KENDALL J. NEWMAN, Magistrate Judge.
Plaintiff is a state prisoner proceeding without counsel. On August 15, 2014, plaintiff filed a document styled, "Ex parte Motion Under Rule 35, Federal Rules of Civil Procedure, Medical Examination." (ECF No. 68.) Defendants filed an opposition with exhibits, and plaintiff filed a reply. As set forth more fully below, plaintiff's motion for medical examination is denied.
Plaintiff contends that his physical condition will become a serious controversy very shortly, and seeks a court order requiring the California Department of Corrections and Rehabilitation ("CDCR") to take plaintiff to an outside major hospital for a "full physical examination by a certified medical doctor." (ECF No. 68 at 1.) Plaintiff claims he was transferred to R.J. Donovan State Prison ("RJD") from High Desert State Prison ("HDSP") for hernia repair surgery. (ECF No. 68 at 2.) Plaintiff claims that once he arrived at RJD, he discovered there was an ongoing FBI investigation into inmate deaths at RJD. Plaintiff claims his primary care physician informed him that RJD doctors allow "hernias to repair themselves," and alleges that Dr. Pankaj Karan was fired shortly after plaintiff's hernia was diagnosed. (ECF No. 68 at 2.) Plaintiff states that he was referred to a vascular surgeon due to the large lump above plaintiff's aneurysm "which is considered another hernia, possibly caused by the irritation from the abdominal hernia's excessive intestines rubbing above the iliac artery aneurysm." (
Plaintiff alleges that both hernias are excruciatingly painful, with nothing being done; at times, plaintiff reports the pain is a 9 on a scale of 10, causing tears. Plaintiff's hernia is not "incarcerated."
Defendants oppose plaintiff's motion for the following reasons:
1. Because plaintiff was transferred to RJD, plaintiff seeks relief from the CDCR and RJD, neither of which are parties herein, citing
2. Defendants argue that the remedy plaintiff seeks is inappropriate because Rule 35 is a discovery tool "whose purpose is to ensure that civil trials no longer need to be carried out in the dark." (ECF No. 77 at 2.) Defendants argue that plaintiff seeks to obtain a second opinion in order to question the medical judgment of health professionals at RJD. Defendants contend that plaintiff may file a health care appeal at RJD if he believes he is being provided inappropriate health care.
3. Defendants also contend that plaintiff failed to demonstrate good cause for such an examination. Defendants contend that plaintiff arguments concerning an FBI investigation and Dr. Karan's alleged termination are not based on plaintiff's personal knowledge and therefore are not admissible under Rule 602 of the Federal Rules of Evidence. Defendants submit that plaintiff's health care needs are being monitored and appropriately treated as demonstrated by the medical records provided with their opposition. Defendants note that plaintiff was seen by a vascular surgeon, and was then examined by Dr. Sarah Ghayouri, who concluded plaintiff's left iliac aneurysm was stable, and that because plaintiff presented with no vascular complaints, and his peripheral pulses were bilaterally normal, without any calf pain or claudication, a CT aortogram was not medically necessary. (ECF No. 77 at 4.) Plaintiff's complaints were noted as attributable to plaintiff's left inguinal hernia, which was described as "small." (
In reply, plaintiff reiterates that he was referred for a surgical consult for hernia repair on February 8, 2011, while plaintiff was housed at Wasco reception. Plaintiff was then transferred to HDSP, but because plaintiff presented as a high risk patient, it was agreed that a medical transfer was appropriate for plaintiff's hernia repair surgery. Plaintiff has now been waiting 44 months for hernia repair. Plaintiff recites from the court's March 28, 2014 order: "Plaintiff's hernia is a serious medical need, . . . the Ninth Circuit has noted that . . . a prisoner states a cognizable deliberate indifference claim where prescribed treatment for a hernia has been delayed for more than a year." (ECF No. 78 at 2, citing ECF No. 35 at 3.) (citations omitted). Plaintiff states that he has filed regular medical complaints about constant hernia pain. Plaintiff claims that the last time he saw Dr. Ghayouri in an emergency visit for hernia pain, she only confirmed the hernia was not "incarcerated," and sent plaintiff back to housing after only a two to three minute exam. (ECF No. 78 at 3.) Plaintiff states there was no vascular exam during this visit.
On August 28, 2014, plaintiff states he saw Dr. Solomon only to hear plaintiff's medical appeals. Plaintiff stated that Dr. Solomon confirmed that Dr. Zepp and Dr. Syverson had already recommended hernia repair surgery, attached the documents to the medical appeal, and forwarded them to medical for approval. (ECF No. 78 at 4.) Plaintiff alleges that Dr. Solomon "informed plaintiff that the hernia issue should [have] been handled long before this medical visit." (
Rule 35(a) of the Federal Rules of Civil Procedure provides as follows:
Fed. R. Civ. P. 35(a). Plaintiff must demonstrate good cause for either a physical or mental examination.
Defendants provided the following medical records:
On May 16, 2014, plaintiff requested health care services, noting his abdominal hernia and "a large lump rising in area of left iliac artery aneurysm. Both issues are becoming more painful, and bothersome." (ECF No. 77 at 35.) The RN noted that plaintiff was seen by his primary care physician on April 17, and that he was scheduled for follow-up appointment on June 2, 2014. (ECF No. 77 at 35.)
On June 4, 2014, plaintiff was examined by Dr. Pankaj Karan, who noted that plaintiff's umbilical hernia was stable, no evidence of obstruction, but that they would keep monitoring it. (ECF No. 77 at 33.) Dr. Karan stated "[t]here is no point for surgery at this point." (
On June 4, 2014, Dr. Karan issued a referral to vascular surgery for plaintiff. (ECF No. 77 at 13.) Plaintiff was scheduled for thirty day follow-up for the aneurysm in his left groin. (
On July 2, 2014, plaintiff was examined by Dr. Patrick Freyne, who reported, in pertinent part:
(ECF No. 77 at 27-28.)
On July 8, 2014, plaintiff requested health care for dizziness; on July 9, 2014, plaintiff denied symptoms or pain. (ECF No. 77 at 25.)
On July 13, 2014, plaintiff requested to see a doctor, complaining that he had been experiencing extreme sharp pains in the same area as his stented aneurysm — left iliac artery — swelling had also increased. (ECF No. 77 at 19.) Plaintiff reported his pain level at between 7 and 9 at times. (
On July 14, 2014, plaintiff was examined by Dr. Ghayouri. (ECF No. 77 at 23-23.) Dr. Ghayouri reported, in pertinent part:
(ECF No. 77 at 24.)
The records provided by defendants reflect that plaintiff is being p[rescribed the following medications at RJD:
metoprolol tartrate — for high blood pressure, angina, irregular heart rhythm; symptoms caused by overactive thyroid gland; terazosin — for symptoms of enlarged prostate; amlodipine besylate — a calcium channel blocker to reduce blood pressure; and lbuprofen 600 mg two times per day for pain. (ECF No. 77 at 9-10.)
mirtazapine — antidepressant (ECF No. 77 at 12.)
Crestor — for high cholesterol and high triglycerides in the blood (ECF No. 77 at 49.)
Nitroglycerin — for chest pain (ECF No. 77 at 62)
Plaintiff provided a copy of his August 31, 2014 request for health care services in which he states that the prescribed Ibuprofen is no longer relieving his hernia pain. (ECF No. 78 at 6.) Plaintiff requested that he either be provided hernia repair surgery, or that he be prescribed something to relieve his pain, which he described as a constant 8 to 9 on a scale of ten. (ECF No. 78 at 6.)
First, plaintiff's allegations as to Dr. Karan are not substantiated with credible evidence and plaintiff fails to demonstrate his allegations are within his personal knowledge. Defendants provided copies of records from the California Department of Consumer Affairs that reflect that Dr. Freyne and Dr. Ghayouri are licensed doctors in good standing. (ECF No. 77 at 66-70.) The Consumer Affairs website also reflects that Dr. Pankaj Karan, License Number 54018, holds a current license, and has no public record actions noted in the same fashion as the records for Dr. Freyne and Dr. Ghayouri. Department of Consumer Affairs, BREEZE, <https://www.breeze.ca.gov> (accessed Sept. 18, 2014). Thus, plaintiff's allegations as to Dr. Karan are disregarded.
Second, defendants' objections to the Rule 35 examination are well-taken, and the undersigned is persuaded that a medical examination under Rule 35 is not the appropriate remedy. Rather, it appears that plaintiff needs hernia repair surgery and/or better pain management for the pain associated therewith.
Third, the undersigned is concerned that plaintiff has not yet received hernia repair surgery, despite being transferred to RJD for that purpose. That said, the last time the parties filed status reports concerning plaintiff's medical care at RJD, it was unclear whether hernia repair was appropriate given plaintiff's other medical issues, as well as his concern about the risks of such surgery:
(ECF No. 41 at 2.) Plaintiff has failed to address these concerns in the instant motion, and the medical records do not articulate the nature of the discussions medical professionals at RJD have had with plaintiff concerning hernia repair surgery. Rather, it appears their focus has been on his iliac aneurysm. On this record, the court is unable to construe plaintiff's filing as a request for injunctive relief seeking hernia repair surgery. Moreover, it appears that plaintiff may have obtained some assistance through the medical appeals process with Dr. Solomon. The September 17, 2014 deadline has now passed, and the court is unaware of any further progress, or lack thereof, that may have been accomplished through this appeal process.
For all of these reasons, plaintiff's motion for Rule 35 examination is denied. However, the parties are advised that despite plaintiff's transfer to RJD, the court is unwilling to require plaintiff to start this journey again, by first exhausting his administrative claims at RJD and then filing a new civil rights action in the Southern District of California. A federal court has the power to issue orders in aid of its own jurisdiction, 28 U.S.C. § 1651(a), and to prevent threatened injury that would impair the court's ability to grant effective relief in a pending action.
A defendant acts with deliberate indifference when he knowingly fails to respond to a serious medical need and, thereby, inflicting harm on the plaintiff.
Recently, in
Here, two prior prison physicians have issued referrals for plaintiff to receive hernia repair surgery, for which plaintiff has been waiting since 2011, or 44 months. Plaintiff now appears to contend that his hernia pain level has increased and is constant at a level of 8 to 9. The medical records provided by defendants reflect that plaintiff is being prescribed Ibuprofen, which plaintiff now contends is insufficient to alleviate his hernia pain.
Therefore, the denial of plaintiff's motion for Rule 35 medical examination is without prejudice to plaintiff filing a motion for injunctive relief should health care professionals at RJD continue to deny plaintiff appropriate pain medication while he awaits the results of his health care appeal through Dr. Solomon. Of course, plaintiff must allege facts demonstrating such deliberate indifference and supporting such relief. "A plaintiff seeking a preliminary injunction must establish that he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest."
For all of the above reasons, IT IS HEREBY ORDERED that plaintiff's request for examination (ECF No. 68) is denied without prejudice.