Staggs et al v. Doctors Hospital of Manteca, Inc. et al

Filing 47

MEMORANDUM AND ORDER signed by Judge Morrison C. England, Jr on 3/28/12 ORDERING that Defendants' MOTION TO DISMISS Plaintiffs' First Claim for relif 33 is GRANTED with leave to amend. The Court dismisses Plaintiffs' Fifth claim for relief sua sponte with leave to amend. Having dismissed Plaintiffs federal claims, the Court declines to exercise supplemental jurisdiction over Plaintiffs' remaining state-law claims at this time. Plaintiffs are directed to file an amended complaint, should they choose to do so, within twenty (20) days of this order. (Mena-Sanchez, L)

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UNITED STATES DISTRICT COURT

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EASTERN DISTRICT OF CALIFORNIA

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LINNIE STAGGS, as
administrator of the ESTATE
of ROBERT E. STAGGS, deceased,
and MELISSA STAGGS,

No. 2:11-cv-00414-MCE-KJN

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MEMORANDUM AND ORDER
Plaintiffs,

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v.
DOCTOR’S HOSPITAL OF MANTECA, INC.,
et al.,

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Defendants.
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----oo0oo----

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Plaintiffs Linnie Staggs, as administrator of the Estate of

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Robert E. Staggs, and Melissa Staggs (collectively, “Plaintiffs”)

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seek redress from defendant Doctor’s Hospital of Manteca, Inc.

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(“DHM”), and a number of individual defendants regarding the

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medical treatment and subsequent death of Robert E. Staggs

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(“Decedent”) while in custody at the Sierra Conservation Center

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(“SCC”).

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Presently before the Court is the Motion to Dismiss of Defendants

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Curtis Allen, M.D., Sharon Aungst, Edwin Bangi, M.D., Jonathan

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Benak, P.A., Frank Chavez, Ivan D. Clay, John Krpan, D.O., Jack

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St. Clair, M.D., and Tim Virga (collectively, “Defendants”)1

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pursuant to Federal Rule of Civil Procedure 12(b)(6).

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Mot. to Dismiss Pl.’s First Am. Compl. [“MTD”], filed August 1,

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2011 [ECF No. 33].)

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motion is GRANTED.2

(Defs.’

For the reasons set forth below, Defendants’

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BACKGROUND3

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Decedent had the Hepatitis C virus (“HCV”) and a history of

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liver problems, including cirrhosis.

In May 2009, while

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incarcerated at SCC, Decedent started experiencing darkened

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urine, skin itching and sores across his body, and also developed

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abdominal pain.

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and pain killers to treat the outward symptoms of Decedent’s

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itching and pain.

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medical advice, allegedly warned Decedent that his symptoms

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pointed to liver failure.

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The prison’s medical staff prescribed lotions

Decedent’s relatives, relying on outside

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1

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On September 20, 2011, the Court dismissed Defendants
Aungst, Chavez, Clay, and Virga from the instant action pursuant
to the parties’ stipulation. [ECF 42].

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Because oral argument will not be of material assistance,
the Court ordered this matter submitted on the briefing. E.D.
Cal. R. 230(g).
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The following facts are taken from Plaintiffs’ First
Amended Complaint (“FAC”), filed June 9, 2011 [ECF No. 4].
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In June 2009, test results revealed that Decedent had a

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significant rise in alpha-feto protein (“AFP”) levels, which

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allegedly should have been a “red flag” for Defendants, because

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the rise of AFP was suggestive of hepatocellular carcinoma

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(“HCC”), a liver cancer.

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healthcare providers at SCC, failed to repeat the test, which

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Plaintiffs contend violated the applicable standard of care.

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August 30, 2009, Decedent underwent an MRI which suggested a

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lesion.

However, Defendants Bangi and Krpan,

On

On October 4, 2009, Decedent underwent another MRI, the

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results of which revealed no evidence of a tumor as determined by

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Defendant Russin.

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the second test’s results was erroneous and in violation of the

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standard of care, or, alternatively, the medical personnel

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negligently conducted the test leading to the erroneous results.

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On December 26, 2009, Decedent went “man-down,” a condition

According to Plaintiffs, the interpretation of

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that is designed to draw immediate attention from the custodial

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and medical personnel at the prison.

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Sonora Regional Medical Center hospital, where he had an

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ultrasound and a contrast CT scan performed.

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revealed a 5 cm lesion in the right lobe of his liver and other

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lesions throughout the liver.

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physicians did not recheck Decedent’s AFP test, but instead

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interpreted the test results as indicative of metastatic colon

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cancer.

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despite two previous negative occult blood tests and the rising

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AFP levels in the context of HCV-induced cirrhosis.

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Decedent was taken to the

The test results

However, Decedent’s treating

The physicians did not report the possibility of HCC,

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According to Plaintiffs, the physicians’ actions fell below the

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applicable standard of care, because a metastatic disease in the

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setting of cirrhosis is very uncommon, whereas HCC in such a

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situation is much more likely.

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On December 29, 2009, Decedent again went “man-down” and was

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taken to the Sonora Regional Medical Center.

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of a severe stabbing pain in the right upper quadrant of his

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body.

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damage and cirrhosis.

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Decedent complained

An X-ray of Decedent’s abdominal area revealed liver

On or about December 14-31, 2009, Defendant Krpan decided,

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and Defendants St. Clair and Allen approved, that Decedent should

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undergo a liver biopsy on January 14, 2010.

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that this decision violated the standard of care because

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(1) where cirrhosis is present, conducting a biopsy when a lesion

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is suspected to be HCC creates a substantial risk that the tumor

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will spread along the needle track; and (2) a liver biopsy, while

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a safe procedure in the normal liver, is much more likely to

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cause bleeding in a cirrhotic liver.

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refused to perform the biopsy because of the associated risks.

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According to Plaintiffs, Defendants Krpan, Allen and St. Clair

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also violated the standard of care when they opted to do a three-

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pass core liver biopsy rather than a fine needle aspirate of the

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lesion, because the three-pass procedure allegedly created a

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significantly greater risk of bleeding.

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Decedent’s biopsy likely caused the large drop in hemoglobin

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(from 12 to 7), and the bloody ascites fluid, which precipitated

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Decedent’s subsequent complications.

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Plaintiffs allege

Two hospitals allegedly

Plaintiffs allege that

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On January 22, 2010, Decedent underwent biopsy at DHM.

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Although the medical standard required Decedent to rest for three

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or more hours after the operation, two correctional

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transportation officers, Does 1 and 2, allegedly compelled

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Decedent to leave his hospital bed after only 20 minutes of rest.

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During the ride to the prison, Decedent started feeling severe

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and sharp abdominal pain.

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Decedent was placed into the Operating Housing Unit for the night

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and, on January 23, was moved back to his cell.

Upon arrival to SCC on January 22,

Decedent’s

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condition kept declining: his abdomen continued to swell, he

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could no longer urinate, started vomiting, could not sleep and

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was in severe pain.

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correctional and medical personnel about his condition.

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He unsuccessfully tried to alert the SCC

At around 3:15 p.m. on January 24, 2010, Decedent again went

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“man-down.”

At 5:00pm, he was transferred to the prison’s

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Operating Housing Unit.

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to the San Joaquin Medical Center for emergency treatment.

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February 4, 2010, he was transferred to the California Medical

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Facility in Vacaville where he died on February 12, 2010, of

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blood loss into his peritoneum.

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result of Decedent’s three-pass liver biopsy.

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On January 25, 2010, Decedent was taken
On

The blood loss was allegedly the

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STANDARD

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On a motion to dismiss for failure to state a claim under

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Federal Rule of Civil Procedure 12(b)(6),4 all allegations of

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material fact must be accepted as true and construed in the light

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most favorable to the nonmoving party.

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Ins. Co., 80 F.3d 336, 337-38 (9th Cir. 1996).

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also assume that “general allegations embrace those specific

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facts that are necessary to support a claim.”

Cahill v. Liberty Mut.
The Court must

Smith v. Pacific

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Props. & Dev. Corp., 358 F.3d 1097, 1106 (9th Cir. 2004).

Rule

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8(a)(2) “requires only ‘a short and plain statement of the claim

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showing that the pleader is entitled to relief,’ in order to

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‘give the defendant a fair notice of what the . . . claim is and

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the grounds upon which it rests.’”

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550 U.S. 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41,

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47 (1957)).

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dismiss does not require detailed factual allegations.

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However, “a plaintiff’s obligation to provide the grounds of his

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entitlement to relief requires more than labels and conclusions,

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and a formulaic recitation of the elements of a cause of action

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will not do.”

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A court is not required to accept as true a “legal conclusion

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couched as a factual allegation.”

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1937, 1950 (2009) (quoting Twombly, 550 U.S. at 555).

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allegations must be enough to raise a right to relief above the

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speculative level.”

Bell. Atl. Corp. v. Twombly,

A complaint attacked by a Rule 12(b)(6) motion to

Id.

Id.

(internal citations and quotations omitted).

Ashcroft v. Iqbal,129 S. Ct.
“Factual

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4

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All further references to “Rule” or “Rules” are to the
Federal Rules of Civil Procedure unless otherwise noted.
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Twombly, 550 U.S. at 555 (citing 5 Charles Alan Wright & Arthur

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R. Miller, Federal Practice and Procedure § 1216 (3d ed. 2004)

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(stating that the pleading must contain something more than a

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“statement of facts that merely creates a suspicion [of] a

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legally cognizable right of action.”)).

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Furthermore, “Rule 8(a)(2) . . . requires a ‘showing,’

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rather than a blanket assertion, of entitlement to relief.”

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Twombly, 550 U.S. at 556 n.3 (internal citations and quotations

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omitted).

“Without some factual allegation in the complaint, it

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is hard to see how a claimant could satisfy the requirements of

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providing not only ‘fair notice’ of the nature of the claim, but

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also ‘grounds’ on which the claim rests.”

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Alan Wright & Arthur R. Miller, supra, at § 1202).

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must contain “only enough facts to state a claim to relief that

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is plausible on its face.”

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have not nudged their claims across the line from conceivable to

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plausible, their complaint must be dismissed.”

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well-pleaded complaint may proceed even if it strikes a savvy

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judge that actual proof of those facts is improbable, and ‘that a

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recovery is very remote and unlikely.’”

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Scheuer v. Rhodes, 416 U.S. 232, 236 (1974)).

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Id. at 570.

Id.

(citing 5 Charles
A pleading

If the “plaintiffs . . .

Id.

However, “a

Id. at 556 (quoting

A court granting a motion to dismiss a complaint must then

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decide whether to grant a leave to amend.

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be “freely given” where there is no “undue delay, bad faith or

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dilatory motive on the part of the movant, . . . undue prejudice

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to the opposing party by virtue of allowance of the amendment,

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[or] futility of the amendment . . . .”

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178, 182 (1962).
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Leave to amend should

Foman v. Davis, 371 U.S.

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Dismissal without leave to amend is proper only if it is clear

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that “the complaint could not be saved by any amendment.”

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Plex Techs., Inc. v. Crest Group, Inc., 499 F. 3d 1048, 1056

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(9th Cir. 2007) (internal citations and quotations omitted).

Intri-

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ANALYSIS

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Plaintiffs assert two federal claims under § 1983 for
violations of Decedent’s Eighth Amendment rights (first and fifth

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claims for relief) and five state-law claims: (1) violation of

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California Government Code § 845.6 (second claim for relief);

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(2) negligence based on failure to diagnose and treat Decedent’s

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liver condition (third claim for relief); (3) violation of

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California Civil Code § 52.1 (fourth claim for relief);

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(4) negligence based on failure to provide post-biopsy recovery

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(sixth claim for relief); and (5) wrongful death (seventh claim

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for relief).

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A.

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First Claim for Relief: Denial of Rights under the

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Eighth and Fourteenth Amendment Against Defendants

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Allen, Bangi, Krpan, and St. Clair

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Plaintiff’s first claim for relief arises under 42 U.S.C.

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§ 1983.

The FAC alleges that Defendants knew of Decedent’s life-

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threatening medical condition and acted with deliberate

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indifference in failing to provide appropriate medical care to

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Decedent.

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(FAC ¶¶ 67-69.)

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Defendants contend that Plaintiffs have failed to state a viable

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Eighth Amendment claim under § 1983 because Plaintiffs’

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allegations against Allen, Bangi, Benak,5 Krpan, and St. Clair do

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not amount to allegations of deliberate indifference, but merely

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to a “disagreement of medical opinion.”

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(MTD at 6-7.)

Under 42 U.S.C. § 1983, an individual may sue “[e]very

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person, who, under color of [law] subjects” him “to the

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deprivation of any rights, privileges, or immunities secured by

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the Constitution and laws.”

An individual may be liable for

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deprivation of constitutional rights “within the meaning of

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section 1983, ‘if he does an affirmative act, participates in

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another’s affirmative acts, or omits to perform an act which he

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is legally required to do that causes the deprivation of which

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complaint is made.’”

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Trs., 479 F.3d 1175, 1183 (9th Cir. 2007).

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Preschooler II v. Clark County Sch. Bd. of

In order to state an Eighth Amendment claim for inadequate

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medical care, “a prisoner must allege acts or omissions

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sufficiently harmful to evidence deliberate indifference to

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serious medical needs.”

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(1976).

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Estelle v. Gamble, 429 U.S. 97, 106

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Although Benak is not specifically named in Plaintiffs’
first claim for relief, Defendants nevertheless contend that
Benak’s failure to summon medical care does not rise to the level
of a constitutional violation. (MTD at 7.) In their opposition,
Plaintiffs do not address Defendants’ assertions regarding Benak.
While Plaintiffs’ second cause of action under California
Government Code § 845.6 clearly names Benak as a defendant,
neither the FAC’s “Statement of Facts” section nor the first
cause of action references any wrongful acts on the part of
Benak. Thus, the Court concludes that Plaintiffs have not named
Banak as a defendant in their first claim for relief and
therefore disregards Defendants’ arguments regarding Plaintiffs’
failure to state a § 1983 claim against Benak.
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Plaintiff must plead sufficient facts to permit the Court to

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infer that (1) Plaintiff had a “serious medical need” and that

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(2) individual Defendants were “deliberately indifferent” to that

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need.

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prisoner can satisfy the “serious medical need” prong by

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demonstrating that “failure to treat [his] condition could result

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in further significant injury or the unnecessary and wonton

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infliction of pain.”

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omitted).

Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006).

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Id. (internal citations and quotations

Defendants acknowledge that Plaintiffs have adequately

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alleged that Decedent had a serious medical need.

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to Pls.’ Opp., filed Sept. 22, 2011 [ECF No. 44], at 2.)

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(Defs.’ Reply

Thus, the issue for the Court is whether Plaintiffs have

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sufficiently alleged that Defendants were deliberately

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indifferent to Decedent’s serious medical need.

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deliberate indifference standard, individual Defendants are not

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liable under the Eighth Amendment for their part in allegedly

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denying necessary medical care unless they knew “of and

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disregard[ed] an excessive risk to inmate health or safety.”

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Farmer v. Brennan, 511 U.S. 825, 837 (1994); Gibson v. County of

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Washoe, Nev., 290 F.3d 1175, 1187-88 (9th Cir. 2002).

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indifference contains both an objective and subjective component:

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“the official must both be aware of facts from which the

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inference could be drawn that a substantial risk of serious harm

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exists, and he must also draw that inference.”

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at 837.

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not,” then the standard of deliberate indifference is not

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satisfied “no matter how severe the risk.”

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///

Under the

Deliberate

Farmer, 511 U.S.

“If a person should have been aware of the risk, but was

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Gibson, 290 F.3d at 1188 (citing Jeffers v. Gomez, 267 F.3d 895,

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914 (9th Cir. 2001)).

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official acted or failed to act believing that harm actually

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would befall on inmate; it is enough that the official acted or

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failed to act despite his knowledge of a substantial risk of

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serious harm.”

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Plaintiffs “need not show that a prison

Farmer, 511 U.S. at 842.

“The indifference to medical needs must be substantial; a

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constitutional violation is not established by negligence or ‘an

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inadvertent failure to provide adequate medical care.’”

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Anderson v. County of Kern, 45 F.3d 1310, 1316 (9th Cir. 1995)

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(quoting Estelle, 429 U.S. at 105-06).

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“deliberately indifferent to a prisoner’s serious medical needs

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when they deny, delay, or intentionally interfere with medical

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treatment.”

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2002); Lolli v. County of Orange, 351 F.3d 410, 419 (9th Cir.

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2003).

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in diagnosing or treating a medical condition does not state a

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valid claim of medical mistreatment under the Eighth Amendment.

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Medical malpractice does not become a constitutional violation

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merely because the victim is a prisoner.”

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106.

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without more, does not constitute “deliberate indifference,”

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unless the plaintiff can show that the delay caused serious harm

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to the plaintiff.

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(9th Cir. 1990).

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Generally, defendants are

Hallett v. Morgan, 296 F.3d 732, 744 (9th Cir.

However, “a complaint that a physician has been negligent

Estelle, 429 U.S. at

Further, a mere delay in receiving medical treatment,

Wood v. Housewright, 900 F.2d 1332, 1335

Defendants’ acts and omissions, as alleged in the FAC, do

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not plausibly rise to the level of deliberate indifference to

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Decedent’s medical needs.
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This case does not present a situation where prison personnel

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completely failed to treat Decedent or where the delay in the

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provision of medical care was so significant as to constitute

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deliberate indifference to Decedent’s serious medical needs.

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In particular, Plaintiffs’ deliberate indifference claim

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against Krpan is based on Krpan’s alleged failure to conduct

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additional testing and his decision to prescribe a liver biopsy

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for Decedent. (FAC ¶¶ 35,45,46.)

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prescribing a biopsy, Krpan “violated the standard of care,”

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because of substantial risks associated with conducting this

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procedure when a lesion is suspected to be HCC where cirrhosis is

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present.

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by opting for a three-pass core liver biopsy rather than a fine

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needle aspirate of the lesion, because the three-pass procedure

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allegedly creates a much greater risk of bleeding.

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In support of their allegations of deliberate indifference,

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Plaintiffs rely on the fact that two hospitals refused to perform

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the biopsy prescribed by Krpan because of the associated risks.

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(FAC ¶ 46.)

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(FAC ¶ 45.)

Plaintiffs allege that, by

Krpan also “violated the standard of care”

(FAC ¶ 47.)

The allegations against Krpan are insufficient to state a

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claim for deliberate indifference.

Plaintiffs’ allegations

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actually suggest that Krpan addressed Decedent’s requests by

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prescribing medical treatment, albeit not the one Plaintiffs

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would have preferred.

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proper course of medical treatment does not constitute deliberate

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indifference.

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2004); Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996).

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A difference of medical opinion over the

Toguchi v. Chung, 391 F.3d 1051, 1059-60 (9th Cir.

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Moreover, Plaintiffs’ allegations that Krpan “violated a standard

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of care” suggest, at best, professional negligence.

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allegation of medical malpractice is not sufficient to state a

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claim for a constitutional violation under the Eighth Amendment.

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Estelle, 429 U.S. at 106.

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claim for deliberate indifference to Decedent’s medical needs

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against Krpan.

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9

An

Thus, Plaintiffs failed to state a

Plaintiffs’ allegations against the other named Defendants
are even more deficient.

The only factual allegation in the FAC

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relevant to St. Clair and Allen is that these Defendants approved

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Decedent’s biopsy after the biopsy was prescribed by Krpan.

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¶ 45.)

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that St. Clair and Allen were deliberately indifferent to

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Decedent’s serious medical needs.

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Allen approved medical treatment for Decedent’s condition,

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Plaintiffs demonstrate the opposite of denial, delay or

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intentional interference with Decedent’s medical treatment, as

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required to state a cognizable claim based on deliberate

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indifference.

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419.

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(FAC

This allegation is plainly insufficient to demonstrate

By stating that St. Clair and

See Hallett, 296 F.3d at 744; Lolli, 351 F.3d at

Plaintiffs’ deliberate indifference claim against Bangi

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rests solely on Bangi’s alleged failure to conduct additional

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testing, which, according to Plaintiffs, was a violation of the

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standard of care. (FAC ¶ 35.)

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neglect does not amount to a constitutional violation under the

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Eighth Amendment.

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///

Such an isolated incident of

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As the Supreme Court has held, “[a] medical decision not to order

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an X-ray, or like measures, does not represent cruel and unusual

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punishment” within the meaning of the Eighth Amendment.

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429 U.S. at 107.

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Eighth Amendment claim against Bangi.

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7

Estelle,

Thus, Plaintiffs have failed to state a viable

Accordingly, the Court grants Defendants’ motion to dismiss
the first claim for relief with leave to amend.

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B.

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Fifth Claim for Relief: Denial of Rights under the
Eighth and Fourteenth Amendment against Does 1-2

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The Court sua sponte analyzes the sufficiency of Plaintiffs’

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fifth claim for relief because, after the dismissal of

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Plaintiff’s first claim, the fifth claim is the only basis for

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the Court’s exercise of federal jurisdiction, and because no

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defendant can move to dismiss this claim as it is brought only

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against Doe Defendants.

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(9th Cir. 1981) (“A trial court may act on its own initiative to

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note the inadequacy of a complaint and dismiss it for failure to

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state a claim, but the court must give notice of its sua sponte

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intention to invoke Rule 12(b)(6) and afford plaintiffs ‘an

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opportunity to at least submit a written memorandum in opposition

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of such motion.’”) (citations omitted); Urias v. Quiroz,

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895 F. Supp. 262, 264 (S.D. Cal. Apr. 27, 1995) (“The court has

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the authority to dismiss the Doe defendants sua sponte.”).

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///

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///

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///

See Wong v. Bell, 642 F.2d 359, 361-62

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1

Plaintiffs allege that Defendant correctional officers Does

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1-2 were deliberately indifferent to Decedent’s serious medical

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needs when they transferred Decedent from his MDH hospital bed

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back to SCC, thus depriving Decedent of the necessary rest after

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the biopsy procedure.

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applicable medical standard of care prescribes that a patient

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should be placed to rest for three or more hours immediately

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after the operation.

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Does 1-2 compelled Decedent to leave his hospital bed only after

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20 minutes of rest.

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(FAC ¶ 88.)

(FAC ¶ 50.)

According to Plaintiffs, the

Yet, correctional officers

(FAC ¶ 51.)

The Court finds Plaintiffs’ allegations against Defendant

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Does 1-2 insufficient to state a claim for the Eighth Amendment

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violation of Decedent’s rights.

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the “deliberate indifference” standard is not satisfied unless a

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plaintiff can plausibly demonstrate that the defendant knew of

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the excessive risk to the prisoner’s health and safety but

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disregarded that risk.

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at 1187-88.

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was not,” then the standard of deliberate indifference is not

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satisfied “no matter how severe the risk.”

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1188.

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the medical standard prescribing a three-hour post-biopsy rest

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period or that they were aware of the “excessive” risk to

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Decedent’s health associated with transporting him to SCC after

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only twenty minutes of rest.

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///

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///

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///

As the Court explained earlier,

Farmer, 511 U.S. at 837; Gibson, 290 F.3d

“If a person should have been aware of the risk, but

Gibson, 290 F.3d at

Nothing in the FAC suggests that Does 1 and 2 knew about

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1

Accordingly, the Court finds Plaintiffs’ allegations

2

insufficient to support a cognizable claim for deliberate

3

indifference to Decedent’s medical needs against Defendants Does

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1 and 2.

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prejudice without affording Plaintiffs the opportunity to cure

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the FAC’s deficiencies or to submit a memorandum in opposition of

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such dismissal, see Wong, 642 F.2d at 361-62, the Court dismisses

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Plaintiffs’ fifth claim for relief with leave to amend.

Because the Court cannot dismiss this claim with

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C.

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State-law Claims

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Having found that both of Plaintiffs’ federal claims fail

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under Rule 12(b)(6), the Court declines to exercise supplemental

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jurisdiction over Plaintiffs’ state-law claims and dismisses

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those claims with leave to amend.

28 U.S.C. § 1367(c).

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CONCLUSION

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19

For the reasons stated above, Defendants’ Motion to Dismiss

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Plaintiffs’ First claim for relief is GRANTED with leave to

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amend.

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sua sponte with leave to amend.

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federal claims, the Court declines to exercise supplemental

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jurisdiction over Plaintiffs’ remaining state-law claims at this

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time. 28 U.S.C. § 1367(c).

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///

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///

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///

The Court dismisses Plaintiffs’ Fifth claim for relief
Having dismissed Plaintiffs

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1

Plaintiffs are directed to file an amended complaint, should they

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choose to do so, within twenty (20) days of this Order.

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amended complaint is filed within said twenty (20) days, this

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action will be dismissed without leave to amend without any

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further notice from the court.

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7

If no

IT IS SO ORDERED.
Dated: March 28, 2012

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_____________________________
MORRISON C. ENGLAND, JR.
UNITED STATES DISTRICT JUDGE

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20
21
22
23
24
25
26
27
28
17