DEBORAH BARNES, Magistrate Judge.
Plaintiff is a state prisoner proceeding pro se and in forma pauperis in this civil rights action filed pursuant to 42 U.S.C. § 1983. This matter proceeds on plaintiff's original complaint against defendants Gebrezghi and Hu on Eighth Amendment claims. Pending before the court is defendants' August 21, 2015, motion for summary judgment, which plaintiff opposes. For the reasons set forth below, the undersigned will recommend that defendants' motion be granted.
Plaintiff initiated this action on January 12, 2012. His complaint was screened on December 20, 2012, and found to state Eighth Amendment claims against the defendant. Service was ordered, and defendants filed an answer on July 24, 2013.
On August 6, 2013, a discovery and scheduling order issued setting the discovery deadline for November 22, 2013, and the dispositive motion deadline for February 14, 2014. (ECF No.
On February 10, 2014, defendants moved to dismiss for failure to exhaust administrative remedies.
On July 9, 2015, defendants' motion was denied (
Also pending is plaintiff's request to continue consideration of defendants' motion for summary judgment pending additional discovery. (ECF No. 56.) Defendants oppose this request. (ECF No. 59.)
Plaintiff alleges that defendants violated his rights under the Eighth Amendment while he was incarcerated at California State Prison-Solano ("CSP-Solano") by taking the following actions:
Plaintiff moves for a continuance on defendant's motion for summary judgment pursuant to Federal Rule of Civil Procedure "56(f)" pending additional discovery.
The court construes plaintiff's motion as one for relief pursuant to Federal Rule of Civil Procedure 56(d).
"Though the conduct of discovery is generally left to a district court's discretion, summary judgment is disfavored where relevant evidence remains to be discovered, particularly in cases involving confined pro se plaintiffs."
Plaintiff has not met his burden under Rule 56(d). Plaintiff's motion does not identify which documents he seeks or how those documents would assist him in opposing defendants' motion. In his opposition to defendants' motion, plaintiff claims that maintenance logs related to the air conditioning unit and reports by an unidentified correctional officer purportedly a witness to Nurse Hu's conduct will help him defeat defendants' motion. Plaintiff does not explain, however, why these records were not and could not have been obtained through the normal course of discovery, which ended three years ago.
At all times relevant to this action, plaintiff was an inmate incarcerated at CSP-Solano. Defendants are Registered Nurse ("RN") S. Gebrezghi, the Supervising Registered Nurse II, and RN K. Hu. Defs.' Statement Undisputed Facts ("DSUF") (ECF No. 52-3) ¶¶ 3-4.
The California Department of Corrections and Rehabilitation ("CDCR") maintains comprehensive medical and mental health records for every inmate in its custody, commonly referred to as a Unit Health Record ("UHR"). DSUF ¶ 5. Encounters between institutional medical and mental staff and inmate-patients are recorded and maintained in the UHR.
Inmates who are diagnosed with a serious mental illness are provided mental health services through CDCR's Mental Health Services Delivery System ("MHSDS"). DSUF ¶ 6. It is designed to provide appropriate levels of treatment and to promote individual functioning within the least-restrictive clinical environment, consistent with the safety and security needs of the inmate-patient and the institution.
The most restrictive level of mental health care within a CDCR institution is a Mental Health Crisis Bed ("MHCB"). DSUF ¶ 7. The MHCB provides short-term (ordinarily ten days or less) inpatient treatment to inmate-patients who exhibit significant impairment and dysfunction, require 24-hour nursing care, and present a danger to themselves or others. MHCB inmates are monitored daily by their primary clinician.
In the clinical judgment of a physician that an emergency situation exists, medication may be forcibly administered to an inmate-patient over the inmate-patient's objection. DSUF ¶ 8. An emergency exists when there is a sudden, marked change in an inmate-patient's condition so that action is immediately necessary for the preservation of life, to prevent serious bodily harm to the inmate or others, and it is impracticable to first obtain consent.
When staff discovers inmates harming themselves, medical assistance is summoned immediately to provide emergency medical care. DSUF ¶ 9. These events are taken very seriously and are considered emergency situations.
Staff members are trained to monitor and record any changes in an inmate-patient's environment that may pose a risk to their health or well-being. DSUF ¶ 11. This includes the cell temperature and any non-functioning equipment.
The CSP-Solano Correctional Treatment Center ("CTC") is cooled by a centralized air conditioning system that blows cool air throughout the building. DSUF ¶ 12. Staff members regularly check and record cell temperatures.
When an inmate is restrained, CDCR nurses are trained to monitor each extremity every fifteen minutes in order to ensure adequate circulation. DSUF ¶ 13. A registered nurse also conducts hourly assessments of the inmate-patient during the entire period of restraint.
Safety cells are those that are designed to be free from hazardous objects or fixtures; have adequate light and ventilation; are maintained at an appropriate temperature; have secure, lockable doors; and have windows that permit visual observation of the inmate-patient by staff. DSUF ¶ 14.
Plaintiff was housed at MCHB in the CSP-Solano CTC between June 3 and 13, 2010, because he had suicidal and homicidal ideations. DSUF ¶¶ 15-16. Dr. Obegi, who participated as a member of plaintiff's IDTT, provided mental health treatment for plaintiff during his stay at the CTC.
Dr. Obegi evaluated plaintiff and conducted his CTC intake assessment on June 3, 2010, at approximately 2:30 p.m. DSUF ¶ 16. He documented plaintiff's mental illness as Mood Disorder Not Otherwise Specified ("NOS"), which is a type of disorder that has features of other mental disorders but does not squarely fit into a single discrete category.
Features of borderline personality disorder include pervasive patterns of instability of interpersonal relationships, self-image, and marked impulsivity. DSUF ¶ 18. Individuals with this condition may be very sensitive to environmental circumstances.
Individuals with borderline personality disorder may have a pattern of unstable and intense relationships. They may idealize potential caregivers, but they may also switch quickly from idealizing other people to devaluing them, and feeling that the other person does not care enough or does not give enough.
Persons with this disorder may also display reoccurring impulsive acts of self-damaging and self-injurious behavior (such as cutting or burning themselves) that frequently include an intent to die. DSUF ¶ 19. Suicide attempts and threats from individuals with borderline personality disorder are very common. DSUF ¶ 20.
Plaintiff's exhibition of these features was documented during his stay at the CSP-Solano CTC. DSUF ¶ 21. These features materialized during his episodes of intense anger at nursing staff, apparently triggered by perceived slights, followed by periods of relative calm.
During the evening of June 4, 2010, nursing staff observed plaintiff attempting to use the edge of a plastic container to cut his right forearm. DSUF ¶ 22. A nurse asked him to stop and called for help.
Within minutes, Dr. Kumar, a Staff Psychiatrist, ordered plaintiff to be secured in five-point restraints for four hours to prevent plaintiff from inflicting further self-harm or from harming others. DSUF ¶ 28. Dr. Kumar ordered nursing checks to be conducted every fifteen minutes.
The medical notes indicate that plaintiff cooperated but with hesitation and visible anger, saying, "do not give me a shot." DSUF ¶¶ 29-30. Nursing staff asked plaintiff to cooperate and submit himself to a restraint bed, which plaintiff did with slight resistance.
During this time, Dr. Kumar ordered 20 mg of Geodon, an antipsychotic medication, and 20 mg of Ativan, a sedative, to be administered by intramuscular injection. DSUF ¶ 36. Around 7:20 p.m., Dr. Kumar came to plaintiff with the Watch Commander, talked to him, and discussed his situation.
Around this time, Defendant Nurse Gebrezghi appeared and administered Dr. Kumar's ordered injections into plaintiff's left thigh. DSUF ¶ 39. This is the only instance in which Nurse Gebrezghi administered an involuntary intramuscular injection for plaintiff during his stay at the CSP-Solano CTC between June 3 and 13, 2010.
Dr. Kumar's decision to order intramuscular administration of Geodon and Ativan was reasonable and clinically indicated under the circumstances.
On June 9, 2010, Dr. Shamasundara, a psychiatrist, ordered plaintiff to be placed in a safety cell around 2:45 p.m. DSUF ¶ 42. One-on-one suicide watch was ordered, with checks to be conducted every fifteen minutes.
Following is a timeline of events beginning on June 9, 2010, at 2:45 p.m., when plaintiff's safety cell temperature measured 72 degrees. DSUF ¶ 44. At that time, plaintiff was sitting up against the door, covered in his blanket.
From 7:30 p.m. on June 9, 2010, until 3:00 a.m. on June 10, 2010, plaintiff was quiet, and appeared to be asleep. DSUF ¶ 48. His cell temperature was between 72 and 73 degrees.
On June 10, 2010, at around 3:00 a.m., plaintiff asked for pain medications for his arthritis, and he fell asleep again at 6:00 a.m. DSUF ¶ 49. At 7:00 a.m., plaintiff told nursing staff that he was not suicidal, denied having hallucinations, and promised that he would not hurt anybody that day.
From 9:00 a.m., until 2:05 p.m., plaintiff's cell temperature was between 72 and 75 degrees. DSUF ¶ 51. Defendants claim plaintiff exhibited no signs of being in distress during this time, but plaintiff claims the air conditioning was not working properly and he fainted from lightheadedness due to the lack of ventilation.
At 4:35 p.m., plaintiff was observed with a tissue containing a small amount of blood in his hand. DSUF ¶ 52. Plaintiff attributed the blood to poor air circulation in his cell, and claimed the bleeding stopped after he blew his nose twice.
At 5:00 p.m., plaintiff was standing by his door and calm. DSUF ¶ 53. His cell temperature measured 74 degrees.
At 6:10 p.m., another portable fan was placed at his door, and more fluids were offered. DSUF ¶ 56. Plaintiff then stuck his arms out his cell door food port and refused for it to be closed; plaintiff claims he did this to complain about the lack of air conditioning.
At 7:00 p.m., plaintiff was yelling intermittently, and he had his arm stuck through the food port. DSUF ¶ 58. Correctional Sergeant responded and ordered plaintiff to remove his arm from the food port and put it back in his cell.
At 10:00 p.m., plaintiff's cell temperature measured 75 degrees. DSUF ¶ 60. Plaintiff was smiling and pleasant.
At around 2:50 a.m. on June 11, 2010, plaintiff began peeling rubber off his safety cell walls, biting the wall, putting paper in his mouth, and complaining that he did not get pain medications when he asked for them. DSUF ¶ 62. He became very angry and alleged staff was trying to punish him.
At 6:00 a.m., plaintiff was asked by a different staff member how he was doing and why he was back in restraints. DSUF ¶ 64. Plaintiff did not saying anything but looked angrily at the staff member.
At 7:20 a.m., the nurse's notes indicate that plaintiff was observed glaring menacingly at them. DSUF ¶ 65. Plaintiff appeared to be sleeping from 8:00 a.m. until 11:00 a.m.
At 1:00 p.m., restraints were removed on each of plaintiff's four limbs, one at a time for fifteen minutes each, so that staff could check his range of motion. DSUF ¶ 69. Plaintiff was angry and complained that staff did not immediately respond to his pain.
Nurse Hu worked with plaintiff beginning at 2:20 p.m. on June 11, 2010; his cell temperature measured 72 degrees at this time. DSUF ¶ 71. Nurse Hu observed plaintiff was lying on his back and did not appear to be in distress.
At 3:20 p.m., plaintiff's cell temperature measured 72 degrees. DSUF ¶ 72. Nurse Hu conducted range of motion exercises, and she observed that plaintiff did not appear to have any objective injuries.
At 4:20 p.m., the nursing notes indicate that plaintiff accused Nurse Hu of wanting to hurt him and/or wanting for him to commit suicide. DSUF ¶ 73. He also asked Nurse Hu to give him a razor so that he can kill himself.
At 5:30 p.m., plaintiff was making excuses to have his restraints removed. DSUF ¶ 74. When Nurse Hu removed the restraints for range of motion exercises, plaintiff was very resistant to have them put back on.
At 6:30 p.m., plaintiff was very upset and angry. DSUF ¶ 75. He accused Nurse Hu of saying he was sent to the gas chamber and asserted that he would file a grievance.
At 7:30 p.m., another nurse took over Nurse Hu's duties for checking on plaintiff. DSUF ¶ 76. This nurse's notes are lengthy, noting that plaintiff was unpredictable and angry; at no point in these notes is there a notation that plaintiff complained of restraints being placed too tightly.
When Nurse Hu returned at 9:30 p.m., the cell temperature measured 73 degrees. DSUF ¶ 77. At 9:35 p.m., Nurse Hu was informed that plaintiff said he was going to get out of his restraints and hurt somebody.
At 10:30 p.m., plaintiff complained of neck pain and was provided Tylenol. DSUF ¶ 79. He did not appear to have any injuries.
During the period Nurse Hu observed plaintiff in restraints, he was monitored every fifteen minutes by Licensed Vocational Nurses, and checked on hourly by Nurse Hu. DSUF ¶ 80. His vital statistics were also checked every shift change.
It is Nurse Hu's custom and practice when applying restraints to allow three fingers to be placed between the inmate-patient and the restraints. DSUF ¶ 70. That way the inmate's circulation will not be restricted.
Nurse Hu does not recall removing a fan from the plaintiff's cell door at any time. DSUF ¶ 43.
Plaintiff disputes many of the above facts relating to Nurse Hu. Instead, he claims that Nurse Hu repeatedly tightened plaintiff's restraints while cursing and threatening him; that a correctional officer witnessed this conduct and reported it to his supervisor; that this correctional officer forced Nurse Hu to leave plaintiff's cell; and that this officer's report will be a "smoking gun" in this case. Though plaintiff claims further discovery is necessary to locate the identity of this correctional officer and his report, this request will be denied for the reasons discussed
Summary judgment is appropriate when the moving party "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).
Under summary judgment practice, "[t]he moving party initially bears the burden of proving the absence of a genuine issue of material fact."
If the moving party meets its initial responsibility, the burden then shifts to the opposing party to establish that a genuine issue as to any material fact actually does exist.
In the endeavor to establish the existence of a factual dispute, the opposing party need not establish a material issue of fact conclusively in its favor. It is sufficient that "`the claimed factual dispute be shown to require a jury or judge to resolve the parties' differing versions of the truth at trial.'"
"In evaluating the evidence to determine whether there is a genuine issue of fact, [the court] draw[s] all inferences supported by the evidence in favor of the non-moving party."
Plaintiff's claim against Nurse Gebrezghi is premised on her administration of two intramuscular injections on June 4, 2010. Plaintiff contends this was deliberately indifferent to his medical needs.
Deliberate indifference to a prisoner's serious illness or injury, or risks of serious injury or illness, gives rise to a claim under the Eighth Amendment.
The requirement of deliberate indifference is less stringent in medical needs cases than in other Eighth Amendment contexts because the responsibility to provide inmates with medical care does not generally conflict with competing penological concerns.
Construing the facts in plaintiff's favor, as the court must, the evidence establishes that Nurse Gebrezghi administered two intramuscular injections at the direction of Dr. Kumar and over plaintiff's objections. Dr. Kumar submits that administering the medication in this manner was reasonable and clinically indicated under the circumstances, which were extensively documented at the time and included plaintiff's attempt to self-harm, his loud and argumentative behavior, his threats to nursing staff, and the physical manifestations of his anger (veins popping out of his neck and arms). While the injections were administered over plaintiff's objections, which will be assumed to have caused psychological harm, there is simply no evidence that Nurse Gebrezghi acted with a sufficiently culpable state of mind. Based on this evidence, the undersigned concludes that no reasonable trier of fact would find that Nurse Gebrezghi violated plaintiff's Eighth Amendment right to be free from excessive force.
Insofar as plaintiff's claim can construed as one involving the involuntary administration of medication, inmates have a substantial liberty interest, grounded in the Due Process Clause, in avoiding the involuntary administration of antipsychotic medication.
And finally, to the extent plaintiff claims that Nurse Gebrezghi injected him in retaliation for his threats against the nurses, he submits no evidence that she was present during or otherwise aware of these threats, that her conduct was motivated by anything other than an order from Dr. Kumar, or that the injections did not advance a legitimate correctional goal of subduing plaintiff under the circumstances presented.
For these reasons, summary judgment should be entered for this defendant.
Plaintiff's claim against Nurse Hu is premised on her alleged removal of a fan from under plaintiff's door on June 9, 2010, with malicious intent. This caused plaintiff's nose to bleed and him to suffer under harsh conditions for twenty-four hours before another fan was placed in front of his cell.
"The Eighth Amendment's prohibition against cruel and unusual punishment protects prisoners not only from inhumane methods of punishment but also from inhumane conditions of confinement."
An Eighth Amendment claim challenging conditions of confinement must satisfy both objective and subjective criteria.
Nurse Hu is entitled to summary judgment on this claim because plaintiff has not satisfied the objective element of his Eighth Amendment conditions of confinement claim. Setting aside the fact that the nursing notes demonstrate that Nurse Hu's first interaction with plaintiff occurred on June 11, 2010, two days after plaintiff claims she removed the fan, the records reveal that plaintiff's cell temperature never rose over 75-degrees even in the absence of a fan and air conditioning. This moderate temperature does not support plaintiff's claim that he suffered under "extremely harsh conditions" as a result of Nurse Hu's conduct. Even if plaintiff can establish deliberate indifference, his placement in a cell for 24 hours with a temperature never exceeding 75 degrees is not, objectively speaking, sufficiently serious to implicate the Constitution. Only those deprivations denying the minimal civilized measure of life's necessities are sufficiently grave to form the basis of an Eighth Amendment violation.
Plaintiff's excessive force claim against Nurse Hu is premised on the latter's placement of a tight restraint on plaintiff's hand on June 11, 2010, and her refusal to loosen it after plaintiff complained. When determining whether the force was excessive, the court looks to the "extent of the injury suffered by an inmate . . ., the need for application of force, the relationship between that need and the amount of force used, the threat `reasonably perceived by the responsible officials,' and `any efforts made to temper the severity of a forceful response.'"
The extent of injury suffered by the plaintiff may indicate the amount of force applied.
Nurse Hu denies having placed the restraints too tightly and asserts that it is her practice to allow three fingers to be placed between the inmate-patient and the restraints so that circulation will not be restricted. Assuming arguendo that Nurse Hu did place the restraints on plaintiff tightly, there is no evidence of plaintiff's complaints of pain or injury to Nurse Hu or any other staff member. There is also no evidence of any physical injury to plaintiff, such as bruising, swelling or abrasion. Instead, the evidence demonstrates that plaintiff repeatedly frustrated nursing staff's efforts to place the restraints on him, both before and after Nurse Hu's shift; that he was combative, uncooperative, unpredictable, threatening, and violent; and that numerous times the range of motion exercises were not performed by Nurse Hu or other nursing staff because of plaintiff's conduct. There is also evidence from defendants' expert, who opines that plaintiff's complaints can be attributed to his borderline personality disorder because individuals exhibiting that condition believe others do not care about them enough or even want to punish them. DSUF ¶ 81. On the facts presented then, the undersigned concludes that no reasonable trier of fact would find that the force applied by Nurse Hu was anything more than de minimis and of minimal duration. Thus, summary judgment should be entered for Nurse Hu.
Based on the foregoing, the undersigned will recommend that defendants' motion for summary judgment granted. In light of this recommendation, the court declines to consider defendants' alternate argument that they are entitled to qualified immunity.
Accordingly, IT IS HEREBY ORDERED that plaintiff's request to continue (ECF No. 56) is DENIED; and
IT IS HEREBY RECOMMENDED that defendants' motion for summary judgment be granted and this action be dismissed.
These findings and recommendations are submitted to the United States District Judge assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(1). Within fourteen days after being served with these findings and recommendations, any party may file written objections with the court and serve a copy on all parties. Such a document should be captioned "Objections to Magistrate Judge's Findings and Recommendations."
Any reply to the objections shall be served and filed within fourteen days after service of the objections. Failure to file objections within the specified time may waive the right to appeal the District Court's order.
