Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_04-cv-04232/USCOURTS-cand-3_04-cv-04232-2/pdf.json

Parties Involved:
Robert Bowman
Defendant
G. Lauber
Defendant
Charles Dudley Lee
Defendant
Sixto Salcido
Plaintiff
David Zarek
Defendant

Document Text:

United States District Court

For the Northern District of California

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United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

SIXTO SALCIDO,

Plaintiff,

 v.

DAVID ZAREK, M.D.; CHARLES

DUDLEY LEE, M.D.; ROBERT

BOWMAN, M.D.; G. LAUBER,

Defendants. _______________________________ 

 

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No. C 04-4232 MMC (PR) 

ORDER GRANTING DEFENDANTS’

MOTIONS FOR SUMMARY

JUDGMENT; GRANTING PLAINTIFF’S

MOTION TO AMEND CROSS-MOTION

FOR SUMMARY JUDGMENT;

DENYING PLAINTIFF’S CROSSMOTION FOR SUMMARY JUDGMENT 

(Docket Nos. 30, 41, 50, 51) 

Plaintiff Sixto Salcido, an inmate at Salinas Valley State Prison (“SVSP”) proceeding

pro se, filed the above-entitled civil rights action under 42 U.S.C. § 1983, alleging he has

received inadequate medical care. On October 19, 2004, after reviewing the complaint, the

Court found plaintiff had stated cognizable claims against defendants Dr. David Zarek (“Dr.

Zarek”), Dr. Charles Dudley Lee (“Dr. Lee”), Dr. Robert Bowman (“Dr. Bowman”), and G.

Lauber (“Lauber”). Drs. Lee and Bowman, along with Lauber, filed a motion for summary

judgment. Dr. Zarek, who was served after the other defendants, subsequently filed a

separate motion for summary judgment. Plaintiff has opposed both motions and has filed a 

cross-motion for summary judgment, which he subsequently moved to amend. Defendants

have filed a joint reply to plaintiff’s opposition, in which, in addition, they have included

their opposition to plaintiff’s motion for summary judgment. 

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These facts are derived from the exhibits submitted by the parties, including

plaintiff’s medical records, plaintiff’s administrative appeals, plaintiff’s declaration in

support of his opposition and cross-motion, and defendants’ answers to interrogatories. 

2

The medical records submitted in connection with the instant motion run through

March 2005. Between November 2002 and March 2005, plaintiff was prescribed a variety of

pain medications, for periods ranging from 30 to 100 days, in November and December

2002, as well as in January, May, July, October and December 2003, continuing in January,

March, June, August, October and December 2004, and thereafter in February and March

2005.

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BACKGROUND

The following facts are undisputed or are read in the light most favorable to plaintiff.1

In 1996, plaintiff was involved in a gun battle with the police, during which several bullet

fragments lodged in his neck area. In March 2002, plaintiff was transferred to SVSP. Dr.

Zarek performed minor surgery on plaintiff on April 24, 2002 at SVSP, removing some of

the bullet fragments. Additional bullet fragments were not removed because they were

embedded in the cervical spine area and Dr. Zarek could not see or feel them. Plaintiff

requested pain medication after the surgery, and again at his May 1, 2002 follow-up

appointment with Dr. Zarek. Dr. Zarek ordered the pain medication for plaintiff, but plaintiff

did not actually receive it. Plaintiff was next seen by a doctor on November 20, 2002, at

which time he was prescribed pain medication. Plaintiff thereafter continued to be examined

and prescribed pain medication on a regular basis.2

 A July 2003 x-ray revealed that scattered

bullet fragments remained in plaintiff’s neck area, near the cervical spine. 

On December 16, 2003, plaintiff filed an administrative grievance, complaining that

he was not receiving adequate care for the remaining fragments in his neck, and requesting

additional surgery to remove them. The appeal was granted in part, and plaintiff was

examined by Dr. Zarek on December 18, 2003, at which time plaintiff requested a second

surgery. Dr. Zarek ordered a neurological consultation, prescribed additional pain

medication, a cervical collar, x-rays and an MRI exam. The x-rays were performed on

December 22, 2003, and the MRI was performed on January 22, 2004. The x-rays showed

bullet fragments remained, and the MRI results were normal. On January 16, 2004, Dr.

Zarek re-ordered a cervical collar. It was eventually issued by SVSP officials on March 3,

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The parties, in their briefs and exhibits, refer to this pillow as a “cervical” pillow.

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The parties do not indicate the precise date on which plaintiff received these items

and treatment.

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2004, but not actually given to plaintiff at that time because the form “chrono” authorizing

plaintiff to possess the collar was not issued.

In the meantime, on January 16, 2004, plaintiff submitted his administrative appeal to

the first formal level and, on January 29, 2004, Lauber interviewed plaintiff in connection

with that appeal. Lauber agreed to postpone the interview until a Spanish-language

interpreter was available. A second interview was not conducted, however. Dr. Bowman

reviewed the appeal, and, on March 3, 2004, directed that plaintiff be seen at the clinic in

order to address his medical needs. The following day, plaintiff was examined by a doctor

who ordered that plaintiff be considered for physical therapy; he also prescribed new pain

medication and scheduled a follow-up visit at the prison clinic for two weeks thereafter.

Plaintiff proceeded with his administrative appeal, which, at this point, was to the

second formal level. On April 30, 2004, Drs. Bowman and Lee, after reviewing the appeal,

ordered that plaintiff be seen in the clinic within a month. Plaintiff was seen on June 3, 2004,

by a doctor who prescribed more pain medication and ordered a special pillow for plaintiff to

use while sleeping.3

 The pillow was not issued to plaintiff at that time, however, because it

was out of stock.

Thereafter, plaintiff proceeded to the next level of appeal, the Director’s level. On

July 28, 2004, the Chief of Inmate Appeals ordered that plaintiff’s use of a cervical collar and

special pillow be authorized, as well as an MRI of his neck, provision of any necessary

physical therapy, and a neurological consultation. Plaintiff thereafter received a cervical

collar, special pillow, physical therapy and more pain medication.4

 The neurosurgical

consultation was approved on August 25, 2004. On September 28, 2004, plaintiff was

examined by Dr. Muizelaar, Chair of the Division of Neurosurgery at the University of

California at Davis. Dr. Muizelaar did not recommend further surgery, stating, “I do not

think there is much that can be done for this patient.” Dr. Muizelaar recommended stronger

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pain medication and use of a special pillow. Plaintiff continues to receive pain medication in

addition to physical therapy, a cervical collar, and a special pillow. 

DISCUSSION

A. Legal Standard

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

is “no genuine issue as to any material fact and that the moving party is entitled to judgment

as a matter of law.” See Fed. R. Civ. P. 56(c). 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.

The court will 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); see also

Anderson v. Liberty Lobby, 477 U.S. at 248 (holding fact is material if it might affect

outcome of suit under governing law; further holding dispute about material fact is genuine

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

party”). 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. 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, or admissions on file,’ designate ‘specific facts

showing that there is a genuine issue for trial.’” See Celotex, 477 U.S. at 324 (citing Fed. R.

Civ. P. 56(e)). 

At summary judgment, the judge must view the evidence in the light most favorable to

the nonmoving party; if direct evidence produced by the moving party conflicts with direct

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.

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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. v. Pacific Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 1987). 

B. Legal Claims

Plaintiff makes a number of claims regarding his medical care; specifically, plaintiff

claims defendants are liable because: (1) Dr. Zarek failed to remove all of the bullet

fragments from his neck while performing surgery in April 2002; (2) plaintiff requested pain

medication from Dr. Zarek following his surgery but received no medication until November

2002; (3) there were substantial delays in providing plaintiff with the cervical collar and

special pillow after those items were ordered by his doctors; (4) a follow-up surgery on his

neck has not been approved or performed. 

Deliberate indifference to a prisoner’s serious medical needs violates the Eighth

Amendment’s proscription against cruel and unusual punishment. See Estelle v. Gamble,

429 U.S. 97, 104 (1976). A determination of “deliberate indifference” involves an

examination of two elements: the seriousness of the prisoner’s medical need and the nature of

the defendant’s response to that need. McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir.

1992), overruled on other grounds, WMX Technologies, Inc. v. Miller, 104 F.3d 1133, 1136

(9th Cir. 1997) (en banc).

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.

(citing Estelle v. Gamble, 429 U.S. at 104). Indications that a prisoner has a “serious” need

for medical treatment include 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, and the existence of

chronic and substantial pain. Id. at 1059-60 (citing Wood v. Housewright, 900 F.2d 1332,

1337-41 (9th Cir. 1990)).

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

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abate it. Farmer v. Brennan, 511 U.S. 825, 837 (1994) (equating standard to that of criminal

recklessness). 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, 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). 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. See McGuckin, 974 F.2d at

1060. 

1. Surgery

As noted, plaintiff complains that Dr. Zarek performed surgery inadequately in April

2002 because he did not remove all of the bullet fragments from plaintiff’s neck area. The

evidence is undisputed, however, that Dr. Zarek was unable to remove all of the fragments

because those fragments were embedded near the cervical spine and could not be seen or felt

by him. There is no evidence that such treatment was in any way medically deficient or

unreasonable. Plaintiff states that, prior to surgery, Dr. Zarek predicted all of the fragments

could be removed, a fact Dr. Zarek disputes. Assuming Dr. Zarek did make a statement to

that effect, however, such prediction is not inconsistent with his ultimate inability to do so. 

In any event, even if a reasonable doctor exercising due care would have removed all of the

fragments during surgery, Dr. Zarek’s failure to do so, in the absence of any evidence that he

acted recklessly or deliberately, would, at most, constitute negligence. Negligence does not

establish a violation of the Eighth Amendment. See Toguchi v. Chung, 391 F.3d 1051, 1060-

61 (9th Cir. 2004) (finding summary judgment in favor of defendant doctor proper where

defendant doctor’s failure to conduct differential diagnosis amounted to no more than

negligence). Plaintiff submits no evidence, nor does any such evidence appear in the records

submitted by respondent, suggesting Dr. Zarek’s failure to remove all of the bullet fragments

during surgery was either deliberate or reckless. Consequently, there is no genuine issue of

material fact as to whether Dr. Zarek was deliberately indifferent to plaintiff’s medical needs,

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Plaintiff eventually received pain medication after he was seen again in November

2002. Plaintiff does not assert, and there is no evidence indicating, that he made any further

complaint of pain to Dr. Zarek or any other SVSP official before he requested the November

2002 appointment.

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in violation of the Eighth Amendment, when he performed surgery on plaintiff.

2. Pain Medication

Plaintiff next complains that his receipt of pain medication after surgery was delayed

for nearly seven months, until November 2002. There is no evidence that this delay was

caused by or is attributable to any of the defendants, however. Liability may be imposed on

an individual defendant under section 1983 only if the plaintiff can show that the defendant

proximately caused the deprivation of the federally protected right. See Leer v. Murphy, 844

F.2d 628, 634 (9th Cir. 1988). According to plaintiff, he complained to Dr. Zarek that he

was in pain, both after surgery and again at his May 1, 2002 follow-up appointment. Plaintiff

states that Dr. Zarek ordered pain medication for him, but that he never received it. Plaintiff

asserts that Dr. Zarek “failed to make certain plaintiff received the medication by making

certain his staff did their job in getting that medication to plaintiff.” (See Opp. at 3.) There is

no evidence, however, that Dr. Zarek was required to take such additional steps. See Walker

v. Benjamin, 293 F.3d 1030, 1038 (7th Cir. 2002) (finding defendant doctor entitled to

summary judgment where plaintiff claimed he did not receive antibiotics prescribed for him

by defendant doctor, but failed to produce any evidence showing such failure was in any way

within defendant doctor’s control). Contrary to plaintiff’s characterization of prison

personnel as “his staff,” there is no evidence in the record indicating Dr. Zarek had any

authority or control over personnel responsible for delivering prescribed pain medication to

the inmates. In the absence of evidence that Dr. Zarek had any control over the distribution

of plaintiff’s medications to plaintiff, Dr. Zarek cannot be held responsible for the delay in

plaintiff’s receiving the medication Dr. Zarek had ordered.5

 Moreover, even if plaintiff had

shown the staff was under Dr. Zarek’s supervision, Dr. Zarek’s failure to check on their

performance, in the absence of any showing he was aware of any failure to provide

prescribed medications, would at most constitute negligence, and not deliberate indifference.

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The parties agree that plaintiff received the collar and pillow at some point after this

decision, but do not state, nor do the submitted records reflect, the exact date on which such

receipt occurred. 

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The other defendants, Lauber and Drs. Lee and Bowman, cannot be held responsible

for the delay in plaintiff’s receiving pain medication between the date of his surgery and

November 2002; they did not become involved in plaintiff’s care until early 2004. Plaintiff’s

medical records indicate that, as of the November 20, 2002 visit, he has been examined

regularly and prescribed a variety of pain medications. In his opposition, plaintiff argues that

defendants also must submit evidence showing plaintiff actually “signed for” this prescribed

medication. Plaintiff’s argument is not persuasive. Plaintiff does not assert, nor is there any

evidence indicating, that he failed to receive any of the pain medication prescribed for him as

of November 2002. 

Consequently, there is no genuine issue of material fact with respect to whether any of

the defendants was deliberately indifferent to plaintiff’s need for pain medication. 

3. Cervical Collar and Special Pillow 

Plaintiff also complains about the delays in his receipt of a cervical collar and special

pillow for sleeping. Plaintiff’s medical records indicate Dr. Zarek ordered the cervical collar

on December 18, 2003, and that the special pillow was ordered by a different doctor on June

6, 2004. There is no dispute that plaintiff did not receive these items until after July 28,

2004, the date the Director’s level decision was issued requiring the items be provided to

plaintiff.6

 Plaintiff attributes such delay to Drs. Lee and Bowman because, in Dr. Bowman’s

March 3, 2004 decision on plaintiff’s first level appeal, and thereafter in the April 30, 2004

decision jointly rendered by Drs. Lee and Bowman on plaintiff’s second level appeal, the

“chronos” necessary for plaintiff to possess the cervical collar and the special pillow were not

issued.

The pillow, however, had not been ordered until June 2004, long after Drs. Lee and

Bowman already had decided plaintiff’s administrative appeals. Thus, there is no evidence

that these defendants’ decisions in any way caused the delay in plaintiff’s receiving the

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pillow after it had been ordered. 

Conceivably, Drs. Lee and Bowman could have accelerated plaintiff’s receipt of a

cervical collar had they ordered, in their rulings on the administrative appeals, that the

requisite chronos be issued. In light of the substantial medical attention plaintiff did receive,

however, the delay in plaintiff’s receiving a cervical collar does not suggest, let alone

demonstrate, deliberate indifference to plaintiff’s medical needs. See, e.g., Frost v. Agnos,

152 F.3d 1124, 1130 (9th Cir. 1998) (finding no merit in claims stemming from alleged

delays in administering pain medication, treating broken nose and providing replacement

crutch, because claims did not amount to more than negligence); O’Loughlin v. Doe, 920

F.2d 614, 617 (9th Cir. 1990) (finding no constitutional violation by reason of defendants’

repeated failure to satisfy requests for aspirin and antacids to alleviate headaches, nausea and

pain; noting isolated occurrences of neglect may constitute grounds for medical malpractice

but do not rise to level of unnecessary and wanton infliction of pain). In November 2002,

after plaintiff complained of pain and requested medical attention, he was examined

repeatedly by doctors, regularly prescribed a wide variety of medication for his pain, x-rayed

twice, given an MRI, and evaluated by an outside neurosurgical consultant. The cervical

collar was prescribed primarily for comfort; there is no evidence it had any therapeutic value

with respect to plaintiff’s condition. Even for comfort, the fact the neurosurgeon’s report

makes no reference to any need for a cervical collar suggests that the collar was not

important. Given the overall amount of medical attention plaintiff received, the majority

directed exclusively to managing his pain, the failure to provide him this additional item for a

limited period of time does not establish deliberate indifference to serious medical needs. 

With respect to Lauber, plaintiff relies on Lauber’s failure to provide an interpreter to

complete an interview with plaintiff for his first level administrative appeal. There is no

evidence that the completion of this interview would have resulted in the earlier issuance of a

chrono for either the cervical collar or pillow. Even if the lack of interview, in some manner,

had delayed plaintiff’s receipt of the collar, for the reasons discussed above with respect to

Drs. Lee and Bowman, no genuine issue of material fact exists as to whether the subject

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delay rises to the level of an Eighth Amendment violation. 

4. Second surgery 

Plaintiff also complains about Dr. Zarek’s failure to perform or recommend a second

surgery to remove the remaining fragments. “A difference of opinion between a prisonerpatient 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); see also Toguchi, 391 F.3d

at 1058, 1059-60 (holding difference of opinion among medical professionals as to need to

pursue one course of treatment over another insufficient, as matter of law, to establish

deliberate indifference). There is no evidence in the record to support a finding that a second

surgery is medically necessary. None of the numerous doctors who have examined plaintiff,

including the independent specialist in neurosurgery, have recommended such surgery. 

Indeed, that neurosurgeon opined that nothing more could be done for plaintiff other than to

give him pain medication and a special pillow for sleeping. Plaintiff’s own opinion that he

needs a second surgery does not suffice to raise a genuine issue of material fact as to whether

the failure to provide a second surgery constitutes deliberate indifference to his medical

needs.

Although plaintiff contends a radiology report by David Staunton, M.D., dated

July 21, 2003, indicates a need for more surgery, that report merely confirms that some bullet

fragments remain, that a larger fragment had been removed, and that plaintiff has no cervical

spine injury. The report does not mention, let alone recommend, surgery. Plaintiff also

argues the report establishes that Dr. Zarek is a “liar,” because the report only mentions one

large bullet fragment as having been removed, whereas Dr. Zarek’s report states that three

bullet fragments were removed, specifically, one large fragment and two smaller fragments. 

Plaintiff mischaracterizes the content of Dr. Staunton’s July 2003 radiology report. The

language in question is a comparison of Dr. Staunton’s current radiological findings with the

findings made in his preoperative report, and simply notes the current absence of the large

fragment that was observed before plaintiff’s surgery as well as the fact that some small

fragments are still present. The report does not purport to count those fragments, let alone to

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compare the number of small fragments seen before the surgery with the number seen after. 

Indeed, neither Dr. Staunton’s pre-operative report nor his post-operative report describes the

smaller fragments as other than “tiny” and “multiple.”

In any event, as noted, neither that report or any other medical evidence suggests plaintiff

requires a second surgery.

In sum, plaintiff has failed to raise a genuine issue of material fact either as to whether

he needs a second surgery, or as to whether Dr. Zarek’s refusal to perform such surgery

violated his Eighth Amendment rights.

CONCLUSION

For the foregoing reasons, defendants’ motions for summary judgment are

GRANTED. Plaintiff’s motion to amend his cross-motion for summary judgment is

GRANTED and plaintiff’s cross-motion for summary judgment is DENIED.

This order terminates Docket Nos. 30, 41, 50 and 51. 

The Clerk shall close the file.

 IT IS SO ORDERED.

DATED: March 16, 2006 _________________________

MAXINE M. CHESNEY

United States District Judge

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