United States District Court, E.D. California
MEMORANDUM AND ORDER
MORRISON C. ENGLAND, Jr., Chief District Judge.
Through this consolidated proceeding, Plaintiff Sandipkumar Tandel ("Plaintiff") alleges that his civil rights were violated during two separate detentions at the Sacramento County Main Jail ("the Jail") from February 7, 2007 to May 20, 2007, and from March 23, 2010 to May 10, 2010. Presently before the Court is a Motion for Summary Judgment brought on behalf of all remaining named Defendants in this action except for Defendant Chris Smith, M.D., whose counsel filed a separate Motion for Summary Judgment on his behalf. Moving Defendants here, the County of Sacramento, Sheriff John McGuiness, Ann Marie Boylan, Michael Sotak, M.D., Susan Kroner, RN, Agnes R. Felicano, NP, Glayol Sahba, M.D., Richard Bauer, M.D., and Deputies Stephanie Jacoby, Mark Medeiros, and Mark Iwasa, allege that they are entitled to summary judgment as to Plaintiff's claims due to the absence of any triable issues of fact.
Plaintiff's first and second causes of action allege violations of the Fourteenth Amendment to the United States Constitution, against both supervisory and medical defendants, pursuant to 42 U.S.C. § 1983. Then, in his third through fifth claims, Plaintiff asserts so-called Monell claims against the County of Sacramento alleging liability for 1) its custom and practice in permitting the alleged lapses in denying or delaying Plaintiff's medical care to occur; 2) its failure to properly train custodial staff; and 3) its failure to adequately staff and supervise custody and medical personnel. Plaintiff thereafter, in his seventh claim, goes on to allege violations of both the Rehabilitation Act of 1973, 29 U.S.C. § 701, et seq. ("Rehabilitation Act") and Title II of the Americans with Disabilities Act, 42 U.S.C. § 12101, et seq. ("ADA"). Finally, Plaintiff makes several claims sounding in state law, including a claim for violation of California Government Code § 845.6. As set forth below, Defendants' Motion for Summary Judgment as to those claims is GRANTED in part and DENIED in part.
This is a complicated case involving numerous claims, multiple defendants, a rare disease, and two separate periods of incarceration.
On February 7, 2007, Plaintiff was arrested and incarcerated at the Sacramento County Main Jail ("the Jail") as a pre-trial detainee. Thereafter, on April 27, 2007, he suffered a head injury as a result of an altercation with two other inmates. Defendants' Statement of Undisputed Fact ("SUF"), No. 56. In addition to a laceration above his right eye, Plaintiff complained of a slight headache but no dizziness, nausea, or vomiting. Id. at Nos. 63-65. Plaintiff was sent to the Doctor's Center in Sacramento, an urgent care facility, where his wound was cleaned and sutured before a tetanus vaccination was administered. Id. at No. 59. Plaintiff was thereafter sent back to the Jail with instructions to remove the sutures in five days, and to keep the wound clean in the meantime.
The day after returning from urgent care, Plaintiff complained of ongoing headaches when he was evaluated by a nurse. Two days later, on April 30, 2007, Plaintiff continued to complain of headaches when evaluated by Dr. Asa Hambly. Defendants contend, however, that Plaintiff made no complaints regarding the need for ongoing medical care during the following two weeks, from May 1, 2007 to May 12, 2007. See id. at No. 70. According to Defendants, during this period, Plaintiff failed to sign up for so-called "Nurses' Sick Call ("NSC"), the primary vehicle through which inmates could seek care for most non-urgent matters. Id. at No. 12. If Plaintiff had signed up on the NSC list, he would have been seen the following day by either a Registered Nurse or Nurse Practitioner, and potentially referred to a physician for further evaluation thereafter. Id. at No. 13. Defendants further allege that Plaintiff did not seek walk-in care, contact custody personnel about his medical issues through his cell intercom or during the hourly cells checks or security count, or take advantage of any other opportunity to inform custody or medical staff of any medical issue. See id. at No. 71. Plaintiff takes issue with Defendants' assertions in that regard, claiming that between May 5, 2007 and May 16, 2007, he repeatedly attempted to complain, by use of his call button, about continuing severe head pain, inability to sleep, and the need for prescribed ointment and clean water to keep his wound disinfected. Pl.'s Ex. 2 at ¶¶ 121-25; Ex. 25 at 66:22-67:17. Although unit housing logs were supposed to document the use of a call button for a medical emergency (Defs.' Ex. 32 at ¶ 16), the logs for the unit where Plaintiff was housed were silent as to these alleged complaints until May 13, 2013. See Defs.' Ex. 3.
On May 13, 2007, after alerting custodial staff during an hourly cell check that he was having head pain, Plaintiff was seen by registered nurse Henry Carl. SUF at Nos. 75, 77. Plaintiff reported headaches for the past four days, but did not complain about his vision or pain involving his eyes. Id. at No. 13. Plaintiff's vital signs were normal, his speech was clear, and Carl's examination showed his pupils were equal and reactive to light, with full and smooth extraocular eye movements. Id. at No. 78. Nurse Carl consulted with Defendant Chris Smith, M.D., over the phone about Plaintiff's headaches and the need to remove his sutures. Dr. Smith ordered removal of Plaintiff's sutures and prescribed 800 milligrams of Motrin, to be taken twice a day for a period of fourteen days, to alleviate Plaintiff's headaches. Consistent with Dr. Smith's orders, Nurse Carl removed Plaintiff's sutures that same day. Id. at Nos. 79-80.
On or about May 14, 2007, Plaintiff again sought medical attention on a walk-in basis, complaining of headaches, sensitivity to light, and a nasal drip. Id. at No. 82. Plaintiff was examined by a nurse, Jim Austin, who found no evidence of ocular or neurological involvement, and Plaintiff was returned to his cell. Id. at Nos. 83-84. Plaintiff's cellmate, Jose Govea, nonetheless subsequently reported that Plaintiff had been exhibiting symptoms of gait impairment and neurological deficits by May 16th, stating as follows:
"Tandel was always stumbling as he walked, but the guards didn't take notice. I told the guards that Tandel needed medicine, but the guards said the doctor will see him. Other inmates told the guard that he needed medical attention, but I don't know if they gave him medicine or anything!"
Pl.'s Ex. 8.
On May 17, 2007, Plaintiff collapsed while taking a shower when he lost control of his legs. SUF at No. 93. Plaintiff claims he yelled for help for 30 minutes or more (Pl.'s Ex. 25 at129:1-14) and eventually, since he was unable to get up, had to put on his underwear, pants and shirt by "rolling around the floor." Id. at 125:17-21. Deputy Pablito Gaddis eventually responded to Plaintiff's request for help, but allegedly failed to use the radio to properly alert medical and custody staff of the emergency. According to Plaintiff, in violation of Jail policy, Gaddis also failed to file an incident or casualty report. Gaddis and another deputy were admonished for failing to properly respond to, report, and log the shower incident, and Gaddis was formally disciplined for his handling and reporting of the incident. Pl.'s Ex. 35; Ex. 17 at 126:5-15, 130:1-131:5.
After Plaintiff was taken by wheelchair for evaluation, he told Nurse Carl about his unexplained loss of use of his extremities and collapse. SUF at Nos. 98-99. Plaintiff alleges that Carl failed to conduct an adequate medical assessment of a patient with an apparent spinal cord injury or neurological disorder, although Carl's chart notes indicate that Plaintiff's lower extremity reflexes were positive and that Plaintiff was able to take his shoes off. Id. at Nos. 101-02. Carl ordered Plaintiff returned to his cell, without arranging for any medical follow up. Carl alleges that when released to return to his cell, Plaintiff walked without assistance. Id. at No. 104. This is disputed by Tandel.
On May 18, 2007, Plaintiff had a sudden and acute loss of vision in his left eye and started noticing that he was unable to move his lower extremities. He was also suffering from urinary retention and constipation, and found he could not control his bladder and bowels. Pl.'s Ex. 2 at ¶¶ 32-33, 39; Smith MSJ, Ex. H, ECF No. 136-12 at 241-46; Defs.' Ex. 1 at 113-14. According to Plaintiff, he repeatedly rang the emergency bell to summon help and informed the officers on duty that his legs did not work, that he could not urinate, and that he was going blind, but was told to stop using the call button and that "this was not going to kill me." Pl.'s Ex 2 at ¶¶ 32-35, 39. On May 19th, after Plaintiff claims to have repeatedly used the call button to frantically request help,  the custody officers allegedly punished the entire pod by removing dayroom privileges and locking the entire pod down for the day due to what appears to have been Plaintiff's excessive use of the call button for aid. Defs.' Ex. 4 at 395; Ex. 3 at 337. Moreover, on May 19th, when officers finally responded, they simply fold Plaintiff to sign up for non-emergent NSC the following day. Pl.'s Ex 4 at 392.
Then, on May 20th, Plaintiff again activated the call button in his cell, telling custody staff that he was in severe pain and had lost consciousness. SUF at No. 113. Plaintiff was transported by wheelchair to the Jail's infirmary and, when initially examined by Nurse Carl, stated his "legs don't work." Id. at No. 116. Nurse Carl's own examination of Plaintiff was normal, and he noted no gross injuries or other abnormalities that could account for Plaintiff's symptomatology. Id. at Nos. 118-19. Nevertheless, since this was the second time he had seen Plaintiff with virtually identical complaints and physical presentation, Nurse Carl referred Plaintiff for further evaluation by Dr. Smith. Id. at No. 120.
At the time of Dr. Smith's examination at 12:30 p.m. on May 20th, Plaintiff's only complaint, consistent with what he told Nurse Carl that morning, was that his legs "didn't work." Dr. Smith conducted a physical and neurological examination of Plaintiff that included both his upper and lower extremities. He found no neurological defects or other abnormalities consistent with Plaintiff's claim that his legs did not work, and accordingly concluded that there was no reason why Plaintiff could not ambulate. Id. at Nos. 120-21. He cleared him to return to his cell. Id. at No. 122.
About eight hours after Dr. Smith's examination, Plaintiff was observed sitting on the floor of his cell, and told custodial staff that he could not move due to constipation. Id. at No. 132. According to Plaintiff's medical chart, an examination revealed for the first time that Plaintiff had vision changes, signaling a potential neurological issue. Id. at No. 135. In contrast with Dr. Smith's examination earlier that day, Plaintiff's left pupil was noted to be sluggish, and his right upper extremities were noted to be weaker than those on the left. After being notified of Plaintiff's condition by phone, the Jail's on-call physician at that time, Dr. Horowitz, ordered Plaintiff to be transferred to an outside emergency room for evaluation. Plaintiff was thereafter taken to the U.C. Davis Medical Center for assessment. Id. at No. 136.
At the time of his initial evaluation in the Emergency Room, Plaintiff identified "very vague" symptomatology to the examining physician, J. Douglas Kirk, M.D., including some left eye blindness along with a generalized weakness in his legs that had progressed into paralysis of the lower extremities. The admission note describes Plaintiff's urine and bowel retention as consistent with being unable to urinate or defecate for the past three days. Smith MSJ, Ex. H, ECF No. 136-12 at 241-46. The lower extremity weakness, however, appeared to resolve after persistent testing of Plaintiff's strength, and the blindness in Plaintiff's left eye also resolved in the course of Dr. Kirk's initial examination. These discrepancies caused Dr. Kirk to note inconsistencies in Plaintiff's presentation of physical signs and symptoms. SUF at No. 139.
Plaintiff's symptomatology initially continued to baffle his attending doctors at UCD, which included infectious disease specialists, critical care specialists, and neurologists (Id. at No. 145), and it was not until the sixth day of his hospitalization at the U.C. Davis Medical Center that Plaintiff was ultimately diagnosed with Acute Disseminated Encephalomyelitis ("ADEM"). ADEM is a neurological disorder characterized by inflammation of the brain and spinal cord caused by damage to the myelin sheath. Vaccination for Tetanus is allegedly a known cause of ADEM. As a result of Plaintiff's initial bout with what was believed to be ADEM, he was rendered a T4 paraplegic. Plaintiff requires catheterization to void his bladder, and further needs stool softeners, suppositories, and digital stimulation to move his bowels. Id. at No. 150. The initial attack also damaged Plaintiff's left optic nerve and left him with decreased vision on that side. Id. at No. 151. Plaintiff alleges that delay in receiving treatment exacerbated those symptoms.
Ultimately, given the nature and severity of his condition, Plaintiff was released from incarceration in 2007. Although his disease process was inactive, Plaintiff nonetheless suffered from chronic pain as a result of the neurological damage he sustained, requiring appropriate pain medication and physical therapy. Pl.'s Ex. 13 at 23:22-24:8; Defs.' Ex. 39 at 1366-68. Plaintiff eventually became capable of managing his bowels without regular accidents. His family provided constant nursing care to ensure that he was clean and not sitting or lying in his own feces, and further ensured that no pressure sores were developing. Pl.'s Ex 24 at 37:6-22; Ex. 4 at ¶¶ 14-16; Ex. 2 at ¶ 49).
In 2009, Plaintiff filed a lawsuit against the County and a number of individual defendants under 42 U.S.C. § 1983 alleging his civil rights' violations during the 2007 detention. (See Pl.'s Second Am. Compl., Case No. 2:09-cv-0842-MEC-GGH, ECF No. 43.)
In 2010, Plaintiff went to the Stanford Neuroimmunology Clinic for a second opinion concerning his condition. As a result of Stanford's assessment, Plaintiff's diagnosis was changed to Neuromyelitis Optica ("NMO") as opposed to ADEM. SUF at Nos. 152-53. NMO is a recurrent autoimmune disorder in which the immune system repetitively attacks and injures the central nervous system and, more specifically, the optic nerves and spinal cord. NMO is an extremely rare disease, being only about 1/100th as common as multiple sclerosis, a similar autoimmune disorder of the nervous system.
On March 23, 2010, Plaintiff was again arrested and detained as a pretrial detainee at the Jail, this time for purchasing ammunition in violation of the terms of his release. At the time of his 2010 arrest, Plaintiff required a wheelchair and was unable to move from the nipple line down. Plaintiff's medical record also allegedly indicates that, during the 2010 detention, all Defendants were aware of Plaintiff's serious neurologic autoimmune disease and that Plaintiff required appropriate treatment. After he was booked, a nurse practitioner, Defendant Agnes Felicano, noted Plaintiff's need for catheters and wrote an order for four. She also wrote an order authorizing him to keep a urinal with him at all times. While Felicano offered Plaintiff Ultram to manage pain, he refused it. Id. at Nos. 177-181. The following day, March 24th, Plaintiff was seen by two physicians, Defendants Richard Bauer and Michael Sotak, as well as two nurses. Plaintiff was ultimately given straight catheters, a suppository for bowel care, and an egg crate mattress. Id. at Nos. 182-184.
On March 25, 2010, Plaintiff allegedly threatened suicide and admitted that the reason he purchased ammunition was to effectuate a suicide attempt in the wake of his NMO diagnosis. See id. at 185. Defendant Gloyal Sahba, M.D., subsequently put Plaintiff on a suicide watch. Defendant Sotak conferred with Medical Director of Jail Psychiatric Services, Defendant Greg Sokolov, concerning a plan to address both his acute suicidality and his special medical needs. Id. at No. 187. Defendant contends that while on suicide watch between March 27th and March 27th [??], Plaintiff not only received standard psychiatric precautions and services, but also continued to receive the same level of healthcare as other inmates housed in the medical unit. Id. at Nos. 188-193. Plaintiff disagrees, and states that the Jail's psychiatric unit was unable to handle a catheterized patient with his medical issues. According to Plaintiff, Defendants Sokolov, Sahba, and Sotak knowingly left Plaintiff "to lay naked, on a mattress on the floor, unable to adequately move, unable to reach the call button, in severe pain, under-medicated, and without adequate supplies or treatment to urinate or defecate cleanly and regularly for a period of three days." Consolidated Second Am. Compl., ECF No. 73 at ¶ 172. This assertion is countered by Defendants, who claim that Plaintiff refused his morning pain medication between March 25th and 29th, and was provided all necessary medical supplies, including catheters. Plaintiff nonetheless claims he urinated on himself numerous times, was unable to have regular bowel movements, and developed bed sores. Pl.'s Ex 2, at ¶¶ 85-86, 90-9. Plaintiff also contends the bed sores worsened because of his lack of access to medical care. Pl.'s Ex. 6 at ¶¶ 25-27; Ex. 2 at ¶¶ 86, 91.
On April 7, 2010, Plaintiff was inexplicably transferred out of the medical unit and into the general population section of the Jail. Defs.' Ex. 2 at 2237. Plaintiff claims this move decreased his access to medical care during a time when his symptoms were worsening.
On April 9, 2010, Plaintiff complained to Dr. Sabha of a burning sensation on the tip of his penis during urination and pressure sores on his inner knees. SUF at No. 200. Sabha ordered an ointment to be applied to Plaintiff's knees, a double mattress, a urine culture, and a test for sexually transmitted diseases. Id. at Nos. 202-04.
Although Dr. Sabha purportedly increased the dosage of Plaintiff's pain medication (Id. at No. 205), Plaintiff's neighboring inmate allegedly pressed the call button on Plaintiff's behalf several times after hearing Plaintiff screaming in agony, but custody staff never responded. Defendant Deputies Jacoby and Medeiros, who worked the day shift on April 11th, informed oncoming night shift personnel that they were having problems with Plaintiff "[y]elling and screaming and causing a problem hitting the button constantly..." Pl.'s Ex. 28 at 70:19-71:25. In contravention of Jail policy, no entries were logged relating to these complaint or to Plaintiff's emergency intercom usage. Defs.' Ex. 5 at5380-82.
It is undisputed that late on the evening of April 11th, Plaintiff activated his emergency intercom and complained of pain with catheterization. SUF at No. 208. A supervising registered nurse, Charles Munn, responded when custody staff notified him of Plaintiff's complaint. Munn provided narcotic pain medication and transferred to the Jail's medical unit for observation and further testing. Id. at Nos. 211-12. A urine dip test was subsequently taken. Id. at No. 214. On April 13, 2010, Defendant Bauer prescribed an antibiotic to Plaintiff to alleviate a urinary tract infection, and also switched Plaintiff's pain medication to Norco. Id. at Nos. 219-220.
On April 22, 2010, Plaintiff was seen by Defendant Susan Kroner, a registered nurse. He complained of burning pain, rated as a 9 on a scale of 1 to 10, in his left knee, and for the first time stated that for the previous two weeks he had been experiencing blurry vision involving the left eye. Id. at Nos. 227-28. Kroner performed a vision test, and noted that Plaintiff's vision in the right eye was better than his left. Given that discrepancy, Kroner referred Plaintiff to be seen by a physician the following day. Id. at No. 231. She failed to arrange for any more immediate care.
On April 23rd, Plaintiff was again seen by Dr. Sabha. In addition to continuing to identify penile pain, Plaintiff further reported generalized pain in his legs and back, as well as vision changes. Id. at Nos. 234-35. After examining Plaintiff, Sabha prescribed Flexeril for back pain, ordered follow-up urinalysis for a potentially continuing urinary tract infection, and, because of Plaintiff's vision complaints, requested referrals to an ophthalmologist and a neurologist. Id. at Nos. 235-236.
According to Defendants, Plaintiff was also evaluated by Dr. Bauer on five occasions, between April 27, 2010 and May 4, 2010 for management of his chronic pain. Id. at No. 237. Over this period, Bauer changed Plaintiff's pain medication and adjusted his dosages in an attempt to better manage Plaintiff's chronic discomfort. Id. at No. 238.
On May 4, 2010, Plaintiff was also seen by Dr. Sotak. He complained of a double vision episode that had resolved, as well as muscle stiffness and weight loss, apparently because of Plaintiff declining to eat some of his food because of religious preferences. Dr. Sotak ...