Opinion
C082490
12-28-2017
JENIFER DAY, Plaintiff and Appellant, v. COUNTY OF SACRAMENTO et al., Defendants and Respondents.
NOT TO BE PUBLISHED California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115. (Super. Ct. No. 34201500178298CUCRGDS)
This is an action under title 42 United States Code section 1983 (section 1983) for damages arising out of plaintiff and appellant Jenifer Day's detention in a Sacramento County jail for driving under the influence of alcohol. At the time of her detention, Day was a nursing mother and she asserts jail staff were deliberately indifferent to her need to extract milk while in jail. She sought assistance from guards and a nurse before, ultimately, declining treatment offered by the nurse.
Day appeals from a judgment of dismissal after the trial court sustained defendants and respondents County of Sacramento and Sheriff Scott R. Jones's demurrer to her amended complaint without leave to amend. The trial court held respondents were not subject to a lawsuit under section 1983 because, to the extent they were alleged to control medical services in the jail, they were state actors performing law enforcement functions. Day contends the trial court erred in reaching this conclusion and her pleading was sufficient to state a claim under section 1983. We affirm on the basis that her complaint failed to state a cause of action against respondents under Monell v. New York City Dept. of Social Services (1978) 436 U.S. 658 (Monell). Under Monell, government officials sued in their official capacity cannot be held liable under section 1983 under a respondeat superior or vicarious liability theory. (Id. at p. 691.) Rather, liability must be based on an official policy that was the moving force behind the constitutional violation. (Id. at p. 694.)
I. BACKGROUND
Day's original complaint alleged causes of action against the County of Sacramento and the Sacramento County Sheriff's Department under section 1983 and the Eighth Amendment of the United States Constitution for deliberate indifference to her serious medical needs and deliberate indifference to a substantial risk of serious harm to her health and safety. The trial court sustained these defendants' demurrer with leave to amend. The court determined that defendants' operation of the county jail was undertaken pursuant to the sheriff's constitutional and statutory law enforcement powers, which are subject to supervision by the California Attorney General. For this reason, plaintiff's claim was actually a claim against the State of California—which is not permitted under section 1983. The court also concluded Day "failed to adequately plead the existence of any particular policy, pattern or practice implemented or followed by [the Sacramento County Sheriff's Department] which is alleged to have been the 'moving force' behind the constitutional violation she claim[ed] to have suffered."
Day filed an amended complaint against respondents County of Sacramento and Sheriff Scott R. Jones in his official capacity alleging the same causes of action but now adding that they were supported by the due process clause of the Fourteenth Amendment to the United States Constitution.
"The fourteenth amendment due process clause applies to pretrial detainee cases and not the eighth amendment. [Citation.] However, the fourteenth amendment due process rights of pretrial detainees are analogized to those of prisoners under the eighth amendment." (Cabrales v. County of Los Angeles (9th Cir. 1988) 864 F.2d 1454, 1461, fn. 2.)
Day alleged that on April 25, 2014, she was arrested for driving under the influence of alcohol and placed in a holding cell at the Sacramento County jail. While in the holding cell, Day began to leak breast milk "all over her shirt." The guards refused her request for a towel, causing her embarrassment. Day was also in pain from not extracting milk. She alleges the guards were "deliberately indifferent to her clear medical treatment [sic] and took no steps to assist her." She also claims she "could have extracted by doing so in the towel which was an easy fix."
Day spoke to a nurse, but alleges "the nurse dissuaded her from obtaining treatment by indicating that if they treated her she would have to stay in jail longer."
When Day was released, she filled out a complaint form and spoke to a sergeant. She alleges the sergeant asked her why she could not have extracted her milk into toilet paper. Day was offended and when she explained that she could not have done so, the sergeant "apologized to her concerning the conduct of the jail staff." Day is not aware of any actions being taken against the guards, the nurse, the sergeant or the individual to whom she gave her complaint form.
Day asserts that because of respondents' actions she suffered harm to her breasts, was unable to provide breast milk to her child, and had to obtain special formula for him due to his allergies. She also asserts that she "lost the emotional bonding with her child which breast feeding [sic] provides."
Day's complaint references an audit by the Office of Inspector General that discussed upcoming budget cuts for the 2009-2010 fiscal year and stated that Sacramento County Correctional Health Services (CHS) "is walking a tightrope in trying to meet" constitutional minimums in terms of inmate medical care and staffing levels had not kept pace with the growth in inmate population. A 2010 report indicated that service levels had been severely compromised by budget cuts. Day also alleged CHS was not accredited and that this was evidence it was not " 'providing constitutionally adequate and regulation-compliant health care services for inmates/detainees.' " While more recent reports are not available to the public, Day alleges the Sacramento County Board of Supervisors continued to provide inadequate funds and that the county through the sheriff's department has hidden information regarding the failure to provide adequate medical staffing.
Day alleges the "County of Sacramento and its elected officials, managers, supervisors and employees in the Sacramento County Sheriff's Department, CHC [sic], and through its Board of Supervisors maintain an illegal policy, pattern, or practice of engaging in deliberate indifference of the serious medical needs of inmates" including, but not limited to "[not] providing adequate medical staff to handle the needs of patients who are suffering emergency needs and by the Sacramento County Board of Supervisor[s] by failing to adequately provide funds for the staffing in the Sacramento County Jail." She also alleged that these entities and individuals failed to "provide instruction to its custodial employees to adequately deal with medical emergencies to individuals such as [Day] who were detained in the Sacramento County Main Jail had [sic] necessary medical care."
Respondents demurred to the amended complaint on the grounds that it was uncertain and also failed to state sufficient facts to constitute a cause of action. Respondents argued Day's claims were barred by the doctrine of sovereign immunity or at least the concept that neither respondent was a "person" as that term is used in section 1983. Respondents also contended Day failed to plead a cognizable claim under Monell. Day opposed the motion. She argued that, if necessary, she should be provided leave to amend, but did not specify any additional allegations she would add if the court granted her leave to amend. The trial court overruled the demurrer for uncertainty and sustained the demurrer for failure to state a valid cause of action without leave to amend. The court incorporated the earlier demurrer ruling. The court added that "[b]ecause the provision of medical care in jails is inextricably linked with the housing and supervision of inmates—both of which are law enforcement functions—it follows that the provision of medical care within jails is a law enforcement function as well. [¶] Because both of Day's [section] 1983 causes of action target Defendants[] for their provision of medical care, Defendants are alleged to be state actors, and neither cause of action is valid. Moreover, because Day has failed to demonstrate a reasonable likelihood she can cure her causes of action through further amendment, leave to amend is denied." The court did not expressly address whether Day's claims are precluded by Monell.
The trial court entered judgment accordingly, and Day timely appealed.
II. DISCUSSION
A. Standard of Review
We "apply federal law to determine whether a complaint pleads a cause of action under section 1983 sufficient to survive a general demurrer." (Bach v. County of Butte (1983) 147 Cal.App.3d 554, 563.)
While a complaint attacked by a motion to dismiss for failure to state a claim under rule 12(b)(6) of the Federal Rules of Civil Procedure (28 U.S.C.) does not need detailed factual allegations to survive, "a plaintiff's obligation to provide the 'grounds' of his 'entitle[ment] to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do, [citation]. Factual allegations must be enough to raise a right to relief above the speculative level." (Bell Atlantic Corp. v. Twombly (2007) 550 U.S. 544, 555, (Twombly).) This standard was further clarified in Ashcroft v. Iqbal (2009) 556 U.S. 662, 678-679, a section 1983 case: "Two working principles underlie our decision in Twombly. First, the tenet that a court must accept as true all of the allegations contained in a complaint is inapplicable to legal conclusions. Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice. [Citation.] . . . Second, only a complaint that states a plausible claim for relief survives a motion to dismiss. . . . [W]here the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged—but it has not 'show[n]'—'that the pleader is entitled to relief.' "
On appeal, a decision to dismiss under rule 12(b)(6) of the Federal Rules of Civil Procedure (28 U.S.C.), like the sustaining of a demurrer under California law, is reviewed de novo. (Manzarek v. St. Paul Fire & Marine Ins. Co. (9th Cir. 2008) 519 F.3d 1025, 1030; McCall v. PacifiCare of Cal., Inc. (2001) 25 Cal.4th 412, 415.) Similarly, a dismissal without leave to amend is reviewed for abuse of discretion under both our rules and the Federal Rules. (Blank v. Kirwan (1985) 39 Cal.3d 311, 318; Manzarek v. St. Paul Fire & Marine Ins. Co., supra, at p. 1031.) B. Whether the Sheriff Was Acting on Behalf of the State
Section 1983 provides in pertinent part: "Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State or Territory or the District of Columbia, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress." (42 U.S.C. § 1983, italics added.) Local governing bodies (including government officials sued in their official capacities) can be sued under section 1983 based on their implementation of official policies. (Monell, supra, 436 U.S. at p. 690.) Conversely, states and state officers sued in their official capacity are not considered persons under section 1983 and cannot be sued in such an action. (Venegas v. County of Los Angeles (2004) 32 Cal.4th 820, 829 (Venegas).) Venegas also explained that states and state officers sued in their official capacity "are immune from liability under the statute by virtue of the Eleventh Amendment and the doctrine of sovereign immunity." (Ibid.) The United States Supreme Court, however, has indicated that the proper inquiry in a state court proceeding is solely whether the defendant is a person under section 1983 because the Eleventh Amendment does not apply in state courts. (Will v. Michigan Dept. of State Police (1989) 491 U.S. 58, 63-64; see also Pierce v. San Mateo County Sheriff's Dept. (2014) 232 Cal.App.4th 995, 1019 ["Venegas is significant and binding on lower California courts with respect to its holding that county sheriffs are arms of the state while performing state law enforcement activities for purposes of damages liability under [section] 1983. Its immunity dicta, however, should be left to fade into history"].) Either way, respondents assert Day's claims are barred because the sheriff acts on behalf of the state in operating county jails.
The determination of whether a particular government official is acting as a policymaker for the state or for the county requires an analysis of state law. (McMillian v. Monroe County (1997) 520 U.S. 781, 786 (McMillian).) It is also "a question of law depending primarily upon the definitions of the official's functions contained in state constitutional, statutory, and decisional law." (County of Los Angeles v. Superior Court (1998) 68 Cal.App.4th 1166, 1171 (Peters).) "This determination does not require an 'all-or-nothing' categorization applying to every type of conduct in which the official may engage. Rather, the issue is whether the official is a local policymaker with regard to the particular action alleged to have deprived the plaintiff of civil rights." (Id. at p. 1172.)
A number of California cases have addressed whether a local government official was acting on behalf of the state or a county for purposes of a section 1983 action. In Pitts v. County of Kern (1998) 17 Cal.4th 340 (Pitts), a group of plaintiffs whose convictions for sex offenses against children had been reversed for prosecutorial misconduct sued the county, the district attorney and other county officials involved in the prosecution. (Id. at pp. 345-346.) The plaintiffs claimed "civil rights violations based on alleged misconduct during the criminal prosecution." (Id. at p. 346.) Our Supreme Court held that "a district attorney is a state official when preparing to prosecute and when prosecuting criminal violations of state law," as well as when he or she is "training and developing policy in these areas." (Id. at pp. 360, 362.) The Supreme Court noted, however, that its "conclusion as to which entity the district attorney represents might differ were plaintiffs challenging a district attorney's alleged action or inaction related to hiring or firing an employee, workplace safety conditions, procuring office equipment, or some other administrative function arguably unrelated to the prosecution of state criminal law violations." (Id. at p. 363.)
In Peters, the plaintiff alleged that after she "posted bail, the Sheriff of Los Angeles County and his deputies nevertheless detained [her] in the Los Angeles County jail for an additional 10 days, in reliance on a warrant which they reasonably should have known did not relate to her." (Peters, supra, 68 Cal.App.4th at p. 1168.) The plaintiff sued the County of Los Angeles under section 1983, alleging that the sheriff had "an official policy of detaining, arresting, imprisoning, searching and harassing persons based on warrants for the arrest of other people; of failing to properly investigate claims of persons that they are not the person named in the warrant; and of failing to properly train, supervise, control, and discipline officers to prevent violations of the rights of persons wrongly arrested." (Peters, supra, at p. 1169.) The appellate court, applying McMillian and Pitts, held that "in establishing policies for the release of persons from a county jail, a sheriff acts as a state official, not a policymaker for the county." (Id. at p. 1174.) The court noted that article V, section 13 of the California Constitution and Government Code section 12560, gave the state Attorney General supervisory authority over sheriffs. (Peters, supra, at pp. 1174-1175.) In addition to a sheriff's duties to enforce criminal law under Government Code sections 26600 (sheriffs' duty to preserve the peace through crime prevention projects), 26601 (sheriffs' authority to arrest criminal offenders), and 26602 (sheriffs' duty to prevent breaches of peace and investigate public offenses), the court cited the requirement in Government Code section 26605 that a sheriff " 'take charge of and . . . keep the county jail and the prisoners in it.' " (Peters, supra, at p. 1175.) The court stated that, in contrast, Government Code section 25303 provides that the county board of supervisors " 'shall not obstruct the investigative function of the sheriff of the county nor shall it obstruct the investigative and prosecutorial function of the district attorney of a county. [¶] Nothing contained herein shall be construed to limit the budgetary authority of the board of supervisors over the district attorney or sheriff.' " (Peters, supra, at p. 1175, italics omitted.) The court explained that "the sheriff operates the jail pursuant to the sheriff's constitutional and statutory law enforcement powers, and not as a policymaker for the board of supervisors, which has no direct control over the sheriff in this regard." (Id. at p. 1177.) The court emphasized that "[t]he function involved in this case is determining whether to release a person who may be subject to arrest on an outstanding warrant. This is a law enforcement function." (Ibid.) It held that "in setting policies concerning release of persons from the Los Angeles County Jail, the Los Angeles County Sheriff acts as a state officer performing state law enforcement duties, and not as a policymaker on behalf of the County of Los Angeles." (Id. at p. 1178.)
In Venegas, supra, 32 Cal.4th 820, the plaintiffs filed an action under section 1983 against Los Angeles County, its sheriff's department, and the sheriff, among others, for unreasonable search and seizure during a criminal investigation. (Venegas, supra, at pp. 827-828.) The county on behalf of its sheriff's department and sheriff claimed "California sheriffs conducting criminal investigations are acting on behalf of the state when performing law enforcement activities," and therefore, "as a state agent, the sheriff enjoys the state's immunity from prosecution for the asserted violations of section 1983." (Id. at p. 828.) The California Supreme Court "conclude[d] that, following the analysis prescribed in McMillian, Pitts and Peters, California sheriffs act as state officers while performing state law enforcement duties such as investigating possible criminal activity." (Id. at p. 839.)
Day begins her arguments by asking us to urge the California Supreme Court to reconsider its decision in Venegas. We recognize that federal courts have largely refused to follow Venegas. (See, e.g., Smith v. County of Los Angeles (C.D. Cal. 2008) 535 F.Supp.2d 1033, 1038 ["[T]he Court urges the California Supreme Court to reconsider Venegas to conform with the federal standard"].) But understanding whether a government official is representing the state or the county in a particular area is dependent upon an analysis of state law, and we are bound to follow Venegas. (McMillian v. Monroe County, supra, 520 U.S. at p. 786; Auto Equity Sales, Inc. v. Superior Court (1962) 57 Cal.2d 450, 455.) For this reason, Day's emphasis on contrary federal authorities is unavailing.
State courts have concurrent jurisdiction with federal courts to entertain suits brought under section 1983. (Peters, supra, 68 Cal.App.4th at p. 1170.)
The relevant constitutional, statutory and decisional law that the parties rely on has already been analyzed in the authorities cited above. For instance, article V, section 13 of the California Constitution provides that "[t]he Attorney General shall have direct supervision over every . . . sheriff . . . in all matters pertaining to the duties of their respective offices." (Italics added.) Significantly, one of those duties is to "take charge of and be the sole and exclusive authority to keep the county jail and the prisoners in it." (Gov. Code, § 26605.) This offers support for respondents' theory that to the extent a sheriff is alleged to control medical services within a jail, he is acting on behalf of the state. Indeed, Peters explained that "the sheriff operates the jail pursuant to the sheriff's constitutional and statutory law enforcement powers, and not as a policymaker for the board of supervisors, which has no direct control over the sheriff in this regard." (Peters, supra, 68 Cal.App.4th at p. 1177.) Nonetheless, as Day observes, other cases concluding that a sheriff acted on behalf of the state may be distinguishable on the basis that they involved, in contrast to providing medical care, actions that more clearly involve law enforcement. (See, e.g., Venegas, supra, 32 Cal.4th at p. 827 [criminal investigation]; Peters, supra, at p. 1168 [release of persons from jail].) In Venegas, our Supreme Court held that "California sheriffs act as state officers while performing state law enforcement duties such as investigating possible criminal activity." (Venegas, supra, at p. 839.) The constitutional and statutory support for the conclusion a sheriff acts as a state official is not as explicit for claims involving non-investigatory functions-like providing medical care for people in jail. Both article V, section 13 of the California Constitution and Government Code section 12560 add that the Attorney General may require sheriffs to provide reports regarding the investigation, detection and punishment of crime in their respective jurisdictions. And "[t]he board of supervisors shall not obstruct the investigative function of the sheriff of the county." (Gov. Code, § 25303.) It is possible that where the sheriff's investigative functions are not implicated, other factors such as the fact that sheriffs are elected by county voters would require a sheriff to be treated as a local policy maker. (See Peters, supra, at p. 1176 [explaining "various other provisions could be cited in support of the argument that the sheriff should be considered a county official for the purpose of the county's liability under section 1983"]; see also Venegas, supra, at p. 838 ["Pitts and Peters are clearly confined, respectively, to situations in which district attorneys and sheriffs are actually engaged in performing law enforcement duties, such as investigating and prosecuting crime, or training staff and developing policy involving such matters"].) Nonetheless, courts have defined the sheriff's law enforcement functions broadly.
In Bougere v. County of Los Angeles (2006) 141 Cal.App.4th 237, the court of appeal concluded that a sheriff was carrying out a law enforcement function on behalf of the state "in setting and implementing policies and procedures pertaining to the placement of inmates at the county jail." (Id. at p. 241.) "The Sheriff's duties to preserve the peace (Gov.Code, § 26600) and to 'prevent and suppress any affrays, breaches of the peace, riots, and insurrections' (Gov.Code, § 26602) are law enforcement functions and do not lose this status simply because they are carried out within the confines of a jail, which the Sheriff is charged with operating (Gov.Code, § 26605). Inmates at the county jail typically consist of those persons who have been arrested for committing state crimes and are awaiting trial, persons who have already been sentenced, and those detained as witnesses or under civil process or contempt orders. We cannot find that a sheriff's policies relating to the safekeeping of such persons is merely an 'administrative function arguably unrelated to the prosecution of state criminal law violations.' " (Id. at p. 247.) Likewise, here, the trial court held that "[b]ecause the provision of medical care in jails is inextricably linked with the housing and supervision of inmates-both of which are law enforcement functions-it follows that the provision of medical care within jails is a law enforcement function as well." Indeed, it does not appear that Day is challenging the sheriff's "alleged action or inaction related to hiring or firing an employee, workplace safety conditions, procuring office equipment, or some other administrative function arguably unrelated to" his law enforcement functions. (Pitts, supra, 17 Cal.4th at p. 363.)
Day disagrees with the conclusion that providing medical care in the jail is a law enforcement function. Even if she is correct in the abstract, in this case she alleges liability under a failure to train theory as well as a failure to provide adequate staffing or funding. The particulars of her two theories control our analysis of whether they relate to the sheriff's law enforcement functions. Indeed, analyzing the policies that Day alleges deprived her of civil rights reveals that Day has failed to plead a cognizable claim under Monell as to any of her theories of liability. We thus affirm on this basis. C. Monell
Her reliance on Mendoza v. County of Tulare (1982) 128 Cal.App.3d 403 does not persuade because the court did not address whether each defendant qualified as a "person" under section 1983. " ' "It is axiomatic that cases are not authority for propositions not considered." ' " (McWilliams v. City of Long Beach (2013) 56 Cal.4th 613, 626.)
Municipalities and government officials sued in their official capacity cannot be held liable under section 1983 under a respondeat superior or vicarious liability theory. (Monell, supra, 436 U.S. at p. 691.) In other words, they may not be sued for an injury inflicted solely by an employee or agent. (Id. at p. 694.) "Instead, it is when execution of a government's policy or custom, whether made by its lawmakers or by those whose edicts or acts may fairly be said to represent official policy, inflicts the injury that the government as an entity is responsible under [section] 1983." (Id. at p. 694.) "In addition, there must be shown to be an affirmative link between the policy or custom and the particular constitutional violation alleged. [Citation.] The alleged policy or custom must be the 'moving force' of the constitutional violations in order to establish liability under section 1983." (Cabrales v. County of Los Angeles, supra, 864 F.2d at p. 1460.) Day contends she satisfied Monell by pleading a policy, pattern or practice of inadequate staffing in the jail by defendants, failure to provide adequate funding by the board of supervisors, and failure to train officers to deal with medical emergencies such as hers. We address these theories next.
1. Failure to Train
"[T]he inadequacy of [officer] training may serve as the basis for [section] 1983 liability only where the failure to train amounts to deliberate indifference to the rights of persons with whom the [officers] come into contact." (City of Canton v. Harris (1989) 489 U.S. 378, 388.) To state a claim for insufficient training, plaintiff must allege facts sufficient to show that respondents " 'disregarded the known or obvious consequence that a particular omission in their training program would cause [municipal] employees to violate citizens' constitutional rights.' " (Flores v. County of Los Angeles (9th Cir. 2014) 758 F.3d 1154, 1159.)
With respect to the failure to train, Day alleges only that respondents did not "provide instruction to its custodial employees to adequately deal with medical emergencies to individuals such as [Day] who were detained in the Sacramento County Main Jail." This conclusory allegation, without more, is insufficient to state a claim for failure to train. (See Flores v. County of Los Angeles, supra, 758 F.3d at 1159 ["A 'pattern of similar constitutional violations by untrained employees is ordinarily necessary to demonstrate deliberate indifference for purposes of failure to train,' though there exists a 'narrow range of circumstances [in which] a pattern of similar violations might not be necessary to show deliberate indifference' "].) Day infers from a single incident that the County has an inadequate training program for its employees with regard to the needs of nursing mothers, yet she does not explain the training program or its purported inadequacy in any meaningful way. Without more facts, we cannot conclude that respondents had an inadequate training program that caused Day's rights to be violated. For all that is alleged, respondents could have a perfectly sound training program for its employees, which was not followed in the instant case. In short, Day only offers "[t]hreadbare recitals of the elements . . . supported by mere conclusory statements." (Ashcroft v. Iqbal, supra, 556 U.S. at p. 678.) This factual allegation does "not permit the court to infer more than the mere possibility of misconduct." (Id. at p. 679.) Day thus failed to state a claim under a failure to train theory.
2. Inadequate Staffing and Funding
Day's pleadings regarding inadequate staffing and funding move beyond the merely conclusory, but they still fail to state a claim. The Eighth Amendment of the United States Constitution protects prison inmates from actions amounting to a "deliberate indifference" to their serious medical needs or a substantial risk of serious harm. (Farmer v. Brennan (1994) 511 U.S. 825, 828; Estelle v. Gamble (1976) 429 U.S. 97, 104.) Understaffing at jail facilities resulting in inadequate care may theoretically support a theory of deliberate indifference to serious medical needs. (See Cabrales v. County of Los Angeles, supra, 864 F.2d at p. 1461 ["The affidavits relied on by the district court adequately demonstrated that the medical understaffing at the jail directly contributed to the decedent's suicide"]; Villareal v. County of Monterey (N.D. Cal. 2017) 254 F.Supp.3d 1168, at pp. 1183-1186 [concluding plaintiffs adequately pled causes of action against county and sheriff based on policy of unconstitutionally denying medical care at jail].) But the most obvious problem with Day's theory is one of causation. "[I]t is not enough for a [section] 1983 plaintiff merely to identify conduct properly attributable to the municipality. The plaintiff must also demonstrate that, through its deliberate conduct, the municipality was the 'moving force' behind the injury alleged. That is, a plaintiff must show that the municipal action was taken with the requisite degree of culpability and must demonstrate a direct causal link between the municipal action and the deprivation of federal rights." (Board of County Comm'rs. of Bryan County v. Brown (1997) 520 U.S. 397, 404.) "Where a plaintiff claims that the municipality has not directly inflicted an injury, but nonetheless has caused an employee to do so, rigorous standards of culpability and causation must be applied to ensure that the municipality is not held liable solely for the actions of its employee." (Id. at p. 405.)
Day does not analyze her claims or her theories of liabilities separately. She also focuses most of her argument on her claim of deliberate indifference to serious medical needs. We conclude her claim of deliberate indifference to a substantial risk of serious harm should be analyzed with her claim of deliberate indifference to serious medical needs. (See, e.g., Villareal v. County of Monterey, supra, 254 F.Supp.3d at pp. 1180-1181 [discussing deliberate indifference to serious medical needs and deliberate indifference to substantial risk of serious harm together].) Regardless, Monell applies to both claims. --------
To the extent Day alleges the guards did nothing to assist her, nothing in the complaint suggests this had anything to do with the respondents' alleged policy or custom of inadequate staffing or funding. The guards were present. Right or wrong, they simply refused to provide her with a towel in the holding cell. Nor do the nurse's actions support this theory of liability. Day alleges "the nurse dissuaded her from obtaining treatment by indicating that if they treated her she would have to stay in jail longer." Day alleges "[i]t was apparent by [the nurse's] statement . . . that there was inadequate medical staff to deal with [Day's] medical emergency." We are not persuaded this is the case. The nurse's statement does not indicate there would be a delay in receiving treatment. Rather, it seems to indicate that if the nurse treated her, then Day would have to stay in jail longer. Either way, delay alone is not enough to state a claim of deliberate medical indifference. (Shapley v. Nevada Bd. of Prison Comm'rs. (9th Cir. 1985) 766 F.2d 404, 407.) The delay must cause harm. (Wood v. Housewright (9th Cir. 1990) 900 F.2d 1332, 1335.) Here, no delay in treatment actually occurred because Day declined treatment from the nurse. Thus, Day cannot establish what harm would have arisen from a hypothetical delay and does not sufficiently allege that a policy or custom of understaffing or underfunding was the moving force behind any alleged constitutional violation.
Day's refusal of care further undercuts her claim that she had a serious medical need. (Cf. Pinkston v. Madry (7th Cir. 2006) 440 F.3d 879, 892 [affirming judgment in favor of prison guards on inmate's claim of deliberate indifference where inmate delayed seeking treatment].) "Because society does not expect that prisoners will have unqualified access to health care, deliberate indifference to medical needs amounts to an Eighth Amendment violation only if those needs are 'serious.' " (Hudson v. McMillian (1992) 503 U.S. 1, 9.) "A 'serious' medical need exists if the failure to treat a prisoner's condition could result in further significant injury or the 'unnecessary and wanton infliction of pain.' [Citation.] Either result is not the type of 'routine discomfort [that] is "part of the penalty that criminal offenders pay for their offenses against society." ' [Citation.] The existence of an injury that a reasonable doctor or patient would find important and worthy of comment or treatment; the presence of a medical condition that significantly affects an individual's daily activities; or the existence of chronic and substantial pain are examples of indications that a prisoner has a 'serious' need for medical treatment." (McGuckin v. Smith (9th Cir. 1992) 974 F.2d 1050, 1059-1160, overruled on other grounds in WMX Technologies, Inc. v. Miller (9th Cir. 1997) 104 F.3d 1133, 1136.) The fact that Day refused treatment from the nurse suggests that even Day did not consider her alleged injuries serious enough that failure to treat them would rise to the level of inflicting further significant injury or unnecessary and wanton pain under the Eighth Amendment. (Pinkston v. Madry, supra, at p. 892.) Additionally, medical personnel are not deliberately indifferent to a prisoner's serious medical needs when the prisoner refuses to accept medical treatment. (See, e.g., Richard v. Bokor (10th Cir. 2010) 379 Fed.Appx. 719, 722 [prisoner failed to state a claim for deliberate indifference where he thwarted medical personnel's efforts by disrupting the medical visits and refusing the offered treatment]; Zatko v. Rowland (N.D. Cal. 1993) 835 F.Supp. 1174, 1179 [dismissing deliberate indifference claim as "factually frivolous" where plaintiff's internal prison records filed in another action showed that he had refused to participate in psychiatric evaluations].) Even construed in the light most favorable to her, the facts pled by Day do not state a cause of action against either respondent under Monell.
Because Day does not identify any facts she can add by way of amendment to state a valid cause of action or even attempt to satisfy her burden on appeal on this point, we conclude the trial court properly dismissed her claims with prejudice. (HFH, Ltd. v. Superior Court of Los Angeles (1975) 15 Cal.3d 508, 513, fn. 3.)
III. DISPOSITION
The judgment is affirmed. The County of Sacramento and Sheriff Scott R. Jones shall recover their costs on appeal. (Cal. Rules of Court, rule 8.278(a)(1) & (2).)
/S/_________
RENNER, J. We concur: /S/_________
NICHOLSON, Acting P. J. /S/_________
HOCH, J.