Ransom v. Department of Corrections & Rehabilitations, et al.

Filing 152

FINDINGS and RECOMMENDATIONS to Grant Defendant M. Dhah's 137 Motion for Summary Judgment signed by Magistrate Judge Michael J. Seng on 06/29/2016. Referred to Judge Ashii; Objections to F&R due by 7/18/2016. (Flores, E)

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UNITED STATES DISTRICT COURT

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EASTERN DISTRICT OF CALIFORNIA

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BRYAN E. RANSOM,

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Plaintiff,

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Case No. 1:11-cv-0068-AWI-MJS (PC)
FINDINGS AND RECOMMENDATION
TO GRANT DEFENDANT M. DHAH’S
MOTION FOR SUMMARY JUDGMENT

v.
DEPARTMENT OF CORRECTIONS AND
REHABILITATION, et al.,
Defendants.

(ECF No. 137)
FOURTEEN-DAY OBJECTION
DEADLINE

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Plaintiff is a state prisoner proceeding pro se and in forma pauperis in this civil

19 rights action pursuant to 42 U.S.C. § 1983. The case proceeds on First Amended
20 Complaint (“FAC”) Eighth Amendment medical indifference claims against Defendants
21 Greaves, Bondoc, Punt, Madina, Swingle, Neubarth, Corea and Dhah. (ECF Nos. 20,
22 21, 26.) Pending before the Court is Defendant Dhah’s March 18, 2016, motion for
23 summary judgment. (ECF No. 137.) Though Plaintiff was required to file an opposition
24 or a statement of non-opposition to this motion within twenty-one days from the date of
25 service, see E.D. Cal. Local Rule 230(l), he has not responded to the motion or sought
26 an extension of time to do so. Accordingly, the Court deems the matter submitted.
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I.

LEGAL STANDARDS
Any party may move for summary judgment, and the Court shall grant summary

judgment if the movant shows that there is no genuine dispute as to any material fact
and the movant is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a); Wash.
Mut. Inc. v. United States, 636 F.3d 1207, 1216 (9th Cir. 2011). Each party’s position,
whether it be that a fact is disputed or undisputed, must be supported by (1) citing to
particular parts of materials in the record, including but not limited to depositions,
documents, declarations, or discovery; or (2) showing that the materials cited do not
establish the presence or absence of a genuine dispute or that the opposing party
cannot produce admissible evidence to support the fact. Fed R. Civ. P. 56(c)(1). The
Court may consider other materials in the record not cited to by the parties, but it is not
required to do so. Fed. R. Civ. P. 56(c)(3); Carmen v. San Francisco Unified Sch. Dist.,
237 F.3d 1026, 1031 (9th Cir. 2001).
Plaintiff bears the burden of proof at trial, and to prevail on summary judgment,
he must affirmatively demonstrate that no reasonable trier of fact could find other than
for him. Soremekun v. Thrifty Payless, Inc., 509 F.3d 978, 984 (9th Cir. 2007).
Defendants do not bear the burden of proof at trial and, in moving for summary
judgment, they need only prove an absence of evidence to support Plaintiff’s case. In re
Oracle Corp. Securities Litigation, 627 F.3d 376, 387 (9th Cir. 2010).
In judging the evidence at the summary judgment stage, the Court may not make
credibility determinations or weigh conflicting evidence, Soremekun, 509 F.3d at 984,
and it must draw all inferences in the light most favorable to the nonmoving party and
determine whether a genuine issue of material fact precludes entry of judgment, Comite
de Jornaleros de Redondo Beach v. City of Redondo Beach, 657 F.3d 936, 942 (9th
Cir. 2011).

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II.

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Plaintiff, who at all relevant times was housed at California State Prison in
Corcoran, California (“CSP-Cor”), suffers from Hepatitis-C (“Hep-C”). “On numerous
occasions,” he complained to Defendant Dhah about pain in his hands and wrists
following the discontinuation of his prescription of Tramadol, a pain reliever.2 Though
Dhah noted the pain and swelling in Plaintiff’s hands and wrists, he refused to prescribe
effective pain medication. This refusal “served no legitimate penological interests or
institutional/medical goal.”
III.

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Practitioner and Physician’s Assistant at CSP-Cor where he was involved with providing
healthcare to patients with Hep-C. In this role, Dhah was familiar with CDCR treatment
guidelines for healthcare treatment for those patients.
Dhah was involved in Plaintiff’s treatment on the following nine days: October 24,
2008; November 14, 2008; November 18, 2008; November 20, 2008; March 25, 2010;
June 30, 2010; September 1, 2010; November 12, 2010; and March 24, 2011.

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Of these nine days, Dhah personally saw Plaintiff on only five days: November
14, 2008; June 30, 2010; September 1, 2010; November 12, 2010; and March 24, 2011.

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A.

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STATEMENT OF FACTS3
During the relevant period in this case, Manjit Dhah worked as a Nurse

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PLAINTIFF’S ALLEGATIONS1

November 14, 2008

On November 14, 2008, Dhah saw Plaintiff for a chronic care follow-up of Hep-C
and hypertension. Though Plaintiff had no symptoms or complaints, he wanted
treatment for his Hep-C. Plaintiff told Dhah that he underwent a liver biopsy in 2006, but
Dhah did not see a record of the biopsy in the chart. Dhah ordered a blood stool test to
be performed, sought a copy of the 2006 liver biopsy, and ordered a battery of tests

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The Court includes only those allegations relevant to Plaintiff’s claim against Defendant Dhah.
Tramadol is a controlled substance analgesic medicine used to treat moderate to severe pain and is sometimes
used when a patient has not responded to more traditional pain medications.
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These facts, which are undisputed unless noted otherwise, are taken from Defendant’s Statement of Undisputed
Facts and Plaintiff’s discovery response and deposition testimony. (ECF No. 137-8.)
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needed for Hep-C treatment evaluation. Plaintiff did not complain of joint pain on that
day.

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On June 30, 2010, Dhah saw Plaintiff for a follow-up of his history of occasional
headaches. Plaintiff did not complain of joint pain on that day and did not have a
headache on that day.

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C.

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September 1, 2010

On September 1, 2010, Dhah saw Plaintiff for a follow-up for Hep-C and high
blood pressure. Dhah’s review of Plaintiff’s medications revealed an old prescription for
Gabapentin. Plaintiff said this prescription was for joint pain that he experienced in the
past, but it did not work for him and he had not been taking it. Plaintiff agreed to a
discontinuation of the prescription. In discussing his health that day, Plaintiff indicated
that he did, among other exercises, two hundred jumping jacks; he had occasional
headaches that were “not bad”; and he had no dizziness or vision issues. Dhah’s
physical examination did not reveal any tenderness or deformities in Plaintiff’s hands.
Based on this examination and his conversation with Plaintiff, Dhah discontinued the
Gabapentin prescription and ordered a 3-month supply of Tylenol, a standard
medication for inmates with occasional headaches and for patients with a history of joint
pains.

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June 30, 2010

Plaintiff’s version of this appointment differs somewhat.4 Plaintiff contends that he
told Dhah he was experiencing chronic joint pain in his hands, wrists, and fingers, and
that the Gabapentin was not helping with pain management. Plaintiff told Dhah that he
was awaiting a decision from the Pain Management Committee to possibly reinstate
Plaintiff’s Tramadol prescription and asked if Dhah could expedite the process. When
Dhah said he would prescribe Motrin, Plaintiff said that Tramadol was initially prescribed
for him because Motrin and Tylenol proved ineffective. In response, Dhah told Plaintiff

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Plaintiff’s version of this appointment is gleaned from his Interrogatory responses and deposition testimony.

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that Tramadol is no longer prescribed for pain and that the only medication he can
prescribe now is Motrin or Tylenol. Plaintiff then inquired about medical marijuana,
which irritated Dhah. Dhah laughed at Plaintiff and ordered an escorting officer to
remove Plaintiff from the clinic.

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Dhah denies laughing at Plaintiff, and he does not recall Plaintiff asking for
medical marijuana. Even if Plaintiff did ask for medical marijuana, Dhah would not have
been authorized to prescribe it. Similarly, prison healthcare guidelines in effect in 2010
precluded Dhah from prescribing Tramadol to patients because of its addictive qualities
and potential for misused. Plaintiff acknowledges that a nurse practitioner cannot
prescribe a medication that he is not authorized to provide.

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D.

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On November 12, 2010, Dhah saw Plaintiff for a follow-up for his Hep-C and high
blood pressure. Plaintiff said he was “feeling fine” but wanted a prescription for antacids
for occasional heartburn. Dhah prescribed a 2-month supply of antacids and ordered
refills of Plaintiff’s high blood pressure medications. Other than heartburn, Plaintiff did
not complain of any pain that day.

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E.

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November 12, 2010

March 24, 2011

On March 24, 2011, Dhah saw Plaintiff one last time. Plaintiff complained of pain
in his hands “every now & then,” but said he had not experienced trauma, numbness, or
any radiation of pain to his wrists or forearms. Dhah’s examination of Plaintiff’s hands
was normal. There were no deformities and the hands were non-tender to palpation.
For Plaintiff’s occasional hand pain, Dhah recommended that he take Tylenol as
needed.
IV.

ANALYSIS
Where a prisoner’s Eighth Amendment claims arise in the context of medical

care, the prisoner must allege and prove “acts or omissions sufficiently harmful to
evidence deliberate indifference to serious medical needs.” Estelle v. Gamble, 429 U.S.

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97, 106 (1976). An Eighth Amendment medical claim has two elements: “the
seriousness of the prisoner’s medical need and the nature of the defendant’s response
to that need.” McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1991), overruled on
other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997) (en banc).
A medical need is serious “if the failure to treat the prisoner's condition could
result in further significant injury or the ‘unnecessary and wanton infliction of pain.’ ”
McGuckin, 974 F.2d at 1059 (quoting Estelle, 429 U.S. at 104). Indications of a serious
medical need include “the presence of a medical condition that significantly affects an
individual's daily activities.” Id. at 1059-60. By establishing the existence of a serious
medical need, a prisoner satisfies the objective requirement for proving an Eighth
Amendment violation. Farmer v. Brennan, 511 U.S. 825, 834 (1994).
If a prisoner establishes the existence of a serious medical need, he must then
show that prison officials responded to the serious medical need with deliberate
indifference. Farmer, 511 U.S. at 834. In general, a prisoner evinces deliberate
indifference by showing that prison officials denied, delayed, or intentionally interfered
with medical treatment, or points the deficient way in which prison officials provided
medical care. Hutchinson v. United States, 838 F.2d 390, 393-94 (9th Cir. 1988).
However, “the indifference to his medical needs must be substantial. Mere 'indifference,'
'negligence,' or 'medical malpractice' will not support this cause of action.” Broughton v.
Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 1980) (citing Estelle, 429 U.S. at 10506). See also Toguchi v. Soon Hwang Chung, 391 F.3d 1051, 1057 (9th Cir. 2004)
(“Mere negligence in diagnosing or treating a medical condition, without more, does not
violate a prisoner's Eighth Amendment rights.”); McGuckin, 974 F.2d at 1059 (same).
Deliberate indifference is “a state of mind more blameworthy than negligence” and
“requires 'more than ordinary lack of due care for the prisoner's interests or safety.'”
Farmer, 511 U.S. at 835 (quoting Whitley v. Albers, 475 U.S. 312, 319 (1986)).

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Mere differences of opinion between a prisoner and prison medical staff or
between medical professionals as to the proper course of treatment for a medical
condition do not give rise to a § 1983 claim. Toguchi, 391 F.3d at 1058; Jackson v.
McIntosh, 90 F.3d 330, 332 (9th Cir. 1996); Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir.
1989); Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981).
There is no dispute here that Plaintiff’s Hep-C and related joint pain amount to a
serious medical need. The only question before the Court is whether Defendant Dhah’s
response to that need was deliberately indifferent. As to that question, the undisputed
facts demonstrate that Plaintiff’s claim against Defendant is premised on a mere
difference of opinion as to the proper course of treatment. Though Plaintiff sought a
renewal of his Tramadol prescription or an alternative treatment like medical marijuana,
the evidence establishes that Defendant prescribed the only pain medication that he
was authorized to provide. Plaintiff acknowledges that a nurse practitioner cannot
prescribe a medication that he is not permitted to provide.
Additionally, in support of his motion, Dhah submits the declaration of Dr. Martin
Sattah, a board certified internist who has consistently treated numerous patients with
acute and chronic pain stemming from their contraction and treatment of HIV and/or
Hep-C, including patients who have suffered from joint pain. Following review of
Plaintiff’s medical records and Dhah’s provision of care, Dr. Sattah opines that Dhah
appropriately responded to Plaintiff’s medical history and complaints of pain, including
ordering laboratory results, obtaining the liver biopsy results, and ordering
recommended tests. Dr. Sattah also opines that the medications prescribed by Dhah
were appropriate under the circumstances. Insofar as Plaintiff claims that Dhah refused
to prescribe Tramadol, Dr. Sattah declares that any refusal would have been
reasonable given the lack of indication by Plaintiff that his joint pains were severe,
debilitating, or worsening on the dates he was seen by Dhah. Dr. Sattah thus concludes

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that Dhah’s treatment of Plaintiff was reasonable and clearly met the standard of care in
the medical community.

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In light of this evidence, the Court concludes that no reasonable trier of fact
would find that Defendant’s treatment of Plaintiff was deliberately indifferent. For these
reasons, the Court will recommend that Defendant Dhah’s motion for summary
judgment be granted.
V.

CONCLUSION
Based on the foregoing, IT IS HEREBY RECOMMENDED that:
1.

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Defendant Dhah’s March 18, 2016, motion for summary judgment (ECF
No. 137) be GRANTED; and

2.

Defendant Dhah be DISMISSED from this action.

The findings and recommendations will be submitted to the United States District
Judge assigned to the case, pursuant to the provisions of Title 28 U.S.C. § 636(b)(1).
Within fourteen (14) days after being served with the findings and recommendations,
the parties may file written objections with the Court. The document should be
captioned “Objections to Magistrate Judge’s Findings and Recommendations.” A party
may respond to another party’s objections by filing a response within fourteen (14) days
after being served with a copy of that party’s objections. The parties are advised that
failure to file objections within the specified time may result in the waiver of rights on
appeal. Wilkerson v. Wheeler, 772 F.3d 834, 839 (9th Cir. 2014) (citing Baxter v.
Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)).

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Dated:

June 29, 2016

/s/

Michael J. Seng

UNITED STATES MAGISTRATE JUDGE
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