MORRISON C. ENGLAND, JR., District Judge.
By way of the present action, Plaintiff Linnie Staggs, individually and as the Administrator of the Estate of Robert E. Staggs ("Decedent"), and Plaintiff Melissa Staggs (collectively "Plaintiffs"), seek redress from,
Presently before the Court are Plaintiffs' Motion for Partial Summary Judgment, ECF No. 188, and Defendants' Motion for Summary Judgment, ECF No. 182.
Decedent Robert Staggs began his prison term at SCC on January 8, 2004. He was diagnosed with Hepatitis C virus ("HCV") in 1980 and began to experience worsening symptoms associated with his HCV diagnosis in May 2009, during his prison term. These worsening symptoms included pruritus, darkened urine, and open sores. Plaintiffs allege that these symptoms were so extreme that they gave Decedent insomnia and interfered with his ability to participate in regular daily activities. According to Plaintiffs, Decedent's symptoms clearly pointed to acute liver failure, but Defendants only gave him pain medication and other treatments intended to mask the symptoms instead of properly diagnosing and addressing the underlying problems. In June 2009, Defendant Bangi, one of the SCC doctors, administered a blood test to Decedent that showed an increase in Decedent's alpha-feta protein ("AFP") level from 11 to 35, while a normal value is between zero and eight. Following this result, Defendants continued to give Decedent only painkillers and did not repeat the AFP test or give him further treatment at that time. In July 2009, Defendant Bangi ordered an MRI of Decedent's liver, and the test was administered on August 30 of that year, showing a possible lesion in his liver.
On December 8, 2009, Decedent submitted a 602 inmate appeal form to the SCC Healthcare Appeals Office requesting medical attention for his symptoms. He received a denial of his request on December 21, 2009, which he appealed two days later. On December 26, 2009, Decedent went "man-down" in his cell, and was taken to the Sonora Regional Medical Center hospital where he received an ultrasound and a CT scan. Both tests indicated cirrhosis and several lesions in Decedent's liver, including one five-centimeter lesion. In January 2010, Defendants St. Clair and Allen scheduled a biopsy of Decedent's liver that Defendant Bangi had originally ordered in October 2009. After two hospitals refused to perform the biopsy on Decedent because of the high risks involved in biopsying a liver like Decedent's with ascites fluid in the peritoneal cavity, DHM agreed to administer the procedure. Plaintiffs assert that Decedent was at a higher risk for acute liver bleeding because of his condition.
Decedent's liver biopsy was performed at DHM on January 22, 2010. Plaintiffs' expert opined that the "universal protocol" for liver biopsies requires the patient to "remain immobile in a supine position" for "three to four hours immediately following the procedure" to help stop internal bleeding, even if the liver is otherwise healthy. However, it is undisputed that Defendants forced Decedent to leave his hospital bed less than an hour after the biopsy so he could be transported back to SCC. The next day, Decedent was unable to urinate, his abdomen became swollen and distended, and he soon began to vomit. No prison personnel came to Decedent's aid until the afternoon of the following day, January 24, 2010. At that point, Decedent was transferred to the Operating Housing Unit at SCC, and on January 25, 2010, he was taken to the San Joaquin Medical Center for emergency treatment. His biopsy results were returned the next day and confirmed hepatocellular carcinoma. Decedent was transferred to the California Medical Facility in Vacaville on February 4, 2010, where he died on February 12, 2010. Plaintiffs' expert opined that the immediate cause of Decedent's death was "blood loss into his peritoneum" resulting from the liver biopsy performed on January 22, 2010. His official causes of death on his death certificate were hepatocellular carcinoma and end stage liver disease.
With regard to the facts described above, Plaintiffs allege the following action or inaction by each named Defendant:
Plaintiffs' first cause of action alleges that Defendants St. Clair, Bangi, Krpan, Allen, and certain Doe Defendants violated Decedent's constitutional rights by providing him such inferior medical treatment that it constituted cruel and unusual punishment in violation of the Eighth Amendment. ECF No. 117. Plaintiffs' second claim for relief alleges that certain Doe Defendants failed to summon and provide proper medical care for Decedent in violation of Cal. Gov. Code § 845.6. Plaintiffs' third claim for relief alleges negligence against Defendants Krpan, Bangi, Russin, Sattah, DHM, and Doe Defendants, claiming they violated the standard of care by failing to provide adequate testing and treatment of Decedent's medical condition. In their fourth claim, Plaintiffs allege deliberate indifference against Defendants Krpan, Allen, St. Clair, Sattah, Bangi, DHM, and other Doe Defendants in their decision to conduct a liver biopsy on Decedent. Plaintiffs' fifth claim for relief alleges that Doe Defendants utilized threats, intimidation, and coercion against Decedent in violation of Cal. Civ. Code § 52.1 to force him to leave his hospital bed after the biopsy. Plaintiffs' sixth claim for relief alleges deliberate indifference against Defendants DHM, Sattah, and other Does arising from their release of Decedent from the hospital less than one hour after his liver biopsy. In the seventh claim for relief, Plaintiff Melissa Staggs, Decedent's daughter, alleges wrongful death under Code Civ. Pro. § 377.60. In the eighth claim for relief, Plaintiffs Linnie Staggs and Melissa Staggs, Decedent's mother and daughter, respectively, allege loss of companionship.
The Federal Rules of Civil Procedure provide for summary judgment when "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);
Rule 56 also allows a court to grant summary judgment on part of a claim or defense, known as partial summary judgment.
In a summary judgment motion, the moving party always bears the initial responsibility of informing the court of the basis for the motion and identifying the portions in the record "which it believes demonstrate the absence of a genuine issue of material fact."
In attempting to establish the existence or non-existence of a genuine factual dispute, the party must support its assertion by "citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits[,] or declarations . . . or other materials; or showing that the materials cited do not establish the absence or presence of a genuine dispute, or that an adverse party cannot produce admissible evidence to support the fact." Fed. R. Civ. P. 56(c)(1). The opposing party must demonstrate that the fact in contention is material, i.e., a fact that might affect the outcome of the suit under the governing law.
In resolving a summary judgment motion, the evidence of the opposing party is to be believed, and all reasonable inferences that may be drawn from the facts placed before the court must be drawn in favor of the opposing party.
Plaintiffs move for partial summary judgment with regard to Defendants' affirmative defense that Plaintiffs did not exhaust administrative remedies prior to filing the present suit, as required under the Prison Litigation Reform Act ("PLRA"). Plaintiffs argue that the exhaustion requirement does not apply to them because they are not prisoners themselves but rather are family members of a deceased prisoner. ECF No. 188. Defendants filed a Notice of Non-Opposition to Plaintiffs' Motion. ECF No. 195.
The PLRA requires that a prisoner exhaust his or her administrative remedies before bringing a claim under § 1983. 42 U.S.C.A. § 1997e(a). However, the PLRA does not require family members or a deceased prisoner's estate to exhaust these administrative remedies before bringing a § 1983 action on behalf of the deceased prisoner. Rather, it only places that requirement on an action brought "by a prisoner confined in any jail, prison, or other correctional facility."
In their Corrected Fourth Amended Complaint, Plaintiffs allege various violations against fifteen separate defendants, eight of whom are specifically named, and seven of whom consist of groups of Doe Defendants. Defendants' present Motion for Summary Judgment addresses summary judgment by party, rather than by claim, and the Court takes the same approach here, after first addressing Defendants' qualified immunity arguments.
To bring a § 1983 action, a plaintiff must show that the defendant was acting "under color of any [law]" at the time of the alleged civil rights violation. 42 U.S.C. § 1983. This generally requires that the plaintiff show the defendant has committed the alleged violation "while acting in his official capacity or while exercising his responsibilities pursuant to state law."
When determining whether a finding of qualified immunity is appropriate at the summary judgment stage, a court must consider "whether a constitutional right would be violated if all facts are viewed in favor of the party opposing summary judgment. . . . [I]f a violation could be made out on a favorable view of the parties' submissions, the next, sequential step is to ask whether the right was clearly established."
First, construing the facts presented in the light most favorable to Plaintiffs, Defendants' conduct would violate a constitutional right. Specifically, Defendants St. Clair, Allen, and Krpan were all somehow involved in approving Decedent's liver biopsy, despite allegedly knowing of Decedent's heightened risk for complications and the fact that two hospitals had already refused to perform the procedure because of that heightened risk. According to Plaintiffs, Defendants Bangi and Krpan both prescribed Decedent painkillers to mask his symptoms instead of actually treating Decedent's liver disease, and Defendant Bangi originally ordered Decedent's liver biopsy. Defendant Sattah personally administered Decedent's liver biopsy; according to Plaintiffs, this was despite the fact that he had to have known—based on his experience and education—of Decedent's special risk for complications. He apparently also released Decedent from the hospital prior to the standard recovery time. And for their part, Plaintiffs complain, Defendants St. Clair and Allen each could have referred Decedent to the appropriate specialist but failed to do so despite protocols in place requiring referrals under applicable circumstances. If a jury believes Plaintiffs, these actions amount to deliberate indifference to Decedent's medical needs, as alleged in Plaintiffs' claims one, four, and six.
Next, the Court considers whether the right supposedly violated was clearly established. "[D]eliberate indifference to serious medical needs of prisoners constitutes the `unnecessary and wanton infliction of pain' . . . proscribed by the Eighth Amendment. This is true whether the indifference is manifested by prison doctors in their response to the prisoner's needs or by prison guards in intentionally denying or delaying access to medical care. . . ."
Finally, whether a reasonable official in each of Defendants' shoes could have believed their conduct to be lawful is analyzed below for each group of defendants. For the following reasons, and taking all facts alleged as true at this point in the analysis, the Court finds that no Defendant is entitled to qualified immunity, and summary judgment of Plaintiffs' deliberate indifference claims based on qualified immunity is not appropriate.
As set forth above, interpreting the facts in the light most favorable to Plaintiffs, the Court finds that a reasonable official knowing what the SCC Defendants (i.e., St. Clair, Allen, Bangi, and Krpan) are alleged to have known could not have believed their actions and inactions were lawful under the circumstances. Indeed, each of these Defendants was involved in scheduling Decedent's liver biopsy, despite all of them allegedly knowing that Decedent had liver complications making the procedure too dangerous to perform, as evidenced by the fact that two other hospitals refused to perform the test. Further, Defendants Bangi and Krpan both treated Decedent while at SCC, and both of them prescribed Decedent painkillers to mask his symptoms, rather than to treat his underlying liver disease. Defendants St. Clair and Allen each could have referred Decedent to the appropriate specialist but failed to do so despite protocols in place requiring referrals under applicable circumstances. If all facts are taken as true, a reasonable officer would not believe those actions were lawful, and the SCC Defendants are therefore not entitled to qualified immunity. Knowing what they purportedly knew, a reasonable officer in Defendants' shoes would have perceived the risk of death to the Decedent and would have known that risk was both excessive and serious. To the extent the SCC Defendants move for summary judgment based on qualified immunity, their motion is DENIED.
Plaintiffs apparently assert a separate Eighth Amendment deliberate indifference claim against Sattah under § 1983, alleging that he was deliberately indifferent to Decedent's medical needs via his performance of the liver biopsy and premature release of Decedent after the biopsy, in violation of Decedent's constitutional rights. Defendants contend first that Sattah was not a state actor subject to liability under § 1983 and, second, that even if he were, he is entitled to qualified immunity.
Sattah was employed by Central Valley Imaging ("CVI"), which contracted with DHM for his performance of Decedent's liver biopsy on January 22, 2010. Defendants argue that as a contracted employee, Sattah was not a state actor and therefore cannot be held liable under § 1983. But a "private doctor who provides medical services to inmates pursuant to a contract with the prison may be held liable in a civil rights suit."
The joint action test is met if "private persons are willful participants in joint activity with the State or its agents that effects a constitutional deprivation."
Under the joint action test, a jury could find that Sattah was a "willful participant" with the State in the activity that violated Decedent's civil rights—the liver biopsy— because he was aware that Decedent was an inmate and that the California Department of Corrections and Rehabilitation had contracted with CVI for Defendant Sattah to administer the biopsy. Similarly, under the nexus test, the relationship between Defendant Sattah and the State, wherein Defendant Sattah agreed to perform a medical procedure on an inmate, could be sufficient to warrant treating his performing the biopsy as an action of the State itself. In any case, this determination is very fact-specific, and because questions of fact remain disputed, it is not appropriate for the Court to determine on a motion for summary judgment.
Assuming Defendant Sattah was a state actor, summary judgment on qualified immunity would also be inappropriate because—for the reasons described above in relation to the SCC Defendants—taking all facts alleged in the light most favorable to Plaintiffs, Sattah's actions in performing the risky liver biopsy violated Decedent's clearly established constitutional right. Therefore, to the extent Defendant Sattah moves for summary judgment based on qualified immunity, the motion is DENIED.
With one exception as to Plaintiffs' Sixth Cause of Action, a host of factual issues preclude the Court from granting Defendants' Motion based on the substance of Plaintiffs' arguments as well.
Plaintiffs assert their first and fourth claims for relief against Jack St. Clair, M.D., the Chief Medical Officer at SCC from 2009-2010. According to Plaintiffs, St. Clair's treatment of Decedent fell far below the medical professional standard of care such that it constituted cruel and unusual punishment in violation of the Eighth Amendment. More specifically, Plaintiffs base this argument on the fact that St. Clair personally signed the December 21, 2009, document from the SCC Healthcare Appeals Office, wherein he rejected Decedent's appeal for "abuse of the appeal procedure." Further, St. Clair was involved in approving the risky liver biopsy that is alleged to have ultimately caused Decedent's premature death. Plaintiffs contend that St. Clair had knowledge of the special risk that Decedent's diseased liver presented, particularly given that two hospitals had already refused to perform the procedure for that reason.
The parties dispute whether St. Clair had knowledge of the increased risk of life threatening complications that the biopsy presented, given the state of Decedent's liver at the time, and whether his treatment of Decedent fell below the standard of care. Whether the standard of care was met in a medical malpractice case is a question of fact that is not properly resolved by the Court on summary judgment.
Plaintiffs also assert their first and fourth causes of action against Curtis Allen, M.D., claiming that he acted with deliberate indifference to Decedent's medical needs, and that his treatment of Decedent fell far below the medical professional standard of care such that it constituted cruel and unusual punishment in violation of the Eighth Amendment. Allen was the Chief Physician and Surgeon at SCC from 2009-2010, and he had supervisory duties over the prison medical staff during the time of the underlying events in this case. According to Plaintiff, Allen was also involved in approving Decedent's biopsy, despite his alleged knowledge of Decedent's heightened risk for complications and knowledge that two other hospitals refused to perform the biopsy. Allen contends to the contrary, that his involvement with Decedent's medical care was limited to supervising other SCC doctors, and that at this level of involvement his conduct did not fall below the standard of care. ECF No. 182-1, ¶¶ 62, 63.
The parties dispute whether Defendant Allen had knowledge of the increased risk of life-threatening complications that the biopsy presented, given the state of Decedent's liver at the time, and whether his treatment of Decedent was so substandard that it constituted cruel and unusual punishment. This issue is material to Plaintiffs' allegations against Defendant Allen and is for the jury to determine, not for the Court to resolve on summary judgment.
Plaintiffs assert their first, third, and fourth claims for relief against Defendant John Krpan, D.O., who was employed as a physician and surgeon at SCC from October 2008 through January 2017, and provided primary care to SCC inmates. Similar to their allegations against Defendants St. Clair, Allen, and Bangi, Plaintiffs claim that Krpan acted with deliberate indifference to Decedent's medical needs, and that his treatment of Decedent fell far below the medical professional standard of care such that it constituted cruel and unusual punishment in violation of the Eighth Amendment. They also assert Krpan was negligent in his treatment of Decedent because he was involved in prescribing Decedent painkillers to mask, rather than treat, Decedent's symptoms. They additionally allege that he acted with deliberate indifference in ordering the liver biopsy despite his knowledge of Decedent's special risks and his awareness that two hospitals had refused to perform the biopsy. Krpan claims that the presence of a small amount of ascites fluid "was not a contraindication for a liver biopsy" in 2009, and thus argues that his conduct did not fall below the standard of care and did not constitute deliberate indifference to Decedent's medical needs. ECF No. 182-1, ¶¶ 51-52. Plaintiffs, however, dispute that the amount of ascites fluid found in Decedent's liver was not a contraindication for a liver biopsy, especially given that two other hospitals refused to do it. ECF No. 196-1, ¶ 51.
The parties dispute whether Krpan's conduct fell below the standard of care, and whether Krpan acted with deliberate indifference to Decedent's medical needs. As discussed above, whether the standard of care was met—or whether Krpan's conduct fell so far below that standard of care as to constitute a constitutional violation—is a question for the jury, not for the court on summary judgment.
Plaintiffs assert their first, third, and fourth claims for relief against Defendant Edwin Bangi, M.D., who was a physician and surgeon at SCC from 2007-2013 and treated Decedent at SCC on several occasions. Plaintiffs assert that Bangi acted with deliberate indifference to Decedent's medical needs, and that his treatment of Decedent fell below the medical professional standard of care such that it constituted cruel and unusual punishment in violation of the Eighth Amendment. Plaintiffs additionally allege that his actions and inactions constitute negligence. More specifically, Plaintiffs claim that Bangi was negligent and acted with deliberate indifference by prescribing Decedent painkillers in response to his liver problems, and that he did not appropriately act on the results of Decedent's elevated AFP levels. Plaintiffs contend that the medical professional standard of care required that Defendant Bangi repeat the AFP test to confirm hepatocellular carcinoma, and that Bangi should not have scheduled Decedent's liver biopsy in light of the fact that he was aware of Decedent's special risks. Bangi responds that his treatment of Decedent did not fall below the standard of care, and that he acted appropriately in response to Decedent's June 2009 AFP test results. ECF No. 182-1, ¶ 16.
The parties dispute whether Bangi's treatment of Decedent fell below the standard of care, and whether Bangi acted with deliberate indifference in his medical treatment of Decedent. Whether the standard of care was met in a medical malpractice case is a question of fact that is not properly resolved on summary judgment.
Plaintiffs assert their third claim for relief against Defendant Lincoln Russin, M.D. Russin was employed at the Mark Twain St. Joseph's Hospital in the Diagnostic Imaging Department at all times relevant to this case, and he administered Defendant's October 2009 MRI scan. Plaintiffs claim Russin was negligent when he reported "no evidence of tumor" based on the MRI results that they allege revealed the presence of a tumor. Plaintiffs' expert states that "any conventional reading of the MRI would have discovered a tumor," because tests given before and after Russin's MRI both indicated a tumor on Decedent's liver.
Russin raises a causation argument in his motion for summary judgment. He argues that Decedent already had "incurable liver disease" when the MRI was administered, and that "no medical intervention at that time would have changed his outcome." ECF No. 182-1, ¶¶ 66, 67. Therefore, according to Russin, Plaintiffs cannot meet the causation requirement for their negligence claim against him.
Even accepting Russin's assertion that Decedent's outcome was the same regardless of his actions, he has not established an absence of a material factual dispute such that summary judgment in his favor would be appropriate. Rather, Defendants merely conclude in their Motion that Decedent had "incurable liver disease," "no medical intervention at that time would have changed his outcome," and that Decedent had a "life expectancy of 6 months to a year and his prognosis would not have been altered with an earlier diagnosis or medical intervention." ECF No. 182-1, ¶¶ 66, 67. But these conclusions, even if supported, do not preclude Plaintiffs from meeting the causation element of their negligence claim. Indeed, Russin has not disproved the possibility that his failure to properly read Decedent's MRI scan was a proximate cause in shortening Decedent's life, even if within the shortened life expectancy he already had. If Russin's failure to identify the tumor shortened Decedent's life, Plaintiffs could establish causation and thus an actionable claim of negligence. Summary judgment is therefore DENIED.
Plaintiffs assert their third and fourth claims for relief against Defendant Mario P. Sattah, M.D., a radiologist employed by CVI. As discussed above, CVI contracts with hospitals to provide imaging services, and on January 22, 2010, Sattah was assigned or selected to administer Decedent's liver biopsy at DHM. Plaintiffs allege that Sattah was negligent in his care of Decedent and that he acted with deliberate indifference towards Decedent's medical needs in administering Decedent's liver biopsy. It is undisputed that Sattah personally performed the biopsy, and Plaintiffs claim he did so despite his knowledge of the riskiness of the procedure as administered on Decedent's liver. Sattah argues that he did not have knowledge of Decedent's special risks, and that he was not aware that two hospitals had previously refused to perform the procedure. ECF No. 182-1, ¶¶ 79-82. These disputed questions of fact prevent summary judgment.
Defendant Sattah also raises a causation/ "lost chance" argument, stating in his Motion that at the time of the liver biopsy, Decedent's life expectancy was no more than three months, there were no "curative therapies" for Decedent's liver cancer, and Decedent was not a liver transplant candidate. ECF No. 182-1, ¶¶ 95, 96. However, as discussed above regarding Defendant Russin's similar argument, Sattah's assertions here do not establish that his performance of the liver biopsy did not shorten Decedent's life within his life expectancy. In fact, Decedent died three weeks after Sattah performed the biopsy, which is significantly shorter than his three-month life expectancy. Sattah has thus not shown that Decedent would have died at that earlier date whether or not he had performed the biopsy and his causation argument similarly fails.
These questions of fact prevent a determination at this stage of whether Defendant Sattah was negligent and/or deliberately indifferent. Again, as discussed above, whether Sattah's treatment constituted deliberate indifference is a question to be resolved by the jury and not by the Court at summary judgment.
Plaintiffs assert their third and fourth claims for relief against Doctors Hospital of Manteca ("DHM"). Plaintiffs allege that DHM acted negligently and with deliberate indifference to Decedent's medical needs by (1) performing Decedent's liver biopsy and (2) discharging him less than one hour after the procedure, when the medical professional standard of care requires that a patient remain supine for three to four hours after the biopsy. DHM argues that it did not have knowledge that two other hospitals had refused to perform the procedure, and that in any case it was Sattah's independent decision to administer the biopsy, not the decision of DHM. ECF No. 182-1, ¶¶ 98-99. As above, these disputed questions of fact prevent summary judgment.
DHM also raises a causation argument similar to Russin and Sattah. DHM argues that there were no "curative therapies" available for Decedent's liver cancer, and that Decedent had "a short life expectancy and no real treatment options that would have altered his outcome." ECF No. 182-1, ¶¶ 111, 112. However, as discussed in regard to Russin and Sattah, this argument fails. Therefore, DHM's causation argument fails. For those reasons, summary judgment with respect to DHM is not appropriate, and the Motion is DENIED.
Plaintiffs include damages claims for wrongful death. The California wrongful death statute provides for damages measured by "the financial benefits the heirs were receiving at the time of death, those reasonably to be expected in the future, and the monetary equivalent of loss of comfort, society, and protection."
Defendants attempt to disprove, or at least minimize, Plaintiffs' wrongful death damages by asserting that Decedent "did not provide any financial support to plaintiffs after he was incarcerated," that Melissa Staggs visited Decedent in prison a total of five times, and that Linnie Staggs visited him once a month while he was incarcerated. ECF No. 182-1, ¶¶ 116-18. Defendants' statements at this point are insufficient to dispose of Plaintiffs' wrongful death claims. Determining the measure of damages for wrongful death "depends to a great extent upon the sound judgment of the jurors as to what would be just, reasonable, and proper under all the circumstances."
Defendants have therefore failed to establish that summary judgment is appropriate on Plaintiffs' claims for wrongful death damages. To the extent Defendants move for summary judgment with regard to Plaintiffs' wrongful death claim, that motion is consequently DENIED.
For the reasons set forth above, Plaintiffs' Motion for Partial Summary Judgment, ECF No. 188, is GRANTED. Defendants' Motion for Summary Judgment, ECF No. 182, is GRANTED with respect to the sixth cause of action, and otherwise DENIED. Plaintiffs' Motion to Strike, ECF No. 200, is DENIED.
IT IS SO ORDERED.
