FINDINGS AND RECOMMENDATIONS, RECOMMENDING THAT DEFENDANT'S MOTION FOR SUMMARY JUDGMENT BE GRANTED (ECF No. 35.)
OBJECTIONS, IF ANY, DUE WITHIN FOURTEEN DAYS
GARY S. AUSTIN, Magistrate Judge.
I. BACKGROUND
Jason Leroy Cooper ("Plaintiff") is a prisoner proceeding pro se and in forma pauperis with this civil rights action pursuant to 42 U.S.C. § 1983. This case now proceeds with Plaintiff's Second Amended Complaint filed on July 7, 2017, against Dr. Chokatos ("Defendant") on Plaintiff's medical claim under the Eighth Amendment. (ECF No. 19.)
On May 18, 2018, defendant Chokatos filed a motion for summary judgment on the grounds that: (1) Plaintiff's claim is barred by the applicable statute of limitations, and that (2) Defendant was not deliberately indifferent to Plaintiff's serious medical needs, and there is no genuine dispute of material fact as to Plaintiff's claim for deliberate indifference.1 (ECF No. 35.) On December 6, 2018, after being granted extensions of time, Plaintiff filed an opposition to the motion. (ECF No. 48.) On December 14, 2018, Defendant filed a reply to the opposition. (ECF No. 49.)
Defendant's motion for summary judgment is now before the court. Local Rule 230(l). For the reasons that follow, the court recommends that the motion be granted.
II. SUMMARY JUDGMENT STANDARD
Any party may move for summary judgment, and the court shall grant summary judgment if 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) (quotation marks omitted); Washington Mut. Inc. v. U.S., 636 F.3d 1207, 1216 (9th Cir. 2011). Each party's position, whether it be that a fact is disputed or undisputed, must be supported by (1) citing to particular parts of materials in the record, including but not limited to depositions, documents, declarations, or discovery; or (2) showing that the materials cited do not establish the presence or absence of a genuine dispute or that the opposing party cannot produce admissible evidence to support the fact. Fed. R. Civ. P. 56(c)(1) (quotation marks omitted). The Court may consider other materials in the record not cited to by the parties, but it is not required to do so. Fed. R. Civ. P. 56(c)(3); Carmen v. San Francisco Unified Sch. Dist., 237 F.3d 1026, 1031 (9th Cir. 2001); accord Simmons v. Navajo Cnty., Ariz., 609 F.3d 1011, 1017 (9th Cir. 2010).
Defendant does not bear the burden of proof at trial and in moving for summary judgment, he need only prove an absence of evidence to support Plaintiff's case. In re Oracle Corp. Sec. Litig., 627 F.3d 376, 387 (9th Cir. 2010) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548 (1986)). If Defendant meets his initial burden, the burden then shifts to Plaintiff "to designate specific facts demonstrating the existence of genuine issues for trial." In re Oracle Corp., 627 F.3d at 387 (citing Celotex Corp., 477 U.S. at 323). This requires Plaintiff to "show more than the mere existence of a scintilla of evidence." Id. (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252, 106 S.Ct. 2505 (1986)).
In judging the evidence at the summary judgment stage, the court may not make credibility determinations or weigh conflicting evidence, Soremekun v. Thrifty Payless, Inc., 509 F.3d 978, 984 (9th Cir. 2007) (quotation marks and citation omitted), and it must draw all inferences in the light most favorable to the nonmoving party and determine whether a genuine issue of material fact precludes entry of judgment, Comite de Jornaleros de Redondo Beach v. City of Redondo Beach, 657 F.3d 936, 942 (9th Cir. 2011) (quotation marks and citation omitted). The court determines only whether there is a genuine issue for trial. Thomas v. Ponder, 611 F.3d 1144, 1150 (9th Cir. 2010) (quotation marks and citations omitted).
III. SUMMARY OF ALLEGATIONS IN THE SECOND AMENDED COMPLAINT2
Plaintiff is currently incarcerated at Mule Creek State Prison in Ione, California, in the custody of the California Department of Corrections and Rehabilitation (CDCR). The events giving rise to this action allegedly occurred at Pleasant Valley State Prison (PVSP) in Coalinga, California, when Plaintiff was incarcerated there.
Plaintiff alleges the following. Plaintiff was transferred to PVSP in November 2011. (ECF No. 19 ¶ 1.) In approximately June 2013, Plaintiff was diagnosed with coccidioidomycosis, or "Valley Fever." (Id. ¶¶ 9-10.) Valley Fever is not a curable disease, and the disseminated form of the disease is progressive, painful, and debilitating, and if left untreated, uniformly fatal once it progresses to meningitis. (Id. ¶¶ 11, 13.) The only medications found to be effective in treating Valley Fever are certain triazole compounds, including Fluconazole dosed at 400 milligrams per day; to be effective, Fluconazole must be taken daily, and lifelong treatment is recommended. (Id. ¶ 14.)
California health officials have long known about the prevalence of Valley Fever in the San Joaquin Valley region of the state. In November 2004, the Deputy Director of Health Care Services at the CDCR wrote a memorandum (the "Kanan Memo") to CDCR staff and officials regarding Valley Fever, its origin, and its treatment. (Id. ¶ 16.) The Kanan Memo recognized that triazole compounds, such as Fluconazole, are the only medications known to be effective on inmates with Valley Fever. (Id.) The Kanan Memo was and continues to be widely available to CDCR physicians, including defendant Dr. Chokatos. (Id.) In April 2012, the California Correctional Health Care Services released a report titled "Coccidiodomycosis in California's Adult Prisons, 2006-2010," which concluded that the incidence of Valley Fever has been increasing in some prisons, including PVSP. (Id. ¶ 17.)
Defendant Dr. Chokatos was the primary care physician assigned to Plaintiff by CDCR during the time he was at PVSP. (Id. ¶ 2.) Defendant Chokatos regularly treated patients with Valley Fever and knew that the only medications shown to be effective in treating the disease were triazole compounds, such as Fluconazole. (Id. ¶ 22.) Soon after Plaintiff was diagnosed with Valley Fever, he requested that defendant Dr. Chokatos start him on Fluconazole. (Id. ¶¶ 23-24.) Defendant Chokatos refused. (Id. ¶ 24.) During the next sixteen months Plaintiff's symptoms worsened and he repeatedly reported his symptoms to defendant Chokatos while requesting Fluconazole; but on each occasion, defendant Chokatos refused to provide such treatment. (Id. ¶ 25.) As a result of his refusal Plaintiff alleges that the disease progressed causing him to suffer body aches, joint pain, and severe and debilitating fatigue. (Id. ¶ 26.) Finally, in September 2014, defendant Chokatos prescribed Fluconazole. (Id. ¶ 27.) The treatment eased his symptoms and appeared to slow the progression of the disease. (Id.) By that time, however, the delay in treatment had caused Plaintiff's disease to progress causing additional and worsening symptoms and suffering. (Id. ¶ 28.)
In this action, Plaintiff seeks monetary and declaratory relief.
IV. UNDISPUTED FACTS (UF)
The following facts derive from Defendant's statement of undisputed material facts, (ECF No. 35-5), Plaintiff's responses to those statements, (ECF No. 48), evidence cited in those statements, and the court's review of the record.
Defendant's Undisputed Material Facts Supporting Evidence, Plaintiff's Reponse,
and Court's Finding
1. Plaintiff Jason Leroy Cooper filed his Compl. 19 (ECF No. 1); First Am. Compl. 6
original Complaint in this matter on June 1, (ECF No. 12); Second Am. Compl. 13 (ECF No.
2015. He filed his First Amended Complaint 19).
on May 25, 2016. He filed his Second
Amended Complaint on April 30, 2017. Court's finding: undisputed.3
2. Cooper currently alleges that he was Second Am. Compl. ¶¶ 23-27 (ECF No. 19);
damaged because from late 2012 to September Cooper Dep. 32:16-19 (Duggan Decl. Ex. I).
2014, Dr. Chokatos did not prescribe Court's finding: undisputed.4
Fluconazole for Cooper.
3. Cooper's original Complaint did not address Compl. (ECF No. 1).
Fluconazole, Cooper's medical treatment, or
Dr. Chokatos. Instead it focuses on Cooper's Court's finding: undisputed.5
alleged contraction of Valley Fever.
4. Cooper filed an administrative grievance on Gates Decl. ¶ 9; Patient-Inmate Healthcare
August 14, 2014, Appeal PVSP HC 14050888, Appeal (Gates Decl. Ex. D at 3).
requesting different treatment for alleged
Valley Fever symptoms. Court's finding: disputed in part.6
5. Appeal log no. PVSP HC 14050888 was Gates Decl. ¶¶ 8-9; Appeal History for (F40950)
Plaintiff's only grievance regarding his Jason Cooper (Gates Decl. Ex. C); Patient-treatment
for alleged Valley Fever symptoms. Inmate Healthcare Appeal (Gates Decl Exs. D-F).
Court's finding: disputed in part.7
6. On October 2, 2014 Appeal log no. PVSP Patient-Inmate Healthcare Appeal (Gates Decl.
HC 14050888 was partially granted at the first Ex. D at 1).
level after Cooper was prescribed Fluconazole.
Cooper did not pursue the grievance further. Court's finding: undisputed.8
7. In his Second Amended Complaint, Cooper Second Am. Compl. ¶ 28 (ECF No. 19).
asserts he exhausted administrative remedies
through grievance log number PVSP-14-01945. Court's finding: undisputed.9
8. Grievance log number PVSP-14-01945 Inmate/Parolee Appeal (Voong Decl. Ex. H at
complains that prison officials were negligent 3-6).
in their dust abatement procedures and policies
for windy days, which resulted in Cooper Court's finding: undisputed.10
contracting Valley Fever. The grievance does
not mention any subsequent treatment, and
does not mention Dr. Chokatos.
9. Cooper's Second Amended Complaint states Second Am. Compl. ¶ 23-24 (ECF No. 19).
that in June 2013, he was diagnosed with Court's finding: undisputed11.
Valley Fever, and "requested that Defendant
Chokatos start him on Fluconazole to alleviate
the symptoms and prevent further progression
of the disease."
10. Cooper's Second Amended Complaint Second Am. Compl. ¶ 25 (ECF No. 19).
alleges that between June 2013 and September
2014 he had several encounters with Dr. Court's finding: undisputed.12
Chokatos and repeatedly requested
Fluconazole, which requests Dr. Chokatos
refused.
11. Cooper's Second Amended Complaint Second Am. Compl. ¶ 27 (ECF No. 19).
alleges that in September 2014 Dr. Chokatos
prescribed Fluconazole for Cooper. Court's finding: undisputed.13
12. Cooper's medical records show that it was Cooper Dep. 38:12-39:6, and Ex. 3 (Duggan
nurse practitioner Ogbuehi who prescribed Decl. Exs. I-J); Feinberg Decl. ¶¶ 26, 39.
Fluconazole for Cooper in September 2014, not
Dr. Chokatos. Court's finding: undisputed.14
13. Coccidioidomycosis is an infection caused Chokatos Decl. ¶ 12; Carol A. Kauffman, et al.,
by inhalation of spores of fungi of the genus Primary Coccidioidal Infection 1 (Chokatos
Coccidioides. When coccidioidomycosis Decl. Ex. B) (hereinafter "Kauffman").
causes acute pneumonia, the condition is Court's finding: undisputed.15
known commonly as "Valley Fever."
14. The most common symptoms of Chokatos Decl. ¶ 13; Kauffman at 3; Feinberg
coccidioidomycosis are chest pain, cough, and Decl. ¶ 39a.
fever. Court's finding: undisputed.16
15. It is estimated that more than half of cases Chokatos Decl. ¶14; Kauffman at 3-4; Feinberg
of coccidioidomycosis are never diagnosed. Decl. ¶ 39a
The symptoms are non-specific and in many
cases the infection resolves on its own without Court's finding: undisputed.17
specific therapy.
16. In cases where it does not resolve on its Chokatos Decl. ¶16; Feinberg Decl. ¶ 39a.
own, coccidioidomycosis may disseminate, or
spread outside the lungs and cause serious Court's finding: undisputed.18
health problems.
17. If coccidioidomycosis is suspected, the Chokatos Decl. ¶15; Kauffman at 3, 8; Cooper
patient is evaluated with serological testing, in medical records (Duggan Decl. Ex. K at 8);
which a blood sample is taken and tested for Feinberg Decl. ¶ 11.
presence of antibodies to coccidioides fungus.
The result is a "titer," which can be 0, 1:2, 1:4, Court's finding: undisputed.19
1:8, 1:16, etc. The higher the second number,
the more antibodies and the worse the
infection. Titers of 1:2 and 1:4 are considered
insignificant, indicating only that the patient
was exposed to the fungus and had an immune
response to it.
18. Where a patient presents without evidence Chokatos Decl. ¶¶15-16, Kauffman at 5;
of extensive coccidioidal infection, and without Feinberg Decl. ¶ 39 a-b.
risk factors for dissemination of the infection,
such as HIV or pregnancy, antifungal Court's finding: undisputed.20
treatment, such as Fluconazole, is not
medically necessary.
19. Plaintiff Cooper is not a doctor, nor is he a Cooper Dep. 20:18-24, 36:6-15 (Duggan Decl.
medical expert. Ex. I).
Court's finding: undisputed.21
20. According to Cooper's Second Amended Second Am. Compl. ¶ 27.
Complaint, once Fluconazole was prescribed,
in September 2014, Plaintiff's alleged Court's finding: undisputed.22
symptoms eased. According to the Second
Amended Complaint, the alleged delay in
prescribing Fluconazole caused Cooper's
suffering from body aches, joint pain, fatigue,
and emotional distress.
21. From November 2012 to September 2014, Chokatos Decl. ¶ 19; Cooper medical records
Dr. Chokatos saw Cooper for eight medical (Duggan Decl. Ex. K at 2-18).
encounters. Court's finding: undisputed.23
22. Coccidioidomycosis is first mentioned in Chokatos Decl. ¶¶ 16, 19, 24, 37; Cooper
Cooper's medical records in April 2013, when medical records (Duggan Decl. Ex. K at 7-10);
Cooper sought testing to rule out hepatitis C Feinberg Decl. ¶¶ 10-13.
and coccidioidomycosis because of feelings of
fatigue and weakness. In May 2013, Cooper's Court's finding: undisputed.24
first coccidioidomycosis test showed a titer of
1:2. Considering Cooper's symptoms at that
time, Dr. Chokatos determined that
Fluconazole was not warranted.
23. At Dr. Chokatos's next encounter with Chokatos Decl. ¶ 25; Cooper medical records
Cooper, on July 12, 2013, Dr. Chokatos (Duggan Decl. Ex. K at 11-12); Feinberg Decl.
evaluated Cooper's symptoms and again ¶¶ 14-15.
determined no specific treatment for
coccidioidomycosis was necessary. Court's finding: undisputed.25
24. At Dr. Chokatos's next encounter with Chokatos Decl. ¶ 27; Cooper medical records
Cooper, on November 26, 2013, Dr. Chokatos (Duggan Decl. Ex. K at 15-16); Feinberg Decl.
evaluated Cooper's symptoms and again ¶¶ 15, 18.
determined no specific treatment for
coccidioidomycosis was necessary. On that Court's finding: undisputed.26
occasion, Cooper's titer score was again
reported at 1:2. Dr. Chokatos concluded
Cooper's coccidioidomycosis had been
successfully treated.
25. At Dr. Chokatos's next encounter with Chokatos Decl. ¶ 28; Cooper medical records
Cooper, on January 7, 2014, Dr. Chokatos (Duggan Decl. Ex. K at 17-18); Feinberg Decl. ¶
treated Cooper for shoulder pain. Dr. Chokatos 20.
also evaluated Cooper's symptoms and found
no symptoms of coccidioidomycosis. Court's finding: undisputed.27
26. After January 7, 2014, Cooper did not have Chokatos Decl. ¶¶ 28-33.
a medical encounter with Dr. Chokatos until Court's finding: undisputed.28
January 2015.
27. Cooper had medical encounters with other Chokatos Decl. ¶¶ 29-30; Cooper medical
CDCR medical practitioners (not Dr. records (Duggan Decl. Ex. K at 19-24);
Chokatos) on January 15, 2014, May 10, 2014, Feinberg Decl. ¶¶ 21-23.
and May 19, 2014. Court's finding: undisputed.29
28. In August 2014, Cooper saw a CDCR nurse Chokatos Decl. ¶¶ 30-31; Cooper medical
practitioner and complained of fatigue. A records (Duggan Decl. Ex. K at 25-29);
coccidioidomycosis test was ordered. In Feinberg Decl. ¶¶ 24-26.
September 2014, the test result came back. The
test result was again 1:2, indicating no active Court's finding: undisputed.30
disease. Despite the only symptom being
fatigue, nurse practitioner Ogbuehi approved a
Fluconazole prescription for Cooper.
29. On January 30, 2015, Dr. Chokatos saw Chokatos Decl. ¶ 33; Cooper medical records
Cooper for a follow-up appointment. Dr. (Duggan Decl. Ex. K at 31-32); Feinberg Decl. ¶
Chokatos noted Cooper had a Fluconazole 27.
prescription despite the treatment not being Court's finding: undisputed.31
medically indicated. Cooper had no symptoms
of a significant coccidioidomycosis infection.
Dr. Chokatos ordered a coccidioidomycosis
test and a follow up appointment.
30. On April 17, 2015 the test results came Chokatos Decl. ¶ 34; Cooper medical records
back with a titer of zero. Since Cooper had no (Duggan Decl. Ex. K at 39-41); Feinberg Decl. ¶
other symptoms of valley fever, the 30.
Fluconazole prescription was discontinued. Court's finding: undisputed.32
31. Cooper is sentenced to life without the Cooper Dep. 35:11-12 (Duggan Decl. Ex. I).
possibility of parole. Court's finding: undisputed.33
32. Cooper was not diagnosed with Valley Chokatos Decl. ¶ 38; Feinberg Decl. ¶ 24.
Fever in the 2012-2016 time frame. Court's finding: undisputed.34
33. Dr. Chokatos determined that in 2012-2016, Chokatos Decl. ¶ 37; Feinberg Decl. ¶ 39.
Cooper did not have symptoms
indicating a Fluconazole prescription was Court's finding: undisputed.35
medically necessary.
34. At his deposition, Cooper testified that he Cooper Dep. 30:1-12 (Duggan Decl. Ex. I).
believed taking Fluconazole reduced his cough,
but did not affect his aches and pains. Court's finding: undisputed.36
35. In his Second Amended Complaint, Cooper Second Am. Compl. ¶ 35.
alleges that Dr. Chokatos acted in "conscious
disregard" of excessive risk to Cooper. Court's finding: undisputed.37
36. Dr. Chokatos did not knowingly or Chokatos Decl. ¶ 38; Feinberg Decl. ¶¶ 39-40;
intentionally act to cause Cooper to experience Cooper Dep. 36:25-37:11 (Duggan Decl. Ex. I).
any pain, suffering, or injury. Court's finding: disputed.38
V. STATUTE OF LIMITATIONS
Defendant argues that Plaintiff's medical claim is barred by the applicable statute of limitations.
A. Legal Standards
"For actions under 42 U.S.C. § 1983, courts apply the forum state's statute of limitations for personal injury actions, along with the forum state's law regarding tolling, including equitable tolling, except to the extent any of these laws is inconsistent with federal law." Jones v. Blanas, 393 F.3d 918, 927 (9th Cir. 2004). The statute of limitations for personal injury actions under California law is two years. See Cal. Code Civ. P. § 335.1; see also Jones, 393 F.3d at 927.
California Code of Civil Procedure § 352.1 provides for the tolling of the statute of limitations for a maximum of two additional years for persons incarcerated for a term less than life at the time the claim accrues. It states:
If a person entitled to bring an action . . . is, at the time the cause of action accrued, imprisoned on a criminal charge . . . for a term less than for life, the time of that disability is not a part of the time limited for the commencement of the action, not to exceed two years.
Cal. Code Civ. P. § 352.1.
The Ninth Circuit has held that prisoners are also entitled to equitable tolling of the statute of limitations while completing the mandatory exhaustion process. Brown v. Valoff, 422 F.3d 926, 942-943 (9th Cir. 2005). The equitable tolling of statutes of limitations is a judicially created, nonstatutory doctrine designed to prevent unjust and technical forfeitures of the right to a trial on the merits when the purpose of the statute of limitations — timely notice to the defendant of the plaintiff's claims — has been satisfied, McDonald v. Antelope Valley Community College District, 45 Cal.4th 88, 99 (2008) (quotation marks and citations omitted), and pursuit of administrative remedies equitably tolls the statute of limitations so long as there was timely notice, lack of prejudice to the defendant, and reasonable, good faith conduct on the part of the plaintiff. Id. at 101-03.
B. Defendant's Motion
Defendant argues that Plaintiff's lawsuit is barred by the two-year statute of limitations, because it was more than two years between January 7, 2014, when Dr. Chokatos's last alleged act or omission took place, and May 25, 2016, when Plaintiff brought his claim in the First Amended Complaint. (UF Nos. 1, 3.) Because Plaintiff is serving a life sentence without parole, (UF No. 31), Defendant asserts that Plaintiff is not eligible for additional tolling of up to two years under Cal. Code Civ. P. § 352.1 for prisoners serving "a term less than for life." Defendant allows, however, that Plaintiff is eligible for 49 days additional tolling for the time spent exhausting his administrative remedies because Plaintiff's only written administrative grievance regarding the claims in this case, (UF No. 7-8), was submitted on August 14, 2014, and partially granted 49 days later on October 2, 2014, and Plaintiff did not pursue the grievance further. (UF Nos. 4-6.) Defendant therefore concludes that Plaintiff's causes of action are barred in this lawsuit.
Defendant also argues that under applicable federal law,39 Plaintiff knew of his injury — and his claim accrued — at least as early as June 2013, because Plaintiff's Second Amended Complaint states that in June 2013, immediately after receiving his first 1:2 titer score, he "requested that Defendant Chokatos start him on Fluconazole to alleviate the symptoms and prevent further progression of the disease." (UF Nos. 9, 11.)
Further, Defendant argues that to the extent Plaintiff may argue that part of his claim accrued after April 7, 2014 because he did not receive Fluconazole until September 2014, (UF No. 2), the continuing violation doctrine does not preserve his claim because Plaintiff did not see Dr. Chokatos during that time period, (UF Nos. 9-12), and Plaintiff is alleging only continuing impact, which is not actionable.
The court finds that Defendant has met his burden of demonstrating that Plaintiff's medical claim is barred by the applicable statute of limitations. Therefore, the burden now shifts to Plaintiff to produce evidence of a genuine material fact in dispute that would affect the final determination in this case.
C. Discussion
The parties do not dispute that under the applicable statute of limitations, Plaintiff had at least two years after his medical claim had accrued in which to bring his medical claim. Also, the parties agree that Plaintiff brought his medical claim on May 25, 2016, the date he filed the First Amended Complaint under the mailbox rule. (UF Nos. 1, 3.) There is no dispute that the two-year statute of limitations was tolled for an additional 49 days while Plaintiff exhausted his administrative remedies, giving Plaintiff 2 years and 49 days in which to bring his claim. The parties do not dispute any of these facts.
The parties' disagreement is about the date that Plaintiff's medical claim accrued, which is a question of law. Although state statutes of limitations and tolling principles apply, "[f]ederal law determines when a federal civil rights claim accrues." Maldonado v. Harris, 370 F.3d 945, 955 (9th Cir. 2004) (internal citation omitted). Under federal law, a § 1983 action accrues, and the statute of limitations begins to run, when the defendant's alleged wrongful act or omission causes damages. See Wallace v. Kato, 549 U.S. 384, 388, 127 S.Ct. 1091, 166 L.Ed.2d 973 (2007). In this regard, "a claim accrues when the plaintiff knows or has reason to know of the injury which is the basis of the action." Maldonado, 370 F.3d at 955.
Defendant argues that Plaintiff's claim accrued in June 2013, immediately after Plaintiff received his first 1:2 titer score, when he "requested that Defendant Chokatos start him on Fluconazole to alleviate the symptoms and prevent further progression of the disease," (UMF No. 9), because that was when Plaintiff knew of his injury.
In opposition, Plaintiff argues that his claim was preserved by the continuing violation doctrine and did not accrue until October 2, 2014, the date when Plaintiff's health care appeal was granted and Dr. Chokatos was ordered to provide Plaintiff with Fluconazole.
Here, the undersigned finds that the continuing violation doctrine brings Plaintiff's initiation of this case well within the statute of limitations. In another prisoner civil rights action in which the plaintiff claimed deliberate indifference to his serious medical needs, another Magistrate Judge of this court explained the doctrine as follows:
The continuing violation doctrine is an equitable doctrine designed "to prevent a defendant from using its earlier illegal conduct to avoid liability for later illegal conduct of the same sort." O'Loghlin v. County of Orange, 229 F.3d 871, 875 (9th Cir. 2000). To establish a continuing violation, a plaintiff must show "a series of related acts against a single individual . . . that . . . `are related closely enough to constitute a continuing violation.'" Green v. Los Angeles County Superintendent of Schools, 883 F.2d 1472, 148081 (9th Cir. 1989) (quoting Bruno v. Western Elec. Co., 829 F.2d 957, 961 (10th Cir. 1987)). However, the mere continuing impact from a past violation is not actionable under the continuing violation doctrine. Knox v. Davis, 260 F.3d 1009, 1013 (9th Cir. 2001) (citing Grimes v. City and County of San Francisco, 951 F.2d 236, 238-39 (9th Cir. 1991)).
Although the Ninth Circuit has not applied the continuing violation doctrine to Eighth Amendment deliberate indifference claims, several other circuits have. See Heard v. Sheahan, 253 F.3d 316, 318 (7th Cir. 2001) (finding that continuous violation doctrine applied to defendants' deliberate indifference for the span of time that prison officials were aware of plaintiff's injury and allegedly refused to treat it); Lavellee v. Listi, 611 F.2d 1129, 1132 (5th Cir. 1980) ("[T]he [arrestee's] allegation of a failure to provide needed and requested medical attention constitutes a continuing tort, which does not accrue until the date medical attention is provided."); Neel v. Rehberg, 577 F.2d 262, 263-64 (5th Cir. 1978) (per curiam) (finding that where inmate alleged that jail officials failed to provide medical treatment over a three-month period, the continuous violation doctrine applied and the statute of limitations did not begin to run until the end of that period); see also Evans v. County of San Diego, No. 06 CV 0877 JM (RBB), 2008 WL 842459, at *12 (S.D.Cal. Mar. 27, 2008) (applying continuing violation doctrine to prisoner's Eighth Amendment medical treatment claim).
Gipbsin v. Kernan, No. 2:12-CV-0556 GEB DAD, 2015 WL 3993073, at *3 (E.D.Cal. June 30, 2015), report and recommendation adopted, No. 2:12-CV-0556 GEB DAD, 2015 WL 4602774 (E.D.Cal. July 28, 2015) (quoting Martin v. Woodford, No. 1:08-cv-0415 LJO SKO PC, 2010 WL 2773235 at *4-*5 (E.D.Cal. July 13, 2010), adopted by 2010 WL 3853305 (E.D.Cal. Sept.29, 2010), aff'd, Case No. 11015830, 2013 WL 29792 (9th Cir. Jan. 3, 2013). The Court in Gipbsin continued,
District courts in the Ninth Circuit have consistently recognized the continuing violation doctrine in prisoner civil rights cases. See, e.g., Watson v. Sisto, No. 2:07-cv-01871 LKK KJN P, 2011 WL 533716 at *5 (E.D.Cal. Feb. 14, 2011) (applying continuing violation doctrine to plaintiff's claim that the prison health system, as administered by doctors and staff, consistently failed to provide adequate medical care for plaintiff's back condition); Evans v. County of San Diego, No. 06 CV 0877 JM (RBB), 2008 WL 842459 at *12 (S.D.Cal. Mar.27, 2008) (applying the continuing violation doctrine to plaintiff's deliberate indifference claim because the claim was not based on the original knee injury but rather on defendants' ongoing failure to treat the injury); see also, e.g., MacGregor v. Dial, No. 2:13-cv-1883 JAM AC P, 2015 WL 1405492 at *9 (E.D.Cal. Mar. 25, 2015) (finding that the continuing violation doctrine did not apply because the plaintiff's allegations were based on discrete acts of deliberate indifference); Navarro v. Herndon, No. 2:09-cv-1878 KJM KJN P, 2011 WL 3741351 at *8 (E.D.Cal. Aug. 24, 2011) (finding that continuing violation doctrine did not apply because each mental health diagnosis and placement was discrete with its own consequences), adopted in part and rejected in part on other grounds by 2011 WL 4578534 (E.D.Cal. Sept. 30, 2011).
Gipbsin, 2015 WL 3993073, at *3.
In this case, Plaintiff's claim is based on defendant Chokatos's alleged failure to treat Plaintiff's Valley Fever symptoms with the medication Fluconazole for more than a year despite multiple complaints from Plaintiff. "A violation is called `continuing,' signifying that a plaintiff can reach back to its beginning even if that beginning lies outside the statutory limitations period, when it would be unreasonable to require or even permit him to sue separately over every incident of the defendant's unlawful conduct." Heard, 253 F.3d at 319; accord Cleveland v. Los Angeles County Sheriff's Department, No. 215CV01399DSFGJS, 2017 WL 1364227, at *10-11 (C.D.Cal. Feb. 7, 2017), report and recommendation adopted sub nom. Cleveland v. Los Angeles Cty. Sheriff's Dep't, No. 215CV01399DSFGJS, 2017 WL 1386003 (C.D.Cal. Apr. 11, 2017). "Not only would it be unreasonable to require [Plaintiff], as a condition of preserving his right to have a full two years to sue in respect of the last day on which his request was ignored, to bring separate suits two years after each of the earlier days of deliberate indifference, but it would impose an unreasonable burden on the courts to entertain an indefinite number of suits and apportion damages among them." Heard, 253 F.3d at 319-20; accord Turley v. Rednour, 729 F.3d 645, 651 (7th Cir. 2013).
In this regard, application of the continuing violation doctrine is appropriate because Plaintiff complains of a continual unlawful act. Gipbsin, 2015 WL 3993073, at *4. Under the continuing violation doctrine, the statute of limitations for Plaintiff's filing of the present action did not begin to run until Plaintiff was prescribed Fluocazole by nurse practitioner Ogbuehi in September 2014. See Heard, 253 F.3d at 319 (cause of action accrues on the last day officials refused to treat inmate's medical condition or on the date he left the jail). Plaintiff commenced this cause of action on May 25, 2016, less than two years later and therefore, the case falls within the applicable two-year statute of limitations with tolling of 49 days while Plaintiff exhausted his administrative remedies, and is timely.40
Accordingly, for all of the foregoing reasons, Defendant's motion for summary judgment based on the statute of limitations should be denied.
VI. EIGHTH AMENDMENT MEDICAL CLAIM
A. Legal Standards
While the Eighth Amendment of the United States Constitution entitles Plaintiff to medical care, the Eighth Amendment is violated only when a prison official acts with deliberate indifference to an inmate's serious medical needs. Snow v. McDaniel, 681 F.3d 978, 985 (9th Cir. 2012), overruled in part on other grounds, Peralta v. Dillard, 744 F.3d 1076, 1082-83 (9th Cir. 2014); Wilhelm v. Rotman, 680 F.3d 1113, 1122 (9th Cir. 2012); Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). The two-part test for deliberate indifference requires the plaintiff to show (1) "`a serious medical need' by demonstrating that `failure to treat a prisoner's condition could result in further significant injury or the unnecessary and wanton infliction of pain,'" and (2) "the defendant's response to the need was deliberately indifferent." Jett, 439 F.3d at 1096 (quoting McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1992), overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc) (internal quotations omitted)).
Deliberate indifference is shown by "(a) a purposeful act or failure to respond to a prisoner's pain or possible medical need, and (b) harm caused by the indifference." Wilhelm, 680 F.3d at 1122 (citing Jett, 439 F.3d at 1096). The requisite state of mind is one of subjective recklessness, which entails more than ordinary lack of due care. Snow, 681 F.3d at 985 (citation and quotation marks omitted); Wilhelm, 680 F.3d at 1122. Deliberate indifference may be manifested "when prison officials deny, delay or intentionally interfere with medical treatment, or it may be shown by the way in which prison physicians provide medical care." Id. Where a prisoner is alleging a delay in receiving medical treatment, the delay must have led to further harm in order for the prisoner to make a claim of deliberate indifference to serious medical needs. McGuckin, 974 F.2d at 1060, overruled on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997) (citing Shapely v. Nevada Bd. of State Prison Comm'rs, 766 F.2d 404, 407 (9th Cir. 1985)).
"Deliberate indifference is a high legal standard." Toguchi v. Chung, 391 F.3d 1051, 1060 (9th Cir. 2004). "Under this standard, the prison official must not only `be aware of the facts from which the inference could be drawn that a substantial risk of serious harm exists,' but that person `must also draw the inference.'" Id. at 1057 (quoting Farmer v. Brennan, 511 U.S. 825, 837 (1994). "`If a prison official should have been aware of the risk, but was not, then the official has not violated the Eighth Amendment, no matter how severe the risk.'" Id. (quoting Gibson v. County of Washoe, Nevada, 290 F.3d 1175, 1188 (9th Cir. 2002)). "A showing of medical malpractice or negligence is insufficient to establish a constitutional deprivation under the Eighth Amendment." Id. at 1060. "[E]ven gross negligence is insufficient to establish a constitutional violation." Id. (citing Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990)).
"A difference of opinion between a prisoner-patient and prison medical authorities regarding treatment does not give rise to a § 1983 claim." Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981) (internal citation omitted). To prevail, a plaintiff "must show that the course of treatment the doctors chose was medically unacceptable under the circumstances . . . and . . . that they chose this course in conscious disregard of an excessive risk to plaintiff's health." Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996) (internal citations omitted).
B. Parties' Arguments
Defendant argues that Plaintiff's complaint rests solely on a mere difference of opinion between a prisoner-patient and prison medical provider, and the medical course of treatment for Plaintiff was medically acceptable. Defendant declares, and offers as evidence Plaintiff's medical records, Dr. Feinstein's declaration, and Dr. Kauffman's article, that in April 2013, Plaintiff requested a coccidioidomycoses test, and the results showed a titer of 1:2, which indicated that Plaintiff was exposed to the coccidioides fungus and had an immune response, but does not indicate active disease, UF Nos. 17, 22 (Chokatos Decl. ¶¶15, 16, 19, 24, 37; Kauffman at 3, 8; Cooper medical records (Duggan Decl. Ex. K at 7-10); Feinberg Decl. ¶¶ 10, 11, 13.) Defendant provides evidence that in the following months he monitored Plaintiff's condition, repeated the test again in November 2013, which again showed a titer of 1:2, and considered the condition was successfully treated. UF No. 24 (Chokatos Decl. ¶ 27; Cooper medical records (Duggan Decl. Ex. K at 15-16); Feinberg Decl. ¶¶ 15, 18.) Because Plaintiff is not a doctor and has no medical training, UF No. 19 (Cooper Dep. 20:18-24, 36:6-15 (Duggan Decl. Ex. I)), Defendant concludes that Plaintiff's disagreement with his assessment is not credible evidence.
Defendant also argues that he did not consciously disregard a risk to Plaintiff's health. Defendant declares, and offers Dr. Feinberg's declaration and Plaintiff's deposition testimony41 to show, that he did not act with any such conscious disregard and his goal was to provide Plaintiff with the proper medical care. UM No. 36 (Chokatos Decl. ¶ 38; Feinberg Decl. ¶¶ 39-40; Cooper Dep. 36:25-37:11 (Duggan Decl. Ex. I). Defendant offers his and Dr. Feinberg's opinions that Fluconazole simply was not medically indicated for Plaintiff, and accordingly Defendant did not prescribe it. UF No. 33 (Chokatos Decl. ¶ 37; Feinberg Decl. ¶ 39).
Based on Defendant's arguments and evidence in support of his motion for summary judgment, the court finds that Defendant has met his burden of demonstrating that his course of medical treatment was medically acceptable and he did not act with deliberate indifference to Plaintiff's serious medical need. Therefore, the burden now shifts to Plaintiff to produce evidence of a genuine material fact in dispute that would affect the final determination in this case.
In opposition, Plaintiff argues that he had a serious medical need because he was diagnosed with Valley Fever and Defendant refused to prescribe him the only medication proven to be effective in treating Valley Fever, Fluconazole, which caused his symptoms to worsen. In his Second Amended Complaint, Plaintiff states that in June 2013, he was diagnosed with Valley Fever. (Second Amended Complaint (SAC), ECF No. 19 at 3 ¶10, 7 ¶ 23; Feinberg Decl., ECF No. 35-8 ¶ 11.) Plaintiff alleges that he immediately requested that Dr. Chokatos start him on Fluconazole but Dr. Chokatos refused. (SAC at 7 ¶ 24.) Plaintiff states that Dr. Chokatos was the primary care physician on a yard with scores of Valley Fever patients and knew that the only medications shown to be effective in treating Valley Fever were certain triazole compounds, including Fluconazole. (SAC at 19 ¶ 22.) Plaintiff argues that Dr. Chokatos refused to consider that because Plaintiff had asthma he was at a heightened risk of developing a more serious case of Valley Fever. (Plaintiff's responses to UF Nos. 23, 25, and 33, ECF No. 48 at 5, 6.) Plaintiff argues that Dr. Chokatos's own evidence, the article by Carol A. Kaufmann, M.D., shows that he should have treated Plaintiff with Fluconazole because he had a pre-existing cardiopulmonary condition. (Chokatos Decl., ECF No. 35-4 ¶ 18 (Exh. B) at 18.)
In reply, Defendant declares that asthma is not a risk factor for the development of severe coccidioidomycosis, and that Plaintiff's mild asthma was not a pre-existing cardiopulmonary condition which placed Plaintiff at increased risk of developing severe disease. (Chokatos 2d Decl., ECF No. 49-1 at 3 ¶¶3, 4.)
C. Analysis
Plaintiff's disagreement with Defendant only presents a difference of opinion between a non-physician inmate and his treating physician, which is insufficient to defeat summary judgment here.42
Here, Plaintiff does not dispute that his claim is based upon symptoms including cough, body aches, joint pain, lethargy, emotional distress, and depression. (SAC, Doc. 19 at 4 ¶ 11.) Plaintiff's reported symptoms are sufficient to show that he had a serious medical need. However, Plaintiff has not met his burden to present evidence of a genuine material fact in dispute that would affect the final determination in this case.
It is undisputed that Defendant saw Plaintiff and reviewed his medical records in response to his complaints of pain and lethargy, including reviewing the results of a blood test showing that Plaintiff had been exposed to Valley Fever. (UF Nos. 21, 22.) Based on Dr. Chokatos's medical training and evaluation, Dr. Chokatos refused to prescribe Fluconazole for Plaintiff and instead monitored his condition and ordered follow-up blood tests. (UF Nos. 22-25.) This course of treatment does not show any deliberate indifference to Plaintiff's complaints of pain, lethargy, and mental distress. There is no evidence that Dr. Chokatos drew the inference that Plaintiff faced an excessive risk to his health without taking Fluconazole and acted unreasonably.
Plaintiff argues that Defendant should have taken into consideration that Plaintiff's asthma was a preexisting cardiopulmonary condition that placed him at heightened risk of developing a severe form of Valley Fever, and should have concluded that Plaintiff should be prescribed Fluconazole before his infection disseminated. Plaintiff has presented no admissible evidence of any change in his condition attributed to the medication Fluconazole or lack thereof, or any evidence that Dr. Chokatos's evaluation of Plaintiff fell below the medical standard of care so significantly that it could constitute deliberate indifference under the Eighth Amendment. Rather, Plaintiff's arguments rely entirely on his non-medical opinion. Plaintiff is not competent to provide medical opinion evidence sufficient to create any triable issue of fact in this case. See Fed. R. Civ. P. 56(c)(4) (affidavit or declaration used to oppose a motion must be made on personal knowledge, set out facts that would be admissible in evidence, and show that the affiant or declarant is competent to testify on the matters stated). Plaintiff agrees in his deposition that he is not a doctor, has no medical training, and has no medical education. (see Cooper Depo., ECF No. 35-7 at 12:18-24.)
Therefore, the court finds that Plaintiff has not shown a triable issue of fact for trial. Accordingly, summary judgment should be granted in favor of Defendant in this case, and the court recommends granting Defendant's motion for summary judgment.
VII. RECOMMENDATIONS
Based on the foregoing, it is HEREBY RECOMMENDED that:
1. Defendant's motion for summary judgment, filed on May 18, 2018, be GRANTED;
2. Judgment be entered in favor of Defendant; and
3. The Clerk be directed to close this case.
These Findings and Recommendations will be submitted to the United States District Judge assigned to the case, pursuant to the provisions of 28 U.S.C. § 636(b)(l). Within fourteen (14) days after being served with these Findings and Recommendations, the parties may file written objections with the court. The document should be captioned "Objections to Magistrate Judge's Findings and Recommendations." Any reply to the objections shall be served and filed within ten (10) days after the date the objections are filed. The parties are advised that failure to file objections within the specified time may result in the waiver of rights on appeal. Wilkerson v. Wheeler, 772 F.3d 834, 838-39 (9th Cir. 2014) (citing Baxter v. Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)).
IT IS SO ORDERED.