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Hoffman v. Khatri

August 3, 2010


The opinion of the court was delivered by: Hon. Dana M. Sabraw United States District Judge



Garrett Hoffman ("Plaintiff"), a prisoner currently incarcerated at Centinela State Prison ("CEN") in Imperial, California, proceeding pro se and in forma pauperis, filed this civil rights action pursuant to 42 U.S.C. § 1983 on January 27, 2009. Plaintiff alleges Defendants violated his right to be free of cruel and unusual punishment by failing to provide him adequate medical care. (Compl. at 2-4, 9.) Plaintiff seeks $500,000 in general and punitive damages. (Id. at 16.)

On July 22, 2009 and December 9, 2009, the Court granted Motions to Dismiss filed on behalf of Defendants Khatri, Cook, Ko and Lai pursuant to FED.R.CIV.P. 12(b)(6). The remaining Defendants, N. Tetteh and C. Navamani have since filed their own Motions to Dismiss pursuant to FED.R.CIV.P. 12(b)(6) [Doc. Nos. 26, 27]. Because Defendant Tettah's Motion seeks to limit Plaintiff's claims based on the specificity of his CDC 602 administrative grievance pursuant to 42 U.S.C. § 1997e(a), the Court provided Plaintiff with notice and an opportunity to include in his opposition evidence of exhaustion pursuant to 42 U.S.C. § 1997e(a) [Doc. No. 28]. See Wyatt v. Terhune, 315 F.3d 1108, 1119-20 (9th Cir. 2003). Plaintiff has filed no opposition, however. Consequently, neither Defendant Tettah nor Navamani filed a reply.

The Court has determined that Defendants' Motions are suitable for disposition upon the papers without oral argument and that no Report and Recommendation from Magistrate Judge Ruben B. Brooks is necessary. See S.D. CAL. CIVLR 7.1(d)(1), 72.3(e).


On August 5, 2007, Plaintiff was incarcerated at Centinela State Prison ("CEN"). (See Compl. at 1.) While Plaintiff was working in the Facility "D" kitchen and carrying ten sheet pans, he slipped on a puddle of water on the floor, fell, and injured his back. (Id. at 4; see also Pl.'s Ex. B [Doc. No. 1-1] at 17-18.) A prison Medical Technical Assistant ("MTA") placed Plaintiff on a backboard to transport him to the Central Health; however, Plaintiff claims he fell off the backboard twice because he was not properly strapped down by the MTA. (Compl. at 4.)

At Central Health, Plaintiff was examined in the Treatment Triage Area and claims he was prescribed aurazine and ibuprofen for his "excruciating pain," but he claims neither had any effect. (Id.) The discharge instructions signed by both Plaintiff and Defendant Tetteh dated August 5, 2007, however, indicate Dr. Tetteh specifically prescribed baclofen, motrin and ultram on that day. (See Pl.'s Ex. B at 16.) In his Physician's Orders (CDC Form 7221) also dated August 5, 2007, Dr. Tetteh further ordered an x-ray of Plaintiff's spine and relieved him from kitchen duty for 30 days. (Pl.'s Ex. B at 21.)

On August 7, 2007, Plaintiff appeared for a follow-up examination, complained to Dr. Ko of continued lower lumbar pain, and reported he "never got his meds delivered to him." (Id. at 23 "Interdisciplinary Progress Notes" CDC Form 7230.) Dr. Ko checked with the pharmacy, confirmed Plaintiff's pain medication would be delivered that day, gave Plaintiff a shot of Toradol and released him back to custody with instructions to "rest with minimal activities" and follow-up by procuring his medication on the yard med-line. (Id. at 24.)

On August 13, 2007, Plaintiff filled out a Health Care Services Request Form ("CDCR 7362"), in which he requested to see a doctor, complained of "extreme pain,' and reported his medication was "not working." (Id. at 26.) Plaintiff also claimed to have not received a "copy of [his] work lay-in" or the x-ray Dr. Tetteh ordered on August 5, 2007. (Id.) On August 15, 2007, Dr. Tetteh issued a CDCR 7393 Notification of Diagnostic Test Results, informing Plaintiff he was being scheduled for a follow-up medical appointment regarding his x-ray. (Id. at 29.) On August 17, 2007, Correctional Sergeant Villeneuve noted Plaintiff's assignment change and on August 23, 2007, Plaintiff's Outpatient Interdisciplinary Progress Notes indicate he was again examined in Central Health. At that time, Plaintiff's Medical Lay-In Order was extended for two additional days, he was prescribed additional motrin and baclofen, and authorized for a new mattress. (Id. at 31-34.) Plaintiff submitted CDCR 7362s again on September 2, 2007 and September 7, 2007--both times requesting follow-ups with a doctor, reporting severe pain, ineffective medication, need for a back brace and trouble sleeping. (Id. at 35-36.)

On September 10, 2007, Plaintiff was examined by the "yard MD," referred for a 30-day specialty physical therapy consult, and advised to continue gentle stretching. Plaintiff was further prescribed naprosyn. (Id. at 37-42.) Three days later on September 13, 2007, and again on September 26, 2007, Plaintiff submitted CDC Form 7362s requesting to see a doctor, complaining of severe back pain and ineffective medication. (Id. at 43, 44.)

On October 10, 2007, Plaintiff was examined by Dr. Aymar, who reviewed his x-ray, noted Plaintiff's continued prescriptions for naprosyn and baclofen, ordered another for Tylenol #3, continued physical therapy and authorized a 2-month follow-up regarding Plaintiff's lower back pain. (Id. at 45, 48.) Plaintiff's Interdisciplinary Progress Notes (CDC Form 7230) thereafter show Plaintiff reported to the medical clinic every day from October 10, 2007 through November 4, 2007, where he continued to report lower back pain and where he received doses of Tylenol #3 three times each day. (Id. at 49-55, 61.) On November 1, 2007, Plaintiff again requested to see a doctor. (Id. at 56.)

Plaintiff was examined again by Dr. Ko on November 5, 2007. (Id. at 59.) Dr. Ko injected Plaintiff with toradol, prescribed ibuprofen and motrin and approved Plaintiff for crutches for 2 weeks. (Id. at 59-60, 62.) Plaintiff continued to report to the clinic on November 6 through 8, 2007, where he received Tylenol #3 twice a day. On November 6, 2007, however, Plaintiff's Interdisciplinary Progress Notes indicate he returned the crutches prescribed by Dr. Ko because he found it "hard to move around." (Id. at 63.) On November 8, 2007, Plaintiff was examined by Dr. Aymar, where he reported feeling "looser" and admitted returning the crutches because he "didn't need" them. (Id. at 66.) Plaintiff was advised to "continue gentle stretching," and engaged in an "extensive discuss[ion] re: chronic nature of his LBP (lower back pain)." (Id.) Following this consult, Dr. Aymar discontinued Plaintiff's prescription for ibuprofen, and authorized "no RF (refill) of Tylenol #3 as not indicated." (Id.) Dr. Aymar did, however, prescribe naproxyn and 650 mg of Tylenol, as well as physical therapy. (Id. at 65.)

On November 9, 2007, Plaintiff requested a cane "because it was hard to use crutches." (Id. at 67, 69.) Plaintiff's medical records further indicate he was prescribed baclofen, toradol, ibuprofen, naproxen, acetominophen, and motrin for pain from November 5, 2007 through January 24, 2008 by Drs. Tetteh, Ko and Aymar. (Id. at 77.)

On November 16, 2007, Plaintiff filed CDC 602 Inmate/Parolee Appeal Log No. CEN-07-01515, "formally request[ing] a cane, to be seen by a back specialist, [and] medication consistently given to help the severe and excruciating pain in his lower back." (Pl.'s Ex. A at 2-4.) On December 12, 2007, C. Cook, a CEN Health Care Appeal Coordinator partially granted Plaintiff's appeal. (Compl. at 5; Pl.'s Ex. A at 2.) Cook "partially granted" Plaintiff's grievance insofar as he had been examined by Dr. Aymar on December 6, 2007, and his prescription for tylenol and naprosyn dated November 8, 2007 remained valid for three months. Cook further noted that Plaintiff had refused a previously physical therapy appointment because it conflicted with a family visit, but noted that Dr. Aymar had since "reordered" a physical therapy consult. (Id.) Plaintiff's request for a cane and referral to a back specialist was denied, however, because "there [wa]s no MD order for a cane or an orthopedic referral." (Id.)

Plaintiff appealed this decision to the first formal level, repeating his request for a cane, back specialist and pain medication. On February 5, 2008, his appeal was again partially granted by C. Cook, CEN's Health Care Appeals Coordinator, and Dr. Khatri, CEN's Chief Physician. (Compl. at 5-6; Pl.'s Ex. A at 8.) Again, Plaintiff's appeal was denied insofar as "there [wa]s no physician order for [Plaintiff] to possess a cane" and "no referral to a back specialist." (Pl.'s Ex. A at 8.) Cook and Khatri did review Plaintiff's medication profile, noting that "Ibuprofen, Ultram, Baclofen, Acetamin/Codeine, Toradol and Naproxen ha[d] all been prescribed and dispensed on an ongoing basis to use for pain control since 7/25/07." (Id.) Plaintiff's first level review also noted Plaintiff "received a face-to-face nurse triage on 1/18/08 with R.N. Manaig to address [his] medical concerns" and that Plaintiff had been scheduled for a "follow-up MD line" in early March where his "attending clinician w[ould] determine if further treatment is indicated." Finally, Cook and Khatri noted Plaintiff "continued to receive physical therapy services and [would] not be permitted to dictate [his] own course of treatment." (Id.)

On February 9, 2008, Plaintiff appealed to the Second Level of administrative review, again requesting a cane, referral to a back specialist and repeating complaints that his pain medication schedule was inconsistent. (Compl. at 7; Pl.'s Ex. A at 3.) On April 21, 2008, N. Barreras, the Chief Medical Officer/Health Care Manager at CEN reviewed Plaintiff's appeal and, once again, partially granted Plaintiff's requests. (Compl. at 7; P.'s Ex. A at 7.) Specifically, Dr. Barreras noted Plaintiff was examined by Defendant Dr. Navamani on February 26, 2008, who ordered a "routine orthopedic consultation." (Id.; see also Pl.'s Ex. C at 79 "CDC 7243 Physician Request for Services.") Plaintiff was advised that "routine services are scheduled chronologically and that [he] w[ould] be ducated accordingly. Any treatment recommendations from th[e] outside contracted specialist will be reviewed and considered by CDCR staff according to medical services treatment criteria." (Pl.'s Ex. A at 7.) Dr. Barreras further noted that while "Baclofen was ordered on 3/13/08 and Robaxin was ordered on 3/27/08 to use as needed for pain relief[,] [t]here continue[d] to be no medical recommendation for a cane at this time." (Id.)

On March 27, 2008, CEN's Medical Authorization Review Committee approved Plaintiff for an orthopedic consult. (Compl. at 8; Pl.'s Ex. A at 5.) On April 24, 2008, Plaintiff was examined by Dr. Lai in the Central Health orthopedic clinic. (Compl. at 8; see also Pl.'s Ex. A at 5, 10.) Dr. Lai recommended a Magnetic Resonance Imaging ("MRI"). (Id.) On May 8, 2008, Plaintiff attended a follow-up visit with his primary care provider, who submitted a referral for the MRI. (Id.. at 8, Pl.'s Ex. A at 5.) Plaintiff was examined again by an ...

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