Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_17-cv-06675/USCOURTS-cand-3_17-cv-06675-5/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 28:1331 Federal Question: Other Civil Rights

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

DAT THANH LUONG, et al.,

Plaintiffs,

v.

NAPA STATE HOSPITAL, et al.,

Defendants.

Case No. 17-cv-06675-EMC 

ORDER GRANTING IN PART AND

DENYING IN PART STATE 

DEFENDANTS’ MOTION FOR 

SUMMARY JUDGMENT; AND 

DENYING PLAINTIFFS’ MOTION 

FOR PARTIAL SUMMARY 

JUDGMENT

Docket Nos. 183, 181

Plaintiffs in this case are (1) the successors in interest to decedent Dat Thanh Luong 

(namely, his wife and minor son); (2) Mr. Luong’s wife, Ai Qiong Zhong; and (3) Mr. Luong’s 

minor son, W.L.1 Mr. Luong was diagnosed with schizophrenia in or about 2001. See Haddad 

Decl., Ex. 2 (N. Luong Depo. at 27-28). In January 2016, he was arrested and booked into 

Alameda County’s Santa Rita Jail. See Prothero Decl., Ex. A (arrest report). In July 2016, a state 

court ordered that Mr. Luong be committed to Napa State Hospital (“NSH”) or “any other 

Hospital” because he was mentally incompetent within the meaning of California Penal Code § 

1368. Defs.’ RJN, Ex. G (Order at 1). By September 2016, Mr. Luong still had not been 

transferred to NSH or any other hospital, thus prompting a state court to issue an order directing

the Director of the California Department of State Hospitals (“DSH”) to transport Mr. Luong or to 

 

1 Mr. Luong’s mother, Mai Chai, is also a named plaintiff; however, she has dismissed all of her 

claims against the State Defendants, see Docket No. 55 (stipulation and order), and the only 

defendants left in the case are the State Defendants. Thus, for purposes of the pending motions, 

Ms. Chai is not a relevant plaintiff.

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show cause re contempt. See Defs.’ RJN, Ex. H (order). Despite the court orders, Mr. Luong was 

never transferred. Pending the transfer that never came, he was killed in jail in October 2016 after 

his cellmate strangled him. 

At this juncture, the only defendants remaining in the case are the State Defendants. They 

are as follows:

(1) DSH;

(2) Pam Ahlin (the Director of DSH during the relevant time);

(3) NSH;

(4) Dolly Matteucci (the Executive Director of NSH during the relevant time);

(5) Patricia Tyler (the Medical Director at NSH during the relevant time); and 

(6) Cindy Black (the Clinical Administrator at NSH during the relevant time). 

Currently pending before the Court are (1) the State Defendants’ motion for summary 

judgment or, in the alternative, summary adjudication and (2) Plaintiffs’ motion for partial 

summary judgment. Having considered the parties’ briefs and accompanying submissions, as well 

as the oral argument of counsel, the Court hereby GRANTS in part and DENIES in part the State 

Defendants’ motion and DENIES Plaintiffs’ motion.

I. FACTUAL & PROCEDURAL BACKGROUND

Both parties have submitted evidence in conjunction with their motions. The evidence 

reflects as follows. Where there are disputes of fact, they are so noted.

A. General Process re Incompetent-to-Stand-Trial (“IST”) Defendants

“DSH was created in 2012 to manage and operate the state psychiatric hospital system.” 

Maynard Decl. ¶ 12.2 It is “comprised of five state hospitals, four of which serve IST defendants,” 

including NSH. Maynard Decl. ¶ 12. In fiscal year 2016-17, DSH had an “average daily census 

of 1,524 IST defendants.” Maynard Decl. ¶ 12.

When a state court commits an IST defendant to the care of DSH, it does so at a hearing in 

 

2 Mr. Maynard is the Deputy Director of Administrative Services for DSH. He has held the 

position since July 2018. See Maynard Decl. ¶ 1. He was designated the 30(b)(6) deponent for 

the State of California.

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which DSH is not a participant. See Black ¶ 7. “When the court orders that the defendant be 

committed to a State Department of State Hospitals facility or other public or private treatment 

facility, the court shall provide,” inter alia, a copy of the commitment order to DSH or other 

facility prior to the admission of the defendant. Cal. Pen. Code § 1370(a)(3). Pursuant to 

California Penal Code § 1370(a)(3), the “admission packet” for an IST defendant also includes, 

e.g., “[c]ourt-ordered psychiatric examination or evaluation reports” and “[m]edical records.” Id. 

Prior to September 2016, “some counties failed to include adequate medical records or any records 

at all.” Black Decl. ¶ 9 (adding that this “was a factor in DSH promulgating regulations [in 

September 2016] requiring [that] full medical records be included in admission packets”).

During the relevant period, NSH had an Admissions Suite that received the commitment 

order and admission packet from the county/court. See Black Decl. ¶ 8. Upon receipt, the 

patient’s name was placed on a wait list. See Black Decl. ¶ 10; Prothero Decl. ¶ 5.3 Like all state 

hospitals, NSH had, during the relevant time, a wait list for admission. See Black Decl. ¶ 11. 

There were wait lists because “[e]ach state hospital has reached its maximum licensing, functional, 

or statutory capacity.” Maynard Decl. ¶ 4; see also Maynard Decl. ¶ 6 (testifying that “[a]ll State 

Hospitals are licensed and regulated by the California Department of Health” and “[e]ach hospital 

has limitations on bed space and bed usage”; NSH’s “total number of beds is limited by its 

license” and, “until June, 2016, [NSH] was limited to 980 beds for patients whose placement was 

required pursuant to the Penal Code”).

The NSH Admissions Suite had an Admissions Coordinator – at the relevant time, Dana 

White, a registered nurse – who would initially review the admission packet “looking for any 

history of escape, violence, sex offender status, or specific medical need, so that the IST defendant 

could be placed in the proper hospital with the proper resources available when he . . . arrived.” 

Prothero Decl. ¶ 3; see also Haddad Decl., Ex. 14 (White Depo. at 27) (testifying that, from 2005 

to May 2019 (when she left NSH), she was the only person at NSH who reviewed the admission 

packets). After the Admissions Coordinator completed her review, she would “release the packet 

 

3 Ms. Prothero is the Supervising Registered Nurse in the Admissions Suite at NSH. She has held 

the position since December 2015. See Prothero Decl. ¶ 1.

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to an analyst in her office who checked the packet for completeness.” Prothero Decl. ¶ 3; see also

Black Decl. ¶ 8; Haddad Decl., Ex. 13 (Black Depo. at 25) (testifying that the packet was 

reviewed for completeness and accuracy by an analyst and not medical staff); Haddad Decl., Ex. 

14 (White Depo. at 25) (testifying that analysts do not, e.g., have a nursing license). If 

information was missing, either the Admissions Coordinator or an analyst would contact the 

county, see Prothero Decl. ¶ 3, and “facilitate the process of completing the packet with the 

required documents.” Black Decl. ¶ 9. After the admissions packet was complete, “the IST 

defendant’s status on the wait list was changed to ‘ready’ to schedule admission.”4 Black Decl. ¶

10.

It appears that, prior to the enactment of regulations in September 2016, a defendant’s 

place on the wait list was – as a general matter – dependent on his commitment date. See Prothero 

Decl. ¶ 5 (testifying that, “[i]n 2016, because of concerns arising out of the fairness of some 

counties in [NSH’s] catchment area having standing orders, the Admissions staff continued to 

place all IST Defendants on the . . . wait list, once their packet was complete, according to 

commitment date”).5 

It also appears that, prior to September 2016, a defendant could be immediately placed at a 

hospital – i.e., in spite of the wait list – if the defendant had an acute psychiatric need. See Haddad 

Decl., Ex. 13 (Black Depo. at 46). Usually, NSH would be told by the county jail that the 

defendant had such a need (although anyone could tell NSH, including the defendant’s attorney or 

any one concerned about the defendant), and then the referral would be reviewed by the Clinical 

Administrator (Ms. Black) and the Medical Director (Dr. Tyler). See Black Decl. ¶¶ 10, 12; see 

 

4

It appears that processing of admission packets is now largely done by the Patient Management 

Unit (“PMU”) instead of each state hospital. See Defs.’ Mot. at 6 n.3 (stating that “DSH 

centralized the referral process by way of the [PMU]”); Maynard Decl. ¶ 15 (testifying that 

processing by PMU is done for 46 counties and “[a]ll remaining counties are at various stages of 

implementation”).

5

In September 2016, the enacted regulations formally “provided a rule that each IST Defendant’s 

position on a wait list would be based on his . . . commitment date.” Black Decl. ¶ 12; see also 9 

Cal. Code Regs. § 4710(a) (providing that, “[i]n scheduling the admission of individuals judicially 

committed to the [DSH] as Incompetent to Stand Trial, the Department shall admit each individual 

to a state hospital according to the date the court committed the individual to the Department”). 

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also Prothero Decl. ¶ 7. “Based on the review of the available records and discussion with staff 

treating the defendant, the Medical Director [would] determine[] if the patient needed immediate 

placement due to [his] psychiatric condition.” Black Decl. ¶ 10.6

There is evidence that DSH/NSH did not have a practice of routinely informing the state 

courts issuing commitment orders, medical staff at the jails, the prosecution, or defense counsel 

that a psychiatric acuity review could get an IST defendant admitted on a priority basis. See, e.g., 

Haddad Decl., Ex. 13 (Black Depo. at 54-55) (testifying that she could not recall a specific 

instance of the above being told “on a routine basis”); see also Haddad Decl., Ex. 18 (Ahlin Depo. 

at 106) (testifying that she is “not aware of a formal notification” to county jail doctors or 

admissions that they can request psychiatric acuity review); Haddad Decl., Ex. 19 (Tyler Depo. at 

172) (testifying that she has “never sent out a letter to jail staff saying they can ask” for a 

psychiatric acuity review for a patient); Blakely Decl. ¶ 7 (testifying that, while he was a public 

defender, he “was never informed that the Department of Mental Health or [DSH] allows for 

psychiatric acuity reviews upon request, to provide an IST criminal Defendant with priority 

admission to [NSH] based on the severity or acuity of his mental illness”).

In addition, there is evidence that DSH/NSH did not have a practice of automatically 

subjecting IST defendants to psychiatric acuity reviews before they were placed on the wait list –

i.e., there was no attempt to “triage.” See, e.g., Haddad Decl., Ex. 13 (Black Depo. at 48, 58) 

(testifying that “[w]e do not do a triage for admission” – i.e., NSH does “not triage patients to 

determine their psychiatric acuity before putting them on the waiting list”); Haddad Decl., Ex. 17 

(Maynard Depo. at 63) (testifying that “[t]here is not a standard that I am aware of while I have 

 

6 With the enactment of regulations in September 2016, an exception to the wait list was formally 

made “for those who were psychiatrically acute.” Black Decl. ¶ 12; see also 9 Cal. Code Regs. §

4710(a)(2) (providing that “[a]ctual date of admission may change upon consideration of any of 

the following factors . . . (2) Whether the individual exhibits psychiatric acuity which may indicate 

the need for admission to the facility, notwithstanding the date the court committed the individual 

to the [DSH]”); id. § 4717(a) (providing that “[a]n individual shall be admitted to a state hospital 

notwithstanding the date the court committed the individual to the [DSH] if the [DSH] determines 

that the individual is psychiatrically acute”); id. § 4717(c) (providing that, “[t]o request a 

psychiatric acuity review of an individual, the committing county’s clinician who is responsible 

for the individual’s clinical assessment or its designee shall contact the Department’s medical 

director or designee about the individual’s psychiatric acuity and the psychiatric acuity needs of 

the individual”).

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been with DSH to triage and evaluate every patient prior to placement on the wait list”). 

However, there is some evidence indicating that the Admissions Suite nurse of a state hospital 

would do a limited kind of psychiatric acuity review at or about the time that the admission packet

was sent to the hospital. See, e.g., Haddad Decl., Ex. 17 (Maynard Depo. at 39-40) (testifying 

that, at the time of referral, “[t]he patient referral information provided by the county is reviewed 

by a nurse in each of the hospitals, or the patient management unit, for specific placement issues 

which could be related to psychiatric acuity” or other matters such as “the type of offense” and 

“medical conditions”); Haddad Decl., Ex. 14 (White Depo. at 39, 41) (testifying that “[w]e have 

medical records before they go on the waiting list” such that, “if anything sticks out in those 

medical records that call to us to ask the jail for further information, we do call the jail”; 

“sometimes, to me, I’ll read something and think: Wow, this person needs to get in a hospital 

now” so “I’ll ask the [Admissions] [S]uite to make a phone call to the jail to see if they are 

suicidal right now or if things have changed or how the person’s doing now, right that moment”). 

According to Plaintiffs, it was feasible to do a more systematic psychiatric acuity review for all 

IST defendants because there is evidence that “it takes Dr. Tyler only about an hour to do one on 

an ad hoc basis.” Pls.’ Opp’n at 8; see also Haddad Decl., Ex. 19 (Tyler Depo. at 171-72) (stating 

that the time to do a psychiatric acuity review “can vary, but I would say less than an hour”; this 

includes reviewing available medical records).

The State Defendants, however, note that “the numbers of IST defendants that counties 

[have] referred to DSH . . . have experienced tremendous growth over the last several years. For 

example, the number of county IST referrals to DSH systemwide increased from 1,859 in Fiscal 

year (FY) 2013-14 to over 3,400 in FY 2016-17.” Maynard Decl. ¶ 10. Although DSH has been

able “to increase admissions and numbers of IST defendants served,” Black Decl. ¶ 11; see also

Maynard Decl. ¶ 12 (testifying that, in “the last four years, DSH has added 970 new beds to its 

overall treatment system of state hospital beds and Jail Based Competency (JBCT) Program 

beds”7), “the number of county referrals continue to outpace the rate of admissions.” Maynard 

 

7

“The JBCT Program was created in 2011 to establish competency restoration in specialized jailbased programs. Competency restoration is offered to participating counties and the programs are 

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Decl. ¶ 10; see also Maynard Decl. ¶ 13.

Given the above, it is not surprising that state courts often had to issue orders to show 

cause (“OSCs”) because an IST defendant had not been transferred to a hospital as required by a 

court commitment order. When a state court issues an OSC “for disobeying a court order of 

commitment, it may be directed to the Director of DSH [e.g., Ms. Ahlin] in [her] official 

capacity.” Maynard Decl. ¶ 8. The OSC, however, “does not [actually] go to the Director of DSH 

and instead [is] routed directly to the DSH legal department for handling.” Maynard Decl. ¶ 8; see 

also Carson Dec., Ex. A (Ahlin Depo. at 42); Ahlin Decl. ¶ 4. “[I]n fiscal year 2016, DSH 

received 1,975 OSCs.” Maynard Decl. ¶ 8.

B. Process Specific to Mr. Luong as an IST Defendant

On January 26, 2016, Mr. Luong was arrested for assault after he allegedly attacked a 

person with a mallet. See Prothero Decl., Ex. A (arrest report). Mr. Luong was eventually placed 

in custody in the Santa Rita Jail in Alameda County.

In February 2016, medical staff at the jail assessed Mr. Luong with schizophrenia and/or 

psychosis. See, e.g., Haddad Decl., Ex. 6 (PLF 617, 620). He was prescribed the antipsychotic 

drug Risperdal. See Haddad Decl., Ex. 6 (PLF 627).

On March 7, 2016, the state court in the criminal proceeding related to the assault 

appointed an alienist (Victoria Campagna) pursuant to California Penal Code § 1368 to assess Mr. 

Luong’s competency. See Defs.’ RJN, Ex. A (order).

Shortly thereafter, medical staff at the Santa Rita Jail made note that Mr. Luong was 

refusing to take his medication. See, e.g., Haddad Decl., Ex. 6 (PLF 629-31). Risperdal continued 

to be prescribed. See, e.g., Haddad Decl., Ex. 6 (PLF 634, 636, 638).

On April 5, 2016, Dr. Campagna (the court-appointed alienist) opined that Mr. Luong was 

competent to stand trial. This was based on, inter alia, an interview with Mr. Luong on the 

preceding day. See Prothero Decl., Ex. A (Campagna report). 

 

established and paid for by DSH.” Maynard Decl. ¶ 14. “DSH must have the cooperation and 

agreement of county officials in order for a program to be created.” Maynard Decl. ¶ 14. 

“Alameda County declined to participate in the JBCT Program.” Maynard Decl. ¶ 14.

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On April 6, 2016, the state court appointed another alienist (Martin Blinder) to assess Mr. 

Luong’s competency. See Defs.’ RJN, Ex. C (order).

On May 7, 2016, Dr. Blinder (the court-appointed alienist) opined that Mr. Luong was not 

competent to stand trial. This was based, inter alia, on an interview with Mr. Luong on May 3, 

2016. See Prothero Decl., Ex. A (Blinder report).

In mid- to late May 2016, Mr. Luong’s condition began to deteriorate, with medical 

records indicating, e.g., that he had been refusing to eat and drink and that he was delusional. See, 

e.g., Haddad Decl., Ex. 6 (PLF 639, 641, 643).

On June 1, 2016, medical staff at the Santa Rita Jail noted that Mr. Luong refused to take 

his anti-psychotic medication and determined that Mr. Luong’s condition had deteriorated to the 

point where he was a danger to self and had a grave disability, thus prompting a detention for 

evaluation and treatment at the John George Psychiatric Pavilion pursuant to California Welfare & 

Institutions Code § 5150.8 See Haddad Decl., Ex. 6 (PLF 646).

On June 2, 2016, the state court appointed another alienist (David Echeandia) to assess Mr. 

Luong’s competency. See Defs.’ RJN, Ex. E (order).

On or about June 10, 2016, Mr. Luong returned to the jail from the John George 

Psychiatric Pavilion. See Haddad Decl., Ex. 6 (PLF 649); see also Haddad Decl., Ex. 7 (hospital 

records from the John George Psychiatric Pavilion).

Beginning in late June 2016 and continuing into July 2016, Mr. Luong began to refuse to 

take his anti-psychotic medication again. See, e.g., Haddad Decl., Ex. 6 (PLF 656, 660).

On July 5, 2016, Dr. Echeandia (the court-appointed alienist) opined that Mr. Luong was 

 

8 Section 5150 provides in relevant part:

When a person, as a result of a mental health disorder, is a danger to 

others, or to himself or herself, or gravely disabled, . . . [a] 

professional person in charge of a facility designated by the county 

for evaluation and treatment . . . or professional person designated 

by the county may, upon probable cause, take, or cause to be taken, 

the person into custody for a period of up to 72 hours for 

assessment, evaluation, and crisis intervention . . . .

Cal. Wel. & Inst. Code § 5150(a).

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not competent to stand trial. This was based, inter alia, on an interview on July 1, 2016. See

Prothero Decl., Ex. A (Echeandia report). 

On July 8, 2016, the state court found Mr. Luong mentally incompetent within the meaning 

of § 1368. The court ordered Mr. Luong to be referred to the Conditional Release Program (also 

known as “CONREP”) for an examination and a recommendation for placement pursuant to 

California Penal Code § 1370. See Defs.’ RJN, Ex. F (order). CONREP is a program 

overseen/administered by DHS. See Cal. Wel. & Inst. Code § 4360(a) (providing that DSH “shall 

provide mental health treatment and supervision in the community for judicially committed 

persons” and that “[t]he program established and administered by [DSH] under this chapter to 

provide these services shall be known as the Forensic Conditional Release Program [or 

CONREP]”).

On or about July 29, 2016, Alameda County, with whom DSH had contracted to provide 

CONREP services, see id. § 4360(b) (providing that DSH “may provide directly, or through 

contract with private providers or counties, for these services”), recommended to the state court 

(via a letter) that the court place Mr. Luong at NSH and that the court authorize the use of 

involuntary medication. See Prothero Decl., Ex. 1 (CONREP letter).

On July 22, 2016, the state court ordered Mr. Luong to be committed to NSH “or any other 

Hospital” pursuant to § 1370.9 Defs.’ RJN, Ex. G (Order at 1). The court also ordered that “the 

treatment facility may administer antipsychotic medication to [Mr. Luong] involuntarily when and 

as prescribed by a treating physician.”10 Defs.’ RJN, Ex. G (Order at 2). (The local jail did not 

have the authority to administer medication involuntarily. See Hayward Rpt. at 6 (noting that “the 

Alameda County jail had no statutory authorization to involuntarily treat Mr. Luong even after the 

court had issued an involuntary medication order”).) Finally, the court ordered that, “within 

ninety (90) days of this commitment and thereafter at no less than six months intervals, the 

Executive Director of the Hospital or facility where [Mr. Luong] is housed shall make a written 

 

9 Although the order is dated July 22, 2016, the order was not formally filed until August 2, 2016.

10 In her deposition, Ms. Black estimated that about 30 to 50% of the court orders provided for 

involuntary medication. See Haddad Decl., Ex. 13 (Black Depo. at 39-40).

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report to this Court . . . concerning [his] progress toward recover of . . . mental competence.” 

Defs.’ RJN, Ex. G (Order at 1). 

In late July 2016, medical staff at the Santa Rita Jail described Mr. Luong as “catatonic,” 

Haddad Decl., Ex. 6 (PLF 664, 666), noted that he was refusing to take his medication, and 

indicated that he would be detained again for a § 5150 evaluation at the John George Psychiatric 

Pavilion. See Haddad Decl., Ex. 6 (PLF 666, 668) (indicating that Mr. Luong had been 

“decompensating since clinician last saw him on 7/7/16”).

On or about August 3, 2016, Mr. Luong was returned to the jail from the John George 

Psychiatric Pavilion. See Haddad Decl., Ex. 6 (PLF 669-70).

On August 22, 2016 – approximately a month after the state court issued the order placing 

Mr. Luong at NSH – Alameda County transmitted the commitment order and admission packet for 

Mr. Luong to NSH.11 See Prothero Decl. ¶ 10; see also Haddad Decl., Ex. 14 (White Depo. at 24) 

(testifying that, although the commitment order issued in late July 2016, it took time for NSH to 

approve Mr. Luong for admission because it took time for the court to generate the admission 

packet and send it to NSH). “The [admission] packet was reviewed and completed on August 26, 

2016.” Prothero Decl. ¶ 10. Because no beds for IST defendants were available at that time, “Mr. 

Luong was placed on the waiting list according to his date of [c]ommitment.” Prothero Decl. ¶ 12.

Mr. Luong’s admission packet included (1) three psychological and psychiatric reports 

regarding competency to stand trial (as ordered by the state court); (2) a letter from CONREP 

regarding placement (as ordered by the state court); and (3) medical records. More specifically, 

these documents indicated as follows:

• Psychological report by Dr. Campagna, dated April 5, 2016. Dr. Campagna 

opined that, “at the present time, Mr. Luong is competent to stand trial.” Prothero 

Decl., Ex. A (Campagna Rpt. at 1) (emphasis omitted). She noted, however, that, 

according to Mr. Luong’s sister, he “functions well when he takes his medication” 

 

11 In their papers, Plaintiffs contend that DSH/NSH had notice of Mr. Luong earlier than August 

22, 2016. However, as discussed below, the date that any State Defendant had notice of Mr. 

Luong specifically is not particularly relevant given that Plaintiffs’ theories of liability do not 

depend on any knowledge of Mr. Luong specifically.

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but not when he does not take his medication, and “[t]his is what appears to have 

happened in this instance.” Prothero Decl., Ex. A (Campagna Rpt. at 2). She 

recommended that, when Mr. Luong “is released to the community, . . . he be 

ordered to investigate the appropriateness of a long-lasting injectable psychiatric 

medication to treat his schizophrenia, and if his physicians feel this is an option for 

him, that he be court-ordered to avail himself of this treatment.” Prothero Decl., 

Ex. A (Campagna Rpt. at 2) (emphasis omitted). 

• Psychiatric report of Dr. Blinder, dated May 7, 2016. Dr. Blinder opined that Mr. 

Luong has “[i]ntermittent psychosis, etiology to be determined.” Prothero Decl., 

Ex. A (Blinder Rpt. at 3). He also opined that Mr. Luong was not competent to 

stand trial: “I find this gentleman’s commerce with reality impaired sufficient[ly] to 

negate any likelihood of rational participation in forthcoming legal proceedings.” 

Prothero Decl., Ex. A (Blinder Rpt. at 3). Dr. Blinder added that Mr. Luong was 

“currently receiving appropriate medications which, though thus far not curative, 

have doubtless brought him closer to remission,” and “it is entirely possible that 

several months hence he may be psychiatrically equal to his day in court. . . . [¶] 

[S]o long as he continues to take his medication he constitutes little danger to self 

or others.” Prothero Decl., Ex. A (Blinder Rpt. at 3).

• Psychological report of Dr. Echeandia, dated July 5, 2016. Notably, Dr. 

Echeandia stated that, during his interview with Mr. Luong, Mr. Luong’s “mental 

state appeared to deteriorate more and more” and “[t]oward the end of the 

interview, [he] decompensated to an acute psychotic state.” Prothero Decl., Ex. A 

(Echeandia Rpt. at 3). Dr. Echeandia also took note that medical records “revealed 

that [Mr. Luong] had been treated with antipsychotic drugs for psychotic symptoms 

. . . over a period spanning the past 15 years or so. Other medical records provided 

diagnoses of Schizophrenia, Paranoid Type and/or Psychotic Disorder NOS, and 

described treatment with antipsychotic medications, as well as several psychiatric 

hospitalizations, the most recent in 2015. During his current incarceration, he was 

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also transported to John George [Psychiatric Pavilion] for psychiatric reasons.” 

Prothero Decl., Ex. A (Echeandia Rpt. at 5). Dr. Echeandia opined that Mr. Luong 

was not competent to stand trial and that “treatment with antipsychotic medications 

both medically appropriate and necessary to restore [his] mental competence, given 

the evidence of his acutely psychotic behavior during the interview.” Prothero 

Decl., Ex. A (Echeandia Rpt. at 5). Dr. Echeandia stated that, based on the assault 

that resulted in Mr. Luong’s arrest, he was “inclined to believe that Mr. Luong may 

continue to represent a danger to others unless adequate treatment in the form of 

more effective psychiatric medication and therapy is provided.” Prothero Decl., 

Ex. A (Echeandia Rpt. at 6).

• CONREP letter, dated July 19, 2016. CONREP stated that it was evaluating Mr. 

Luong for placement as ordered by the state court. CONREP noted that 

Mr. Luong has a serious mental illness, Schizophrenia”; that, pursuant to California 

Welfare & Institutions Code § 5150, he had been detained for evaluation and 

treatment at John George Psychiatric Pavilion (“JGPP”) in October 2015 (i.e., a 

few months before his arrest in January 2016); and that he had been hospitalized 

for nine days at JGPP in June 2016 (i.e., several months after his arrest). Prothero 

Decl., Ex. A (CONREP Letter at 1). (CONREP did not mention the second 

hospitalization at JGPP in late July/early August 2016 because that hospitalization 

took place after the date of the CONREP letter.) CONREP also stated that it 

appeared Mr. Luong “generally does well when he takes his anti-psychotic 

medications” but that he “was not taking his medications at the time of the alleged 

offenses”; that he “is currently refusing to take” an anti-psychotic drug prescribed 

at the jail; and that, without “consistent treatment to keep his psychotic symptoms 

under control,” he “is at high risk for deterioration.” Prothero Decl., Ex. A 

(CONREP Letter at 1). CONREP recommended to the state court that it place Mr. 

Luong at NSH and that it authorize the use of involuntarily medication.

• Medical records. The medical records consisted of two pages. The first page was 

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a “Medical Information Transfer Form” from the Alameda County Sheriff’s Office. 

It indicated that Mr. Luong had a “mental disorder” for which he was being 

prescribed, inter alia, Risperdal (which is an antipsychotic drug) as of August 

2016. Prothero Decl., Ex. A (Medical Information Transfer Form). The second 

page was a form from the Santa Rita Jail indicating that a skin test for tuberculosis 

had been applied to Mr. Luong in February 2016. See Prothero Decl., Ex. A (PPD 

Skin Test). Alameda County did not transfer the full medical records from the 

Santa Rita Jail, nor did it transfer the medical records from Mr. Luong’s two 

hospitalizations at the John George Psychiatric Pavilion (i.e., while he was in 

custody in June and late July/early August 2016). See Defs.’ Mot. at 11.

In late August 2016, medical staff at the Santa Rita Jail noted that Mr. Luong was once 

again not compliant with his medication. See Haddad Decl., Ex. 6 (PLF 678).

On September 7, 2016 – after receiving notice from the public defender that Mr. Luong 

was still at Santa Rita Jail and had not been transferred to NSH – the state court issued an order to 

Ms. Ahlin, the Director of DSH, instructing her to comply with the order to transport Mr. Luong 

or to show cause why she should not be held in contempt. A hearing was set for September 12, 

2016. See Defs.’ RJN, Ex. H (order). 

It appears that a hearing was held on September 12, 2016, as reflected by a state court 

minute order. The minute order indicates that, at the hearing, a September 20, 2016, progress 

report was canceled. See Defs.’ RJN, Ex. I (order). 

On or about October 7, 2016, the Santa Rita Jail staff assigned Aref Popal to be Mr. 

Luong’s cellmate. See SAC ¶ 81.

On October 11, 2016, NSH’s Admissions Suite “was notified that a bed would become 

available for the next IST Defendant on the wait list,” which was Mr. Luong. Prothero Decl. ¶ 13. 

The Admissions Suite called the Santa Rita Jail to arrange for Mr. Luong’s transport and was 

subsequently told that Mr. Luong had died. See Prothero Decl. ¶¶ 13-14. Mr. Luong had been 

killed by his cellmate on the same date. See Haddad Decl., Ex. 4 (autopsy report for Mr. Luong) 

(indicating death from asphyxiation/strangulation).

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According to Plaintiffs, at least twelve inmates have died awaiting transfer to a state 

hospital.12 See Pls.’ Opp’n at 11-12. Plaintiffs also maintain that multiple inmates have waited for

as long as 100-300 days for transfer to a state hospital. See Pls.’ Opp’n at 12; Haddad Decl., Ex. 

32 (Plaintiffs’ chart on “Longest Waits on Direct Admission Wait List”). But see Defs.’ Opp’n at 

22-23 (asserting that there were reasons for these wait times).

C. Plaintiffs’ Experts

Plaintiffs have provided expert evidence in support of their opposition to the State 

Defendants’ summary judgment motion. There are four experts in total:

(1) Dr. Terry Kupers. The expert report from Dr. Kupers was technically submitted in a 

different case, Stiavetti v. Ahlin, No. RG15779731 (Alameda Superior Court). 

However, Plaintiffs indicate that they will be using Dr. Kupers as an expert in their 

case as well. In his report, Dr. Kupers states, inter alia, as follows. 

a. “Adequate competency restoration treatment can only occur in a setting 

conducive to mental health treatment.” Kupers Rpt. at 31.

b. “Jail is not a setting conducive to mental health treatment nor to competency 

restoration treatment, absent major alterations in milieu, staffing, and 

programming. Jail crowding, the threat of violence, the culture of punishment 

that permeates the facilities, and the relative inadequacy of programs and 

treatments have a very detrimental effect on the mental status of incompetent 

prisoners, and on the ability to participate effectively in competency 

restoration.” Kupers Rpt. at 31-32.

c. “Jails are violent places. Prisoners with serious mental illness are 

disproportionately victims of violence, or lose control of their temper and get 

involved in altercations.” Kupers Rpt. at 32.

d. “[S]ixty days is far too long for incompetent individuals to remain in harmful 

 

12 The Court GRANTS the request to seal DSH’s amended responses to Plaintiffs’ interrogatories 

(Set No. 1). See Docket Nos. 195, 200 (motions). In the interrogatories, Plaintiffs ask for 

information about other IST defendants who died before being admitted to a state hospital.

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jail conditions with limited mental health treatment.” Kupers Rpt. at 33.

(2) Dr. Bruce Gage. The expert report from Dr. Gage was also technically submitted in a 

different case, Stiavetti v. Ahlin, No. RG15779731 (Alameda Superior Court). 

However, as above, Plaintiffs indicate that they will be using Dr. Gage as an expert in 

their case as well. In his report, Dr. Gage states, inter alia, as follows. 

a. DSH has an “unwieldy admissions process[] that demand[s] excessive 

information from the counties and other local entities.” Gate Rpt. at 1.

b. The process is “not currently causing delay in DSH” but “only because DSH 

capacity to treat this population is so limited that the delays caused by lack of 

capacity mask the inefficiencies of the admission process.” Gage Rpt. at 1.

c. “Once placement is determined, two weeks gives ample time to conduct 

medical and short-term risk assessment, communicate with the jails for 

clarification of packet information, identify the appropriate facility, provide the 

information to the receiving facility, and arrange transportation. To accomplish 

this most efficiently, central control of the admissions process is essential. 

Standardization of admission screening is also essential.” Gage Rpt. at 7.

d. “Because the clinical needs of the acutely ill patient should outweigh forensic 

needs and institutional convenience, acute admissions should be handled 

differently, as recognized by current policy but poorly implemented and 

tracked. Only information essential to safely admit the patient should be 

required; additional packet information can be obtained subsequently.” Gate 

Rpt. at 7.

(3) Dr. Michael Freeman. In his report, Dr. Freeman states, inter alia, as follows.

a. “It is . . . well established that inmates who are mentally ill are more likely to be 

victimized than the general population in correctional settings.” Freeman Rpt. 

at 9.

b. “In addition to increased risk of inmate-on-inmate violence, mentally ill 

prisoners are more likely to be subjected to inconsistent medical evaluations 

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and unreliable monitoring of medication, food, and water intake as they would 

be outside of prison such as in a hospital or care facility.” Freeman Rpt. at 9.

c. “Mr. Luong’s death would have been avoided[] had Mr. Luong been transferred 

to a hospital, per court order, sooner than the 81 days he was left to languish 

with inadequate medical care in a cell with a homicidal cellmate.” Freeman 

Rpt. at 10.

(4) Dr. Richard Hayward. In his report, Dr. Hayward states, inter alia, as follows:

a. “The State of California and [DSH] contributed to [Mr. Luong’s] death by 

failing to provide Mr. Luong with prompt treatment after he was found to be 

IST on July 8.” Hayward Rpt. at 4.

b. “[T]he Alameda County jail had no statutory authorization to involuntarily treat 

Mr. Luong even after the court had issued an involuntary medication order. . . . 

For Mr. Luong[,] the state hospital remained the only resource that could 

provide the involuntary antipsychotic medication necessary to reduce his 

psychotic symptoms. Also, the state hospital would be the only option that 

could provide the necessary therapeutic milieu including daily access to mental 

health clinicians . . . .” Hayward Rpt. at 6.

c. “[T]he State of California and [DSH] contributed to Mr. Luong’s death by 

failing to expand bed capacity for IST’s at the state hospitals since at least 

2005.” Hayward Rpt. at 6.

d. “[I]t is obvious that . . . jail based [competency] programs cannot replace the 

comprehensive competency restoration and therapeutic milieu treatment 

provided at a state hospital.” Hayward Rpt. at 7.

e. “[T]he State of California has encoded into Penal Code 1370 a requirement for 

all IST defendants to be evaluated by the Community Program Director or a 

designee,” who “almost always recommend[s] treatment in a state hospital IST 

bed except for several counties that have a Jail-Based Competency Treatment 

unit. The evaluation and recommendation of the Community Program Director 

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is redundant and serves no critical purpose” and further “results in an additional 

delay.” Hayward Rpt. at 7.

f. “California and [DSH] need to add a sufficient number of state hospital beds to 

reduce the wait time for an IST hospital bed to no more than one week 

following the court determination that a defendant is Incompetent to Stand 

Trial.” Hayward Rpt. at 9. 

g. “There is no evidence that DSH ever attempted to routinely assess psychiatric 

acuity of IST’s in the county jails that were waiting for a state hospital bed. 

Acuity was not assessed unless some advocate at the county jail knew to 

contact the state hospital and request a priority admission. . . . A routine 

assessment of psychiatric acuity by DSH would have flagged Mr. Luong as 

psychiatrically acute and in need of a priority admission.” Hayward Rpt. at 13.

h. “California and [DSH] failed to provide training to the top administrative staff 

from DSH regarding the constitutional rights of defendants found to be 

Incompetent to Stand Trial.” Hayward Rpt. at 15.

D. Plaintiffs’ Causes of Action

Plaintiffs have asserted the following causes of action against the State Defendants:

(1) Violation of 42 U.S.C. § 1983, predicated on individual liability, against Ms. Ahlin (the 

Director of DSH), Ms. Matteucci (the Executive Director of NSH), Dr. Tyler (the 

Medical Director at NSH), and Ms. Black (the Clinical Administrator at NSH). As 

discussed below, the § 1983 claim is predicated on various constitutional rights. 

(2) Violation of § 1983, predicated on supervisory liability, against Ms. Ahlin, Ms. 

Matteucci, and Dr. Tyler.13 

(3) Violation of Titles II and III of the Americans with Disabilities Act (“ADA”) and 

violation of the Rehabilitation Act (“RA”) against DSH and NSH.

 

13 Ms. Black is not a named defendant for this claim. At the hearing, Plaintiffs indicated for the 

first time that this was an administrative error. The parties should meet and confer to determine 

whether they can reach agreement on adding Ms. Black as a defendant for this cause of action.

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(4) Violation of California Civil Code § 52.1 against Ms. Ahlin, Ms. Matteucci, Dr. Tyler, 

and Ms. Black. Similar to above, the § 52.1 claim is predicated on various 

constitutional rights (both federal and state).

(5) Negligence against Ms. Ahlin, Ms. Matteucci, Dr. Tyler, and Ms. Black.

II. LEGAL STANDARD

Federal Rule of Civil Procedure 56 provides that a “court shall grant summary judgment 

[to a moving party] if the movant shows that there is no genuine dispute as to any material fact and 

the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). An issue of fact is 

genuine only if there is sufficient evidence for a reasonable jury to find for the nonmoving party. 

See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-49 (1986). “The mere existence of a 

scintilla of evidence . . . will be insufficient; there must be evidence on which the jury could 

reasonably find for the [nonmoving party].” Id. at 252. At the summary judgment stage, evidence 

must be viewed in the light most favorable to the nonmoving party and all justifiable inferences 

are to be drawn in the nonmovant’s favor. See id. at 255.

Where a defendant moves for summary judgment based on a claim for which the plaintiff 

bears the burden of proof, the defendant need only by pointing to the plaintiff’s failure “to make a 

showing sufficient to establish the existence of an element essential to [the plaintiff’s] case.” 

Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986); see also Fontenot v. Upjohn Co., 780 F.2d 

1190, 1194 (5th Cir. 1986) (stating that, “if the movant bears the burden of proof on an issue, 

either because he is the plaintiff or as a defendant he is asserting an affirmative defense, he must 

establish beyond peradventure all of the essential elements of the claim or defense to warrant 

judgment in his favor”) (emphasis omitted).

Where a plaintiff moves for summary judgment on claims that it has brought (i.e., for 

which it has the burden of proof), it “must prove each element essential of the claims . . . by 

undisputed facts.” Cabo Distrib. Co. v. Brady, 821 F. Supp. 601, 607 (N.D. Cal. 1992).

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III. STATE DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

A. Section 1983 Claim: Individual Liability

1. Multiple Constitutional Rights

Plaintiffs have asserted two § 1983 claims. The first § 1983 claim is for individual 

liability; the second § 1983 claim is for supervisory liability. This section addresses the § 1983 

claim for individual liability, which is asserted against Ms. Ahlin, Ms. Matteucci, Dr. Tyler, and 

Ms. Black. 

As an initial matter, the Court must take into consideration how the § 1983 claim for 

individual liability is pled in the complaint. The § 1983 claim is predicated on a violation of a 

number of constitutional rights, namely:

(1) The right to be free from an ongoing seizure.

(2) The right to be free from deliberate indifference to serious medical need.

(3) The right to be free from reckless disregard to safety.

(4) The right to freedom from incarceration and the right to restorative treatment.

(5) The right to be free from government interference with familial relationships and the 

right to companionship, society, and support.

See SAC ¶ 118.

Although there are multiple constitutional rights implicated in the § 1983 claim for 

individual liability, the individual defendants do not address either (1) or (5) in their motion. In 

light of this fact, the Court does not address them either.

As for the remaining constitutional rights (i.e., (2)-(4)), to the extent Plaintiffs claim that 

they are based on the Fourth Amendment, the Court rejects that claim as Plaintiffs do not seem to 

have relied on any Fourth Amendment authority in their papers. Therefore, for the remainder of 

this order, the Court focuses on the constitutional rights as predicated on the Fourteenth 

Amendment, in particular, substantive due process. 

2. Deliberate Indifference or Conscious Indifference

Although the constitutional rights in (2)-(4) are all based on substantive due process, there 

is some lack of clarity in the law as to what is the standard for holding an individual liable where 

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each constitutional right is allegedly violated. 

For a pretrial detainee’s right to be free from deliberate indifference to serious medical 

need,14 the Ninth Circuit has held that an objective standard applies. That is, 

the elements of a pretrial detainee's medical care claim against an 

individual defendant under the due process clause of the Fourteenth 

Amendment are: (i) the defendant made an intentional decision with 

respect to the conditions under which the plaintiff was confined; (ii) 

those conditions put the plaintiff at substantial risk of suffering 

serious harm; (iii) the defendant did not take reasonable available 

measures to abate that risk, even though a reasonable official in the 

circumstances would have appreciated the high degree of risk 

involved – making the consequences of the defendant's conduct 

obvious; and (iv) by not taking such measures, the defendant caused 

the plaintiff's injuries. "With respect to the third element, the 

defendant's conduct must be objectively unreasonable, a test that 

will necessarily 'turn[] on the facts and circumstances of each 

particular case.'" 

Gordon v. Cty. of Orange, 888 F.3d 1118, 1125 (9th Cir. 2018) (emphasis added). Compare 

Castro v. Cty. of L.A., 833 F.3d 1060, 1068 (9th Cir. 2016) (noting that, under the Eighth 

Amendment which applies to a claim brought by a convicted prisoner (as opposed to a pretrial 

detainee), an “official must both be aware of the facts from which the inference could be drawn 

that a substantial risk of serious harm exists, and he must also draw that inference[;] [i]in other 

words, the official must demonstrate a subjective awareness of the risk of harm”) (internal 

quotation marks and emphasis omitted). 

For a pretrial detainee’s right to be free from reckless disregard to safety, the applicable 

standard is either: (1) objective deliberate indifference, see id. at 1067, 1071 (stating that “Castro –

a pretrial detainee who had not been convicted of any crime – had a due process right to be free 

from violence from other inmates” and that, for deliberate indifference, “a pretrial detainee need 

not prove [the] subjective elements about [an] officer’s actual awareness of the level of risk”); or 

(2) “conscious indifference amounting to gross negligence.” Estate of Conners v. O’Connor, 846 

F.2d 1205, 1208 (9th Cir. 1988) (holding that this was essentially the standard established by the 

Supreme Court in Youngberg v. Romeo, 457 U.S. 307, 310 (1982), where the plaintiff asserted, 

inter alia, unsafe conditions of confinement because he was injured on multiple occasions, in 

 

14 A pretrial detainee’s rights are different from that of a convicted prisoner.

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some instances from violence from other residents). It is not clear whether these standards differ

and, if so, how. For purposes of the instant case, there may not be any material difference between 

the two standards as a practical matter.

Finally, for an IST defendant’s right to freedom from incarceration and right to restorative 

treatment, the applicable standard is “conscious indifference amounting to gross negligence.” 

Estate of Conners, 846 F.2d at 1208 (construing Youngberg); see also Or. Advocacy Ctr. v. Mink, 

322 F.3d 1101 (9th Cir. 2003) (applying Youngberg in a case where IST defendants sued the 

Supervisor of the Oregon State Hospital and the Director of Oregon’s Department of Human 

Services – in their official capacities only (i.e., no damages were sought) – because there was a 

delay in their being admitted to the state hospital). The Court rejects the State Defendants’ 

suggestion that a “shock-the-conscience” standard applies – although even they seem to admit 

that, in nonemergency situations, shock the conscience essentially means deliberate indifference. 

See Defs.’ Opp’n at 12. Under Estate of Conners, the applicable standard is equivalent to gross 

negligence.

In summary, for the constitutional rights at issue, the standard of review is either deliberate 

indifference or conscious indifference amounting to gross negligence. 

3. Theories of Liability

Having established the legal standard(s) applicable to Plaintiffs’ § 1983 claim, the Court 

now turns to Plaintiffs’ theories of liability. Although not always articulated with clarity in 

Plaintiffs’ SAC or papers, Plaintiffs fleshed out their theories at the hearing on the parties’ 

motions (upon prompting by the Court). According to Plaintiffs, the individual defendants were 

deliberately indifferent or acted with conscious indifference amounting to gross negligence in the 

following ways:

(1) Failing to expand capacity at DSH/NSH. 

(2) Not doing a psychiatric acuity review for each IST defendant before putting him or her 

on the wait list (i.e., not doing a triage and instead waiting for someone to make a 

request for a psychiatric acuity review).

(3) Not doing psychiatric acuity reviews for at least those IST defendants who, per their

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commitment orders, could be involuntarily medicated while committed.

(4) Not notifying relevant actors – such as the superior courts, county jail clinicians, 

defense counsel, or prosecutors – that a psychiatric acuity review could be requested 

for an IST defendant which could thereby affect his or her placement on the wait list. 

As should be clear from the descriptions above, none of these theories of liability turns on whether 

the individual defendants actually had knowledge of Mr. Luong specifically. Rather, Plaintiffs’ 

point is that, without having a policy or practice on the above, it should have been obvious a

pretrial detainee like Mr. Luong would suffer injury. The facts of Mr. Luong’s case and his 

medical record (that would have been considered had safeguards been in place) may, on the other 

hand, go to causation. 

a. Having a Wait List for Admission

Plaintiffs’ first theory of liability is that the individual defendants acted with deliberate or 

conscious indifference to Mr. Luong’s constitutional rights by not expanding capacity at 

DSH/NSH, which would thereby reduce the wait list. See, e.g., Hayward Rpt. at 6 (“[T]he State of 

California and [DSH] contributed to Mr. Luong’s death by failing to expand bed capacity for 

IST’s at the state hospitals since at least 2005.”); Hayward Rpt. at 9 (“California and [DSH] need 

to add a sufficient number of state hospital beds to reduce the wait time for an IST hospital bed to 

no more than one week following the court determination that a defendant is Incompetent to Stand 

Trial.”).

On this theory of liability, the Court grants the individual defendants’ motion for summary 

judgment. In order for a jury to find that the individual defendants were deliberately or 

consciously indifferent by failing to expand capacity at DSH/NSH, Plaintiffs must first make a 

showing that the individual defendants actually had the ability to expand capacity. Plaintiffs have 

failed to provide any evidence indicating that the individual defendants did have the ability to 

expand capacity and thus effect shorter wait times. Indeed, the only evidence before the Court 

actually indicates to the contrary. The individual defendants could not expand capacity because of 

feasibility constraints; “[e]ach state hospital has reached its maximum licensing, functional, or 

statutory capacity.” Maynard Decl. ¶ 4; see also Maynard Decl. ¶ 6 (testifying that “[a]ll State 

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Hospitals are licensed and regulated by the California Department of Health” and “[e]ach hospital 

has limitations on bed space and bed usage”; NSH’s “total number of beds is limited by its 

license” and, “until June, 2016, [NSH] was limited to 980 beds for patients whose placement was 

required pursuant to the Penal Code”). 

Plaintiffs protest that, under Mink, “‘[l]ack of funds, staff or facilities cannot justify the 

State’s failure to provide [such persons] with [the] treatment necessarily for rehabilitation.’” 

Mink, 322 F.3d at 1121. However, Mink was not a case where (as here) individuals were sued in 

their personal capacities for damages; rather, in Mink, the plaintiffs sued individuals in their 

official capacities for injunctive relief only. This distinction is important. As the Ninth Circuit 

explained in Peralta v. Dillard, 744 F.3d 1076 (9th Cir. 2014) (en banc), “[l]ack of resources is 

not a defense to a claim for prospective relief because prison officials may be compelled to expand 

the pool of existing resources in order to remedy continuing [constitutional] violations”; but

“[w]hat resources were available is highly relevant” for a claim for damages, which are 

retrospective in nature, because that “define[s] the spectrum of choices that officials had at their 

disposal.” Id. at 1082-83.15 Accordingly, based on the record presented to the Court, the

individual defendants cannot be held liable based on a failure to expand capacity at DSH/NSH. 

Moreover, even if the above was not a sufficient basis to grant summary judgment in favor 

of the individual defendants, the individual defendants would still be entitled to summary 

judgment based on qualified immunity. 

“The doctrine of qualified immunity protects government officials 

‘from liability for civil damages insofar as their conduct does not 

violate clearly established statutory or constitutional rights of which 

a reasonable person would have known.’” It “gives government 

officials breathing room to make reasonable but mistaken judgments 

about open legal questions,” and, “[w]hen properly applied, [] 

protects ‘all but the plainly incompetent or those who knowingly 

violate the law.’”

Capp v. Cty. of San Diego, No. 18-55119, 2019 U.S. App. LEXIS 26407, at *10 (9th Cir. Aug. 30, 

 

15 Peralta is an Eighth Amendment case about the rights of a convicted prisoner, and not (as here) 

a Fourteenth Amendment case about the rights of a pretrial detainee. Nevertheless, that distinction 

– while relevant in other contexts (e.g., objective or subjective deliberate indifference) – is not 

relevant here.

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2019).

For purposes of the instant case, there is qualified immunity based on Youngberg. In 

Youngberg, a plaintiff who was subject to involuntary commitment under civil proceedings sued 

the director of the facility as well as two supervisors for, e.g., failing to provide safe conditions of 

confinement. The Supreme Court noted that, “[i]n an action for damages against a professional in 

his individual capacity . . . , the professional will not be liable if he was unable to satisfy his 

normal professional standards because of budgetary constraints; in such a situation, good-faith 

immunity [i.e., qualified immunity] would bar liability.” Youngberg, 457 U.S. at 323. In Ammons 

v. State Department of Social & Health Services, 648 F.3d 1020 (9th Cir. 2011), the Ninth Circuit 

adopted a similar approach, noting that, in a prior case, it had found “the lower-level supervisors 

qualifiedly immune due to their compliance with hospital regulations and supervisory guidance 

and directives (to the extent such directives were issued), and because their conduct was 

reasonable in light of practical considerations.” Id. at 1030. Because, as indicated above, the 

evidence indicates that the individual defendants did not have the ability to expand capacity at 

DSH/NSH, see, e.g., Maynard Decl. ¶ 4 (testifying that there were wait lists because “[e]ach state 

hospital has reached its maximum licensing, functional, or statutory capacity”), qualified 

immunity is another basis supporting dismissal of Plaintiffs’ first theory of liability.

b. Not Doing Psychiatric Acuity Reviews for All IST Defendants

Plaintiffs’ second theory of liability is that the individual defendants exhibited deliberate or 

conscious indifference to Mr. Luong’s constitutional rights because they failed to implement a 

policy under which a psychiatric acuity review would automatically be done for each IST 

defendant before putting him or her on the wait list. (As noted above, the evidence indicates that a 

psychiatric acuity review was done only if a request for such was made – e.g., by a county 

clinician or a defense attorney.)

For this theory of liability, summary judgment in favor of the individual defendants is also 

appropriate. Similar to above, Plaintiffs have not provided sufficient evidence that it was feasible 

to implement such a policy, and, without feasibility, the individual defendants cannot be said to 

have acted with deliberate or conscious indifference.

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According to Plaintiffs, such a policy was feasible because “it takes Dr. Tyler only about 

an hour to do one [psychiatric acuity review] on an ad hoc basis.” Pls.’ Opp’n at 8; see also

Haddad Decl., Ex. 19 (Tyler Depo. at 171-72) (stating that the time to do a psychiatric acuity 

review “can vary, but I would say less than an hour”; this includes reviewing available medical 

records). But Plaintiffs have not provided any evidence as to how many hours it would have taken

to do psychiatric acuity reviews for all IST defendants who were referred for commitment. 

Tellingly, Plaintiffs have submitted no evidence as to the number of IST defendants for whom 

reviews would have had to have been conducted. Furthermore, evidence submitted by the 

individual defendants indicates that the number of reviews would have been substantial – e.g., 

during the relevant period, “the number of county IST referrals to DSH systemwide [was] over 

3,400” per year.16 Maynard Decl. ¶ 10 (addressing FY 2016-17). While the number of referrals to 

NSH specifically would necessarily have been smaller (as one of four state hospitals that serve 

IST defendants), the number would likely have been significant. The point is there is no evidence 

in the record that NSH could have accommodated reviews with respect to the IST defendants 

referred to it.

At the hearing, Plaintiffs argued still that it was feasible to do psychiatric acuity reviews of 

all IST defendants because the individual defendants

could have hired several clinicians to routinely visit the IST’s in the 

jails to evaluate their acuity level. They also could have used the 

jail’s telepsychiatry equipment to conduct a remote evaluation of the 

inmate-patients. Even one or two clinicians might have been 

sufficient to phone the jail mental health clinicians to request 

information about the IST inmate-patients’ clinical status.

Hayward Rpt. at 14. But Plaintiffs have failed to provide evidence that DSH/NSH had the budget 

to hire more employees; that, even if it did, the individual defendants had the authority to hire new 

employees; and that the individual defendants could compel the jails to cooperate with them. Cf. 

Maynard Decl. ¶ 14 (noting that “Alameda County declined to participate in the JBCT Program” 

 

16 At the hearing, the individual defendants indicated that there are approximately 6,000 

commitments to DSH each year, with NSH specifically having approximately 1,800-2,000 of 

those commitments. However, the Court was not able to find support for these figures in the 

record before it, particularly for the relevant time period.

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that “was created in 2011 to establish competency restoration in specialized jail-based programs”). 

To the extent Plaintiffs suggested that no budgetary changes needed to be made if the individual 

defendants simply readjusted priorities, they offered no evidence as to what that readjustment 

would entail and whether such readjustment would be feasible, particularly in light of the fact that, 

“[i]n FY 2016-17, DSH served over 4600 IST patients.” Maynard Decl. ¶ 11. In short, Plaintiffs 

have failed to present any evidence of feasibility of the systemic practice they have proposed. 

Where damages are sought, the resources available to a defendant is “highly relevant” under 

Peralta. As the burden of proof lies with Plaintiffs in establishing a claim, the failure to present 

sufficient evidence from which a jury could reasonably infer liability warrants grant of summary 

judgment.

Furthermore, the Court notes that based on the record herein, no reasonable jury could find 

the individual defendants deliberately or consciously indifferent when there is no indication that 

all or most IST defendants were, or likely were, psychiatrically acute. That is, a criminal 

defendant who was found incompetent to stand trial may have been psychiatrically acute but that 

was not necessarily or likely to be the case – at least there is no evidence in the record of such. In 

particular, Plaintiffs presented no evidence about the percentage of IST defendants who are 

psychiatrically acute. Based on the lack of evidence on the number of IST defendants who are 

psychiatrically acute and the lack of evidence on feasibility discussed above, no reasonable jury 

could find that the individual defendants acted with deliberate or conscious indifference by not 

having psychiatric acuity reviews done for all IST defendants.

Finally, similar to above, qualified immunity provides an independent basis for summary 

judgment on the second theory of liability. As noted above, qualified immunity protects a 

government official from liability for damages if her conduct does not violate a clearly established 

right. See Capp, 2019 U.S. App. LEXIS 26407, at *10. Here, it cannot be said that the individual 

defendants’ violated Mr. Luong’s clearly established rights given Youngberg’s statement that 

qualified immunity obtains where a professional is “unable to satisfy his normal professional 

standards because of budgetary constraints.” Youngberg, 457 U.S. at 323. Moreover, for a right 

to be clearly established, there need not be a case directly on point but “‘existing precedent must 

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have placed the statutory or constitutional question beyond debate,’” Capp, 2019 U.S. App. 

LEXIS 26407, at *22, or, in some cases, “‘the constitutional right at issue [must be] defined by a 

standard that is so “obvious” that [a court] must conclude . . . that qualified immunity is 

inapplicable, even without a case directly on point.’” Jessop v. City of Fresno, No. 17-16756, 

2019 U.S. App. LEXIS 26674, at *10-111 (9th Cir. Sep. 4, 2019). Here, Plaintiffs have not 

pointed to existing precedent that puts the constitutional question before the Court beyond debate; 

nor have they shown that the constitutional right at issue is defined by a standard such that there 

are facts that make the violation so obvious that qualified immunity may not apply. Mink, for 

example, is not dispositive authority because it does not address any contention that a “triage” 

approach was necessary with respect to admission to a state hospital. Moreover, as noted above, 

Mink does not address under what circumstances an individual defendant could be held personally 

liable for damages; it involved injunctive relief. Cf. Horton v. City of Santa Maria, 915 F.3d 592, 

600 (9th Cir. 2019) (noting that “the qualified immunity inquiry ‘must be undertaken in light of 

the specific context of the case, not as a broad general proposition’” and so it is “critical whether 

our case law had, at the time of the events in this case, sufficiently clarified when a detainee’s 

imminent risk of suicide was substantial enough to require immediate attention”).

c. Not Doing Psychiatric Acuity Reviews for IST Defendants Subject to 

Involuntary Medication Orders

In their third theory of liability, Plaintiffs assert that the individual defendants were 

deliberately or consciously indifferent by not having a policy where psychiatric acuity reviews 

were automatically done for a subset of the IST defendant population – more specifically, those 

IST defendants who were subject to involuntary medication orders (as specified on the 

commitment orders issued by the state superior courts). In essence, Plaintiffs take the position 

that, if a state superior court made a finding that the IST defendant could or should be 

involuntarily medicated, then he or she stood a good chance of being psychiatrically acute and 

thus in need of prompt review for transfer.

The Court grants the motion for summary judgment on this theory of liability for several 

reasons. First, Plaintiffs never clearly articulated this theory of liability, either in the operative 

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SAC or in the briefs that they filed as part of the summary judgment proceedings. Rather, the first 

time Plaintiffs articulated this theory was (with prompting from the Court) at the hearing on the 

summary judgment motions. Because Plaintiffs never clearly made this theory of liability a part 

of their case, they cannot interject it at this late stage of proceedings.

Second, as discussed above, in order for the individual defendants to be held liable for 

deliberate or conscious indifference, Plaintiffs must first make some showing that their proposed 

policy (i.e., of doing psychiatric acuity reviews for those IST defendants subject to involuntary 

medication orders) was feasible. Plaintiffs have offered no evidence on feasibility. Admittedly, 

there is evidence in the record that approximately 30 to 50% of all IST defendants are subject to 

involuntary medication orders. See Haddad Decl., Ex. 13 (Black Depo. at 39-40) (estimating that 

about 30 to 50% of the court orders provided for involuntary medication). But beyond the fact 

that this number is smaller than the entire IST population, Plaintiffs have submitted no evidence 

regarding the individual defendants’ ability to implement psychiatric acuity reviews for this subset 

of the IST population.

Third, Plaintiffs have essentially assumed that an IST defendant who is subject to an 

involuntary medication order is or is likely to be psychiatrically acute but they have not offered 

any concrete evidence to support this assumption. Cf. Youngberg, 457 U.S. at 323 (stating that 

“liability may be imposed only when the decision by the professional is such a substantial 

departure from accepted professional judgment, practice, or standards as to demonstrate that the 

person responsible actually did not base the decision on such a judgment”). The fact that the 

medication to be involuntarily administered is antipsychotic medication is, in and of itself, not 

enough to support psychiatric acuity (that warrants immediate admission to a hospital such as

NSH). 

Indeed, there is some evidence in the recording suggesting that not all IST defendants who 

are subject to an involuntary medication order are psychiatrically acute. For example, the form 

commitment order provides as follows regarding involuntary medication.

. . . THE COURT ORDERS that the treatment facility may 

administer antipsychotic medication to the defendant involuntarily 

when and as prescribed by a treating physician pursuant to Penal 

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Code section 1370(a)(2)(B)(iii) based upon the following finding:

□ Defendant lacks capacity to make decisions regarding 

antipsychotic medication and that defendant’s mental disorder 

requires medical treatment with antipsychotic medication and 

that, if not so treated, it is probable that serious harm to the 

physical or mental health of the patient will result.

□ Defendant is a danger to others in that defendant has inflicted, 

attempted to inflict, or made a serious threat of inflicting 

substantial physical harm on another either while in custody or 

such that it resulted in his being taken into custody, and 

defendant presents, as a result of mental disorder or defect, a 

demonstrated danger of inflicting substantial physical harm on 

others.

□ Defendant does not meet the requirements of either of the two 

preceding paragraphs but has been charged with a serious crime 

against persons or property; involuntary administration of 

antipsychotic medication is substantially likely to render 

defendant competent to stand trial; the medication is unlikely to 

have side effects that interfere with defendant’s ability to 

understand the nature of the criminal proceedings or to assist 

counsel in the conduct of a defense in a reasonable manner; less 

intrusive treatments are unlikely to have substantially the same 

results; and antipsychotic medication is in the patient’s best 

medical interest in light of his/her medical condition.

Defs.’ RJN, Ex. G (commitment order). The form commitment order suggests that not all IST 

defendants subject to involuntary medication orders are psychiatrically acute for purposes of 

immediate admission to a state hospital. Under the third category in which the state court placed 

Mr. Luong, the state’s purpose of involuntary medication is to restore competency to stand trial, 

not to safeguard against immediate risk and harm. Hence, although a close call, Plaintiffs’

constitutional claim on this theory cannot be established based on the record presented. 

Finally, even if a viable constitutional claim were presented, summary judgment is 

warranted based on qualified immunity. Assuming there was a plausible claim based on the

theory that IST defendants subject to involuntary medication orders must be afforded automatic

psychiatric acuity review, the law establishing that constitutional rule was not clearly established. 

No case so holds on even remotely similar facts. Furthermore, application of the general legal 

standards applicable under, e.g., Youngberg to the record facts in the instant case does not 

establish an obvious constitutional violation.

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d. Failing to Notify Relevant Actors That a Psychiatric Acuity Review Could 

Be Requested

Plaintiffs’ final theory of liability is that the individual defendants were deliberately or 

consciously indifferent to Mr. Luong’s constitutional rights by failing to notify relevant actors –

such as the superior courts, county jail clinicians, defense counsel, or prosecutors – on a systemic 

basis that a psychiatric acuity review could be requested for an IST defendant.17

Here, the Court denies the individual defendant’s motion for summary judgment because a 

reasonable jury could find that it was feasible for the individual defendants to give some kind of 

systemic or routine notice and, thus, by failing to give such notice, the individual defendants were 

deliberately or consciously indifferent. As a practical matter, giving notice is obviously more 

feasible than undertaking systemic psychiatric acuity reviews for all (or a substantial portion of) 

IST defendants. The Court does not have before it undisputed evidence that would prevent a jury 

from finding such notice was feasible. And given that acuity reviews currently are made only 

when requested, notice of the availability of such review plays a critical role in the effectiveness of

DSH/NSH’s triage. 

Accordingly, qualified immunity cannot be granted at this stage of proceedings. The fact 

that there is no case directly on point factually does not require a finding of qualified immunity. 

See Jessop, 2019 U.S. App. LEXIS 26674, at *11. If Plaintiffs can establish that it should have 

been obvious to the individual defendants that there was a significant risk that some 

psychiatrically acute IST defendants would suffer harm because they were not getting transferred 

promptly to the state hospitals, and that it was feasible to give notice to address this problem, then 

it would have been clear to any reasonable hospital official with responsibility that the failure to 

give notice would constitute deliberate or conscious indifference. Cf., e.g., Clouthier v. Cty. of 

Contra Costa, 591 F.3d 1232, 1245 (9th Cir. 2010) (holding that defendant was not entitled to 

qualified immunity because the evidence (taken in the light most favorable to plaintiffs) indicated 

 

17 The Court acknowledges that this theory of liability was not pled in Plaintiffs’ SAC. However, 

Plaintiffs sufficiently put the individual defendants on notice of this theory in their opposition to 

the State Defendants’ motion for summary judgment – even submitting the Blakeley declaration in 

support. 

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that defendant knew the decedent was at a substantial risk of serious harm), overruled in part by 

Castro, 833 F.3d at 1060; Clement v. Gomez, 298 F.3d 898, 906 (9th Cir. 2002) (noting that “a 

resolution of the factual issues may well relieve the prison officials of any liability in this case, 

[but] if the prisoners' version of the facts were to prevail at trial, a jury might conclude that the 

officers were deliberately indifferent to such [medical] needs during the four-hour period after the 

incident” and “[v]arious supervisory officials may also have been deliberately indifferent to 

obvious risks of injury[;] [u]nder such circumstances, the officials' actions are not protected by 

qualified immunity”); accord Estate of Ford v. Ramirez-Palmer, 301 F.3d 1043, 1050 (9th Cir. 

2002) (in discussing an Eighth Amendment claim for deliberate indifference, stating that qualified 

immunity would apply where “a reasonable prison official[,] understanding that he cannot 

recklessly disregard a substantial risk of serious harm, could know all of the facts yet mistakenly, 

but reasonably, perceive that the exposure in any given situation was not that high”).

Finally, to the extent the individual defendants argue for summary judgment because there 

is no genuine dispute of fact that they did not cause Mr. Luong any injury, the Court does not 

agree and finds that there are questions of fact that make summary judgment inappropriate. If a 

prompt acuity review had been undertaken, the evidence suggests Mr. Luong would have been 

transferred earlier and thus would not have been murdered. The Court acknowledges that the 

individual defendants have raised a fair argument, particularly with respect to whether they were a 

legal (or proximate) cause of Mr. Luong’s death; nevertheless, even here, the Court cannot say that 

no reasonable jury could find in favor of Plaintiffs on causation given the evidence of record. See, 

e.g., Kupers Rpt. at 32 (“Jails are violent places. Prisoners with serious mental illness are 

disproportionately victims of violence, or lose control of their temper and get involved in 

altercations.”); Freeman Rpt. at 9 (“It is . . . well established that inmates who are mentally ill are 

more likely to be victimized than the general population in correctional settings.”).

4. Summary

For the foregoing reasons, the Court grants in part and denies in part the individual 

defendants’ motion for summary judgment on the § 1983 individual liability claim. The motion is 

granted with respect to Plaintiffs’ first, second, and third theories of liability but denied with 

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respect to Plaintiffs’ fourth theory of liability.

B. Section 1983 Claim: Supervisory Liability

As noted above, Plaintiffs have asserted a § 1983 claim based on not only individual 

liability but also supervisory liability. Per the SAC, the only individual defendants against whom 

supervisory claims are made are Ms. Ahlin, Ms. Matteucci, and Dr. Tyler – i.e., Ms. Black is not 

identified as a defendant. As stated in footnote 13, the parties are to meet and confer regarding 

naming Ms. Black as a defendant in this claim for relief.

As a practical matter, the analysis for the supervisory liability claim is the same as that for 

the individual liability claim. This is because Plaintiffs are seeking to hold Ms. Ahlin, Ms. 

Matteucci, and Dr. Tyler liable based on their own actions, and not, e.g., the actions of their 

subordinates. See Starr v. Baca, 652 F.3d 1202, 1207 (9th Cir. 2011) (“A defendant may be held 

liable as a supervisor under § 1983 ‘if there exists either (1) his or her personal involvement in the 

constitutional deprivation, or (2) a sufficient causal connection between the supervisor’s wrongful 

conduct and the constitutional violation.’”).

Accordingly, the motion for summary judgment is granted in part and denied in part on 

the supervisory liability claim. Plaintiffs may proceed with their fourth theory of liability, but not 

their first, second, and third.

C. ADA and RA Claims

The ADA and RA claims are brought against DSH and NSH only, and not the individual 

defendants.

1. Title II v. Title III of the ADA

As an initial matter, the Court takes note that, per the SAC, Plaintiffs have brought claims 

under both Title II and Title III of the ADA. Title II provides: “[N]o qualified individual with a 

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

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

by any such entity.” 42 U.S.C. § 12132. Title III provides: “No individual shall be discriminated 

against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, 

advantages, or accommodations of any place of public accommodation by any person who owns, 

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leases (or leases to), or operates a place of public accommodation.” Id. § 12182(a).

To the extent Plaintiffs are asserting a Title III claim, the Court finds summary judgment in 

favor of DSH and NSH proper. Public entities are subject to Title II but they do not appear to be 

proper defendants under Title III. The ADA regulations indicate that only private entities are 

subject to Title III. See, e.g., 28 C.F.R. § 36.104 (providing that “[p]ublic accommodation means 

a private entity that owns, leases (or leases to), or operates a place of public accommodation” and 

that “[p]lace of public accommodation means a facility operated by a private entity whose

operations affect commerce and fall within at least one of the following categories”). See also 42 

U.S.C. § 12181(7) (providing that “[t]he following private entities are considered public 

accommodations for purposes of this title [42 U.S.C. § 12181 et seq.], if the operations of such 

entities affect commerce – (A) an inn, hotel, motel, or other place of lodging . . . ; (B) a restaurant, 

bar, or other establishment serving food or drink; (C) a motion picture house, theater, stadium, or 

other place of exhibition or entertainment,” etc.). Cases are in accord. See, e.g., Sandison v. Mich. 

High Sch. Athletic Ass'n, 64 F.3d 1026, 1036 (6th Cir. 1995) (stating that “Title III protects 

disabled individuals from unequal enjoyment of ‘places of public accommodation’ [a]nd § 

12181(7) and § 36.104 make clear that public accommodations are operated by private entities, not 

public entities”); DeBord v. Bd. of Educ., 126 F.3d 1102, 1106 (8th Cir. 1997) (stating that “Title 

III of the ADA applies to private entities providing public accommodations, however, not to 

public entities”); Bloom v. Bexar Cty., 130 F.3d 722, 726-27 (5th Cir. 1997) (citing, inter alia, 

Sandison and DeBord for the proposition that Title III is inapplicable to public entities); see also 

Hernandez v. Cty. of Monterey, 70 F. Supp. 3d 963, 973 (N.D. Cal. 2014) (noting that “Title II and 

Title III are ‘parallel provisions’ with Title II covering only public entities and Title III covering 

only private entities,” although “‘[t]here are many situations . . . in which public entities stand in 

very close relation to private entities that are covered by title III’”); Ward v. Cty. of Siskiyou, No. 

2:17-cv-00519-JAM-DMC, 2019 U.S. Dist. LEXIS 18619, at *14 (E.D. Cal. Feb. 4, 2019) (stating 

that “[p]ublic entities, like the County, are covered by Title II of the ADA,” and, “[a]lthough an 

individual may bring a claim under Title II against a public entity, actions under Title III are 

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limited to private entities”).18

Moreover, Title III provides for limited remedies: “Only injunctive relief is available under 

Title III.” Disabled Rights Action Comm., 375 F.3d at 867 n.4; see also 42 U.S.C. § 12188(a) 

(providing that [t]he remedies and procedures set forth in section 204(a) of the Civil Rights Act of 

1964 (42 U.S.C. 2000a-3(a)) are the remedies and procedures this title [42 U.S.C. § 12181 et seq.] 

provides to any person who is being subjected to discrimination on the basis of disability in 

violation of this title”); id. § 2000a-3(a) (providing that “a civil action for preventive relief, 

including an action for a permanent or temporary injunction, restraining order, or other order, may 

be instituted”); Oliver v. Ralphs Grocery Co., 654 F.3d 903, 905 (9th Cir. 2011) (in discussing 

Title III claim, stating that “a private plaintiff can sue only for injunctive relief (i.e., for removal of 

the barrier). And notably, here, Plaintiffs do not seem to have asked for injunctive relief in the 

SAC, see SAC ¶ 143 – presumably because they lack standing to seek such relief. 

Accordingly, to the extent Plaintiffs assert a Title III claim (as opposed to Title II), that 

claim is dismissed. 

2. Title II and RA: “Because of” Disability

There is no dispute that, for the Title II and RA claims, there must be discrimination 

because of disability in order for liability to obtain. See, e.g., 42 U.S.C. § 12132 (providing that 

“no qualified person with a disability shall, by reason of such disability, be excluded from 

participation in or be denied the benefits of the services, programs, or activities of a public entity, 

 

18 In Disabled Rights Action Committee v. Las Vegas Events, Inc., 375 F.3d 861, 875 n.12 (9th Cir. 

2004), the Ninth Circuit took note of the DOJ’s Title II Technical Assistance Manual. The manual 

notes that, “‘[i]n many situations . . . public entities have a close relationship to private entities that 

are covered by title III, with the result that certain activities may be at least indirectly affected by 

both titles.’” Id. at 875 n.12. For example:

ILLUSTRATION 2: A city owns a downtown office building 

occupied by its department of human resources. The building's first 

floor, however, is leased to a restaurant, a newsstand, and a travel 

agency. The city, as a public entity and landlord of the office 

building, is subject to title II. As a public entity, it is not subject to 

title III, even though its tenants are public accommodations that are 

covered by title III.

Id. (emphasis added).

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or be subjected to discrimination by any such entity”); 29 U.S.C. § 794(a) (providing that “[n]o 

otherwise qualified individual with a disability . . . shall, solely by reason of his or her disability, 

be excluded from the participation in, be denied the benefits of, or be subjected to discrimination 

under any program or activity receiving Federal financial assistance”) (emphasis added). Even 

where a plaintiff’s theory is a failure to provide reasonable accommodations under the ADA or 

RA, there must still be discrimination on the basis of disability. See Weinreich v. L.A. Cty. Metro. 

Transp. Auth., 114 F.3d 976, 978 (9th Cir. 1997) (stating that “[t]he duty to provide ‘reasonable 

accommodations’ under the ADA and the Rehabilitation Act arises only when a policy 

discriminates on the basis of disability”) (emphasis omitted).

In the instant case, DSH and NSH argue for dismissal of the Title II and RA claims on the 

ground that there is no genuine dispute of material fact that their actions or inactions were not 

based on Mr. Luong’s disability (i.e., his mental impairments). According to DSH and NSH, Mr. 

Luong was not immediately transferred from the Santa Rita Jail to a hospital only because there 

was a waiting list and an IST defendant’s placement on the list was based on his commitment date.

Previously, at the 12(b)(6) stage, the Court denied DSH and NSH’s motion to dismiss the 

Title II and RA claims even though they argued – similar to here – that Plaintiffs had failed to 

allege that Mr. Luong was not admitted “because of” his disability. See Docket No. 54 (Order at 

13). The Court noted that “[t]he allegations in the complaint regarding discriminatory intent are 

fairly conclusory,” but “Plaintiffs have essentially alleged that Mr. Luong was completely denied

medical services for his mental disability, and so one could reasonably infer that that denial was so 

arbitrary and capricious given Mr. Luong’s serious medical need that there must have been a 

discriminatory motive.” Docket No. 54 (Order at 13) (emphasis in original). 

In assessing the motion for summary judgment, the Court is not bound by its earlier 

12(b)(6) ruling since it now must consider evidence under Rule 56. Given the evidence presented, 

there does not appear to be anything from which one could reasonably infer that DSH and NSH 

acted or failed to act because of Mr. Luong’s disability. Plaintiffs suggest that there has been 

disparate treatment of disabled and nondisabled persons because IST defendants have not been 

given “the same access to the criminal justice system” (i.e., as they have not been given 

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competency restoration services). Pls.’ Opp’n at 30; see also Docket No. 54 (Order at 13 n.5) 

(noting that Plaintiffs “allege no facts demonstrating disparate treatment relative to others 

similarly situated”). But even if disparate treatment might ordinarily give rise to an inference of 

discrimination, DSH and NSH have provided evidence that their actions/inactions were not based 

on disability, and Plaintiffs have not pointed to anything suggesting that the reason given by 

DSH/NSH for its actions/inactions was pretextual or that DSH/NSH, in not transferring Mr. 

Luong, purposefully treated IST defendants less favorably than others needing mental health 

placement. Indeed, it would appear that all those referred for competency restoration services are 

presumptively disabled.

The Court therefore grants DSH/NSH’s motion for summary judgment on the ADA and 

RA claims, both Title III and Title II.

D. Section 52.1 Claim

Under § 52.1,

[a]ny individual whose exercise or enjoyment of rights secured by 

the Constitution or laws of the United States, or of the rights secured 

by the Constitution or laws of this state, has been interfered with, or 

attempted to be interfered with, as described in subdivision (a), may 

institute and prosecute in his or her own name and on his or her own 

behalf a civil action for damages . . . .

Cal. Civ. Code § 52.1(c). Subdivision (a) refers to interference or an attempt to interfere “by 

threat, intimidation, or coercion.” Id. § 52.1(a). Section 52.1, however, does not require that “the 

‘threat, intimidation or coercion’ element of the claim . . . be transactionally independent from the 

constitutional violation alleged.” Reese v. Cty. of Sacramento, 888 F.3d 1030, 1043 (9th Cir. 

2018) (citing Cornell v. City and Cty. of San Francisco, 17 Cal. App. 5th 766, 799-800 (2017)). 

Plaintiffs’ § 52.1 claim is brought against all of the individual defendants (i.e., Ms. Ahlin, 

Ms. Matteucci, Dr. Tyler, and Ms. Black). The constitutional rights underlying the § 52.1 claim 

come from both federal and state law – e.g., the right to be free from an unreasonable ongoing 

seizure, the right to be free from deliberate indifference to serious medical need, the right to be 

free from reckless disregard to safety, the right to freedom from incarceration, and the right to 

restorative treatment. See SAC ¶ 145. The individual defendants challenge the § 52.1 claim 

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largely because Plaintiffs have failed to show that there was interference or an attempt to interfere 

by threat, intimidation, or coercion.

At the 12(b)(6) phase, the Court found persuasive the argument that Plaintiffs failed to 

allege threat, intimidation, or coercion. It noted that, in cases cited by Plaintiffs, “it was the fact of 

detention [by the defendant] that gave rise to coercion, and, here, “[i]n the absence of detention by 

the [State] Defendants, there is no apparent basis for a claim of coercion.” Docket No. 54 (Order 

at 16).

Plaintiffs acknowledge this ruling by the Court but argue that the individual defendants had 

custody of Mr. Luong – sufficient for § 52.1 purposes – because “treatment facilities have certain 

custodial duties under the Fourteenth Amendment with respect to [IST pretrial] detainees, which 

attach at the time the state court commitment order is issued.” Atayde v. NAPA State Hosp., 255 

F. Supp. 3d 978, 992 (E.D. Cal. 2017). But in making this statement, the Atayde court was simply 

referring to the fact that California Penal Code § 1370 “imposes responsibilities onto the state 

hospital to which the incompetent defendant is being committed”; for example, it requires the state 

court to provide certain documents related to the detainee to the state hospital and also “requires 

the state hospital’s medical director to make a written report regarding the detainee’s progress 

toward recovery within ninety days of commitment.” Id. Moreover, the Atayde court simply 

made the above statement in support of its conclusion that the individual defendants (including 

Ms. Matteucci) “owed a duty of care to decedent for Fourth Amendment purposes, and are 

properly subject to suit under § 1983 for failing to take steps to effect decedent’s transfer to NSH.” 

Id. The Court makes that same assumption here – § 1983 applies. The Atayde court did not, 

however, opine on § 52.1 and its requirement of threat, intimidation, or coercion. That the 

individual defendants’ actions or inactions led to a prolonged incarceration of Mr. Luong does not 

mean that they thereby interfered with Mr. Luong’s rights by threat, intimidation, or coercion

under § 52.1.

Plaintiffs protest still that “two or more violations of rights also satisfy [§ 52.1’s] coercion 

element. Here, Defendants[] knew that their policies and conduct denied IST inmates, like [Mr.] 

Luong, both timely restorative treatment and freedom from incarceration after the suspension of 

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criminal charges.” Pls.’ Opp’n at 32. In support of this statement, Plaintiffs cite Bender v. County 

of Los Angeles, 217 Cal. App. 4th 968 (2013). But Bender does not support the proposition that a 

“double violation of rights . . . satisfies [§ 52.1].” Pls.’ Opp’n at 32. In Bender, the state court 

simply held that it did not have to decide whether § 52.1 

requires “threats, intimidation or coercion” beyond the coercion 

inherent in every arrest, or whether, when an arrest is otherwise 

lawful, a [§ 52.1] claim based on excessive force also requires 

violation of some right other than the plaintiff’s Fourth Amendments 

rights. Where, as here, an arrest is unlawful and excessive force is 

applied in making the arrest, there has been coercion “independent 

from the coercion inherent in the wrongful detention itself.”

Bender, 217 Cal. App. 4th at 978. Moreover, as indicated by the above, Bender clearly involved a 

detention – an arrest – which is not the same situation as here. Here, there is no evidence of 

“threats, intimidation or coercion” beyond the coercion inherent in the fact that Mr. Luong was in 

custody in the county jail during the pendency of the State Defendants’ process of admitting him.

E. Negligence Claim

Plaintiffs’ negligence claim is brought against the individual defendants. The individual 

defendants move for summary judgment on the negligence claim largely based on the argument 

that they owed no duty to Mr. Luong; rather, any duty was owed by the County Defendants (with 

whom Plaintiffs have now settled). But this argument is unavailing because the state court clearly 

committed Mr. Luong to DSH/NSH, and there is no real argument that the individual defendants 

did not play some kind of role regarding admission. Given the Court’s order of commitment, 

Defendants owed a duty to Mr. Luong under negligence law. Cf. Atayde, 255 F.Supp. at 992. See 

generally Conte v. Wyeth, Inc., 168 Cal. App. 4th 89, 109, 85 Cal. Rptr. 3d 299, 316 (2008) 

(“[F]oreseeability is the principal determinant of duty where the risk created is one of personal 

injury.”).

The individual defendants otherwise contend that the negligence claim is, in essence, 

“derivative of [the] constitutional claims [under § 1983],” Defs.’ Reply at 17, and Plaintiffs do not 

materially dispute such. Thus, the analysis of the negligence claim parallels the analysis of the § 

1983 claims above, and, accordingly, the Court grants in part and denies in part the motion for 

summary judgment on the negligence claim. Plaintiffs may proceed with their fourth theory of 

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liability, but not their first, second, and third. No reasonable jury could find in favor of Plaintiffs 

on the first, second, and third theories of liability given the lack of evidence of feasibility and/or 

authority. The Court acknowledges that qualified immunity is not a defense to a negligence claim 

(as opposed to a § 1983 claim). However, as discussed above, the first, second, and third theories 

of liability are not viable based on grounds independent of qualified immunity. 

F. Punitive Damages

Finally, the individual defendants move for summary judgment on the claim for punitive 

damages. Although the Court is not unsympathetic to the individual defendants’ position, so long 

as the § 1983 claims are viable, then the issue of punitive damages shall be reserved for the jury. 

See Smith v. Wade, 461 U.S. 30, 56 (1983) (“hold[ing] that a jury may be permitted to assess 

punitive damages in an action under § 1983 when the defendant's conduct is shown to be 

motivated by evil motive or intent, or when it involves reckless or callous indifference to the 

federally protected rights of others”; “this threshold applies even when the underlying standard of 

liability for compensatory damages is one of recklessness”); see also Dang v. Cross, 422 F.3d 800, 

807 (9th Cir. 2005) (indicating the same).

With respect to the negligence claim, “ordinary negligence is not sufficient to support an 

award of punitive damages” but 

the simple fact that [a] [p]laintiff has labeled its claim as one 

sounding in negligence does not conclusively preclude the 

possibility that punitive damages may be awarded. Punitive 

damages may be awarded where the facts demonstrate that the 

defendant had the intent to vex, annoy, and injure. This showing 

may be met by demonstrating that the defendant's conduct is “so 

recklessly disregardful of the rights of others, so as to be 

characterized as wanton or willful conduct.” Thus, even where the 

claim formally sounds in negligence, if the plaintiff can make a 

showing that defendant's conduct goes beyond gross negligence and 

demonstrates a knowing and reckless disregard, punitive damages 

may be available.

Simplicity Int’l v. Genlabs Corp., No. CV 09-6146 SVW (RCx), 2010 U.S. Dist. LEXIS 148159, 

at *7 (C.D. Cal. Apr. 21, 2010) (emphasis added and omitted).

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IV. PLAINTIFFS’ MOTION FOR PARTIAL SUMMARY JUDGMENT

The Court now turns to Plaintiffs’ motion for partial summary judgment.

As noted above, two of the constitutional rights on which the § 1983 individual liability 

claim are the right to freedom from incarceration and the right to restorative treatment. The Ninth 

Circuit deemed both of these rights liberty interests in Mink. For this part of the § 1983 claim, 

Plaintiffs move for partial summary judgment. In particular:

At this time, Plaintiffs do not seek a declaration and finding from 

this Court that any of the State Defendants personally violated Mr. 

Luong’s rights with deliberate indifference, lack of objectively 

reasonable professional judgment, or other appropriate level of 

individual culpability, as those standards would require a jury to 

weigh each individual’s culpability and responsibility for the 

violation of Mr. Luong’s due process rights. . . . Plaintiffs seek a 

finding and declaration from this Court that Mr. Luong’s due 

process rights were violated when, after he was committed to DSH, 

he was denied admission to a state or other hospital for more than 

seven days after the commitment order, or alternatively, when he 

was denied admission to a state or other hospital for 81 days until he 

died in jail.

Pls.’ Mot. at 2. The 81 days refer to the time between the July 22, 2016, commitment order and 

Mr. Luong’s October 11, 2016, date of death. In their reply brief, Plaintiffs argue that there is still 

a constitutional violation even if the period were shortened to 50 days (i.e., from August 22, 2016, 

when the commitment order and admission packet were sent to DSH, to October 11, 2016).

The Court denies Plaintiffs’ motion because Mink does not lend sufficient support to 

Plaintiffs’ argument that due process rights are violated when a transfer does not happen in seven 

days. In Mink, the Ninth Circuit did hold that the district court did not “abuse[] its discretion in 

imposing a seven-day time limit,” Mink, 322 F.3d at 1122 n.13, but the court never held that seven 

days was what was constitutionally required. Furthermore, the Ninth Circuit indicated that the 

seven-day mark was appropriate given that “[t]he district court set the time limit . . . based in part 

on the Oregon legislature’s choice of that time limit in the now-superseded version of the relevant 

state statute.” Id. Admittedly, the Ninth Circuit also stated that the time limit should be 

“reasonably short”; however, the precise parameters of what is “reasonably short” were never 

established. Id. Moreover, the Court bears in mind that the Ninth Circuit’s analysis was 

predicated on a request for injunctive relief and not, as here, a request for damages.

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Plaintiffs’ contention that 81 days, or even 50 days, constitutes a constitutional violation of 

due process is a stronger argument in light of the “reasonably short time limit” referred to in Mink. 

Id. Nevertheless, the Ninth Circuit still did not give a concrete time frame. See also id. at 1122 

(stating that “[h]olding incapacitated criminal defendants in jail for weeks or months violates their 

due process rights because the nature and duration of their incarceration bear no reasonable 

relation to the evaluative and restorative purposes of which courts commit those individuals”). 

Because the Ninth Circuit did not state with any precision what was constitutionally permissible or 

impermissible, and the context before the Ninth Circuit was a request for injunctive relief rather 

than a request for damages (where feasibly available resources are likely relevant to establish 

damages), the Court concludes that the individual defendants have qualified immunity based on a 

lack of clearly established law on the amount of time that an IST defendant may be kept in a jail 

rather than being transferred to a state hospital. See Jessop, 2019 U.S. App. LEXIS 26674, at *10-

11.

V. CONCLUSION

For the foregoing reasons, the Court grants in part and denies in part the State Defendants’ 

motion for summary judgment and denies Plaintiffs’ motion for partial summary judgment.

The Court sets a Status Conference at 9:30 a.m., September 26, 2019, so that the parties 

may address with the Court the trial length, trial dates, settlement discussions, Ms. Black’s status 

as a defendant for the § 1983 supervisory liability claim, and any other non-merits-related trial 

matters. A Joint Status Conference statement shall be filed by September 19, 2019.

This order disposes of Docket Nos. 181, 183, 195, and 200. 

IT IS SO ORDERED.

Dated: September 12, 2019

______________________________________

EDWARD M. CHEN

United States District Judge

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