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Ayala v. Andreasen

August 26, 2008

MANUEL AYALA, PLAINTIFF,
v.
ANDREASEN, ET AL., DEFENDANTS.



The opinion of the court was delivered by: Craig M. Kellison United States Magistrate Judge

FINDINGS AND RECOMMENDATIONS

Plaintiff, a state prisoner proceeding pro se, brings this civil rights action pursuant to 42 U.S.C. § 1983. Pending before the court is defendants' motion for summary judgment (Doc. 106). Plaintiff has not filed an opposition.

I. BACKGROUND

A. Plaintiff's Allegations

This action proceeds on plaintiff's fourth amended complaint, filed on June 6, 2006, as against defendants Andreasen, Bick, Enriquez, Grannis, Sullwold, Gutierrez, and Sawker.*fn1 Plaintiff claims that, in July 1999, he underwent surgery to place a shunt in his chest. Plaintiff asserts that a piece of this shunt broke off and lodged in or near plaintiff's heart. He states that a medical doctor attempted unsuccessfully to remove the broken piece from plaintiff's body. Plaintiff was then placed under the care of a specialist from the University of California, San Francisco. Plaintiff claims that this specialist prescribed a specific course of treatment and that defendants have interfered with this treatment for budgetary reasons.

In particular, plaintiff asserts that defendant Andreasen informed him that he would not be following the specialist's prescribed course of treatment, which included additional surgery to remove the broken shunt. Plaintiff states that, after presenting an inmate grievance concerning the issue, defendant Bick also refused to follow the specialist's recommendations. Plaintiff alleges that the remaining defendants also "acquiesced" in the above-described interference with the specialist's course of treatment.

B. Defendants' Evidence

In support of their motion for summary judgment, defendants submit their own declarations as well as plaintiff's responses to their interrogatories. Through these documents, defendants respond to plaintiff's specific factual claims against each of them.

1. Andreasen

In his responses to defendant Andreasen's interrogatories, plaintiff responds as follows when asked to identify the constitutional rights this defendant violated:

Defendant violated Plaintiff's Eighth & Fourteenth Amendment rights. Plaintiff had a right to have access to medical care and to be free from cruel and unusual punishment which Defendant violated when he intentionally interferred [sic] with, delayed, and denied Plaintiff medical attention to his serious medical needs. Defendant violated Plaintiff's right to Due Process and Equal Protection under the law when defendant refused to address Plaintiff's many requests and appeals for medical care.

As to the specifics of this case, plaintiff stated in his responses that, from July through November 1999, defendant Andreasen was aware that plaintiff received a catheter that was ineffective but could not be removed. Plaintiff states that, despite an October 1999 report by Dr. P. Leoni recommending immediate surgical intervention, "Defendant Dr. Andreasen took no action." He also states that, between November 1999 and March 2001, defendant Andreasen ignored several requests for medical assessment and treatment of his chest pain. Plaintiff states that, between March 2001 and November 2001 additional x-rays were taken and forwarded to defendant Andreasen, but that "he did not institute a medical authorization review or health care review committee to authorize surgical intervention for plaintiff's life-threatening condition." Plaintiff states that defendant Andreasen also ignored a January 2002 recommendation by Dr. Timothy S. Hall for "surgical intervention."

In his declaration, defendant Andreasen states that, at the time relevant to plaintiff's complaint, he was the Chief Medical Officer of Building 1 at the California Medical Facility ("CMF"), but was not plaintiff's primary care physician. He states that his involvement with plaintiff's case included review of inmate grievances or requests for accommodations pursuant to the Americans with Disabilities Act ("ADA"). Defendant Andreasen states that he was also responsible for consultations with plaintiff's primary care physicians and referrals to outside specialists as needed. As to plaintiff's medical problems, defendant Andreasen states:

I am familiar with plaintiff Manuel Ayala as Mr. Ayala was an inmate at CMF for several years. Mr. Ayala was a dialysis patient while at CMF, and received treatment from doctors and other health care professionals (nurses, medical technicians, etc.) who specifically worked with dialysis patients. he was also on the kidney transplant list at UCSF while he was incarcerated at CMF. Mr. Ayala was assigned to Housing Unit 1 . . . while at CMF. He was not diagnosed with HIV while at CMF.

My Ayala informed me when I first met him that a catheter tip was lodged in his heart and I confirmed that a fragment of something consistent with a catheter tip was lodges in his right ventricle. I agreed to refer Mr. Ayala to a cardiac surgeon and referred him to Dr. Klingman. I later learned that Dr. Klingman was the surgeon who previously operated on Mr. Ayala (when the catheter tip broke off and lodged in his right ventricle) and, after Mr. Ayala requested a different surgeon, I referred Mr. Ayala to Dr. Timothy Hall at the University of California, San Francisco (UCSF) Medical Center.

I authorized several "temporary transfers" of Mr. Ayala for treatment with several UCSF doctors, including Dr. Hall, Dr. Sobol, and Dr. Anastossou. UCSF doctors attempted to remove the catheter fragment on October 4, 2002, through a percutaneous transvenous approach but were unsuccessful. Doctors at UCSF recommended that plaintiff undergo an open heart surgery when the transvenous approach did not work. Because the open heart procedure requires cardiopulmonary bypass and includes a 15% mortality rate, I encouraged Mr. Ayala to talk with his family before agreeing to this procedure.

My Ayala initially declined to undergo open heart surgery after our meeting. We discussed this issue further between 2002 and 2005 and, after declining to undergo the surgery one more time, Mr. Ayala finally decided to undergo surgery to remove the catheter fragment.

Mr. Ayala ultimately underwent open heart surgery on September 12, 2005, at UCSF. The surgery was deemed a success as the catheter fragment was extracted.

Defendant Andreasen states that, due to the poor prognosis for plaintiff's kidneys, obtaining a transplant was the first priority. He adds that, for this reason, he did not believe open heart surgery to remove the catheter fragment was "absolutely necessary for Mr. Ayala when he was examined at UCSF between September 2002 through February 2003." However, he states that he did not attempt to discourage plaintiff from undergoing the surgery.

2. Bick

As to defendant Bick, plaintiff's statements concerning the factual bases for liability are essentially the same as those relating to defendant Andreasen. Plaintiff adds:

. . . For six (6) years Defendant Dr. Bick and other Defendants continued on a wholly ineffectual and repetitive course of action whereby Plaintiff would be examined by specialists who would recommend surgery only to have Defendant Dr. Bick and other Defendants re-refer Plaintiff to other cardiothoracic surgeons who would in turn make the same recommendations. This continued until September 12, 2005, when Plaintiff underwent major invasive catheter removal surgery that included a sternotomy, heart/lung bypass assist, clavicle resection, and reconstruction of Plaintiff's subclavian, innonimate, and jugular veins -- a surgery that may not have been necessary if it had not been so needlessly long-delayed.

Plaintiff also states that defendant Bick failed to respond to a "missive" he sent on November 2, 2001 "which Plaintiff had sent to apprise him of his extreme chest pain and request his assistance in directing medical officials to assess and treat it."

Defendant Bick was the Chief Medical Officer for Building 4 at CMF. At the times relevant to this case, Building 4 housed inmates with HIV. Because plaintiff did not have HIV infection, he was not housed in Building 4 and, therefore, was not under defendant Bick's direct care. Defendant Bick states in his declaration that he became aware of plaintiff cardiac surgery in 1999 incident to his review of plaintiff's request for accommodation under the ADA. Defendant Bick was not plaintiff's primary care physician and, for this reason, had defendant Bick received any correspondence from plaintiff regarding his health care, he would have forwarded it to plaintiff's primary doctor. Defendant Bick states that he was never directly involved with plaintiff's medical care and that he "had no role in reviewing, approving, or delaying any requests for patients to be seen by a ...


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