Spillard v. Hoffman

Background

Everett L. Spillard, an incarcerated plaintiff representing himself, sued under 42 U.S.C. § 1983. He alleged that Humboldt County Jail nurse Iver Lien and Dr. Burleson were deliberately indifferent to his serious medical needs by failing to provide metformin during part of October 2017 and by prescribing nortriptyline without his knowledge. The court had previously dismissed other allegations, including claims concerning his diet, toe infection treatment, gabapentin, medication timing, housing, property, sleeping arrangements, and a blanket.

The record did not establish whether Spillard was a pretrial detainee or incarcerated following a conviction. The court therefore analyzed the metformin and nortriptyline medical-care claims under both the Fourteenth Amendment standard for pretrial detainees and the Eighth Amendment standard for convicted prisoners.

Metformin claim

Spillard arrived at Butte County Jail on October 2, 2017, reporting diabetes and stating that he took metformin and glipizide. His initial blood glucose level was 294. After his transfer to Humboldt County Jail, staff learned from his pharmacy that there was no active prescription for metformin. Staff provided glipizide and other medications, and later prescribed metformin on October 27, 2017.

The court held that Spillard had not shown a triable issue of fact under the Fourteenth Amendment. The evidence showed that his glucose levels fell after he began receiving glipizide, and the record did not reasonably support a finding that the initial decision to use glipizide alone was objectively unreasonable, placed him at substantial risk of serious harm, or caused his later toe infection and amputation.

The court also granted summary judgment under the Eighth Amendment. It found no evidence from which a factfinder could reasonably conclude that Lien or Burleson knew that treating Spillard with glipizide alone exposed him to a substantial risk of serious harm. The court characterized the parties’ disagreement about appropriate diabetes treatment as, at most, a disagreement about medical judgment or possible negligence, neither of which established deliberate indifference on this record.

Nortriptyline claims

Spillard was prescribed 50 milligrams of nortriptyline daily beginning October 27, 2017, for chronic nerve pain. He claimed that he did not know about the prescription until after he arrived at San Quentin State Prison and argued that the drug had been given to impair him before or during trial. Defendants maintained that it was prescribed for diabetic nerve pain, and their expert stated that nortriptyline is commonly used for neuropathic pain.

The court granted defendants’ summary judgment on the Fourteenth Amendment medical-care claim concerning the purpose and adequacy of the nortriptyline prescription. It found no evidence that the prescription placed Spillard at risk, was objectively unreasonable, or caused him an injury. The court also granted summary judgment on the Eighth Amendment claim because the record did not show that nortriptyline harmed Spillard or that defendants knew it posed a substantial risk of serious harm.

The court treated Spillard’s allegation that he received nortriptyline without consent as a separate Fourteenth Amendment informed-consent claim. It explained that the Fourteenth Amendment can protect a person’s right to refuse unwanted medical treatment and receive enough information to make that choice. Because the court had not clearly identified this claim in its screening order and neither side had briefed it, the court did not decide it. Instead, it ordered defendants to file a later dispositive motion addressing that claim.

Other rulings

The court granted defendants’ request to strike Spillard’s sur-reply because it was filed after the reply without permission and did not fall within the applicable exception. The court also denied Spillard’s motion for summary judgment: it denied the motion without prejudice as to the unbriefed informed-consent claim and denied it as to the other claims because those theories were outside the third amended complaint.

The court denied Spillard’s request to amend the complaint for a fourth time to add claims about his diet and the timing of his medications. It relied in part on his repeated failure to cure deficiencies after several opportunities and found that the proposed claims would not establish constitutional violations on the record described. The court also denied his request for appointed counsel because he had not shown exceptional circumstances.

Disposition

The court granted defendants’ motion for summary judgment on the medical-care claims, granted defendants’ motion to strike, denied Spillard’s motion for summary judgment, denied leave to amend, and denied appointment of counsel. The court ordered defendants to file a dispositive motion on the remaining informed-consent claim within 60 days, followed by briefing from the parties.