(PC) Cortinas v. Ikegbu

District Court, E.D. California·Decided June 16, 2023·No. 2:23-cv-00285·Unknown

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 LARRY WILLIAM CORTINAS, No. 2:23-cv-00285-CKD P 12 Plaintiff, 13 v. ORDER AND 14 N. IKEGBU, et al., FINDINGS AND RECOMMENDATIONS 15 Defendants. 16 17 Plaintiff is a state prisoner proceeding pro se in this civil rights action filed pursuant to 42 18 U.S.C. § 1983. This proceeding was referred to this court pursuant to 28 U.S.C. § 636(b)(1) and 19 Local Rule 302. 20 I. Factual and Procedural History 21 At the time of filing the initial complaint in this matter, plaintiff also filed a motion for a 22 temporary restraining order and/or a preliminary injunction. ECF No. 3. A second ex parte 23 motion for a temporary restraining order was filed on March 26, 2023.1 ECF No. 8. 24 On May 1, 2023, the court screened plaintiff’s complaint and gave him the option of 25 proceeding on the Eighth Amendment deliberate indifference claims against defendants Ikegbu, 26 Osman, Haile, and Patterson or of amending his complaint to fix the deficiencies with respect to 27 1 The filing date was calculated using the prison mailbox rule. See Houston v. Lack, 487 U.S. 28 266 (1988). 1 the remaining defendant and claims. In a separate order filed the same date, the court directed the 2 Supervising Deputy Attorney General to enter a special appearance in this action prior to service 3 of the complaint, and to file a response to plaintiff’s motions seeking injunctive relief. ECF No. 4 10. On May 15, 2023, a response was filed. ECF No. 15. Plaintiff’s motions seeking 5 preliminary injunctive relief have now been fully briefed. ECF Nos. 16-19. 6 II. Motions for a Temporary Restraining Order 7 In his original motion, plaintiff seeks a preliminary injunction requiring defendants to 8 follow the treatment recommendations of Neurosurgeon Morris Senegor documented in medical 9 reports dated November 15, 2021 and March 14, 2022. ECF No. 3. Specifically, plaintiff 10 indicates that Dr. Senegor recommended that his morphine dose be increased, Baclofen be added 11 to his pain management regimen, and that plaintiff have arthroplastic surgery of the C5-6 and C6- 12 7 discs with a Mobi-C device implanted. ECF No. 3 at 4. In a more detailed second motion for 13 preliminary injunctive relief, plaintiff attaches the reports of Dr. Senegor that contain these 14 treatment recommendations. ECF No. 8 at 11-17. Plaintiff further indicates that defendant 15 Ikegbu has cancelled the orders of other doctors to provide plaintiff with morphine for pain 16 management. ECF No. 8 at 2. According to plaintiff, he has been denied surgery for his lumbar 17 issues as well as adequate pain management as retaliation against him for filing the present 18 lawsuit and to maliciously cause him pain. ECF No. 8 at 5. Regarding his ability to succeed on 19 the merits of his Eighth Amendment deliberate indifference claims, plaintiff points out that there 20 is no dueling medical opinions in this case because defendant Ikegbu has never examined or 21 treated plaintiff. ECF No. 8 at 2; ECF No. 8-1 at 4-5. In the absence of injunctive relief, plaintiff 22 alleges that he suffers diminished daily functioning based on the ongoing denial of surgery and 23 adequate pain medication. ECF No. 8-1 at 8. 24 In response to these motions, defendants “acknowledge that plaintiff has a serious medical 25 need and that the surgery recommended by Dr. Senegor is needed. Defendants, however, have 26 legitimate medical concerns whether authorizing the surgery at the present time would lead to an 27 unfavorable outcome because of plaintiff’s lack of participation in physical therapy and the high 28 dosages of pain medication, including opioid medication, which pose risks of addiction and 1 dependence. Rather, the [d]efendants continue to recommend participation in physical therapy 2 and a reduction in pain medication in favor of safer alternatives.” ECF No. 15 at 7. According to 3 defendants, plaintiff’s claims “raise a dispute concerning a course of treatment which does not 4 constitute deliberate indifference” in violation of the Eighth Amendment. ECF No. 15 at 7. 5 Regarding whether plaintiff will suffer irreparable harm without injunctive relief, defendants 6 point out that the recommendation for cervical spine surgery was made on an elective basis and 7 not on an emergency basis. ECF No. 15 at 19. Defendants also submit that the requested 8 injunctive relief extends further than necessary to correct the asserted harm which violates the 9 Prison Litigation Reform Act (“PLRA”). Id. 10 The defendants’ response also includes declarations from defendants Dr. Haile and Dr. 11 Ikegbu. ECF No. 15 at 24-45. This evidence indicates that plaintiff’s case was presented to the 12 interdisciplinary Care Team Enhancement Conference (“CTEC”) on March 30, 2022, which 13 included a presentation of Dr. Senegor’s recommendations. ECF No. 15 at 26. “The CTEC 14 noted that the surgery recommended by Dr. Senegor could be an appropriate treatment option but 15 was not the first option of treatment at that time due to concerns whether the recommended 16 surgery would result in a good outcome….” ECF No. 15 at 26. In May 2022, plaintiff’s case was 17 also presented to the Complex Case Conference Committee at the California Medical Facility. 18 ECF No. 15 at 26-27. “This committee also supported interdisciplinary modalities to chronic 19 pain management in lieu of the use of long-term opioids, based on concerns regarding Mr. 20 Cortinas’ past refusal to participate in …physical therapy, and the lack of evidence in the medical 21 community that the long term use of opioid medications had been successful in managing 22 mechanical cervical and low back pain….” Id. Based on the treatment recommendations of 23 these two committees, “the level of morphine sulfate prescribed for Mr. Cortinas has been tapered 24 down and reduced, and the Lyrica and Baclofen have been tapered and discontinued….” Id. at 25 27. While defendant Ikegbu acknowledges “tak[ing] steps to discontinue the use of medication 26 inconsistent with the CTEC and the Complex Case Conference committee recommendations[, 27 t]hese steps have not been taken to inflict harm or pain to Mr. Cortinas; rather, these steps have 28 been taken in order to provide appropriate medication and treatment consistent with current best 1 medical practices and to address Mr. Cortinas’ symptoms and complaints without prompting 2 adverse outcomes such as opioid addiction and dependence and poor surgical results.” ECF No. 3 15 at 43. 4 By way of reply, plaintiff indicates that he is currently engaged in additional physical 5 therapy sessions recommended by defendant Haile. ECF No. 16 at 1. He disputes ever testing 6 positive for heroin or cannabis while in custody. Id.; see also ECF No. 17 at 1 (plaintiff’s 7 supplemental declaration). According to plaintiff, his current dose of morphine is below the daily 8 maximum dosage outlined in CDCR guidelines. ECF No. 16 at 3. Plaintiff also filed an 9 objection to defendants’ response disputing the contents of the declarations provided by Dr. 10 Ikegbu and Dr. Haile. ECF No. 19. In the objections, plaintiff generally disputes the medications 11 that he was prescribed and what type of pain they are used to treat even though he is not a 12 medical doctor. ECF No. 19. In a separately filed pleading, plaintiff requests that the court take 13 judicial notice of an April 26, 2022 Addendum prepared by Dr. Haile that contains a list of the 14 medications he was taking. ECF No. 18 at 7-9. According to plaintiff, this contradicts Dr. 15 Haile’s declaration and also impeaches that of Dr. Ikegbu. ECF No. 18 at 5. Lastly, plaintiff 16 filed a separate objection to Dr.

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