Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_09-cv-01568/USCOURTS-casd-3_09-cv-01568-2/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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Plaintiff also names Warden Neotti in his First Amended Complaint, who the Court sua sponte

dismissed on October 1, 2009. (ECF No. 4.) Based theron, the Court hereby disregards portions of the

First Amended Complaint stating claims against Warden Neotti. 

2

 Under Plaintiff’s first claim for “State Law Claims,” Plaintiff claims “defendants have denied plaintiff

of his rights to equal protection of the law, state and federal law claims, due process and right to medical

care...” (ECF No. 34 at 24-25.) In Claim 2, styled as an “Application for State Law Claims and

Regulations,”Plaintiff contends each defendant, while acting under state law, was deliberately

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

LESLIE JOHNSON, Civil No. 09-CV-1568-BEN (POR)

Plaintiff,

REPORT AND RECOMMENDATION

DENYING DEFENDANTS’ MOTION

TO STRIKE PORTIONS OF

PLAINTIFF’S FIRST AMENDED

COMPLAINT, AND GRANTING IN

PART AND DENYING IN PART

DEFENDANTS’ MOTION TO DISMISS

PLAINTIFF’S FIRST AMENDED

COMPLAINT

[ECF No. 38]

v.

SILVA, Medical Doctor; AKABARA, Medical

Doctor; LIPSHIR, Transportation Officer;

ESPINOZA, Transportation Officer; and S

LAMING, Registered Nurse,

Defendants.

I. INTRODUCTION

On December 1, 2010, Plaintiff Leslie Johnson, a state prisoner proceeding pro se, filed a

First Amended Complaint pursuant to 42 U.S.C. § 1983 against Defendants Silva, Akbari, Liptscher,

and Espinoza, in their individual capacities.1

 (ECF No. 34.) Plaintiff raises the following claims:

(1) deliberate indifference to medical needs2

; (2) conspiracy to be deliberately indifferent to serious

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indifferent toward Plaintiff’s serious medical need. Id. at 25-26. In Claim 4, which is styled as

“Punitive State Law Sufferings,” Plaintiff claims each defendant was aware of and ignored his

complaints and desires to receive medical care. Id. at 27-28. Finally, in Claim 6, entitled “Denial of

Medical Care,” Plaintiff re-alleges he was improperly denied competent medical care. Id. at 33-34.

Although Plaintiff asserts his First, Second, Fourth, and Sixth claims are distinct in his Opposition, the

Court finds these claims each allege deliberate indifference to Plaintiff’s serious medical need, and

therefore shall address these claims collectively in this Report and Recommendation.

3

 Plaintiff’s Third Cause of Action is styled as “Co-Conspiratorial (State-Law) Claims, which the Court

construes as a claim for conspiracy to be deliberately indifferent to Plaintiff’s serious medical needs.

(ECF No. 34 at 26-27.)

4

 Plaintiff’s Eighth Cause of Action is styled “Torts of Gross Neglect,” which the Court construes as a

claim for gross neglect or negligence. (ECF No. 34 at 35-36.)

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medical needs3; (3) breach of implied and express contract; (4) intentional infliction of emotional

distress; and (5) gross neglect or negligence.4

 Id. As Plaintiff does not delineate which Defendants

he is suing with respect to each cause of action, the Court shall assume Plaintiff sues each Defendant

for each cause of action. 

On January 14, 2011, Defendants Akbari, Silva, Liptscher, and Espinoza filed a Motion to

Dismiss Plaintiff’s First Amended Complaint and/or Strike Portions Thereof. (ECF No. 38.) 

Defendants contend there is no actionable claim against Defendants and therefore, each of Plaintiff’s

claims must be dismissed. Id.

Plaintiff filed an Opposition to Defendants’ Motion to Dismiss on May 11, 2011. (ECF No.

48.) Plaintiff contends he has presented a proper claim based on Defendants’ acts for deliberate

indifference to his medical needs. Id. at 21. Second, Plaintiff contends Defendants “ignored

plaintiff’s request for proper and adequate medical care, and they did so with a common

understanding and knowledge or awareness of one another.” Id. at 26. Third, Plaintiff contends

CCR Title 15 establishes an express and implied contract between him and Defendants. Id. at 28-29. 

Fourth, Plaintiff contends Defendants’ “outrageous” acts caused him severe emotional distress. Id.

at 30-32. Finally, Plaintiff contends Defendants failed to act with “due care.” Id. at 32.

On May 20, 2011, Defendants filed a Reply to Plaintiff’s Opposition. (ECF No. 49.) 

Defendants contend Plaintiff’s Opposition offers no basis for rejecting Defendants’ motion to

dismiss. (ECF No. 49 at 2.) 

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 Although Plaintiff did not attach the 109 pages of medical documents and other exhibits to his First

Amended Complaint, both Plaintiff and Defendants rely on them in either supporting or opposing the

instant Motion to Dismiss. Additionally, material properly submitted with the original complaint may

be considered as part of the complaint for purposes of a Rule 12(b)(6) motion. Hal Roach Studios, Inc.

v. Richard Feiner & Co., Inc., 896 F.2d 1542, 1555 (9th Cir. 1990). Accordingly, the Court shall refer

to these documents to the extent necessary in this Report and Recommendation.

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After a thorough review of the parties’ papers and all supporting documents, the Court

hereby RECOMMENDS Defendants’ Motion to Strike Plaintiff’s First, Second, Fourth and Sixth

causes of action be DENIED, and Defendants’ Motion to Dismiss be GRANTED in part and

DENIED in part.

II. BACKGROUND

A. Factual Background

Plaintiff presents facts related to his claims in his First Amended Complaint as well as in the

Attachments to his original Complaint, which consists of 109 pages of medical records and other

documents to support his claims. (ECF No. 1-1, hereinafter “Attachments.”)5

1. First Amended Complaint

Plaintiff Leslie Johnson is an inmate at the R.J. Donovan State Prison Facility (“R.J.D.” or

“Donovan”) in San Diego, California. [First Amended Complaint (“FAC”) (ECF No. 34) p. 3, ¶ 3.] 

Plaintiff claims that he was injured in a rear-end vehicular accident while being transported back to

Donovan from Alvarado Hospital, after receiving a liver biopsy. [FAC, pp. 8-9, ¶¶ 22a-25.] Plaintiff

further alleges as follows: An ambulance responded to the scene of the accident, and Plaintiff was

examined by paramedics. Plaintiff told paramedics of the location of his pain. The paramedics

suggested that Plaintiff be taken to the hospital to check out Plaintiff’s alleged injuries. The

transportation officers–Defendants Liptscher, and Espinoza– responded, stating that they would be

taking Plaintiff back to the prison to be examined by prison medical staff. [FAC, pp. 9-10, ¶¶ 25-26.]

Plaintiff states that upon his arrival back in prison, that same day, he was seen by Registered

Nurse S. Laming, who advised Plaintiff that he was fine to return to his cell and that he should take

ibuprofen and drink tea. Plaintiff contrasts the medical treatment provided to the corrections officers,

who were taken to the hospital, and himself, and claims that the difference in the treatment received

between the officers who were taken to the hospital, and himself, who was returned to be treated by

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jail medical staff, is indicative of deliberate indifference to his serious medical needs. [FAC, pp. 10,

¶¶ 27.] Plaintiff further claims that the deliberate indifference is evidenced by the fact that upon

his return to the jail medical facility, he was initially treated by a nurse and not a doctor. [FAC,

pp.11, ¶ 30.] Plaintiff claims that only months later did he receive treatment from medical doctors –

defendants Akbari and Silva, amongst other facility doctors. [FAC, pp. 11, ¶ 31.]

Plaintiff also claims that pain medications and x-rays, as well as a cane and MRIs were

ordered by medical staff, but took months to receive. [FAC, pp. 12-13, ¶¶ 32-35.] Plaintiff claims

that due to the wrong decisions of defendants, he was forced to endure months of pain and suffering.

Specifically, Plaintiff points to the decision of Defendants Liptscher or Espinoza, to return Plaintiff

to the prison for medical treatment and of Defendant Laming, to provide plaintiff with ibuprofen.

[FAC, pp. 13-14, ¶ 38.] Plaintiff further alleges that the denials of medical treatment and surgery

caused him to suffer “future harm related to neglect” and that he is in such pain so as to require

narcotic medication in order to sleep. [FAC, pp. 13-14, ¶ 38.] Plaintiff further contends that

Nurse Laming was not qualified to assess his medical needs upon his return to prison. [FAC, p. 14, ¶

40.]

Plaintiff claims that the failure to provide him with x-rays and allow him to be examined by a

doctor immediately upon his return to the prison indicates that he did not receive prompt medical

care. [FAC, pp. 15-16, ¶ 43.] Plaintiff claims that nurse Laming mis-diagnosed him when deciding

to provide him with ibuprofen and that therefore he needlessly suffered pain for several months.

[FAC, pp. 15-16, ¶ 43.] Plaintiff goes on to complain that medical orders he received after being

examined by nurse Laming took several months to be carried out. Plaintiff claims that had he been

transported to the hospital by the paramedics, he would have received the protections, provisions,

and the

proper medical care which he was entitled to receive. [FAC, pp. 17-18, ¶ 46.]

Plaintiff states that Defendants Silva and Akbari both made orders for medication, x-rays, an

MRI, a cane, and physical therapy for plaintiff. However, Plaintiff claims Defendants did not follow

up to ensure these orders were complied with and failed to check up on Plaintiff after entering the

orders. [FAC, pp. 18, ¶ 47.] Plaintiff claims that Defendants Silva and Akbari further failed to check

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6

 The Court refers to the supporting documents attached to Plaintiff’s Complaint, which appear as Doc.

1-1 on the Court’s docket, as “Attachments.” 

7 Upon the Court’s review of Plaintiff’s Complaint and Attachments, Plaintiff appears to attribute his

injuries and pain to the car accident, and not to his liver biopsy. 

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up on him for several months despite Plaintiff filling out several inmate complaints and medical

requests. [FAC, pp. 18, ¶ 47.] Plaintiff goes on to complain that tests were ordered and that

medications were prescribed but not immediately provided due to pharmacy “screw ups”. [FAC, pp.

18-19, ¶ 49.] Specifically, Plaintiff claims that Defendant Silva purportedly ordered an MRI for

Plaintiff on May 20, 2008, but he did not actually receive the MRI until October 2008. [FAC, pp.

19-20, ¶ 51.]

Plaintiff claims to not assert any imputed or supervisory liability against any Defendants, and

claims to sue Defendants solely in their individual capacities. [FAC, p. 20, ¶ 54.] Plaintiff goes on to

contend that his injuries were attributable to the lack of training of Defendants and the improper

“employment” of their own abilities when transporting inmates to and from the local community

hospital. [FAC, p. 21, ¶ 55.] Plaintiff goes on to allege that the deficient performance of Defendants

Liptscher and Espinoza in responding to his medical needs after the car accident and the failure of

Defendant doctors Silva and Akbari to provide him with continuous medical care violated his rights

to “continuous medical care and treatment.” [FAC, pp. 21-22, ¶ 56.]

2. Attachments

The medical records and other supporting documents Plaintiff attached to his original

Complaint provide more details on the prison van accident and Plaintiff’s medical care after the

accident. In a declaration attached to his original Complaint, Plaintiff alleges that on the date of the

accident, he had a liver biopsy at Alvarado Hospital. (Decl., Attachments at 2.)6

 Plaintiff contends

that during the journey back to R.J.D. after the procedure, the prison van he was riding in was struck

on the rear end by another vehicle. (Decl., Attachments at 2.) As a result of the accident, Plaintiff

claims in his declaration that he was thrust forward and suffered injuries to his shoulder, back, wrist,

and the right side of his body. (Decl., Attachments at 3.)7 In a prison appeal form attached to the

Complaint, Plaintiff contends his belief that Defendants Liptscher and Espinoza acted in “reckless

disregard to the fact that their passenger ... was injured” and should have allowed Plaintiff to be

treated at a hospital. (Attachments at 5.) 

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In his declaration, Plaintiff contends he was denied medical treatment after the initial exam

by Laming. (Decl., Attachments at 3.) Plaintiff also alleges he was prescribed pain medications by

Defendants Akbari and Silva, and other facility doctors only after several months of complaining

and filing inmate appeals. (Decl., Attachments at 3.) 

The medical records show Plaintiff sought medical care numerous times between May 2,

2008, and October 30, 2008. On May 3, 2008, Plaintiff sought pain medication. (Attachments at

11.) The medical records show a physician ordered pain medication and X-rays, and Plaintiff

received a cane to aid his walking. (Attachments at 10, 11, 23.) On May 4, 2008, Plaintiff again

sought pain medication and X-rays, and a physician ordered pain medication. (Attachments at 22,

53.) Plaintiff’s records also include a prescription for pain medication from May 5, 2008. 

(Attachments at 27.)

On May 13, 2008, Plaintiff also received medical care for back pain and chest pain, and a

doctor ordered trigger point injections. (Attachments at 15, 26, 45.) That same day, after treating

Plaintiff, a doctor ordered physical therapy, pain medication, and X-rays. (Attachments at 20.) On

May 14, 2008, a physician ordered Motrin, which Plaintiff refused. (Attachments at 42.) On May

18, 2008, a physician ordered another pain medication, Toradol. (Attachments at 21). On May 20,

2008, Plaintiff received medical care again for pain in his neck, shoulder, and back, and a physician

ordered pain medication, X-rays, and an MRI. (Attachments at 14.) On May 21, June 15, and June

16, 2008, Plaintiff again sought medical care for back pain. (Attachments at 43, 39, 38.) On June

20, 2008, a medical care provider indicated in progress notes that pain medication was again

prescribed to Plaintiff. (Attachments at 17.) 

On July 2, 2008, Plaintiff received trigger point injections, administered by Dr. Glazener at

Alvarado Hospital. (Attachments at 8, 65, 69.) On July 14, 2008, Plaintiff again requested medical

care for back pain. (Attachments at 30.) In mid-September, Plaintiff received trigger point

injections again, and in late October, Plaintiff had an MRI. (Attachments at 7, 16.) In his

declaration, Plaintiff alleges after his MRI, orthopedic surgeon Dr. Smith ordered surgery on his

shoulder and wrist. (Decl., Attachments at 3.) Plaintiff also claims in his declaration that because

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 It is apparent Plaintiff had surgery, but the medical records do not indicate the date of the surgery.

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he experienced extreme pain after surgery, Dr. Smith prescribed morphine.4 (Decl., Attachments at

3.) Plaintiff contends in his declaration “the [denial] and delay of medical treatment is the reason

[his] surgery has not been successful and is why [he is] still suffering in pain and need[s] prescribed

narcotics just to sleep.” (Decl., Attachments at 2.) 

B. Procedural Background

On July 14, 2009, Plaintiff filed a complaint against Defendants Neotti, Laming, Akbari,

Silva, Liptscher, and Espinoza. (ECF. No. 1.) In his Complaint, Plaintiff alleged Defendants

violated his First Amendment right to petition the government for redress of grievances and his

Eighth Amendment right to be free from cruel and unusual punishment based on Defendant’s

alleged deliberate indifference to Plaintiff’s medical needs. On October 1, 2009, the Court sua

sponte dismissed Defendant Neotti. (ECF No. 4.)

On December 29, 2009, Defendants Akbari, Silva, Liptscher, and Espinoza filed a Motion to

Dismiss Plaintiff’s Complaint, or Strike Portions Thereof. (ECF No. 11.) Defendants sought

dismissal on the grounds that: (1) Defendants are immune to suit in their official capacities under the

Eleventh Amendment; (2) Plaintiff fails to state a claim against Defendants under the Eighth

Amendment; (3) Plaintiff fails to state a claim against Defendants under the First Amendment; and

(4) Defendants are not liable based on a theory of vicarious liability. On May 10, 2010, Plaintiff

filed an Opposition to Defendants’ Motion to Dismiss. (ECF No. 21.) Defendants filed a Reply on

May 14, 2010. (ECF No. 22.)

On July 1, 2010, this Court issued a Report and Recommendation that Defendants’ Motion to

Dismiss be Granted. (ECF No. 23.) Shortly thereafter, Plaintiff filed a Motion for Leave to File a

First Amended Complaint. (ECF No. 24.) On July 26, 2010, the Honorable Roger T. Benitez

granted Plaintiff’s Motion for Leave to File a First Amended Complaint against Defendants Silva,

Akabari, Lipshir and Espinoza only, thereby rendering moot Defendants’ Motion to Dismiss

Plaintiff’s Complaint. (ECF No. 25.) Also on July 26, 2010, the Court issued an Order to Show

Cause as to why the Court should not dismiss all claims against Defendant S. Laming for want of

prosecution pursuant to Federal Rule of Civil Procedure 4(m). (ECF No. 26.) On August 31, 2010,

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1 Though Plaintiff mentions Laming in his First Amended Complaint, he does not appear to raise any

claims against her. To the extent Plaintiff does raise claims against Defendant Laming in his First

Amended Complaint, the Court RECOMMENDS that these claims be DISMISSED in accordance with

the Court’s August 31, 2010 order. 

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Judge Benitez dismissed all claims against Defendant S. Laming without prejudice for failure to

respond to the Court’s July 26, 2010 order.1

 (ECF No. 27.) 

On December 1, 2010, Plaintiff filed his First Amended Complaint. (ECF No. 34.) On

January 14, 2011, Defendants Akbari, Silva, Liptscher, and Espinoza filed a Motion to Dismiss

Plaintiff’s First Amended Complaint and/or Strike Portions Thereof. (ECF No. 38.) Plaintiff filed

an Opposition to Defendants’ Motion to Dismiss on May 11, 2011. (ECF No. 48.) On May 20,

2011, Defendants filed a Reply to Plaintiff’s Opposition. (ECF No. 49.) 

C. Defendants’ Motion to Strike

Defendants contend Plaintiff’s First, Second, Fourth and Sixth causes of action are redundant

and cannot state an actionable claim against each of the Defendants. (ECF No. 38-1 at 17.) Under

Rule 12(f), a party may move to strike “from any pleading any insufficient defense or any redundant,

immaterial, impertinent, or scandalous matter.” FED.R.CIV.P. 12(f). Upon the Court’s review, the

First, Second, Fourth and Sixth causes of action do not appear to be entirely redundant. Rather,

these causes of action discuss separate aspects of Plaintiff’s claim for deliberate indifference to his

medical needs . Based thereon, the Court RECOMMENDS Defendants’ Motion to Strike Plaintiff’s

First, Second, Fourth, and Sixth causes of action be DENIED.

 III. STANDARD OF REVIEW

A. Rule 12(b)(6) Motions to Dismiss

A motion to dismiss for failure to state a claim pursuant to Federal Rule of Civil Procedure

12(b)(6) tests the legal sufficiency of the claims in the complaint. See Davis v. Monroe County Bd.

of Educ., 526 U.S. 629, 633 (1999).

A complaint must be dismissed if it does not contain “enough facts to state a claim to relief

that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). “A claim has

facial plausibility when the plaintiff pleads factual content that allows the court to draw the

reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, __

U.S. __, 129 S.Ct. 1937, 1949 (2009). The court must accept as true all material allegations in the

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complaint, as well as reasonable inferences to be drawn from them, and must construe the complaint

in the light most favorable to the plaintiff. Cholla Ready Mix, Inc. v. Civish, 382 F.3d 969, 973 (9th

Cir. 2004) (citing Karam v. City of Burbank, 352 F.3d 1188, 1192 (9th Cir. 2003)); Parks Sch. of

Bus., Inc. v. Symington, 51 F.3d 1480, 1484 (9th Cir. 1995); N.L. Indus., Inc. v. Kaplan, 792 F.2d

896, 898 (9th Cir. 1986). 

The court does not look at whether the plaintiff will “ultimately prevail but whether the

claimant is entitled to offer evidence to support the claims.” Scheuer v. Rhodes, 416 U.S. 232, 236

(1974); see Bell Atl. Corp. v. Twombly, 550 U.S. at 563 n.8. A dismissal under Rule 12(b)(6) is

generally proper only where there “is no cognizable legal theory or an absence of sufficient facts

alleged to support a cognizable legal theory.” Navarro v. Block, 250 F.3d 729, 732 (9th Cir. 2001)

(citing Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1988)). 

The court need not accept conclusory allegations in the complaint as true; rather, it must “examine

whether [they] follow from the description of facts as alleged by the plaintiff.” Holden v. Hagopian,

978 F.2d 1115, 1121 (9th Cir. 1992) (citation omitted); see Halkin v. VeriFone, Inc., 11 F.3d 865,

868 (9th Cir. 1993); see also Cholla Ready Mix, 382 F.3d at 973 (citing Clegg v. Cult Awareness

Network, 18 F.3d 752, 754-55 (9th Cir. 1994)) (stating that on Rule 12(b)(6) motion, a court “is not

required to accept legal conclusions cast in the form of factual allegations if those conclusions

cannot reasonably be drawn from the facts alleged[]”). “Nor is the court required to accept as true

allegations that are merely conclusory, unwarranted deductions of fact, or unreasonable inferences.” 

Sprewell v. Golden State Warriors, 266 F.3d 979, 988 (9th Cir. 2001).

In addition, when resolving a motion to dismiss for failure to state a claim, courts may not

generally consider materials outside the pleadings. Schneider v. Cal. Dep’t of Corrs., 151 F.3d

1194, 1197 n.1 (9th Cir. 1998); Jacobellis v. State Farm Fire & Cas. Co., 120 F.3d 171, 172 (9th Cir.

1997); Allarcom Pay Television Ltd. v. Gen. Instrument Corp., 69 F.3d 381, 385 (9th Cir. 1995). 

“The focus of any Rule 12(b)(6) dismissal . . . is the complaint.” Schneider, 151 F.3d at 1197 n.1. 

This precludes consideration of “new” allegations that may be raised in a plaintiff’s opposition to a

motion to dismiss brought pursuant to Rule 12(b)(6). Id. (citing Harrell v. United States, 13 F.3d

232, 236 (7th Cir. 1993).

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“When a plaintiff has attached various exhibits to the complaint, those exhibits may be

considered in determining whether dismissal [i]s proper . . . .” Parks Sch. of Bus., 51 F.3d at 1484

(citing Cooper v. Bell, 628 F.2d 1208, 1210 n.2 (9th Cir. 1980)). The court may also consider

“documents whose contents are alleged in a complaint and whose authenticity no party questions,

but which are not physically attached to the pleading . . . .” Branch v. Tunnell, 14 F.3d 449, 454

(9th Cir. 1994), overruled on other grounds by Galbraith v. County of Santa Clara, 307 F.3d 1119

(9th Cir. 2002); Stone v. Writer’s Guild of Am. W., Inc., 101 F.3d 1312, 1313-14 (9th Cir. 1996). 

B. Standards Applicable to Pro Se Litigants

Where a plaintiff appears in propria persona in a civil rights case, the court must construe the

pleadings liberally and afford the plaintiff any benefit of the doubt. Karim-Panahi v. Los Angeles

Police Dep’t, 839 F.2d 621, 623 (9th Cir. 1988). The rule of liberal construction is “particularly

important in civil rights cases.” Ferdik v. Bonzelet, 963 F.2d 1258, 1261 (9th Cir. 1992). In giving

liberal interpretation to a pro se civil rights complaint, courts may not “supply essential elements of

claims that were not initially pled.” Ivey v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266,

268 (9th Cir. 1982). “Vague and conclusory allegations of official participation in civil rights

violations are not sufficient to withstand a motion to dismiss.” Id.; see also Jones v. Cmty. Redev.

Agency, 733 F.2d 646, 649 (9th Cir. 1984) (finding conclusory allegations unsupported by facts

insufficient to state a claim under § 1983). “The plaintiff must allege with at least some degree of

particularity overt acts which defendants engaged in that support the plaintiff’s claim.” Jones, 733

F.2d at 649 (internal quotation omitted).

Nevertheless, the court must give a pro se litigant leave to amend his complaint “unless it

determines that the pleading could not possibly be cured by the allegation of other facts.” Lopez v.

Smith, 203 F.3d 1122, 1127 (9th Cir. 2000) (en banc) (quotation omitted) (citing Noll v. Carlson,

809 F.2d 1446, 1447 (9th Cir. 1987)). Thus, before a pro se civil rights complaint may be dismissed,

the court must provide the plaintiff with a statement of the complaint’s deficiencies. Karim-Panahi,

839 F.2d at 623-24. But where amendment of a pro se litigant’s complaint would be futile, denial of

leave to amend is appropriate. See James v. Giles, 221 F.3d 1074, 1077 (9th Cir. 2000).

///

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C. Stating a Claim Under 42 U.S.C. § 1983

To state a claim under § 1983, the plaintiff must allege facts sufficient to show (1) a person

acting “under color of state law” committed the conduct at issue, and (2) the conduct deprived the

plaintiff of some right, privilege, or immunity protected by the Constitution or laws of the United

States.

IV. DISCUSSION

A. Eighth Amendment Deliberate Indifference

In his First, Second, Fourth, and Sixth causes of action, Plaintiff contends Defendants

Liptscher, Espinoza, Silva and Akbari were deliberately indifferent to his medical needs. (ECF No.

34.) 

Defendants contend there is no basis for a finding of deliberate indifference to Plaintiff’s

serious medical needs, as there is no evidence to support the claim of a denial, delay, or intentional

interference with medical treatment. (ECF No. 38-1 at 18-19.) 

“[D]eliberate indifference to a prisoner’s serious illness or injury states a cause of action

under § 1983.” Estelle v. Gamble, 429 U.S. 97, 105 (1976). “A determination of ‘deliberate

indifference’ involves an examination of two elements: the seriousness of the prisoner’s medical

need and the nature of the defendant’s response to that need.” McGuckin v. Smith, 974 F.2d 1050,

1059 (9th Cir. 1992). 

First, “[a] ‘serious’ medical need exists if the failure to treat a prisoner’s condition could

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

974 F.2d at 1059 (quoting Estelle, 429 U.S. at 104). 

Second, to establish deliberate indifference, a defendant must purposefully ignore or fail to

respond to a prisoner’s pain or possible medical need. McGuckin, 974 F.2d at 1060. Deliberate

indifference to medical needs occurs when prison officials “‘deny, delay, or intentionally interfere

with medical treatment.’” Hunt v. Dental Dep’t, 865 F.2d 198, 201 (9th Cir. 1989) (quoting

Hutchinson v. US, 838 F.2d 390, 394 (9th Cir. 1984)). Specifically, “this is true whether the

indifference is manifested by prison doctors in their response to the prisoner’s needs, or by prison

guards in intentionally denying or delaying access to medical care or intentionally interfering with

the treatment once prescribed.” Estelle, 429 U.S. at 104-05 (footnotes omitted). “In order to show

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deliberate indifference, an inmate must allege sufficient facts to indicate that prison officials acted

with a culpable state of mind.” Wilson v. Seiter, 501 U.S. 294, 302 (1991). The indifference to

medical needs also must be substantial; inadequate treatment due to malpractice, or even gross

negligence, does not amount to a constitutional violation. Estelle, 429 U.S. at 106; Toguchi v.

Chung, 391 F.3d 1051, 1060 (9th Cir. 2004) (“Deliberate indifference is a high legal standard.”)

(citing Hallett v. Morgan, 296 F.3d 732, 1204 (9th Cir. 2002); Wood v. Housewright, 900 F.2d 1332,

1334 (9th Cir. 1990)). 

A mere delay in treatment does not constitute a violation of the Eighth Amendment, unless

the delay or denial was harmful. See McGuckin, 974 F.2d at 1060; Shapley v. Nevada Bd. of State

Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985); Hunt, 865 F.2d at 200 (“[D]elay in providing a

prisoner with dental treatment, standing alone, does not constitute an Eighth Amendment

violation.”); Sealock v. Colorado, 218 F.3d 1205, 1210 (10th Cir. 2000) (“Certainly, not every

twinge of pain suffered as the result of delay in medical care is actionable.”). While the harm caused

by delay need not necessarily be “substantial,” McGuckin, 974 F.2d at 1060 & n.2; see also Wood

v. Housewright, 900 F.2d at 1336, 1339-40 (9th Cir. 1990) (Reinhardt, J., dissenting), the Eighth

Amendment is violated if “delays occurred to patients with problems so severe that delays would

cause significant harm and that Defendants should have known this to be the case,” Hallett, 287 F.3d

at 1206, and “a finding that the inmate was seriously harmed by the defendant’s action or inaction

tends to provide additional support to a claim that the defendant was ‘deliberately indifferent’ to the

prisoner’s medical needs.” McGuckin, 974 F.2d at 1060. 

However, differences in judgment between an inmate and prison medical personnel

regarding appropriate medical diagnosis and treatment are not enough to establish a deliberate

indifference claim. Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). Further, a prison inmate has

no independent constitutional right to outside medical care additional and supplemental to the

medical care provided by the prison staff within the institution. See Roberts v. Spalding, 783 F.2d

867, 870 (9th Cir. 1986).

///

///

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1. Defendants Liptscher and Espinoza

Plaintiff contends Defendants Liptscher and Espinoza acted in reckless disregard of his

medical needs by bringing him to the prison medical facility instead of a hospital after he suffered

injuries in a car accident. (ECF No. 34 at 9-10.) Plaintiff states that upon his arrival back in prison,

he was seen by Registered Nurse S. Laming, who advised Plaintiff that he was fine to return to his

cell and that he should take Ibuprofen and drink tea. Id. at 10. Plaintiff contrasts the medical

treatment provided to the corrections officers, who were taken to the hospital, and himself, who was

returned to be treated by jail medical staff, and claims the difference in treatment received is

indicative of deliberate indifference to his serious medical needs. Id. Further, Plaintiff contends that

as a result of Defendants’ decision to return him to prison for medical treatment, months passed

before he received treatment from medical doctors, pain medications, x-rays, a cane and a MRI,

causing him to suffer harm and pain severe enough to require narcotic medication in order to sleep. 

Id. at 11-14.

Defendants Liptscher and Espinoza contend they took Plaintiff back to the prison to be

examined by prison medical staff within one hour of the accident. (ECF No. 38-1 at 18.) Therefore,

Defendants contend “there is nothing which would or could give rise to a deliberate indifference

claim based on a denial o[r] delay of medical care against either defendant Liptscher or Espinoza,

the transportation officers.” Id. at 18.

Here, Plaintiff adequately pleads sufficient facts for the first element of deliberate

indifference, his serious medical need. McGuckin, 974 F.2d at 1059. Plaintiff states that, following

the car accident, he suffered injuries to his wrist, shoulder, back, and the right side of his body, and

paramedics indicated Plaintiff should be taken to the hospital to receive medical treatment. (ECF

No. 34 at 9-10.) A failure to treat Plaintiff’s injuries or alleviate his pain with medication likely

would have resulted in “unnecessary and wanton infliction of pain,” and thus Plaintiff adequately

pleads sufficient facts to demonstrate his serious medical need. McGuckin, 974 F.2d at 1059

(quoting Estelle, 429 U.S. at 104). 

However, Plaintiff has not adequately plead sufficient facts for the second element, that

Defendants acted with a culpable state of mind in denying, delaying, or interfering with Plaintiff’s

medical care. Wilson, 501 U.S. at 302; Hunt, 865 F.2d at 201. Contrary to Plaintiff’s assertions of

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delay, the records attached to Plaintiff’s original complaint show Defendants Liptscher and Espinoza

returned Plaintiff to R.J.D. after the car accident, and Plaintiff received medical treatment within one

hour of the alleged incident. (Attachments at 6.) Therefore, Defendants Liptscher and Espinoza

ensured Plaintiff received prompt medical care by driving him back to R.J.D. after the accident and

did not deny, delay, or interfere with Plaintiff’s medical care. Additionally, although Plaintiff

preferred to receive treatment for his injuries at a community hospital instead of at R.J.D., he had no

constitutional right to outside medical care. Roberts, 783 F.2d at 870. Thus, Plaintiff does not allege

facts indicating Defendants Liptscher and Espinoza acted with a culpable state of mind in denying,

delaying, or interfering with Plaintiff’s medical care. Wilson, 501 U.S. at 302; Hunt, 865 F.2d at

201.

2. Defendants Silva and Akbari

Plaintiff contends that although Defendants Silva and Akbari made orders for medication, xrays, a MRI, a cane, and physical therapy for Plaintiff, these Defendants were deliberately

indifferent to his medical needs by not following up to ensure these orders were complied with and

failing to check up on Plaintiff for several months. Id. at 18. Specifically, Plaintiff contends

Defendant Silva ordered a MRI for Plaintiff on May 20, 2008, which took until October 2008 to

receive. Id. at 19-20. 

Defendants Silva and Akbari contend they did not intentionally deny or delay Plaintiff’s

medical treatment. (ECF No. 38-1 at 19.) Conversely, Defendants contend it is clear from the

documents attached to Plaintiff’s original complaint that Defendants Silva and Akbari took

immediate and responsive action to provide Plaintiff with medical care. Id. at 9. 

As discussed above, Plaintiff has plead sufficient facts for the first element of deliberate

indifference to medical needs by demonstrating his serious medical need. Additionally, Plaintiff has 

met the second element of deliberate indifference to medical needs by alleging facts showing

Defendants Akbari and Silva purposefully ignored or failed to respond to Plaintiff’s pain or possible

medical need. McGuckin, 974 F.2d at 1060. With regard to Defendant Akbari, Plaintiff contends

Akbari knew of Plaintiff’s serious medical condition because Akbari reviewed Plaintiff’s May 3, 4,

5, and 8 medical requests and prescribed pain medication and x-rays in the days following the

accident. (ECF No. 34 at 18, 19.) Despite this knowledge, Plaintiff contends Akbari failed to

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follow-up on Plaintiff’s condition, resulting in a delay in Plaintiff receiving his pain medication. Id.

Plaintiff alleges this delay in medical treatment resulted in an unsuccessful surgery which has caused

him great pain. Id. at 14. Therefore, Plaintiff has plead sufficient facts to show Akbari’s delay in

treatment was harmful, thereby constituting deliberate indifference to his medical needs. McGuckin,

974 F.2d at 1060. 

Similarly, with regard to Defendant Silva, Plaintiff has plead sufficient facts demonstrating

Defendant Silva purposefully ignored or failed to respond to Plaintiff’s pain or possible medical

need. McGuckin, 974 F.2d at 1060. Plaintiff contends Silva ordered a MRI for Plaintiff on May 20,

2008, which Plaintiff did not actually receive until October 2008. (ECF No. 34 at 19.) Plaintiff

contends Silva’s failure to follow-up on his order or check on Plaintiff’s condition resulted in a delay

in receiving adequate medical attention, which ultimately resulted in an unsuccessful surgery. Id. at

14, 19-20. Therefore, Plaintiff has also plead sufficient facts to show Silva’s delay in treatment was

harmful, thereby constituting deliberate indifference to his medical needs. McGuckin, 974 F.2d at

1060. 

Based on the foregoing, while Plaintiff has not adequately plead facts that meet the high legal

standard for deliberate indifference for Defendants Liptscher and Espinoza, Plaintiff has plead

sufficient facts demonstrating Defendants Akbari and Silva were deliberately indifferent to his

medical needs. Toguchi, 391 F.3d at 1060. Accordingly, the Court RECOMMENDS Defendants’

Motion to Dismiss Plaintiff’s Eighth Amendment Claim of deliberate indifference to his medical

needs be GRANTED with leave to amend against Defendants Liptscher and Espinoza, and

DENIED as to Defendants Akbari and Silva.

B. Conspiracy

In his Third Cause of Action, Plaintiff contends Defendants acted in concert and conspired to

deny Plaintiff his right to proper medical care. (ECF No. 34 at 26-27.) 

Defendants contend, as an initial matter, that Plaintiff cannot demonstrate any deliberate

indifference to his medical needs. (ECF No. 38-1 at 20.) Second, Defendants contend Plaintiff’s

state law conspiracy claims cannot withstand scrutiny because public employees are not liable for an

injury caused . Id. 

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1

 The Ninth Circuit has specifically held that conspiracy claims, since they require the plaintiff to show

that the defendant agreed to join the conspiracy, see Margolis, 140 F.3d at 853, are subject to this

heightened pleading standard. See Harris, 126 F.3d at 1195; Mendocino Envtl. Ctr. v. Mendocino

County, 14 F.3d 457, 459 (9th Cir. 1994) (applying identical standard to conspiracy claim in Bivens

action). 

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To prove a conspiracy in violation of Section 1983, a plaintiff must show: (1) an agreement

between the defendants to deprive the plaintiff of a constitutional right; (2) an overt act in

furtherance of the conspiracy and; (3) a constitutional violation. See Gilbrook v. City of

Westminster, 177 F.3d 839, 856-57 (9th Cir. 1999) (en banc); Margolis v. Ryan, 140 F.3d 850, 853

(9th Cir. 1998); see also Askew v. Millerd, 191 F.3d 953, 957 (8th Cir. 1999); Pangburn v.

Culbertson, 200 F.3d 65, 72 (2d Cir. 1999); Hinkle v. City of Clarksburg, 81 F.3d 416, 421 (4th Cir.

1996); Villanueva v. McInnis, 723 F.2d 414, 416 (5th Cir. 1984). Because conspiracies, by their

very nature, are secret agreements, “[a] defendant’s knowledge of and participation in a conspiracy

may be inferred from circumstantial evidence and from evidence of the defendant’s actions.”

Gilbrook, 177 F.3d at 857-58.

However, pleading a conspiracy requires more than a conclusory allegation that defendants

conspired to deprive plaintiff’s civil rights. The Ninth Circuit applies a heightened pleading standard

to conspiracy claims under Section 1983 and has held that mere conclusory allegations of conspiracy

(i.e. a bare allegation that a defendant “conspired” with another) are insufficient to state a claim.1

See Harris v. Roderick, 126 F.3d 1189, 1195 (9th Cir. 1997); Buckey v. County of Los Angeles, 968

F.2d 791, 794 (9th Cir. 1992); Woodrum v. Woodward County, 866 F.2d 1121, 1126-27 (9th Cir.

1989). Rather, “[t]o state a claim for a conspiracy to violate one’s constitutional rights under section

1983, the plaintiff must state specific facts to support the existence of the claimed conspiracy.” 

Burns v. County of King, 883 F.2d 819, 821 (9th Cir. 1989); see also Lee v. City of Los Angeles,

250 F.3d 668, 679 n.6 (9th Cir. 2001) (holding that plaintiffs must allege facts which are “specific

and concrete enough to enable the defendants to prepare a response, and where appropriate, a motion

for summary judgment based on qualified immunity.”); Buckey, 968 F.2d at 794. A plaintiff can

meet the heightened pleading standard by alleging “which defendants conspired, how they conspired

and how the conspiracy led to a deprivation of his constitutional rights even though he does not

identify which officer said or did what at which particular time.” Harris, 126 F.3d at 1196.

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Here, Plaintiff has failed to allege any facts which show an agreement or meeting of the

minds to violate any of Plaintiff's constitutional rights. Woodrum, 866 F.2d at 1126. Further,

Plaintiff has failed to allege any facts which show an overt act in furtherance of the conspiracy. 

Gilbrook, 177 F.3d at 856-57. Rather, Plaintiff has made conclusory allegations of conspiracy,

which are insufficient to state a claim. See Harris, 126 F.3d at 1195. Accordingly, the Court

RECOMMENDS Defendants' motion to dismiss Plaintiff's conspiracy claim be GRANTED with

leave to amend.

C. Breach of Implied and Express Contract

In his Fifth Cause of Action, Plaintiff contends Defendants violated the express and implied

contract existing between him and the California Department of Corrections and Rehabilitation

pursuant to Cal. Code Regs. Title 15, Rules and Regulations. (ECF No. 34 at 29-33.) Specifically,

Plaintiff contends Defendants alleged deliberate indifference to his medical needs breaches the

aforementioned contract. Id. 

Defendants contend Plaintiff cannot demonstrate the existence of an implied or express

contract between himself and Defendants. (ECF No. 38-1 at 21.) 

To state a claim for breach of contract under California law, Plaintiff must establish: (1) the

existence of a contract; (2) Plaintiff’s performance or excuse for nonperformance of the contract; (3)

Defendants’ breach of the contract; and (4) resulting damages. CA BAJI 13.85 (Spring 2011 Ed.);

see also Armstrong Petrol. Corp. v. Tri Valley Oil & Gas Co., 116 Cal. App. 4th 1375, 1391 n. 6

(2004) (citing Careau & Co. v. Security Pacific Business Credit, Inc., 222 Cal. App. 3d 1371, 1388

(1990)). 

Here, Plaintiff fails to state sufficient facts to establish the elements for a breach of contract

claim. First, the Court’s review of Title 15, Article 9, §§ 3350, 3351, and 3355 indicates these

provisions do not support the proposition that there is an express or implied contract between

Plaintiff and Defendants. Consequently, Plaintiff is unable to establish the existence of a contract. 

Further, Plaintiff is unable to state facts either demonstrating his performance or excuse for

nonperformance of the alleged contract, or Defendants’ breach of the alleged contract. Accordingly,

the Court RECOMMENDS Defendants' motion to dismiss Plaintiff's breach of contract claim be

GRANTED with prejudice.

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D. Intentional Infliction of Emotional Distress

In his Seventh Cause of Action, Plaintiff raises a claim for intentional infliction of emotional

distress. (ECF No. 34 at 34-35.) Plaintiff contends Defendants “became increasingly uncaring of

[P]laintiff’s injuries.” Id. Plaintiff contends Defendants’ “outrageous conduct” was “intentional”

and “malicious.” Id. 

Defendants contend Plaintiff has failed to state a viable claim for intentional infliction of

emotional distress. (ECF No. 38-1 at 21-22.) 

The elements of a cause of action for intentional infliction of emotional distress are (1)

outrageous conduct by the defendant; (2) intention to cause or reckless disregard of the probability

of causing emotional distress; (3) severe emotional suffering; and (4) actual and proximate causation

of the emotional distress. Cole v. Fair Oaks Fire Protection Dist., 43 Cal.3d 148, 155 n.7 (1987). 

“‘Conduct to be outrageous must be so extreme as to exceed all bounds of that usually tolerated in a

civilized society.’” Christensen v. Superior Court, 54 Cal.3d 868, 903 (1991). 

Here, Plaintiff fails to state sufficient facts to establish the elements for an intentional

infliction of emotional distress claim. First, Plaintiff fails to allege facts showing Defendants’

conduct was “outrageous.” With regard to Defendants Liptscher and Espinoza, their decision to

send Plaintiff to receive medical attention at the prison rather than at a hospital was not “so extreme

as to exceed all bounds of that usually tolerated in a civilized society.” Christensen, 54 Cal.3d at

903. Similarly, Defendants Silva’s and Akbari’s alleged failure to ensure prison staff complied with

their orders for medication, x-rays, a MRI, a cane, and physical therapy does not rise to the level of

“outrageous conduct” necessary to state a claim for intentional infliction of emotional distress. See

Id. Moreover, Plaintiff fails to assert facts demonstrating Defendants intentionally caused, or

recklessly disregarded the probability of causing emotional distress. Accordingly, the Court

RECOMMENDS Defendants' motion to dismiss Plaintiff's intentional infliction of emotional

distress claim be GRANTED with leave to amend.

E. Negligence

In his Eighth Cause of Action, Plaintiff contends Defendants were “negligent, reckless and

[acted] without due regard for the rights, privileges and interests of [P]laintiff’s welfare.” (ECF No.

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34 at 35-36.) Specifically, in being deliberately indifferent to his medical needs, Plaintiff contends

Defendants failed to exercise their duty of care. Id.

Defendants contend Plaintiff cannot demonstrate Defendants were deliberately indifferent to

his serious medical needs, thereby foreclosing his claim for negligence. (ECF No. 38-1.)

Under California law, an action in negligence requires a showing that the defendant owed the

plaintiff a legal duty, that the defendant breached the duty, and that the breach was a proximate or

legal cause of injuries suffered by the plaintiff. Ann M. v. Pacific Plaza Shopping Center, 6 Cal.4th

666, 673; 6 Witkin, SUMMARY OF CAL. LAW (9th ed. 1988) Torts, § 732 at 60.

Here, Plaintiff alleges sufficient facts to demonstrate Defendants acted negligently. First, as

to all Defendants, Plaintiff contends Defendants had a “duty to act with...‘due care’ towards

[P]laintiff.” (ECF No. 34 at 35.) Second, Plaintiff alleges Defendants Liptscher and Espinoza’s

decision to take Plaintiff back to the prison rather than a hospital constituted a breach of their duty of

care. See Id. at 36. With regard to Defendants Akbari and Silva, Plaintiff contends the delay

resulting from their failure to check on Plaintiff’s condition and follow-up on their medical orders

constitutes a breach of their duty of care as doctors. See Id. Third, as to all Defendants, Plaintiff

contends Defendants’ action have caused him humiliation, a denial of adequate medical care, mental

anguish, severe tension, profound shock, and anxiety. Id. Thus, Plaintiff has plead facts sufficient

to establish all three elements of a negligence cause of action. Ann M., 6 Cal.4th at 673.

Accordingly, the Court RECOMMENDS Defendants' motion to dismiss Plaintiff's negligence claim

be DENIED. 

V. CONCLUSION

For the reasons set forth herein, it is RECOMMENDED that:

1) Defendants’ Motion to Strike Plaintiff’s First, Second, Fourth, and Sixth causes of

action be DENIED;

2) Defendants’ Motion to Dismiss Plaintiff’s Eighth Amendment Claim of deliberate

indifference to his medical needs be GRANTED with leave to amend against

Defendants Liptscher and Espinoza, and DENIED as to Defendants Akbari and

Silva;

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3) Defendants' motion to dismiss Plaintiff's conspiracy claim be GRANTED with leave

to amend;

4) Defendants' motion to dismiss Plaintiff's breach of contract claim be GRANTED

with prejudice;

5) Defendants' motion to dismiss Plaintiff's intentional infliction of emotional distress

claim be GRANTED with leave to amend;

6) Defendants' motion to dismiss Plaintiff's negligence claim be DENIED. 

This Report and Recommendation of the undersigned Magistrate Judge is submitted to the

United States District Judge assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(1)

(1994).

This Report and Recommendation will be submitted to the United States District Court judge

assigned to this case pursuant to the provisions of 28 U.S.C. § 636(b)(1). Any party may file written

objections with the Court and serve a copy on all parties on or before August 5, 2011. This

document should be captioned “Objections to Report and Recommendation.” Any reply to the

objections shall be served and filed no later than August 19, 2011. The parties are further advised

that failure to file objections within the specified time may waive the right to appeal the district

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

IT IS SO ORDERED.

DATED: July 13, 2011

LOUISA S PORTER

United States Magistrate Judge

cc: The Honorable Roger T. Benitez

all parties

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