Source: https://docs.justia.com/cases/federal/district-courts/california/casdce/3:2016cv00105/493900/28
Timestamp: 2016-09-25 20:59:54
Document Index: 356521347

Matched Legal Cases: ['§ 1915', '§ 1983', '§ 845', '§ 15', '§ 636', '§ 1915', '§ 845', '§ 15', '§ 1983', 'Art. 1', '§ 15', '§ 15', 'art 1', '§ 15', '§ 15', '§ 17', 'art 1', '§ 15', '§ 1983', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1915', '§ 1983', '§ 1915', '§ 1915', '§ 845', '§ 1367', '§ 1367', '§ 1915', '§ 1367']

ORDER Granting 8 , 10 Defendant Butera's and Hood's Motions to Dismiss; and Sua Sponte Dismissing Plaintiff's Eighth Amendment Claims as to All Remaining Defendant for Santana v. Zhang et al :: Justia Dockets & Filings Log In
Santana v. Zhang et al
ORDER Granting 8 , 10 Defendant Butera's and Hood's Motions to Dismiss; and Sua Sponte Dismissing Plaintiff's Eighth Amendment Claims as to All Remaining Defendant. The Court GRANTS Plaintiff forty-five (45) days leave in which to file an Amended Complaint that addresses the pleading deficiencies identified in this Order. If a plaintiff does not take advantage of the opportunity to fix his complaint, a district court may convert the dismissal of the complaint into dismissal of the entire action. Signed by Judge Gonzalo P. Curiel on 9/15/16. (All non-registered users served via U.S. Mail Service)(dlg)
JOSE SANTANA,
CDCR #AH-0190,
Case No.: 3:16-cv-00105-GPC-JMA
1) GRANTING DEFENDANT
BUTERA’S AND HOOD’S MOTIONS
TO DISMISS PURSUANT TO
[ECF Nos. 8, 10]
R. ZHANG, et al.,
2) SUA SPONTE DISMISSING
PLAINTIFF’S EIGHTH
AMENDMENT CLAIMS AS TO ALL
28 U.S.C. § 1915(e)(2)(b)(ii)
Jose Santana (“Plaintiff”), a prisoner at Richard J. Donovan Correctional Facility
(“RJD”) in San Diego, California, proceeding pro se and in forma pauperis (“IFP”), has
filed a complaint pursuant to the Civil Rights Act, 42 U.S.C. § 1983 (ECF No. 1).
3:16-cv-00105-GPC-JMA
Plaintiff claims Defendants, all medical and medical appeals officials at RJD and
Alvarado Medical Center (“AMC”) in San Diego, acted with deliberate indifference to his
serious medical needs, specifically, a methicillin resistant staphylococcus aureas
(“MRSA”) infection, which developed and recurred over the course of two years in
violation of the Eighth Amendment. (ECF No. 1 at 21-37.) Plaintiff also alleges pendent
state law claims of medical negligence and malpractice in violation of Cal. Govt. Code
§§ 845.6 and 815.2, and the California Constitution, Art I, §§ 15, 17. (Id. at 37-48, 50-51.)
He seeks declaratory and injunctive relief, as well as nominal, presumed, and punitive
damages. (Id. at 52-53.)
Defendants Butera and Hood, both doctors employed by AMC, where Plaintiff was
referred and admitted twice for emergency care, have filed Motions to Dismiss his first and
third causes of action, as well as his request for punitive damages pursuant to FED. R. CIV.
P. 12(b)(6). See Def. Hood’s Mot. to Dismiss (ECF No. 8); Def. Butera’s Mot. to Dismiss
(ECF No. 10).1 On June 16, 2016, the Court issued briefing schedules as to both Motions,
determined that no proposed findings and recommendations by the magistrate judge
pursuant to 28 U.S.C. § 636(b)(1)(A) and S.D. CAL. CIVLR 72.3(a) would be necessary,
and permitted Plaintiff to file and serve his Opposition to both Motions no later than July
15, 2016. (See ECF Nos. 9, 11.) No opposition has been filed.2
No other Defendants have yet to be served, although the U.S. Marshal has returned
summonses as unexecuted as to Defendants Benitez, Steward, and Robinson (ECF Nos.
While S.D. CAL. CIVLR 7.1(f)(3)(a) requires the non-moving party to file a written
opposition, or statement of non-opposition, and S.D. CAL. CIVLR 7.1(f)(3)(c) further
provides that the failure to file an opposition “may constitute a consent to the granting of
[the] motion,” the Court declines to simply grant Defendants’ Motions because they are
unopposed. See Ghazali v. Moran, 46 F.3d 52, 53 (9th Cir. 1995) (per curiam) (noting that
while that a district court may properly grant a motion to dismiss as unopposed pursuant to
a local rule, enforcement of the local rule is within the district court’s discretion); see also
Simmons v. Navajo Cty., Ariz., 609 F.3d 1011, 1017 (9th Cir. 2010) (“‘District courts have
Having considered both Motions on the papers submitted, the Court finds that
Plaintiff has failed to state a plausible claim upon which relief may be granted as to both
Defendants Butera and Hood, and therefore GRANTS their Motions to Dismiss pursuant
to FED. R. CIV. P. 12(b)(6). The Court further finds that Plaintiff has failed to state a
plausible Eighth Amendment claim for relief as to any other named Defendant, and
therefore DISMISSES the remainder of his Complaint sua sponte pursuant to 28 U.S.C.
§ 1915(e)(2)(b)(ii).
Left Leg Abscess – December 2013 to February 2014
From October 2013 through January 2014, Plaintiff claims Defendants Robinson,
Silva, and Cook, his primary care providers at RJD, “had actual knowledge of” and failed
to adequately treat a “staph/MRSA” infection in his left leg. (ECF No. 1 at 24, 37-39.)
Specifically, Plaintiff contends Robinson “ordered an incision and drainage
(“I&D”)” of fluid that had accumulated on his left leg on December 30, 2013, at RJD’s
triage and treatment area (“TTA”), and that Defendant Cook “ordered a culture test” on
January 6, 2014, and scheduled him for a “follow up after discovering MRSA.” (Id. at 24,
Plaintiff’s exhibits show that he first complained of “a big red bump on [his] left leg
– behind [his] thigh” on December 29, 2013 (ECF No. 1-1 at 16), and that Robinson
examined him on December 30, 2013. (Id. at 17-18.) Robinson diagnosed Plaintiff with a
left thigh skin abscess and cellulitis, prescribed Bactrim DS for seven days, Tylenol 3 “for
one week to cover the discomfort,” and “contacted the doctor in the [TTA],” to schedule
an “incision and drainage” in 1-2 days. (Id. at 18-21.) When Robinson examined him again
on January 3, 2014, Plaintiff reported feeling better, but had not yet had the I&D, so
broad discretion in interpreting and applying their local rules.’”) (quoting Miranda v. S.
Pac. Transp. Co., 710 F.2d 516, 521 (9th Cir. 1983)).
Robinson noted she would “contact the TTA” to “make sure that he ha[d] an appointment
to prevent recurrence.” (Id. at 24.) Plaintiff’s CDC 7382 “Treatment Record,” signed by
Dr. Cook, shows that Plaintiff reported to the daily RN line for wound care every day from
January 6 through 10, 2014, and again on January 15, 2014, and notes that he was “healing
progressively.” (Id. at 29, 31, 35-36.) Dr. Robinson’s Progress Notes dated January 10,
2014, and February 10, 2014, indicate that the I&D procedure was performed sometime
between January 3, 2014 and January 10, 2014, and that Plaintiff “had the blood test with
MRSA on 01/06/2014; however the antibiotic resistance pattern stated there was only scant
growth of MRSA.” (Id. at 41, 54.) Plaintiff also “had several comprehensive metabolic
panels and CBCs from 01/06/2014 to 01/27/2014 and all were normal save very minor
elevations in transaminases less than 2 times the upper limit of normal.” (Id. at 54.)
Therefore, as of February 10, 2014, Robinson noted Plaintiff’s skin abscess had “resolved,”
counseled him as to a “cosmetic” toenail fungus condition, noted he “fel[t] well,” was “not
taking any medication,” and needed only a “well male” check up in one year. (Id. at 54,
Right Leg & Knee – March 2014 to August 2015
Plaintiff further claims Dr. Robinson, as well as other RJD primary care providers,
Defendants Chau, Suleiman, Newton, Casian, Zhang, Ghayouri, Wiley, and Newton, and
AMC doctors Butera and Hood, all “had actual knowledge of [his] staph/MRSA infection,”
knew that he was “in need of immediate medical care,” and failed to take “reasonable action
to summon such medical care” in relation to his right leg and knee from March 2014
through August 2015. (ECF No. 1 at 25.) Plaintiff contends their “deliberate indifferen[ce]”
to his MRSA infection, caused him “to suffer prolonged and extreme pain,” “unnecessary
complications,” and two hospitalizations at AMC – once in May 2014, and once again in
September 2014, where he underwent surgery. (Id. at 25-26, 40-45.)
Plaintiff’s exhibits show that on March 24, 2014, he submitted a CDC 7362 Health
Care Services Request Form, No. 0341064, in which he claimed to have “caught staph
again,” and reported an “abscess in [his] right leg,” headaches, pain, and irritation. (ECF
No. 1-1 at 61; ECF No. 1 at 26.) Plaintiff was examined by an unidentified nurse on March
26, 2016, who “consulted with PCP [primary care physician] on site.” (ECF No. 1-1 at 63.)
Plaintiff was prescribed Bactrin and directed to follow up in 5 days. (Id. at 63-64.) His
exhibits show he was next examined by RN Kaestner on April 1, 2014, who changed his
dressings, instructed him on proper wound care, and discharged him back to housing. (Id.
at 65.)
One month later, on May 2, 2014, Plaintiff submitted another CDC 7362, marked
“emergency,” and designated No. 1735990 to RN Benitez. (ECF No. 1 at 28; ECF No. 1-
1 at 66, 77.) Plaintiff reported swelling and “severe pain” in his right knee and difficulty
walking. (ECF No. 1-1 at 28, 41-42.) Plaintiff was examined in the TTA by G. Wiley, NP
and Dr. Karan.3 Karan “attempted a tap[] at the sub patellar space,” but “no fluid was
noted.” (Id. at 68; ECF No. 1 at 28.) Plaintiff’s May 2, 2014 Progress Notes further indicate
that an “aseptic technique along with 1% lidocaine” was used, and his knee was x-rayed.
(ECF No. 1-1 at 68, 70-71.) The x-rays showed “prepatellar soft tissue swelling,” but no
fracture. (Id. at 70-71.) Plaintiff was diagnosed with prepatellar cellulitis4 and bursitis,
ordered to undergo a “CBC w/diff” and prescribed rochepin, Keflex, toradol,
acetaminophen with codeine phosphate, and naproxyn.5 (ECF No. 1 at 41; ECF No. 1-1 at
67, 68, 73, 79.) Plaintiff was further advised to follow up in 5 days, advised to elevate his
Dr. Karan is alleged to have treated Plaintiff’s right knee at RJD on May 2, 2014, (id. at
28), but he is not included in the portion of Plaintiff’s pleading that identifies Defendants.
(Id. at 9-17.) Consequently, Dr. Karan was not included in the summons which issued on
March 22, 2016 (ECF No. 4), and has not been served.
Plaintiff claims cellulitis is a bacterial infection of the skin and underlying tissue that is
treated with antibiotics. (ECF No. 1 at 28 n.1.)
According to Plaintiff, Keflex is the brand name for the antibiotic cephalexin which “is
used to treat pneumonia and bone, ear[,] skin and urinary tract infections.” (ECF No. 1 at
41.) “Naproxyn is a nonsteroidal anti-inflammatory drug or NSAID, used to relieve pain,
inflammation, fever, or stiffness.” (Id. at 41-42.)
knee, apply cool compress[es], rest, and “take meds as prescribed.” (Id. at 68.) On the
following day, May 3, 2014, Plaintiff’s wound was checked and he was advised to “f/u
[with] PCP Monday.” (Id. at 75.)
On May 4, 2014, however, when Plaintiff “walk[ed] in TTA for wound check,” he
was referred to Dr. Casian by RN Garcia. (ECF No. 1 at 29, ECF No. 1-1 at 80-84.) Plaintiff
claims his “whole right leg was swollen” and he was authorized for outpatient care “via
state vehicle” to AMC. (ECF No. 1 at 42, ECF No. 1-1 at 80-84, 96.)
Once he arrived at AMC on May 4, 2014, Plaintiff was examined by Defendant Dr.
Hood, diagnosed with “cellulitis of the right knee and leg,” prescribed “IV antibiotics,”
admitted to the “Med/Surg floor,” and referred to Defendant Dr. Butera, an infectious
disease specialist. (ECF No. 1 at 29-30, 42; ECF No. 1-1 at 85-86, 92-93.) Dr. Hood’s
History and Physical notes indicate Plaintiff had been previously treated “for some type of
infected lesion in his right leg that recurred three months [prior],” and which was “treated
with oral antibiotics.” (ECF No. 1-1 at 85.) Dr. Hood also noted Plaintiff was currently
taking Tylenol with codeine, cephalexin, and naprosyn, but that he had swelling of the right
knee around the patella, a “raised erythematous area measuring about 2 cm,” an area that
“appeared to be purulent,” and “some erythema, several centimeters above and below the
knee,” but an X-ray of the knee “showed no acute findings.” (Id. at 86.)
Plaintiff admits he was “hospitalized and treated for staph infection with IV
antibiotics (vancomycin6 and Zosyn)” while at AMC. (ECF No. 1 at 29.)
Dr. Hood’s discharge notes, dated May 7, 2014, further indicate that “[a]ttempts to
aspirate fluid from the joint were unsuccessful,” and that an x-ray of Plaintiff’s knee
“showed no evidence of fluid or osteoarthritis.” (ECF No. 1-1 at 93.) Dr. Hood’s notes
further confirm Plaintiff was “empirically placed on IV vancomycin and Zosyn,” in consult
Plaintiff contends that vancomycin “is an antibiotic” and “the only drug that deals with
MRSA.” (ECF No. 1 at 29 n.2.)
with Dr. Butera, who recommended at least two days of IV antibiotics, which Plaintiff
completed during his stay at AMC. (Id.)
Dr. Butera’s consultation notes indicate that “two sets of [Plaintiff’s] blood cultures”
were “negative and nares MRSA screen [was] in progress with a preliminary negative.”
(ECF No. 1-1 at 105.) Dr. Butera assessed Plaintiff with:
Probable acute prepatellar septic bursitis of the right knee in the
setting of a small knee abrasion and scab. These are almost
always Staphylococcus aureus. The patient’s nares methicillinresistant Staphylococcus aureus screen is negative. Though he
was actually getting worse on Keflex, it may be we just were not
getting adequate drug levels into the bursa with the Keflex.
Dr. Butera “discontinue[d] the broad-spectrum Zosyn” on May 6, 2014, and
“switched [him] to Ancef along with vancomycin” in order “observe at least another day
before considering changing to p.o.” (ECF No. 1-1 at 105.) Butera noted that “[g]enerally
a two-week course of therapy of antibiotics appropriate to cover the pathogen is necessary,”
and that it is “sometimes necessary to incise and drain the bursa,” however, Plaintiff was
“rapidly improving on IV therapy with no definite drainable fluid collection.” (Id.)
Therefore, on May 7, 2014, Dr. Hood discharged Plaintiff with “acute
bursitis/cellulitis, right knee,” which had “markedly improved” and “started [him] on oral
antibiotics.” (Id. at 93.) “Infectious disease recommended Keflex 500 mg q.i.d. for 10 days
and doxycycline 100 mg b.i.d. for 10 days,” together with Tylenol with codeine for pain
and naprosyn. (Id.)
Plaintiff returned to RJD “on the night of May 7, 2014,” and admits he was given
“antibiotic pills.” (ECF No. 1 at 29.) Plaintiff was examined by RN Stewart and Dr. Chau,
and ordered to follow up with his PCP in 5 days. (ECF No. 1-1 at 107.) A “Medication
Reconciliation” sheet dated May 9, 2014 indicates Dr. Chau discontinued Plaintiff’s
prescription for naproxen, renewed his prescription for acetaminophen with codeine, and
prescribed a ten-day course of cephalexin and doxycycline hyclate. (ECF No. 1-1 at 108.)
Plaintiff claims after May 7, 2014 his “condition made a turn for the worse.” (ECF
No. 1 at 29.) His exhibits show that he was examined by Dr. Ghayouri, his PCP, on May
9, 2014, and again on May 16, 2014. (Id. at 112; ECF Doc. No. 1-2 at 1-4.) Both times, Dr.
Ghayouri noted Plaintiff’s “right knee cellulitis [was] improving,” that Plaintiff “report[ed]
significant improvement in pain, redness, and swelling,” and “den[ied] any complaint.” Dr.
Ghayouri continued his acetaminophen, cephalexin, and doxycycline prescriptions, as well
as his prescription for naproxen “as needed for pain.” (ECF No. 1-1 at 112-13; ECF No. 1-
2 at 4.)
Approximately one month later, on July 15, 2014, Plaintiff “submitted a medical slip
(CDC 7362) complaining again of pain in his right knee,” inflammation, and trouble
walking. (ECF No. 1 at 29; ECF No. 1-2 at 6.) Plaintiff “called to the clinic” and was
evaluated by Defendant Paule, RN on July 17, 2014. (ECF No. 1 at 30). Plaintiff claims to
have “explained his severe pain and swelling,” to have informed Paule of his “prior history
of infection” and to have told Paule “it was urgent” that he see a doctor. (ECF No. 1 at 30.)
The “Encounter Form” completed by Paule and dated July 17, 2014, reflects Plaintiff’s
complaints of pain and swelling in his right knee, as well as his history of “septic pre-
patellar bursitis.” (ECF No. 1-2 at 12.) Paule noted that Plaintiff requested “possible
ultrasound of MRI,” because he was “worried about last incident of right knee bursitis,”
and claimed Ibuprofen gave him “no symptomatic relief,” therefore “he would rather wait
to see PCP before taking anything.” (Id.) Paule further noted Plaintiff’s knees appeared
symmetrical, “both lower extremities [were] within normal limits,” that he was “able to
walk without difficulty,” and was “given instructions of signs and symptons to … monitor.”
(Id. at 13.) Plaintiff claims Paule “intentionally and unjustifiably failed to summon medical
care” on this occasion, but he also admits, and his exhibits show that Paule “scheduled [him
for] an appointment with the doctor.” (ECF No. 1 at 30; ECF No. 1-2 at 13.)
Plaintiff claims he was “finally called and seen by Defendant Zhang” on September
15, 2014. (ECF No. 1 at 30.) Plaintiff claims he “communicated … his whole medical
history,” and requested a “cat scan or MRI to see if the infection had developed.” (Id. at
31.) Plaintiff admits Zhang ordered an x-ray and “inspected” his knee, but “told [him] he
was fine,” and only recommended resting and weight loss. (Id.)
Dr. Zhang’s Progress Notes dated September 15, 2014, include Plaintiff’s previous
diagnosis of “right knee cellulitis” and his complaints of “intermittent right knee pain.”
(ECF No. 1-2 at 7.) Zhang further noted Plaintiff “ambulat[ed] to the room … without any
signs of difficulty or any signs of pain,” but he ordered a “repeat x-ray of the right knee,”
a “CBC and ESR,” a “trial of etodolac 300 mg,” and recommended Plaintiff “follow up “in
90 days or earlier if needed.” (Id. at 7-11, 14.)
Plaintiff’s x-ray results, dated September 18, 2014, showed “no acute fracture or
dislocation,” no “significant degenerative changes,” and “no large joint effusion,” but
“[s]oft tissue swelling [wa]s present.” (Id. at 15.) Plaintiff claims that because this x-ray
indicated “everything seem[ed] to be fine,” he “assumed” Dr. Zhang “thought that he was
lying, and [he] never heard from him again.” (ECF No. 1 at 31.)
On September 25, 2014, Plaintiff claims he experienced “major headaches, fever,
chills, and excruciating pain,” but unidentified medical staff “refused to see [him] unless
he had a life-threatening problem.” (ECF No. 1 at 31.) Three days later, on September 28,
2014, when he “could not take the pain or hang on any longer,” Plaintiff’s celly, Ray
Maldonado, called a “man down.” (Id. at 32.) Plaintiff claims RJD Officer De La Cruz
responded and two unidentified nurses “finally attended [to his] medical needs.” (Id.)
Plaintiff’s exhibits show he was examined by RN Wenzel at 8:40 am, and
complained of both chest and right knee pain. Wenzel noted Plaintiff’s history of
cellulitis/bursitis, his May 2015 hospitalization, that he previously “d[id] well” on
antibiotics, and was “last seen by PCP two weeks ago and was doing well.” (ECF No. 1-2
at 17.) Wenzel noted “obvious prepatellar swelling.” (Id.) At 9:15 am, Wenzel’s notes
indicate Plaintiff was examined by Dr. Suleiman. (Id.) Suleiman noted Plaintiff’s “history
of knee cellulitis” and noted he “might have a subcutaneous abscess versus developing
septic arthritis,” and therefore authorized Plaintiff’s transfer to the ER at AMC “for further
evaluation and possible arthrocentesis or incision and drainage of that area.” Dr. Suleiman
further noted Plaintiff would “need IV antibiotics initially.” (ECF No. 1-2 at 16, 21-23.)
At 11:15 am, on September 28, 2014, Dr. Christopher Dewar7 diagnosed Plaintiff
with prepatellar bursitis after evaluating him in the ER at AMC. (ECF No. 1-2 at 26-17.)
Dr. Dewar’s encounter notes state:
Basically, the patient is a 23-year-old male who is presenting
with right knee infection. I feel he is extremely low risk of septic
arthritis. He has full range of motion. He has no fever. He has a
normal white count. His sedimentation rate and CRP are not
dramatically elevated. We consulted Dr. Butera from infectious
disease. He agrees with this. We will start him on vancomycin. I
did use ChloraPrep to cleanse the knee and used an 18-gauge
needle deroof this abscess and a clean pus was taken from the
wound site. It was not a large abscess that was able to be drained.
AMC Dr. Richard O. Butcher’s8 History and Physical Notes, also dated September
28, 2014, describe Plaintiff’s previous admission in May 2014, his 2-day course of IV
antibiotics, his May 2014 consultation with Dr. Butera, and his continuation of oral
medications for 2 weeks post-discharge. (ECF No. 1-2 at 29.) Plaintiff told Butcher “he
has done well for a while” and suffered no trauma to the knee, but that “all of a sudden,” it
began being painful and swollen. (Id.) Butcher noted Plaintiff “was on etodolac 300 mg”
for pain prior to admission, and was given a dose of vancomycin “after cultures were taken”
from the wound site in ER. (Id. at 30.) Butcher then noted “Infectious Disease will ask
Orthopedics to check the patient because if alleged septic arthritis,” but Butcher “d[id] not
feel that he ha[d] this,” because Plaintiff was “stable otherwise.” (Id.) Butcher also
prescribed Motrin and Norco, found Plaintiff “stable for admission,” and ordered a “repeat
[of Plaintiff’s] labs in the morning.” (Id.)
Dr. Dewar is not named as a Defendant.
Dr. Butcher is not named as a Defendant.
Dr. Butera’s consultation assessment, also dated September 28, 2014, recounts
Plaintiff’s May 2014 admission, Butera’s prior diagnosis of “acute prepatellar bursitis to
the right knee in the setting of a small skin abrasion and scab,” which he felt “was almost
always due to Staphylococcus aureus,” as well as Plaintiff’s “negative nares MRSA
screen.” (ECF No. 1-2 at 36.) Butera noted that in May “there was no definite drainable
fluid,” and therefore, “no surgical cultures,” but Plaintiff’s “cellutitic component improved
dramatically” due to a 4-day course of IV antibiotic therapy, followed by 10 days of Keflex
and doxycycline. (Id.) Plaintiff admitted to Butera that “the pain in his knees as well as the
induration and erythema did resolve completely,” but that he had “over the past two
weeks,” developed discomfort in the right knee again. (Id.) Plaintiff further reported “no
fever, chills or rigors,” but “over the last few days, [] developed new induration, erythema,
and possibly some early fluctuance over the right knee without any pustule or breaks in the
skin, or other trauma.” (Id.) Butera noted that Plaintiff “was sent to the ER again as a
possible septic arthritis,” and that [h]e had a similar episode back in January, which would
make this as third recurrence.” (Id.)
Dr. Butera assessed Plaintiff with “[r]ecurring inflammation in the soft tissues over
the right patella” which “probably represent[ed] a relapsing prepatellar septic bursitis,”
which “are almost always due to Staphylococcus aureus.” (Id. at 37.) Butera further noted
however, that “previous MRSA screenings ha[d] been negative” and “blood cultures done
during [Plaintiff’s] last admission were negative,” but “repeat blood cultures done during
this admission [we]re pending,” and it appeared Plaintiff was “developing [a] subcutaneous
fluctuant area that may be evolving into a drainable fluid collection or at least, the fluid
collection can be aspirated for culture.” (Id.) Because it was Plaintiff’s “third relapse with
the similar presentation,” Butera noted “at some point, proper incision and drainage or
bursectomy may need to be considered.” But because Plaintiff did “not appear to be septic
with no fever and normal white count,” Dr. Butera recommended Plaintiff be
observed, that warm compresses be applied, that he continue on vacomycin IV, 9 and
referred for an orthopedic consult. (Id.)
Plaintiff remained on IV vancomycin and on September 30, 2014, he was evaluated
by Dr. Roman B. Cham, an AMC surgeon and orthopedist.10 (ECF No. 1 at 45; ECF No.
1-2 at 40.) Dr. Cham’s consultation notes indicate that Plaintiff’s infection “look[ed]
better,” but Dr. Butera “recommended excision of the septic bursitis in part because of the
previous failed treatment.” (ECF No. 1-2 at 40.) Dr. Cham’s notes also show that Plaintiff’s
“wound culture from 09/28/2104 [wa]s positive for MRSA.” (Id.) Plaintiff gave “full
informed consent for the surgery.” (Id.)
Dr. Cham performed an excision of Plaintiff’s right knee at AMC on October 1,
2014. (ECF No. 1 at 32-33; ECF No. 1-2 at 41.) Cham’s Operative Report shows Plaintiff
was anesthetized, “all questionable tissue down to [Plaintiff’s] patellar tendon” was
removed, and the “wound was irrigated with triple antibiotic solution, which included
gentamicin and vancomycin.” (ECF No. 1-2 at 41.) “The conclusion appeared to be [a]
very clean wound.” (Id.)
Plaintiff was discharged from AMC and returned to RJD “late at night” on October
2, 2014. (ECF No. 1 at 33; ECF No. 1-2 at 48.) AMC Dr. Butcher noted Plaintiff had done
well postoperatively, and noted he was ambulatory but “should lie [i]n for two weeks.”
(ECF No. 1-2 at 48.) Plaintiff’s discharge medications included Tylenol, Tylenol with
codeine, a seven day course of doxycycline, bactroban, and rifampin, Motrin, and Prilosec.
(Id. at 48-49.)
Dr. Butera also considered ceftaroline, but “preferred not to use [it]” because it “is
basically too broad spectrum similar to Rocephin, [and] covers many enteric gram-negative
rods and other pathogens” that did “not need to [be] cover[ed] in this setting.” (ECF No.
1-2 at 37.)
Dr. Cham is not named as a Defendant.
Plaintiff claims that when he returned to RJD, he was given antibiotics, but no pain
medication. (ECF No. 1 at 33.) He later admits, however, that Drs. Zhang and Newton
“prescribed medication for [him]” “from October 2-6, 2014.” (Id. at 45.)
The CDC 7230 Interdisciplinary Progress Notes, CDC 7221 Physician’s Orders
attached to his Complaint, however, show that Plaintiff’s prescriptions for doxycycline,
rifampin, and Tylenol #3 were ordered by M. Garikaparthi, M.D. 11 upon his return to
custody on October 2, 2104, and that he was treated by RNs Janasco, Paule, and Wallace
for wound care and dressing changes on October 3, 2014, October 4, 2014, and October 5,
2014. When Plaintiff appeared at his 5-day follow-up on October 6, 2014, he reported he
was “taking antibiotics,” complained of pain, was given “T#3 bid for 3 days,” assigned to
a temporary bottom bunk, authorized to use a wooden cane for 3 months, told to continue
daily dressing changes “per RN line,” advised his sutures would be removed in 2 weeks,
that he’d have a telemed follow–up appointment with AMC Dr. Cham in 3 weeks, and
another follow up with his PCP in 30 days. (ECF No. No. 1 at 45-46; ECF No. 1-2 at 65-
On October 7, 2014, Plaintiff filed a CDCR 602 HC Appeal, Log No. 14052082,
complaining of “negligence” and “deliberate indifference” to his right knee infection. (ECF
No. 1-1 at 2-5.) On October 9, 2014, Plaintiff was informed that his lab work results were
“essentially within normal limits.” (ECF No. 1-2 at 75). On October 16, 2014, his sutures
were removed. Plaintiff tolerated the procedure well and his incision appeared to be healing
well with no redness or swelling noted. (ECF No. 1-2 at 72.)
On October 17, 2014, Plaintiff had a follow-up appointment with Dr. Zhang, his PCP
(Id. at 72, 74, 77.) Dr. Zhang’s Progress Notes include reference to Plaintiff’s “Medical
602” requesting “stronger pain medication,” but otherwise document his “unremarkable”
lab work, completed course of doxycycline, and improvement of the infection. (Id. at 77.)
Dr. Garikaparthi is not named as a Defendant.
Zhang further noted that Plaintiff was ambulating with the use of his cane, able to move
his right knee freely, and that there did not appear to be any sign of decrease in his range
of motion. (Id.) Zhang advised Plaintiff to “continue ibuprofen 600 mg” and added a
“Tylenol No. 3 x5 days one p.o. at bedtime.” Zhang also started Plaintiff “on nortriptyline
25 mg one p.o. at bedtime for adjunct pain control.” (Id.) Plaintiff was “concerned about
recurrence of infection,” and advised to alert medical staff if his knee became warm, red,
or swollen, or if he had a fever. Zhang also cautioned that Plaintiff “will continue to have
intermittent pain; however, that d[id] not mean he ha[d] an active infection. (Id.)
On October 21, 2014, Plaintiff “present[ed] to telemedicine” for his post-operative
follow-up with Dr. Cham at AMC. (ECF No. 1 at 46; ECF No. 1-2 at 78-79.) Dr. Cham
noted Plaintiff “was doing quite well,” “[h]is incision and knee look[ed] completely
benign,” and he “had no complaints.” (ECF No. 1-2 at 79.) Cham noted Plaintiff’s “yard
doctor want[ed] to keep him on the antibiotics for an additional two weeks,” but Cham
concluded “no additional orthopedic follow[-]up [wa]s needed.” (Id.)
Plaintiff was next examined on November 4, 2014 by Dr. Zhang for his “PCP follow-
up from [his] recent visit with orthopedic surgeon.” (ECF No. 1 at 46-47; ECF No. 1-2 at
82.) Zhang noted Plaintiff’s “septic arthritis of the right knee currently resolved,” that he
was doing well and ambulated without any signs of limping. Plaintiff was advised to alert
medical immediately if redness or pain returned. (ECF No. 1-2 at 82.)
Two months later, on January 4, 2015, Plaintiff “submitted a medical slip number
1037871 because of constant pain to his right knee.” (ECF No. 1 at 47; ECF No. 1-2 at 87.)
Plaintiff was examined by RN Calderon on January 6, 2015, whom he claims “intentionally
and unjustifiably failed to summon medical care for [his] excruciating pain.” (ECF No. 1
at 47.) The CDC 7362 attached to his pleading, however, indicates Calderon recorded
Plaintiff’s complaints, noted he was ambulating with a steady gait, and did not appear to
need a cane. She prescribed Naproxen 220 mg, instructed him to follow-up in RN clinic of
symptoms persisted, and referred him for a routine PCP follow-up. (ECF No. 1-2 at 87-
On January 20, 2015, Plaintiff was again examined by his PCP, Dr. Zhang. (ECF
No. 1 at 47; ECF No. 1-2 at 92.) Zhang noted Plaintiff’s reports of pain in his right knee
which was “worse if he plac[ed] pressure on it,” but no increase in temperature, signs of
limp, slowness, or any functional impairment. (ECF No. 1-2 at 92.) Zhang noted no signs
of active infection, but that Plaintiff complained of pain “despite trial of Tylenol, Motrin,
and Naprosyn.” (Id.) Zhang therefore prescribed a “trial of Voltaren gel,” and advised
Plaintiff to “avoid jumping” or putting pressure on his right knee whenever possible. (Id.
at 92-96.) Plaintiff admits Zhang also approved him for a bottom bunk, but claims he
“failed to prescribe effective pain medication or summon medical care for [his] pain.” (ECF
No. 1 at 47.)
Plaintiff next claims to have seen Dr. Wiley on May 20, 2015, and reported that he
“was unable to bear total weight on his right leg.” (ECF No. 48.) The CDCR 7230-M
attached to his complaint, however, shows that Plaintiff reported to Wiley on that day, and
complained of a history of pain and swelling that “never actually resolved” but which had
been exacerbated by his “playing soccer.” (ECF No. 1-2 at 99.) Dr. Wiley ordered Tylenol
for pain, and that a large permanent neoprene knee support brace be “expedited” for
Plaintiff’s use. (Id. at 99-100.)
Finally, on August 3, 2015, Plaintiff submitted yet another CDC 7362, No. 2121359,
requesting that he “talk to [his] prime physician regarding [his] medication and treatment.”
(ECF No. 1 at 48; ECF No. 1-2 at 101.) RN Gines12 assessed Plaintiff’s complaints of
“chronic knee pain” on August 6, 2015, prescribed Naproxen, and advised him to notify
staff “asap “ if swelling or redness returned. (ECF No. 1-2 at 102-04.) Plaintiff’s knee pain
was next evaluated by an unidentified doctor on August 14, 2105. (ECF No. 1 at 48; ECF
No. 1-2 at 105.) Plaintiff complained that Tylenol did not alleviate his “dull and aching”
knee pain, but reported to “playing sports every day.” (ECF No. 1-2 at 105.) The doctor
RN Gines is not named as a Defendant.
recommended trying Motrin and sulindac, weight loss, and explained that Plaintiff’s right
knee “will never be equal to the left” due to his past infection. (Id.) Plaintiff “was not happy
with his explanation because he requested … medical care [on] numerous occasions before
the infection became out of control.” (ECF No. 1 at 48.)
In addition to the doctors and nurses who are alleged to have treated him between
2013 and 2015, Plaintiff also contends Defendants Walker, RJD’s Chief Physician and
Surgeon, Roberts, a Chief Medical Executive, and Glynn, a Chief Executive Officer,
“failed to instruct” the other RJD medical officials “on how to treat or identify MRSA
infection,” (ECF No. 1 at 2, 27), and “negligently failed to monitor and supervise the
inadequate and untimely medical care” he received, by reviewing and denying, together
with Defendant Zhang, his CDCR-602 HC Inmate/Parolee Health Care Appeal Log No.
14052082 (Id. at 10-14, 40-41; see also ECF No. 1-1 at 2-11).
Supervisory and/or Administrative Medical Officials
Finally, as to the RNs who are alleged to have assessed and examined him on various
occasions, Plaintiff claims Defendants Paule, Janasco, Calderon, Kaestner, Benitez,
Garcia, Wallace, Wenzel, Manning, and Steward “were responsible for providing [him]
health care” from 2013 through 2015, but he “does not know the level of injury and/or
damages” they caused. (Id. at 15.)
Plaintiff divides his pleading into three separate causes of action. First, he claims all
Defendants acted with deliberate indifference to his serious medical needs in violation of
the Eighth Amendment of the U.S. Constitution. (“First Cause of Action”). (ECF No. 1 at
21-37.) Second, Plaintiff claims all Defendants committed “medical negligence” and
“malpractice” in violation of CAL. GOVT. CODE §§ 845.6 and 815.2 (“Second Cause of
Action”). (Id. at 37-50.) Third, Plaintiff claims Defendants violated his rights to due
process and to be free from cruel and unusual punishment in violation of CAL. CONST. Art.
I. §§ 15, 17 (“Third Cause of Action”). (Id. at 50-51.)
Plaintiff seeks a declaratory and injunctive relief, as well as nominal, presumed,
punitive, and “mental and emotional” damages against each Defendant “jointly or
severally.” (ECF No. 1 at 51-53.)
A motion to dismiss under Federal Rule of Civil Procedure 12(b)(6) “tests the legal
sufficiency of a claim.” Navarro v. Block, 250 F.3d 729, 732 (9th Cir. 2001). Because Rule
12(b)(6) focuses on the “sufficiency” of a claim rather than the claim’s substantive merits,
“a court may [ordinarily] look only at the face of the complaint to decide a motion to
dismiss.” Van Buskirk v. Cable News Network, Inc., 284 F.3d 977, 980 (9th Cir. 2002).
However, courts may consider exhibits that are attached to the complaint. See FED. R. CIV.
P. 10(c) (“A copy of a written instrument that is an exhibit to a pleading is a part of the
pleading for all purposes.”); Hal Roach Studios, Inc. v. Richard Feiner & Co., Inc., 896
F.2d 1542, 1555 n.19 (9th Cir. 1990) (citing Amfac Mortg. Corp. v. Ariz. Mall of Tempe,
Inc., 583 F.2d 426 (9th Cir. 1978) (“[M]aterial which is properly submitted as part of the
complaint may be considered” in ruling on a Rule 12(b)(6) motion to dismiss.) However,
exhibits that contradict the allegations of a complaint may fatally undermine the
complaint’s allegations. See Sprewell v. Golden State Warriors, 266 F.3d 979, 988 (9th
Cir. 2001) (a plaintiff can “plead himself out of a claim by including . . . details contrary
to his claims.” (citing Steckman v. Hart Brewing, Inc., 143 F.3d 1293, 1295-96 (9th Cir.
1998) (courts “are not required to accept as true conclusory allegations which are
contradicted by documents referred to in the complaint.”))); see also Nat’l Assoc. for the
Advancement of Psychoanalysis v. Cal. Bd. of Psychology, 228 F.3d 1043, 1049 (9th
Cir.2000) (courts “may consider facts contained in documents attached to the complaint”
to determining whether the complaint states a claim for relief).
accepted as true, to ‘state a claim to relief that is plausible on its face.’ A claim has facial
plausibility when the plaintiff pleads factual content that allows the court to draw the
reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v.
Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 556,
570 (2007)).
“All allegations of material fact are taken as true and construed in the light most
favorable to the nonmoving party.” Cahill v. Liberty Mut. Ins. Co., 80 F.3d 336, 337-38
(9th Cir. 1996) (citing Nat’l Wildlife Fed. v. Espy, 45 F.3d 1337, 1340 (9th Cir. 1995)).
The Court need not, however, “accept as true allegations that are merely conclusory,
unwarranted deductions of fact, or unreasonable inferences.” Sprewell, 266 F.3d at 988
(citing Clegg v. Cult Awareness Network, 18 F.3d 752, 754-55 (9th Cir. 1994)); see also
Iqbal, 556 U.S. at 678 (“Threadbare recitals of the elements of a cause of action, supported
by mere conclusory statements, do not suffice.”); Papasan v. Allain, 478 U.S. 265, 286
(1986) (on motion to dismiss, court is “not bound to accept as true a legal conclusion
couched as a factual allegation.”). “[T]he pleading standard Rule 8 announces does not
require ‘detailed factual allegations,’ but it demands more than an unadorned, the
defendant-unlawfully-harmed-me accusation.” Iqbal, 556 U.S. at 678 (quoting Twombly,
Thus, “[w]hile legal conclusions can provide the framework of a complaint, they
must be supported by factual allegations. When there are well-pleaded factual allegations,
a court should assume their veracity and then determine whether they plausibly give rise
to an entitlement to relief.” Id. at 679. “The plausibility standard is not akin to a ‘probability
requirement,’ but it asks for more than a sheer possibility that a defendant has acted
unlawfully.” Id. at 678. “Where a complaint pleads facts that are ‘merely consistent with’
a defendant’s liability, it ‘stops short of the line between possibility and plausibility of
‘entitlement to relief.’’” Id. (quoting Twombly, 550 U.S. at 570 (when a plaintiff has not
“nudged [his] claims across the line from conceivable to plausible, [his] complaint must be
dismissed.”)).
“In sum, for a complaint to survive a motion to dismiss, the non-conclusory ‘factual
content,’ and reasonable inferences [drawn] from that content, must be plausibly suggestive
of a claim entitling the plaintiff to relief.” Moss v. United States Secret Serv., 572 F.3d 962,
969 (9th Cir. 2009) (quoting Iqbal, 556 U.S. at 678).
“In civil rights cases where the plaintiff appears pro se, the court must construe the
pleadings liberally and must afford [the] plaintiff the benefit of any doubt.” Karim-Panahi
v. L.A. Police Dep’t, 839 F.2d 621, 623 (9th Cir. 1988). The rule of liberal construction is
“particularly important in civil rights cases.” Ferdik v. Bonzelet, 963 F.2d 1258, 1261 (9th
Cir. 1992). The rule, however, “applies only to a plaintiff’s factual allegations.” Neitzke v.
Williams, 490 U.S. 319, 330 n.9 (1989). In giving liberal interpretation to a pro se civil
rights complaint, courts may not “supply essential elements of claims that were not initially
pled.” Ivey v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982).
“Vague and conclusory allegations of official participation in civil rights violations are not
sufficient to withstand a motion to dismiss.” Id.; see also Jones v. Cmty. Redev. Agency,
733 F.2d 646, 649 (9th Cir. 1984) (finding conclusory allegations unsupported by facts
insufficient to state a claim under § 1983).
Defendants’ Motions
Both AMC Doctors Hood and Butera move to dismiss Plaintiff’s first cause of action
alleging deliberate indifference to his serious medical needs in violation of the Eighth
Amendment, (ECF No. 8-1 at 4-6; ECF No. 10-1 at 4-6), his third cause of action alleging
violations of the California Constitution’s Articles 15 and 17, (ECF No. 8-1 at 6-8; ECF
No. 10-1 at 7), and to strike his request for punitive damages pursuant to Fed. R. Civ. P.
12(b)(6) (ECF No. 8-1 at 8-9; ECF No. 10-1 at 7-8.)
As noted above, Plaintiff has filed no Opposition.
Eighth Amendment Inadequate Medical Care Claims
Only “deliberate indifference to serious medical needs of prisoners constitutes the
unnecessary and wanton infliction of pain . . . proscribed by the Eighth Amendment.”
Estelle v. Gamble, 429 U.S. 97, 103, 104 (1976) (citation and internal quotation marks
omitted). “A determination of ‘deliberate indifference’ involves an examination of two
elements: (1) the seriousness of the prisoner’s medical need and (2) the nature of the
defendant’s response to that need.” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir.
1991), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir.
1997) (en banc) (quoting Estelle, 429 U.S. at 104); see also Wilhelm v. Rotman, 680 F.3d
1108, 1113 (9th Cir. 2012); Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006).
First, “[b]ecause society does not expect that prisoners will have unqualified access
to health care, deliberate indifference to medical needs amounts to an Eighth Amendment
violation only if those needs are ‘serious.’” Hudson v. McMillian, 503 U.S. 1, 9 (1992),
citing Estelle, 429 U.S. at 103-104. “A ‘serious’ medical need exists if the failure to treat
a prisoner’s condition could result in further significant injury or the ‘unnecessary and
wanton infliction of pain.’” McGuckin, 914 F.2d at 1059 (quoting Estelle, 429 U.S. at 104).
“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; or the existence of chronic and substantial pain are
examples of indications that a prisoner has a ‘serious’ need for medical treatment.” Id.,
citing Wood v. Housewright, 900 F.2d 1332, 1337-41 (9th Cir. 1990); Hunt v. Dental Dept.,
865 F.2d 198, 200-01 (9th Cir. 1989).
Here, neither Dr. Hood nor Dr. Butera argue that Plaintiff has failed to allege facts
to plausibly show that his medical needs were ‘serious,’ and the Court finds Plaintiff’s
Complaint is sufficiently pleaded in this regard. See e.g., Sansome v. Lopez, No. CV 1-07-
1086-FRZ, 2013 WL 3198594, at *4 (E.D. Cal. June 21, 2013) (finding prisoner’s claims
of having developed “(staph) MRSA infections” to be serious medical needs because “an
infection, if not properly treated, ‘could result in further significant injury or the
unnecessary and wanton infliction of pain.’”) (citing Wilhelm, 680 F.3d at 1122; Jett, 439
F.3d at 1096)); Amason v. Wedell, No. 2:12-CV-0388 KJN P, 2014 WL 2987695, at *3
(E.D. Cal. July 1, 2014) (assuming prisoner’s “cellulitis, neuropathy, leg, foot, and ankle
swelling and pain” were sufficiently serious medical needs under the Eighth Amendment).
Therefore, the Court must next decide whether Plaintiff’s Complaint further contains
sufficient “factual content” to show that both Drs. Hood and Butera acted with “deliberate
indifference” to his needs. McGuckin, 914 F.2d. at 1060; see also Jett, 439 F.3d at 1096;
Iqbal, 556 U.S. at 678. “Deliberate indifference is a high legal standard.” Toguchi v. Chung,
391 F.3d 1051, 1060 (9th Cir. 2004).
While Plaintiff claims Drs. Hood and Butera, as well as all his RJD doctors, “had
actual knowledge of [his] staph/MRSA infection,” knew that he was “in need of immediate
medical care,” and failed to take “reasonable action to summon such medical care” in
relation to his right leg and knee from March 2014 through August 2015, (ECF No. 1 at
25), his pleading lacks the “further factual enhancement” which demonstrates either Hood
or Butera’s “purposeful act[s] or failure[s] to respond to [his] pain or possible medical
need,” or any “harm caused by [this] indifference.” Iqbal, 556 U.S. at 678 (citing Twombly,
550 U.S. at 557); Wilhelm, 680 F.3d at 1122 (citing Jett, 439 F.3d at 1096). Indeed,
Plaintiff’s pleading offers only the type of “labels and conclusions” or “formulaic
recitation[s] of the elements of a[n] [Eighth Amendment] cause of action that will not do.”
Iqbal, 662 U.S. at 678 (citing Twombly, 550 U.S. at 555.)
Moreover, as discussed below, the voluminous exhibits and medical records Plaintiff
offers in support of his Complaint show that both Drs. Hood and Butera acted promptly,
carefully, and responsibly when they both treated him at AMC on May 4-7, 2014, and when
Dr. Butera again treated him upon re-admission to AMC on September 28, 2014. Plaintiff’s
exhibits belie any plausible claims of deliberate indifference. Id.; see also Sprewell, 266
F.3d at 988; Nat’l Assoc. for the Advancement of Psychoanalysis, 228 F.3d at 1049 (noting
that court “may consider facts contained in documents attached to the complaint” to
determine whether a complaint states a claim for relief).
Specifically, Plaintiff claims that “from May 4, 2014 through May 7, 2014, both Drs.
Hood and Butera were “responsible” to provide him medical care by diagnosing,
evaluating, and exercising their medical judgments as to “the medical care needed.” (ECF
No. 1 at 15.) Plaintiff’s exhibits show both Dr. Hood and Dr. Butera, an infectious disease
specialist, examined Plaintiff, reviewed an x-ray of his knee and his current course of oral
antibiotics, diagnosed him with cellulitis of the right knee and leg, admitted him to AMC,
and in consultation “empirically placed [him] on IV vancomycin and Zosyn.” (ECF No. 1
at 29-30; ECF No. 1-1 at 85-86, 92-93.) Only after Plaintiff had “markedly improved” after
3 days of IV antibiotics, did both Drs. Hood and Butera clear him for discharge back to
RJD, and prescribe a continued course of oral antibiotic, pain, and inflammation therapy,
including Keflex, doxycycline, Tylenol with codeine and Naprosyn, noting that
“[g]enerally, a two week course of therapy of antibiotics appropriate to cover the pathogen
is necessary.” (ECF No. 1-1 at 105.) While Plaintiff concludes both Drs. Hood and Butera
were “deliberate[ly] indifferent” because they “failed to identify and treat [his] MRSA
infection” in May 2014 (ECF No. 1 at 25), his exhibits show a “nares methicillin-resistant
Staphylococcus aureus screen [was] negative” when he was admitted to AMC on May 4,
2014, (ECF No. 1-1 at 105), and that both Drs. Hood and Butera aggressively treated his
infection with IV Zosyn and vacomycin, the “only drug” he claims that “deals with
As to his subsequent admission to AMC on September 28, 2014, Plaintiff again
claims Dr. Butera was one of several doctors who were “responsible for [his] medical care.”
(ECF No. 1 at 25-26.) He also admits Butera “treated [him] with strong antibiotics due to
the resistance” of his infection during this hospitalization, (ECF No. 1 at 32, 45), but claims
the “MRSA infection was in an advanced stage” requiring surgery. (Id. at 26.) Plaintiff’s
exhibits show that in fact, Dr. Butera did in fact place Plaintiff back on vancomycin IV on
September 28, 2014, and noted that Plaintiff’s “previous MRSA screenings ha[d] been
negative,” but recommended that Plaintiff be observed until his “repeat[ed] blood cultures”
could be evaluated, an orthopedist could be consulted to evaluate whether a “proper
incision and drainage or bursectomy” was necessary due to Plaintiff’s relapse. (ECF No.
1-2 at 36-37, 40.) Plaintiff’s exhibits further show that it was not until his September 28,
2014 wound culture that Plaintiff tested “positive for MRSA,” and he consented to surgery.
(ECF No. 1 at 45; ECF No. 1-2 at 40.)
Plaintiff contends all Defendants, including Drs. Hood and Butera, violated his
Eighth Amendment rights because he “believes surgery could have been prevented if he
had been treated with adequate medical care since the beginning.” (ECF No. 1 at 33.) But,
to support a claim of deliberate indifference, Plaintiff must plead facts that demonstrate
something more than an ordinary lack of due care. Snow v. McDaniel, 681 F.3d 978, 985
(9th Cir. 2012) (citation and quotation marks omitted); Wilhelm, 680 F.3d at 1122. “A
difference of opinion between a physician and the prisoner–or between medical
professionals–concerning what medical care is appropriate does not amount to deliberate
indifference.” Snow, 681 F.3d at 987 (citing Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir.
1989)); Wilhelm, 680 F.3d at 1122-23. Instead, Plaintiff must allege facts sufficient to
“show that the course of treatment the [defendants] chose was medically unacceptable
under the circumstances and that the defendants chose this course in conscious disregard
of an excessive risk to [his] health.” Snow, 681 F.3d at 988 (citation and internal quotations
omitted). “Mere negligence in diagnosing or treating a medical condition, without more,
does not violate a prisoner’s Eighth Amendment rights.” Toguchi, 391 F.3d at 1057
Plaintiff’s Complaint, together with his exhibits however, contain no facts sufficient
to show that either Dr. Hood or Dr. Butera acted with deliberate indifference to his plight
by “knowing of and disregarding an[y] excessive risk to his health and safety,” or choosing
any “medically unacceptable” course of treating his infection in conscious disregard to his
health, on either occasion he was admitted to AMC and treated by them. Farmer, 511 U.S.
at 837; Snow, 681 F.3d at 988.
Accordingly, the Court GRANTS both Dr. Hood’s and Dr. Butera’s Motions to
Dismiss Plaintiff’s first cause of action based on the Eighth Amendment.
In his third cause of action, Plaintiff incorporates by reference all factual allegations
made in support of his Eighth Amendment claim, and asserts pendent state law claims
against all Defendants pursuant to Cal. Const., Art. 1 §§ 15, 17. (ECF No. 1 at 50.) Both
Dr. Hood and Dr. Butera also move to dismiss this cause of action pursuant to Fed. R. Civ.
P. 12(b)(6). (ECF No. 8-1 at 6-8; ECF No. 10-1 at 7.)
Cal. Const. Art I §§ 15 & 17 Claims
First, section 15 of Article I of the California Constitution provides:
[t]he defendant in a criminal cause has the right to a speedy
public trial, to compel attendance of witnesses in the defendant’s
behalf, to have the assistance of counsel for the defendant's
defense, to be personally present with counsel, and to be
confronted with the witnesses against the defendant. The
Legislature may provide for the deposition of a witness in the
presence of the defendant and the defendant’s counsel.
Persons may not twice be put in jeopardy for the same offense,
be compelled in a criminal cause to be a witness against
themselves, or be deprived of life, liberty, or property without
CAL. CONST., art 1 § 15. Thus, by its own terms, § 15 is applicable only in criminal cases.
See County of Sutter v. Davis, 234 Cal.App.3d 319, 324 n.2 (1991).
Second, section 17 of the California Constitution, like the Eighth Amendment of the
U.S. Constitution, prohibits cruel and unusual punishment. CAL. CONST. art. I § 17.
However, there is no private cause of action for money damages under Article I, section
17. Giraldo v. California Dep’t of Corr. and Rehab., 168 Cal.App.4th 231, 257, 85
Cal.Rptr.3d 371 (2008) (citing Katzberg v. Regents of the University of California, 29
Cal.4th 300, 329, 127 Cal.Rptr.2d 482, 58 P.3d 339 (2002)); see also Davis v. Kissinger,
2009 WL 256574, at *12 n. 4 (E.D. Cal. Feb. 3, 2009), adopted, 2009 WL 647350 (Mar.
10, 2009). Even though California’s cruel or unusual punishment clause represents a
significant right, alternative remedies are available to prisoners in the form of a negligence
action or an action for damages under the federal cruel and unusual punishment clause.
Giraldo, 168 Cal. App. 4th at 257; 85 Cal.Rptr.3d 371. Thus, Plaintiff is precluded from
bringing a claim under section 17 of the California Constitution for money damages.
And while relief for violations of Article I, section 17 is not limited to injunctive and
declaratory relief, those remedies must be premised on a valid and on-going cruel and
unusual punishments violation. See id. Because the Court has dismissed Plaintiff’s Eighth
Amendment cruel and unusual punishments claims as to both Dr. Hood and Dr. Butera, see
In re Alva, 33 Cal. 4th 254, 291 (2004) (“[W]e have never suggested that article I, section
17 employs a different or broader definition of ‘punishment’ itself than applies under the
Eighth Amendment.”), no grounds for injunctive or declaratory relief based on those claims
remain. See e.g., Mwasi v. Corcoran State Prison, No. 1:13-CV-00695-AWI, 2015 WL
3419203, at *7 (E.D. Cal. May 27, 2015).
Dismiss Plaintiff’s third cause of action pursuant to Cal. Const., art 1 §§ 15, 17.
Finally, Dr. Hood and Dr. Butera both move to dismiss Plaintiff’s request for
punitive damages pursuant to FED. R. CIV. P. 12(b)(6) because he has failed to allege facts
sufficient to show that either of them acted with the requisite culpability. (ECF No. 8-1 at
8-9; ECF No. 10-1 at 7-8.) Punitive damages may be assessed in § 1983 actions “when the
defendant’s conduct is shown to be motivated by evil motive or intent, or when it involves
reckless or callous indifference to the federally protected rights of others.” Smith v. Wade,
461 U.S. 30, 56 (1983).
Because the Court has found Plaintiff’s Complaint fails to state facts sufficient to
show that either Dr. Hood or Dr. Butera acted with deliberate indifference to his serious
medical needs, let alone any “evil motive or intent,” it DENIES their Motions to dismiss
Plaintiff’s claims for punitive damages based on his Eighth Amendment claims as moot.
Plaintiff is proceeding IFP in this case pursuant to 28 U.S.C. § 1915(a) (ECF No. 3).
On March 22, 2016, the Court conducted a sua sponte review of Plaintiff’s Complaint soon
after filing, and found it contained Eighth Amendment medical care claims sufficient to
overcome the “low threshold” for surviving the initial sua sponte screening required by 28
U.S.C. §§ 1915(e)(2) and 1915A(b), (id. at 5 (citing Wilhelm, 680 F.3d at 1123)), and
directed the U.S. Marshal to effect service upon Defendants on Plaintiff’s behalf. Id. at 5-
7. Plaintiff was cautioned, however, that “the sua sponte screening and dismissal procedure
is cumulative of, and not a substitute for, any subsequent Rule 12(b)(6) motion that [a
defendant] may choose to bring.” (Id. at 5 n.1 (citing Teahan v. Wilhelm, 481 F. Supp. 2d
1115, 1119 (S.D. Cal. 2007)).
As noted previously, no Defendants named in Plaintiff’s Complaint, other than Dr.
Hood and Dr. Butera, have yet to be served. See supra n.1. As a result of having since
carefully considered all the allegations in Plaintiff’s Complaint, together with all the
medical records he has attached as exhibits as the result of Dr. Hood and Dr. Butera’s
Motions to Dismiss, the Court now finds that it must also sua sponte dismiss the remainder
of Plaintiff’s claims as to all other named, but yet-to-be-served Defendants pursuant to 28
U.S.C. § 1915(e)(2)(b)(ii) for failing to state a claim upon which relief may be granted. See
Lopez v. Smith, 203 F.3d 1122, 1127 (9th Cir. 2000) (en banc) (“It is also clear that section
1915(e) not only permits but requires a district court to [sua sponte] dismiss an in forma
pauperis complaint” “at any time” if the court determines that it fails to state a claim) (citing
28 U.S.C. § 1915(e)(2)(B)(ii); see also Chavez v. Robinson, 817 F.3d 1162, 1167 (9th Cir.
2016) (“The statute governing IFP filings requires a court to dismiss an action ‘at any time’
if it determines that the complaint ‘seeks monetary relief against a defendant who is
immune from such relief.’”) (citing 28 U.S.C. § 1915(e)(2)(B)(iii)), and even “before the
defendants have been served and affirmatively raised the issue in a responsive pleading.”).
“The standard for determining whether a plaintiff has failed to state a claim upon
which relief can be granted under § 1915(e)(2)(B)(ii) is the same as the Federal Rule of
Civil Procedure 12(b)(6) standard for failure to state a claim.” Watison v. Carter, 668 F.3d
1108, 1112 (9th Cir. 2012).
To state an Eighth Amendment claim based on allegations of inadequate medical
care, Plaintiff’s Complaint must contain sufficient factual content to show that all the RJD
medical officials he has named as Defendants, just like AMC Drs. Hood and Butera, acted
with deliberate indifference to his serious medical needs. Estelle, 429 U.S. at 104; Peralta
v. Dillard, 744 F.3d 1076, 1081 (9th Cir. 2014) (en banc).
Plaintiff’s Eighth Amendment claims as to the named RJD Defendants can be
classified into three separate chronological incidents: 1) his December 2013 through
February 2014 left leg abscess, for which he alleges to have been treated by RJD Drs.
Robinson, Silva, and Cook; 2) his May through September 2014 pre- and post- AMC
admission for right knee and leg care, for which he alleges to have been treated by RJD
Drs. Casian, Chau, Ghayori, Wiley, and Zhang, and RNs Paule, Kaestner, Benitez, Garcia,
and Steward; and 3) his pre- and post-September 28, 2014 re-admission to AMC for
recurrent pain and swelling in his right knee and leg, for which he alleges to have been
treated by RJD Drs. Zhang, Newton, Suleiman and Wiley and RNs Wenzel, Paule, Janasco,
Wallace, and Calderon.13 As to the remaining named Defendants, RJD’s Chief Medical
Remaining Claims against Unserved Defendants
Plaintiff includes B. Manning in a list of RNs he names as Defendants, (ECF No. 1 at
15), and alleges he/she “was responsible for providing [him] health care,” (id.) but nowhere
else in his Complaint, or in the exhibits attached, does Plaintiff allege or show when he
was actually treated by Manning. See Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989)
(“Liability under [§] 1983 arises only upon a showing of personal participation by the
defendant.”). A person deprives another of a constitutional right, “within the meaning of
§ 1983 ‘if he does an affirmative act, participates in another’s affirmative act, or omits to
perform an act which he is legally required to do that causes the deprivation of which
Executive S. Roberts, Chief Executive Officer M. Glynn, and Chief Physician and Surgeon
R. Walker, Plaintiff alleges they are responsible for failing to “oversee” and/or supervise
his attending RJD physicians and nurses, and for “reviewing” his administrative medical
appeal, CDC 602 Log. No. RJD HC 14052082. (ECF No. 1 at 11-14; ECF No. 1-1 at 1-
RJD Treating Physicians and Nurses
As to Plaintiff’s Eighth Amendment claims as to Drs. Robinson, Silva, and Cook,
the Court finds he has failed to allege facts sufficient to show that any of them acted with
deliberate indifference to his left thigh abscess in December 2013. See Lopez, 203 F.3d at
1126-27; Peralta, 744 F.3d at 1081-82.
While Plaintiff claims Robinson, Silva, and Cook “failed to adequately treat” his
infection at the time (ECF No. 1 at 24, 37-39), he also admits they examined him, diagnosed
him with cellulitis, performed an I&D, prescribed oral antibiotics and pain relievers, and
ordered blood tests. (ECF No. 1 at 24, 38-39; ECF No. 1-1 at 16-60.) None of these facts
“allow the court to draw the reasonable inference” that Robinson, Silva, or Cook chose a
course of treatment that was “medically unacceptable under the circumstances” and in
“conscious disregard of an excessive risk” to Plaintiff’s health. Iqbal, 556 U.S. at 676;
Snow, 681 F.3d at 988; Farmer, 511 U.S. at 837. Indeed, Plaintiff’s left leg abscess was
“resolved” by February 10, 2014. (ECF No. 1-1 at 54-55.)
As to Plaintiff’s claims that Drs. Casian, Chau, Ghayori, Wiley, and Zhang, and RNs
Paule, Kaestner, Benitez, Garcia, and Steward “failed to take reasonable action to summon
… medical care” (ECF No. 1 at 25), for his right leg and knee infection both before and
after his May 7, 2014 admission to AMC, the Court also finds he has failed to allege facts
sufficient to show the deliberate indifference required to support an Eighth Amendment
claim. See Lopez, 203 F.3d at 1126-27; Peralta, 744 F.3d at 1081-82.
complaint is made.’” Preschooler II v. Clark Cnty. Sch. Bd. of Trs., 479 F.3d 1175, 1183
(9th Cir. 2007) (quoting Johnson v. Duffy, 588 F.2d 740, 743 (9th Cir. 1978)).
Plaintiff claims to have first requested medical attention for his right knee on March
24, 2014, but admits he was examined by an unidentified nurse who consulted with the
“PCP on site” who prescribed Bactrim, and directed him to follow up in 5 days. (ECF No.
1 at 26; ECF No. 1-1 at 63-64). On April 1, 2014, Plaintiff was examined by RN Kaestner
for a wound check. (ECF No. 1-1 at 65.) Plaintiff does not again complain about his right
leg and knee until a month later, when on May 2, 2014, he filed an emergency request due
to pain and swelling in his right knee, and was examined by RN Benitez (ECF No. 1-1 at
66, 76-77). Defendant Wiley examined him, and Dr. Karan ordered an x-ray, which showed
swelling, but no fracture, and attempted to tap fluid from his sub-patellar space for testing.
(Id. at 68, 70-71.) Plaintiff was diagnosed with prepatellar cellulits and bursitis, placed on
oral antibiotics, anti-inflammatories and pain killers. (ECF No. 1 at 41; ECF No. 1-1 at 67,
68, 73, 79.) Two days later, Defendants Casian and Garcia noted his swelling had
increased, and referred him to AMC for outpatient care. (ECF No. 1 at 29, 42; ECF No. 1-
1 at 80-84, 96.) Following his return to RJD on May 7, 2014, Plaintiff admits being placed
on oral antibiotics, anti-inflammatories, and pain medication. (ECF No. 1-1 at 107-108,
112-13), to have received a subsequent x-ray, and to have been examined no fewer than
five times by Defendants Chau, Stewart, Ghayouri, Paule, and Zhang on May 7, 9, 16,
2014, July 17, 2014, and September 15, 2014. (ECF No. 1 at 29-31; ECF No. 1-1 at 108,
112-13; ECF No. 1-2 at 1-4, 6, 7-15.) Based on these facts, the Court finds Plaintiff has
failed to plead facts that allow it to draw a reasonable inference that Drs. Casian, Chau,
Ghayori, Wiley, and Zhang, and RNs Paule, Kaestner, Benitez, Garcia, and Steward may
be held liable for violating Plaintiff’s Eighth Amendment rights. See Iqbal, 556 U.S. at
Plaintiff’s additional allegations that Drs. Zhang, Newton, Suleiman, Wiley and RNs
Wenzel, Paule, Janasco, Wallace, and Calderon failed to “pay attention” to his medical
needs (ECF No. 1 at 31), “intentionally and unjustifiably failed to summon medical care,”
(id. at 43, 47), and either failed to “prevent” his surgery and/or “intentionally delayed”
treatment (id. at 32-34), also fails to state a plausible claim for relief. Iqbal, 556 U.S. at
“The plausibility standard is not akin to a ‘probability requirement,’ but it asks for
more than a sheer possibility that a defendant has acted unlawfully.” Id. at 678 (quoting
Twombly, 550 U.S. at 556). Here, nothing in either Plaintiff’s Complaint or the exhibits he
has attached supports his claims of deliberate indifference as to these Defendants’
treatment of his right knee infection either prior to or following his September 28, 2014 re-
admission to AMC. Specifically, Plaintiff admits to have been examined by Dr. Zhang on
September 15, 2014 complaining of pain, and to have undergone an x-ray three days later,
which showed swelling, but no fracture, and to have been prescribed etodolac. (ECF No. 1
at 30-31; ECF No. 1-2 at 7-11, 14.) Ten days later, Plaintiff alleges to have developed a
fever, was evaluated by RN Wenzel and Dr. Suleiman, and on that same day authorized for
immediate transfer and admitted to AMC. (ECF No. 1 at 25-26, 32, 44-45; ECF No. 1-2 at
16, 21-23.) Upon his discharge from AMC on October 2, 2014, Plaintiff admits Drs. Zhang,
Newton and Garikaparthi all prescribed a continued course of oral antibiotics and pain
medication, as recommended by his AMC physicians upon discharge. (ECF No. 1 at 45;
ECF No. 1-2 at 48-49, 53, 63-68.) RNs Paule, Janasco, and Wallace treated his surgical
wound and changed his dressings on at least three separate occasions between October 2-
5, 2014 (ECF No. 1-2 at 54-55, 59, 61, 62), and when Dr. Zhang examined him again on
October 17, 2014, and again on November 4, 2014, Plaintiff’s infection had resolved, he
had completed his course of antibiotics, was able to move his right knee freely, and
continued to use pain medication. (ECF No. 1-2 at 72, 74, 77, 82). Plaintiff complained
again of knee pain in January 2015, but was evaluated by RN Calderon, prescribed
Naproxen and scheduled for a follow-up appointment with his PCP. (ECF No. 1 at 47; ECF
No. 1-2 at 87-90). Plaintiff next alleges to have been evaluated by Dr. Zhang on January
20, 2015, who prescribed Voltaren gel, and approved him for a bottom bunk, (ECF No. 1
at 47; ECF No. 1-2 at 92-96), and to have only again reported knee pain on May 20, 2015,
when he was examined by D. Wiley, prescribed more pain medication, and given a
neoprene knee brace after he exacerbated his knee injury playing soccer. (ECF No. 1 at 48;
ECF No. 1-2 at 99-100.)
Based on the facts as Plaintiff himself has alleged, the Court finds he has failed to
“nudge[] [his] claims” of deliberate indifference as to any named Defendant “across the
line from conceivable to plausible.” Iqbal, 556 U.S. at 680 (quoting Twombly, 550 U.S. at
570). Therefore, his remaining Eighth Amendment claims must be dismissed sua sponte
pursuant to 28 U.S.C. § 1915(e)(2). Lopez, 203 F.3d at 1126-27; Watison, 668 F.3d at 1112.
RJD Supervisory Defendants
As to Defendants Walker, Roberts, and Glynn, none of whom are alleged to have
treated Plaintiff personally, but instead are alleged to have negligently supervised or
instructed Plaintiff’s treating doctors and nurses “on how to treat or identify MRSA,” (ECF
No. 1 at 2, 27), and to have reviewed his CDCR 602 Inmate/Parolee Health Care Appeal,
Log No. 14052082, (id. at 10-14, 40-41; ECF No. 1-1 at 2-11), the Court also finds Plaintiff
has failed to state a claim upon which relief can be granted. Lopez, 203 F.3d at 1126-27.
To state a claim, Plaintiff must demonstrate that each defendant personally
participated in the deprivation of his constitutional rights. Iqbal, 556 U.S. at 673; Colwell
v. Bannister, 763 F.3d 1060, 1070 (9th Cir. 2014). Liability may not be imposed on
supervisory personnel for the acts or omissions of their subordinates under the theory of
respondeat superior. Iqbal, 556 U.S. at 672-673; Jones v. Williams, 297 F.3d 930, 934 (9th
Cir. 2002). Instead, supervisors may be held liable only if they “participated in or directed
the violations, or knew of the violations and failed to act to prevent them.” Taylor v. List,
880 F.2d 1040, 1045 (9th Cir. 1989); accord Starr v. Baca, 625 F.3d 1202, 1205-06 (9th
Here, Plaintiff alleges no facts to show how or to what extent Defendants Walker,
Walker, or Glynn personally violated his Eighth Amendment rights, directed the other
Defendants to violate his rights, or knew of their subordinates’ violations and failed to
prevent them. Id. And while Defendants Walker, Roberts, and Glynn are alleged to have
reviewed Plaintiff’s CDCR 602 Inmate/Parolee Health Care Appeal, (ECF No. 1 at 12-4)
this, by itself, is insufficient to support any independent constitutional violation. See
Ramirez v. Galaza, 334 F.3d 850, 860 (9th Cir. 2003) (finding it well-established that
“inmates lack a separate constitutional entitlement to a specific prison grievance
procedure.”) (citing Mann v. Adams, 855 F.2d 639, 640 (9th Cir. 1988)); Randall v. Arnold,
No. 2:15-CV-1711-EFB P, 2016 WL 4399391, at *4 (E.D. Cal. Aug. 18, 2016) (finding
that a prisoner “may not impose liability on defendants simply because they played a role
in processing [his] inmate appeals.”(citing Buckley v. Barlow, 997 F.2d 494, 495 (8th Cir.
1993)); Archini v. Sanders, No. 2:14-CV-1392-CMK-P, 2015 WL 5698384, at *3 (E.D.
Cal. Sept. 28, 2015) (sua sponte dismissing prisoner’s claims against officials who denied
his 602 inmate grievance for failing to state a claim pursuant to 28 U.S.C. § 1915A); Smith
v. Calderon, No. C 99-2036 MJJ PR, 1999 WL 1051947 at *3 (N.D. Cal. 1999) (finding
“the defendants’ alleged failure to properly process and decide [plaintiff’s] administrative
grievance and appeals did not violate any constitutional right”).
VII. Supplemental Jurisdiction
All that remains is Plaintiff’s “Second Cause of Action” alleging pendent state law
violations against all Defendants for “medical negligence and malpractice” in violation of
CAL. GOVT. CODE § 845.6 and 815.2 (ECF No. 1 at 37).
Federal courts should refrain from exercising their pendent jurisdiction over state
law claims when the federal claims are dismissed before trial. United Mine Workers v.
Gibbs, 383 U.S. 715, 726 (1966). Because the Court has found that Plaintiff has failed to
state an Eighth Amendment claim as to any named Defendant, it declines to exercise
supplemental jurisdiction over Plaintiff’s state law negligence and malpractice claims
pursuant to 28 U.S.C. § 1367(c)(3). See Carlsbad Tech., Inc. v. HIF Bio, Inc., 556 U.S.
635, 639 (2009) (district court retains discretion over whether to exercise supplemental
jurisdiction over state law claims after all federal claims are dismissed); see also 28 U.S.C.
§ 1367(c)(3) (“The district courts may decline to exercise supplemental jurisdiction over a
claim ... if ... the district court has dismissed all claims over which it has original
jurisdiction.”); Lacey v. Maricopa Cty., 693 F.3d 896, 940 (9th Cir. 2012) (accord).
For all the reasons discussed, the Court:
GRANTS Defendant Hood and Defendant Butera’s Motions to Dismiss
pursuant to FED. R. CIV. P. 12(b)(6) (ECF Nos. 8, 10);
DISMISSES Plaintiff’s Eighth Amendment claims as to all remaining
Defendants sua sponte for failing to state a claim pursuant to 28 U.S.C. § 1915(e)(2)(b)(ii);
exercise supplemental
jurisdiction over Plaintiff’s
supplemental state law claims pursuant to 28 U.S.C. § 1367(c)(3); and
GRANTS Plaintiff forty-five (45) days leave in which to file an Amended
Complaint that addresses the pleading deficiencies identified in this Order. Plaintiff is
cautioned, however, that should he choose to file an Amended Complaint, it must be
complete by itself, comply with Federal Rule of Civil Procedure 8(a), and that any claim
not re-alleged will be considered waived. See S.D. CAL. CIVLR 15.1; Hal Roach Studios,
Inc. v. Richard Feiner & Co., Inc., 896 F.2d 1542, 1546 (9th Cir. 1989) (“[A]n amended
pleading supersedes the original.”); Lacey, 693 F.3d at 928 (noting that claims dismissed
with leave to amend which are not re-alleged in an amended pleading may be “considered
waived if not repled.”). If Plaintiff fails to follow these instructions and/or files an
Amended Complaint that still fails to state a claim, his case will be dismissed without
further leave to amend. See Lira v. Herrera, 427 F.3d 1164, 1169 (9th Cir. 2005) (“If a
plaintiff does not take advantage of the opportunity to fix his complaint, a district court
may convert the dismissal of the complaint into dismissal of the entire action.”).