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Jorge Robles Jauregui v. Matthew Cate

February 20, 2013




Plaintiff is a state prisoner proceeding pro se with a civil rights complaint pursuant to 42 U.S.C. § 1983. Plaintiff has alleged that defendant Hsieh was deliberately indifferent to his serious medical needs in violation of the Eighth Amendment. Presently before the court is Hsieh's motion for summary judgment. For the following reasons, Hsieh's motion for summary judgment should be granted.


All facts are undisputed unless otherwise noted. Plaintiff is a prisoner in the custody of the California Department of Corrections and Rehabilitation (CDCR) at California State Prison - Solano ("CSP - Solano"). (Defendant Hsieh's Statement of Undisputed Facts ("DUF") ¶ 1.) Defendant Hsieh is a licensed physician and surgeon at CSP - Solano. (DUF ¶ 2.) As a physician and surgeon at CSP - Solano, Hsieh's responsibilities include treating inmates at clinics and interviewing inmates at the first level of review for medical appeals. (DUF ¶ 3.) In August of 2000, plaintiff was diagnosed with acute appendicitis and received an appendectomy at Doctor's Hospital of Manteca. (DUF ¶ 4.) Surgical clips were used to clamp the mesoappendix and are currently inside plaintiff's abdominal cavity. (DUF ¶ 5.) It is standard practice to use surgical clips after various surgeries, including appendectomies. (DUF ¶ 6.) Surgical clips are routinely left in the body to close blood vessels after an organ is removed. (DUF ¶ 7.) Generally, surgical clips do not cause any pain or pose a risk to a patient's health. (DUF ¶ 8.)

Plaintiff alleges that he has suffered from chronic pain in his abdomen since the appendectomy in 2000. (DUF ¶ 9.) Plaintiff also asserts that the surgical clips are causing his abdominal pain. (DUF ¶ 10.) Plaintiff has no medical training but believes the pain will stop if the clips are removed. (DUF ¶ 12.)

Medical services are provided for inmates which are based on medical necessity and supported by outcome data as effective medical care. (DUF ¶ 14.) In the absence of available outcome data for a specific case, treatment is based on the judgment of the physician that the treatment is considered effective for the purpose intended and is supported by diagnostic information and consultations with appropriate specialists. (DUF ¶ 15.) Treatment for conditions which might otherwise be excluded may be allowed on a case by case basis. (DUF ¶ 16.)

Hsieh partially granted plaintiff's first level of review on September 19, 2008. (DUF ¶ 18.) Prior to filing the appeal, plaintiff had undergone extensive work-up at CSP -Solano regarding his abdominal pain. (DUF ¶ 19.) On March 24, 2008, plaintiff underwent an abdomen ultrasound. (DUF ¶ 20.) The ultrasound revealed fatty infiltration of the liver, but no evidence of upper abdominal pathology. (DUF ¶ 21.)

On June 18, 2008, plaintiff receive an x-ray of the abdomen. (DUF ¶ 22.) The xray revealed the existence of the surgical clips, but there was no evidence of obstruction in the abdomen. (DUF ¶ 23.) On July 15, 2008, plaintiff received a Fluro Barium enema at Queen of the Valley Hospital (QVH). (DUF ¶ 24.) The results showed a negative barium enema scan. (DUF ¶ 25.)

On July 31, 2008, plaintiff returned to QVH for a CT scan of the pelvis. (DUF ¶ 26.) The study revealed some muscosal or wall thickening in the cecum and ascending colon. (DUF ¶ 27.) A colonoscopy was recommended. (DUF ¶ 28.)

In November 2008, plaintiff received a radionuclide hepatobillary ininodiacetic acid (HIDA) scan of his gallbladder. (DUF ¶ 29.) The study was normal, but revealed the gallbladder ejection fraction was depressed and the etiology for that was uncertain. (DUF ¶ 30.) Plaintiff also received x-rays of his right rib cage and chest, which revealed no abnormalities in the ribs and only mild hyperinflation in the chest suggesting chronic obstructive pulmonary disease (COPD), but no acute process was identified. (DUF ¶ 31.)

On December 31, 2008, plaintiff returned to QVH for a colonoscopy. (DUF ¶ 32.) The exam revealed minimal inflammation of the ileocecal valve, which was biopsied. (DUF ¶ 33.) The biopsy revealed no abnormalities. (DUF ¶ 34.) The colonoscopy results were unremarkable. (DUF ¶ 35.)

On February 19, 2009, plaintiff returned to QVH for an upper endoscopy with biopsy to rule out peptic ulcer disease. (DUF ¶ 36.) The exam revealed that plaintiff had some gastritis and duodenitis. (DUF ¶ 37.) A biopsy was positive for H. pylori. (DUF ¶ 38.) Plaintiff was treated for the H. pylori. (DUF ¶ 39.)

Plaintiff alleges he became aware of the surgical clips when he saw a radiology report in February 2009. (DUF ¶ 40.) The first doctor plaintiff told about the surgical clips was Dr. Perez at CSP - Solano on June 15, 2009. (DUF ¶ 41.) Plaintiff was examined by Dr. Perez on June 15, 2009. (DUF ¶ 42.) Plaintiff's vitals were stable and his abdomen was soft. (DUF ¶ 43.) Dr. Perez wrote that plaintiff exaggerated his response to gentle palpation of his abdomen and that he suspected malingering behavior from plaintiff. (DUF ¶¶ 44 & 45.)

On August 4, 2009, plaintiff submitted an inmate/parolee appeal form which was assigned log number SOL-24-09-12870. (DUF ¶¶ 46-47.) In this appeal, plaintiff alleged that he was receiving inadequate medical treatment because multiple doctors had examined him and multiple tests had been conducted, yet the etiology of his abdominal pain was unknown. (DUF ¶

48.) Plaintiff alleged that the surgical clips caused him severe pain and needed to be removed. (DUF ¶ 49.) He further alleged that his doctors knew about the surgical clips in his stomach, but did nothing to remove them. (DUF ¶ 50.) He requested to be seen by a medical doctor, be medically unassigned from working, to see a consultant regarding the removal of the clips, for a list of his treating doctors since 2000, and for a formal investigation of the doctors who had treated him since 2000. (DUF ¶ 51.)

On August 13, 2009, plaintiff saw Dr. Collinsworth regarding his abdominal pain. (DUF ¶ 52.) Plaintiff had undergone multiple abdominal studies, but the etiology of the pain was unknown. (DUF ¶ 53.) Plaintiff requested a pain injection or to be sent to the emergency room. (DUF ¶ 54.) Dr. Collinsworth noted in his progress report that plaintiff threatened to sue him if Dr. Collinsworth did not send him to a hospital. (DUF ¶ 55.) Dr. Collinsworth wrote an order for stool sample analysis and renewed an order for Tramadol. (DUF ¶ 56.) Dr. Collinsworth also wrote a referral to send plaintiff to a GI specialist at QVH. (DUF ¶ 57.)

Hsieh examined plaintiff on August 19, 2009 for the first time. (DUF ¶ 58.) Plaintiff alleged that he was suffering from severe abdominal pain because of surgical clips left in his abdomen. (DUF ¶ 59.) Plaintiff's vitals were all within normal limits and his abdomen was soft. (DUF ¶ 60.) Hsieh noted that plaintiff did not show any signs of guarding or rebounding when he pressed on his abdomen which was inconsistent with plaintiff's subjective complaint. (DUF ¶ 61.) Hsieh reviewed plaintiff's medical records and noticed that he had undergone an extensive work-up regarding his abdominal pain. (DUF ¶ 62.) Hsieh concluded that plaintiff's abdominal exam was normal and that plaintiff's pain could be psychological. (DUF ¶ 63.) Hsieh wrote orders for lab work, including stool ...

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