Opinion
No. C 00-1616 SI (pr)
February 27, 2001
JUDGMENT
Pursuant to the Order Granting Defendants' Motion For Summary Judgment signed today, judgment is entered in favor of defendants and against plaintiff.
IT IS SO ORDERED AND ADJUDGED.
INTRODUCTION
Donald LeRoy Corsetti, an inmate currently housed at the California Medical Facility in Vacaville, filed this pimae civil rights action under 42 U.S.C. § 1983, claiming that defendants were deliberately indifferent to his medical needs. Defendants now move for summary judgment and Corsetti opposes the motion. The court finds no triable issues of material fact exist and defendants are entitled to judgment as a matter of law. The court therefore will grant defendants' motion.
BACKGROUND
The following facts are undisputed:
At all times relevant to this action, Corsetti was a convicted felon serving a prison sentence. Defendants Martin, Vong, Thomson, Bui and Weden are doctors and defendant Mitchell is a nurse; all were members of the medical staff at San Quentin State Prison, where Corsetti was housed during part of the relevant period. Corsetti had a long history of ingesting 1999, April 15, 1999, June 24, 1999, July 7, 1999 (after Corsetti swallowed 5 more razor blades), May 6, 2000, May 7, 2000, May 8, 2000, and May 9, 2000. The x-ray on March 4, 1999 showed "a single edged razor blade lying over the proximal descending colon this time indicating continued progression through the bowel." Exh. 8. The x-rays taken on March 31, April 8 and April 15, 1999 all showed the razor blade's position to be unchanged. Corsetti was sent to the California Medical Facility ("CMF") in Vacaville for examination by that institution's gastroenterologist, Dr. Sogge, in late March 1999. Dr. Sogge (according to Dr. Weden's summary report) stated that he "felt that further conservative observation was indicated, and agreed that the best place to perform this would be at CMF or some other prison where there was a hospital on site where surgery could be performed if indicated." Exh. 10. Dr. Weden noted that Corsetti had been treated intensively with laxatives and enemas without further movement of the razor blade.
On April 20, 1999, a recommendation was made to transfer Corsetti from San Quentin to CMF. Corsetti arrived at CMF on April 22, 1999 and did not return to San Quentin before he was paroled from prison on June 1, 1999. He was arrested again on June 24, 1999 and returned to custody. There is no indication that he sought to have the razor blade removed or to receive any kind of medical treatment during the few weeks he was on parole.
After his arrest, Corsetti was sent to San Quentin again. His abdomen was x-rayed on June 24, 1999 and the razor blade was noted in the left upper quadrant. On June 30, 1999, Dr. Weden wrote: "The recommendation now as in April is that this man with his known foreign body in the left upper quadrant, presumably in the small intestime, without evidence of obstruction, should be transferred as soon as possible to CMF where he is well known and where there is a gastroenterologist and surgical team to take care of any emergency which might arise. Exh. 15.
On July 17, 1999, Corsetti reported that he had swallowed many razor blades; an examination showed 5 new razor blades in the bowel. He was admitted to the infirmary on July 17, and seen numerous times before his transfer on August 23, 1999 to "out to court" status.
Corsetti returned to San Quentin on March 6, 2000. On April 24, 2000, he filed an inmate appeal advising of pain and requesting that the remaining razor blade be removed.
On May 5, 2000, Corsetti was seen at Novato Community Hospital. The parties describe the cause of this visit differently: defendants contend that Corsetti was sent after purportedly swallowing two more razor blades; plaintiff contends that he was sent because he had overdosed on Tylenol and Advil; the medical records show that Corsetti reported to hospital staff that he had swallowed two more razor blades and consumed numerous Tylenol and Advil within the previous day. The doctor's assessment stated: "X-ray reveals one of these razor blades in the splenic flexure of the colon, the other one in the rectum. The patient has a negative abdominal exam. He will be admitted for observation. . . . Hopefully he will pass these without problem." Exh. 20, p. 1. Corsetti remained at that hospital from May 6, 2000 through May 11, 2000. Although he was hospitalized for the purposes of surgery, surgery was not performed. The parties disagree as to why the surgery was not performed. Defendants present evidence that Corsetti was returned to prison without surgery because he was hostile and threatened hospital staff; Corsetti states that he was returned after he got into an argument with a guard over the guard's concern that Corsetti would excrete the razor blade and use it to assault a guard. It is undisputed that one doctor at Novato Community Hospital wrote that "Colyte will be started tonight and abdominal films done to see if he has made any progress. There appears to be no evidence of a surgical abdomen at this time and if the foreign object cannot be removed easily, by Colyte lavage, or endoscopic removal it may be best to observe rather than to try to remove them because of his extensive past surgical history." Exh. 20, p. 8.
Corsetti was seen at San Quentin numerous times between May 12, 2000 and June 2, 2000. On June 13, 2000, Corsetti arrived at CMF. The razor blade was surgically removed on August 29, 2000.
Defendants now move for summary judgment, contending that they are entitled to judgment as a matter of law on Corsetti's complaint. Corsetti opposes the motion. Corsetti does not dispute the accuracy of the hefty stack of medical records submitted by defendants; indeed, he relies on those records to support at least one of his contentions. The only pieces of evidence Corsetti submits are his verified complaint, his declarationlopposition to defendants' motion, and a single inmate appeal form.
VENUE AND JURISDICTION
Venue is proper in the Northern District of California under 28 U.S.C. § 1391 because the events or omissions giving rise to the claims occurred here. This court has federal question jurisdiction over this action brought under 42 U.S.C. § 1983. See 28 U.S.C. § 1331.
LEGAL STANDARD FOR SUMMARY JUDGMENT
The court will grant summary judgment "against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial . . . since a complete failure of proof concerning an essential element of the nonmoving pafty's case necessarily renders all other facts immaterial." Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986) (a fact is material if it might affect the outcome of the suit under governing law, and a dispute about a material fact is genuine "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.") The moving party bears the initial burden of identifying those portions of the record which demonstrate the absence of a genuine issue of material fact. The burden then shifts to the nonmoving party to "go beyond the pleadings, and by his own affidavits, or by the "depositions, answers to interrogatories, or admissions on file,' designate "specific facts showing that there is a genuine issue for trial."' Celotex, 477 U.S. at 324 (citations omitted). The court's function on a summary judgment motion is not to make credibility determinations or weigh conflicting evidence with respect to a disputed material fact. See T.W. Elec. Serv. v. Pacific Elec. Contractors Ass'n, 809 F.2d 626, 630 (9th Cir. 1987). The evidence must be viewed in the light most favorable to the nonmoving party, and the inferences to be drawn from the facts must be viewed in a light most favorable to the nonmoving party. See id. at 631.
DISCUSSION
A. Causation In A Damages Case
At this point, only the claims for damages remain for adjudication. Corsetti's complaint sought injunctive relief as well as damages, but his injunctive relief requests are now moot. His request for the court to order the removal of the razor blade is moot because the razor blade was surgically removed after he filed his complaint. His request for the court to order treatment for the pain is moot because he is no longer housed at San Quentin and has been moved to CMF. See Dilley v. Gunn, 64 F.3d 1365, 1368 (9th Cir. 1995) (inmate's transfer from one prison to another while his claims are pending generally will moot any claims for injunctive relief concerning first prison's policies). The fact that only damages claims remain is important because the causation inquiry is more rigid.
When, as here, the prisoner seeks only damages against defendants, the "inquiry into causation must be individualized and focus on the duties and responsibilities of each individual defendant whose acts or omissions are alleged to have caused a constitutional deprivation." Leer v. Murphy, 844 F.2d 628, 633 (9th Cir. 1988). Leer explained that "it is important to distinguish the causal connection required when a plaintiff seeks injunctive or declaratory relief as opposed to damages." Id. In the former case, a broader and more generalized approach to causation is taken. See id.
When plaintiffs, such as the inmates, seek to hold an individual defendant personally liable for damages, the causation inquiry between the deliberate indifference and the eighth amendment deprivation must be more refined. We must focus on whether the individual defen an was in a position to take steps to avert the [harm], but failed to do so intentionally or with deliberate indifference. In order to resolve this causation issue, we must take a very individualized approach which accounts for the duties, discretion, and means of each defendant. Sweeping conclusory allegations will not suffice to prevent summary judgment. . . . The prisoner must set forth specific facts as to each individual defendant's deliberate indifference.
Id. at 633-34 (citations omitted).
B. Deliberate Indifference To Medical Needs
Deliberate indifference to serious medical needs violates the Eighth Amendment's proscription against cruel and unusual punishment. Estelle v. Gamble, 429 U.S. 97, 104 (1976). To prove that the response of prison officials to a prisoner's medical needs was constitutionally deficient, the prisoner must establish (1) a serious medical need and (2) deliberate indifference to that need by prison officials. McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992). A medical need is serious if the failure to treat the prisoner's condition could result in further significant injury or the "`unnecessary and wanton infliction of pain.'" Id. at 1059 (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)). A prison official is deliberately indifferent if he knows that a prisoner faces a substantial risk of serious harm and disregards that risk by failing to take reasonable measures to abate it. Farmer v. Brennan, 511 U.S. 825, 847 (1994). A mere difference of opinion as to which medically acceptable course of treatment should be followed does not establish deliberate indifference. Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). Thus, deliberate indifference is not shown if the defendant has based his actions on a medical judgment that either of two alternative courses of treatment would be medically acceptable under the circumstances. Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996). Where defendant doctors have chosen one course of action and a plaintiff contends that they should have chosen another course of action, the plaintiff "must show that the course of treatment the doctors chose was medically unacceptable under the circumstances, ... and the plaintiff must show that they chose this course in conscious disregard of an excessive risk to plaintiffs health." Id.
C. Analysis of Corsetti's Claims
Corsetti presents no probative evidence of the appropriate course of treatment for a razor blade stuck in one's bowel. He apparently believes that the razor blade should have been removed promptly, but he provides no proof that removal was medically necessary or proper. His own opinion as to the appropriate course of care does not create a triable issue of fact because he has not shown he has any medical training or expertise upon which to base such an opinion and it is not common knowledge that surgical removal of a sharp object is appropriate in a case such as Corsetti's. (Of course, defendants also have not presented any evidence affirmatively describing the appropriate treatment for such a condition, but their failure to do so is not the problem for them that it is for Corsetti because he bears the burden of proof on the issue.) The evidence before the court indirectly suggests that defendants' course of conduct was medically appropriate. Several doctors at two different prisons as well as doctors at an outside hospital took the wait-and-see approach, suggesting that was a medically appropriate course of action. Also, the fact that other razor blades passed through Corsetti's system and were excreted without harming him demonstrates that the wait-and-see approach could work, even where the ingested object was sharp. Corsetti has failed to create a triable issue of fact as to whether the course of treatment the doctors chose was medically unacceptable under the circumstances and was chosen in conscious disregard of an excessive risk to Corsetti's health. Lee Jaekaomx. McIntosh, 90 F.3d 330.
Corsetti also does not provide evidence of deliberate indifference by any particular defendant on any particular occasion to show the causal connection required by Leer. He talks in generalities at a time when specifics are needed. Corsetti makes sweeping statements such as:
"None of the defendants would do more than order a x-ray. Most of the time they refused to see me at all." Opposition, p. 1
"At no time while I was at San Quentin did they treat me for 1. vomiting blood.
2. passing blood in my stool 3. extreem (sic) pain. In fact nothing was ever given for pain." Id. at 3.
"All of the defendant (sic) saw me on more than one occasion and were indifferent to my need." Id. at 4.
These generalizations are not enough to create a triable issue of fact. Corsetti has not provided evidence of specific instances when he had a problem, alerted a specific defendant to the problem, that defendant deliberately chose to ignore the request for help, and that caused him further injury or pain.
As noted earlier, Corsetti does not dispute the accuracy of the medical records submitted by defendants and in fact directs the reader to see them as proof of his contention that he did not receive pain medications. See Opposition, p. 1. Those records show that Corsetti received plenty of attention from the medical staff at San Quentin who frequently saw him and evaluated him for his self-inflicted injuries and complaints of pain and blood. Custody records in Exhibits 2 and 18 show that Corsetti was housed at San Quentin for three periods between his ingestion of the razor blade in February 1999 and its removal in August 2000 and the medical records in Exhibits 5-8, 10, 14, 16, 17, 22, and 23 show medical staffs notes about his visits and progress. First, Corsetti was housed at San Quentin from February 16, 1999 until April 22, 1999 (except for a one-day visit to see Dr. Sogge at CMF on March 31, 1999). Corsetti was seen by San Quentin medical staff on 52 of those 67 days, was sent to an outside hospital, and was sent to CMF for a GI consultation. Second, Corsetti was housed at San Quentin from June 24, 1999 through August 23, 1999 (except for a one-week stay at CMF from July 7 — 14, 1999). Corsetti was seen by medical staff at San Quentin on 36 of those 54 days. Third, he was housed at San Quentin from March 6, 2000 through June 13, 2000. Corseffi was seen by San Quentin medical staff on 22 of those 100 days, and was hospitalized at an outside hospital for almost a week during that period.
Corsetti states that defendant Mitchell refused to see him on April 24, and 25, 2000, but it is clear from his statement he has no personal knowledge of that fact. See id. at 3. A guard called the infirmary and someone at the infirmary refused to see Corsetti, stating that they were too busy to do so. Corsetti only speculates that nurse Mitchell was the person denying him access to the infirmary. Such speculation cannot defeat a summary judgment motion. Corsetti also states that he asked Dr. Martin for pain medication on an unstated date for unstated symptoms, and that Dr. Martin refused to give it to him, but his statement is so lacking in detail that it does not raise a triable issue of fact that pain medication was medically necessary for him at that time.
Corsetti's case suffers from a failure of proof on the essential element of deliberate indifference. Even viewing the evidence in the light most favorable to Corsetti and drawing the inferences therefrom in his favor, no reasonable jury could return a verdict in favor of Corsetti and against any defendant. Defendants are entitled to summary judgment.
CONCLUSION
Defendants' motion for summary judgment is GRANTED. Judgment shall be entered in defendants' favor against plaintiff.
IT IS SO ORDERED.