Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_15-cv-03109/USCOURTS-cand-3_15-cv-03109-3/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

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

RAYMOND ALLEN REDWINE,

Plaintiff,

v.

M.E. SPEARMAN, et. al.,

Defendants.

Case No. 15-cv-3109-TEH 

ORDER GRANTING DEFENDANT’S 

MOTION FOR SUMMARY JUDGMENT

Dkt. No. 23

Plaintiff Raymond Redwine, a state prisoner, filed this pro 

se action under 42 U.S.C. § 1983. This case proceeds under the 

amended complaint (Docket No. 6) against Defendant Dr. Branch

with allegations that she denied treatment for Plaintiff’s medial 

epicondylitis, also known as golfer’s elbow. Opposition at 30. 

Plaintiff only seeks injunctive relief, presumably either shock 

wave therapy or surgery. Defendant filed a motion for summary 

judgment. Plaintiff filed an opposition, and Defendant filed a 

reply. The Court has reviewed the motion for summary judgment 

and for the reasons that follow, Defendant’s motion is GRANTED. 

I

Plaintiff, who is 46 years old, was incarcerated at 

Correctional Training Facility (“CTF”) during the relevant time.1

 

First Amended Complaint (“FAC”) at 1; Motion for Summary Judgment 

 1 The following facts, unless otherwise noted, are undisputed.

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(“MSJ”), Branch Decl. ¶ 3. Defendant was a doctor at CTF during 

the relevant time. MSJ, Branch Decl. ¶ 1.

Plaintiff started reporting elbow pain in November 2010. 

MSJ, Ex. B at AG0057. Plaintiff stated to a physician’s 

assistant that exercising had caused his elbow pain. Id. at 

AG0008. Plaintiff was diagnosed with medial epicondylitis and 

provided 800 mg of Motrin, and an x-ray was ordered. Id. The xray was negative. Id. at AG0009.

People with epicondylitis feel pain between the inside 

portion of the elbow through to the palm side of the forearm. 

Branch Decl. ¶ 3. The pain is generally felt when bending the 

wrist toward the palm against resistance or when squeezing an 

object. Id. Epicondylitis is often caused by repetitive stress 

and is an injury seen in athletes or those engaging in repetitive 

physical activities. Id. Plaintiff has reported that his elbow 

hurts more after exercising, including doing pull-ups on a bar. 

MSJ, Ex B at AG0012. Plaintiff states that he has been typing 

thousands of words a day as he authors a book on an unknown 

subject. Id. at AG0031.

Treatments for epicondylitis are often conservative 

measures, such as rest, ice pack application, physical therapy, 

stretching and strengthening exercises, braces and antiinflammatory medications. MSJ, Branch Decl. ¶ 4. Patients with 

medial epicondylitis may be given corticosteroid injections for 

pain relief. Id. Even with appropriate conservative measures, 

pain may linger for months or even years. Id. Some medical

studies have assessed shock wave therapy as an additional 

treatment, but the evidence is inconclusive that there is any 

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long-term benefit, especially when compared to the more 

conventional treatments. Id. Surgery is necessary only if 

conservative treatment methods are consistently unsuccessful in 

regaining functional mobility and if the surgery is likely to 

result in an improved outcome. In most patients, epicondylitis 

resolves with conservative treatment at six months, but recovery 

may take up to two years. Id.

Dr. Branch first examined Plaintiff in January 2011. MSJ, 

Ex B at AG0010. Plaintiff stated that he had right elbow pain 

for the last couple of months. Id. Dr. Branch recommended that 

Plaintiff receive steroid injections. Id. Dr. Branch examined 

Plaintiff a week later and Plaintiff stated that he felt pain 

after doing his usual routine of 50 pull-ups and 300 burpees.2 

Id. at AG0012. Dr. Branch provided some stretching and 

strengthening exercises for Plaintiff to perform, recommended an 

elbow brace, and told Plaintiff to ice his elbow after exercise. 

Id. 

Dr. Branch saw Plaintiff again in March 2011. Id. at 

AG0013. Plaintiff stated that his elbow pain was doing better 

with the exercises and icing and he did not want the steroid 

injection. Id. 

Dr. Branch treated Plaintiff next in November 2011, when 

Plaintiff complained of more elbow pain. Id. at AG0014. 

Plaintiff stated that the prior treatment was not working, so Dr. 

 2 Burpees are a full body exercise consisting of a series of 

repetitive movements: crouch down, kicking the feet out into a 

push-up position, bringing the feet back towards the hands, 

jumping upward and repeating the entire series. MSJ, Branch 

Decl. ¶ 9.

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Branch scheduled him for a steroid injection. Id. Plaintiff 

received the shot in March 2012 and reported two weeks later that 

it had not helped. Id. at AG0016-17. Dr. Branch told Plaintiff 

to keep taking ibuprofen and to use the elbow brace because

medial epicondylitis can take a long time to improve. MSJ, 

Branch Decl. ¶ 10. In May 2012, Plaintiff lost his elbow brace 

and another one was provided. MSJ, Ex B at AG0070.

In June 2012, Plaintiff sought medical help for abdominal

pain that he believed was a hernia. Id. at AG0071. Dr. Branch 

treated Plaintiff, who did not complain of any elbow pain. Id. 

at AG0021. Plaintiff sought treatment again in October and 

December 2012 for side pain, but said nothing about elbow pain. 

Id. at AG0022-23.

In February 2013, Plaintiff sought medical care stating his 

epicondylitis had returned. Id. at AG0024, AG0074. Plaintiff 

requested another steroid injection and stated that the prior 

injection had in fact helped. Id. at AG0024, AG0074. Dr. Branch 

scheduled another injection, which occurred in March 2013. Id. 

at AG0026, AG0074.

On May 8, 2013, Plaintiff had a medical appointment, during 

which he noted that the steroid injection had helped and Dr. 

Branch wrote that the epicondylitis had been resolved. Id. at 

AG0027. Plaintiff’s primary concerns at this appointment were

eye redness and abdominal pain. Id. Dr. Branch treated 

Plaintiff again in late May 2013 for abdominal pain. Id. at 

AG0028.

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In July 2013, Plaintiff requested another steroid injection 

for the elbow pain. Id. at AG0029. Plaintiff stated that the 

steroid injections had helped, but afterward he was unable to do 

push-ups. Id. Dr. Branch prescribed a pain reliever, Sulindac, 

and told Plaintiff to avoid strenuous exercises. Id. The 

Sulindac was increased in September. Id. at AG0030. 

Plaintiff had no more interactions with Dr. Branch for elbow 

pain for several months. MSJ, Branch Decl. ¶ 17. In March 2014, 

Plaintiff requested to be seen by a specialist to consider shock 

wave therapy or surgery.3 MSJ, Ex G at AA003-005. Plaintiff 

admitted that the Sulindac helped but claimed there was still 

pain. Id. at AA005.

Dr. Branch examined Plaintiff in April 2014. According to 

the progress notes made at that time, Plaintiff stated that he 

was unable to do push-ups and pull-ups, but was walking five

miles a day and typing 3000 words a day for a book he was 

writing. MSJ, Ex B at AG0031. However, Plaintiff disputes this, 

stating that he had been walking only five-quarter mile laps a 

day and writing 300 words per day, three or four days a week. 

Opposition (Docket No. 24) at 8. Dr. Branch noted that while 

Plaintiff was in pain, he continued to be functional given his 

walking, writing, and ability to perform the activities of daily 

living. MSJ, Branch Decl. ¶ 18. Dr. Branch cautioned against 

more aggressive and potentially hazardous treatments like surgery 

or narcotics. Id. Dr. Branch concluded that a specialist was 

not needed; counseled Plaintiff to avoid strenuous activities; 

 3 Plaintiff states he read about shock wave therapy in a medical 

encyclopedia, but he has not included a copy of the material.

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and renewed the Sulindac prescription for three more months. 

MSJ, Ex B at AG0031. Dr. Branch also referred Plaintiff for a 

psychological evaluation because he said the pain made him wish 

to commit suicide. Id.

On April 18, 2014, Plaintiff met with another health care 

provider to discuss the suicide statement. Id. at AG0032. 

Defendant contends that Plaintiff denied any pain or discomfort

at this appointment. The health care provider recorded 

Plaintiff’s pain level at that time as a zero out of ten, and 

that he denied any suicidal thoughts. Id. Plaintiff denies 

stating that he was not in pain; rather, Plaintiff claims he 

stated that it was a medical issue, not a mental health issue. 

Opposition at 12. Plaintiff states that he does not intend to 

kill himself immediately but that he will kill himself if he 

fails to convince the prison medical staff to properly treat his 

injury. Id. at 12-13. Plaintiff was seen several more times by 

mental health personnel regarding his suicide statement. MSJ, Ex 

B at AG0321-0324. 

Dr. Branch renewed Plaintiff’s Sulindac prescription in 

September 2014. Id. at AG0143. Plaintiff filed a request to see 

a doctor in October 2014 and wrote that he rarely sleeps and 

could not use his arm. Id. at AG0086. A nurse treated Plaintiff 

and noted that he was not in distress, was able to move his elbow 

without any limitation, and there was no redness or swelling. 

Id.; MSJ, Branch Decl. ¶ 20. Dr. Branch also examined Plaintiff 

and found he had no atrophy in his right arm and was able to 

remove his shirt and undershirt without any problems. Branch 

Decl. ¶ 20. These are signs that Plaintiff was able to use his 

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arm despite his comments. Id. ¶ 18. Plaintiff demanded shock 

wave therapy, but Dr. Branch did not think that was needed, and 

instead referred Plaintiff to a physical therapist. MSJ, Ex B at 

AG0033. Plaintiff also stated that he stopped walking and 

writing his book due to the elbow pain. Opposition, Ex. M 

(Docket No. 25-2).

Beginning in November 2014, Plaintiff was seen by the 

physical therapist and given a program of exercises. MSJ, Ex D 

at AG0001-0005. After beginning physical therapy, Plaintiff 

reported that his forearm had a better range of motion. Docket 

No. 26 at 4. After formal physical therapy concluded, Plaintiff 

was told to keep performing certain exercises on his own. MSJ, 

Ex D at AG0005.

Dr. Branch also referred Plaintiff for mental health 

services to develop coping skills related to his chronic pain. 

MSJ, Ex B at AG0033. Dr. Branch thought that Plaintiff may have 

chronic pain syndrome. Id. Plaintiff was seen by a licensed 

clinical social worker on November 7, 2014. MSJ, Ex E at AG0315. 

Plaintiff stated he was not interested in mental health services 

and was not open to exploring coping skills. Id.

In early 2015, Plaintiff sought medical help for carpal 

tunnel syndrome. MSJ, Ex B at AG0088-0090. Dr. Branch saw 

Plaintiff on February 3, 2015, and believed that Plaintiff may 

have been over-stretching or over-exercising and had irritated a 

nerve in his forearm. Id. at AG0037. Dr. Branch instructed 

Plaintiff to avoid stretching or exercising for two to four weeks 

and to follow up with medical. Id.

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On May 18, 2015, Plaintiff filed a health care request 

stating there had been no improvement in his elbow pain or carpal 

tunnel syndrome. Id. at AG0098. Plaintiff filed no other 

medical requests regarding his elbow in 2015.

In February 2016, Plaintiff requested medical attention for 

several ailments including his elbow problem and carpal tunnel 

syndrome. MSJ, Ex F at AG0291. Dr. Branch prescribed wrist 

braces and ordered additional x-rays to evaluate the elbow pain. 

Id. at AG0290. She also told Plaintiff to avoid strenuous 

activities. Id.

The wrist braces broke shortly after Plaintiff received 

them. MSJ, Branch Decl. ¶ 27. Dr. Branch states that this 

indicates Plaintiff is engaging in strong wrist movements, a 

cause of medial epicondylitis, which the braces are designed to 

stop. Id. Plaintiff disputes that he broke the braces, claiming 

they broke on their own due to being defective and poorly made. 

Opposition at 25. Plaintiff eventually stopped using and 

returned the braces. Id. at 26-27. 

Dr. Branch also believes that Plaintiff’s continued typing, 

including all the typed documents involved with this litigation,

could be exacerbating the medial epicondylitis and carpal tunnel 

syndrome. MSJ, Branch Decl. ¶ 25. 

Dr. Branch believes that surgery is not the best option for 

a patient with symptoms of pain but no objectively verifiable 

disease. Id. ¶ 28. Dr. Branch has concerns that surgery would 

not help the pain and could make the pain worse. Id.

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II

A

Summary judgment is properly granted when no genuine 

disputes of material fact remain and when, viewing the evidence 

most favorably to the nonmoving party, the movant is clearly 

entitled to prevail as a matter of law. Fed. R. Civ. P. 56(c); 

Celotex v. Catrett, 477 U.S. 317, 322-23 (1986); Eisenberg v. 

Ins. Co. of N. Am., 815 F.2d 1285, 1288-89 (9th Cir. 1987). The 

moving party bears the burden of showing there is no material 

factual dispute. Celotex, 477 U.S. at 331. Therefore, the Court 

must regard as true the opposing party's evidence, if supported 

by affidavits or other evidentiary material. Id. at 324; 

Eisenberg, 815 F.2d at 1289. The Court must draw all reasonable 

inferences in favor of the party against whom summary judgment is 

sought. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 

U.S. 574, 587 (1986); Intel Corp. v. Hartford Accident & Indem. 

Co., 952 F.2d 1551, 1559 (9th Cir. 1991). 

The moving party bears the initial burden of identifying 

those portions of the pleadings, discovery and affidavits which 

demonstrate the absence of a genuine issue of material fact. 

Celotex, 477 U.S. at 323. If the moving party meets its burden 

of production, the burden then shifts to the opposing party to 

produce “specific evidence, through affidavits or admissible 

discovery material, to show that the dispute exists.” Bhan v. 

NME Hosps., Inc., 929 F.2d 1404, 1409 (9th Cir.), cert. denied, 

502 U.S. 994 (1991); Nissan Fire & Marine Ins. Co. v. Fritz Cos., 

210 F.3d 1099, 1105 (9th Cir. 2000). 

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Material facts that would preclude entry of summary judgment 

are those which, under applicable substantive law, may affect the 

outcome of the case. The substantive law will identify which 

facts are material. Anderson v. Liberty Lobby, Inc., 477 U.S. 

242, 248 (1986). Questions of fact regarding immaterial issues 

cannot defeat a motion for summary judgment. Reynolds v. County 

of San Diego, 84 F.3d 1162, 1168-70 (9th Cir. 1996), rev'd on 

other grounds by Acri v. Varian Associates, Inc., 114 F.3d 999 

(9th Cir. 1997). A dispute as to a material fact is genuine if 

there is sufficient evidence for a reasonable jury to return a 

verdict for the nonmoving party. Anderson, 477 U.S. at 248.

B

Deliberate indifference to serious medical needs violates 

the Eighth Amendment’s proscription against cruel and unusual 

punishment. Estelle v. Gamble, 429 U.S. 97, 104 (1976); McGuckin 

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

grounds, WMX Technologies, Inc. v. Miller, 104 F.3d 1133, 1136 

(9th Cir. 1997) (en banc). 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. Id. at 1059. 

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.” Id. The 

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 

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pain are examples of indications that a prisoner has a “serious” 

need for medical treatment. Id. at 1059-60. 

A defendant is deliberately indifferent if he or she knows 

that a prisoner faces a substantial risk of serious harm and 

disregards that risk by failing to take reasonable steps to abate 

it. Farmer v. Brennan, 511 U.S. 825, 837 (1994). Deliberate 

indifference describes a state of mind more blameworthy than 

negligence and requires “more than ordinary lack of due care for 

the prisoner’s interests or safety.” Id. at 835. Thus, if a 

defendant should have been aware of the substantial risk of 

serious harm, but was not, then the defendant has not violated 

the Eighth Amendment, no matter how severe the risk. Gibson v. 

County of Washoe, 290 F.3d 1175, 1188 (9th Cir. 2002). 

Consequently, in order for deliberate indifference to be 

established, there must exist both a purposeful act or failure to 

act on the part of the defendant and harm resulting therefrom. 

McGuckin, 974 F.2d at 1060. 

A difference of opinion between a prisoner-patient and 

prison medical authorities regarding treatment does not give rise 

to a § 1983 claim. Franklin v. Oregon, 662 F.2d 1337, 1344 (9th 

Cir. 1981). Similarly, a showing of nothing more than a 

difference of medical opinion as to the need to pursue one course 

of treatment over another is insufficient, as a matter of law, to 

establish deliberate indifference. Toguchi v. Chung, 391 F.3d 

1051, 1058-60 (9th Cir. 2004). 

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III

For purposes of this motion, the Court finds that Plaintiff 

has demonstrated a serious medical need based on his medial 

epicondylitis. The primary issue that remains is whether

Defendant was deliberately indifferent in her treatment of 

Plaintiff.

It is undisputed that Plaintiff is suffering from pain that

has adversely affected his life. However, even though he is 

suffering from pain, he is still able to exercise, type, remove 

his clothing, and perform other basic necessities. He has a good 

range of motion and no signs of atrophy. It is also undisputed 

that Defendant has provided a great deal of treatment over six 

years, specifically, several different courses of treatment, 

including x-rays, medication, steroid shots, strengthening 

exercises, braces, and referrals for physical therapy and mental 

health treatment. It is undisputed that many of the courses of 

treatment provided relief to Plaintiff. Plaintiff concedes that 

the treatment was effective until 2013 or 2014. Opposition at 7.

Plaintiff only seeks injunctive relief in this case. While 

he does not set forth exactly what he seeks, it appears that he 

seeks to either have shock wave therapy or surgery. However, 

Plaintiff does not have an objectively verifiable disease, and 

the x-rays were negative. Defendant, in her medical opinion, 

does not believe that surgery is the best option for a patient 

with pain but no objectively verifiable disease. Defendant also 

has concerns that surgery would not alleviate Plaintiff’s pain 

and could make the pain worse. While Plaintiff believes that 

shock wave therapy could help, he provides no evidence to support 

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this assertion. He read about it in a medical book but has not 

included portions of that medical text in this case. It is 

undisputed that the medical evidence is inconclusive about 

whether there is any long-term benefit from shock wave therapy.

While Plaintiff is experiencing pain, he has improved the 

range of motion of his elbow and can still engage in daily 

activities. There are no signs of atrophy. Plaintiff also

engages in activities that exacerbate his injury.

Even viewing the evidence in a light most favorable to 

Plaintiff, Defendant is still entitled to summary judgment. 

While Plaintiff has presented well-thought-out arguments, he 

ultimately presents a difference of opinion between him and 

Defendant. This is insufficient to establish deliberate 

indifference. Toguchi, 391 F.3d at 1058-60. Defendant and other 

medical staff have provided many different types of treatment to 

address Plaintiff’s medial epicondylitis, carpal tunnel syndrome 

and the underlying pain both cause him. Defendant notes that it 

is possible that Plaintiff is suffering from chronic pain 

syndrome. Yet, plaintiff has repeatedly rebuffed Defendant’s 

efforts to treat him in other ways. For example, Plaintiff has 

refused mental health treatment to address the mental component 

of the pain. In addition, Plaintiff does not allege that pain 

medication has been denied or that he has requested and been 

denied different or stronger pain medication. In fact he has 

stated that while still in pain, the Sulindac medication

prescribed by Defendant has helped. 

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Plaintiff has failed to show that Defendant demonstrated a 

deliberately indifferent state of mind in denying him shock wave 

treatment and surgery to support an Eighth Amendment claim. 

Defendant has provided Plaintiff with a great deal of treatment,

and there are legitimate medical reasons for denying the shock 

wave therapy and surgery. Moreover, the care provided by 

Defendant has improved Plaintiff’s health in many respects.

IV

For the foregoing reasons, the Court hereby orders as 

follows:

1. Defendant’s motion for summary judgment (Docket No. 23) 

is GRANTED. 

2. The Clerk shall close the file. This order terminates 

Docket No. 23.

IT IS SO ORDERED.

Dated: 12/15/2016

________________________

THELTON E. HENDERSON

United States District Judge

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