“[A] Rule 12(b)(6) dismissal 27 is not appropriate unless we can determine, based on the complaint itself, that qualified immunity applies.”
How later courts described this case
- “[A] Rule 12(b)(6) dismissal 27 is not appropriate unless we can determine, based on the complaint itself, that qualified immunity applies.”
Written by the judges who cited it.
The opinion
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8 UNITED STATES DISTRICT COURT
9 SOUTHERN DISTRICT OF CALIFORNIA
10
11 MARILYN MORTON and DEAN Case No. 21-cv-1428-MMA (KSC)
MORTON,
12
ORDER GRANTING IN PART AND
Plaintiffs,
13 DENYING IN PART COUNTY
v. DEFENDANTS’ MOTION TO
14
DISMISS
COUNTY OF SAN DIEGO, et al.,
15
Defendants. [Doc. No. 10]
16
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19 Marilyn Morton (“Ms. Morton”), as successor in interest to Decedent Joseph Earl
20 Morton’s (“Morton”) estate,1 as well as Ms. Morton and Dean Morton as individuals,
21 (collectively, “Plaintiffs”) bring this civil rights action pursuant to 42 U.S.C. § 1983
22 against Defendants County of San Diego (the “County”), Samantha Macanlalay
23
24
1 Ms. Morton has not filed the affidavit required to establish standing as Morton’s successor in interest.
25 See Cal. Code Civ. Proc. §§ 377.30, 377.32(a); see also Tatum v. City & Cnty. of San Francisco, 441
F.3d 1090, 1093 n.2 (9th Cir. 2006) (“A claim under 42 U.S.C. § 1983 survives the decedent if the claim
26 accrued before the decedent’s death, and if state law authorizes a survival action.”). However, “a
plaintiff’s failure to file the required declaration does not mean the case must be dismissed;
27 noncompliance may be cured.” See Estate of Miller v. County of Sutter, No. 12-cv-03928-MEJ, 2020
U.S. Dist. LEXIS 204517, at *13 (E.D. Cal. Oct. 30, 2020) (citing Frary v. County of Marin, 81 F. Supp.
28
1 (“Macanlalay”), Bijan Rahmani (“Rahmani”), Hosanna Alto (“Alto”), Matthew Berlin
2 (“Berlin”), Liberty Healthcare (“Liberty”), and Does 1–10. See Doc. No. 8 (“FAC”).
3 Defendants Macanlalay, Alto, and the County move to dismiss all causes of action
4 against them pursuant to Federal Rule of Civil Procedure 12(b)(6).2 Doc. No. 10.
5 Plaintiffs filed an opposition to County Defendants’ motion, to which County Defendants
6 replied. See Doc. Nos. 13, 15. The Court found the matter suitable for determination on
7 the papers and without oral argument pursuant to Federal Rule of Civil Procedure 78(b)
8 and Civil Local Rule 7.1.d.1. See Doc. No. 16. For the following reasons, the Court
9 GRANTS IN PART and DENIES IN PART County Defendants’ motion to dismiss.
10 I. BACKGROUND3
11 This action arises from Joseph Morton’s death on May 17, 2020, while confined at
12 Vista Detention Facility (“VDF”) in San Diego County. See FAC ¶¶ 5, 16, 29. Broadly,
13 Plaintiffs allege that each medical Defendant, during Morton’s intake evaluation and
14 subsequent suicide assessments, was required by the County’s suicide prevention policies
15 to flag Morton as a “high risk” for suicide. Id. ¶ 17. Pursuant to County policy, inmates
16 flagged as a high risk for suicide must be placed in safety cell housing and provided with
17 advanced monitoring and psychiatric care. Id. Plaintiffs allege that because Morton was
18 improperly assessed as a “low risk” of suicide, he was not placed in suicide safety
19 housing (“ISP housing”), which ultimately provided Morton the means and opportunity
20 to commit suicide. See id. ¶¶ 8, 17.
21 On May 11, 2020, Morton was arrested by San Diego Sheriff deputies after he
22 “used a toy gun in an attempted robbery.” See id. ¶ 5. At the time of his arrest, Morton
23 “made suicidal statements to the arresting deputies[.]” Id. Morton was transported to
24
25
2 There appears to be some dispute as to whether Alto was an employee of the County or Liberty.
26 Compare FAC ¶ 28 with Doc. No. 17 ¶ 28. However, this dispute is immaterial to the present motion
and therefore, for the sake of convenience, the Court refers to Macanlalay, Alto, and the County
27 collectively as “County Defendants.”
3 Because this matter is before the Court on a motion to dismiss, the Court must accept as true the
28
1 VDF, where the “arresting deputies notified the VDF intake staff, including intake nurse,
2 Defendant [ ] Macanlalay, of the suicidal statements [Morton] made during his arrest.”
3 Id.
4 During Macanlalay’s intake evaluation, Morton informed Macanlalay “that he
5 suffered from mood disorders and major depression[,]” that he “had been drinking and
6 taking Xanax and anticipated suffering from withdrawals[,]” and that he “was recently
7 dealing with the loss of his dear aunt and that he felt helpless and hopeless.” Id. ¶ 6.
8 Morton also “admitted that he had just been released from a 5150 hold the day prior for
9 trying to kill himself” and that he had “actual thoughts of killing himself imminently.”
10 Id. ¶ 7 (emphasis in original).
11 “In her subjective note, [ ] Macanlalay acknowledged [Morton]’s suicide risk
12 factors and his recent suicide attempt.” Id. ¶ 8. However, Macanlalay “cleared [Morton]
13 for mainline booking and processing” and “did not notate or document [Morton]’s
14 imminent suicidal ideations in the intake notes[,]” “flag [Morton] as a suicide risk,”
15 “elect to house [Morton] in suicide safety housing[,]” have Morton “assessed by a mental
16 health provider, or recommend admission to the Psychiatric Security Unit.” Id.
17 “Forty minutes later, while being processed, [Morton] vocalized his suicidal
18 ideations to a deputy and [actively] attempted to harm himself.” Id. ¶ 9. “The deputy
19 intervened and escorted [Morton] to medical” where Defendant Rahmani “performed a
20 suicide assessment[,]” which assessed Morton as a “low risk of suicide because [Morton]
21 asked for food and inquired about bail.” Id. Rahmani “housed [Morton] in Enhanced
22 Observation Housing and scheduled a follow up in 12–24 hours.” Id. Enhanced
23 Observation Housing “is a step-down housing unit within the Inmate Suicide Program”
24 for “inmates that present a risk for suicide” but who do not require safety cell placement.
25 Id. ¶ 9 fn.1. Enhanced Observation Housing “is void of any mechanism or means for one
26 to harm or hang themselves.” Id.
27 The following morning, May 12, 2020, Defendant Alto, a mental health clinician,
28 “performed [Morton]’s follow-up suicide assessment.” Id. ¶ 10. Alto “noted that
1 [Morton] was facing serious criminal charges involving child cruelty” and that “the
2 reason for her assessment is that [Morton] verbalized suicidal intent.” Id. “During the
3 assessment, [Morton] inquired about withdrawal medication.” Id. Morton also reported
4 “that he was struggling with symptoms of withdrawal and depression[,]” that “the effect
5 of the withdrawals was the reason he attempted suicide on May 8, 2020[,]” and that “he
6 was having a hard time dealing with the loss of his aunt.” Id. Alto “assessed [Morton] as
7 a low risk for suicide because he wanted withdrawal medication and talked about needing
8 recovery treatment.” Id. ¶ 11. Alto “cleared [Morton] for mainline housing.” Id. ¶ 12.
9 Hours later, Morton “was again escorted to medical and assessed by a
10 psychologist, Defendant [ ] Berlin” who noted that Morton “had ‘verbalized suicide
11 intent in [the] housing unit’ and was escorted to him for a suicide assessment.” Id. ¶ 13.
12 Berlin thought Morton “was faking his suicidal ideations to manipulate staff in an effort
13 to get access to a phone” because Morton “indicated that his mother’s disappointment
14 [about his relapse] was devastating and left him feeling helpless.” Id. Berlin
15 “acknowledged [Morton]’s May 8, 2020, suicide attempt” and “his self-harming attempt
16 in front of a deputy the day prior.” Id. Berlin also “knew that [Morton] had just been
17 released from [Enhanced Observation Housing] and had verbalized suicidal intent four
18 times while in-custody.” Id. “Following the path laid before him by” the other
19 Defendants, “Berlin ignored [Morton]’s imminent threat of suicide” and the risk factors
20 he displayed while incarcerated, and “sent [Morton] back to isolated housing and did not
21 order a follow-up evaluation, a medical sick call or depression/withdrawal medication.”
22 Id. ¶ 14.
23 Because Morton was cleared for mainline housing, he had to “quarantine for ten
24 days in an isolation cell” “[d]ue to the ongoing pandemic[.]” Id. ¶ 12. Morton “remained
25 in an isolated cell, with no recreation time, for the next five days.” Id. ¶ 15. “[Morton]
26 was not evaluated by medical staff during that time nor was he distributed any medication
27 for his withdrawals and/or depression.” Id. “On May 17, 2020, [Morton] was discovered
28
1 in the isolated cell hanging by a bed-sheet, unresponsive” and “was pronounced dead on
2 the scene.” Id. ¶ 16.
3 Plaintiffs bring four causes of action in their First Amended Complaint: (1) a
4 Fourteenth Amendment medical care claim against Macanlalay, Rahmani, Alto, Berlin,
5 and Does 1–10, individually; (2) a Fourteenth Amendment medical care claim against the
6 County and Liberty; (3) “Gross Negligence / Medical Malpractice” against all
7 Defendants; and (4) “Wrongful Death / Survival” against all Defendants. FAC ¶¶ 33–
8 129.
9 County Defendants now move to dismiss all causes of action against them under
10 Rule 12(b)(6). See Doc. No. 10.
11 II. LEGAL STANDARD
12 A Rule 12(b)(6) motion tests the legal sufficiency of the claims made in the
13 complaint. See Navarro v. Block, 250 F.3d 729, 732 (9th Cir. 2001). A pleading must
14 contain “a short and plain statement of the claim showing that the pleader is entitled to
15 relief,” Fed. R. Civ. P. 8(a)(2), such that the defendant is provided “fair notice of what the
16 . . . claim is and the grounds upon which it rests.” Bell Atl. Corp. v. Twombly, 550 U.S.
17 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47 (1957)). However, plaintiffs
18 must also plead “enough facts to state a claim to relief that is plausible on its face.” Fed.
19 R. Civ. P. 12(b)(6); Twombly, 550 U.S. at 570. The plausibility standard demands more
20 than “a formulaic recitation of the elements of a cause of action,” or “naked assertions
21 devoid of further factual enhancement.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)
22 (internal quotation marks omitted). Instead, the complaint “must contain allegations of
23 underlying facts sufficient to give fair notice and to enable the opposing party to defend
24 itself effectively.” Starr v. Baca, 652 F.3d 1202, 1216 (9th Cir. 2011).
25 In reviewing a motion to dismiss under Rule 12(b)(6), courts must assume the truth
26 of all factual allegations and must construe them in the light most favorable to the
27 nonmoving party. See Cahill v. Liberty Mut. Ins. Co., 80 F.3d 336, 337–38 (9th Cir.
28 1996). A court need not take legal conclusions as true merely because they are cast in the
1 form of factual allegations. See Roberts v. Corrothers, 812 F.2d 1173, 1177 (9th Cir.
2 1987). Similarly, “conclusory allegations of law and unwarranted inferences are not
3 sufficient to defeat a motion to dismiss.” Pareto v. FDIC, 139 F.3d 696, 699 (9th Cir.
4 1998).
5 Where dismissal is appropriate, a court should grant leave to amend unless the
6 plaintiff could not possibly cure the defects in the pleading. See Knappenberger v. City
7 of Phoenix, 566 F.3d 936, 942 (9th Cir. 2009) (quoting Lopez v. Smith, 203 F.3d 1122,
8 1127 (9th Cir. 2000)).
9 III. DISCUSSION4
10 County Defendants challenge the plausibility of Plaintiff’s first, second, third, and
11 fourth causes of action. See Doc. No. 10. The Court assesses each claim in turn.
12 A. Fourteenth Amendment Medical Care – Individual Liability Under § 1983
13 In their first cause of action, Plaintiffs allege that Defendants Macanlalay,
14 Rahmani, Alto, Berlin, and Does 1–10 were deliberately indifferent to Morton’s medical
15 needs. See FAC ¶¶ 33–74. “[C]laims for violations of the right to adequate medical care
16 ‘brought by pretrial detainees against individual defendants under the Fourteenth
17 Amendment’ must be evaluated under an objective deliberate indifference standard.”
18 Gordon v. County of Orange, 888 F.3d 1118, 1125 (9th Cir. 2018) (quoting Castro v.
19 County of Los Angeles, 833 F.3d 1060, 1070 (9th Cir. 2016)). Therefore, “the plaintiff
20 must ‘prove more than negligence but less than subjective intent—something akin to
21 reckless disregard.’” Id.
22 In order to survive dismissal, Plaintiffs must allege facts sufficient to show that:
23
(i) [each] defendant made an intentional decision with respect to the
24
conditions under which [he] was confined; (ii) those conditions put [him] at
25
26
4 Only County Defendants bring the present motion to dismiss; Rahmani, Berlin, and Liberty neither
27 bring nor join in the present motion and have instead answered the FAC. See Doc. No. 17. Accordingly,
the Court only addresses the sufficiency of Plaintiffs’ claims to the extent they are brought against
28
1 substantial risk of suffering serious harm; (iii) [each] defendant did not take
reasonable available measures to abate that risk, even though a reasonable
2
official in the circumstances would have appreciated the high degree of risk
3 involved—making the consequences of the defendant’s conduct obvious; and
(iv) by not taking such measures, [each] defendant caused [his] injuries.
4
5 Gordon, 888 F.3d at 1125.
6 1. Defendant Macanlalay
7 County Defendants argue that Plaintiffs fail to allege conduct by Macanlalay that
8 amounts to objective deliberate indifference. Doc. No. 10-1 at 14–17.5 Specifically,
9 County Defendants argue that instead the “allegations regarding Macanlalay suggest a
10 thorough intake and suicide screening was done, but that Macanlalay’s professional
11 judgment was that Morton was not at imminent risk of suicide” and that “[t]he fact that
12 forty minutes later a psychologist may have reached a different conclusion and placed
13 Morton in [Enhanced Observation Housing] is not sufficient to show Macanlalay was
14 deliberately indifferent.” Doc. No. 10-1 at 16.
15 Plaintiffs allege that Macanlalay failed to follow the County’s medical suicide
16 prevention policies, which “required [each] Defendant to house [Morton] in [ISP
17 housing] as a ‘high-risk’ for suicide” based on Morton’s “multiple high-risk factors
18 coupled with pending withdrawals.” See FAC ¶¶ 37–42, 49. Plaintiffs claim that the
19 County’s “correctional suicide prevention policy, J.5., sets forth a procedure delineating
20 ‘high-risk’ suicide factors[,]” and that Morton displayed four out of five “high-risk”
21 factors and three out of five “other risk” factors. Id. ¶¶ 38–41. Plaintiffs further allege
22 that Macanlalay “was advised by the arresting officers that [Morton] made suicidal
23 statements during arrest[,]” and that during his intake evaluation Morton advised
24 Macanlalay “that he suffered from mood disorders and major depression[,]” that “he was
25 recently dealing with the loss of his dear aunt and that he felt helpless and hopeless[,]”
26
27
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1 that “he had been drinking and taking Xanax and anticipated suffering from
2 withdrawals[,]” and “that he had [actual] thoughts of killing himself.” Id. ¶¶ 45–46.
3 Construing the allegations in the light most favorable to Plaintiffs, the Court finds
4 that Plaintiffs have plausibly alleged Macanlalay’s deliberate indifference to Morton’s
5 serious medical needs under the Fourteenth Amendment for the purpose of surviving a
6 motion to dismiss. See Deloney v. County of Fresno, No. 1:17-cv-1336-LJO-EPG, 2019
7 U.S. Dist. LEXIS 71089, at *18–21 (E.D. Cal. Apr. 26, 2019) (finding the plaintiff’s
8 allegations sufficient to defeat a motion to dismiss § 1983 claims against individual
9 defendants where the defendants were aware of the decedent’s high suicide risk through
10 an evaluation that noted further steps needed to be taken to reduce his suicide risk and
11 that the decedent told staff that he was hearing voices telling him to kill himself);
12 Palacios v. County of San Diego, No. 20-cv-450-MMA (DEB), 2020 U.S. Dist. LEXIS
13 130385, at *14 (S.D. Cal. July 22, 2020) (finding the plaintiff plausibly pled deliberate
14 indifference where jail staff “provid[ed] [food in] a plastic bag to [the decedent inmate]
15 while insufficiently monitored given [the decedent’s] recent suicide attempt and
16 continuing suicidal ideations.”).
17 Additionally, County Defendants argue that Plaintiffs fail to plead sufficient facts
18 to establish causation against Macanlalay. Doc. No. 10-1 at 17–23. Specifically, County
19 Defendants argue that Macanlalay’s conduct, which occurred six days before Morton’s
20 death, cannot be the proximate cause of Morton’s death and that Berlin’s conduct breaks
21 the chain of causation between Macanlalay’s intake assessment and Morton’s death. Id.
22 at 17–21. County Defendants also argue that Morton’s intentional act of suicide is a
23 superseding cause of his death. Id. at 21–23.
24 “Traditional tort law defines intervening causes that break the chain of proximate
25 causation” in § 1983 actions. Van Ort v. Estate of Stanewich, 92 F.3d 831, 837 (9th Cir.
26 1996) (citation omitted). A defendant’s conduct is not the proximate cause of an injury
27 “if another cause intervenes and supersedes his liability for the subsequent events.”
28 White v. Roper, 901 F.2d 1501, 1506 (9th Cir. 1990). “However, foreseeable intervening
1 causes . . . will not supersede the defendant’s responsibility.” Conn v. City of Reno, 591
2 F.3d 1081, 1101 (9th Cir. 2009), vacated, 563 U.S. 915 (2011), reinstated in part and
3 vacated in part, 658 F.3d 897 (9th Cir. 2011) (internal quotation marks and citation
4 omitted).
5 Plaintiffs primarily rely on Moriarty v. County of San Diego, No. 17cv1154-LAB
6 (AGS), 2019 U.S. Dist. LEXIS 46399 (S.D. Cal. Mar. 20, 2019), for the proposition that
7 Macanlalay’s conduct, which occurred six days before Morton’s death and which
8 preceded Berlin’s suicide assessment, cannot be the proximate cause of Morton’s death.
9 Doc. No. 10-1 at 18. Moriarty concerned the § 1983 liability of two deputies and a nurse
10 following an inmate’s in-custody suicide. Moriarty, 2019 U.S. Dist. LEXIS 46399, at
11 *11–17. The Moriarty plaintiff alleged the defendants were deliberately indifferent “for
12 failing to recognize that [the decedent] was suicidal or communicate that fact to others at
13 VDF,” resulting in the decedent inmate’s suicide. Id. at *12–13. The court ultimately
14 dismissed the § 1983 claims against the three individual defendants, finding that what the
15 three defendants “may have done or failed to do . . . was not a proximate cause of [the
16 decedent’s] death.” Id. at *11–17. The court reasoned that none of the Defendants were
17 “alleged to have had any involvement in the decision to leave [the decedent] unmonitored
18 on the day he died” and that “[o]f the three, only [the nurse] had anything to do with
19 where [the decedent] was placed.” Id. at *12–13. The court also found that the nurse
20 was not deliberately indifferent but rather made “[a] mistake about whether [the
21 decedent] was suicidal”; she mistakenly concluded that the decedent was not suicidal
22 because the decedent said “no” when the nurse asked if he was suicidal. Id. at *16–17.
23 The court further found that “even if [the nurse]’s negligence or deliberate indifference
24 had led her to classify [the decedent] as not suicidal and to fail to have him evaluated,
25 that was corrected well before he died.” Id. at *16–17. The court reasoned that because
26 the decedent “died six days [after the nurse’s assessment], after many changes of
27 circumstance, [the nurse’s] action or inaction cannot be the proximate cause of his death”
28 and that “[n]othing in the FAC suggests [the nurse] would have had the authority to
1 overrule” later decisions by a sergeant and multi-disciplinary committee not to place the
2 decedent in a safety cell. Id.
3 Moriarty is distinguishable from the instant case. Unlike the deputies in Moriarty,
4 Macanlalay’s role as an intake nurse was to screen detainees for suicide risk. Compare
5 FAC ¶ 47 with Moriarty, 2019 U.S. Dist. LEXIS 46399, at *5–9, *14–16. And unlike the
6 intake nurse in Moriarty, Plaintiffs allege that Macanlalay was aware that Morton had
7 “actual thoughts of killing himself” and that Macanlalay’s screening “set in motion a
8 medical trajectory that was a substantial factor in causing [Morton]’s death.” FAC ¶ 45–
9 46, 49. Moreover, Plaintiffs allege that “given [Morton]’s multiple high-risk factors
10 coupled with pending withdrawals, the policies required [each] Defendant to house
11 [Morton] in [ISP] housing as a ‘high-risk’ for suicide[,]” id. ¶ 42 (emphasis added), and
12 that “pursuant to MSD.P.8, the county’s PSU policy . . . it was incumbent on [ ]
13 Macanlalay to recommend admission to the PSU (Psychiatrist Security Unit) for acute
14 psychiatric treatment given [Morton]’s 5150 hold the day prior, his active intent to kill
15 himself, and his untreated mental health disorders.” Id. ¶ 50. This is sufficient to survive
16 Rule 12(b)(6) dismissal.
17 County Defendants’ argument that Morton’s intentional act of suicide was also a
18 superseding cause that broke the causal chain is similarly unavailing. In support of their
19 argument, County Defendants rely on Cavanaugh v. County of San Diego, No. 18-cv-
20 02557-BEN-LL, 2020 U.S. Dist. LEXIS 212779 (S.D. Cal. Nov. 12, 2020). See Doc.
21 No. 10-1 at 21–23. But Cavanaugh is inapposite. In Cavanaugh, “there [was] no
22 allegation that any of the individual defendants in the case had any interaction with or
23 information about” the decedent prior to the call from another deputy alerting the
24 defendants that the decedent had hung himself. Cavanaugh, 2020 U.S. Dist. LEXIS
25 21277939, at *39 (emphasis added). By contrast, as noted above, Plaintiffs provide
26 specific allegations regarding Macanlalay’s interaction with Morton and her knowledge
27 about Morton’s recent mental health history. FAC ¶¶ 8, 45–51.
28
1 At this stage of litigation, the Court is satisfied that Plaintiffs plausibly allege
2 causation against Macanlalay. See Mendoza v. County of San Bernardino, No. EDCV
3 19-1056 JGB (SHKx), 2020 U.S. Dist. LEXIS 79972, at *15 (C.D. Cal. Feb. 21, 2020)
4 (“Providing some care is not an absolute bar to a medical indifference claim, especially if
5 the care provided could have equally alerted Defendant to the existence of a substantial
6 ongoing medical risk.”); Palacios, 2020 U.S. Dist. LEXIS 130385, at *16 (finding
7 causation sufficiently alleged at the motion to dismiss stage where the plaintiff alleged
8 defendants provided a “means to commit suicide without proper supervision[,]”
9 reasoning that “[i]f jail staff did not provide [plaintiff] with the plastic bag or did not
10 leave him with the bag while insufficiently monitored, [plaintiff] would not have been
11 able to commit suicide through a means provided by the jail.”). Therefore, the Court
12 DENIES County Defendants’ motion on this basis.
13 2. Defendant Alto
14 County Defendants argue that Plaintiffs fail to allege conduct by Alto that amounts
15 to objective deliberate indifference. Doc. No. 10-1 at 14–17. County Defendants posit
16 that “Alto’s subsequent opinion that Morton no longer met the criteria for EOH . . . does
17 not suggest deliberate indifference.” Doc. No. 10-1 at 16.
18 Plaintiffs allege that Defendant Alto “performed [Morton]’s follow-up suicide
19 assessment.” FAC ¶ 10. Alto “noted that [Morton] was facing serious criminal charges
20 involving child cruelty” and that “the reason for her assessment is that [Morton]
21 verbalized suicidal intent.” Id. During the assessment, Morton “inquired about
22 withdrawal medication[,] and reported “that he was struggling with symptoms of
23 withdrawal and depression[,]” that “the effect of the withdrawals was the reason he
24 attempted suicide on May 8, 2020[,]” and that “he was having a hard time dealing with
25 the loss of his aunt.” Id. As described above regarding Macanlalay, Plaintiffs allege that
26 “given [Morton]’s multiple high-risk factors coupled with pending withdrawals, the
27 policies required [each] Defendant to house [Morton] in [ISP housing] as a ‘high-risk’ for
28 suicide.” Id. ¶ 42.
1 Construing the allegations in the light most favorable to Plaintiffs, the Court finds
2 that Plaintiffs have pleaded sufficient facts to show Alto’s deliberate indifference to
3 Morton’s serious medical needs under the Fourteenth Amendment for the purpose of
4 surviving a motion to dismiss. See Deloney, 2019 U.S. Dist. LEXIS 71089, at *19–21.
5 County Defendants also argue that Plaintiffs fail to adequately plead causation
6 against Alto on the same bases discussed above. Doc. No. 10-1 at 17–23. Specifically,
7 County Defendants argue that Alto’s conduct, which occurred five days before Morton’s
8 death, cannot be the proximate cause of Morton’s death and that Berlin’s conduct breaks
9 the chain of causation between Alto’s assessment and Morton’s death. Id. at 17–21.
10 County Defendants also argue that Morton’s intentional act of suicide is a superseding
11 cause of his death. Id. at 21–23.
12 The same analysis applied supra Section III.A.1 regarding causation as to
13 Macanlalay applies to Alto. Although Alto is a mental health clinician rather than an
14 intake nurse like Macanlalay, Plaintiffs allege that she was similarly required to flag
15 Morton as a high-risk for suicide given her knowledge of, inter alia, Morton’s “verbalized
16 suicidal ideations, the self-harming attempt in front of the unknown deputy the day prior,
17 his recent suicide attempt on May 8, 2020, and symptoms of withdrawal.” See FAC ¶¶
18 42, 57. At this stage of litigation, the Court is satisfied that Plaintiffs plausibly allege
19 causation against Alto. See Mendoza, U.S. Dist. LEXIS 79972, at *15. Accordingly, the
20 Court DENIES County Defendants’ motion to dismiss Claim 1 against Alto.6
21
22
23 6 County Defendants alternatively argue that, even if the FAC sufficiently alleges Macanlalay or Alto
violated the Fourteenth Amendment, they are entitled to qualified immunity. Doc. No. 10-1 at 23–27.
24
However, the Ninth Circuit has cautioned that a motion to dismiss on qualified immunity grounds puts
25 the Court in the potentially untenable position of trying “to decide far-reaching constitutional questions
on a nonexistent factual record[.]” Kwai Fun Wong v. United States, 373 F.3d 952, 957 (9th Cir. 2004).
26 The Court concludes that such a fact intensive determination is inappropriate at this stage of the
proceedings. See Groten v. California, 251 F.3d 844, 851 (9th Cir. 2001) (“[A] Rule 12(b)(6) dismissal
27 is not appropriate unless we can determine, based on the complaint itself, that qualified immunity
applies.”). Thus, the Court DENIES County Defendants’ request for qualified immunity without
28
1 B. Fourteenth Amendment Medical Care – Municipal Liability Under § 1983
2 In their second cause of action, Plaintiffs allege the County’s suicide prevention
3 and self-harm policy and training program is inadequate and violates the Fourteenth
4 Amendment. FAC ¶¶ 75–106. Accordingly, Plaintiffs bring a § 1983 claim against the
5 County and Liberty. Id.
6 “Section 1983 provides a cause of action for ‘the deprivation of any rights,
7 privileges, or immunities secured by the Constitution and laws’ of the United States.”
8 Wilder v. Virginia Hosp. Ass’n, 496 U.S. 498, 508 (1990) (quoting 42 U.S.C. § 1983).
9 Section 1983 “‘is not itself a source of substantive rights,’ but merely provides ‘a method
10 for vindicating federal rights elsewhere conferred.’” Graham v. Connor, 490 U.S. 386,
11 393–94 (1989) (quoting Baker v. McCollan, 443 U.S. 137, 144 n.3 (1979)).
12 Municipalities cannot be held vicariously liable under § 1983 for the actions of their
13 employees. Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 691, 694 (1978). “Instead, it is
14 when execution of a government’s policy or custom, whether made by its lawmakers or
15 by those whose edicts or acts may fairly be said to represent official policy, inflicts the
16 injury that the government as an entity is responsible under § 1983.” Id. at 694.
17 To establish liability for governmental entities under Monell, a plaintiff must prove
18 “(1) that the plaintiff possessed a constitutional right of which she was deprived; (2) that
19 the municipality had a policy; (3) that this policy amounts to deliberate indifference to the
20 plaintiff’s constitutional right; and[] (4) that the policy is the moving force behind the
21 constitutional violation.” Dougherty v. City of Covina, 654 F.3d 892, 900 (9th Cir. 2011)
22 (brackets omitted) (quoting Plumeau v. Sch. Dist. No. 40 County of Yamhill, 130 F.3d
23 432, 438 (9th Cir. 1997)).
24 District courts have found that Monell allegations are sufficient for Rule 12(b)(6)
25 purposes where the allegations “(1) identify the challenged policy/custom; (2) explain
26 how the policy/custom is deficient; (3) explain how the policy/custom caused the plaintiff
27 harm; and (4) reflect how the policy/custom amounted to deliberate indifference, i.e.
28 show how the deficiency was obvious and that the constitutional injury was likely to
1 occur.” Soler v. County of San Diego, No. 14-cv-2470-MMA (RBB), 2015 WL
2 13828659, at *4 (S.D. Cal. Mar. 19, 2015) (quoting Lucas v. City of Visalia, No. 1:09-cv-
3 1015 AWI DLB, 2010 WL 1444667, at *4 (E.D. Cal. Apr. 12, 2010)).
4 County Defendants argue that “Plaintiffs cannot show that any County policy was
5 the ‘moving force’ behind the defendants’ alleged wrongful conduct while
6 simultaneously claiming that same conduct violated County policy.” Doc. No. 10-1 at
7 30. County Defendants also argue that the FAC fails to specify “how [the County’s
8 suicide prevention policies and protocols] are inadequate, or what changes would render
9 them adequate.” Id. at 29.
10 In their FAC, Plaintiffs cite to a variety of news articles detailing in-custody
11 suicides of inmates in San Diego County. FAC ¶¶ 76–96. Plaintiffs allege that these
12 articles illustrate that the County “continues to be deliberately indifferent by failing to
13 adequately train its medical staff how to identify inmates that are a high-risk for suicide
14 and how to properly treat and house those inmates on a continued basis.” Id. ¶ 98.
15 Plaintiffs further allege that “[t]he inadequate provisions identified by the [California]
16 Grand Jury include shortcomings pertaining to the intake screening [of detainees], the
17 interplay of self-harming conduct with mental health issues, and overall training in
18 regards to treating and housing inmates facing on-going suicidal ideations.” Id. ¶¶ 76,
19 78.
20 However, Plaintiffs fail to identify any specific policy provision, nonetheless
21 explain how such a provision is deficient. While Plaintiffs incorporate a “Grand Jury
22 Report,” see id. ¶ 76 fn.3, 78, by reference, this is insufficient to provide County
23 Defendants with “fair notice of what the . . . claim is and the grounds upon which it
24 rests.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). Plaintiffs cannot simply
25 point to evidence of broad inadequacy; they must also explain how a challenged
26 municipal policy or custom is deficient. Soler, 2015 WL 13828659, at *4. Accordingly,
27 the Court GRANTS County Defendants’ motion to dismiss Claim 2 against the County.
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1 C. Medical Malpractice / Gross Negligence
2 In their third cause of action, Plaintiffs allege “Gross Negligence / Medical
3 Malpractice” against all Defendants. FAC ¶¶ 107–18. “There is no separate, recognized
4 cause of action for ‘gross negligence.’” Bradford v. Khamooshian, No. 17-cv-02053-
5 BAS-MDD, 2019 U.S. Dist. LEXIS 13423, at *11 (Jan. 28, 2019) (citing Allen v.
6 Woodford, No. 05-cv-1104, 2006 WL 3762053, at *15 (E.D. Cal. 2006)). Thus, the
7 Court construes the claim as one for medical malpractice.
8 “[I]n any medical malpractice action, the plaintiff must establish: (1) the duty of
9 the professional to use such skill, prudence, and diligence as other members of his
10 profession commonly possess and exercise; (2) a breach of that duty; (3) a proximate
11 causal connection between the negligent conduct and the resulting injury; and (4) actual
12 loss or damage resulting from the professional’s negligence.” Hanson v. Grode, 76 Cal.
13 App. 4th 601, 606 (Cal. Ct. App. 1999).
14 The California Code of Civil Procedures sets forth the statute of limitations for
15 medical malpractice:
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In an action for injury or death against a health care provider based upon such
17
person’s alleged professional negligence, the time for the commencement of
18 action shall be three years after the date of injury or one year after the plaintiff
discovers, or through the use of reasonable diligence should have discovered,
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the injury, whichever occurs first.
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21 Cal. Code. Civ. Proc. 340.5.
22 County Defendants argue that Plaintiffs’ medical malpractice claim is time barred.
23 Doc. No. 10-1 at 31. Specifically, County Defendants contend that the statute of
24 limitations began to run on May 17, 2020—the date of Morton’s death—and that
25 Plaintiffs’ filing date of August 9, 2021 in this case therefore exceeds the one-year time
26 limit for filing. Id.
27 “When an issue as to the statute of limitations appears ‘on the face of the
28 complaint,’ the party seeking tolling ‘has an obligation to anticipate the defense and plead
1 facts to negative the bar.’” Haaland v. Garfield Beach CVS, No. LA CV18-01115 JAK
2 (MRWx), 2018 U.S. Dist. LEXIS 237325, at *9 (C.D. Cal. June 6, 2018) (quoting Union
3 Carbide Corp. v. Super. Ct., 36 Cal. 3d 15, 25 (1984)). Here, the FAC is silent as to any
4 delay between Morton’s date of death and Plaintiffs’ discovery of the alleged
5 professional negligence.7 Accordingly, the Court GRANTS County Defendants’ motion
6 to dismiss Claim 3 against Alto, Macanlalay, and the County.
7 D. Wrongful Death / Survival
8 In their fourth cause of action, Plaintiffs allege “Wrongful Death / Survival”
9 against all Defendants. FAC ¶¶ 119–29. As an initial matter, wrongful death claims and
10 survival claims have separate statutory bases. See Chipman v. Nelson, No. 2:11-cv-2770-
11 TLN-EFB PS, 2015 U.S. Dist. LEXIS 121559, at *11, 33 (E.D. Cal. Sept. 11, 2015).
12 “Unlike a wrongful death cause of action, a survival cause of action is not a new cause of
13 action that vests in heirs on the death of the decedent, but rather is a separate and distinct
14 cause of action which belonged to the decedent before death but, by statute, survives the
15 event.” See id. at *11 (quoting Dela Torre v. City of Salinas, No. C-09-00626 RMW,
16 2010 U.S. Dist. LEXIS 97725, at *19 (N.D. Cal. Sept. 17, 2010). As such, a wrongful
17 death claim brought by a decedent’s survivor is a separate and distinct cause of action
18 from a personal injury claim brought by a decedent’s estate, which survives his death
19 pursuant to California’s survival statute, California Code of Civil Procedure § 377.30.
20
21
22
23 7 In their opposition to the motion to dismiss, Plaintiffs argue that the medical malpractice claim is
timely brought because the Section 340.5 clock was tolled until Plaintiffs became aware of the wrongful
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cause leading to the injury. Doc. No. 13 at 25. Plaintiffs state that they “were ignorant of any potential
25 negligence until they received [Morton]’s in-custody medical records on March 11, 2021.” Id. at 26.
However, the Court can only consider facts alleged in the complaint—not facts raised for the first time
26 in opposition to a motion to dismiss. Schneider v. Cal. Dep’t of Corr., 151 F.3d 1194, 1197 n.1 (9th Cir.
1998) (“In determining the propriety of a Rule 12(b)(6) dismissal, a court may not look beyond the
27 complaint to a plaintiff’s moving papers, such as a memorandum in opposition to a defendant’s motion
to dismiss . . . The focus of any Rule 12(b)(6) dismissal—both in the trial court and on appeal—is the
28
1 Moreover, a wrongful death claim is not a “survival” claim; as it never belonged to a
2 decedent, it cannot survive his death. See Cal. Code Civ. Proc. § 377.60.
3 It is unclear from the FAC what “survival” claim Plaintiffs seek to hold County
4 Defendants liable for in their fourth cause of action. To be sure, in their fourth cause of
5 action, Plaintiffs do not identify any claim that survives Morton’s death. Accordingly,
6 the Court DISMISSES the fourth cause of action to the extent Ms. Morton attempts to
7 bring a “survival” claim on Morton’s behalf.
8 Plaintiffs do, however, allege wrongful death as Morton’s survivors. See FAC ¶¶
9 119–29. “The elements of the cause of action for wrongful death are the tort (negligence
10 or other wrongful act), the resulting death, and the damages, consisting of the pecuniary
11 loss suffered by the heirs.” Quiroz v. Seventh Ave. Center, 140 Cal. App. 4th 1256, 1263
12 (2006) (internal citation omitted).
13 County Defendants argue that the wrongful death claim is derivative of Plaintiffs’
14 negligence claim and so must be dismissed if the negligence claim is dismissed. See
15 Doc. No. 10-1 at 32. However, “[a] wrongful death claim may be based on a federal
16 claim of deliberate indifference under § 1983.” Estate of Miller v. County of Sutter, 2020
17 WL 6392565, at *16 (E.D. Cal. Oct. 30, 2020) (citing Villarreal v. County of Monterey,
18 254 F. Supp. 3d 1168, 1190–91 (N.D. Cal. 2017)); see also Deloney, 2019 U.S. Dist.
19 LEXIS 71089, at *28–29 (concluding that because Plaintiff alleged sufficient facts to
20 state a § 1983 claim for deliberate indifference, “it follows that Plaintiff has sufficiently
21 pled the [Cal. Code Civ. Proc.] § 377.60 wrongful death claim”) (additional citations
22 omitted).
23 In this case, Plaintiffs’ § 1983 claims against Defendants Macanlalay and Alto
24 survive County Defendants’ motion to dismiss and therefore can plausibly serve as a
25 basis for Plaintiffs’ wrongful death claim. However, because the Court dismisses
26 Plaintiffs’ § 1983 and medical malpractice claims against the County supra, Plaintiffs’
27 wrongful death claim against the County lacks a plausible basis in the FAC.
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1 Accordingly, to the extent Claim 4 is brought against Defendants Macanlalay and
2 || Alto, the Court DENIES County Defendants’ motion to dismiss. However, the Court
3 ||}GRANTS County Defendants’ motion to dismiss Claim 4 as to the County.
4 IV. CONCLUSION
5 For the foregoing reasons, the Court GRANTS IN PART and DENIES IN PART
6 || County Defendants’ motion to dismiss. In particular, the Court GRANTS the motion
7 |}and DISMISSES Claims 2, 3, and 4 as described above and with leave to amend. See
8 || Knappenberger, 566 F.3d at 942. The Court DENIES the remainder of County
9 || Defendants’ motion. If Plaintiffs wish to file a second amended complaint curing the
10 || deficiencies noted herein, they must do so on or before February 7, 2022.
11 IT IS SO ORDERED.
12 Dated: January 10, 2022
13 DMiiduk UU - hills
14 HON. MICHAEL M. ANELLO
15 United States District Judge
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