against him would fail for the same reasons as those claims against the other

Defendants fail as discussed further below.

The Supreme Court, holding that the infliction of unnecessary suffering on prisoners

violated the Eighth Amendment, stated:

[D]eliberate indifference to serious medical needs of prisoners constitutes

the unnecessary and wanton infliction of pain proscribed by the Eighth

Amendment. This is true whether the indifference is manifested by prison

doctors in their response to the prisoner’s needs or by prison guards in

intentionally denying or delaying access to medical care or intentionally

interfering with the treatment once prescribed. Regardless of how evidenced,

deliberate indifference to a prisoner’s serious illness or injury states a cause

of action under § 1983.19

In Estelle the Supreme Court distinguished “deliberate indifference to serious medical

needs of prisoners,” from “negligen[ce] in diagnosing or treating a medical condition,”

holding that only the former violates the Constitution.20In short, Eighth Amendment liability

requires “more than ordinary lack of due care for the prisoner's interests or safety.”21

In determining deliberate indifference, the court scrutinizes the particular facts and

looks for substantial indifference in the individual case, indicating more than mere

negligence or isolated occurrences of neglect.22 The Ninth Circuit has spoken to the subject

of the appropriate test under Estelle:

19 Estelle v. Gamble, 429 U.S. 97, 104–105 (1976) (footnotes, internal quotation

marks and citations omitted).

20

 Id. at 106. 

21

 Whitley v. Albers, 475 U.S. 312, 319 (1986).

22

 Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990). 

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In the Ninth Circuit, the test for deliberate indifference consists of two parts. 

First, the plaintiff must show a serious medical need by demonstrating that

failure to treat a prisoner’s condition could result in further significant injury

or the unnecessary and wanton infliction of pain. Second, the plaintiff must

show the defendant’s response to the need was deliberately indifferent. This

second prong - defendant’s response to the need was deliberately indifferent

- is satisfied by showing (a) a purposeful act or failure to respond to a

prisoner’s pain or possible medical need and (b) harm caused by the

indifference. Indifference may appear when prison officials deny, delay or

intentionally interfere with medical treatment, or it may be shown by the way

in which prison physicians provide medical care. Yet, an inadvertent [or

negligent] failure to provide adequate medical care alone does not state a

claim under § 1983. A prisoner need not show his harm was substantial;

however, such would provide additional support for the inmate’s claim that

the defendant was deliberately indifferent to his needs. If the harm is an

isolated exception to the defendant’s overall treatment of the prisoner [it]

ordinarily militates against a finding of deliberate indifference.23

A defendant must purposely ignore or fail to respond to a prisoner’s pain or medical

need in order for deliberate indifference to be established. Where the claim is based upon

delay in providing a specified treatment, a prisoner has no claim for deliberate medical

indifference unless the delay was harmful.24 

The problem with Williams’ Complaint as presently constituted is that it names

practically every medical professional with whom Williams came into contact or was

otherwise somehow involved in providing heath care during his incarceration at SATF. As

to at least three of the Defendants, RN Powell, NP Merritt, and RN Whiting, the allegations

do not come close to meeting the high threshold required for a deliberate indifference

23

Jett v. Penner, 429 F.3d 1091, 1096 (9th Cir. 2006) (internal quotation marks and

citations omitted).

24 McGuckin v. Smith, 974 F.2d 1050, 1060 (9th Cir. 1992), overruled on other

grounds, WMX Technologies, Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc).

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claim. As to Drs. Nyenke, Ugwueeze, and Rosenblatt, Williams’ allegations show nothing

more than either his disagreement with the course of treatment or a difference of opinion

among medical professionals as to the appropriate course of treatment. While this might

rise to the level of medical malpractice, as noted above, it is insufficient to establish a

deliberate indifference under the Eighth Amendment warranting the granting relief by a

federal court. 

To the extent that Williams alleges that a Defendant acted in retaliation for the filing

of internal grievances the allegations are not only made in mere conclusory terms, but are

based upon nothing more than supposition and conjecture. The Ninth Circuit has defined

the parameters of a retaliation claim:

Within the prison context, a viable claim of First Amendment

retaliation entails five basic elements: (1) An assertion that a state actor took

some adverse action against an inmate (2) because of (3) that prisoner's

protected conduct, and that such action (4) chilled the inmate's exercise of

his First Amendment rights, and (5) the action did not reasonably advance

a legitimate correctional goal.25

The Ninth Circuit has “also noted that a plaintiff who fails to allege a chilling effect may still

state a claim if he has suffered some harm.”26 A prisoner must show some causal

connection between the action taken by the state actor and the prisoner’s protected

conduct. That is, “[t]o prevail on a retaliation claim, a plaintiff must show that his protected

25 Rhodes v. Robinson, 408 F.3d 559, 567–68 (9th Cir. 2005) (footnote and

citations omitted).

26 Brodheim v. Cry, 584 F.3d 1262, 1269 (9th Cir. 2009) (citing Rhodes, 408 F.3d

at 568 n. 11).

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Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 21 of 23
conduct was the substantial or motivating factor behind the defendant's conduct.”27

In this

case the allegations of the Complaint clearly show that the acts of the Defendants had no

“chilling effect” on Williams exercise of his First Amendment right of seeking redress. 

Williams has not pleaded a viable retaliation claim. 

To the extent that Williams attempts to raise a conspiracy claim it also fails. The

elements of a conspiracy are twofold: (1) an agreement or meeting of the minds to violate

constitutional rights; and (2) an actual deprivation of those rights.28 Williams’ vague and

conclusory allegations of a conspiracy are patently insufficient on their face.29In addition,

as noted above, Williams has failed to plead a viable claim that his Constitutional rights

were violated. Even if there were an agreement among the Defendants to do the acts of

which Williams complains, they did not constitute a deprivation of any cognizable

Constitutional right.

V. CONCLUSION/ORDER

Ordinarily the Court would grant Williams leave to amend his complaint; however, 

“when a district court has already granted a plaintiff leave to amend, its discretion in

deciding subsequent motions to amend is particularly broad.”30In this case it is patently

27

 Id. at 1271 (internal quotation marks and citation omitted).

28 See Avalos v. Baca, 596 F.3d 583, 592 (9th Cir. 2010); Hart v. Parks, 450 F.3d

1059, 1069 (9th Cir. 2006) (quoting Franklin v. Fox, 312 F.3d 423, 441 (9th Cir. 2002)).

29 See Simmons v. Sacramento Cty. Superior Ct., 318 F.3d 1156, 1161 (9th Cir.

2003) (holding that conclusory allegations are insufficient to state a claim of conspiracy);

Ivey v. Bd. of Regents, 673 F.2d 266, 268 (9th Cir. 1982) (same)

30 See Chodos v. West Publ’g Co., 292 F.3d 992, 1003 (9th Cir. 2002) (citation and

(continued...)

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Case 1:15-cv-00861-RRB Document 25 Filed 07/13/16 Page 22 of 23
evident from the Amended Complaint and the documents attached thereto that Williams

cannot truthfully plead a plausible Constitutional violation claim against any Defendant. 

Thus, any further attempt to amend would be futile.31

Accordingly, the Amended Complaint is hereby DISMISSED in its entirety without

leave to amend.

The Court, having fully considered the matter finds that reasonable jurists could not

disagree with this Court’s resolution of his constitutional claims or that jurists could

conclude the issues presented are adequate to deserve encouragement to proceed further. 

Accordingly, any appeal would be frivolous or taken in bad faith.32 Therefore, Williams' in

forma pauperis status is hereby REVOKED.

The Clerk of the Court is directed to enter final judgment accordingly.

IT IS SO ORDERED this 13th

 day of July, 2016.

S/ RALPH R. BEISTLINE

UNITED STATES DISTRICT JUDGE

30

(...continued)

internal quotation marks omitted).

31 See Hartman v. California Dept. of Corr. and Rehab., 707 F.3d 1141, 1130 (9th

Cir. 2013) (“A district court may deny leave to amend when amendment would be futile.”);

Lopez v. Smith, 203 F.3d 1122, 1130–31 (9th Cir. 2000) (en banc) (explaining that leave

to amend should be given unless amendment would be futile).

32

28 U.S.C. § 1915(a)(3); see Hooker v. American Airlines, 302 F.3d 1091, 1092

(9th Cir. 2002) (revocation of in forma pauperis status is appropriate if the appeal is

frivolous).

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