Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_04-cv-03350/USCOURTS-cand-3_04-cv-03350-1/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court

For the Northern District of California

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United States District Court

For the Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

RICKY TYRONE HARRIS,

Plaintiff,

v.

DWIGHT WINSLOW, M.D.,

Health Care Manager,

Defendant. /

No. C 04-3350 SI (pr)

ORDER DENYING SUMMARY

JUDGMENT MOTION

INTRODUCTION

Ricky Harris filed this action under 42 U.S.C. § 1983, concerning the medical response

to a keloid (i.e., hyperplastic scar tissue) that developed on his scalp after he burned himself.

Harris claims that Dr. Dwight Winslow was deliberately indifferent to his serious medical needs.

This action is now before the court for consideration of defendant's motion for summary

judgment. For the reasons discussed below, defendant's motion will be denied.

BACKGROUND

The following facts are undisputed unless otherwise noted. 

At the relevant time, Ricky Harris was an inmate and Dr. Dwight Winslow was the chief

medical officer at Pelican Bay State Prison. There is no evidence that Dr. Winslow actually

treated Harris' medical condition. Instead, Dr. Winslow appears to be a defendant because he

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Defendant's recitation of the rest of Dr. Cooper's evaluation of the case does not make sense.

Defendant states that "The prognosis was to maintain vulcation to the area and observe for 2nd degree

burn formation." Winslow Decl., ¶ 5(e); Motion, p. 4. The court has checked a medical dictionary, a

French-English dictionary, a Spanish-English dictionary, a Latin-English dictionary and the Oxford

English Dictionary but cannot find a definition for the word "vulcation" or any form of it. It also makes

no sense why a second degree burn would be forming a year after the chemical burning agent had been

applied and removed.

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was in charge of the prison's medical staff and was a decision-maker on the committee that

denied Harris' requests for surgery. 

Harris went to the prison's emergency room on May 1, 2000, complaining of facial, neck

and scalp pain that resulted when he left a permanent hair solution on his hair too long. Harris

was admitted to the prison infirmary several days later for treatment of hair loss and scalp burns.

Dr. Allen treated him with a topical medication for second, as possibly third, degree burns on

his scalp.

After his scalp healed from the burns, a keloid formed. This action concerns the medical

response to the keloid and not to the burn that preceded it.

On November 17, 2000, Dr. Alexander, an assistant clinical professor of dermatology at

U.C. Davis, examined Harris. Her examination of Harris' scalp revealed a tender, scaly plaque.

She opined that if Harris' condition was felt to be a keloid, then steroid injections may be helpful.

She also opined that if there was persistent inflammation, then a biopsy should be performed.

Thereafter, Harris was seen by several different health care providers who monitored his

condition. On February 9, 2001, Harris was seen by Dr. Faulstick for a follow-up on the

dermatology consultation. Dr. Faulstick determined that Harris appeared to have a keloid scar

on the right scalp but had no evidence of an inflammatory reaction. On May 4, 2001, Harris was

seen by Dr. Cooper, who assessed the area as a keloid formation and did not believe a biopsy

would benefit Harris.1

 On September 10, 2001, Harris was examined by Dr. Polidore, who

estimated Harris to have a burn scar about 5 centimeters by 1 centimeter in size. Dr. Polidore

advised that Harris would be a candidate for excision if the scar increased in size or began to

burn or itch. 

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On January 3, 2003, Harris' case and request for surgical removal of the keloid was

brought before the medical authorization review committee, consisting of all physicians at the

facility. The committee reviewed the medical records, assessed his case, and recommended that

surgery not be performed. 

Thereafter, Harris saw health care providers for continuing evaluation and follow-up

appointments regarding his condition. On January 23, 2003, Harris was examined by Dr. David,

who noted that the keloid was cosmetic at the time. On April 22, 2003, Harris was examined

again by Dr. David. Harris told him there had been no change in the size of the keloid, but it had

started to itch. Dr. David referred him to minor surgery for consultation and consideration of

a steroid injection. On August 27, 2003, Dr. David examined Harris again and noted a slight

decrease in the size of the keloid and that Harris requested surgical removal of the keloid. 

On September 22, 2003, Harris' case and request for surgical removal of the keloid was

again brought before the medical authorization review committee. The committee reviewed the

medical records, assessed his case, determined that the keloid was a cosmetic issue, and

recommended that surgery not be performed. 

Harris was examined again by Dr. David on September 26, 2003 and November 12, 2003.

Dr. David observed that the keloid remained stable. 

On July 9, 2004, Harris was seen by nurse practitioner Lazore. During that visit, it was

noted for the first time that the keloid was very painful at times and that Harris was having

trouble sleeping due to the pain. 

On July 26, 2004, Harris' case and request for surgical removal of the keloid was again

brought before the medical authorization review committee. The committee reviewed the

medical records, assessed his case, recommended that surgery not be performed, and

recommended that Harris instead should be monitored at the clinic.

On or about October 17, 2004, Dr. Goldenson examined Harris and reviewed his medical

records under a procedure established in the Madrid class action that dealt with conditions of

confinement at the prison. Soon thereafter, Dr. Winslow consulted with Dr. Goldenson about

the treatment plan for Harris. The two doctors agreed that, generally, surgical removal of keloids

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is considered cosmetic and is often not successful. Dr. Winslow stated that there were a number

of factors to assess when considering surgery. Here, the factors included the fact that the keloid

had become large, was causing Harris discomfort and interfering with his sleep. Dr. Winslow

also opined that it was appropriate to monitor Harris' condition and continuously re-evaluate as

to when surgical removal of the keloid was appropriate. After consulting with Dr. Goldenson

and the medical authorization review committee, Dr. Winslow decided to authorize the surgical

removal of the keloid.

On November 29, 2004, Harris was seen by Dr. Jaderborg for a surgical evaluation of the

keloid. The keloid, which was then 3 centimeters by 5 centimeters in size, was surgically

removed on December 17, 2004 at the Sutter Coast Hospital in Crescent City, California. In Dr.

Winslow's opinion, Harris' right ear healed quite well and he has not had any further problems.

 

VENUE AND JURISDICTION

Venue is proper in the Northern District of California because the events or omissions

giving rise to Harris' claim occurred at Pelican Bay State Prison in Del Norte County, which is

located within the Northern District. See 28 U.S.C. §§ 84, 1391(b). This Court has federal

question jurisdiction over this action brought under 42 U.S.C. § 1983. See 28 U.S.C. § 1331.

LEGAL STANDARD FOR SUMMARY JUDGMENT

Summary judgment is proper where the pleadings, discovery and affidavits show that

there is "no genuine issue as to any material fact and [that] the moving party is entitled to

judgment as a matter of law." Fed. R. Civ. P. 56(c). A court will grant summary judgment

“against a party who fails to make a showing sufficient to establish the existence of an element

essential to that party’s case, and on which that party will bear the burden of proof at trial . . .

since a complete failure of proof concerning an essential element of the nonmoving party’s case

necessarily renders all other facts immaterial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322-23

(1986). A fact is material if it might affect the outcome of the lawsuit under governing law, and

a dispute about such a material fact is genuine “if the evidence is such that a reasonable jury

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could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242,

248 (1986). 

Generally, as is the situation with defendant's challenge to the Eighth Amendment claim,

the moving party bears the initial burden of identifying those portions of the record which

demonstrate the absence of a genuine issue of material fact. The burden then shifts to the

nonmoving party to "go beyond the pleadings, and by his own affidavits, or by the 'depositions,

answers to interrogatories, or admissions on file,' designate 'specific facts showing that there is

a genuine issue for trial.'" Celotex, 477 U.S. at 324 (citations omitted).

Where, as is the situation with defendant's qualified immunity defense, the moving party

bears the burden of proof at trial, he must come forward with evidence which would entitle him

to a directed verdict if the evidence went uncontroverted at trial. See Houghton v. Smith, 965

F.2d 1532, 1536 (9th Cir. 1992). He must establish the absence of a genuine issue of fact on

each issue material to his affirmative defense. Id. at 1537; see also Anderson v. Liberty Lobby,

Inc., 477 U.S. at 248. When the defendant-movant has come forward with this evidence, the

burden shifts to the non-movant to set forth specific facts showing the existence of a genuine

issue of fact on the defense

A verified complaint may be used as an opposing affidavit under Rule 56, as long as it

is based on personal knowledge and sets forth specific facts admissible in evidence. See

Schroeder v. McDonald, 55 F.3d 454, 460 & nn.10-11 (9th Cir. 1995) (treating plaintiff's

verified complaint as opposing affidavit where, even though verification not in conformity with

28 U.S.C. § 1746, plaintiff stated under penalty of perjury that contents were true and correct,

and allegations were not based purely on his belief but on his personal knowledge). Harris'

complaint is verified and will be considered in opposition to the motion for summary judgment

even though he failed to file an opposition to the motion.

 The court's function on a summary judgment motion is not to make credibility

determinations or weigh conflicting evidence with respect to a disputed material fact. See T.W.

Elec. Serv. v. Pacific Elec. Contractors Ass'n, 809 F.2d 626, 630 (9th Cir. 1987). Evidence must

be viewed in the light most favorable to the nonmoving party, and the inferences to be drawn

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from the facts must be viewed in a light most favorable to the nonmoving party. Id. at 631.

DISCUSSION

Deliberate indifference to a prisoner's serious medical needs violates the Eighth

Amendment's proscription against cruel and unusual punishment. See Estelle v. Gamble, 429

U.S. 97, 102-04 (1976). To prove that the response of prison officials to a prisoner's medical

needs was constitutionally deficient, the prisoner must establish (1) a serious medical need and

(2) deliberate indifference to that need by prison officials. See McGuckin v. Smith, 974 F.2d

1050, 1059-60 (9th Cir. 1992), overruled on other grounds, WMX Technologies, Inc. v. Miller,

104 F.3d 1133, 1136 (9th Cir. 1997) (en banc). A prison official is deliberately indifferent if he

knows that a prisoner faces a substantial risk of serious harm and disregards that risk by failing

to take reasonable measures to abate it. See Farmer v. Brennan, 511 U.S. 825, 837, 844 (1994).

A mere difference of opinion as to which medically acceptable course of treatment should be

followed does not establish deliberate indifference. See Sanchez v. Vild, 891 F.2d 240, 242 (9th

Cir. 1989); see also Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir.), cert. denied, 519 U.S.

1029 (1996). Where doctors have chosen one course of action and a prisoner-plaintiff contends

that they should have chosen another course of action, the plaintiff "must show that the course

of treatment the doctors chose was medically unacceptable under the circumstances, . . . and the

plaintiff must show that they chose this course in conscious disregard of an excessive risk to

plaintiff's health." Id.

As a threshold matter, the court notes that Dr. Winslow can be held liable for the rejection

of Harris' requests for surgery. Dr. Winslow was in charge of the administration of health care

by medical doctors and other medical staff at Pelican Bay State Prison. He also apparently was

on the medical authorization review committee that considered Harris' requests for surgery

because the committee consisted of all physicians at the facility. 

The parties do not dispute that Harris had a keloid on his scalp. The issues here are

whether there are triable issues of fact that the keloid was a serious medical condition (the

objective prong of an Eighth Amendment claim) and that Dr. Winslow was deliberately

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indifferent to it (the subjective prong).

There is a triable issue of fact that Harris' keloid presented a serious medical need.

Although Harris' keloid may have started as a cosmetic issue, it became a more noteworthy

problem over time and a reasonable jury could determine that it was a serious medical condition.

This case would present an intriguing question of whether there is a right to medical care for a

purely cosmetic problem if Harris' keloid didn't evolve into an itchy, painful, and sleep-depriving

condition, but it did so evolve. Cf. Brock v. Wright, 315 F.3d 158, 164 n.3 (2d Cir. 2003). By

September 2003, Harris was complaining that the keloid was itchy and by July 2004, he was

complaining that it was very painful and causing him to lose sleep. 

There also is a triable issue of fact as to whether Dr. Winslow exhibited deliberate

indifference. Five months after Harris complained to a doctor that the keloid had started itching,

Dr. Winslow's committee determined, on September 22, 2003, that the keloid was a cosmetic

issue and recommended no surgery or steroid injections. Two weeks after Harris complained

to a nurse practitioner that the keloid was very painful at times and that he was having trouble

sleeping due to the pain, Dr. Winslow's committee determined, on July 26, 2004, that the keloid

was a cosmetic issue and recommended continued monitoring and no surgery. It was only when

the Special Master and other people involved with the Madrid class action became involved that

surgery was finally approved by Dr. Winslow -- suggesting the possibility that, but for their

involvement, the keloid would still be on Harris' scalp today. After consulting with Dr.

Goldenson in October 2004, Dr. Winslow decided to authorize the surgical removal of the

keloid. He wrote that "[t]here are a number of factors to assess when considering surgery. In

the case of Mr. Harris, the keloid had become large, was causing him discomfort, and interfered

with his sleep." Winslow Decl., ¶ 5.p. From this, a reasonable jury could infer that his earlier

rejection of surgery on July 24, 2004 – when the listed conditions existed – amounted to

deliberate indifference. Viewing the evidence in the light most favorable to the non-movant, a

reasonable jury also might be able to determine that Dr. Winslow exhibited deliberate

indifference in rejecting surgery in September 2003, when the medical records included a

notation that Harris had complained that the keloid was itchy. Cf. Brock v. Wright, 315 F.3d

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at 162-64 (summary judgment should not have been granted on deliberate indifference claim

regarding a painful and disfiguring keloid on inmate's face). 

Dr. Winslow cannot prevail based on the rule that a mere difference of opinion does not

amount to deliberate indifference. On the matters in the record, the court cannot say that as a

matter of law, Dr. Winslow's refusal to authorize surgery was a matter of a mere difference of

opinion about the proper course of treatment for Harris' keloid. Dr. Winslow's motion for

summary judgment on Harris' claim must be denied because there is a triable issue of fact as to

whether Dr. Winslow exhibited deliberate indifference to a serious medical need. 

The same triable issue of fact requires that the motion for summary judgment on the

defense of qualified immunity be denied. See Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982)

(defense 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); Saucier v. Katz, 533 U.S. 194, 201

(2001) (threshold question in qualified immunity analysis is: "Taken in the light most favorable

to the party asserting the injury, do the facts alleged show the officer's conduct violated a

constitutional right?"). The prisoner's right to have doctors not be deliberately indifferent to his

serious medical needs was clearly established long before Harris' keloid developed in 2000. See

Estelle v. Gamble, 429 U.S. 97, 104 (1976); see also Jackson v. McIntosh, 90 F.3d at 332 ("For

a right to be clearly established it is not necessary that the very action in question have

previously been held unlawful.") 

CONCLUSION

For the foregoing reasons, defendant's motion for summary judgment is DENIED.

(Docket # 11.) 

Defendant must file an answer to the complaint no later than June 2, 2006. 

In order to move this case toward resolution, a case management conference will be held

at 3:30 p.m. on June 21, 2006. The conference will be by telephone; defense counsel will

initiate the conference call. No later than June 2, 2006, each party must file a case management

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conference statement indicating what discovery remains to be done, the amount of time needed

for discovery, whether any further motions will be filed, when he will be ready for trial, and an

estimate of the number of days needed for trial. The case management conference statements

need not be jointly prepared. 

The court is concerned that plaintiff lost interest in pursuing this case now that the keloid

has been removed, as is suggested by his failure to file any opposition to the motion for summary

judgment. He must take steps to prosecute this action or it will be dismissed for failure to

prosecute. Plaintiff is advised specifically that failure to file a case management conference

statement will be viewed as a failure to prosecute this action and will result in the dismissal of

this action for failure to prosecute. See Fed. R. Civ. P. 41(b).

IT IS SO ORDERED.

Dated: April 24, 2006 ________________________

 SUSAN ILLSTON

United States District Judge

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