Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_19-cv-01338/USCOURTS-caed-2_19-cv-01338-6/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

FOR THE EASTERN DISTRICT OF CALIFORNIA

KEENAN WILKINS, aka NERRAH 

BROWN,

Plaintiff,

v.

DR. CHRISTINE S. BARBER, et al.,

Defendants.

No. 2:19-cv-1338 WBS KJN P

ORDER AND FINDINGS AND 

RECOMMENDATIONS

Plaintiff is a state prisoner, proceeding without counsel. Plaintiff seeks relief pursuant to 

42 U.S.C. § 1983. This proceeding was referred to this court pursuant to 28 U.S.C. § 636(b)(1) 

and Local Rule 302. On July 24, 2019, plaintiff filed a motion for preliminary injunction, and 

pursuant to the court’s order, the state provided a response by special appearance (ECF No. 15). 

On October 3, 2019, plaintiff filed his reply (ECF No. 25). On October 31, 2019, plaintiff filed a 

motion for temporary restraining order, and the state provided a response by special appearance 

(ECF No. 32). On December 4, 2019, the undersigned issued findings and recommendations. 

However, plaintiff subsequently informed the court that his reply had not been received by the 

court, and therefore sought reconsideration. Good cause appearing, the December 4, 2019 

findings and recommendations are vacated. 

In the meantime, plaintiff filed a second motion for temporary restraining order on 

December 26, 2019. 

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As discussed below, the undersigned recommends that plaintiff’s motions be denied

without prejudice.

I. Plaintiff’s Complaint

On July 17, 2019, plaintiff filed a complaint alleging the following. Plaintiff suffers from 

a myriad of serious medical conditions including a disc herniation, syringomyelia, spondylosis, 

and alleged shoulder separation that causes him extreme pain. Plaintiff also has schizophrenia, 

and at times has suicidal ideations due to pain. (ECF No. 1 at 7.) For four years, plaintiff was 

prescribed morphine, 30 mg, twice a day for pain management. On November 28, 2018, plaintiff 

was transferred to the California Health Care Facility (“CHCF”). Plaintiff alleges that defendant 

Dr. Barber immediately began threatening to take plaintiff off opioids. Subsequently, a psych 

tech falsely reported that plaintiff was “cheeking” his medications. The next day, Dr. Barber had 

plaintiff sign a narcotic contract and began reducing plaintiff’s morphine. One week later, the 

morphine was completely stopped, and plaintiff was given Tylenol that offered no pain relief. 

Plaintiff began having extreme pain and withdrawals. Despite putting in repeated sick call slips, 

he was denied care and defendant Nurse Escobar told plaintiff to “drink water” for the 

withdrawals. Plaintiff suffered withdrawal symptoms for two weeks or more without any medical 

assistance. On March 6, 2019, plaintiff saw Dr. Barber, and informed her of his suffering. 

Plaintiff told Dr. Barber that he had reported her to her superiors and submitted a Medical Board 

complaint. Plaintiff claims Dr. Barber became enraged, told plaintiff to “suffer” and made him 

leave. Dr. Barber then entered a false note claiming plaintiff was caught cheeking medication 

two days in a row and that was why she stopped his pain medication. Plaintiff alleges that Dr. 

Singh found Dr. Barber violated policy by writing such a false note. (ECF No. 1 at 5, citing ECF 

No. 1 at 18-19.)

On March 15, 2019, plaintiff saw an outside surgeon, who requested a current MRI of disc 

herniation for surgery and recommended a non-narcotic pain medication. On March 25, 2019, 

Dr. Barber denied the MRI and the pain medication, and discontinued plaintiff’s prescription for

orthopedic shoes which plaintiff had for two years to help him walk with syringomyelia, etc. 

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On May 3, 2019, plaintiff saw an outside orthopedist for plaintiff’s shoulder separation 

that has allegedly gone unaddressed since December 2015. The orthopedist recommended 

plaintiff receive a cortisone shot in his shoulder, which to date plaintiff has not received.

Plaintiff further alleges that Chief Recarey, Chief Adams, and Chief Singh insisted 

plaintiff still see Dr. Barber. On July 10, 2019, plaintiff saw CHCF Dr. Monsour by TV 

appointment. Dr. Monsour would not order an MRI or the orthopedic shoes because Dr. Barber 

allegedly said plaintiff does not need surgery or shoes.

In his second claim, plaintiff contends Dr. Barber retaliated against plaintiff because 

plaintiff sought redress via medical grievances and complaints by Dr. Barber telling plaintiff to 

“suffer,” and then discontinued plaintiff’s prescription orthopedic shoes, and denied plaintiff an 

MRI and surgery.

Plaintiff seeks injunctive relief, declaratory relief, and money damages. Specifically, 

plaintiff seeks an order requiring an MRI so that plaintiff can be scheduled for surgery to stop his 

daily pain. (ECF No. 1 at 12.)

II. Plaintiff’s Motion for Preliminary Injunction

In his verified motion, plaintiff states he was previously prescribed 30 mg of morphine for 

pain twice a day for four years, and orthopedic shoes to help plaintiff walk due to his serious 

spinal problems. Plaintiff alleges that false reports of cheeking were lodged to cancel plaintiff’s 

opioid prescription, and his morphine prescription was subsequently reduced to zero with no 

medical assistance during his period of withdrawal. Then, he was prescribed Tylenol, which 

plaintiff claims does not help at all. 

On March 15, 2019, plaintiff saw an outside neurosurgeon, Dr. Rahimifar, who requested 

a current MRI on plaintiff’s disc herniation to schedule plaintiff’s surgery, and requested plaintiff 

receive a non-opioid pain medication Ultram. (ECF No. 6 at 3, 22.) On March 25, 2019, Dr. 

Barber denied the MRI request, the non-opioid pain medication, and discontinued plaintiff’s twoyear permanent orthopedic shoe prescription. (ECF No. 6 at 4, 24.) As of the date of his motion, 

plaintiff had not received the cortisone shot in his shoulder requested on May 3, 2019. (ECF No.

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6 at 4.) On July 10, 2019, Dr. Mansour denied the MRI and orthopedic shoes because Dr. Barber 

states plaintiff does not need surgery or shoes. (Id.) 

Plaintiff alleges that for over five months, he has been allowed to endure the unnecessary 

and wanton infliction of pain, and suffers excruciating pain and agony every day, is unable to 

sleep, and at times contemplates suicide. (ECF No. 6 at 5.) He states he has trouble walking 

because it shoots pain up his spine, and he has fallen twice. Despite his grievances, plaintiff has 

been unable to obtain relief, and complains that the recommendations of the outside specialists 

are not being followed. (ECF No. 6 at 6, 22, 26.) Plaintiff specifically seeks the following: relief 

from his daily pain; an MRI of his disc herniation as requested by the neurosurgeon, cortisone 

shot in his shoulder as requested by the outside specialist, and orthopedic shoes as previously and 

permanently prescribed.

III. Plaintiff’s Motion for Temporary Restraining Order

Plaintiff repeats many of his allegations from his original pleading, and complains that he 

is still being required to see Dr. Barber. Plaintiff confirms that he received a cortisone shot in his 

shoulder on July 25, 2019, but alleges it provided no relief. Plaintiff has not received the MRI 

that the specialist allegedly requested if the shot did not work. (ECF No. 26 at 3.) Plaintiff 

“seek[s] a temporary restraining order from seeing Dr. Barber pending this action and medical 

board investigation.” (Id.)

IV. Plaintiff’s Second Motion for Temporary Restraining Order

Plaintiff contends that he is in serious pain every day, “no exercise; little sleep.” (ECF 

No. 47 at 1.) On December 11, 2019, plaintiff’s legs became numb, and pain shot through his 

spine, causing him to fall and suffer a lump on his head. Plaintiff is still receiving over the 

counter Tylenol, also known as Acetaminophen, 1300 mg daily, which he has taken for nine 

months without pain relief. Plaintiff contends that Acetaminophen should not be prescribed for 

longer than seven to ten days because high doses can result in kidney or liver damage if taken 

over long periods. Plaintiff has been deprived of the pain management committee review since 

March of 2019, and denied a step by step approach to pain management as required under the 

pain management guidelines. Plaintiff seeks a court order restraining defendants from prescribing 

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Tylenol, denying plaintiff the step by step approach to pain management, and denying plaintiff 

review by the pain management committee. 

V. Responses by Special Appearance

Pursuant to the undersigned’s requests, the Office of the Attorney General provided two 

responses to plaintiff’s motions by special appearance. (ECF Nos. 15, 32.) In the first response, 

Chief Medical Executive (“CME”) Adams set forth all of the medical treatment provided to 

plaintiff at CHCF between November 28, 2018, and August 7, 2019. (ECF No. 15 at 4-10.) 

CME Adams noted that plaintiff’s morphine was tapered off, not stopped cold turkey, and that the 

form 7362 documented plaintiff’s withdrawal symptoms, but also noted plaintiff refused to be 

seen for the evaluation and treatment of his symptoms. (ECF No. 15 at 10.) CME Adams also 

noted that plaintiff was getting two non-narcotic pain medications, Cymbalta and Tylenol, for his 

pain, and the specialist agrees that a non-narcotic should be used for plaintiff’s pain control. (Id.) 

In any event, CME Adams stated that “[p]ain relief is not the goal when treating chronic pain, it is 

treating the pain to the point where the patient is able to perform his ADLs (activities of daily 

living) and remain functional in a normal prison setting.” (Id.) CME Adams added that plaintiff 

did not meet the criteria for orthopedic shoes, and that his request for MRI was deferred until 

surgery was being considered. (ECF No. 15 at 11.) CME Adams opined that “[s]pinal surgery 

should be used to improve function, not solely for pain control,” and that it was “reasonable to 

treat the shoulder first with conservative therapy in a step-by-step fashion, prior to cutting into a 

patient’s neck.” (Id.) Plaintiff received his cortisone shot on July 25, 2019, and his mental health 

clinician confirmed that plaintiff is checked on regularly and he has not claimed to be suicidal. 

(Id.) Finally, CME Adams noted that plaintiff has been seen by two different primary care 

physicians who both feel surgery is not medically indicated at this time. (ECF No. 15 at 11.)

On November 19, 2019, the second response by special appearance confirmed that 

plaintiff’s administrative complaint “did not meet staff complaint criteria and failed to identify 

misconduct even if his allegations were assumed to be true.” (ECF No. 32 at 2.) No adverse 

action was taken against Dr. Barber as a result. In any event, the removal of the February 17, 

2019 chrono from plaintiff’s records “would have no effect on his medical care or custody 

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decisions.” (ECF No. 32 at 2.) The Deputy Attorney General noted that plaintiff had not yet 

been seen by the pain committee, but that “[p]laintiff has refused multiple visits to see the 

physician over the past several months, and due to these refusals, there has not been an updated 

assessment, completion of referral paperwork, or discussion regarding referrals or updates in the 

treatment plan with plaintiff.” (ECF No. 32 at 2.) In light of such refusals, “medical staff cannot 

determine whether plaintiff should be rescheduled for neck surgery without evaluating him.” 

(Id.) Finally, plaintiff is no longer assigned to Dr. Barber, but was assigned to a different primary 

care provider, Dr. A. Dredar. (Id.) 

VI. Motions for Injunctive Relief

A. Applicable Law

A temporary restraining order may issue upon a showing “that immediate and irreparable 

injury, loss, or damage will result to the movant before the adverse party can be heard in 

opposition.” Fed. R. Civ. P. 65(b)(1)(A). The purpose of such an order is to preserve the status 

quo and to prevent irreparable harm “just so long as is necessary to hold a hearing, and no 

longer.” Granny Goose Foods, Inc. v. Brotherhood of Teamsters, 415 U.S. 423, 439 (1974). In 

ruling on a motion for temporary restraining order, district courts apply the same factors used to 

evaluate a request for preliminary injunctive relief: whether plaintiff “is likely to succeed on the 

merits, . . . likely to suffer irreparable harm in the absence of preliminary relief, . . . the balance of 

equities tips in his favor, and . . . an injunction is in the public interest.” Winter v. Natural Res. 

Def. Council, Inc., 555 U.S. 7, 20 (2008); see Stuhlbarg Int’l. Sales Co. v. John D. Brush & Co., 

240 F.3d 832, 839 n.7 (9th Cir. 2001) (“Because our analysis is substantially identical for the 

injunction and the TRO, we do not address the TRO separately.”).

“A preliminary injunction is an extraordinary remedy never awarded as of right.” Winter, 

555 U.S. at 24 (citation omitted).

Federal courts are courts of limited jurisdiction and in considering a request for 

preliminary injunctive relief, the court is bound by the requirement that as a preliminary matter, it 

have before it an actual case or controversy. City of L.A. v. Lyons, 461 U.S. 95, 102 (1983); 

Valley Forge Christian Coll. v. Ams. United for Separation of Church & State, Inc., 454 U.S. 

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464, 471 (1982). If the court does not have an actual case or controversy before it, it has no 

power to hear the matter in question. Id. Further, requests for prospective relief are limited by 18 

U.S.C. § 3626(a)(1)(A) of the Prison Litigation Reform Act (“PLRA”), which requires that the 

court find the “relief [sought] is narrowly drawn, extends no further than necessary to correct the 

violation of the Federal right, and is the least intrusive means necessary to correct the violation of 

the Federal right.”

Finally, the pendency of an action does not give the court jurisdiction over prison officials 

in general. Summers v. Earth Island Inst., 555 U.S. 488, 491-93 (2009); Mayfield v. United 

States, 599 F.3d 964, 969 (9th Cir. 2010). The court’s jurisdiction is limited to the parties in this 

action and to the viable legal claims upon which this action is proceeding. Summers, 555 U.S. at 

491-93; Mayfield, 599 F.3d at 969. 

B. Discussion

Plaintiff filed two of his motions before the complaint was screened, and no defendant had

yet been served with process. Until defendants have been served with process, this court lacks 

personal jurisdiction over them, and may not grant the injunctive relief he seeks. See Fed. R. Civ. 

P. 65(d)(2); see Murphy Bros., Inc. v. Michetti Pipe Stringing, Inc., 526 U.S. 344, 350 (1999) 

(noting that one “becomes a party officially, and is required to take action in that capacity, only 

upon service of summons or other authority-asserting measure stating the time within which the 

party served must appear to defend.”). 

In his request for reconsideration, plaintiff now claims that in addition to Dr. Barber, who 

allegedly committed various criminal and fraudulent actions against him, plaintiff has been seen 

by Dr. Mansour, Dr. Niccoledge, and Dr. Dredar, who all “fail to afford adequate care and who 

all also falsify evaluations they never did,” and argues the June 12, 2019 grievance response was 

falsely changed after this action was brought. (ECF No. 43 at 3.) 

Since plaintiff filed this action, he has received the requested steroid shot to his shoulder, 

received an assignment to a different doctor, and was given an MRI in December of 2019. The 

record reflects that plaintiff has been seen by multiple physicians, received neurosurgical consults 

and has been seen by mental health clinicians. Thus, even assuming, arguendo, that plaintiff has 

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shown that he is likely to suffer harm in the absence of injunctive relief because his chronic pain 

is not adequately treated with 1300 mg of Acetaminophen every day, plaintiff cannot at this time 

establish that he is likely to succeed on the merits of his claim. 

The standards governing plaintiff’s Eighth Amendment claims are as follows. Inadequate 

medical care does not constitute cruel and unusual punishment cognizable under §1983 unless the 

mistreatment rose to the level of “deliberate indifference to serious medical needs.” Estelle v. 

Gamble, 429 U.S. 97, 106 (1976). 

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.

Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (internal citations and quotations omitted). 

To establish deliberate indifference, a plaintiff must show that defendants knew of and 

disregarded an excessive risk to his health or safety. Farmer v. Brennan, 511 U.S. 825, 837 

(1994). A prison 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 inferences.” Id. The 

nature of a defendant’s responses must be such that the defendant purposefully ignores or fails to 

respond to a prisoner’s pain or possible medical need in order for deliberate indifference to be 

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

grounds, WMX Techs., Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997). Deliberate 

indifference may occur when prison officials deny, delay, or intentionally interfere with medical 

treatment, or may be demonstrated by the way in which prison officials provide medical care. 

McGuckin, 974 F.2d at 1059-60.

However, a showing of merely inadvertent or even negligent medical care is not enough to 

establish a constitutional violation. Estelle, 429 U.S. at 105-06; Frost v. Agnos, 152 F.3d 1124, 

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1130 (9th Cir. 1998). A mere difference of opinion concerning the appropriate treatment cannot 

be the basis for an Eighth Amendment violation. Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 

1996); Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981). Instead, an inmate must allege 

facts sufficient to indicate a culpable state of mind on the part of prison officials. Wilson v. 

Seiter, 501 U.S. 294, 297-99 (1991). Accordingly, a difference of opinion about the proper 

course of treatment is not deliberate indifference and a dispute between a prisoner and prison 

officials over the necessity for or extent of medical treatment does not amount to a constitutional 

violation. See, e.g., Toguchi v. Chung, 391 F.3d 1051, 1058 (9th Cir. 2004); Sanchez v. Vild, 

891 F.2d 240, 242 (9th Cir. 1989).

Here, while the court determined that the complaint is appropriate for service on 

defendants, no defendant has yet responded to the complaint. No discovery has been conducted 

or evidence presented to the court. Plaintiff disputes the responses submitted by the office of the 

Attorney General by special appearance, but the responses suggest that plaintiff has a difference 

of opinion with the medical care he is receiving at CHCF. See, e.g., Joseph v. Hawkins, 2015 

WL 2455718, at *3 (E.D. Cal. May 22, 2015) (“To the extent plaintiff contends that defendants 

should have provided plaintiff with additional pain medication or taken further steps to involve 

themselves with the PMC [Pain Management Committee], such contentions represent a mere 

difference of opinion.”). Thus, while plaintiff has a possibility of succeeding on the merits of his 

claims should he be able to demonstrate a defendant’s deliberate indifference, the undersigned 

cannot find that plaintiff is likely to succeed on the merits of his claims at this stage of the 

proceedings.

Because plaintiff cannot at this time make each of the showings required under Winter, 

injunctive relief is not appropriate.

VII. Conclusion

Accordingly, IT IS HEREBY ORDERED that the findings and recommendations (ECF 

No. 42) are vacated; and

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Further, IT IS RECOMMENDED that:

1. Plaintiff’s motion for injunctive relief (ECF No. 6) be denied without prejudice; and

2. Plaintiff’s motions for temporary restraining order (ECF Nos. 26, 47) 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 fourteen days 

after being served with these findings and recommendations, plaintiff 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.” Plaintiff is advised that failure to file

objections within the specified time may waive the right to appeal the District Court’s order. 

Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991). 

Dated: January 23, 2020

/wilk1338.tro2.pi

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