Smith v. Schuyler

Background

Larry Smith, a California prisoner without a lawyer, filed a civil-rights action under 42 U.S.C. § 1983, a federal law that allows claims against state officials for violating constitutional rights. His amended complaint alleged that doctors at prisons and hospitals failed to provide adequate medical care for his back pain and spinal infection. The order addressed the joint motion for summary judgment by Dr. Sevaq Kalinjian and Dr. Mandeep Singh. The court had previously granted summary judgment to Dr. Jonathan Doherty and Dr. Kathryn Bergen.

Smith alleged that Dr. Kalinjian failed to examine him adequately, dismissed his reports of pain and weight loss, failed to locate or review an October 2022 scan, declined to prescribe morphine, and did not respond properly after Smith swallowed a razor blade. Smith also alleged that Dr. Singh reduced his Tylenol with codeine, treated him as if he were seeking drugs, and failed to respond appropriately when his spinal infection may have returned.

The defendants submitted medical records, declarations, and an expert opinion stating that their treatment was medically acceptable. The evidence showed that Dr. Kalinjian ordered testing, prescribed several non-opioid pain treatments, referred Smith to physical therapy, addressed his weight loss with a dietitian referral, and sent him to an outside hospital after an MRI showed a possible spinal infection. Smith underwent emergency surgery there.

The evidence regarding Dr. Singh showed that she saw Smith 12 times between May and July 2023, sent him to a hospital six times, ordered imaging, prescribed pain medication and antibiotics, consulted a neurosurgeon, arranged a psychological evaluation, and evaluated his substance-use history. Smith left the hospital against medical advice each time, according to the undisputed record. He also declined or refused some recommended treatments, including antibiotics and a needle aspiration.

Legal Standard

Summary judgment is proper when the evidence shows that no genuine dispute exists about a fact that could affect the result and the moving party is entitled to judgment as a matter of law. The court must view the evidence in the light most favorable to the nonmoving party, here Smith.

For a prisoner’s Eighth Amendment medical-care claim, the prisoner must show a serious medical need and that the defendant was deliberately indifferent to it. Deliberate indifference requires evidence that the official knew about a substantial risk of serious harm and consciously disregarded that risk. Negligence, medical malpractice, an inadvertent failure to provide adequate care, or a disagreement over medical treatment is not enough. When a doctor chooses between medical treatments, the prisoner must show that the chosen treatment was medically unacceptable under the circumstances and was selected while consciously disregarding an excessive health risk.

Dr. Kalinjian

The court held that the evidence did not support a reasonable finding that Dr. Kalinjian was deliberately indifferent to Smith’s back pain, swallowed razor blade, or weight loss. The court noted that Dr. Kalinjian reviewed records, examined Smith on multiple occasions, offered various pain treatments, ordered diagnostic testing, referred Smith for treatment after the MRI showed a spinal infection, offered spinal injections or surgery, referred him to physical therapy, and authorized continued use of a wheelchair.

The court rejected Smith’s argument that Dr. Kalinjian improperly failed to review an October 12, 2022 MRI. The records showed a computed tomography scan on that date and stated that an MRI might be useful later; they did not show that Smith had received an MRI. The court also found that Dr. Kalinjian responded to the swallowed razor blade by ordering an abdominal X-ray and an outside emergency-department evaluation. Regarding weight loss, the court found that Dr. Kalinjian reviewed the records, calculated an approximately 30-pound loss, and referred Smith to a dietitian.

The court concluded that Smith’s disagreement with Dr. Kalinjian’s medical judgments, including the decision not to prescribe morphine at that time, did not create a triable constitutional claim. The court held that Dr. Kalinjian was entitled to summary judgment.

Dr. Singh

The court likewise held that the evidence did not support a reasonable finding that Dr. Singh was deliberately indifferent. The court emphasized her repeated examinations, hospital referrals, imaging orders, pain treatment, consultation with a neurosurgeon, mental-health evaluation, and substance-use evaluation. The court found that these measures were medically acceptable under the circumstances.

The court considered Smith’s objections to the reduction in his Tylenol with codeine and to Dr. Singh’s decisions about stronger opioids. It found that she reviewed his medical history and test results, considered the risks of opioids given his substance-use history, continued some opioid medication, and later prescribed morphine when she believed it was necessary to manage his pain and facilitate hospital transportation. The court treated Smith’s disagreement with those decisions as a difference of medical opinion, which did not establish deliberate indifference.

The court also considered Smith’s assertion that Dr. Singh knew his spinal infection had returned. Even assuming the infection had returned, the court found that Dr. Singh repeatedly sent Smith to hospitals for evaluation, possible antibiotics, monitoring, and possible surgery; warned him about the seriousness of the condition; and consulted medical specialists. The court concluded that the record did not reasonably show that any worsening was caused by Dr. Singh’s purposeful actions or inaction rather than by Smith’s conduct, the condition itself, or another cause.

Other Issues and Disposition

Smith argued that he could not present additional facts because the court had denied his request for documents from nonparties. The court rejected that argument, explaining that the entities were not parties that could be compelled to produce documents under the cited discovery rule. The court also noted that the defendants had provided hundreds of pages of medical records and that Smith did not identify additional relevant records he lacked. His argument about the absence of a separate statement of undisputed facts was also rejected because such a statement had not been ordered or allowed.

The court granted the motion for summary judgment by Drs. Kalinjian and Singh. It denied Smith’s motion for appointment of counsel because the ruling left no upcoming court dates. The clerk was directed to enter judgment and close the file.