Goodwin v. California Department of Corrections & Rehabilitation et al

Filing 82

ORDER GRANTING IN PART AND DENYING IN PART DEFENDANTS' MOTION FOR SUMMARY JUDGMENT re 50 MOTION for Summary Judgment Notice of and Motion for Summary Judgment; Memo. P&As filed by California Department of Corrections & Rehabilitation. Signed by Judge James Larson on 3/21/11. (jlsec, COURT STAFF) (Filed on 3/21/2011)

Cruz-Dominguez v. California Department of Corrections & Rehabilitation et al

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Jessica Cruz-Dominguez as Guardian ad Litem for Santos Eddie Fitzgerald, Plaintiff, v. California Department of Corrections Rehabilitation, et al., Defendants. ________________________________/ I. Introduction

No. C 07-1924 JL Motion Granting in part and denying in Part Defendants' motion for summary judgment (Docket #50)

Defendants' motion for summary judgment came on for hearing. All parties had previously consented to this Court's jurisdiction under 28 U.S.C. §636(c). Mashhood Rassam, FENWICK & WEST LLP, appeared for the minor Plaintiff Santos Eddie Fitzgerald through his guardian ad litem Jessica Cruz-Dominguez. Deputy Attorney General Thomas Blake appeared for Defendants. The Court carefully considered the moving and opposing papers and the arguments of counsel, and hereby grants the motion in part and denies it in part. II. Facts

Defendants and Plaintiff agree on the basic facts of this case. Mr. Fitzgerald was a brittle diabetic who died on September 12, 2006. An autopsy by Dr. Ikechi Ogan

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determined the cause of death to be "acute diabetic coma with seizure activity," which was caused by a sharp drop in Mr. Fitzgerald's blood sugar. Declaration of Mashhood Rassam ("Rassam Decl."), Ex. 1 (Ogan Depo. Ex. 2011) at 2; Ex. 2 (Ogan Depo.) at 89:5-11. In 2006, defendants Bui and Saylor were both employed by San Quentin, the latter as Chief Medical Officer ("CMO"), and the former as "Physician and Surgeon." As these basic facts are not in dispute, the remainder of this "FACTS" section will focus on evidence either omitted or misrepresented in defendants' brief. Mr. Fitzgerald had also suffered a catastrophic drop in blood sugar ("hypoglycemic crisis") on July 28, 2006. Rassam Decl., Ex. 3 (Bui Depo.) at 78:4-79:5. He was taken unconscious to San Quentin's Triage and Treatment Area ("TTA"), which is the equivalent of the prison's urgent care clinic. There, Dr. Bui administered medication and managed to elevate Mr. Fitzgerald's blood sugar. Id. at 79:13-19. Dr. Bui also stitched up Mr. Fitzgerald's forehead, which had been cut open when Mr. Fitzgerald lost consciousness and fell to the ground. Id. at 57:8-58:20. After Dr. Bui treated him, Mr. Fitzgerald was rushed to the hospital. Rassam Decl., Ex. 4 (Clarke Depo.) at 28:8-16. Dr. Bui testified that to his knowledge Mr. Fitzgerald had suffered "many" such hypoglycemic events. Rassam Decl., Ex. 3 (Bui Depo.) at 59:21-25. The doctors at San Quentin testified that as a brittle diabetic who suffered from such severe bouts of low blood sugar, Mr. Fitzgerald should have been provided with a certain standard care to stabilize his blood sugar. Both Dr. Saylor and Dr. Jessica Clarke, a physician who treated Mr. Fitzgerald after he went to the hospital in July 2006, testified that Mr. Fitzgerald's blood sugar should have been checked every six hours, for a total of four times per day. Rassam Decl., Ex. 5 (Saylor Depo.) at 63:14-64:1; Ex. 4 (Clarke Depo.) at 37:11-38:5. Drs. Saylor and Bui testified that as a brittle diabetic Mr. Fitzgerald should have been treated by an endocrinologist, or a diabetes specialist, who could have worked to better manage Mr. Fitzgerald's disease. Rassam Decl., Ex. 5 (Saylor Depo.) at 60:7-61:13; Ex. 3 (Bui Depo.) at 30:1-6. Dr. Saylor also testified that as a "medically complex patient," Mr. Fitzgerald should have been transferred to the California Medical

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Facility in Vacaville ("CMF"), a California Department of Corrections ("CDCR") institution boasting a hospital and other medical facilities where his diabetes could have been monitored and better treated. Rassam Decl., Ex. 5 (Saylor Depo.) at 64:10-65:3. Both Drs. Saylor and Bui could have recommended that Mr. Fitzgerald receive such standard treatment, or provided the treatment themselves. Indeed, although Dr. Bui frequently worked in the TTA in 2006, his duties were not limited to treating patients in the TTA; rather he was generally tasked with the following: "examines patients and diagnoses their illness and prescribes and administers medical treatment." Rassam Decl., Ex. 6 (Kanan Depo. Ex. 2021) at 2. Consequently, he could have followed up with Mr. Fitzgerald once he left the TTA and continued to provide him care. Rassam Decl., Ex. 7 (Kanan Depo.) at 49:18-51:1. This care could have included ensuring that Mr. Fitzgerald's blood sugar be checked four times per day, and referring him to an endocrinologist. Id. at 51:2-14. Dr. Saylor could also have ensured that Mr. Fitzgerald receive the treatment San Quentin doctors believed to be standard for a patient with brittle diabetes. In fact, Dr. Saylor's duties included both caring for patients and making recommendations about patient care to other doctors. Rassam Decl., Ex. 8 (Kanan Depo. Ex. 2022) at 2; Ex. 7 (Kanan Depo.) at 60:23-61:8. Thus, she could have ensured that Mr. Fitzgerald's blood sugar was checked four times per day, and that he was referred to an endocrinologist. Rassam Decl., Ex. 7 (Kanan Depo.) at 85:1-86:10. In addition, Dr. Saylor has admitted that she could have requested that Mr. Fitzgerald be transferred to CMF. Rassam Decl., Ex. 5 (Saylor Depo.) at 64:10-65:11. Despite the fact that they could have worked to ensure that Mr. Fitzgerald received the standard care necessary to treat his disease, Drs. Bui and Saylor did nothing. Dr. Bui testified that he made no effort to treat Mr. Fitzgerald after he was discharged from the TTA. Rassam Decl., Ex. 3 (Bui Depo.) at 49:5- 50:25. Dr. Saylor also failed to ensure that Mr. Fitzgerald received adequate treatment, such as having his blood sugar checked four times per day. In fact, Dr. Saylor had in place a procedure where the blood sugar of

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diabetic patients would only be checked twice per day, and even though it was possible to have Mr. Fitzgerald's blood sugar checked more often she did not deviate from the established procedure. Rassam Decl., Ex. 5 (Saylor Depo.) at 63:19-64:1; Ex. 4 (Clarke Depo.) at 37:11-38:5; Ex. 7 (Kanan Depo.) at 72:6-13. Moreover, Mr. Fitzgerald's medical files do not show that he was referred to an endocrinologist; indeed, San Quentin did not have one on staff. Rassam Decl., Ex. 5 (Saylor Depo.) at 40:7-12. Dr. Saylor also did not recommend that Mr. Fitzgerald be transferred to CMF. Id. at 64:14-65:11. Both Dr. Bui and Dr. Saylor have offered reasons as to why they failed to provide Mr. Fitzgerald with standard care for a brittle diabetic. Dr. Bui testified that it was not part of his job duties to care for Mr. Fitzgerald after he left the TTA. Rassam Decl., Ex. 3 (Bui Depo.) at 49:13- 50:10. The evidence set forth above directly contradicts this explanation. Supra at 4:3-10. Dr. Saylor likewise denies responsibility for Mr. Fitzgerald's death, testifying that she did not know Mr. Fitzgerald suffered from diabetes until after his death. Rassam Decl., Ex. 5 (Saylor Depo.) at 47:17-20. This assertion is not credible. During the course of discovery Plaintiff obtained evidence from two different witnesses who testified that Dr. Saylor knew before Mr. Fitzgerald died that he suffered from brittle diabetes. First, Dr. Clarke explained that she informed Dr. Saylor of Mr. Fitzgerald's medical condition shortly after he suffered a hypoglycemic crisis in July, because it was customary to inform the CMO after an inmate was hospitalized. Rassam Decl., Ex. 4 (Clarke Depo.) at 41:23-42:13. Rather than categorically deny that any such meeting took place, Dr. Saylor responded that she cannot recall the meeting. Rassam Decl., Ex. 9 (Saylor's Response to Plaintiff's Requests for Admissions) at 2-3. Dr. Williams, Dr. Saylor's deputy, also testified that Dr. Saylor knew of Mr. Fitzgerald's medical condition prior to his death. As a result of the seizure he suffered in July 2006, Mr. Fitzgerald fell and cut his forehead open. Rassam Decl., Ex. 4 (Clarke Depo.) at 28:8-19. After Dr. Bui sutured the cut, Mr. Fitzgerald lodged an official complaint,

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known in San Quentin parlance as a "602," about the quality of the suturing. Rassam Decl., Ex. 10 (Inmate Appeal Form). In the complaint, Mr. Fitzgerald clearly stated that he received a cut on his head as a result of a seizure brought on by low blood sugar: "I had a seizure as a result of low blood sugar. During this seizure I banged my head on something within my assigned cell, resulting in a jagged contusion in the forehead above the eyebrow." Id. Dr. Williams testified that Dr. Saylor saw that complaint, dispatching him to examine Dr. Bui's suturing job and to determine if Mr. Fitzgerald needed to be seen by a plastic surgeon. Rassam Decl., Ex. 11 (Williams Depo.) at 13:21-15:3. Thus, as Dr. Saylor read Mr. Fitzgerald's complaint, she cannot credibly claim that she did not know of his medical condition until it was too late to help him. III. Defendants' Motion

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With the unserved defendants dismissed (Aside from Drs. Bui and Saylor, Plaintiff does not oppose summary judgment as to the other served Defendants. (See Plaintiff's Opposition at Section V.G.)), this case boils down to one question: should Drs. Tam Bui and Karen Saylor be held liable for the death of the minor Plaintiff's father, Scott A. Fitzgerald, the 34 year-old San Quentin inmate who suffered from brittle type I diabetes and died on September 12, 2006 when his blood sugar fell to a catastrophically low level? Defendants argue that Drs. Saylor and Bui should not be held liable because they were not Mr. Fitzgerald's "treating doctors." In making this argument, Defendants begin their liability analysis by misapplying the law. The legal standard for whether Drs. Bui and Saylor should be held liable is not whether they were Mr. Fitzgerald's "treating doctors," but whether they violated Mr. Fitzgerald's Eighth Amendment rights through deliberate indifference to Mr. Fitzgerald's medical needs. Defendants also argue that there is no vicarious liability under 42 U.S.C. §1983. This begs the question. Plaintiff is not arguing that Drs. Saylor and Bui bore responsibility for the negligent conduct of other health care personnel, but rather, that they each had their own responsibility to Plaintiff which they failed to meet.

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The question is whether Defendants knew of Fitzgerald's serious medical condition, and failed to provide him with the necessary care such that he suffered and died. Although Nowhere in Defendants' brief is the standard rigorously applied to the facts of the case. Instead, Defendants' brief contains a short discussion of deliberate indifference, followed by a non sequitur assertion that Drs. Bui and Saylor are not liable because other unnamed doctors should have been caring for Mr. Fitzgerald. Opening Br. at 14. Defendants also fail to mention key facts that demonstrate that genuine issues of material fact exist regarding whether Drs. Bui and Saylor were deliberately indifferent to Mr. Fitzgerald's medical needs. For instance, when arguing that Drs. Bui and Saylor should not be liable for Mr. Fitzgerald's death because they were not his "treating doctors," Defendants fail to mention that as a part of their duties at San Quentin both doctors could personally treat Mr. Fitzgerald, or recommend that he receive specific treatments from other doctors. Defendants also argue that Dr. Saylor cannot possibly be liable for the death of Mr. Fitzgerald because she testified that she did not know he suffered from brittle diabetes until after he died. Opening Br. at 7. Defendants fail to mention, however, that other doctors contradicted Dr. Saylor's testimony, and testified that she knew of Mr. Fitzgerald's condition before he died. Plaintiff argues that, when Defendants' distortions of law and fact are corrected, there can be little doubt that Drs. Bui and Saylor violated Mr. Fitzgerald's constitutional rights. First, there is no question that Mr. Fitzgerald suffered from a serious medical condition. Second, the evidence shows that Drs. Bui and Saylor knew of Mr. Fitzgerald's medical condition, but failed to provide him with standard care for a brittle diabetic. As a result, Mr. Fitzgerald died. That is the definition of deliberate indifference, meaning that Drs. Bui and Saylor are liable for violating Mr. Fitzgerald's Eight Amendment rights, as well as for his wrongful death. At the very least, however, in light of the correct legal standard and full factual record, there are several genuine issues of material fact as to the liability of Drs.

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Saylor and Bui so that summary judgment is inappropriate.

IV. A.

Legal Standard This case cannot be fully resolved on summary judgment

A high bar must be cleared before Defendants can be granted summary judgment. As an initial matter, to prevail on summary judgment Defendants bear the burden of showing that no genuine issue of material fact exists regarding whether Drs. Bui and Saylor are liable for the death of Mr. Fitzgerald. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247 (1986). In determining whether Defendants have met this burden, the evidence of the non-movant must be believed. Blankenhorn v. City of Orange, 485 F.3d 463, 470 (9th Cir. 2007). In addition, all justifiable inferences must be drawn in favor of the non-moving party. Id. A "justifiable inference" is not necessarily the most likely inference or the most persuasive inference. United Steelworkers of America v. Phelps Dodge Corp., 865 F.2d 1539, 1542 (9th Cir. 1989). Rather, an inference in favor of the non-moving party may be drawn "if it is rational or reasonable." Id. Summary judgment is inappropriate if reasonable jurors, drawing all inferences in favor of the nonmoving party, could return a verdict in the nonmoving party's favor. United States v. Shumway, 199 F.3d 1093, 1103-04 (9th Cir. 1999). Cases such as this one are not amenable for resolution on summary judgment. First, summary judgment should be used sparingly in cases which involve judging the credibility of witnesses, because doing so is the province of the jury. Espinosa v. City & County of San Francisco, 598 F.3d 528, 537 (9th Cir. 2010); Bator v. Hawaii, 39 F.3d 1021, 1026 (9th Cir. 1994). The Court finds that this case involves judging the credibility of central actors; for example, a finding of fact whether Dr. Saylor knew of Mr. Fitzgerald's diabetic condition prior to his death will boil down to whether a finder of fact believes Dr. Saylor, or Drs. Williams and Clarke. In addition, "questions involving a person's state of mind are generally factual issues inappropriate for resolution by summary judgment." Conn v. City of Reno, 591 F.3d 1081, 1098 (9th Cir. 2010), petition for cert. filed, (U.S. May 6, 2010) (No. 09-1361) (internal quotations omitted).
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This case will largely turn on the states of mind of Drs. Bui and Saylor, and whether they understood that not providing Mr. Fitzgerald with the standard treatment for brittle diabetics would put him at risk of harm. Accordingly, this case should not be resolved without a trial. B. Prison officials can be held liable for violating an inmate's Eighth Amendment rights

A prison official may be liable for violating an inmate's Eighth Amendment right if the official is deliberately indifferent to the inmate's medical needs, citing Lolli v. County of Orange, 351 F.3d 410, 418-419 (9th Cir. 2003). Defendants distinguish the Lolli case, as well as the Conn case. Conn v. City of Reno, 591 F.3d 1081, at 1098 (9th Cir. 2010). In this case, the Court held that liability can be established by "setting in motion a series of acts by others which the actor knows or reasonably should know would cause others to inflict the constitutional injury." The Ninth Circuit has stated that a determination of "deliberate indifference" is less stringent in cases involving a prisoner's medical needs than in other cases involving harm to incarcerated individuals because `the State's responsibility to provide inmates with medical care ordinarily does not conflict with competing administrative concerns.'" McGuckin v. Smith, 974 F. 2d 1050, 1060 (9th Cir. 1992) (overruled on other grounds by WMX Techs. v. Miller, 104 F.3d 1133 (9th Cir. 1997) (quoting Hudson v. McMillian, 503 U.S. 1, 6 (1992)). Whether an official is deliberately indifferent to medical needs does not turn on whether that official is a "treating doctor," as Defendants contend. Rather, to be deliberately indifferent towards an inmate's medical needs a prison official must know of the inmate's serious medical condition, infer from that fact that a risk of harm to the inmate exists, and in response provide unacceptable treatment or no treatment such that harm to the inmate results. Jackson v. McIntosh, 90 F. 3d 330, 332 (Fed. Cir. 1996). Thus, a finding of deliberate indifference requires an objective component (serious medical condition), and subjective components (knowing of an inmate's medical condition and inferring that a risk of harm exists, but failing to properly respond). Conn, 591 F.3d at
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1095. A medical need is considered 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. at 1059 (citation omitted). Moreover, the failure to respond to an inmate's serious medical condition can be a cause in fact of any harm that results to the inmate because the "requisite causal connection can be established not only by some kind of direct personal participation in the deprivation, but also by setting in motion a series of acts by others which the actor knows or reasonably should know would cause others to inflict the constitutional injury." Conn, 591 F.3d at 1098 (quoting Johnson v. Duffy, 588 F.2d 740, 743-44 (9th Cir. 1978)) (reversing summary judgment in favor of police officers who knew of the decedent's threats to commit suicide, but did nothing intervene before decedent hanged herself). The standard for deliberate indifference encompasses persons in supervisory capacities who know that an inmate's constitutional rights are being violated as a result of inadequate care for a serious medical condition, but fail to prevent that violation. Redman v. County of San Diego, 942 F.2d 1435, 1447 (9th Cir. 1991) (reversing a directed verdict in favor of defendant supervisor because the supervisor knew of the conditions that led to the violation of the inmate's constitutional rights, but did not rectify them); Langford v. Norris, 614 F.3d 445, 461-464 (8th Cir. 2010) (explaining that defendant medical supervisor, who was not personally responsible for the plaintiff inmate's treatment, could be held liable under § 1983 because he knew that the inmate's medical needs were not being adequately met, but did not act to remedy that situation). The fact that a prison official knows of an inmate's serious medical condition and infers from that fact that a risk of harm to the inmate exists need not be proven through direct evidence. Such facts "may be shown by circumstantial evidence." Lolli, 351 F.3d at 421. For instance, a finder of fact may infer that a prison official knew of a substantial risk of harm if the risk was obvious. Conn, 591 F.3d at 1097 (finding that the risk of suicide was obvious where the decedent had threatened to commit suicide and choked herself with a seatbelt). Moreover, "a finding that the inmate was seriously harmed by defendant's actions

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or inaction tends to provide additional support to a claim that defendant was `deliberately indifferent' to [a] prisoner's medical needs." McGuckin, 974 F. at 1060. Applying this standard to diabetes cases, the Ninth Circuit has recognized that failure to provide inmates suffering from type I diabetes with proper medical care constitutes deliberate indifference, as discussed above, in Lolli. Defendant police officers refused to provide the plaintiff who was in their custody with food or insulin despite the fact plaintiff told them he was a diabetic who was suffering from low blood sugar. Lolli, 351 F.3d at 421. The Ninth Circuit reversed the lower court's grant of summary judgment in favor of defendants, holding that evidence of plaintiff's protestation about his diabetes and his requests for food and insulin, coupled with the defendants' failure to provide them, meant that there was a genuine issue of material fact as to whether defendants were deliberately indifferent. Id. at 420-21. In reversing a summary judgment, the Court largely relied on circumstantial evidence of deliberate indifference. The Court noted that "the officers' indifference to Lolli's extreme behavior, his obviously sickly appearance and his explicit statements that he needed food because he was a diabetic could easily lead a jury to find that the officers consciously disregarded a serious risk to Lolli's health." Id. at 421. C. Drs. Saylor and Bui are not entitled to qualified immunity.

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Although Defendants believe that the Court need not reach the issue, they argue that Drs. Saylor and Bui are entitled to qualified immunity because there was no clearly established law that would have put them on notice that their actions ­ relying on other licensed physicians to discharge the primary care physician's duty to manage Mr. Fitzgerald's chronic diabetes--would be unlawful. Saucier v. Katz, 533 U.S. 194, 201 (2001) ("Qualified immunity is an entitlement not to stand trial or face the other burdens of litigation."). The Court has discretion to consider either question in the Saucier two-step inquiry first. Pearson v. Callahan, 129 S.Ct. 808, 818-19 (2009). A court must decide (1) whether the facts alleged or shown by the plaintiff make out a violation of a constitutional right, and (2) if so, whether that right was "clearly established" at the time of the defendant's alleged misconduct, id., at 201, 121 S.Ct. 2151. Qualified immunity applies unless the official's conduct violated such a right. Pearson v. Callahan, 129 S.Ct. 808, 811 (2009)
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(internal citations omitted. This Court finds that under the facts alleged by Plaintiff, if Drs. Saylor and Bui were both aware of Fitzgerald's brittle diabetic condition and did nothing to provide appropriate treatment, that they could be found to have been deliberately indifferent to his medical needs under the Eighth Amendment, as discussed above. The standard for deliberate indifference encompasses persons in supervisory capacities who know that an inmate's constitutional rights are being violated as a result of inadequate care for a serious medical condition, but fail to prevent that violation. Redman v. County of San Diego, 942 F.2d 1435, 1447 (9th Cir. 1991) (reversing a directed verdict in favor of defendant supervisor because the supervisor knew of the conditions that led to the violation of the inmate's constitutional rights, but did not rectify them); Langford v. Norris, 614 F.3d 445, 461-464 (8th Cir. 2010) (explaining that defendant medical supervisor, who was not personally responsible for the plaintiff inmate's treatment, could be held liable under § 1983 because he knew that the inmate's medical needs were not being adequately met, but did not act to remedy that situation). Accordingly, Drs. Bui and Saylor are not entitled to qualified immunity. D. Conclusion

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The Court finds that Plaintiff Santos Eddie Fitzgerald has standing. The Eleventh Amendment bars the suit against the State of California and the state agencies so the complaint is dismissed as to them. Plaintiff is not alleging liability under 42 U.S.C. §1983 on a theory of respondeat superior, which would not be valid. However, he is alleging direct responsibility of the supervising physicians to see to it that Plaintiff's medical needs were met, if they were aware of them, in order to escape liability under the Eighth Amendment. There are disputed issues of fact as to these physicians' knowledge of and actions regarding Plaintiff's medical needs. In particular Dr. Bui actually treated Plaintiff when he fell and cut his head, so there is a question of fact whether he was a treating physician, even if he didn't treat Plaintiff for the fatal hypoglycemic episode. Regarding both Dr. Saylor and Dr. Bui, there are questions of fact as to their knowledge of Plaintiff's condition and their involvement in his care. Finally, neither Dr. Bui nor Dr. Saylor are entitled to qualified

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immunity. Consequently, summary judgment is denied as to claims against the individual Defendants. IT IS SO ORDERED. DATED: March 21, 2011 __________________________________ James Larson United States Magistrate Judge

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