Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_14-cv-04689/USCOURTS-cand-3_14-cv-04689-7/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

LOURDES A. ACASIO,

Plaintiff,

v.

SAN MATEO COUNTY, et al.,

Defendants.

Case No. 14-cv-04689-JSC 

ORDER RE: MOTION TO DISMISS 

THIRD AMENDED COMPLAINT

Re: Dkt. No. 41

Plaintiff Lourdes Acasio, proceeding pro se, brings this action against the County of San 

Mateo (the “County”) and San Mateo County Sheriff Officers Lucy and Curley (the “Individual 

Defendants” and, collectively, “Defendants”). (Dkt. No. 33.) Plaintiff alleges that Defendants 

violated her civil rights by humiliating and injuring her during post-arrest booking procedures and 

ignoring her pleas for medical treatment during booking and thereafter. Ruling on Defendants’ 

motion to dismiss the First Amended Complaint (“FAC”), the Court concluded that Plaintiff had 

adequately pleaded a Fourth Amendment excessive force claim against Officer Lucy, but had 

failed to allege facts to state a plausible claim of municipal liability against the County for 

knowingly failing to provide adequate medical treatment. See Acasio v. San Mateo Cnty., No. 14-

cv-04689-JSC, 2015 WL 5568345, *7-9 (N.D. Cal. Sept. 22, 2015) (“Acasio IV”). Plaintiff has 

since filed a Third Amended Complaint (“TAC”). (Dkt. No. 33.) Now pending before the Court 

is Defendants’ motion to dismiss the deliberate indifference municipal liability claim on the 

grounds that Plaintiff has failed to cure the defects that the Court earlier identified.1 (Dkt. No. 41.) 

 

1 Defendants’ motion is labeled “Motion to Dismiss Plaintiff’s Third Amended Complaint. (Dkt. 

No. 41 at 2.) In their Notice of Motion, Defendants represent that they seek an order “granting 

dismissal without leave to amend of all counts filed against Defendants in the Third Amended 

Complaint[.]” (Dkt. No. 41 at 2.) Similarly, at some places in the motion Defendants urge that 

Case 3:14-cv-04689-JSC Document 45 Filed 12/15/15 Page 1 of 7
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Having considered the parties’ submissions, the Court concludes that oral argument is 

unnecessary, see Civ. L.R. 7-1(b), and GRANTS Defendants’ motion to dismiss the municipal 

liability claim.

BACKGROUND

The factual allegations of this matter were already addressed in detail in the Court’s Order 

reviewing the SAC pursuant to 28 U.S.C. § 1915(e)(2) and Order granting in part Defendant’s 

motion to dismiss the SAC, which the Court incorporates by reference here. See Acasio IV, 2015

WL 5568345, at *1-2; Acasio v. San Mateo Cnty., No. 14-cv-04689-JSC, 2015 WL 2411943, at 

*1-2 (N.D. Cal. May 20, 2015) (“Acasio III”). The allegations of the TAC are nearly identical to 

the earlier iterations of the complaint. Indeed, portions of the TAC merely duplicate pages of 

Plaintiff’s first and second amended complaints and her opposition to Defendants’ motion to 

dismiss the SAC. Moreover, the only allegations at issue here are those pertaining to Plaintiff’s 

claim for municipal liability against the County for failure to provide adequate medical treatment, 

which centers on her claim that the jailhouse nurse’s examination was constitutionally insufficient 

and she should have been referred to a doctor for immediate medical treatment. Thus, the Court 

will not reiterate the entire background here, and instead will highlight only the newly-added 

allegations in the TAC.

2

Plaintiff alleges that the nurse’s medical examination was insufficient for several reasons. 

First, because the nurse only checked her vital signs and told Plaintiff that she had high blood 

pressure, but did not provide any medication to remedy that condition. (Dkt. No.33-1 at 11-12, 

 

the Court should dismiss the entire TAC with prejudice. (See id. at 4, 9.) Elsewhere, however, 

Defendants clarify that the only claim they seek to dismiss is the municipal liability claim, and 

their argument for dismissal focuses only on municipal liability. (See id. at 5-9.) Moreover, the 

Court has already held that Plaintiff adequately pleads a Section 1983 excessive force claim 

against Officer Lucy. See Acasio IV, 2015 WL 5568345, *7. The Court therefore construes 

Defendants’ motion as a motion to dismiss the municipal liability claim only.

2

Plaintiff also submitted a declaration in support of her opposition to Defendants’ motion to 

dismiss. (Dkt. No. 43 at 9-13.) The Court does not consider this declaration, as a 12(b)(6) motion 

focuses on the allegations of the complaint. See Ramirez v. United Airlines, Inc., 416 F. Supp. 2d 

792, 795 (N.D. Cal. 2005) (“[M]aterials outside the pleadings ordinarily are not considered on a 

motion to dismiss[.]”). However, it will consider the declaration in the context of whether leave to 

amend would be futile.

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17.) Second, because Plaintiff informed the nurse that she suffered from depression, but the nurse 

did not prescribe Plaintiff any anti-depressant medication. (Id.) And third, because the nurse 

exercised poor judgment and was unprofessional and negligent in not requesting that Plaintiff see 

a doctor. (Id. at 11-12, 17.) Besides that, Plaintiff repeats her allegation that she requested to see 

a doctor many times to no avail, and that the jail has no policy for emergency medical treatment. 

(Id. at 12-13, 16, 18; Dkt. No. 33-2 at 1.) She alleges that her condition worsened because she was 

not able to see a doctor inasmuch as she continued to experience panic attacks, continued crying 

non-stop, and experienced back pain. (Dkt. No. 33-1 at 18.)

LEGAL STANDARD

A Rule 12(b)(6) motion challenges the sufficiency of a complaint as failing to allege 

“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 facial plausibility standard is not a “probability requirement” but 

mandates “more than a sheer possibility that a defendant has acted unlawfully.” Ashcroft v. Iqbal, 

556 U.S. 662, 678 (2009) (internal quotations and citations omitted). For purposes of ruling on 

a Rule 12(b)(6) motion, the court “accept[s] factual allegations in the complaint as true and 

construe[s] the pleadings in the light most favorable to the non-moving party.” Manzarek v. St. 

Paul Fire & Mar. Ins. Co., 519 F.3d 1025, 1031 (9th Cir. 2008). “[D]ismissal may be based on 

either a lack of a cognizable legal theory or the absence of sufficient facts alleged under a 

cognizable legal theory.” Johnson v. Riverside Healthcare Sys., 534 F.3d 1116, 1121 (9th Cir. 

2008) (internal quotation marks and citations omitted); see also Neitzke v. Williams, 490 U.S. 319, 

326 (1989) (“Rule 12(b)(6) authorizes a court to dismiss a claim on the basis of a dispositive issue 

of law.”).

Even under the liberal pleading standard of Federal Rule of Civil Procedure 8(a)(2), under 

which a party is only required to make “a short and plain statement of the claim showing that the 

pleader is entitled to relief,” a “pleading that offers ‘labels and conclusions’ or ‘a formulaic 

recitation of the elements of a cause of action will not do.’” Iqbal, 556 U.S. at 678 (quoting 

Twombly, 550 U.S. at 555). “[C]onclusory allegations of law and unwarranted inferences are 

insufficient to defeat a motion to dismiss.” Adams v. Johnson, 355 F.3d 1179, 1183 (9th Cir. 

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2004); see also Starr v. Baca, 652 F.3d 1202, 1216 (9th Cir. 2011) (“[A]llegations in a complaint 

or counterclaim may not simply recite the elements of a cause of action, but must contain 

sufficient allegations of underlying facts to give fair notice and to enable the opposing party to 

defend itself effectively.”), cert. denied, 132 S. Ct. 2101 (2012). The court must be able to “draw 

the reasonable inference that the defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. 

at 663. “Determining whether a complaint states a plausible claim for relief . . . [is] a contextspecific task that requires the reviewing court to draw on its judicial experience and common 

sense.” Id. at 663-64.

Pro se pleadings are generally liberally construed and held to a less stringent standard. See 

Erickson v. Pardus, 551 U.S. 89, 94 (2007). In Hebbe v. Pliler, 627 F.3d 338 (9th Cir. 2010), the 

Ninth Circuit held that courts must still liberally construe pro se filings post-Iqbal noting that 

“[w]hile the standard is higher, our obligation remains, where the petitioner is pro se, particularly 

in civil rights cases, to construe the pleadings liberally and to afford the petitioner the benefit of 

any doubt.” Id. at 342 (internal quotation marks and citations omitted). Nevertheless, the Court 

may not “supply essential elements of the claim that were not initially pled.” Ivey v. Bd. of 

Regents of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982).

DISCUSSION

To state a claim for municipal liability, a plaintiff must show (1) she possessed a 

constitutional right of which she was deprived; (2) the entity had a policy; (3) the policy amounts 

to deliberate indifference to the plaintiff’s constitutional rights; and (4) the policy is the moving 

force behind the constitutional violation. Plumeau v. Sch. Dist. No. 40 Cnty. of Yamhill, 130 F.3d 

432, 438 (9th Cir. 1997). In dismissing the SAC’s municipal liability claim, the Court noted that 

Plaintiff had failed to plausibly allege the first and third elements. The Court advised Plaintiff 

that, if she wished to amend her claim, she must include factual allegations that “indicate why the 

treatment by the nurse was insufficient, how the County’s failure to provide treatment by a doctor 

or at the hospital caused Plaintiff further harm, and actual facts—aside from conclusory 

allegations—from which the Court can draw an inference of the existence of a County policy of 

refusal to provide emergency medical treatment to pretrial detainees.” Acasio IV, 2015 WL 

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5568345, at *9. Plaintiff has failed to do so.

With respect to the first element, as the Court previously explained, to establish deliberate 

indifference to the need for medical treatment, a plaintiff must plausibly allege “(1) a serious 

medical need and (2) a deliberately indifferent response.” Acasio IV, 2015 WL 5568345, at *8. 

To show deliberate indifference, Plaintiff must allege facts sufficient to give rise to a plausible 

inference that the defendant was aware of a prisoner’s substantial risk of serious harm but 

disregards that risk by failing to take reasonable steps to abate it. Farmer v. Brennan, 511 U.S. 

825, 837. Failure to take reasonable steps may include either engaging in a course of treatment 

that is “medically unacceptable under the circumstances” or taking action—or inaction—“in 

conscious disregard of an excessive risk to plaintiff’s health.” Jackson v. McIntosh, 90 F.3d 330, 

332 (9th Cir. 1996) (internal quotation marks and citations omitted). “[D]ifferences of opinion 

between the prisoner and the medical staff regarding the appropriate medical treatment does not 

amount to deliberate indifference.” Acasio IV, 2015 WL 5568345, at *8 (citing Jackson, 90 F.3d 

at 332). Similarly, deliberate indifference is more than mere “negligence in diagnosing or treating 

a medical condition.” Estelle v. Gramble, 429 U.S. 97, 106 (1976).

The Court found the SAC allegations insufficient because the allegations demonstrated that 

Plaintiff was actually seen by a nurse who checked Plaintiff’s vital signs and who was told that 

Plaintiff was having panic attacks, but did not provide medication. The Court reasoned that these 

allegations amounted only to disagreement with the nurse’s course of treatment, not deliberate 

indifference. Id. The TAC has not cured either of these defects and instead, if anything, further 

emphasizes that the gravamen of Plaintiff’s claim is disagreement with the nurse’s treatment—that 

is, mere negligence or medical malpractice, not deliberate indifference. In the TAC, Plaintiff 

repeatedly alleges that she was not satisfied with the nurse’s checkup, that the nurse did not show 

sufficient concern for Plaintiff’s condition, and that the nurse exercised poor judgment, 

negligence, and malpractice in failing to refer Plaintiff to a doctor. But disagreement with 

treatment or negligence is not enough to state a claim for deliberate indifference. See Estelle, 429 

U.S. at 106; Jackson, 90 F.3d at 332. There are not enough facts from which the Court can 

plausibly infer that the nurse’s decision not to refer Plaintiff to a doctor for emergency care was 

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medically unacceptable under the circumstances or in conscious disregard of an excessive risk to 

Plaintiff’s health. The TAC therefore fails to plausibly allege a constitutional deprivation, which

is fatal to a municipal liability claim.3

Nor does the TAC adequately allege the third element: that the County has an actionable 

policy of deliberate indifference to medical treatment that caused Plaintiff’s constitutional 

violation. Plumeau, 130 F.3d at 438. A plaintiff may satisfy this element in one of two ways: 

either (1) showing that the municipality had an actual policy that motivated the wrong; or (2) 

showing that the municipality failed to train or supervise its employees. Gibson v. Cnty. of 

Washoe, Nev., 290 F.3d 1175, 1193-95 (9th Cir. 2002). In this case, Plaintiff alleges that the 

County had an actual policy of refusing to provide emergency medical treatment to pretrial 

detainees. See Acasio IV, 2015 WL 5568345, at *9.

The Court concluded that the SAC failed to adequately allege such a policy because the 

allegations only demonstrated that Plaintiff’s requests to see a doctor were denied, but the SAC 

did “not adequately allege that the County never takes detainees to the hospital other than through 

conclusory allegations.” Id. The same is true of the TAC. Plaintiff has more than adequately 

alleged that the County denied her repeated requests for medical treatment by a doctor and that a 

nurse informed her that a doctor was not available to see her. But, just like its predecessor 

pleading, the TAC includes only conclusory allegations that the County has an actual policy of 

refusing to provide a doctor or hospital care for any pretrial detainee in need of emergency 

medical treatment. Once again, there are no factual allegations—such as the experience of other 

pretrial detainees—that allow the Court to reasonably draw such an inference. Thus, the TAC still 

fails to plausibly allege that the County has a policy of depriving inmates of their constitutional 

right to adequate medical treatment. As a result, the municipal liability claim for deliberate 

 

3 Defendants also contend that Plaintiff has failed to allege that the County’s failure to provide 

medical treatment resulted in harm to Plaintiff. In reviewing the SAC, the Court noted that 

Plaintiff’s conclusory allegations that her condition deteriorated was not enough. Acasio IV, 2015 

WL 5568345, at *8. In the TAC, Plaintiff explains more that because the nurse was unable to 

provide prescription medication, Plaintiff’s depression worsened while she waited to see a doctor. 

This allegation sufficiently connects the alleged inadequate treatment to harm. However, because 

the TAC does not plausibly allege that the treatment was constitutionally inadequate, this does not 

save Plaintiff’s claim.

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indifference against the County is dismissed.

Generally, when a complaint is dismissed, “leave to amend shall be freely given when 

justice so requires.” Carvalho v. Equifax Info. Servs., LLC, 629 F.3d 876, 892 (9th Cir. 2010). 

However, leave to amend may be denied “where the amendment would be futile.” Gardner v. 

Martino, 563 F.3d 981, 990 (9th Cir. 2009). Plaintiff has already amended her deliberate 

indifference to medical treatment claim several times, once with the benefit of adversarial briefing. 

The Court specifically explained how Plaintiff could amend her municipal liability claim and what 

facts were necessary, but she failed to do so in the TAC. Nor did she identify in her declaration or 

opposition—which does not substantively respond to Defendants’ argument and instead largely 

reiterates the allegations of the TAC—any facts she could add that would render the claim 

plausible. (See Dkt. No. 43 at 6-8.) Under these circumstances, the Court concludes that 

permitting Plaintiff another opportunity to amend her municipal liability claim would be futile. 

See Semiconductor Energy Lab. Co. v. Yujurio Nagata, No. C 11-02793 CRB, 2012 WL 177557, 

at *8 n.6 (N.D. Cal. Jan. 23, 2012) (citing Bonin v. Calderon, 59 F.3d 815, 845 (9th Cir. 1995)).

CONCLUSION

For the reasons described above, the Court GRANTS Defendants’ motion to dismiss the 

municipal liability claim with prejudice. The Court therefore dismisses from this action the 

County and Officer Curley, as there are no claims alleged against him, either. Defendants shall 

answer Plaintiff’s TAC, solely as to the excessive force claim against Officer Lucy, within the 

time prescribed by Federal Rule of Civil Procedure 12(a)(4). 

This Order disposes of Docket No. 41.

IT IS SO ORDERED.

Dated: December 15, 2015

________________________

JACQUELINE SCOTT CORLEY

United States Magistrate Judge

Case 3:14-cv-04689-JSC Document 45 Filed 12/15/15 Page 7 of 7