Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_19-cv-04834/USCOURTS-azd-2_19-cv-04834-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

David William Flahive,

Plaintiff, 

v. 

Corizon Health Services, et al.,

Defendants.

No. CV 19-04834-PHX-DWL (MHB)

ORDER

Plaintiff David William Flahive, who is currently confined in the Arizona State 

Prison Complex-Lewis, brought this civil rights action pursuant to 42 U.S.C. § 1983. Two 

of the defendants, Centurion of Arizona, L.L.C. (“Centurion”) and Angela White (“White”) 

(collectively, “Defendants”), have now moved for summary judgment. (Doc. 39.) Plaintiff 

was informed of his rights and obligations to respond pursuant to Rand v. Rowland, 154 

F.3d 952, 962 (9th Cir. 1998) (en banc) (Doc. 41), and he opposes the motion. (Doc. 42.) 

For the following reasons, the motion will be denied without prejudice.

I. Background

A. The Complaint

In the complaint, which was filed on July 26, 2019, Plaintiff alleges that he suffers 

from Hepatitis-C and raises various claims related to the alleged failure to provide 

appropriate treatment for this condition. (Doc. 1.) 

Specifically, in Count One, Plaintiff alleges that on December 20, 2018, he saw 

Defendant Ende, a nurse practitioner, for a chronic care appointment but Ende refused to

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submit his name to the Hepatitis-C committee and told Plaintiff that he did not qualify for 

treatment. (Id. at 4.) Plaintiff alleges that, as a result, his Hepatitis-C progressed to stage 

2 fibrosis and stage 2 liver inflammation, placing him at a greater risk of hepatocellular 

carcinoma and death. (Id.) In Count Two, Plaintiff alleges that on May 13, 2019, 

Defendant Johnson, a nurse practitioner, denied his request for direct-acting antiviral agent 

medication (“DAA”) to treat and cure his Hepatitis-C and that Defendant Johnson 

continued refusing to provide DAA after reviewing Plaintiff’s blood labs, which indicated 

stage 2 fibrosis and liver inflammation. (Id. at 5.) In Count Three, Plaintiff alleges that 

on July 4, 2019, he requested that Defendant White, a registered nurse, place him on the 

provider’s line so he could obtain medication to cure his Hepatitis C, but White said that 

he would not get treatment because “it is too expensive” and “there is a limited supply of 

drugs” and that Johnson would not see Plaintiff for six months. (Id. at 6.) In Count Four, 

Plaintiff alleges that Corizon has a policy, practice, or custom that resulted in the failure to 

treat Plaintiff’s Hepatitis-C for over five years and that this absence of treatment caused 

Plaintiff to develop stage 2 fibrosis and liver inflammation. (Id. at 7.) In Count Six, 

Plaintiff alleges that since taking over for Corizon in May 2019, Centurion has also failed 

to implement protocols to ensure that Plaintiff’s Hepatitis-C could be treated and that, 

despite his many requests for treatment, Centurion has refused to treat his Hepatitis-C. (Id.

at 9.) 

On screening under 28 U.S.C. § 1915A(a), the Court determined that “Plaintiff has 

stated an Eighth Amendment claim and a state-law malpractice claim against Defendant 

Ende in Count One, Defendant Johnson in Count Two, and Defendant White in Count 

Three; Plaintiff has also stated Eighth Amendment claims against Defendant Corizon in 

Count Four and Defendant Centurion in Count Six.” (Doc. 8 at 7.)1

...

...

1 The Court also dismissed Count Five, which asserted a deliberate-indifference claim 

against an additional medical provider. (Doc. 8 at 5-7.)

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B. The Preliminary Injunction Request

At the same time he filed his complaint, Plaintiff filed a motion seeking a 

preliminary injunction to “order ADOC and herein listed defendants” to treat his HepatitisC with DAAs. (Doc. 4 at 7.)

On October 9, 2019, Defendants filed an opposition. (Doc. 18.) In a nutshell, 

Defendants argued that Plaintiff had been seen by medical staff every six months to 

monitor his Hepatitis-C and that Corizon had not administered DAAs because Plaintiff did 

not satisfy Corizon’s “criteria for Hepatitis C treatment.” (Id. at 2.) The opposition 

identified four different Corizon criteria that counseled against the administration of 

DAAs, including (1) Plaintiff’s APRI scores had “consistently been calculated 0.3-0.8 and 

never over 1.0, which is stable”; (2) Plaintiff had tested negative for Hepatitis-A and 

Hepatitis-B and had been vaccinated to protect against those conditions; (3) Plaintiff was 

not suffering from cirrhosis of the liver; and (4) Plaintiff had admitted to substance abuse 

and tested positive for amphetamines. (Id. at 2-3.) The opposition further stated that, 

although Centurion does not follow the exact same criteria as Corizon (for example, 

Centurion does not rely on APRI scoring), Plaintiff also failed to qualify for DAA 

administration under Centurion’s criteria, which are “very similar to the triaging of patients 

for treatment in the community and match[] the most recent HCV Guidelines as published 

in May 2018 by the AASLD (American Association for the Study of Liver Diseases), and 

by ISDA (Infectious Diseases Society of America).” (Id. at 3.) In support of these 

assertions, Defendants submitted (1) a declaration from Dr. Wendy Orm, Centurion’s 

statewide medical director (id. at 13-15), and (2) a handful of records from Plaintiff’s 

medical visits (id. at 16-25).

On October 17, 2019, Plaintiff filed a reply. (Doc. 20.) In it, Plaintiff clarified that 

he “is not disputing that the defendant[s] are[] providing treatment” but asserted that “the 

treatment is inadequate and is nothing more than ‘active surveillance’ [which] is equal to 

no treatment at all.” (Id. at 2.) On the merits, Plaintiff focused primarily on whether his 

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Hepatitis-C qualifies as a “serious” medical condition for Eighth Amendment purposes. 

(Id. at 3-5.) 

On December 10, 2019, the Court issued an order denying Plaintiff’s motion for a 

preliminary injunction. (Doc. 33.) First, the Court concluded that Plaintiff hadn’t 

established a likelihood of success on the merits of his Eighth Amendment claims. (Id. at 

7-8.) Second, and alternatively, the Court concluded that Plaintiff hadn’t shown a 

likelihood of irreparable harm in the absence of a preliminary injunction because “[t]here 

is no indication that Plaintiff’s hepatitis C is likely to progress to the point that he will 

suffer irreparable harm before the merits of his claims can be addressed in the course of 

this litigation.” (Id. at 8.)

II. Summary Judgment Standard

A court must grant summary judgment “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). See also Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). The 

movant bears the initial responsibility of presenting the basis for its motion and identifying 

those portions of the record, together with affidavits, if any, that it believes demonstrate 

the absence of a genuine issue of material fact. Celotex, 477 U.S. at 323.

If the movant fails to carry its initial burden of production, the nonmovant need not 

produce anything. Nissan Fire & Marine Ins. Co., Ltd. v. Fritz Co., Inc., 210 F.3d 1099, 

1102-03 (9th Cir. 2000). But if the movant meets its initial responsibility, the burden shifts 

to the nonmovant to demonstrate the existence of a factual dispute and that the fact in 

contention is material, i.e., a fact that might affect the outcome of the suit under the 

governing law, and that the dispute is genuine, i.e., the evidence is such that a reasonable 

jury could return a verdict for the nonmovant. Anderson v. Liberty Lobby, Inc., 477 U.S. 

242, 248, 250 (1986); Triton Energy Corp. v. Square D. Co., 68 F.3d 1216, 1221 (9th Cir. 

1995). The nonmovant need not establish a material issue of fact conclusively in its favor, 

First Nat’l Bank of Ariz. v. Cities Serv. Co., 391 U.S. 253, 288-89 (1968); however, it must 

“come forward with specific facts showing that there is a genuine issue for trial.” 

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Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) (internal 

citation omitted); see also Fed. R. Civ. P. 56(c)(1).

At summary judgment, the court’s function is not to weigh the evidence and 

determine the truth but to determine whether there is a genuine issue for trial. Anderson, 

477 U.S. at 249. In its analysis, the court must believe the nonmovant’s evidence and draw 

all inferences in the nonmovant’s favor. Id. at 255. The court need consider only the cited 

materials, but it may consider any other materials in the record. Fed. R. Civ. P. 56(c)(3). 

III. Discussion

A. Preliminary Matters

As noted, the Court held in the screening order that Plaintiff had stated two different 

claims (a § 1983 claim for deliberate indifference and a state-law malpractice claim) 

against White in Count Three and that Plaintiff had stated a single claim (a § 1983 claim 

for deliberate indifference) against Centurion in Count Six. (Doc. 8 at 7.)

In the introductory paragraph of their motion, Defendants state that they are moving 

“for summary judgment on all of Plaintiff’s claims against them.” (Doc. 39 at 1.) 

However, in the body of the motion, Defendants only address the elements of the § 1983 

claims. (Id. at 4-8.) No mention is made of the medical malpractice claim against White 

in Count Three. Although Defendants attempt to belatedly address the medical malpractice 

claim in their reply (Doc. 45 at 5-6), “the district court need not consider arguments raised 

for the first time in a reply brief.” Zamani v. Carnes, 491 F.3d 990, 997 (9th Cir. 2007). 

Thus, Defendants’ motion will be denied, without prejudice, to the extent it seeks summary 

judgment on the medical malpractice claim against White in Count Three.

The Court further notes that, as to the § 1983 claims against White and Centurion, 

Defendants did not approach the summary judgment briefing process with the necessary 

level of detail. The thrust of Defendants’ position is that, because the Court previously 

denied Plaintiff’s request for a preliminary injunction, this means that Defendants must be 

entitled to summary judgment, too. (See, e.g., Doc. 39 at 2 [“Because this Court has now 

been provided declaratory evidence and medical records that confirm Centurion medical 

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providers have determined that Plaintiff does not meet the criteria for the treatment he is 

requesting, and . . . this Court has already decided that Plaintiff is not likely to succeed on 

the merits and is not suffering irreparable harm, . . . summary judgment is also warranted 

on Plaintiff’s claims against these Defendants . . . .”]; id. at 6 [“[T]his Court has already 

determined . . . that Plaintiff simply disagrees with his medical providers about whether he 

should be receiving treatment with direct acting anti-viral medications for his Hepatitis C

. . . .”].) Thus, Defendants submitted very little evidence in support of their motion—they 

simply incorporated by reference the Orm declaration and other documents that were 

submitted in opposition to the preliminary injunction request. (Doc. 40.)

This approach is improper. A preliminary injunction is an extraordinary remedy 

that may be granted only when the movant—here, Plaintiff—makes several discrete 

showings, including a showing that success on the merits is not just possible, but likely (or, 

at a minimum, that there are substantial questions concerning the merits). In contrast, a 

party seeking summary judgment—here, Defendants—has the burden of demonstrating the 

absence of any genuine issues of material fact. A plaintiff’s inability to satisfy the rigorous 

test for preliminary injunctive relief isn’t tantamount to a finding that the plaintiff’s claims 

cannot survive summary judgment. 

In any event, because Defendants have sought a determination under Rule 56 as to 

whether they are entitled to summary judgment on the § 1983 claims asserted against them 

in Counts Three and Six, the Court will consider the evidence and arguments they have 

submitted.

B. Legal Standard

Under the Eighth Amendment, a prisoner must demonstrate that a defendant acted 

with “deliberate indifference to serious medical needs.” Jett v. Penner, 439 F.3d 1091,

1096 (9th Cir. 2006) (citing Estelle v. Gamble, 429 U.S. 97, 104 (1976)). There are two 

prongs to the deliberate-indifference analysis: an objective prong and a subjective prong. 

First, a prisoner must show a “serious medical need.” Jett, 439 F.3d at 1096 (citations 

omitted). A “‘serious’ medical need exists if the failure to treat a prisoner’s condition could 

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result in further significant injury or the ‘unnecessary and wanton infliction of pain.’” 

McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992), overruled on other grounds 

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

citation omitted). Examples of a serious medical needsinclude “[t]he existence of an injury 

that a reasonable doctor or patient would find important and worthy of comment or 

treatment; the presence of a medical condition that significantly affects an individual’s 

daily activities; or the existence of chronic and substantial pain.” McGuckin, 974 F.2d at 

1059-60. 

Second, a prisoner must show that the defendant’s response to that need was 

deliberately indifferent. Jett, 439 F.3d at 1096. An official acts with deliberate indifference 

if he “knows of and disregards an excessive risk to inmate health or safety; to satisfy the 

knowledge component, the official must both be aware of facts from which the inference 

could be drawn that a substantial risk of serious harm exists, and he must also draw the 

inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). “Prison officials are 

deliberately indifferent to a prisoner’s serious medical needs when they deny, delay, or 

intentionally interfere with medical treatment,” Hallett v. Morgan, 296 F.3d 732, 744 (9th 

Cir. 2002) (internal citations and quotation marks omitted), or when they fail to respond to 

a prisoner’s pain or possible medical need. Jett, 439 F.3d at 1096. Deliberate indifference 

is a higher standard than negligence or lack of ordinary due care for the prisoner’s safety. 

Farmer, 511 U.S. at 835. “Neither negligence nor gross negligence will constitute 

deliberate indifference.” Clement v. California Dep’t of Corr., 220 F. Supp. 2d 1098, 1105 

(N.D. Cal. 2002). See also Broughton v. Cutter Labs., 622 F.2d 458, 460 (9th Cir. 1980) 

(mere claims of “indifference,” “negligence,” or “medical malpractice” do not support a 

claim under § 1983). “A difference of opinion does not amount to deliberate indifference 

to [a plaintiff’s] serious medical needs.” Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). 

A mere delay in medical care, without more, is insufficient to state a claim against prison 

officials for deliberate indifference. Shapley v. Nevada Bd. of State Prison Comm’rs, 766 

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F.2d 404, 407 (9th Cir. 1985). The indifference must be substantial. The action must rise 

to a level of “unnecessary and wanton infliction of pain.” Estelle, 429 U.S. at 105.

Finally, even if deliberate indifference is shown, to support an Eighth Amendment 

claim, the prisoner must demonstrate harm caused by the indifference. Jett, 439 F.3d at 

1096; Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989) (delay in providing medical 

treatment does not constitute Eighth Amendment violation unless delay was harmful). 

C. Analysis

Defendants contend they are entitled to summary judgment because (1) “Plaintiff 

has failed to show that these Defendants’ course of treatment was medically unacceptable 

or that they chose that course of treatment in a conscious disregard of an excessive risk to 

Plaintiff” (Doc. 39 at 6-7) and (2) “Plaintiff has failed to provide evidence of any damage 

. . . [or] any injury [that] is related to any action or inaction of Defendants” (id. at 7-8).

As for the first issue, Defendants’ position hinges on their assertion that, when 

choosing whether to administer DAAs to prisoners with Hepatitis-C, they adhere to 

guidelines that “match[] the most recent HCV Guidelines as published in May 2018 by the 

AASLD (American Association for the Study of Liver Diseases), and by ISDA (Infectious 

Diseases Society of America).” (Doc. 40 ¶ 18; Doc. 18 at 14 ¶ 19. See also Doc. 39 at 8 

[“Plaintiff has received continuous and appropriate assessment and treatment . . . based on 

. . . community standards”].) However, Defendants did not actually submit a copy of their 

guidelines or the AASLD/ISDA guidelines—they are not attached to Orm’s declaration 

and were not submitted in support of Defendants’ summary judgment motion. Moreover, 

Plaintiff disputes the factual accuracy of this assertion in his separate statement, claiming

that the “AASLD guidelines . . . state that all infected Hep-C patients should be treated.” 

(Doc. 43 at 3 ¶ 12.) On this record, Defendants are not entitled to summary judgment.2

2 Moreover, several recent decisions appear to support Plaintiff’s, rather than 

Defendants’, characterization of the AASLD/ISDA guidelines. See, e.g., Atkins v. Parker, 

412 F. Supp. 3d 761, 782 (M.D. Tenn. 2019) (“Plaintiffs[] rely upon the AASLD/IDSA 

Guideline . . . that favor administering DAAs to inmates with chronic HCV as soon as 

possible. Plaintiffs then reason that [the prison’s] HCV treatment policies fall short of the 

prevailing standard of care because they do not guarantee immediate, universal treatment 

of all HCV inmates with DAAs.”); Buffkin v. Hooks, 2019 WL 1282785, *7 (M.D.N.C. 

2019) (“[T]he AASLD/IDSA Guidance itself . . . reflects, at least in part, the laudable 

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As for the second issue, the Court is again hamstrung by an undeveloped record. 

Plaintiff’s complaint, which was executed under penalty of perjury (and which therefore 

may be considered for summary judgment purposes), alleges that the lack of adequate 

treatment has resulted in a tangible worsening of Plaintiff’s condition: “The . . . refusal to 

place me on medication to cure my [Hepatitis-C] has caused fibrosis stage 2 and stage 2 

inflammation of my liver.” (Doc. 1 at 5.) In response, Defendants offer the Orm

declaration, which asserts in conclusory fashion that these are “minimal” degrees of 

fibrosis and inflammation that don’t qualify for DAAs under Centurion’s treatment criteria. 

(Doc. 40 ¶¶ 13, 16-17.) But this assertion doesn’t address Plaintiff’s point—that his 

condition has worsened due to the lack of care—and the allusion to Centurion’s criteria is 

unpersuasive in light of the unresolved questions concerning whether those criteria actually 

track the AASLD/IDSA guidelines. 

In short, Defendants have not met their burden of showing they are entitled to 

judgment as a matter of law. Nonetheless, because Defendants may be able to present 

additional facts and arguments supporting their position, they will be granted leave to file 

a second summary judgment motion. Hoffman v. Tonnemacher, 593 F.3d 908, 911-12 (9th 

Cir. 2010) (district courts have discretion to permit successive motions for summary 

judgment).

IT IS ORDERED:

(1) The reference to the Magistrate Judge is withdrawn as to Defendants’

motion for summary judgment (Doc. 39).

(2) Defendants’ motion for summary judgment (Doc. 39) is denied without 

prejudice. 

medical goal of eradicating HCV in society as a whole . . . [and] state that ‘HCV DAA 

therapy for chronic HCV is now logistically feasible within the prison setting and would 

aid the HCV elimination effort.’ While these goals are commendable and desirable, they 

are also aspirational objectives and thus do not provide a standard for evaluating deliberate 

indifference in the prison system.”). This underscores why it would be inappropriate to 

grant summary judgment to Defendants based on their characterization of guidelines they 

have not actually submitted for the Court to review.

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(3) Defendants may file another dispositive motion by the deadline for filing 

dispositive motions outlined in the Scheduling Order. (Doc. 30.) 

Dated this 8th day of June, 2020.

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