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Linnie Staggs, As Administrator of the v. Doctor's Hospital of Manteca

March 28, 2012


The opinion of the court was delivered by: Morrison C. England, Jr. United States District Judge


Plaintiffs Linnie Staggs, as administrator of the Estate of Robert E. Staggs, and Melissa Staggs (collectively, "Plaintiffs") seek redress from defendant Doctor's Hospital of Manteca, Inc. ("DHM"), and a number of individual defendants regarding the medical treatment and subsequent death of Robert E. Staggs ("Decedent") while in custody at the Sierra Conservation Center ("SCC").

Presently before the Court is the Motion to Dismiss of Defendants Curtis Allen, M.D., Sharon Aungst, Edwin Bangi, M.D., Jonathan Benak, P.A., Frank Chavez, Ivan D. Clay, John Krpan, D.O., Jack St. Clair, M.D., and Tim Virga (collectively, "Defendants")*fn1 pursuant to Federal Rule of Civil Procedure 12(b)(6). (Defs.' Mot. to Dismiss Pl.'s First Am. Compl. ["MTD"], filed August 1, 2011 [ECF No. 33].) For the reasons set forth below, Defendants' motion is GRANTED.*fn2


Decedent had the Hepatitis C virus ("HCV") and a history of liver problems, including cirrhosis. In May 2009, while incarcerated at SCC, Decedent started experiencing darkened urine, skin itching and sores across his body, and also developed abdominal pain. The prison's medical staff prescribed lotions and pain killers to treat the outward symptoms of Decedent's itching and pain. Decedent's relatives, relying on outside medical advice, allegedly warned Decedent that his symptoms pointed to liver failure.

In June 2009, test results revealed that Decedent had a significant rise in alpha-feto protein ("AFP") levels, which allegedly should have been a "red flag" for Defendants, because the rise of AFP was suggestive of hepatocellular carcinoma ("HCC"), a liver cancer. However, Defendants Bangi and Krpan, healthcare providers at SCC, failed to repeat the test, which Plaintiffs contend violated the applicable standard of care. On August 30, 2009, Decedent underwent an MRI which suggested a lesion. On October 4, 2009, Decedent underwent another MRI, the results of which revealed no evidence of a tumor as determined by Defendant Russin. According to Plaintiffs, the interpretation of the second test's results was erroneous and in violation of the standard of care, or, alternatively, the medical personnel negligently conducted the test leading to the erroneous results.

On December 26, 2009, Decedent went "man-down," a condition that is designed to draw immediate attention from the custodial and medical personnel at the prison. Decedent was taken to the Sonora Regional Medical Center hospital, where he had an ultrasound and a contrast CT scan performed. The test results revealed a 5 cm lesion in the right lobe of his liver and other lesions throughout the liver. However, Decedent's treating physicians did not recheck Decedent's AFP test, but instead interpreted the test results as indicative of metastatic colon cancer. The physicians did not report the possibility of HCC, despite two previous negative occult blood tests and the rising AFP levels in the context of HCV-induced cirrhosis.

According to Plaintiffs, the physicians' actions fell below the applicable standard of care, because a metastatic disease in the setting of cirrhosis is very uncommon, whereas HCC in such a situation is much more likely.

On December 29, 2009, Decedent again went "man-down" and was taken to the Sonora Regional Medical Center. Decedent complained of a severe stabbing pain in the right upper quadrant of his body. An X-ray of Decedent's abdominal area revealed liver damage and cirrhosis.

On or about December 14-31, 2009, Defendant Krpan decided, and Defendants St. Clair and Allen approved, that Decedent should undergo a liver biopsy on January 14, 2010. Plaintiffs allege that this decision violated the standard of care because (1) where cirrhosis is present, conducting a biopsy when a lesion is suspected to be HCC creates a substantial risk that the tumor will spread along the needle track; and (2) a liver biopsy, while a safe procedure in the normal liver, is much more likely to cause bleeding in a cirrhotic liver. Two hospitals allegedly refused to perform the biopsy because of the associated risks. According to Plaintiffs, Defendants Krpan, Allen and St. Clair also violated the standard of care when they opted to do a three-pass core liver biopsy rather than a fine needle aspirate of the lesion, because the three-pass procedure allegedly created a significantly greater risk of bleeding. Plaintiffs allege that Decedent's biopsy likely caused the large drop in hemoglobin (from 12 to 7), and the bloody ascites fluid, which precipitated Decedent's subsequent complications.

On January 22, 2010, Decedent underwent biopsy at DHM. Although the medical standard required Decedent to rest for three or more hours after the operation, two correctional transportation officers, Does 1 and 2, allegedly compelled Decedent to leave his hospital bed after only 20 minutes of rest. During the ride to the prison, Decedent started feeling severe and sharp abdominal pain. Upon arrival to SCC on January 22, Decedent was placed into the Operating Housing Unit for the night and, on January 23, was moved back to his cell. Decedent's condition kept declining: his abdomen continued to swell, he could no longer urinate, started vomiting, could not sleep and was in severe pain. He unsuccessfully tried to alert the SCC correctional and medical personnel about his condition.

At around 3:15 p.m. on January 24, 2010, Decedent again went "man-down." At 5:00pm, he was transferred to the prison's Operating Housing Unit. On January 25, 2010, Decedent was taken to the San Joaquin Medical Center for emergency treatment. On February 4, 2010, he was transferred to the California Medical Facility in Vacaville where he died on February 12, 2010, of blood loss into his peritoneum. The blood loss was allegedly the result of Decedent's three-pass liver biopsy.


On a motion to dismiss for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6),*fn4 all allegations of material fact must be accepted as true and construed in the light most favorable to the nonmoving party. Cahill v. Liberty Mut. Ins. Co., 80 F.3d 336, 337-38 (9th Cir. 1996). The Court must also assume that "general allegations embrace those specific facts that are necessary to support a claim." Smith v. Pacific Props. & Dev. Corp., 358 F.3d 1097, 1106 (9th Cir. 2004). Rule 8(a)(2) "requires only 'a short and plain statement of the claim showing that the pleader is entitled to relief,' in order to 'give the defendant a fair notice of what the . . . claim is and the grounds upon which it rests.'" Bell. Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47 (1957)). A complaint attacked by a Rule 12(b)(6) motion to dismiss does not require detailed factual allegations. Id. However, "a plaintiff's obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do." Id. (internal citations ...

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