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Stribling v. Brock

United States District Court, N.D. California

March 10, 2017

DR. K. BROCK, et al., Defendants.



         Plaintiff Aaron Lamont Stribling, a state prisoner currently incarcerated at California State Prison - Sacramento, has filed a pro se civil rights complaint under 42 U.S.C. § 1983 stemming from constitutional violations that took place at Salinas Valley State Prison (“SVSP”), where he was previously incarcerated. Specifically, Plaintiff alleges a claim of deliberate indifference to medical needs against two SVSP psychologists, Drs. K. Brock and R. Mahan, stemming from inadequate mental health treatment in 2013. Dkt. 1 at 3.

         The parties are presently before the Court on Defendants' Motion for Summary Judgment. Dkt. 16. Plaintiff has filed an opposition to Defendants' motion, and Defendants have filed a reply. Dkts. 24, [1] 25. Plaintiff has also filed a motion to strike Defendants' reply brief. Dkt. 26.

         For the reasons stated below, Plaintiff's motion to strike is DENIED, and Defendants' motion for summary judgment is GRANTED.


         Plaintiff has moved to strike Defendants' reply brief as untimely. Dkt. 26.

         Defendants' reply brief is properly understood as a reply brief in support of their motion for summary judgment. Litigants may file reply briefs in support of their motions wherein they address arguments raised in oppositions to their motions and they reemphasize arguments set forth in their motions. Such a reply brief is authorized by both Local Rule 7-3(c) and by the Court's January 12, 2016 Order of Partial Dismissal and Service, which set forth a briefing schedule. Dkt. 4 at 4-6. The Court's briefing schedule required Defendants to file a reply brief “no later than fourteen (14) days after the date Plaintiff's opposition is filed.” Id. at 6 (emphasis in original). Plaintiff claims that his opposition was “filed” on “7-11-16.” Dkt. 26 at 1. However, the record shows that he merely signed his opposition on that date. Dkt. 24 at 9. Plaintiff's opposition was stamped as “FILED” by the Clerk of the Court on July 15, 2016. Dkt. 24. Defendants' reply was filed on July 29, 2016-fourteen days after Plaintiff's opposition was filed. Dkt. 25. Therefore, the Court finds that Defendants' reply brief was timely filed. Accordingly, the Court DENIES Plaintiff's motion to strike and will consider the substance of Defendants' reply.


         A. Factual Background[2]

         1. The Parties

         At the time of the events set forth in his complaint, Plaintiff was a state prisoner who was incarcerated at SVSP. Dkt. 1 at 1. Also during the same time frame, Defendants were clinical psychologists at SVSP. Mahan Decl. ¶ 1; Brock Decl. ¶ 1.

         2. Plaintiff's Version

         The following is taken from the Court's January 12, 2016 Order of Partial Dismissal and Service:

Plaintiff claims that on August 23, 2013, he attempted suicide and was “sent to the crisis bed” area for eleven days. Dkt. 1 at 3. However, Plaintiff alleges Defendants Brock and M[a]han kept trying to discharge him, only to have him return after attempting to commit suicide on two more occasions after being discharged on September 3 and 4, 2013. Plaintiff claims that these Defendants “purposely discharged [him] wrongfully because they needed more room for other inmates that were suicidal.” Id.

Dkt. 4 at 3.

         After liberally construing Plaintiff's aforementioned allegations that Defendants failed to provide adequate mental health treatment, the Court found that Plaintiff stated a cognizable deliberate indifference claim. Id.

         3. Defendants' Version

         a. The CDCR's Mental Health Care Program

         The California Department of Corrections and Rehabilitation's (“CDCR”) program for mental health encompasses four levels of mental health treatment, which include (in order from the lowest to highest level of treatment), the Correctional Clinical Case Management System, the Enhanced Outpatient Program (“EOP”), the Mental Health Crisis Bed (“MHCB”), and the California Department of Mental Health. Williams v. Kernan, 2009 WL 2905760, *1 (E.D. Cal. 2009).

         The appropriate level of care for an inmate is based upon his level of functioning. Id. An inmate's level of functioning is determined by the severity of his symptoms, his ability to conduct self-care, his ability to participate in activities of daily living, and his general adaptation to the prison environment. Id.

         The EOP is the most intensive level of outpatient care for mentally ill inmates, involving a separate housing unit and structured activities for inmates who have difficulty housing in general population but do not require inpatient hospitalization. Brock Decl. ¶ 2. Inmates at the EOP level of care receive increased clinical and custodial support, including comprehensive mental health services. Id.

         The MHCB unit provides an elevated level of care to inmates who are experiencing acute psychiatric symptoms leading to marked impairment and dysfunction, dangerousness to others, or dangerousness to self. Id. ¶ 3. At SVSP, the MHCB is located within the prison's inpatient medical facility-the Correctional Treatment Center (“CTC”)-and offers 24-hour mental health care to inmates who need it. Id. CDCR employees who become aware of an inmate's “suicidal ideation” (i.e., suicidal thoughts), threats, or an attempt to commit suicide are required to notify mental health staff immediately. Id. ¶ 4. The inmate will then receive a suicide-risk assessment by a qualified mental health clinician on an emergency basis. Id.

         Inmates expressing “suicidal ideation” are initially placed in a holding cell in the CTC. Id. ¶ 5. A triage nurse conducts a preliminary evaluation of the inmate's mental and physical status and refers the inmate for an MHCB admission evaluation. Id. The triage nurse may also put the inmate on suicide precaution, which means the inmate is at high risk of attempting self-injurious behavior, but is not in immediate danger. Id. The inmate is provided with a safety smock, a safety blanket, as well as a safety mattress, and the inmate will receive checks by nursing staff every fifteen minutes until the inmate is either admitted to MHCB or cleared for release back to the housing unit. Id.

         The MHCB admission evaluation is conducted face-to-face by a clinician who has been trained to conduct suicide-risk assessments. Id. ¶ 6. Such assessments include consideration of certain static, long-term, short-term, and protective risk factors, using the clinician's best clinical judgment, and the results are recorded on a Suicide Risk Evaluation form. Id. Inmates who are at significant suicide risk are admitted to the MHCB for further mental health treatment, stabilization, and suicide prevention. Id. Once an inmate no longer presents a significant suicide risk, he can be discharged from the MHCB. Id. Admission to MHCB is not contingent on available bed space at a particular institution; if the beds are full, the inmate will be kept under observation and transferred to an MHCB at a different institution. Id.

         b. Plaintiff's Mental Health Treatment

          For many years, Plaintiff has been a participant in CDCR's Mental Health Services Delivery System, also known as the Mental Health Delivery System (“MHDS”). Mahan Decl. ¶ 2.

         In 2013, Plaintiff was receiving mental health treatment at the EOP level of care. Id. In April 2013, after receiving a Rules Violation Report for “Battery on an inmate with serious bodily injuries, ” Plaintiff was placed in administrative segregation (“ad-seg”). Van Loh Decl., Ex. C, Plaintiff's Dep. 44:6-22. On June 19, 2013, a mental health treatment team, called the Interdisciplinary Treatment Team (“IDTT”), consisting of two psychologists, a psychiatrist, a psychiatric technician, and a correctional counsel (none of which are named as Defendants in this action), conducted a comprehensive evaluation of Plaintiff, and on June 24, 2013, they drafted a 3-page “Mental Health Treatment Plan.” Mahan Decl. ¶ 2; Van Loh Decl., Ex. B at 1-5. The team noted his diagnoses of “Mood Disorder, NOS [not otherwise specified], ” “Antisocial Personality Disorder, ” and “Narcissistic Personality Disorder.” Van Loh Decl., Ex. B at 3. The team also noted as follows:

. . . [Plaintiff] came to [ad-seg] for battery on an IM [inmate]. Recently, there has been no indication of delusional thinking or psychological thought process. Previous clinicians indicated that the psychotic symptoms which he presented were questionable. [Plaintiff] has a history of being evasive when asked about specifics of AHs [auditory hallucinations] or VHs [visual hallucinations]. Additionally, [Plaintiff] has frequently been observed to be laughing and joking with other inmates, often immediately before or after he has reported being severely depressed to his clinicians. It is unlikely that [Plaintiff] will require or benefit from long term EOP placement. According to his last clinician on the EOP yard, [Plaintiff] progressed in his level of functioning and was close to reaching maximum benefits from the EOP MHDS. [Plaintiff] has proven to be a strong advocate from himself when needing services from custody, medical as well as mental health. [Plaintiff] is prescribed Strattera.[3] Housing COs [custody officers] report that [Plaintiff] has been “quiet” since coming to [ad-seg]. Current clinical issues include mood instability and anger management. He has had a poor MH [mental health] treatment compliance during the last 6 months. [Plaintiff] has no history of suicide attempts. . . . .

Id. at 1 (footnote and brackets added).

         Based on progress notes, written by his primary clinician Dr. A. Capre, dated from June 20, 2013 through the morning of August 23, 2013, Plaintiff reported no acute psychiatric symptoms and denied having suicidal thoughts. Mahan Decl. ¶ 3; Van Loh Decl., Ex. B at 6-16.

         On July 19, 2013, Plaintiff informed Dr. Capre as follows: “I don't have any problems with my mental health. All of my problems are with the administration and the court.” Van Loh Decl., Ex. B at 10.

         On August 16, 2013, Plaintiff reported that he was having problems with custody officers, and he described the stress from interacting with these officers as “unbearable.” Id. at 15. Plaintiff asked Dr. Capre for a transfer to the Department of State Hospitals (“DSH”) to address his anger problems, and Plaintiff “became irritated” when informed that his level of care would be decided by the “treatment team including psychiatry and custody.” Id. A week later, on August 23, 2013 at around 10:30 a.m., Plaintiff again asked Dr. Capre about transferring to DSH. Id. at 16. When she refused, responding that Plaintiff was “functioning higher than a person who would be sent to DSH, ” he “became angry and asked to return to his cell.” Id. Dr. Capre noted that, at that time, Plaintiff did not report that he was having suicidal thoughts. Id.

         1) August 23, 2013 - Alleged Suicide Attempt and Admission to MHCB

          On August 23, 2013 at approximately 9:15 p.m., Plaintiff was brought to CTC after notifying custody staff that he was having suicidal thoughts. Brock Decl. ¶ 9; Van Loh Decl., Ex. B at 17, 20. Plaintiff “walk[ed]” to CTC to be examined by the triage nurse, V. Welzenbach, R.N., and he reported as follows: “I feel like taking myself out before someone else does.” Van Loh Decl., Ex. B at 17. The nurse's notes under “TRAUMA” indicates that Plaintiff “DENIE[D]” any injury at that time. Id. The nurse further noted that Plaintiff was “ALERT” and “OBEY[ED] COMMANDS.” Id. Plaintiff was referred to the MHCB for an admission evaluation and retained in a separate holding area (as the holding cells at CTC were filled) until he could be evaluated by a clinician trained to conduct suicide evaluations in the morning. Van Loh Decl., Ex. B at 18, 20. He was placed on suicide precaution and given a safety smock, safety blanket, as well as a safety mattress. Id. at 18. During this time, Plaintiff received periodic checks by nursing staff, which indicated that he showed “no distress” while he waited to be evaluated. Id. at 20. According to the Triage and Treatment Services Flow Sheet notes from August 23, 2013 at 12:00 a.m. through August 24, 2013 at 9:15 p.m., Plaintiff displayed “no self-harm” and “no distress” while he was at the holding area. Id. at 20.

         At approximately 9:15 a.m. on August 24, 2013, a clinician named Dr. R. Sardy evaluated Plaintiff. Mahan Decl. ¶ 4; Van Loh Decl., Ex. B at 20. According to the Suicide Risk Evaluation conducted by Dr. Sardy, Plaintiff reported with no supporting evidence that he had been “hoarding medication” and “took ‘a lot' of pills ‘overdosing' last night in front of medical [staff].” Mahan Decl., Ex. A at 1-2, 19. However, Plaintiff was “not sent to outside hospital and there was no medical evidence of OD [overdose].” Id. at 40. Dr. Sardy continued “suicide precaution” Id. Dr. Sardy also completed a Mental Health Evaluation, in which he stated that Plaintiff “reported intent to engage in self-harm” and “that [Plaintiff] had a plan but would not discuss [it].” Id. at 3 (brackets added). At 10:35 a.m., Dr. Sardy approved Plaintiff for admission to the MHCB. Van Loh Decl., Ex. B at 19. According to the Triage and Treatment Services Flow Sheet notes and Interdisciplinary Progress Notes from August 23, 2013 at 10:25 a.m. through August 24, 2013 at 3:15 p.m., Plaintiff displayed “no self-harm” while was at the holding area prior to his transfer to MHCB. Id. at 20; Mahan Decl., Ex. A at 16.

         According to Plaintiff's Admission Assessment at MHCB dated August 24, 2013 at 3:15 p.m., his aforementioned suicidal “plan” was “to take a lot of pills . . . .” Mahan Decl., Ex. A at 6, 7. According to the Nursing Care Record dated August 24, 2015, Plaintiff was moved to his cell at MHCB and showed “no distress” and “no sign of self-harm.” Id. at 12, 16. According to the Restraint/Seclusion Record, Plaintiff was placed on suicide precaution with checks by nursing staff every fifteen minutes beginning as soon as he was transferred to MHCB on August 24, 2013 at 3:15 p.m. through August 26, 2013 at 1:45 p.m., and he showed “no sign of self-harm.” Id. at 17-18, 20-23, 27, 31-33, 36.

         On August 26, 2013 around 2:00 p.m., Plaintiff underwent another IDTT review, and this time the team included Plaintiff's primary clinicians, Defendants Brock (who also served as IDTT leader) and Mahan. Id. at 33, 36, 39. The team drafted another 3-page “Mental Health Treatment Plan.” Id. at 40-42. The team again noted his diagnoses of “Mood Disorder, NOS, ” “Antisocial Personality Disorder.” Id. at 42. The team also noted as follows:

. . . [Plaintiff] was admitted to the MHCB after making statements of self-harm and that he's been hoarding medications and subsequently “I took a lot of pills” in front of medical staff. He was not sent to [an] outside hospital and there was no evidence of OD. Upon admission, he stated, “I can't take it anymore and I fell [sic] like taking myself out before someone else does.” The [treatment] note after admission indicates improvement in mood and that [Plaintiff] was focused on herring a housing change. When interviewed today, he explained that certain custody officers were “out to get me cause I file a lot of lawsuits and 602's.” He also stated he fears they will kill him and make it look like a suicide. He denies thoughts of self-harm today and was more focused on problem[] solving about housing. His mood appeared anxious, no evidence of thought disorder, though he may be paranoid. He has a history of 1 MHCB admission for stated SI [suicidal ideation] secondary to frustration over an extended [ad-seg] placement. He carries a diagnosis of Mood disorder, NOS and has reported psychotic symptoms, which are questionable. He has also been diagnosed with Narcissistic and Antisocial Personality disorder. He was recently discharged from the EOP program (6/2013) after reaching “maximum benefit” and cessation of depressive symptoms. He has no history of suicide attempt. Plan is to assess/treat at MHCB LOC [level of care] to determine risk of self-harm and stabilize mood. He confirmed he didn't attempt suicide [and stated], “I just needed to vacate the premises.”[4]

Id. at 40 (footnote and brackets added). According to the IDTT-Level of Care Decision dated August 26, 2013, Plaintiff was to remain at his current placement at the MHCB after his IDTT review[5] and was “not being referred to a higher LOC because [he] is being treated and evaluated at the MHCB and DSH placement is being considered . . . but not indicated until further clinical assessment is conducted including medication adjustment.” Id. at 43. The specific treatment modifications to the treatment plan were as follows: “medication management (as applicable) and individual psychotherapy, continued assessment of risk of self-harm and veracity/severity of slated symptoms.” Id.

         According to the Nursing Care Records, Plaintiff was monitored frequently (a time frame that ranged from every one to two hours) beginning after his IDTT review on August 26, 2013 at 2:30 p.m. through September 3, 2013 at 3:30 p.m., and he showed neither signs of distress nor self-harm. Id. at 33, 36, 46, 49, 50, 52, 53, 60, 61, 64, 65, 68, 69, 72, 74, 76, 77. He was also interviewed daily by various clinicians, including Defendants as indicated, during the following dates: August 28, 2013 (Defendant Brock); August 29, 2013; August 30, 2013 (Defendant Mahan); August 31, 2013; September 1, 2013 (Defendant Mahan); and September 2, 2013 (Defendant Mahan). Id. at 47, 56, 58, 62, 66, 70. Plaintiff largely focused on addressing his housing situation rather than his mental state. Brock Decl. ¶ 10. Plaintiff reported, “I'm suicidal” on a daily basis, but clinicians noted that he was frequently seen smiling, laughing, and engaging with staff. Mahan Decl., Ex. A at 35, 49-50, 58, 64-66, 69-70, 72. Plaintiff also requested a transfer to the DSH, and he threatened legal action against mental health providers when they suggested he raise his housing concerns with custody staff. Brock Decl. ¶ 10. Plaintiff reported that he would attempt suicide by taking pills if he were discharged from the MHCB, stating that “he doesn't have pills but plans to collect them.” Mahan Decl., Ex. A at 68, 72. Mental health providers ultimately determined that Plaintiff was not demonstrating any indication of genuine depression or psychosis. Id. at 84; Brock Decl. ¶ 10. They concluded instead that Plaintiff was using suicidality to effect changes in his housing and custody situation. Id.

         2) September 3, 2013 - ...

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