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WO JDN

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT 

OF ARIZONA

Lee Michael Beitman,

Plaintiff, 

vs. 

Correct Care Solutions, et al.,

Defendants.

No. CV 17-08229-PCT-JAT (DMF)

ORDER

Plaintiff Lee Michael Beitman, who is confined in the Arizona State Prison 

Complex-Florence, South Unit, brought this pro se civil rights action under 42 U.S.C. 

§ 1983 against Correct Care Solutions (CCS) and multiple individual medical personnel:

Dr. Martin Gruenberg; Dr. D. Schmit; Nurse Practitioner (NP) Stephanie Herrick; NP 

Dorothy Igwe; NP Betty Hahn; and Nurse Amber Norton. (Doc. 35.)1 Before the Court 

are Beitman’s Motion for Injunctive Relief, Motion for Order, and Motion for 

Restraining Order with Injunctive Relief. (Docs. 41, 44, 49.)2 The Court will deny 

Beitman’s Motions. 

1 CCS is the private medical provider contracted to provide medical services at the 

Central Arizona Correctional Facility, a private prison in Florence, Arizona that is 

operated by the GEO Group. 

2 Also before the Court are Beitman’s Motion for Order to Show Cause (Doc. 78), 

Motion for Default Judgment (Doc. 79), and Motions for Extension of Time for Service 

and for Discovery (Docs. 85–86). These Motions will be addressed in separate orders. 

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I. Background

In Count One of his Third Amended Complaint, Beitman alleged that in February 

2016, while he was housed at the GEO private prison in Kingman Arizona, he was 

assaulted by another prisoner and punched in the side of the face, which caused him to 

suffer a displaced jaw, a pushed-in cheek bone, and severe pain. (Doc. 35 at 4.) Beitman 

alleged that Dr. Schmit and NP Herrick failed to provide adequate treatment for his 

injuries and were deliberately indifferent to his serious medical need, and Beitman further 

alleged that CCS had customs, policies, and practices to ignore health needs requests; to 

falsify medical records and keep incomplete records; and to deny specialist care, medical 

procedures, and medications in part to save money. (Id. at 7–8.) 

In Count Two, Beitman alleged that for years he was denied proper medication 

and proper medication dosages to treat his low testosterone levels despite lab tests and 

prior medical records confirming his low testosterone levels. (Id. at 9–11.) Beitman

alleged that Nurse Norton, Dr. Gruenberg, and then NP Igwe and NP Hahn, all failed to 

properly treat his hormone condition, and, consequently, Beitman’s suffered secondary 

problems including pain, cramping, and spine deterioration. (Id. at 10–11.) 

In October 2019, Beitman filed a Motion for Injunctive Relief, which alleges that 

medical staff and Arizona Department of Corrections (ADC) staff have intimated that 

because Beitman filed this lawsuit, he should not be housed in the Florence South Unit, 

and Beitman seeks an order to prevent his transfer out of the South Unit. (Doc. 41.) On 

November 13, 2019, after Defendants failed to respond to his injunction request, Beitman 

filed his Motion for Order of Preliminary Injunction, asking the Court to grant his prior 

Motion. (Doc. 44.)

On December 4, 2019, Beitman filed a Motion for Restraining Order with 

Injunctive Relief, which seeks specific medical treatment related to his low testosterone 

condition. (Doc. 49.) 

II. Preliminary Injunction Standard 

“A preliminary injunction is ‘an extraordinary and drastic remedy, one that should 

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not be granted unless the movant, by a clear showing, carries the burden of persuasion.’” 

Lopez v. Brewer, 680 F.3d 1068, 1072 (9th Cir. 2012) (quoting Mazurek v. Armstrong, 

520 U.S. 968, 972 (1997) (per curiam)); see also Winter v. Natural Res. Def. Council, 

Inc., 555 U.S. 7, 24 (2008) (citation omitted) (“[a] preliminary injunction is an 

extraordinary remedy never awarded as of right”). A plaintiff seeking a preliminary 

injunction must show that (1) he is likely to succeed on the merits, (2) he is likely to 

suffer irreparable harm without an injunction, (3) the balance of equities tips in his favor, 

and (4) an injunction is in the public interest. Winter, 555 U.S. at 20. “But if a plaintiff 

can only show that there are ‘serious questions going to the merits’—a lesser showing 

than likelihood of success on the merits—then a preliminary injunction may still issue if 

the ‘balance of hardships tips sharply in the plaintiff’s favor,’ and the other two Winter

factors are satisfied.” Shell Offshore, Inc. v. Greenpeace, Inc., 709 F.3d 1281, 1291 (9th 

Cir. 2013) (quoting Alliance for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1135 (9th 

Cir. 2011)). Under this “serious questions” version of the sliding-scale test, the elements 

of the preliminary injunction test are balanced, so that a stronger showing of one element 

may offset a weaker showing of another. See Alliance for the Wild Rockies, 632 F.3d at 

1135.

Regardless of which standard applies, the movant “has the burden of proof on each 

element of the test.” See Envtl. Council of Sacramento v. Slater, 184 F. Supp. 2d 1016, 

1027 (E.D. Cal. 2000). Further, there is a heightened burden where a plaintiff seeks a 

mandatory preliminary injunction, which should not be granted “unless the facts and law 

clearly favor the plaintiff.” Comm. of Cent. Am. Refugees v. I.N.S., 795 F.2d 1434, 1441 

(9th Cir. 1986) (citation omitted).

The Prison Litigation Reform Act imposes additional requirements on prisoner 

litigants who seek preliminary injunctive relief against prison officials and requires that 

any injunctive relief be narrowly drawn and the least intrusive means necessary to correct 

the harm. 18 U.S.C. § 3626(a)(2); see Gilmore v. People of the State of Cal., 220 F.3d 

987, 999 (9th Cir. 2000).

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“The urgency of obtaining a preliminary injunction necessitates a prompt 

determination” and makes it difficult for a party to procure supporting evidence in a form 

that would be admissible at trial. Flynt Distrib. Co. v. Harvey, 734 F.2d 1389, 1394 (9th 

Cir. 1984). As a result, “a preliminary injunction is customarily granted on the basis of 

procedures that are less formal and evidence that is less complete than in a trial on the 

merits.” Univ. of Texas v. Camenisch, 451 U.S. 390, 395 (1981). In addressing a motion 

for preliminary injunction, a court may consider evidence or developments that postdate 

the pleadings. Farmer v. Brennan, 511 U.S. 825, 846 (1994).

When evaluating the merits of a preliminary injunction motion, a court’s factual 

findings and legal conclusions are not binding at trial on the merits. Camenisch, 451 U.S. 

at 395.

III. Motion for Injunctive Relief to Prevent Transfer/Motion for Order

In his Motion for Injunctive Relief, filed on October 18, 2019, Beitman states that 

he was advised by ADC security staff and Florence South health unit employees that his 

filing of this lawsuit is causing “disharmony” within the health unit and among ADC 

officials. (Doc. 41 at 1.) Beitman fears that he will be relocated to a different South Unit 

facility, even though the other facilities house high risk and violent prisoners, which 

would present a risk of harm to Beitman’s safety. (Id. at 1–2.) He requests an order 

preventing his transfer out of the Florence South Unit. (Id. at 2.) Defendants did not 

respond to the Motion.

“When a plaintiff seeks injunctive relief based on claims not pled in the 

complaint, the court does not have the authority to issue an injunction.” Pacific 

Radiation Oncology, LLC v. Queen’s Med. Center, 810 F.3d 631, 633 (9th Cir. 2015). A 

court should not grant an injunction “when the injunction in question is not of the same 

character, and deals with a matter lying wholly outside the issues in the suit.” Kaimowitz 

v. Orlando, 122 F.3d 41, 43 (11th Cir. 1997). Here, Beitman’s injunction request to 

prevent a retaliatory transfer is unrelated to the basis of his underlying § 1983 claims—

Eighth Amendment medical care claims. As such, an injunction is not appropriate. 

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Even if the Court could properly entertain Beitman’s request for a preliminary 

injunction, he has failed to present any evidence that a transfer is likely. Speculative 

injury is not irreparable injury sufficient for a preliminary injunction. Caribbean Marine 

Servs. Co. v. Baldrige, 844 F.2d 668, 674 (9th Cir. 1988). 

Accordingly, Beitman’s Motion for Injunctive Relief and Motion for Order, which 

asks the Court to grant the Motion for Injunctive Relief, will be denied. 

IV. Motion for Retraining Order with Injunctive Relief

In this Motion, Beitman alleges that NP Hahn is not properly treating Beitman’s 

hormone/low testosterone condition. (Doc. 49.) Beitman seeks an order to restrain NP 

Hahn from seeing and treating Beitman; an order for Hahn’s employer—Centurion––to 

schedule a telemed appointment with Dr. Sharon Kary, who had previously ordered lab 

tests for Beitman; and an order to refer Beitman to his outside physician, Dr. Paul 

Stallone, or to an independent endocrinologist. (Id.) NP Hahn opposes the Motion and 

argues that she is not in a position to provide injunctive relief; that there is no evidence 

Beitman has been denied appropriate medical care; and that Beitman cannot satisfy any 

of the Winter factors necessary to support an injunction. (Doc. 60.)

A. Proper Defendant for Injunctive Relief 

NP Hahn states that she is not able to make determinations regarding injunctive 

relief and she is named only in her individual capacity. (Doc. 60 at 2.) NP Hahn 

explains that she is an employee of Centurion, which took over as the contracted 

healthcare provider in July 2019. (Id. at 1.)

Under Federal Rule of Civil Procedure 20, “[p]ersons . . . may be joined in one 

action as defendants if:

(A) they assert any right to relief against them jointly, 

severally, or in the alternative with respect to or arising out of 

the same transaction, occurrence, or series of transactions or 

occurrences; and

(B) any question of law or fact common to all defendants will 

arise in the action.

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Fed. R. Civ. P. 20(a)(2). Rule 20 “is to be construed liberally in order to promote trial

convenience and to expedite the final determination of disputes.” League to Save Lake

Tahoe v. Tahoe Reg’l Planning Agency, 558 F.2d 916, 917 (9th Cir. 1977). Other 

Federal Rules of Civil Procedure also promote the addition of parties when necessary.

Rule 21 provides that a court may, on its own initiative and at any time, on just terms, 

add a party. And Rule 19 provides that a party must be joined where that party’s absence 

renders the Court unable to afford complete relief among the existing parties. Fed. R. 

Civ. P. 19(a)(1)(A). 

In his Third Amended Complaint, Beitman requested injunctive relief in the form 

of medical treatment to repair injuries to his face (relevant to the Count One claim) and 

medical treatment for spine injuries caused by the denial of adequate medication for his 

low testosterone and hormone levels (relevant to the Count Two claim). (Doc. 35 at 9, 

15.) Beitman’s pending Motion requests injunctive relief in the form of adequate 

treatment for his low testosterone, and he requests that Centurion provide specific 

injunctive relief. (Doc. 49.) The Court considers this request for injunctive relief to be 

related to his Count Two claim. See Erickson v. Pardus, 5551 U.S. 89, 94 (2007) (a pro 

se litigant may “bolster[] his claim by making more specific allegations . . . in later 

filings”); Alvarez v. Hill, 518 F.3d 1152, 1158 (9th Cir. 2008) (district courts are required 

to afford a pro se litigant “‘the benefit of any doubt’ in ascertaining what claims he 

‘raised in his complaint and argued to the district court’”). Centurion is the appropriate 

Defendant to provide the injunctive relief requested in both Counts One and Two. Thus, 

the addition of Centurion as a party satisfies the permissive joinder requirements of the 

Federal Rules of Civil Procedure. Accordingly, Centurion will be added as a Defendant. 

B. Relevant Facts3

3

In support of her opposition to Beitman’s Motion, NP Hahn submits excerpts of 

Beitman’s medical records from July 2019–December 2019, and the declaration of Dr. 

Wendy Orm, Statewide Medical Director for Centurion. (Doc. 60, Exs. A–B.) Dr. Orm 

did not treat Beitman; she avers that her declaration is based on a review of Beitman’s 

medical records. (Id., Ex. B, Orm Decl. ¶ 4 (Doc. 60-2 at 2).) Dr. Orm’s declaration 

includes statements regarding Beitman’s treatment, medical interactions, and lab results 

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Beitman has received hormone replacement therapy since 1987 due to pituitary 

trauma suffered in an accident. (Doc. 50, Beitman Decl. ¶ 3.) Prior to his incarceration, 

Beitman was treated by Scottsdale physician Dr. Paul Stallone, a specialist in hormone 

replacement therapy. (Id. ¶ 6.) Dr. Stallone diagnosed Beitman with pituitary trauma and 

treated Beitman with testosterone cypionate; micronized DHEA; humatropin (growth 

hormone); and sermorelin (growth hormone-releasing hormone). (Id. ¶ 9.) The ADC 

medical records show that Beitman is diagnosed with, among other conditions, 

hypothyroidism (underactive thyroid), testicular hypofunction (declining/low 

testosterone), and “unspecified injury of head.” (Doc. 60-1 at 3–4.) 

Beitman was first prescribed testosterone by an ADC provider in January 2018, 

when lab results showed that his free testosterone was “Below Low Normal.” (Doc. 77 at 

47.) According to Beitman, he had not been prescribed testosterone for four years prior 

to this time because ADC failed to properly test his active/free testosterone level. (Id. at 

5.) During those four years Beitman did not receive proper hormone medication and 

testosterone replacement, and he suffered testicular atrophy and torn muscles and 

connective tissue that led to disc deterioration in his lower spine. (Doc. 35 at 9.)

In February 2019, lab results showed that Beitman’s free testosterone level was 

“Below Low Normal.” (Doc. 49 at 20.) 

On April 11, 2019, Beitman saw NP Hahn for a chronic care appointment. (Doc. 

77 at 34.) NP Hahn noted in the medical record that Beitman’s “labs have been good, 

in 2017 and 2018; however, there are no attached medical records or lab results from 

those years. (See id. ¶¶ 8–13, 19.) Dr. Orm’s declaration also includes statements 

regarding Beitman’s treatment in 2019; however, there are no citations to specific 

medical records that purportedly support her statements, and a review of the attached 

medical records shows that some of her averments are not supported by any of attached 

documents, which—as stated—are only excerpts. (See e.g., id. ¶¶ 16–17.) This is 

insufficient. See Corbin v. Ryan, No. 09-2677-PHX-JAT (LOA), 2010 WL 3327717, at 

*2 (D. Ariz. Aug. 24, 2010) (in addressing a motion for preliminary injunction seeking

medical equipment, finding that the nurse’s declaration submitted by the defendants was 

not admissible because the nurse did not demonstrate personal knowledge, there were no 

medical records attached to the declaration, and most of the declaration statements 

constituted hearsay). Therefore, the Court has relied directly on medical records 

submitted by the parties, which includes some 2017 and 2018 medical records submitted 

by Beitman.

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including his Testosterone levels.” (Id.) At this encounter, Beitman’s weight was 

documented at 206 pounds. (Id.) 

In July 2019, Beitman was being prescribed testosterone cypionate injections 

every two weeks, and levothyroxine tablets (thyroid medication) every night. (Doc. 60-1 

at 73.) On July 11, 2019, NP Hahn entered a medical note documenting that Beitman 

requested to receive the testosterone injections weekly and to have the thyroid medication 

decreased. (Id. at 72.) NP Hahn noted that labs were needed; testosterone injections will 

stay biweekly; Beitman’s testosterone level will be obtained; and TSH (thyroid 

stimulating hormone) will be checked and medication changed according to labs. (Id.) 

NP Hahn ordered a free testosterone lab test and a TSH lab test. (Id. at 72–73.) 

On July 21, 2019, labs and a diagnostic panel were ordered. (Doc. 60-1 at 79–81.) 

The lab results, received at 6:30 a.m. on July 26, 2019, reported that Beitman’s 

free testosterone was 4.0, which was “Below Lower Panic Levels.” (Doc. 49 at 19.) The 

normal range/reference for free testosterone is 7.2–24.0. (Id. at 17.) 

On July 26, 2019, at 9:30 a.m., Beitman saw NP Hahn for a chronic care 

appointment. (Doc. 60-1 at 67.) According to NP Hahn’s notes, Beitman requested that 

his thyroid medication be decreased, and he stated that he does not take the thyroid 

medication because it is an unhealthy alternative for him as he used to be on more natural 

supplements. (Id.) NP Hahn explained to Beitman that natural remedies are not offered 

in prison and she would not decrease his thyroid medication because it regulates every 

organ in the body. (Id.) NP Hahn noted that there would be no changes to medications. 

(Id. at 70.) There is no mention in the medical record of Beitman’s lab results showing 

low testosterone levels. (See id. at 67–71.)

On October 21, 2019, Beitman had a chronic care appointment via a telemed 

encounter with NP Sharon Kary. (Id. at 59.) Beitman reported his history of pituitary 

trauma and affected hormone levels. (Id.) NP Kary noted that Beitman stopped taking 

thyroid medication in June 2019 and wishes to take homeopathic medication. (Id.) A 

diagnostic panel and free testosterone labs were ordered, and NP Kary explained the 

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importance of taking his thyroid medication. (Id. at 62.) A chronic care visit was 

planned in three months. (Id. at 63.) 

On October 29, 2019, Beitman had a blood draw for labs, and the results showed 

that his testosterone was 2.3, which was “Below Low Normal.” (Doc. 49 at 17.)

On November 12, 2019, Beitman submitted an Inmate Letter stating that he had 

seen the telemed practitioner on October 21, 2019, and the practitioner was concerned 

about Beitman’s weight loss, low free testosterone level, and other complications. (Id. at 

7.) Beitman wrote that he received the October 29, 2019 lab results indicating that his 

free testosterone was at just 2.3, despite his regular testosterone injections. (Id.) Beitman 

wrote that he is having more problems with cramping and tearing of tissue. (Id.) 

Beitman explained his concern that NP Hahn cannot be impartial or objective when 

treating him because she is a defendant in his civil rights lawsuit, and he requested that 

his lab results be sent to the telemed provider and he be scheduled for follow up with the 

telemed provider. (Id.) 

On November 19, 2019, the Director of Nursing, M. Diaz, responded to Beitman’s 

Inmate Letter. (Id. at 8.) Nurse Diaz informed Beitman that he was scheduled to see the 

provider who ordered the testosterone labs—referring to the telemed provider. (Id.) 

On November 26, 2019, Beitman received a second response to his Inmate Letter 

from Dr. David Robertson, the Medical Program Manager. (Doc. 77 at 65.) Dr. 

Robertson informed Beitman that he received Beitman’s letter regarding declining 

testosterone values and concerns over receiving appropriate care. (Id.) Dr. Robertson 

informed Beitman that he can advocate for patient needs when he feels it is appropriate, 

and that he had forwarded Beitman’s letter to the Medical Director of Centurion and 

expects her to look into the matter and discuss it with Beitman’s practitioner. (Id.) 

Also on November 26, 2019, Beitman went to medical for his telemed 

appointment, but when he arrived, he learned that there was no telemed appointment. 

(Doc. 49 at 3.) Beitman then spoke to Nurse Diaz, who informed Beitman that he was 

going to see NP Hahn instead. (Id.; Doc. 50, Beitman Decl. ¶ 21.) At the encounter with 

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NP Hahn, Beitman reported that he felt like he had lost weight and had fatigue. (Doc. 60-

1 at 7.) His weight was documented at 142 pounds. (Id. at 8.) According to NP Hahn’s 

notes, Beitman stated that he did not feel the effects of his last testosterone injection, and 

he reported that prior to incarceration, he received weekly testosterone from a 

naturopathic physician. (Id at 7.) NP Hahn threatened Beitman that she would take away 

his testosterone if he did not have another lab to test his TSH level and take the thyroid 

medication at the “watch and swallow” window every day. (Doc. 50, Beitman Decl. 

¶ 24.) NP Hahn noted in the record that although Beitman stated that he quit taking his 

thyroid medication in June, his TSH results were normal, but his testosterone level was 

low. (Doc. 60-1 at 7.) NP Hahn wrote that she consulted with the Regional Medical 

Director, who advised that the thyroid medication was to be made DOT—directly 

observed therapy (i.e., “watch and swallow”)—and not to administer testosterone if 

Beitman does not take the thyroid medication. (Id.) NP Hahn also noted that Beitman’s 

records did not include history of pituitary tumor, but that the issue will be explored, and 

labs and an MRI will be done. (Id.) NP Hahn wrote that based on the MRI results, if 

indicated, an endocrine follow up will be sent. (Id.) NP Hahn ordered lab tests, and they 

were scheduled for December 6, 2019. (Id. at 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 

53.) NP Hahn also submitted a consult request for an MRI, priority “urgent,” and the 

medical record shows that the request was authorized. (Doc. 77 at 30.) The lab results 

and MRI results were not submitted. 

At some point after the November 26, 2019 encounter, Beitman stopped seeing NP 

Hahn, and since he has been treated by a different provider, he has been prescribed 

Nature-Throid, an all-natural hormone replacement medication. (Doc. 77 at 9, 44.)

C. Discussion

1. Likelihood of Success/Serious Questions 

To establish a likelihood of success on the merits of an Eighth Amendment 

medical care claim, a prisoner must demonstrate “deliberate indifference to serious 

medical needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (citing Estelle v. 

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Gamble, 429 U.S. 97, 104 (1976)). The prisoner must show (1) that his condition 

constitutes a “serious medical need” and (2) that the defendant’s response to that need 

was deliberately indifferent. Jett, 439 F.3d at 1096. 

a. Serious Medical Need

Examples of indications that a prisoner has a serious medical need include “[t]he 

existence of an injury that a reasonable doctor or patient would find important and worthy 

of comment or treatment; the presence of a medical condition that significantly affects an 

individual’s daily activities; or the existence of chronic and substantial pain.” McGuckin 

v. Smith, 974 F.2d 1050, 1059–60 (9th Cir. 1992), overruled on other grounds, WMX 

Techs., Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997). 

NP Hahn argues that there is no evidence that Beitman is suffering from a serious 

medical need at this time. (Doc. 60 at 9.) NP Hahn also maintains that testosterone 

hormone replacement is an elective and very expensive treatment and there are no risks to 

health if it is not given, and that such treatment is unnecessary unless a man has been 

castrated because of testicular cancer. (Id. at 7–8.) The evidence shows, however, that 

Beitman’s pituitary trauma and low testosterone conditions have been diagnosed and 

worthy of treatment including medication, injections, regular testing and monitoring, an 

order for an MRI, and intervention by the Medical Program Manager and Centurion’s 

Medical Director. Beitman avers that without proper hormone medication adjustments he 

has suffered extreme weight loss, muscle cramps, torn tissue, deteriorated discs, and 

testicular atrophy. (Doc. 50, Beitman Decl. ¶ 25; Doc. 35 at 9.) The available medical 

records document a 64-pound weight loss from April to November 2019. (Doc. 60-1 at 

8; Doc. 77 at 34.) This record supports the finding of a serious medical need; thus, 

Beitman satisfies the objective prong of the deliberate indifference analysis. 

b. Deliberate Indifference

With respect to the second prong, a plaintiff must first show that the defendant 

was “subjectively aware of the serious medical need[.]” Simmons v. Navajo Cnty., Ariz., 

609 F.3d 1011, 1017–18 (9th Cir. 2010) (quotation and citation omitted). Then, the 

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plaintiff mush show (a) a purposeful act or failure to respond to a prisoner’s pain or 

possible medical need and (b) harm caused by the indifference. Jett, 439 F.3d at 1096. A 

plaintiff may meet the harm requirement by demonstrating that the defendant’s actions or 

policies expose the prisoner to a “substantial risk for serious harm.” Parsons v. Ryan, 

754 F.3d 657, 677 (9th Cir. 2014). A plaintiff need not “await a tragic event” before 

seeking a remedy. Farmer, 511 U.S. at 828. 

A defendant’s knowledge of a serious medical need or substantial risk to health “is 

a question of fact subject to demonstration in the usual ways, including inference from 

circumstantial evidence,” and a defendant may be found to have known of a substantial 

risk if the risk was obvious. Farmer, 511 U.S. at 842. There can be no dispute that NP 

Hahn and Centurion medical staff are aware of Beitman’s diagnosed condition and 

serious medical need because it is documented in his medical records, and those records 

document that Beitman has been treated for years for low testosterone. Further, the 

medical records show that in the last year, Beitman’s testosterone levels have consistently 

tested below low normal or “below lower panic levels,” and he has lost a significant 

amount of weight. (Doc. 49 at 17, 19–20; Doc. 60-1 at 8; Doc. 77 at 34.) Beitman also 

submits evidence that he has used the grievance process to notify medical staff and 

administrators of his low testosterone levels and need for adequate treatment. (Doc. 49 at 

7, 9; Doc. 50, Beitman Decl. ¶ 14.) This evidence is sufficient to demonstrate that 

medical staff are aware that Beitman suffers low testosterone levels and that he seeks 

adequate treatment. 

After showing that a defendant was subjectively aware of a serious medical need, 

a plaintiff must show that the defendant “failed to adequately respond” to that need. 

Simmons, 609 F.3d at 1018. Prison officials are deliberately indifferent to a prisoner’s 

serious medical needs when they deny, delay, or intentionally interfere with medical 

treatment.” Hallett v. Morgan, 296 F.3d 732, 744 (9th Cir.2002) (internal citations and 

quotation marks omitted). Deliberate indifference may also be shown “by a purposeful 

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act or failure to respond to a prisoner’s pain or possible medical need.” Jett, 439 F.3d at 

1096. 

The medical records show that Beitman has undergone periodic lab tests over the 

last year to measure his free testosterone levels, and the lab results show that his 

testosterone levels have been consistently below normal, and even reported at “below 

lower panic levels.” (Doc. 49 at 17, 19–20; Doc. 77 at 47.) The evidence shows that 

despite lab results showing low levels of testosterone in February 2019, NP Hahn 

thereafter documented in the medical record that Beitman’s “labs have been good, 

including his Testosterone levels.” (Doc. 77 at 34.) The medical records also indicate 

that, following the July and October 2019 lab results showing below low normal and 

“below lower panic levels” of free testosterone, and despite Beitman’s documented

severe weight loss and fatigue, there was no change to Beitman’s treatment. This 

evidence supports that NP Hahn and medical staff ignored or failed to respond to test 

results confirming Beitman’s serious medical need. In her opposition, NP Hahn argues 

generally that Beitman “simply disagrees with the prison medical providers who have 

determined that he is receiving appropriate medication and testing to assess and address 

his Testosterone levels,” and that he has been seen and tested regularly, and only had his 

medications, “including Testosterone, adjusted as medically indicated.” (Doc. 60 at 9.) 

But there is no medical evidence that his Testosterone was adjusted despite the repeated 

lab results showing low and below lower panic levels of the hormone. The fact that 

Beitman was seen regularly and repeatedly tested is meaningless if the medical staff 

failed to respond to the test results and to Beitman’s medical need. See Ortiz v. City of 

Imperial, 884 F.2d 1312, 1314 (9th Cir. 1989) (“access to medical staff is meaningless 

unless that staff is competent and can render competent care”); see Estelle, 429 U.S. at 

105 & n.10 (the treatment received by a prisoner can be so bad that the treatment itself 

manifests deliberate indifference); Lopez v. Smith, 203 F.3d 1122, 1132 (9th Cir. 2000) 

(prisoner does not have to prove that he was completely denied medical care to support 

deliberate indifference claim). 

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On this record, at the least, there are serious questions whether NP Hahn’s and 

medical staff’s failure to respond to Beitman’s confirmed low free testosterone levels 

constitutes deliberate indifference. Beitman therefore satisfies the first Winter factor. 

See Alliance for the Wild Rockies, 632 F.3d at 1135 (under the sliding-scale test, a court 

may issue a preliminary injunction if the plaintiff demonstrates “serious questions going 

to the merits and a balance of hardships that tips sharply towards the plaintiff”); see also

Republic of the Phil. v. Marcos, 862 F.2d 1355, 1362 (9th Cir. 1988) (“[s]erious 

questions need not promise a certainty of success, nor even present a probability of 

success, but must involve a fair chance of success on the merits”) (internal quotation 

omitted). 

2. Irreparable Injury

A plaintiff must demonstrate that absent an injunction, he will be exposed to 

irreparable harm. Caribbean Marine Servs. Co., 844 F.2d at 674; see Winter, 555 U.S. at 

22. To support a mandatory preliminary injunction for specific medical treatment, a 

plaintiff must demonstrate ongoing harm or the present threat of irreparable injury, not a 

past injury. See Conn. v. Mass., 282 U.S. 660, 674 (1931) (an injunction is only 

appropriate “to prevent existing or presently threatened injuries”); Caribbean Marine, 

844 F.2d at 674. “[T]here must be a presently existing threat of harm, although injury 

need not be certain to occur.” Villaneuva v. Sisto, CIV S-06-2706 LKK EFB P, 2008 WL 

4467512, at *3 (E.D. Cal. Oct. 3, 2008) (citing FDIC v. Garner, 125 F.3d 1272, 1279–80 

(9th Cir. 1997)). Pain can constitute irreparable harm. See Rodde v. Bonta, 357 F.3d 

988, 999 (9th Cir. 2004) (irreparable harm includes delayed and/or complete lack of 

necessary treatment, and increased pain); McNearney, 2012 WL 3545267, at *14 (finding 

a likelihood of irreparable injury where the plaintiff’s medical condition predated her 

incarceration and had not worsened, but the evidence showed that she continued to suffer 

unnecessary pain due to the defendants’ inadequate treatment plan). 

It is troubling that NP Hahn failed to submit the lab results from the December 6, 

2019 tests or any medical records documenting medical’s response thereto, even though 

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her Response was not filed until January 3, 2020. (See Doc. 60.) As to the harm 

element, Beitman asserts that due to the inadequate treatment from NP Hahn, he has 

already suffered most of the complications of hypogonadism. (Doc. 49 at 4.) He states

that “without explaining all the specific complications” he is going through, he seeks 

injunctive relief to avoid further imminent harm. (Id.) But explanation of the specific 

complications is necessary for a determination as to whether there is a threat of 

irreparable harm. Beitman avers that the inadequate medication regimen, and the 

prescribed thyroid medication—Levothyroxine—have caused him to suffer muscle 

cramps and tearing of connective tissue. (Doc. 50, Beitman Decl. ¶ 25; Doc. 77 at 5.) 

But in his Reply, he explains that he is no longer taking Levothyroxine; instead, he is 

now prescribed Nature-Throid, and the damaged areas are starting to heal. (Doc. 77 at 5.) 

Beitman also indicates that he is no longer treated by NP Hahn, which was one of the 

requests in his Motion. (Id. at 9.) 

On this limited record, and in light of evidence that NP Hahn no longer treats 

Beitman, and there has been at least one medication change that has led to improvement 

in his condition, Beitman fails to demonstrate that he is subject to irreparable harm absent 

an injunctive order for a telemed appointment or an endocrinologist referral. The Motion 

for Restraining Order with Injunctive Relief will therefore be denied without prejudice to 

refiling. See Center for Food Safety v. Vilsack, 636 F.3d 1166, 1174 (9th Cir. 2011) 

(because the plaintiffs failed to show they are likely to suffer irreparable harm in the 

absence of preliminary relief, the court need not address the remaining elements of the 

preliminary injunction standard). 

IT IS ORDERED:

(1) The Clerk of Court must correct the caption on the docket to reflect that the 

Defendant in this action is “Correct Care Solutions, et al.”4

4 The original complaint misspelled Correct Care Solutions as “Correct Clear

Solutions.” (Doc. 1.) The Third Amended Complaint corrected the spelling to “Correct 

Care Solutions.” (Doc. 35.)

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(2) The reference to the Magistrate Judge is withdrawn as to Plaintiff’s Motion 

for Injunctive Relief (Doc. 41), Motion for Order (Doc. 44), and Motion for Restraining 

Order with Injunctive Relief (Doc. 49). 

(3) Plaintiff’s Motion for Injunctive Relief (Doc. 41), Motion for Order (Doc. 

44), and Motion for Restraining Order with Injunctive Relief (Doc. 49) are denied.

(4) The Clerk of Court must update the docket to add Centurion of Arizona,

L.L.C. as a Defendant to this action pursuant to Federal Rule of Civil Procedure 20(a)(2). 

Further, the Clerk of Court must prepare a service packet and forward it to the United 

States Marshal Service for service.

(5) The United States Marshal must, immediately, personally serve copies of

the Summons, Third Amended Complaint, and this Order upon Centurion of Arizona, 

L.L.C. pursuant to Federal Rule of Civil Procedure 4(e)(2) at the address below:

Centurion of Arizona, L.L.C.

c/o Statutory Agent

CT Corporation System

3800 N. Central Ave Ste 460

Phoenix, Arizona 85012

(6) Within 3 business days after personal service is effected, the United 

States Marshal must file a return of service for Defendant Centurion of Arizona, L.L.C.

(7) The United States Marshal must retain the Summons, a copy of the Third 

Amended Complaint, and a copy of this Order for future use.

(8) Defendant Centurion of Arizona, L.L.C. must answer the Third Amended 

Complaint, or otherwise respond, within 15 days of service.

(9) Any answer or response must state the specific Defendant by name on 

whose behalf it is filed. The Court may strike any answer, response, or other motion or 

paper that does not identify the specific Defendant by name on whose behalf it is filed.

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(10) The Clerk of Court must electronically send a copy of this Order to Sarah 

L. Barnes at slb@bowwlaw.com.

Dated this 20th day of April, 2020.

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