Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_15-cv-01576/USCOURTS-cand-3_15-cv-01576-1/pdf.json

Parties Involved:
Billy Ballinger
Plaintiff
Darin Bright
Defendant
Greg Ellis
Defendant
J. Lewis
Defendant

Document Text:

United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

BILLY BALLINGER,

Plaintiff, 

 v.

DARIN BRIGHT; GREG ELLIS; J.

LEWIS;

Defendants.

/

No. C 15-1576 WHA (PR) 

ORDER GRANTING DEFENDANTS’

MOTION FOR SUMMARY

JUDGMENT

(Docket No. 11)

INTRODUCTION

This is a civil rights action filed under 42 U.S.C. 1983 by a pro se prisoner at Avenal

State Prison. Plaintiff claims that defendants Dr. Darin Bright, Greg Ellis, and J. Lewis, who

are prison officials, violated his Eighth Amendment rights when he was housed at the California

Training Facility (“CTF”) by being deliberately indifferent to his knee condition. Defendants

move for summary judgment, plaintiff has opposed the motion, and defendants have replied. 

For the reasons set out below, defendants’ motion is GRANTED.

STATEMENT

The following facts are not in dispute, unless otherwise noted. 

Plaintiff suffers from extensive degenerative joint disease in his left knee, and he also

has a discrepancy in his leg length. In 2007, plaintiff received an M.R.I. for his knee and in

May 2008 he underwent arthroscopic surgery. Since that surgery, he has continued to

experience locking, buckling, spasms and instability in his knee that causes him severe pain. 

He has received steroid injections, narcotic and non-narcotic pain medication, a hinged knee

brace and a cane, custom orthotic boots, and enrolled in the CTF Chronic Care Program (under

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which prisoners are closely monitored for changes in their medical condition) (Custodian of

Records (“COR”) Decl. CCHCS-000011; Bright Decl. ¶ 14). Plaintiff is morbidly obese (COR

Decl. CCHSC-000011).

In September 2014, plaintiff filed an administrative appeal at CTF requesting to be seen

by a podiatrist, an orthopedic specialist for knee replacement surgery (id. CCHCS-000006). In

the appeal he explained his condition, the surgery, and his continuing symptoms (ibid.). He

further stated that the knee brace and medications he was provided were alleviating the pain

(ibid.) In response, he was seen by Dr. Tarrar, a primary care physician and surgeon (id.

CCHCS-000008). He was advised to lose weight and exercise to alleviate his knee pain, his

request to see an orthopedic specialist for knee replacement surgery was denied, and he was

referred to a podiatrist to address his leg-length disparity (ibid).

Plaintiff appealed this decision to the second level of review, reiterating his requests and

complaints, and adding a request for a new M.R.I. examination (id. CCHCS-000005). He

further stated that the brace and pain medication are the “reason” he can work (ibid.) at his job

in the kitchen. The appeal was denied at the second level by defendant Dr. Bright, the Chief

Medical Executive at CTF, and S. Camara, whom defendant Ellis, the CTF Chief Executive

Officer, designated to act on his behalf because Ellis was absent (id. CCHCS-000010-11; Ellis

Decl. ¶¶ 6-7). Dr. Bright found that an orthopedist would not help because a second surgery

would not have a better outcome than the unsuccessful first surgery, plaintiff is morbidly obese

and requires weight loss to address his knee pain, and plaintiff is able to walk to and from the

yard and the mess hall (COR Decl. CCHCS-000011; Bright Decl. ¶ 14). Dr. Bright in his

declaration further explains that his reasoning was based on the fact that steroids had not

relieved the pain, plaintiff was provided narcotic and non-narcotic pain medication, a cane, a

hinged knee brace, had a job in the prison kitchen, declined a lower bunk, and enrolled in the

CTF Chronic Care Program (ibid.). Dr. Bright advised plaintiff that he could improve his knee

problems by losing weight and strengthening his leg with exercise (COR Decl. CCHSC000011). Dr. Bright also denied the referral to a podiatrist because a podiatrist does not treat

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leg length disparities or knee conditions, and instead recommended that plaintiff’s primary care

physician order orthotics for the problem (ibid.).

In December 2014, petitioner appealed this decision to third and final level of review

where it was denied by R. Robinson, a designee of defendant Lewis, who is the Deputy Director

with the California Correctional Health Care Services and responsible for reviewing

administrative appeals at the third level of review (COR Decl. CCHCS-000003). Lewis states

that he receives too many appeals to review and decide them all within the legal deadline 

denied plaintiff’s administrative appeal. (Lewis Decl. ¶¶ 2, 4-5). In this appeal, plaintiff stated

that the “hardly” goes to the yard because of the knee pain, and that he feels pain while he

works (COR Decl. CCHCS-00005). His appeal was denied on the grounds that he was

evaluated by doctors, and receiving the medically necessary treatment for his condition (id.

CCHCS-000003). On January 8, 2015, Dr. Tarrar, submitted a “Physician Request for

Services” (“RFS”) form to defendant Dr. Bright requesting an updated M.R.I. of plaintiff’s left

knee (Compl. 3b-3c). Dr. Bright denied the request on January 20, 2015 (Bright Decl. ¶ 3 n.1).

Plaintiff received custom boots from the orthotics department, and he has not

complained about their functionality (Bright Decl. ¶ 13). 

Plaintiff claims that defendants violated the Eighth Amendment and were deliberately

indifferent to his serious medical needs. 

ANALYSIS

A. STANDARD OF REVIEW

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

there is "no genuine issue as to any material fact and that the moving party is entitled to

judgment as a matter of law." Fed. R. Civ. P. 56(c). Material facts are those which may affect

the outcome of the case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242,248 (1986). A dispute

as to a material fact is genuine if there is sufficient evidence for a reasonable jury to return a

verdict for the nonmoving party.

The moving party for summary judgment bears the initial burden of identifying those

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portions of the pleadings, discovery and affidavits which demonstrate the absence of a genuine

issue of material fact. Celotex Corp.v. Cattrett, 477 U.S. 317, 323 (1986). When the moving

party has met this burden of production, the nonmoving party must go beyond the pleadings

and, by its own affidavits or discovery, set forth specific facts showing that there is a genuine

issue for trial. If the nonmoving party fails to produce enough evidence to show a genuine issue

of material fact, the moving party wins. Ibid.

B. ANALYSIS

The parties agree that defendants Lewis and Ellis had no personal involvement in

plaintiff’s medical care, and plaintiff requests that the claims against them be dismissed. 

Plaintiff claims, however, that Dr. Bright was deliberately indifferent to his serious medical

needs in violation of the Eighth Amendment. Deliberate indifference to a prisoner's serious

medical needs violates the Eighth Amendment's proscription against cruel and unusual

punishment. Estelle v. Gamble, 429 U.S. 97, 104 (1976). 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. See ibid. 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). Neither negligence

nor gross negligence will constitute deliberate indifference. Id. at 835-36 & n.4.

There is no dispute that plaintiff suffers from a degenerative and painful knee condition. 

There is also no dispute that plaintiff has received a wide array of medical treatment, including

surgery, steroids, narcotic and non-narcotic pain medication, a hinged knee brace, and a cane,

and that he has been offered a lower bunk and is a prison program that monitors inmates closely

for changes in their medical condition. Plaintiff disagrees, however, with Dr. Bright’s opinion

as to the proper course of treatment for plaintiff’s condition. In Dr. Bright’s opinion, an

examination by an orthopedic specialist for knee replacement surgery and a new M.R.I. are not

medically necessary because in light of plaintiff’s morbid obesity the knee pain and immobility

need to be addressed by weight loss and exercise, and another surgery would not help. Plaintiff

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believes that the proper course of treatment is for him to get a new M.R.I. examination and to be

seen by an orthopedic specialist for knee replacement surgery. 

"A difference of opinion between a prisoner-patient and prison medical authorities

regarding treatment does not give rise to a § 1983 claim." Franklin v. Oregon, 662 F.2d 1337,

1344 (9th Cir. 1981). Similarly, a showing of nothing more than a difference of medical

opinion as to the need to pursue one course of treatment over another is insufficient, as a matter

of law, to establish deliberate indifference. Toguchi v. Chung, 391 F.3d 1051, 1058-60. In

order to prevail on a claim involving choices between alternative courses of treatment, a

plaintiff must show that the course of treatment the doctors 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. Id. at 1058.

There is no evidence from which a reasonable fact-finder could that the course of

treatment Dr. Bright’s chose was medically unacceptable under the circumstances. In light of

plaintiff’s obesity, Dr. Bright’s opinion that he should address his knee pain and mobility with

weight loss and exercise is not only sensible but corroborated by the doctor who examined him,

Dr. Tarrar. Plaintiff complains that he cannot properly straighten and exercise his leg, but he

has not shown that there are no exercises that he could perform after losing weight or that he

cannot lose weight. There is also no evidence that Dr. Bright’s recommendation of orthotics to

treat the disparity in plaintiff’s leg lengths was medically unacceptable. Plaintiff wants knee

replacement surgery, and to that end he sought an M.R.I. and examination by an orthopedic

specialist. However, there is no evidence that such a course of treatment was medically

necessary, or even medically preferable to the course recommended by Dr. Bright of weight

loss, exercise and orthotics. The only evidence as to the medical benefit of a second surgery for

plaintiff is Dr. Bright’s medical opinion that a second surgery would not help, and consequently

neither would an M.R.I. or referral to an orthopedic specialist. Dr. Bright explains that

plaintiff’s condition of osteoarthritis is properly monitored by x-rays, whereas an M.R.I. would

be a precursor to surgery (Bright Decl. ¶ 3 n.1). Plaintiff speculates that if he was allowed to

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see an orthopedic specialist he would get a recommendation for a knee replacement surgery, but

such speculation is not supported by any evidence.

There is no evidence that Dr. Bright’s choice of weight loss, exercise and orthotics for

plaintiff’s condition, and his rejection of an M.R.I., an orthopedic specialist, and surgery was

medically unacceptable in the context of the failed prior surgery, plaintiff’s excessive weight,

and the pain medication and other treatments and accommodations plaintiff was given. 

Consequently, there is no triable factual issue as to whether Dr. Bright was deliberately

indifferent to plaintiff’s medical needs. Accordingly, Dr. Bright is also entitled to summary

judgment on plaintiff’s Eighth Amendment claims. Defendants’ alternate arguments based on

exhaustion and mootness need not be addressed. 

CONCLUSION

Defendants’ motion for summary judgment is GRANTED. The clerk shall enter

judgment and close the file.

IT IS SO ORDERED.

Dated: June 15 , 2016. 

WILLIAM ALSUP

UNITED STATES DISTRICT JUDGE

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