Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-4_17-cv-06977/USCOURTS-cand-4_17-cv-06977-12/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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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

DARREN HENDERSON,

Plaintiff,

v.

J. LEWIS, et al.,

Defendants.

Case No.17-cv-06977-HSG 

ORDER GRANTING DEFENDANTS' 

MOTION FOR SUMMARY 

JUDGMENT; DENYING PLAINTIFF'S 

MOTION FOR SUMMARY 

JUDGMENT

Re: Dkt. Nos. 45, 49, 60

INTRODUCTION

Plaintiff, an inmate at California State Prison, Sacramento (“CSP-SAC”) filed this pro se

civil rights action under 42 U.S.C. § 1983 alleging that prison officials at Salinas Valley State 

Prison (“SVSP”) where he was previously incarcerated were deliberately indifferent to his serious 

medical needs when they failed to provide him with diabetic snacks. Now before the Court are 

plaintiff’s and defendants’ cross-motions for summary judgment. For the reasons set forth below, 

defendants’ motion for summary judgment is GRANTED and plaintiff’s motion for summary 

judgment is DENIED. 

BACKGROUND

The following factual allegations are undisputed unless stated otherwise. Plaintiff is 

diabetic and takes insulin for his diabetes. He was incarcerated at SVSP from May 27, 2016 to 

January 12, 2017. While at SVSP his blood sugar levels were checked twice per day, and he was 

prescribed glucose pills to take if he felt symptoms of hypoglycemia (low blood sugar). Plaintiff 

requested that he be given a daily diabetic snack (two packages of cheese and crackers or peanut 

butter and crackers plus one fresh fruit) in order to eat the snack if he felt signs of hypoglycemia. 

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This request was denied as not medically indicated. 

Plaintiff was seen by medical provider Dr. Tuvera three times while he was at SVSP: on 

June 1, 2016; July 1, 2016; and September 30, 2016. (Defendants’ Mot. For Summary Judgment 

(“MSJ”), Tuvera Decl., ¶ 2.) At each appointment, Dr. Tuvera noted that plaintiff had, among 

other conditions, type 2 diabetes and obesity. (Id. at ¶ 3; Ex. A.) At the first appointment, Dr. 

Tuvera discussed with plaintiff the importance of taking glucose gel (also referred to as glucose 

tablets) if he experienced symptoms of hypoglycemia. (Id. at ¶ 6; Ex. A.) At the second and third 

appointments Dr. Tuvera noted that plaintiff had no hypoglycemia. (Id. at Exs. B and C.) 

On June 1, 2016, plaintiff submitted health care appeal SVSP-HC-16055478. (MSJ, 

Gamboa Decl., Ex. A.) In this appeal plaintiff requested that he be given a diabetic snack, arguing 

that it was mandatory under Plata1and that SVSP was withholding the snack from insulindependent diabetics as a form of punishment. (Id.) He requested that SVSP acknowledge his 

previous prescribed treatment of a daily snack which began in 2005, and declare that the policy of 

not issuing diabetic snacks violated Plata. (Id.) 

The first level response, issued by Dr. Fu and defendant Gamboa, partially granted 

plaintiff’s request, referring him to the dietician for an assessment regarding diabetic snacks and to 

his primary care provider for a diabetes assessment. (Defendants’ MSJ, Gamboa Decl., Ex. B.) 

Plaintiff appealed to the second level of administrative review, stating he was dissatisfied and still 

not receiving a diabetic snack, and that SVSP was in breach of Plata. (Id. at Ex. A.)

The second level response issued by defendant Kumar states that plaintiff’s second level 

appeal indicated that he was still waiting to be seen for his diabetic assessment. (Defendants’ 

MSJ, Kumar Decl., Ex. D.) Because records showed that he was seen for the assessment on July 

1, 2016, Kumar ultimately granted the second level appeal. (Id.) 

Plaintiff appealed to the third level of review stating that despite the second level decision 

granting his appeal, he was still not receiving a diabetic snack, and stating that under Plata CDCR 

 

1 The Court assumes that plaintiff is referring to the Stipulation for Injunctive Relief entered in 

2002 in Plata v. Davis, Case No. 3:01-cv-01351-TEH. Plaintiff makes allegations throughout his 

motion that SVSP’s policies violate Plata, but these vague allegations do not create a genuine 

issue of material fact that would preclude summary judgment for defendants. 

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doctors and dieticians have no discretion in determining a course of action concerning 

nourishment for inmates treated with insulin. (Defendants’ MSJ, Gamboa Decl., Ex. A.) The 

appeal was denied at the third level of review. (Defendants’ MSJ, Lewis Decl., Ex. 1.) The third 

level decision was signed by S. Gates for Lewis and stated that plaintiff had been seen by both his 

primary care provider and a dietician and that neither recommended a diabetic snack. (Id.) 

Plaintiff’s second health care appeal, SVSP-HC-16056045, submitted on August 10, 2016 

stated that a nurse named “Rodriqez” was denying him diabetic snacks and saying that it did not 

matter that his appeal was granted. (Defendants’ MSJ, Gamboa Decl., Ex. C.) Plaintiff requested 

that SVSP recognize Volume 4 Medical Services, Chapter 20A and 20B, which he asserted 

required that all inmates treated with insulin receive diabetic snacks. (Id.) 

At the first level of review Dr. Fu and Gamboa partially granted the appeal as to 

recognizing Chapter 20 of Volume 4 Medical Services, but denied plaintiff’s request for a diabetic 

snack. (Id. at Ex. D). The decision notes that plaintiff was assessed by a primary care physician 

and dietician, neither of whom recommended a snack; that plaintiff had not received a snack for 

several months; and that the dietician was not able to successfully discuss the matter with him and 

had to terminate the appointment. (Id.) 

Plaintiff appealed to the second level of review, stating that his interview with dietician 

Watson had ended without incident, and that SVSP’s refusal to give diabetic inmates a snack was 

deliberate indifference to a serious medical need. (Id. at Ex. B.) Plaintiff asserted that SVSP was 

in violation of Plata and had implemented a discretionary policy in place of Plata’s mandatory 

policy. 

At the second level of review, Kumar and another reviewer, B. Brizendine, denied the 

request for a diabetic snack and granted the request to recognize Volume 4, Chapters 20A and

20B. (Defendants’ MSJ, Kumar Decl., Ex. F.) Plaintiff appealed the second level decision, 

arguing that his blood sugar was not well controlled, that prior prisons had always honored his 

standing order for a diabetic snack, and that SVSP’s policy to deny diabetic snacks was not an 

individual diagnosis but rather a policy that was applied to all diabetic inmates as a form of 

punishment. (Defendants’ MSJ, Gamboa Decl., Ex. B.) 

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At the third level of review this appeal was denied, again by S. Gates for Lewis. 

(Defendants’ MSJ, Lewis Decl., Ex. 2.) The decision states that that the policies in Volume 4 

Chapter 20.2 are that a diabetic snack may be issued to patients with juvenile onset type 1 diabetes 

mellitus or brittle diabetes with indication, but that diabetic snacks are not indicated as mandatory. 

(Id.) Further, the decision states that the request for a snack is duplicative of plaintiff’s request in 

his other administrative appeal which was already decided at the third level, and therefore would 

not be addressed again in the appeal response. (Id.) 

DISCUSSION

A. Standard of Review

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

“no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of 

law.” See Fed. R. Civ. P. 56(a). Material facts are those that may affect the outcome of the case. 

See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute as to a material fact is 

genuine if the evidence is such that a reasonable jury could return a verdict for the nonmoving 

party. See id.

A court shall grant summary judgment “against a party who fails to make a showing 

sufficient to establish the existence of an element essential to that party’s case, and on which that 

party will bear the burden of proof at trial[,] . . . since a complete failure of proof concerning an 

essential element of the nonmoving party’s case necessarily renders all other facts immaterial.” 

See Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). The moving party bears the initial 

burden of identifying those portions of the record that demonstrate the absence of a genuine issue 

of material fact. Id. The burden then shifts to the nonmoving party to “go beyond the pleadings 

and by [his] own affidavits, or by the ‘depositions, answers to interrogatories, and admissions on 

file,’ designate ‘specific facts showing that there is a genuine issue for trial.’” See id. at 324 

(citing Fed. R. Civ. P. 56(e) (amended 2010)). The nonmoving party must show more than “the 

mere existence of a scintilla of evidence.” In re Oracle Corp. Sec. Litig., 627 F.3d 376, 387 (9th 

Cir. 2010) (citing Liberty Lobby, 477 U.S. at 252). “In fact, the non-moving party must come 

forth with evidence from which a jury could reasonably render a verdict in the non-moving party’s 

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favor.” Id. (citing Liberty Lobby, 477 U.S. at 252). If the nonmoving party fails to make this 

showing, “the moving party is entitled to judgment as a matter of law.” Celotex Corp., 477 U.S. at 

323.

For purposes of summary judgment, the court must view the evidence in the light most 

favorable to the nonmoving party; if the evidence produced by the moving party conflicts with 

evidence produced by the nonmoving party, the court must assume the truth of the evidence 

submitted by the nonmoving party. See Leslie v. Grupo ICA, 198 F.3d 1152, 1158 (9th Cir. 1999). 

The court’s function on a summary judgment motion is not to make credibility determinations or 

weigh conflicting evidence with respect to a disputed material fact. See T.W. Elec. Serv., Inc. v. 

Pac. Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 1987). When, however, “opposing 

parties tell two different stories, one of which is blatantly contradicted by the record, so that no 

reasonable jury could believe it, a court should not adopt that version of the facts for purposes of 

ruling on a motion for summary judgment.” Scott v. Harris, 550 U.S. 372, 380 (2007). When the 

parties file cross-motions for summary judgment, the court must consider all of the evidence 

submitted in support of both motions to evaluate whether a genuine issue of material fact exists 

precluding summary judgment for either party. The Fair Housing Council of Riverside County, 

Inc. v. Riverside Two, 249 F.3d 1132, 1135 (9th Cir. 2001). 

B. Exhaustion

Defendants Kumar, Lewis, and Gamboa assert that plaintiff failed to exhaust his claims 

against them because he did not name them or bring any claim of wrongdoing against them in his 

administrative appeals. Defendants have not, however, met their burden to show that plaintiff 

failed to exhaust his claims. 

1. Standard

The Prison Litigation Reform Act (“PLRA”) provides that “[n]o action shall be brought 

with respect to prison conditions under [42 U.S.C. § 1983], or any other Federal law, by a prisoner 

confined in any jail, prison, or other correctional facility until such administrative remedies as are 

available are exhausted.” 42 U.S.C. § 1997e(a). Compliance with the exhaustion requirement is 

mandatory. Porter v. Nussle, 534 U.S. 516, 524 (2002); Booth v. Churner, 532 U.S. 731, 739-40 

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& n.5 (2001). All available remedies must be exhausted; those remedies “need not meet federal 

standards, nor must they be ‘plain, speedy, and effective.’” Porter, 534 U.S. at 524. 

Exhaustion of available remedies is a prerequisite to suit even if the prisoner seeks relief 

not available in grievance proceedings, such as money damages. Booth, 532 U.S. at 741. Section 

1997e(a) requires “proper exhaustion” of available administrative remedies. Woodford v. Ngo, 

548 U.S. 81, 93 (2006). Proper exhaustion requires using all steps of an administrative process 

and complying with “deadlines and other critical procedural rules.” Id. at 90. “[I]t is the prison’s 

requirements, and not the PLRA, that define the boundaries of proper exhaustion.” Jones v. Bock, 

549 U.S. 199, 218 (2007). 

The failure to exhaust administrative remedies is an affirmative defense that must now be 

raised in a motion for summary judgment. See Albino v. Baca, 747 F.3d 1162, 1166 (9th Cir.

2014) (en banc). In bringing such a motion, the defendant has the initial burden to prove “that 

there was an available administrative remedy, and that the prisoner did not exhaust that available 

remedy.” Id. at 1172. If the defendant carries that burden, “the burden shifts to the prisoner to 

come forward with evidence showing that there is something in his particular case that made the 

existing and generally available administrative remedies effectively unavailable to him.” Id. The 

ultimate burden of proof remains with the defendant, however. Id. “If material facts are disputed, 

summary judgment should be denied, and the district judge rather than a jury should determine the 

facts.” Id. at 1166.

The California Department of Corrections and Rehabilitation (“CDCR”) provides its 

inmates and parolees the right to appeal administratively “any policy, decision, action, condition, 

or omission by the department or its staff that the inmate or parolee can demonstrate as having a 

material adverse effect upon his or her health, safety, or welfare.” 15 Cal. Code Regs. § 3084.1(a). 

Generally, an inmate must submit the appeal within thirty days of the “occurrence of the event or 

decision being appealed, or . . . [u]pon first having knowledge of the action or decision being 

appealed, or . . . [u]pon receiving an unsatisfactory departmental response to an appeal filed.” Id.

§ 3084.8(b). In order to exhaust available administrative remedies within this system, a prisoner 

must proceed through three formal levels of appeal and receive a decision from the Secretary of 

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the CDCR or his designee. Id. § 3084.1(b), § 3084.7(d)(3). “The third level review constitutes the 

decision of the Secretary of the California Department of Corrections and Rehabilitation on an 

appeal, and shall be conducted by a designated representative under the supervision of the third 

level Appeals Chief or equivalent. The third level of review exhausts administrative remedies; 

however, this does not preclude amending a finding previously made at the third level.” Id.

§ 3084.7(d)(3). 

California prison regulations require the grievance to “describe the specific issue under 

appeal and the relief requested,” “all staff member(s) involved and [] describe their involvement in 

the issue,” and “state all facts known and available to [the inmate] regarding the issue being 

appealed” at the time the grievance is submitted. 15 Cal. Code Regs. § 3084.2(a).

If an inmate’s grievance does not comply with a procedural rule but prison officials decide 

it on the merits anyway at all available levels of administrative review, it is exhausted. Reyes v. 

Smith, 810 F.3d 654, 656, 658 (9th Cir. 2016) (agreeing with all circuits to consider the issue). 

Thus, the California inmate in Reyes whose grievance failed to name all staff members involved in 

his case, as required by 15 Cal. Code Regs. § 3084.2(a), nevertheless exhausted his claim of 

deliberate indifference to his serious medical needs because that claim was decided on its merits at 

all levels of review. See id. at 656-57. 

2. Analysis

Defendants argue that to exhaust his claims against Kumar, Lewis, and Gamboa, plaintiff 

was required to bring a separate appeal challenging Kumar, Lewis, and Gamboa’s denial of his 

appeals seeking diabetic snacks, citing to Frost v. Hallock, 2019 WL 1102379, at *7 (N.D. Cal. 

March 3, 2019). Frost is inapplicable here. In Frost, the plaintiff-inmate argued that the prison 

officials reviewing his appeal violated his due process rights when they denied his appeal 

challenging the discipline he received for participating in a hunger strike. The legal claim, a due 

process violation in handling the appeal, was distinct from the subject of the appeal, challenging 

the discipline. Here, plaintiff’s claim is that Kumar, Lewis, and Gamboa were deliberately 

indifferent to his serious medical needs when they denied him diabetic snacks by denying his 

appeals requesting these snacks. 

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Both of plaintiff’s administrative appeals provided Kumar, Lewis, and Gamboa notice of 

plaintiff’s claim that he was being denied diabetic snacks that he required to treat a serious 

medical need. Both these appeals were exhausted. His first appeal, SVSP-HC-16055478, was 

decided on the merits at the highest level of review. His second appeal, SVSP-HC-16056045, was 

partially decided on the merits and partially found to be duplicative of the first appeal. Bringing a 

separate grievance against the reviewers for denying his administrative appeals seeking the snacks 

would be duplicative. Accordingly, defendants have not met their burden of showing that plaintiff 

failed to exhaust his claims against Lewis, Kumar and Gamboa. 

C. Deliberate Indifference to Serious Medical Needs

Plaintiff claims that reviewers Lewis, Kumar and Gamboa, Watson (the dietician that 

evaluated him) and J. Rodriguez (a nurse who provided him care), all violated his Eighth 

Amendment rights by not providing him a diabetic snack. Plaintiff asserts that he experienced 

over 40 episodes of hypoglycemia while at SVSP and needed the snack to control his blood sugar. 

He asserts that he had a prior prescription for a diabetic snack, was given a diabetic snack at the 

prisons where he was incarcerated before and after his time at SVSP, and that a diabetic snack is 

mandatory under the prison medical guidelines. Plaintiff also asserts that while he did have a 

prescription for glucose pills at SVSP, once he finished it the nurses from whom he requested a 

refill refused to give it to him.

The defendants argue that they are entitled to summary judgment in their favor because 

plaintiff did not have a serious medical need for snacks. However, plaintiff’s serious medical need 

was his diabetes. The question is whether the defendants’ refusal to provide him diabetic snacks 

constituted deliberate indifference to this serious medical need in violation of the Eighth 

Amendment.

Defendants Watson, Kumar, and Gamboa assert that a diabetic snack was not medically 

indicated for plaintiff due to his weight, that the prescribed glucose pills were the proper 

prescription for plaintiff to use in controlling his blood sugar levels and they were unaware of 

anyone refusing to refill the prescription, and that plaintiff’s diabetes treatment was in accordance 

with prison health care guidelines. And Lewis asserts that she was not personally involved in 

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denying plaintiff’s appeals, while Rodriguez argues that he is not the correct defendant because he 

is a male nurse and plaintiff asserts that the “Nurse Rodriguez” who provided him medical care 

was female.

1. Standard

Deliberate indifference to a serious medical need violates the Eighth Amendment’s

proscription against cruel and unusual punishment. See 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 Techs, 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. See McGuckin, 

974 F.2d 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.” McGuckin, 974 F.2d 

at 1059 (citing Estelle, 429 U.S. at 104). 

A prison official is deliberately indifferent if he knows that a prisoner faces a substantial 

risk of serious harm and disregards that risk by failing to take reasonable steps to abate it. Farmer 

v. Brennan, 511 U.S. 825, 837 (1994). The prison official must not only “be aware of facts from 

which the inference could be drawn that a substantial risk of serious harm exists,” but he “must 

also draw the inference.” Id. If a prison official should have been aware of the risk but was not, 

then the official 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), overruled on other grounds, Castro v. 

County of Los Angeles, 833 F.3d 1060, 1076 (9th Cir. 2016). Mere negligence, or even gross 

negligence, is not enough. Farmer, 511 U.S. at 835–36 & n.4.

A claim of medical malpractice or negligence is insufficient to make out a violation of the 

Eighth Amendment. McGuckin, 974 F.2d at 1059. Nor does “a difference of opinion between a 

prisoner patient and prison medical authorities regarding treatment” amount to deliberate 

indifference. Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981). In order to prevail on a 

claim involving choices between alternative courses of treatment, a plaintiff must show that the 

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course of treatment the defendant chose was medically unacceptable under the circumstances and 

that he or she chose this course in conscious disregard of an excessive risk to plaintiff’s health. 

Toguchi v. Chung, 391 F.3d 1051, 1058 (9th Cir. 2004); Jackson v. McIntosh, 90 F.3d 330, 332 

(9th Cir. 1996) (citing Farmer, 511 U.S. at 837).

2. Watson

The undisputed record shows that Watson took reasonable steps to address plaintiff’s 

serious medical need. Watson, a registered dietician, met with plaintiff to evaluate his request for 

a diabetic snack on July 13, 2016. (Defendants’ MSJ, Watson Decl., ¶ 10.) After reviewing 

plaintiff’s medical records and meeting with plaintiff, Watson advised against a diabetic snack. 

(Id. at ¶ 13.) Watson concluded that given plaintiff’s weight, his type 2 diabetes, and his generally 

good control of his blood sugar levels, a snack would not be beneficial for his health and the 

already-prescribed glucose tablets were a better option for hypoglycemia relief. (Id. at ¶¶ 11-13.) 

Plaintiff did not inform Watson that he had taken all his glucose pills and was denied a refill, so

Watson was unaware of this allegation. (Defendants’ Reply, Watson Decl. ¶ 3.) Indeed, the 

record does not show that plaintiff informed anyone that he was being denied a prescription refill, 

and his medical records show that the prescription was filled on June 2, 2016, and again on June 

15, 2016. (Defendants’ MSJ, Ruhparwar Decl., Ex. G.)

In recommending against a snack, Watson also took into account the policies and 

procedures set forth in California Correctional Health Care Services’ (“CCHCS”) Inmate Medical 

Services Program Policy and Procedures (“IMPP”), Volume 4, Chapter 20, Sections 4.20.1., 

4.20.2, SVSP Local Operational Procedure, CCHCS Care Guide: Diabetes, and the 

recommendations from the Academy of Nutrition and Dietetics, the American Diabetes 

Association, and peer reviewed articles. (Defendants’ MSJ, Watson Decl., ¶ ¶ 4-8.) 

Plaintiff asserts that he is entitled to summary judgment because diabetic snacks were 

mandatory for him, both under general prison guidelines and in his individual case. The record 

contradicts Plaintiff’s assertions. The version of the IMPP Volume 4, Chapter 20 in effect at the 

time that plaintiff was at SVSP did not require snacks for all insulin-dependent diabetics. It 

provides that “[d]iet instruction, outpatient therapeutic diets, nourishments, and supplements shall 

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be provided as medically indicated,” and that patients must have “juvenile onset type 1 diabetes 

mellitus or brittle diabetes” to qualify for nourishments or supplements, except in special 

situations.2 (Defendants’ MSJ, Ruhparwar Decl., Ex. C). The version of the policies that plaintiff 

submitted and referred to in his filings is not the version effective during the relevant time period. 

The CCHCS Care Guide: Diabetes states that “patients who are prone to hypoglycemia should 

have access to glucose tablets, glucose gel, or a diabetic snack.” (Id. at Ex. D.) There is no triable 

issue of fact showing that defendants, including Watson, did not follow the guidelines that were 

current at the time plaintiff was at SVSP. And, as discussed supra, Watson concluded that

plaintiff’s specific health factors indicated glucose tablets were a better option for hypoglycemia 

relief. A difference of opinion regarding medical treatment does not constitute deliberate 

indifference. See Toguchi, 391 F.3d at 1058. 

Accordingly, the evidence in the undisputed record reflects no genuine dispute of material 

fact that would preclude a grant of summary judgment in favor of Watson. 

2. Gamboa

Plaintiff asserts that as a first level reviewer of his health care appeals, Gamboa was 

deliberately indifferent because he denied plaintiff’s request for a diabetic snack. The undisputed 

record shows that Gamboa took reasonable steps to address plaintiff’s serious medical need and 

his decision did not disregard a risk of harm to plaintiff. Gamboa based his denial on the prison 

medical guidelines, Dr. Fu’s findings and recommendations, Dr. Fu’s interview with plaintiff, and 

plaintiff’s medical records. (Defendants’ MSJ, Gamboa Decl., ¶ ¶ 8-9, 11-13, Fu Decl., ¶ ¶ 4-11.) 

 

2The Court notes that in his deposition plaintiff stated that he has type 1 diabetes. (Plaintiff’s Opp. 

to Defendants’ MSJ, Ex. C, ECF No. 52 at 60.) However, all the documents in the record, 

including the declarations of his examining doctors at SVSP, reflect that plaintiff had a diagnosis 

of type 2 diabetes, and there is no allegation that plaintiff informed defendants that this diagnosis 

was incorrect. Defendants made their decisions based on plaintiff’s medical records, 

recommendations from his doctors, and the prison guidelines and policies. The guidelines at issue 

state that special nourishment such as diabetic snacks shall be provided as medically indicated, so 

even if plaintiff had a diagnosis of type 1 diabetes, a snack had to be medically indicated to be 

prescribed. In any event, plaintiff does not argue that he should have been given a snack because 

he has type 1 diabetes: he argues that he should have been given a snack because he is insulin 

dependent. Thus, the Court finds that plaintiff’s statement in his deposition does not create a 

genuine issue of material fact.

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In reviewing Plaintiff’s appeal, Gamboa took reasonable steps to address plaintiff’s 

medical needs by seeking more information. Gamboa ordered an evaluation by plaintiff’s primary 

care doctor and a dietician to assess whether a diabetic snack was recommended for plaintiff. 

Although plaintiff asserts that he has always been given a diabetic snack while incarcerated, 

except for his time at SVSP, he does not dispute that in 2013, while incarcerated at a different 

prison, he was removed from the diabetic snack list. The record also reflects that both in 2005 and 

2013 plaintiff filed administrative appeals seeking diabetic snacks from the prisons where he was 

incarcerated, and these appeals were denied with findings that a snack was not medically 

indicated. (Defendants’ MSJ, Rhupawar Decl., ¶¶ 9-10.) Plaintiff’s medical records from January 

1, 2010 through August 3, 2018, did not indicate that he had a prescription for a diabetic snack 

when he arrived at SVSP or at any time while at SVSP. (Id. at ¶ 7.) Plaintiff has submitted what 

appears to be a 2005 prescription for a diabetic snack from another institution. (Plaintiff’s Opp. to 

Defendants’ MSJ, Ex. E, ECF No. 52 at 88.) Although defendants object to this exhibit as 

unauthenticated, this dispute is not material because even if plaintiff did have a prescription for a 

snack in 2005, Gamboa’s decision to order an evaluation from a primary care provider and 

dietician in response to the request for a snack does not show deliberate indifference, even if 

plaintiff once had a snack prescription or did at times receive snacks at other prisons. See

Toguchi, 391 F.3d at 1058-60. 

In response to the second appeal, Gamboa explained in denying the request that neither 

plaintiff’s primary care doctor nor dietician recommended a diabetic snack. There is no evidence 

in the record that Gamboa was aware of any allegation by plaintiff that he had requested refills to 

his glucose pills and that his request was denied. In sum, although plaintiff disagrees with 

Gamboa’s conclusions and decision to deny his appeals at the first level, Gamboa took reasonable 

steps to address plaintiff’s serious medical needs and a difference of opinion regarding medical 

treatment does not constitute deliberate indifference. See Toguchi, 391 F.3d at 1058. There is no 

evidence in the record that would preclude a grant of summary judgment in Gamboa’s favor. 

3. Kumar

Plaintiff asserts that as the second level reviewer of his health care appeals, Kumar was 

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deliberately indifferent because he denied plaintiff’s requests for a diabetic snack. Kumar granted 

plaintiff’s appeal insofar as plaintiff wanted to ensure he was seen by his primary care doctor as 

previously ordered, but denied the request for snacks. 

The undisputed record shows that Kumar took reasonable steps to address the serious 

medical need, as his second level denials were based on a review of plaintiff’s medical records, the 

recommendations of his primary care doctors, and the prison medical guidelines. (Defendants’ 

MSJ, Kumar Decl. ¶¶ 8-10.) Based on Kumar’s review, plaintiff’s request for diabetic snacks was 

not medically indicated as he did not have type 1 or brittle diabetes, and it was not recommended 

by plaintiff’s doctor or dietician. (Id.) There is no evidence in the record that Kumar was aware 

of any allegation by plaintiff that he had requested refills to his glucose pills and that his request 

was denied. Although plaintiff disagrees with Kumar’s conclusions and decision to deny his 

appeals at the second level, a difference of opinion regarding medical treatment does not constitute 

deliberate indifference. See Toguchi, 391 F.3d at 1058. There is no evidence in the record that 

precludes summary judgment in Kumar’s favor. 

4. Lewis

Plaintiff asserts that as the third level reviewer of both of his health care appeals, Lewis 

was deliberately indifferent because she denied plaintiff’s request for a diabetic snack. Lewis, as 

the former Deputy Director, Policy and Risk Management Services at CCHCS, is named on the 

third level decisions for both of plaintiff’s health care appeals, but she was not personally involved 

in deciding either appeal. There was a broad delegation of authority in place that allowed for 

managers to prepare and sign CCHCS’s third level decision on Lewis’ behalf. (Defendants’ MSJ, 

Lewis Decl., ¶ 8.) Lewis’ responses were prepared and signed by S. Gates. (Id. at ¶¶ 6-10.) She 

did not approve the responses, speak to S. Gates about the responses, or instruct S. Gates as to the 

content of the responses. Id. 

The undisputed record contains no evidence that Lewis was personally involved in 

plaintiff’s healthcare or the decision to deny plaintiff’s requests for a diabetic snack. Therefore 

she cannot be held liable for any alleged violation of plaintiff’s rights. “Liability under section 

1983 arises only upon a showing of personal participation. A supervisor is only liable for 

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constitutional violations of his subordinates if the supervisor participated in or directed the 

violations, or knew of the violations and failed to act to prevent them.” Taylor v. List, 880 F.2d 

1040, 1045 (9th Cir. 1989) (internal citation omitted). There is no evidence in the record that 

would create a genuine issue of material fact as to Lewis’ personal participation in plaintiff’s 

health care or in any violation of his rights that would preclude a grant of summary judgment in 

Lewis’ favor.

5. J. Rodriguez

In his amended complaint plaintiff alleged that a nurse “Rodriqez” saw him daily and she 

refused to give him a diabetic snack despite his hypoglycemic episodes. After being notified that 

no nurse by that name was employed at SVSP, but there was a nurse by the name of J. Rodriguez, 

plaintiff confirmed that J. Rodriguez was the nurse he intended to sue. LVN J. Rodriguez, 

however, moves for summary judgment on the grounds that he is the wrong defendant: he is male 

and all of plaintiff’s allegations are against a female nurse. While plaintiff continues to assert that 

it was a female nurse named Rodriguez who provided his medical care and is the subject of his 

claims, the undisputed record shows that there was only one nurse by the name of J. Rodriguez at 

SVSP during the time plaintiff was incarcerated there, and that this person is male. (Defendants’ 

MSJ, Rodriguez Decl., ¶ 3, Nunez Decl., ¶ 2.) Accordingly, summary judgment is granted in 

favor of J. Rodriguez as the undisputed record shows that he was not the nurse who had the 

interactions with plaintiff that are the subject of plaintiff’s claims. 

D. Qualified Immunity

The defense of qualified immunity protects “government officials . . . from liability for 

civil damages insofar as their conduct does not violate clearly established statutory or 

constitutional rights of which a reasonable person would have known.” Harlow v. Fitzgerald, 457 

U.S. 800, 818 (1982). To determine whether a government official is entitled to qualified 

immunity, courts must consider (1) whether the official’s conduct violated a constitutional right, 

and (2) whether that right was “clearly established” at the time of the alleged misconduct. See 

Pearson v. Callahan, 555 U.S. 223, 232-236 (2009) (overruling the sequence of the two-part test 

that required determination of a deprivation first and then whether such right was clearly 

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established, as required by Saucier v. Katz, 533 U.S. 194 (2001)). Courts may “exercise their 

sound discretion in deciding which of the two prongs of the qualified immunity analysis should be 

addressed first in light of the circumstances in the particular case at hand.” Id. at 236. 

As discussed above, the undisputed record gives rise to no genuine issue of fact as to 

whether defendants were deliberately indifferent to plaintiff’s serious medical needs when they 

denied his requests for a diabetic snack. Defendants thus are entitled to summary judgment in 

their favor on the defense of qualified immunity because the Court has found that no constitutional 

violation occurred. See Aguilera v. Baca, 510 F.3d 1161, 1167 (9th Cir. 2007) (“If we determine . 

. . that no constitutional violation occurred, the qualified immunity inquiry is at an end.”).

CONCLUSION

For the foregoing reasons, defendants’ motion for summary judgment is GRANTED, and 

plaintiff’s motion for summary judgment is DENIED. 

Defendant’s motion to strike plaintiff’s sur-reply is GRANTED.3 

This order terminates Dkt. Nos. 45, 49, and 60.

The Clerk shall enter judgment for defendants and close the file.

IT IS SO ORDERED.

Dated:

HAYWOOD S. GILLIAM, JR.

United States District Judge

 

3 The Court has reviewed the sur-reply and determined that even were it to consider the sur-reply, 

that filing would not affect the outcome of the case.

 9/10/2019

9/9/2019

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