United States District Court, N.D. California
ORDER DENYING PLAINTIFF'S MOTION TO STRIKE REPLY;
AND GRANTING DEFENDANTS' MOTION FOR SUMMARY
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.
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,  25. Plaintiff has also filed a motion
to strike Defendants' reply brief. Dkt. 26.
reasons stated below, Plaintiff's motion to strike is
DENIED, and Defendants' motion for summary judgment is
PLAINTIFF'S MOTION TO STRIKE
has moved to strike Defendants' reply brief as untimely.
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.
DEFENDANTS' MOTION FOR SUMMARY JUDGMENT
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.
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.”
Dkt. 4 at 3.
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.
The CDCR's Mental Health Care Program
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).
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.
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.
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.
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.
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.
Plaintiff's Mental Health Treatment
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.
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. 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).
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.
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.
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.
August 23, 2013 - Alleged Suicide Attempt and Admission to
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.
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.
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,
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.”
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 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.”
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.
September 3, 2013 - ...