United States District Court, D. Idaho
MEMORANDUM DECISION AND ORDER
Lynn Winmill U.S. District Court Judge.
the Court is Plaintiff's Motion for Preliminary
Injunction Pursuant to F.R.C.P. 65. Dkt. 18. Having reviewed
the parties' briefing, as well as the record in this
case, the Court has determined that oral argument is
unnecessary. Accordingly, the Court enters the following
65 preliminary injunction may be granted if the moving party
demonstrates the following elements: (1) that the moving
party will suffer irreparable injury if the relief is denied;
(2) that the moving party will probably prevail on the
merits; (3) that the balance of potential harm favors the
moving party; and (4) that the public interest favors
granting relief. Winter v. Natural Res. Defense Council,
Inc., 555 U.S. 7, 20 (2008); Doe v. Kelly, 878
F.3d 710, 719 (9th Cir. 2017). “Because a preliminary
injunction is an extraordinary remedy, the movant's right
to relief must be clear and unequivocal.” Dominion
Video Satellite v. Echostar Satellite Corp., 269 F.3d
1149, 1154 (10th Cir. 2001).
purpose of a preliminary injunction is to preserve the status
quo if the balance of equities so heavily favors the moving
party that justice requires the court to intervene to secure
the positions of the parties until the merits of the action
are ultimately determined. University of Texas v.
Camenisch, 451 U.S. 390, 395 (1981). Where, as here, a
party seeks a mandatory preliminary injunction, the court
must deny such relief “unless the facts and law clearly
favor the moving party.” Stanley v. Univ. of S.
Cal., 13 F.3d 1313, 1320 (9th Cir.1994) (internal
quotation marks omitted).
deciding whether to issue a preliminary injunction, the Court
“is not bound to decide doubtful and difficult
questions of law or disputed questions of fact.”
Int'l Molders' and Allied Workers' Local Union
No. 164 v. Nelson, 799 F.2d 547, 551 (9th Cir.1986).
Because the first element-likelihood of success on the
merits-is “a threshold inquiry, when a plaintiff has
failed to show the likelihood of success on the merits, [a
district court] need not consider the remaining three.”
Garcia v. Google, Inc., 786 F.3d 733, 740 (9th Cir.
2015) (internal quotation marks omitted). The Court begins
its analysis there.
Amended Complaint, Mr. Cox alleges that an outside
specialist, Dr. Bunt, diagnosed him with Thoracic Outlet
Syndrome (“TOS”) and recommended surgery to
address the condition. Dkt. 7 at 7. Mr. Cox alleges
Defendants then failed to authorize and provide surgery as
recommended, instead sending him to another doctor who
diagnosed him with Complex Regional Pain Syndrome
(“CRPS”) and recommended alternative treatment.
Id. at 8. As a result, Plaintiff alleges he suffers
pain and blockage of his arteries, and that he lives with
fear of blood clots, stroke, or heart attack. Id.
Now, Mr. Cox seeks mandatory injunctive relief that he be
“sent to an outside doctor, a specialist in his field
of medicine, to be tested, diagnosed, and treated for his
medical condition, ” which he alleges is TOS, not CRPS,
as diagnosed by Defendants. Dkt. 18 at 13, 16. He further
asks the court to order the IDOC to follow the
recommendations of the outside specialist and submit a
remedial plan to cure the symptoms he alleges in his Amended
Complaint. Id. Although Mr. Cox has alleged
sufficient facts to survive the Court's initial screening
pursuant to 28 U.S.C. § 1915A, he does not present
enough evidence to establish a likelihood of success on the
merits to justify mandatory preliminary injunctive relief.
Mr. Cox Does Not Establish a Likelihood of Success on the
motion for preliminary injunction that “orders a
responsible party to ‘take action'” is a
request for a mandatory preliminary injunction, which
requires a more significant factual showing from Mr. Cox.
Marlyn Nutraceuticals, Inc. v. Mucos Pharma GmbH
& Co., 571 F.3d 873, 879 (9th Cir. 2009) (citation
omitted). As the Ninth Circuit has cautioned, a mandatory
injunction “goes well beyond simply maintaining the
status quo pendente lite [and] is particularly
disfavored.” Garcia, 786 F.3d at 740. Mr. Cox
therefore faces a heightened burden to show “that the
law and facts clearly favor h[is] position, not simply that
he is likely to succeed.” Id. Furthermore,
to prevail on a claim that he was denied adequate medical
care in violation of the Eighth Amendment, Mr. Cox must
establish that Defendants were deliberately indifferent to
his “serious” medical needs. Lopez v.
Smith, 203 F.3d 1122, 1131 (9th Cir. 2000). Deliberate
indifference is shown only where an official “knows of
and disregards an excessive risk of inmate health and
safety....” Farmer v. Brennan, 511 U.S. 825,
bases his Eighth Amendment claim on a difference of medical
opinion between Dr. Bunt, who initially recommended surgery
and a referral to an outside pain specialist, and Defendants
Dr. Migliori, Mr. Pierson, Mr. Roberts and Ms. Seigert, who
collectively carried out an alternate course of treatment.
Dkt. 10 at 6. But a difference of medical opinion between
doctors over medical treatment does not amount to deliberate
indifference to a serious medical need. See Sanchez v.
Vild, 891 F.2d 240, 242 (9th Cir. 1989). “[T]o
prevail on a claim involving choices between alternative
courses of treatment, a prisoner must show that the chosen
course of treatment ‘was medically unacceptable under
the circumstances,' and was chosen ‘in conscious
disregard of an excessive risk' to the prisoner's
health.” Toguchi v. Chung, 391 F.3d 1051, 1058
(9th Cir. 2004). Mr. Cox has not pointed to any evidence to
suggest any individual Defendant made a decision that was
“medically unacceptable” or that
“conscious[ly] disregard[ed] an excessive risk”
to his health and safety.
contrary, Defendants have submitted evidence to show that Mr.
Cox's treatment plan was reasonable under the
circumstances. For example, Defendants have pointed to the
fact that Dr. Migliori is an expert in treating chronic pain,
and that Mr. Cox has responded well to some of the treatments
he has received. Dkt. 21 at 7-9. Defendants also introduce
evidence which suggests Mr. Cox's original diagnosis came
from a doctor who was “not an expert in the field,
” and that CRPS is a “poorly understood
condition” that is difficult to diagnose and treat.
Dkt. 21-1 at 3. Mr. Cox does not refute these claims with any
evidence of his own. In all, the evidence accompanying Mr.
Cox's Amended Complaint and Motion for Preliminary
Injunction favors the Defendants, rather than Mr. Cox. He has
therefore failed to meet the heavy burden required to show a
likelihood of success on the merits that would justify
mandatory preliminary injunctive relief.
only does Plaintiff fail to demonstrate a likelihood of
success on the merits of his claim, he also fails to show
that he is likely to suffer irreparable injury if a
preliminary injunction does not issue. There is no evidence
in the record that Mr. Cox's pain is increasing, or that
he will suffer further significant harm if he does not
receive the treatment he seeks. See generally Dkts.
7, 18. Instead, Dr. Migliori who has significant experience
in pain management submits that Mr. Cox “is not at any
risk of harm- imminent, irreparable, or otherwise-and an
off-site referral would very likely result in a
recommendation to attempt the very treatments he is now
receiving.” Dkt. 21-1 at 5. Because Mr. Cox does not