Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_07-cv-00670/USCOURTS-azd-2_07-cv-00670-12/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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Plaintiff is currently confined in the Arizona State Prison Complex in Tucson,

Arizona (Doc. 132).

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Allan Kenneth Morgal, 

Plaintiff, 

vs.

Joseph Arpaio, et al., 

Defendants.

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No. CV 07-0670-PHX-RCB

O R D E R

Plaintiff Allan Kenneth Morgal brought this civil rights action under 42 U.S.C. § 1983

against the Maricopa County Board of Supervisors (BOS) (Doc. 1). Before the Court is

Defendant’s third summary judgment motion, entitled “Renewed Motion for Summary

Judgment” (Doc. 142), which Plaintiff opposes (Doc. 167). 

The Court will deny Defendant’s motion.

I. Background

A. Complaint

Plaintiff’s claim stems from his confinement as a detainee in the Maricopa County

Fourth Avenue Jail and Lower Buckeye Jail in 2005-2006 (Doc. 1 at 1).1

 He alleged that

Defendant’s medical care policies at the jail exhibited deliberate indifference to Plaintiff’s

serious medical needs and violated his Fourteenth and Eighth Amendment rights (id. at 4,

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Defendant BOS is a local governing body amenable to suit under § 1983 (Doc. 26 at

4). Monell v. Dep’t of Social Servs. of New York, 436 U.S. 658, 691-94 (1978). The county

is responsible for providing medical care to county jail inmates through its BOS (Doc. 26 at

4). See Ariz. Rev. Stat. § 11-291(A) (the BOS provides for the medical care of inmates in

the county corrections agency).

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Throughout this Order, reference is made to CHS, which is the administrative

subdivision or “medical department” within the jail that provides health services to inmates

(see Doc. 1 at 2; Doc. 26 at 4 (actions against a county policy must be brought against the

county or the BOS and not against an administrative subdivision)).

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4H-J).2 

Plaintiff stated that in August 2005, he began trying to see a doctor for a respiratory

infection (id. at 4A). He was repeatedly told by Correctional Health Services (CHS) that he

was on the “sick call list,” but he was never seen by medical (id. at 4-4A).3

 In December

2005, he instituted the inmate grievance process and was finally seen by medical on January

24, 2006, approximately 6 weeks after he submitted his inmate grievance (id. at 4-4B).

Plaintiff claimed that as a result of the delay in treatment for his infection, he was coughing

up blood and suffered splitting headaches, ringing ears, and a virus (id. at 4). 

Plaintiff also alleged that he was denied high blood-pressure medication prescribed

to him by a physician (id. at 4D). Plaintiff explained that since suffering a stroke in 2005,

he has taken medication and he continued taking his medication in jail. But on March 17,

2006, he submitted a grievance stating that he had put in three written orders for his

medication and inquired about it verbally at least 12 times but had gone without his

medication for 10 days (id.). Plaintiff claimed that he ultimately asked for his medication at

least 20 times, in writing and verbally (id. at 4E). Plaintiff eventually received his

medication after going 19 days without it (id.). He claimed that as a result of the delay in

obtaining medication, he suffered from high blood pressure, dizziness, and a constant

headache (id. at 4H). 

B. Procedural 

Plaintiff initiated this action in March 2007 (Doc. 1). Defendant first moved for

summary judgment, along with two other named Defendants—the sheriff and a detention

officer—in April 2008 (Doc. 37). On January 14, 2009, the Court granted summary

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judgment to the sheriff and the detention officer but denied summary judgment as to the BOS

after finding material factual disputes whether medical policies at the jail caused delays in

healthcare that harmed Plaintiff (Doc. 52). 

In April, 2009, the Court held a status hearing and set a trial date for August 2009

(Doc. 61). 

Defendant then filed its second Motion for Summary Judgment (Doc. 92). The Court

granted this second motion after finding that Plaintiff submitted evidence related solely to

his isolated treatment and failed to demonstrate that there existed a policy of denying medical

care or that Defendant regularly failed to provide adequate medical care to its detainees (Doc.

116). 

Plaintiff filed an appeal to the Ninth Circuit Court of Appeals (Doc. 119). 

On August 9, 2011, the Ninth Circuit issued its Mandate affirming summary judgment

for the sheriff and the detention officer and vacating summary judgment as to the BOS (Doc.

122). The Ninth Circuit noted that summary judgment was issued on the ground that

Plaintiff failed to proffer sufficient evidence of a policy; however, at the time of the ruling,

there were five pending discovery submissions by Plaintiff (id., Mem. at 2-3). In its

Memorandum, the Ninth Circuit referred to Plaintiff’s submission of a February 24, 2006

report entitled “Revised Accreditation Report on the Health Care Services at Maricopa

County Sheriff’s Office-Detention Bureau,” which was authored by the National

Commission on Correctional Health Care (NCCHC) (id., Mem. at 3 n. 1). The appellate

court record was supplemented to include this document for the purpose of identifying it as

the subject of Plaintiff’s discovery submissions to the district court (id.). Because pending

discovery motions by a party opposing summary judgment must be resolved before summary

judgment, summary judgment for the BOS was vacated and the matter was remanded (id. at

3).

 Plaintiff then moved to re-open discovery on the basis that after obtaining the

NCCHC report, he learned of material facts about which he sought to conduct additional

depositions (Doc. 123). The Court denied Plaintiff’s motion to re-open discovery (Doc. 133),

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as well as his subsequent motions for discovery and to amend his Complaint to add facts

(Docs. 134, 139-140, 144, 161, 173).

Defendant filed its Renewed Motion for Summary Judgment on March 22, 2012, and

the Motion is now ready for ruling (Doc. 142).

II. Summary Judgment Standard 

A court must grant summary judgment “if the movant shows that there is no genuine

dispute as to any material fact and the movant is entitled to judgment as a matter of law.”

Fed. R. Civ. P. 56(a); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). Under

summary judgment practice, the movant bears the initial responsibility of presenting the basis

for its motion and “identifying those portions of ‘the pleadings, depositions, answers to

interrogatories, and admissions on file, together with the affidavits, if any,’ which it believes

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

initial burden on the movant, however, “may be discharged by ‘showing’—that is, pointing

out to the district court—that there is an absence of evidence . . . .” Id. at 325. 

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

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

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

point to the pleadings and sufficiently argue that the nonmovant has failed to establish an

element essential to his case, see Celotex 477 U.S. at 323, then the burden shifts to the

nonmovant, who must come forward with sufficient evidence demonstrating to the Court that

there are genuine issues of material fact to be decided at trial. Fed. R. Civ. P. 56(e). The

opposing party must demonstrate the existence of a factual dispute and that the fact in

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

governing law, Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986), and that the

dispute is genuine, i.e., the evidence is such that a reasonable jury could return a verdict for

the non-movant. Id. at 250; see Triton Energy Corp. v. Square D. Co., 68 F.3d 1216, 1221

(9th Cir. 1995). 

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

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Defendant did not submit a separate statement of facts with its Renewed Motion for

Summary Judgment as required under Local Rule of Civil Procedure 56.1(a), nor did

Defendant submit any supporting documentary evidence. 

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determine the truth but to determine whether there is a genuine issue for trial. Anderson, 477

U.S. at 249. The evidence of the nonmovant is “to be believed, and all justifiable inferences

are to be drawn in his favor.” Id. at 255. Although the court need consider only the cited

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

III. Parties’ Contentions

A. Defendant’s Motion

Defendant moves for summary judgment on the grounds that Plaintiff has failed to

present evidence of an official policy, practice, or custom that was the moving force behind

his claimed injuries and he has failed to present evidence that Defendant had the requisite

knowledge of a constitutionally deficient policy, custom, or practice but failed to act (Doc.

142 at 2). Defendant asserts that the Court previously held that Plaintiff failed to submit

evidence to support his policy claim, and, according to Defendant, the evidentiary record has

not changed since that ruling, and “[t]his includes any reference Plaintiff might make to the

so-called 2008 ‘NCCHC Report’ regarding CHS which the Court already considered in

reaching its original order granting Defendant’s Motion for Summary Judgment” (id. at 5,

citing Doc. 116 at 6). Defendant contends that for this reason, the Court should again grant

summary judgment for the BOS (id. at 5).

Defendant states that its Renewed Motion is supported by its second Motion for

Summary Judgment, the separate Statement of Facts filed in support of its first Motion for

Summary Judgment, and “the Court’s entire file in this matter” (Doc. 142 at 1, citing Docs.

92, 37).4

B. Plaintiff’s Response

In response, Plaintiff argues that Defendant’s motion fails to comply with any of the

applicable Rules of Procedure (Doc. 166). He asserts that Defendant’s Renewed Motion for

Summary Judgment is past the dispositive-motions deadline set in the Scheduling Order and

Defendant did not file a separate motion for leave (id. at 1). Plaintiff notes that the

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Plaintiff also argues that Defendant failed to meet its discovery obligations and

discovery was not completed; Plaintiff requests that he be allowed to take depositions or

further discovery (Doc. 169 at 4). He also points to various examples of what he claims are

evidence of defense counsel’s attempts to deceive the Court, including misrepresentations

of the report dates and of the evidence actually provided in discovery, and he lists documents

he recently became aware of that he believes should have been disclosed (id. at 4-6, 8-10).

Because the Court has already addressed his motions to re-open discovery, Plaintiff’s

pending request for discovery will be denied (see Docs. 133, 173). 

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procedural rules have been strictly applied to his requests for leave to file motions (id.).

Plaintiff next contends that Defendant attempts to mislead the Court by stating that

the “so-called 2008 NCCHC Report” has already been considered by the Court in its prior

summary judgment ruling (id. at 1-2). Plaintiff asserts that the Court could not have

previously considered the NCCHC Report—which is actually dated 2006—because Plaintiff

did not obtain it until January 2010 during his appeal (id. at 2). 

Plaintiff argues that the Court has already found that he sufficiently alleged a serious

medical need (id., citing Doc. 52 at 11-12). He further argues that Defendant was put on

notice through numerous lawsuits and complaints, the loss of accreditation, and reports

issued by its own experts that the county delayed and denied medical care to inmates, and

Plaintiff alleges that, despite this knowledge, Defendant failed to take corrective actions (id.).

He adds that Defendant is liable for the resulting constitutional violations based on its

decision not to fund a record-keeping system and adequate staffing (id. at 3). 

Although Defendant raised no such argument in its motion, Plaintiff asserts that the

physical-injury requirement set forth in the Prison Litigation Reform Act (PLRA), 42 U.S.C.

§ 1997e(e), does not apply to his claim because he is not seeking damages for emotional or

mental injury; rather, he seeks compensation for a constitutional violation under the Eighth

Amendment (id. at 2-3).

In support of his opposition, Plaintiff submits a Statement of Disputed Facts, which

primarily sets forth legal arguments for Defendant’s liability (Doc. 169 at 1-3, 8).5

 He also

submits his own affidavit, (id., Attach., Pl. Aff.), copies of correspondence with defense

counsel (Doc. 167, Ex. A), a transcript of the deposition of Dr. Todd Randall Wilcox taken

in Graves v. Arpaio, et al., No. CV 77-479-PHX-NVW (id., Ex. B, Wilcox Dep., June 28,

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2008); newspaper articles (id., Ex. C); a February 20, 2008 letter from Dr. Wilcox to the BOS

(id., Ex. D); the copy of a returned mail notice (id., Ex. E); the copy of the first page of a

February 20, 2006 letter from CHS to the NCCHC in response to the a draft of the 2006

NCCHC report (id., Ex. F); and a copy of CHS’s handout on “The Common Cold” (id., Ex.

G). 

C. Defendant’s Reply

Defendant argues in reply that Plaintiff’s claim is barred by the PLRA because he did

not sustain a physical injury (Doc. 172 at 1, 3-4). Defendant further argues that, even if his

claim is not barred, Plaintiff cannot show that a unlawful policy established by Defendant

directly caused him injury (id.). 

Defendant reasserts its claim that the factual and evidentiary record in this matter has

not changed since the Court’s prior grant of summary judgment and the Court already

determined there was no evidence of a deliberately-indifferent policy that harmed Plaintiff

(id. at 2-3, 5). 

Defendant also argues that the Court should not consider the exhibits Plaintiff

submitted in support of his opposition because none of those exhibits were disclosed during

the discovery phase of this case (id. at 2, 6). Defendant states that it would be prejudiced if

the Court considered the exhibits because Defendant had no opportunity to produce

additional evidence or conduct discovery in response to these documents (id.). Defendant

asserts that Plaintiff was required to seek Dr. Wilcox’s deposition during the discovery

period but he failed to do so and he should not be permitted to use such deposition evidence

now (id. at 6-7). Finally, Defendant contends that the newspaper articles and the letter from

Dr. Wilcox are hearsay and inadmissible (id. at 7). 

IV. Procedural and Evidentiary Issues 

A. Timeliness of Defendant’s Motion

Plaintiff argues that Defendant’s Renewed Motion for Summary Judgment was filed

well after the dispositive-motions deadline and Defendant did not properly file a separate

motion for leave to file its pending motion (Doc. 166). Federal Rule of Civil Procedure

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6(b)(1) provides that if a filing deadline has expired, a request for an extension must be on

a separate motion and the standard to be met is excusable neglect. Local Rule of Civil

Procedure 7.3 requires a party seeking an extension to disclose any previous extensions and

to lodge a separate proposed form of order.

Following remand by the Ninth Circuit, the district court did not issue a new

scheduling Order or set a new dispositive-motions deadline. The procedural posture of the

case, however, would have normally resulted in the Court setting a new deadline rather than

proceeding directly to trial following resolution of the issues raised by the Ninth Circuit’s

Mandate. Accordingly, when Defendant filed its Renewed Motion for Summary Judgment,

the Court issued a Rand Notice directing the parties to brief the motion and instructing that

the motion would be ready for ruling following the date set for a reply filing (Doc.143). The

Court therefore implicitly granted leave for the filing of the motion.

More importantly, because the Court herein denies Defendant’s Renewed Motion,

Plaintiff is not unduly prejudiced, and addressing the motion serves to clarify and narrow the

issues for trial. 

B. Plaintiff’s Exhibits

1. Dr. Wilcox’s Deposition

Defendant asserts that Dr. Wilcox’s deposition from the Graves proceeding should

not be considered because Plaintiff was required to seek such discovery during the

established time period and it would constitute an “end-run” around the Court’s prior Order

which denied re-opening discovery to conduct depositions (Doc. 172 at 6-7).

Under Federal Rule of Civil Procedure 32, a deposition may not be used in court

proceedings unless (1) the opposing party was present or represented at the taking of the

deposition or had reasonable notice of it or (2) there is a ground for admission under Rule

32(a), such as for impeachment purposes or because the witness is unavailable. Fed. R. Civ.

P. 32(a)(1)(A) and (2)-(8). But the Ninth Circuit has held that a deposition can be used to

support or oppose a summary judgment motion if it meets the requirements for an affidavit

under Rule 56, i.e., it is made on personal knowledge and sets out facts that would be

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The Court notes that the Graves defendants represented at Dr. Wilcox’s deposition

included the Sheriff and the Maricopa County Sheriff’s Office; BOS Brock, Stapley,

Kunasek, Wilson and Wilcox; and CHS (Doc. 167, Ex. B, Wilcox Dep. 4:13-25). See

Graves, 77-479-PHX-NVW. 

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admissible in evidence. Fed. R. Civ. P. 56(c)(4); Hoover v. Switlik Parachute Co., 663 F.2d

964, 966 (9th Cir. 1981). This includes deposition testimony taken in a separate proceeding

involving different parties. Gulf USA Corp. v. Fed. Ins. Co., 259 F.3d 1049, 1056 (9th Cir.

2001).6

 Even an uncompleted, unsigned deposition is admissible under Rule 56 “[b]ecause

there is no reason to believe that the sworn answers to questions are less reliable than an

affidavit.” In re Sunset Bay Assocs., 944 F.2d 1503, 1509-10 (9th Cir. 1991). Dr. Wilcox’s

deposition meets the Rule 56 requirements; it is sworn testimony based on personal

knowledge, and it sets forth facts admissible in evidence (see Doc. 167, Ex. B, Wilcox Dep.

6:1-3). See Fed. R. Civ. P. 56(c)(4).

 Defendant asserts, however, that it would be prejudiced if the Court considers the

deposition because it was not previously disclosed and Defendant had no opportunity to

produce evidence in response (Doc. 172 at 6). Yet Defendant provides no legal authority to

support that at summary judgment, Plaintiff is limited to evidence that was disclosed during

discovery. There is nothing in Rule 56 suggesting that affidavits used to oppose summary

judgment must have been previously disclosed. See Fed. R. Civ. P. 56(c)(1)(A) and (4).

Indeed, Dr. Wilcox’s deposition was not taken until June 2008, which was after discovery

in this matter closed (see Doc. 167, Ex. B, Wilcox Dep. at 1; Doc. 12). And Plaintiff avers

that he did not obtain a copy of the deposition until just prior to filing his response

memorandum (Doc. 169 at 9). Thus, there is no evidence that Plaintiff acted in bad faith in

failing to disclose earlier that he sought to use Dr. Wilcox’s testimony, nor is there evidence

that Defendant was unaware of this testimony (see n. 7). Most importantly, this is

Defendant’s summary judgment motion; therefore, Defendant had the opportunity to file a

reply and respond to any evidence proffered by Plaintiff, including Dr. Wilcox’s testimony.

Accordingly, Dr. Wilcox’s deposition testimony will not be used as a deposition under

Rule 32 but it will be considered as an affidavit under Rule 56 in support of Plaintiff’s

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Section 1997e(e) provides “[n]o Federal civil action may be brought by a

prisoner . . . for mental or emotional injury suffered while in custody without a prior showing

of physical injury.”

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opposition.

2. Dr. Wilcox Letter and Newspaper Articles 

The Court need not address Defendant’s arguments that the resignation letter from Dr.

Wilcox and the newspaper articles are inadmissible because it does not consider either

exhibit in its summary judgment analysis (see Doc. 172 at 7).

V. PLRA Physical Injury Requirement 

Defendant argues that Plaintiff’s claim is barred because he cannot demonstrate that

he suffered a physical injury, which, according to Defendant, is required under § 1997e(e)

the PLRA (Doc. 172 at 3-4).7

 Defendant’s reliance on out-of-circuit case law to support this

argument is misplaced because the Ninth Circuit has expressly held that even absent physical

injury, a prisoner is entitled to seek compensatory, nominal, and punitive damages premised

on violations of his constitutional rights. Oliver v. Keller, 289 F.3d 623, 629-30 (9th Cir.

2002). In his Complaint, Plaintiff specifically sought compensatory and punitive damages

for violations of his Fourteenth and Eighth Amendment rights (Doc. 1 at 4, 7). Therefore,

his claim is not barred by § 1997e(e).

VI. Medical Care-Policy Claim

To succeed on his claim against Defendant, Plaintiff must show that “action pursuant

to official municipal policy” caused his injury. Monell, 436 U.S. at 691. The elements

necessary to support a § 1983 claim against a municipality are: (1) the plaintiff was deprived

a constitutional right; (2) the municipality had a policy or custom; (3) the policy or custom

amounted to deliberate indifference to the plaintiff’s constitutional right; and (4) the policy

or custom was the moving force behind the constitutional violation. Mabe v. San Bernardino

County, Dep’t of Pub. Soc. Servs., 237 F.3d 1101, 1110-11 (9th Cir. 2001). 

A. Deprivation of a Constitutional Right

1. Standard Governing Medical Care

At the relevant time, Plaintiff was a pretrial detainee. Pretrial detainees are protected

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by the Fourteenth Amendment’s Due Process Clause, which provides that “detainees have

a right against jail conditions or restrictions that ‘amount to punishment.’” Pierce v. County

of Orange, 526 F.3d 1190, 1205 (9th Cir. 2008) (citing Bell v. Wolfish, 441 U.S. 520, 535-57

(1979)). The Fourteenth Amendment standard is more protective than the Eighth

Amendment standard, however, the Ninth Circuit has held that pretrial detainees’ rights

under the Fourteenth Amendment are nonetheless comparable to prisoners’ rights under the

Eighth Amendment. See Pierce, 526 F.3d at 1205; Frost v. Agnos, 152 F.3d 1124, 1128 (9th

Cir. 1998); Jones v. Johnson, 781 F.2d 769, 771 (9th Cir. 1986) (“the eighth amendment

guarantees provide a minimum standard of care for determining [the plaintiff’s] rights as a

pretrial detainee, including his right to medical care”).

To support an Eighth Amendment claim based on medical treatment, an inmate must

demonstrate deliberate indifference. Estelle v. Gamble, 429 U.S. 97, 104 (1976). This

analysis includes an objective prong and a subjective prong. First, an inmate must show a

“serious medical need.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (citation

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

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

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) (citation omitted).

Second, an inmate must show that the defendant’s response to that need was

deliberately indifferent. Jett, 439 F.3d at 1096. The deliberate-indifference prong is met if

the inmate demonstrates (1) a purposeful act or failure to respond to a prisoner’s medical

need and (2) harm caused by the indifference. Id.

2. Analysis

In its Renewed Motion for Summary Judgment, Defendant does not directly address

the two prongs in the deliberate-indifference analysis. Instead, Defendant acknowledges that

there is evidence of possible “inadvertent delays” in medical treatment that might support a

negligence claim against an individual provider but maintains that Plaintiff has failed to

satisfy his “burden at each step of the” Monell analysis (Doc. 142 at 4). 

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The second citation refers to the relevant page number in the Court’s Case

Management/Electronic Case Filing system. 

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Plaintiff submits evidence supporting that both his respiratory infection and high

blood pressure conditions constituted serious medical needs (Doc. 169, Pl. Aff. ¶¶ 1-3, 6, 9,

20 (Doc. 169 at 11-12, 14)8

). As Plaintiff notes, the Court previously determined that his

conditions met this first prong of the deliberate-indifferent analysis, and, absent any evidence

or dispute from Defendant, that finding does not change (see Doc. 52 at 11-12).

With respect to the second prong—whether the responses to Plaintiff’s serious

medical needs were deliberately indifferent—Plaintiff presents the following facts:

Plaintiff developed a serious respiratory infection; his throat was almost closed, he

was barely able to eat or swallow, and he began losing weight (Doc. 169, Pl. Aff. ¶ 9 (Doc.

169 at 12)). On December 3, 2005, he submitted an inmate grievance stating that since

August 2005, he had been trying to see a doctor and had already submitted three sick-call

lists (or requests) seeking treatment but had not yet been seen (Doc. 1 at 4). See Jones v.

Blanas, 393 F.3d 918, 923 (9th Cir. 2004) (courts must consider as evidence in opposition

to summary judgment the plaintiff’s contentions in pleadings if those contentions are attested

to under penalty of perjury, are based on personal knowledge, and set forth facts that would

be admissible in evidence). The grievance also stated that Plaintiff was now coughing up

green sputum with a mixture of blood (Doc. 1 at 4). On December 13, 2005, CHS responded

to his inmate grievance by informing him that he was on the sick call list and reminding him

that he had been given the “Cold Handout Sheet” in response to one of his requests for

medical treatment (id.). The “Cold Handout Sheet” advises inmates how to make themselves

feel better if they have a cold and includes a highlighted “Warning” that if symptoms last for

more than 10-14 days or the inmate coughs up green or bloody sputum or neck glands

become swollen, to submit a Medical Request (Doc. 168, Ex. G (Doc. 168 at 64)). Plaintiff

appealed his grievance and wrote in his appeal that “medical keeps telling me that I am on

sick call since August. I have never been seen,” and he noted that he has the same symptoms

for which the Handout Sheet warns inmates to submit a medical request (Doc. 1 at 4A).

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Plaintiff was seen on January 24, 2006 (id. at 4B). Plaintiff alleges that going 9-10 weeks

without any treatment caused him significant weight loss and suffering from headaches,

ringing ears, and cold and cough symptoms (id. at 4; Doc. 169, Pl. Aff. ¶ 9 (Doc. 169 at 12)).

In its first Summary Judgment Order, the Court noted that Defendant failed to submit

any admissible evidence to contradict these facts or demonstrate that Plaintiff was not

harmed by the delay in treatment for his respiratory infection (Doc. 52 at 13-14). And

Defendant presents no evidence with its pending motion.

As to his high-blood pressure condition, Plaintiff avers that he has been on

prescription medication for hypertension since his diagnosis in 1999 (Doc. 169, Pl. Aff. ¶¶ 1-

3 (Doc. 169 at 11)). He also avers that when he was admitted into the jail in August 2005,

his hypertension condition was confirmed (id. ¶ 6). Plaintiff states that on numerous

occasions, the jail failed to provide his blood-pressure medications (id.). On March 17, 2006,

Plaintiff submitted an inmate grievance stating that he ordered his high-blood pressure

medication in writing on March 1, 10, and 14, 2006, and he had verbally inquired about his

medication at least 12 times; however, he has now been without his medication for 10 days

(Doc. 1 at 4D). Plaintiff ended up going 19 days without his blood-pressure medication after

at least 20 requests for it (id. at 4E). In late April 2006, Plaintiff went at least 8 days without

his medication due to gaps in the provision of refills (id. at 4E-4F). Plaintiff alleges that the

delays in medication caused him to suffer high blood pressure, dizziness, and constant

headaches (Doc. 1 at 4, 4H).

Again, Defendant did not previously, nor does it presently, submit any admissible

evidence to contradict Plaintiff’s alleged facts regarding delays in medication for his high

blood pressure and the resulting harm (see Doc. 52 at 12-13).

On this record, the Court finds genuine issues of material facts whether Plaintiff was

deprived of his constitutional right to adequate medical care with regard to his respiratory

infection and high blood pressure, thereby satisfying the first element needed to support his

Monell claim.

B. Existence of Policy or Custom

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“Liability for improper custom may not be predicated on isolated or sporadic

incidents; it must be founded upon practices of sufficient duration, frequency and consistency

that the conduct has become a traditional method of carrying out policy.” Trevino v. Gates,

99 F.3d 911, 918 (9th Cir. 1996). Thus, an unwritten policy or custom must be so “persistent

and widespread” that it constitutes a “permanent and well settled” policy. Monell, 436 U.S.

at 691.

As to this second element, Defendant relies on the option in Celotex that allows for

the movant’s initial burden of production to be discharged by directing the court’s attention

to the absence of evidence supporting the nonmovant’s case (Doc. 142 at 3-5). See Celotex,

477 U.S. at 325. To discharge its initial burden, a movant must “point to shortfalls in the

[plaintiff’s] case to demonstrate the absence of evidence . . . .” United Steelworkers of Am.

v. Phelps Dodge Corp., 865 F.2d 1539, 1543 (9th Cir. 1989); see Celotex, 477 U.S. at 332

(Brennan, J., dissenting) (a conclusory assertion that the nonmovant lacks any evidence is

insufficient; the movant must affirmatively demonstrate that there is no evidence in the

record).

Here, Defendant relies solely on the Court’ prior determination that there was no

evidence to demonstrate a policy of denying medical care at the jail (Doc. 142 at 4-5, citing

Doc. 116 at 10). Defendant contends that because the evidentiary record is the same now as

when the previous Summary Judgment Order was entered, there is no basis for finding the

existence of a policy (Doc.142 at 4-5). 

But the evidentiary record is not the same; it now includes evidence Plaintiff

submitted in response to Defendant’s pending motion. That evidence includes Dr. Wilcox’s

testimony, in which he establishes that he worked at the jail for four years—as a consultant

and then medical director for the Maricopa County Jail System from 2004 to February 2006,

and as a consulting assistant to the CHS Director and a treating physician from 2006 to

February 2008 (Doc. 167, Ex. B, Wilcox Dep. 32:6-23, 39:24-40:4). During these four years,

he had the opportunity to observe the health care provided at the jails (id. 38:20-39:16, 64:7-

24). 

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Dr. Wilcox testified that he observed problems with inmate access to health care,

including the lack of a triage program at the jail, which he stated was essential for identifying

the patients requesting care who are sicker and need to see providers as soon as possible:

Prisoners would submit a sick call request and that sick call request was not

triaged as I would consider it in the system, . . . . What you would see on a

sick call request, and I saw this on one after another after another, is the nurse

would write in the response section “scheduled,” and so they would add them

to the list to be seen, but there was no sense of how quickly that needed to

happen (id. 75:5-14, 78:2-12).

Dr. Wilcox stated that as a result of this system, many chronically ill patients “end up being

placed on a list and they don’t get seen in a timely fashion” (id. 79:17-21). He confirmed

that while he was at CHS, he saw individuals who had to be admitted to a hospital because

they hadn’t receive sufficient care prior to their condition becoming an emergency; “many

times you will find that they have submitted numerous sick call requests. They have not been

seen. They finally kind of reach a point at which its an emergency” (id. 94:10-95:2). Dr.

Wilcox also testified that he was frustrated by how CHS “developed their sick call requests

and they determined who was going to be seen by the provider not based on acuity, but based

on housing locations”; they simply picked a certain housing location and saw “however

many” inmates in that location for that day (id. 78:19-25).

As to the provision of medications at the jail, Dr. Wilcox testified that he frequently

saw medications that were ordered not get to the patient: “it’s a fairly common occurrence

within CHS to have glitches in the medication process. It’s very common to have patients

who have medications ordered and they are not receiving those medications” (id. 106:18-

107:2). 

The above evidence demonstrates more than isolated incidents of denied care; rather,

it suggests that the jail regularly failed to provide adequate and timely medical care to its

detainees. See Bd. of County Comm’rs of Bryan County v. Brown, 520 U.S. 397, 403-04

(1997); Trevino, 99 F.3d at 918. The Court finds that Plaintiff sufficiently establishes a

disputed material fact whether, during his confinement at the jail, there was a ongoing policy

or custom of denying and/or delaying medical care to detainees who submitted sick call

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requests, as well as a policy or custom of failing to timely provide inmates with prescribed

medications. See Gibson v. County of Washoe, 290 F.3d 1175, 1194-95 (9th Cir. 2002)

(whether a policy or custom exists is normally a jury question). 

C. Policy or Custom that Amounts to Deliberate Indifference

Because deliberate indifference is exhibited where jail officials deny or delay medical

treatment and harm results, see Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990),

and Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989), an ongoing policy or practice

that delays treatment or medication for serious medical needs and thereby causes injury

would constitute a deliberately-indifferent policy.

Moreover, Plaintiff submits evidence showing that Defendant had the requisite

knowledge of deficient policies or practices governing health care at the jail but chose not

to correct those deficiencies. Dr. Wilcox explained that he began working with the Maricopa

County Jail in November 2004 as a consultant with Phase 2 Consulting, which provided

consulting and management services for correctional health care (Doc. 167, Wilcox Dep.

30:6-10, 32:6-11, 33:1-18). Once the Phase 2 Consulting contract was in place, Dr. Wilcox

was hired as the medical director at the beginning of December 2004 (Doc. 167, Wilcox Dep.

35:23-36:3). According to Dr. Wilcox, the county was unwilling to implement

recommendations made by Phase 2 Consulting (id. 131:25-136:122:2). He states that when

Phase 2 came in:

[W]e made a number of significant recommendations to the County about

restructuring the health care delivery process to try to address some of the

problems, . . . . And there was a real consistent pattern that we even joked

about . . . we would make recommendations to the County, [but CHS

operational director] Sandi Wilson, [ ] would promptly say no . . . and the

recommendations would not be implemented. There were a number of those

that [] just made it impossible to move the system ahead because we couldn’t

lay down those core foundational changes that needed to occur (id. 122:3-

123:5).

Dr. Wilcox also explains that the NCCHC, a non-profit organization that has

established an accreditation process and a set of standards that correctional facilities may

participate in, conducted an audit of the jail in December 2005 (id. 44:24-45:6, 45:20-22,

46:23-47:4). Dr. Wilcox was at the jail when the audit survey was performed, the NCCHC

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Defendant incorrectly asserts that the Court already considered the NCCHC report

in its prior Summary Judgment Order (Doc. 142 at 5). The report was not a part of the record

when the prior Order was issued, nor is a copy of the report submitted with the current

summary-judgment briefing. Thus, the Court considers only Dr. Wilcox’s undisputed

testimony that the report stemmed from a December 2005 audit and that after the report was

issued, the jail was placed on probationary status. 

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interviewed him as part of the audit, and he reviewed the February 2006 NCCHC

accreditation report (id. 55:19-56:12, 57:18-20). He confirms that following that audit, the

NCCHC accreditation committee voted to place the jail on probation (id. 58:11-15). The

inference from this evidence is that placement on probationary status would have put

Defendant on notice of deficiencies with health care at the jail.9

 See Anderson, 477 U.S. at

255 (all inferences drawn in nonmovant’s favor).

Finally, Dr. Wilcox testified that with respect to addressing the needs of CHS patients,

having been a part of management within CHS, he knows that upper management was “well

informed about the issues and challenges” (Doc. 168, Ex. B, Wilcox Dep. 213:18-24).

The above evidence raises a genuine issue of material fact whether the on-going

policies or customs governing access to medical care and the provision of prescribed

medication amounted to deliberate indifference.

D. Moving Force Behind Violation

To establish that the policy or custom is the “moving force” behind the constitutional

violation, Plaintiff must demonstrate a direct causal link between the policy or custom and

the constitutional deprivation. See Brown, 520 U.S. at 404. He must show that had the

policy or practice been different, the injury would have been avoided. Gibson, 290 F.3d at

1196 (citing Oviatt v. Pearce, 954 F.2d 1470, 1478 (9th Cir. 1992)).

If a policy or custom is found to have a known or obvious consequence of infringing

on federally protected rights, it is difficult to see how such a policy is not also the “moving

force” behind the known or obvious harms. See Brown, 520 U.S. at 405 (“the conclusion

that the action taken or directed by the municipality . . . itself violates federal law will also

determine that the municipal action was the moving force behind the injury of which the

plaintiff complains”). Plaintiff has already established a genuine issue of material fact

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whether there existed at the jail a policy or custom of delaying health care and prescribed

medications for serious medical needs. The Court finds that an obvious consequence of such

a policy or custom may be the denial of constitutionally adequate medical care. On this basis

alone, the moving-force element is satisfied.

Plaintiff’s evidence is otherwise sufficient to support a direct link between a policy

or custom of delaying health care and his alleged injuries. Plaintiff’s allegations that he

submitted numerous sick call lists and was repeatedly told he was scheduled but, nonetheless,

was never seen by medical, are in accordance with procedures that Dr. Wilcox testified he

observed time and again with regard to sick call requests (see Doc. 167, Wilcox Dep. 75:5-

14, 78:2-12, 79:17-21). Likewise, Plaintiff’s allegations that he did not timely receive his

prescribed high blood-pressure medication correlate directly to evidence that it was a “very

common” practice at the jail for medications to be ordered but then not actually provided to

inmates (see id. 106:18-107:2). It follows that if these procedures and practices were

different, Plaintiff would have been provided timely medical care for his respiratory infection

and medication for his high blood pressure and not suffered a deprivation of his

constitutional rights. See Gibson, 290 F.3d at 1196. As such, a material factual dispute

exists whether the jail’s policies or customs were the moving force behind the alleged

violations.

In sum, there are genuine issues of material fact as to whether Defendant was

deliberately indifferent to the risk that its policies and customs governing access to medical

care and medications would violate inmates’ right to constitutionally adequate medical

treatment. Defendant’s Renewed Motion for Summary Judgment will therefore be denied.

IT IS ORDERED that Defendant’s Renewed Motion for Summary Judgment (Doc.

142) is denied.

DATED this 5th day of November, 2012.

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