1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 SOUTHERN DISTRICT OF CALIFORNIA 10 11 ESTATE OF MATTHEW SETTLES, by Case No.: 3:24-cv-352-CAB-MSB and through its successor in interest 12 BRENDA SETTLES, and BRENDA ORDER PARTIALLY GRANTING 13 SETTLES, MOTIONS TO DISMISS

14 Plaintiffs, [Doc. Nos. 73, 81] 15 v. 16 COUNTY OF SAN DIEGO, et al., 17 Defendants. 18 19 Plaintiffs Estate of Matthew Settles, by and through its successor in interest Brenda 20 Settles (“Estate”), and Brenda Settles (collectively, “Plaintiffs”) sued Defendants County 21 of San Diego, et al. for the death of Matthew Settles (“Decedent”) on August 16, 2022 22 while he was held in administrative segregation at George Bailey Detention Facility 23 (“GBDF”). The Court partially granted motions to dismiss the First Amended Complaint 24 pursuant to Fed. R. Civ. P. 12(b)(6). [Doc. No. 67.] Plaintiffs then filed a Second Amended 25 Complaint (“SAC”) on May 30, 2025. [Doc. No. 68.] The SAC asserts eight causes of 26 action against eight named Defendants and twenty Doe Defendants. [SAC ¶¶ 20–33.] 27 Pending before the Court are two motions to dismiss the SAC pursuant to Fed. R. Civ. P. 28 1 12(b)(6). [Doc. Nos. 73, 81.] For the reasons discussed below, the Court PARTIALLY 2 GRANTS the motions to dismiss. 3 I. BACKGROUND 4 A. Relevant Facts 5 Given the length of the SAC and this case’s previous opinion outlining the case, 6 [Doc. No. 67], the Court recites only the core allegations, many of which remain the same. 7 The Court takes the alleged material facts as true and construes them in the light most 8 favorable to Plaintiff. Stoner v. Santa Clara Cnty. Off. of Educ., 502 F.3d 1116, 1120 (9th 9 Cir. 2007). 10 While hospitalized at San Diego County Psychiatric Hospital (“County Mental 11 Health” or “CMH”), Decedent was transferred to the San Diego Central Jail (“Central Jail” 12 or “SDCJ”) on June 4, 2022 after expressing aggression toward another patient. [SAC ¶ 13 64.] Decedent suffered from severe psychiatric issues and had been under permanent 14 conservatorship since November 2019. [SAC ¶ 45.] As alleged, Decedent had no right to 15 refuse medical treatment. [Id.] Decedent had previously put himself in harm’s way, 16 including by leaping in front of the San Diego trolley and by jumping into the bear exhibit 17 at the San Diego Zoo, where he was mauled. [SAC ¶ 40.] 18 Plaintiffs allege that during Decedent’s intake process at the Central Jail, no medical 19 staff nor correctional officer flagged within the Jail Information Management System 20 (“JIMS”) that Decedent was under permanent conservatorship and should have been 21 housed in the Psychiatric Security Unit (“PSU”). [See SAC ¶¶ 49–53, 66–67, 100.] The 22 PSU is a psychiatric care facility operated by the San Diego County Sheriff’s Department 23 at the Central Jail that offers 24-hour mental health treatment. [SAC ¶ 50.] Plaintiffs allege 24 that the Sheriff’s PSU Policy requires people like Decedent—who are deemed gravely 25 disabled and appointed a permanent conservator—to be admitted to the PSU. [SAC ¶ 51.] 26 Decedent was previously housed in the PSU prior to his June 4, 2022 booking at the Central 27 Jail. [SAC ¶ 53.] During that time, he apparently refused medications on a routine basis, 28 1 adhered to poor hygiene, and at one point stabbed himself in the eye with a hypodermic 2 needle after hearing a voice commanding that he do so. [SAC ¶¶ 60–62.] 3 On his third day of custody at SDCJ, Decedent’s cellmate allegedly assaulted him, 4 and Decedent received emergency care at the hospital. [SAC ¶ 73.] He returned to SDCJ 5 upon his discharge from the hospital. But instead of placement in the PSU, he was housed 6 in a medical observation unit (“MOB”) where he continued to refuse treatment. [SAC ¶¶ 7 75–76.] At least one medical professional requested an evaluation of whether Decedent 8 had the capacity to refuse treatment. [SAC ¶ 78.] 9 On July 13, 2022, Decedent apparently suffered a skull fracture due to an assault he 10 suffered while housed in MOB. [SAC ¶¶ 79–80.] This time, after receiving treatment, 11 Decedent was placed into administrative segregation rather than the PSU. [SAC ¶¶ 81– 12 83.] Plaintiffs allege that administrative segregation amounted to solitary confinement. 13 [SAC ¶¶ 84–85.] Plaintiffs generally allege that administrative segregation is very harmful 14 to those, like Decedent, who are severely incapacitated and are at risk for suicide. [Id.] 15 From there, Plaintiffs describe Decedent’s steady decline. They identify numerous 16 Defendants as having some involvement in the decision to place Decedent in administrative 17 segregation, the failure to remove him from administrative segregation, and the failure to 18 provide adequate medical care. These Defendants include various medical care providers, 19 mental health professionals, and jail officers. [See generally, SAC ¶¶ 83–100, 109–134.] 20 As pleaded, the healthcare providers checked on Decedent with some regularity, though 21 there were days where he was not seen by any medical or mental health professionals. [Id.] 22 Decedent’s condition continued to deteriorate in administrative segregation. [See, e.g., 23 SAC ¶¶ 111, 120.] 24 On August 16, 2022, Decedent was found hanging in his cell. [SAC ¶ 127.] The 25 day of his death, he was third in line to be transferred to a state hospital for mental health 26 treatment. [SAC ¶ 134.] The District Attorney had agreed to dismiss all pending charges 27 against him once he was so hospitalized. [Id.] 28 /// 1 B. PROCEDURAL BACKGROUND 2 This case already has a lengthy procedural history. Most recently, the Court 3 dismissed several defendants and claims in the First Amended Complaint, some with 4 prejudice and others with leave to amend. [Doc. No 67.] 5 There are now two motions to dismiss the SAC under Fed. R. Civ. Proc. 12(b)(6). 6 The first is by the Medical Defendants Janet Medenwald-Hogg, Jason Balingit, Anthony 7 Cruz, Naphcare of San Diego, LLC, and NaphCare, Inc. [Doc. No. 81.] The second is by 8 the County Defendants, which include San Diego County, the San Diego Sheriff’s 9 Department, the San Diego County Central Jail, and the George Bailey Detention Center 10 (collectively, “County of San Diego”), as well as Aseel Ross and Does 1–20. [Doc. 73-1 11 at 8–9.]1 12 II. LEGAL STANDARD 13 The familiar standard applies for a motion to dismiss. Fed. R. Civ. P. 12(b)(6) 14 permits a party to file a motion to dismiss for “failure to state a claim upon which relief 15 can be granted.” “To survive a motion to dismiss, a complaint must contain sufficient 16 factual matter . . . to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 17 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). 18 “Vague and conclusory allegations” concerning government involvement in civil rights 19 violations are insufficient to withstand a motion to dismiss. Ivey v. Bd. of Regents of Univ. 20 of Alaska, 673 F.2d 266, 268 (9th Cir. 1982). 21 III. ANALYSIS 22 A. Allegations Against the Doe Defendants 23 Plaintiffs have reduced the number of Doe Defendants from over 100 in the FAC to 24 20 in the SAC. Does 1–5 are housing deputies assigned to the portion of the GBDF where 25

26 1 Some of the individuals sued appear to be private actors, but no Defendant has raised the argument that 27 there is a state action problem challenging the Section 1983 claims. See Sutton v. Providence St. Joseph Med. Ctr., 192 F.3d 826, 835 (9th Cir. 1999) (listing factors by which a private actor can be viewed as 28 1 Matthew Settles was housed. [SAC ¶ 30.] Does 6–20 are unknown “jail staff, detention 2 officers, JPMU (‘classification’) officers, medical staff, medical providers, mental health 3 staff, mental health providers, supervisors, employees, agents, contractors, and final 4 policymakers who substantially contributed to the acts and omissions giving rise to the 5 damages claimed herein.” [SAC ¶ 31.] Despite the SAC’s reduced number of alleged Doe 6 Defendants, County Defendants argue that Plaintiffs’ accusations remain too generalized 7 to satisfy federal and state pleading standards for Doe defendants. [Doc. No. 73-1 at 15– 8 18.] Plaintiffs acknowledge the need for individualized allegations and contend that they 9 have “endeavored to be guided by this Court’s admonishment” to so plead each Doe’s 10 involvement. [Doc. No. 82 at 13.] The Court disagrees. 11 Plaintiffs are still unable to “furnish the information necessary to identify the 12 defendant,” as Plaintiffs acknowledge they must. [Doc. No. 82 at 16 (quoting Keavney v. 13 Cnty. of San Diego, 2020 U.S. Dist. LEXIS 128512, *8 (S.D. Cal. 2020)).] For example, 14 Plaintiffs’ opposition to the County Defendants’ motion to dismiss cites paragraphs 127– 15 130 and 226–227 of the SAC as evidence of individualized factual allegations against Does 16 1-5. [Doc. No. 82 at 16–17.] None of these paragraphs even mention Does 1–5, let alone 17 make individualized factual allegations against them. Indeed, the only difference the Court 18 can discern between Plaintiffs’ allegations against the Doe Defendants in the FAC and 19 SAC is a reduction in total number and the splitting of remaining Does into two groups— 20 Does 1–5 (GBDF housing staff) and Does 6–20 (a group that sweeps in jail staff to 21 policymakers). This is insufficient. The Court again GRANTS the County Defendants’ 22 motion to DISMISS Does 1–20. 23 B. Qualified Immunity 24 Defendants Cruz, Medenwald-Hogg, Ross, Balingit, Ortiz, and Boyd assert a 25 qualified immunity defense against Plaintiffs’ first and second causes of action. [Doc. No. 26 81-1 at 16-17]. Plaintiffs argue that under Jensen v. Lane Cnty., 222 F.3d 570 (9th Cir. 27 2000), the defense of qualified immunity is unavailable to private medical providers 28 contracted to provide care in a prison. [Doc. No. 85 at 27.] In Jensen, the Ninth Circuit 1 held that a private medical doctor providing contracted mental health services to a county 2 was not entitled to qualified immunity. 222 F.3d at 576–79. Defendants argue that the 3 present case is distinguishable because Plaintiffs have not alleged the performance of any 4 non-medical, administrative tasks. [Doc. No. 89 at 6.] The Court finds Jensen squarely on 5 point and is not persuaded by Defendants’ superficial attempts to distinguish it based on 6 the amount of non-medical, administrative tasks performed by the Defendants. 7 The motion to dismiss based on the affirmative defense of qualified immunity is 8 DENIED. 9 C. First Cause of Action: Violation of Fourteenth Amendment Pursuant to 10 42 U.S.C. Section 1983 (Successor in Interest) 11 Plaintiffs plead a § 1983 claim against Defendants Cruz, Medenwald-Hogg, Ross, 12 Balingit, Ortiz, Boyd, and Does 1–20 for deliberate indifference to Decedent’s medical 13 needs. [SAC ¶¶ 135–144.] 14 To sustain a Fourteenth Amendment claim in this context, Plaintiffs must show 15 objective deliberate indifference. Gordon v. Cnty. of Orange, 888 F.3d 1118, 1125 (9th 16 Cir. 2018). To do so, Plaintiffs must allege sufficient facts to show that: “(i) the defendant 17 made an intentional decision with respect to the conditions under which the plaintiff was 18 confined; (ii) those conditions put the plaintiff at substantial risk of suffering serious harm; 19 (iii) the defendant did not take reasonable available measures to abate that risk, even though 20 a reasonable official in the circumstances would have appreciated the high degree of risk 21 involved—making the consequences of the defendant’s conduct obvious; and (iv) by not 22 taking such measures, the defendant caused the plaintiff’s injuries.” Id. The Supreme 23 Court has explained that “mere lack of due care by a state official” does not “‘deprive’ an 24 individual of life, liberty, or property under the Fourteenth Amendment.” Castro v. Cnty. 25 of Los Angeles, 833 F.3d 1060, 1071 (9th Cir. 2016) (quoting Daniels v. Williams, 474 U.S. 26 327, 330–31 (1986)). This Circuit has held that a plaintiff needs “more than negligence.” 27 Gordon, 888 F.3d at 1125. 28 1 The Court analyzes the arguments raised by each group of Defendants in their 2 respective papers. 3 i. Defendants Cruz, Balingit, Medenwald-Hogg, and Ross [Doc. No. 81] 4 Defendant Cruz is a psychiatrist employed by NaphCare, Inc. and/or Naphcare of 5 San Diego, LLC (“Naphcare”) who provided mental health services at the Central Jail in 6 July 2022. [SAC ¶¶ 23.] Plaintiffs allege that Dr. Cruz was responsible for providing 7 mental healthcare to Decedent, including reviewing Decedent’s medical chart and history 8 on June 29, 2022 and participating in a meeting on July 15, 2022 where the decision was 9 made to place Decedent in administrative segregation at the Central Jail. [SAC ¶¶ 77, 83.] 10 Plaintiffs also claim that—despite Decedent’s known psychiatric history and risk—Dr. 11 Cruz failed to appropriately treat Decedent or flag that Decedent should not be placed in 12 administrative segregation. [SAC ¶¶ 89–90.] Defendants respond that Plaintiffs do not 13 allege how Dr. Cruz made an intentional decision to put Decedent in administrative 14 segregation, that the alleged decision put Decedent at substantial risk of suicide, or that Dr. 15 Cruz did not take reasonable available measures to abate such risk. [Doc. No. 81-1 at 13.] 16 The Court disagrees. 17 As opposed to the FAC, the SAC now alleges Dr. Cruz’s involvement in the 18 decision to place Decedent in administrative segregation and how that decision was 19 connected to his death. The SAC alleges that Dr. Cruz reviewed Decedent’s extensive 20 mental health and detention history and therefore knew, or should have known, the risk of 21 placing Decedent in administrative segregation instead of a PSU. [SAC ¶ 77 (alleging Dr. 22 Cruz reviewed Decedent’s chart on June 29, 2022).] The SAC also alleges that a 23 reasonable mental health professional would understand the risks of administrative 24 segregation for individuals with histories of severe mental health illness. [SAC ¶¶ 84–90, 25 101–08.] And the SAC alleges Dr. Cruz participated in the meeting where the decision 26 was made to place Decedent in administrative segregation. [SAC ¶ 83.] Though Dr. Cruz’s 27 actions may ultimately be found reasonable, or his actions at a different facility and a month 28 before Decedent’s death too attenuated, those are factual determinations the Court declines 1 to make at this juncture. The motion to dismiss the first cause of action against Defendant 2 Cruz is therefore DENIED. 3 The Court similarly DENIES the motion to dismiss the first cause of action against 4 Defendant Balingit, a psychiatric nurse practitioner employed by Naphcare who 5 participated in the care of Decedent during his time in administrative segregation at GBDF. 6 The Court previously dismissed the claim against Defendant Balingit because Plaintiffs 7 alleged no facts that Defendant Balingit “had anything to do with placing the Decedent into 8 administrative segregation. Nor do they plead that Defendant Balingit objectively 9 appreciated the risk associated with administrative segregation.” [Doc. No. 67 at 11.] The 10 SAC now contains allegations about the objective appreciation of the risk to Decedent of 11 administrative segregation. [See SAC ¶ 114 (“As a psychiatric nurse practitioner, 12 [Defendant Balingit] was also aware that the medical literature and caselaw clearly 13 established that placement of seriously mentally ill inmates in administrative segregation 14 created a high risk of suicide.”), ¶ 115 (“As an experienced psychiatric nurse practitioner, 15 Defendant Balingit knew that relying on inmates to self-report risks of suicide and self- 16 harm is completely unreliable.”).] The SAC also explains that Plaintiffs’ theory is not that 17 Defendant Balingit placed Decedent in administrative segregation, but instead that his 18 mental health care providers, including Defendant Balingit, should have recommended his 19 removal to a PSU, consulted with his conservator due to treatment refusal, and coordinated 20 with his case manager. [See, e.g., Id. ¶ 258.] The SAC therefore supplies sufficient 21 allegations, including the facts in the incorporated declarations by clinicians in similar 22 cases, that someone in Defendant Ballingit’s position should have been aware of the 23 allegedly high risk of harm that could befall Decedent in administrative segregation. See 24 Castro, 833 F.3d at 1071. At this stage, the Court draws that inference in Plaintiffs’ favor. 25 See Retail Clerks Int’l Ass’n, Loc. 1625, AFL-CIO v. Schermerhorn, 373 U.S. 746, 753 n.6 26 (1963) (a court may infer a fact from those alleged). 27 Defendant Medenwald-Hogg is a psychiatrist employed by Naphcare who 28 participated in the care of Decedent, including an alleged chart check on June 11, 2022 and 1 a telepsychiatry evaluation on July 23, 2022. [SAC ¶¶ 24, 74, 94.] The Court’s previous 2 order denied a motion to dismiss the § 1983 deliberate indifference claims against her 3 because even though “Defendant Medenwald-Hogg’s actions may have been entirely 4 reasonable . . . at this stage, the Court declines to make this factual determination.” [Doc. 5 No. 67 at 12.] Defendant Medenwald-Hogg acknowledges the prior denial of dismissal 6 but says the arguments were repeated (1) to avoid waiver and (2) because Plaintiffs 7 allegedly amended the factual allegations against Dr. Medenwald-Hogg. [Doc. No. 89 at 8 4.] Defendant Medenwald-Hogg points to no specific facts that were changed in the SAC. 9 Nor does she cite any case supporting the need to move again after the Court found the 10 prior complaint sufficient to survive 12(b)(6) dismissal. The Court again DENIES the 11 motion to dismiss the § 1983 claim against Dr. Medenwald-Hogg. 12 Similarly, the Court again DENIES the motion to dismiss the § 1983 claim against 13 Defendant Ross. The Court’s previous order allowed Plaintiffs to “proceed with their 14 Section 1983 claim against Defendant Ross” because Plaintiffs pleaded that “Defendant 15 Ross knew of Decedent’s status on a conservatorship, observed Decedent’s worsening 16 condition days before his suicide, and failed to take any action to remove him from 17 administrative segregation.” [Doc. No. 67 at 13.] Plaintiffs’ opposition points out the 18 Court’s previous order, which Defendants do not address. 19 ii. Defendants Ortiz and Boyd [Doc. No. 73] 20 Defendants Ortiz and Boyd are housing deputies at GBDF who were responsible for 21 conducting the safety checks of Matthew Settles’ housing module on the day he died. [SAC 22 ¶ 140.] Plaintiffs repeatedly conclude that these Defendants “violated Matthew’s 23 constitutional rights when they performed the deficient and untimely safety checks.” [SAC 24 ¶ 140; see also id. ¶¶ 27–28, 30, 133.] The totality of Plaintiffs allegations against these 25 Defendants, therefore, is that they conducted a safety check on Decedent at a 75-minute 26 interval instead of a 60-minute interval. This is insufficient. The Complaint wholly lacks 27 the requisite factual allegations for a finding of deliberate indifference, namely that 28 Defendants Ortiz and Cruz intentionally conducted their check fifteen minutes late, or that 1 a reasonable housing officer in the circumstances would have appreciated the high degree 2 of risk of conducting a safety check fifteen minutes late. See Castro, 833 F.3d at 1070; 3 Cavanaugh v. Cnty. of San Diego, No. 3:18-CV-02557-BEN-LL, 2020 WL 6703592 at 4 *13 (S.D. Cal. Nov. 12, 2020), aff’d, No. 20-56311, 2021 WL 6103115, at *1 (9th Cir. 5 Dec. 22, 2021) (dismissing § 1983 claims because plaintiff did not allege the officer’s “less 6 than thorough shift counts were the result of an intentional decision rather than mere or 7 even gross negligence or oversight”). 8 Finally, Plaintiffs make much of the existence of a pretrial detainee’s Constitutional 9 right to safety checks in Gordon v. Cnty. of Orange, 6 F.4th 961, 973 (9th Cir. 2021) 10 (“Gordon II”). However, Gordon II’s recognition of the existence of this right does not 11 abrogate the fundamental pleading requirements for stating a claim of deliberate 12 indifference. 13 The claims in the first cause of action against Defendants Ortiz and Boyd are 14 DISMISSED. 15 D. Second Cause of Action: Right of Association Claim (Brenda Settles) 16 Plaintiffs bring a Section 1983 right of association claim against Defendants Cruz, 17 Medenwald-Hogg, Ross, Balingit, Ortiz, Boyd, and Does 1–20. [SAC ¶¶ 145–157.] 18 Plaintiffs’ right of association claim is based on the theory that the above Defendants 19 caused Decedent’s death and therefore violated her Fourteenth Amendment right to 20 association with her son. [SAC ¶ 152.]2 The Court’s previous opinion dismissed the 21 FAC’s claims right of association claims against all defendants except Defendants 22 Medenwald-Hogg and Ross because the FAC did not contain facts meeting the “shocks the 23 conscience standard.” [Doc. No. 67 at 18 (quoting Porter v. Osborn, 546 F.3d 1131, 1137 24 25 2 Strangely, Defendants’ opposition argued that Plaintiffs’ theory was that Decedent’s right to association 26 with his mother was violated by his detention and lack of appropriate care or placement. [Doc. No. 73 at 23 (“[T]he SAC states that because Decedent was place in administrative segregation . . . his constitutional 27 right to association was violated.”) (emphasis added).] However, the SAC’s second cause of action is by Brenda Settles in her own right for the deprivation “of her liberty interest in her relationship with her 28 1 (9th Cir. 2008)).] Deliberate indifference may be “conscience-shocking” if the “official 2 had time to deliberate before acting or failing to act in a deliberately indifferent manner.” 3 Lemire v. California Dep’t of Corr. & Rehab., 726 F.3d 1062, 1075 (9th Cir. 2013). The 4 standard is an objective one. See Gordon, 888 F.3d at 1124–25. 5 Given the Court’s analysis of Plaintiffs’ first cause of action, Plaintiffs have not 6 alleged sufficient facts that would rise to the level of conscience shocking behavior to 7 sustain a § 1983 claim against Defendants Ortiz and Boyd. The second cause of action 8 against them is DISMISSED. However, the Court has allowed the § 1983 claims to 9 proceed against Defendants Medenwald-Hogg, Ross, Balingit, and Cruz and therefore 10 DENIES the motion to dismiss the second cause of action against these Defendants too. 11 E. Third Cause of Action: Monell Liability Claims Against the County of 12 San Diego (Brenda Settles and Successor in Interest) 13 Plaintiffs’ third cause of action is a Monell claim against the County of San Diego 14 under the Due Process Clause of the Fourteenth Amendment. [SAC ¶ 159.] Plaintiffs 15 appear to allege both traditional and omission Monell theories related to nine purported 16 policies, practices, and customs maintained by the county. [See SAC ¶ 160.] Although the 17 Plaintiffs frame their argument in different ways, they amount to the assertion that the 18 County’s procedures for dealing with mentally ill detainees were deficient, that the County 19 knew or should have known of these deficiencies, and that the County’s deliberate 20 indifference to these deficiencies resulted in Decedent’s death. Defendants argue that the 21 SAC does not “allege how each [policy, practice, or custom] was deficient, how each 22 Policy caused Decedent harm, and how that policy amounted to deliberate indifference.” 23 [Doc. No. 73 at 26.] 24 1. Monell Policy/Custom Claim 25 First is the traditional Monell theory. To survive a motion to dismiss under this 26 theory, Plaintiffs must allege (1) that the Decedent was deprived of his constitutional rights 27 by Defendants and their employees acting under color of state law; (2) that Defendants 28 have customs or policies which amount to deliberate indifference to his constitutional 1 rights; and (3) these policies are the moving force behind the constitutional violations. Lee 2 v. City of Los Angeles, 250 F.3d 668, 681–82 (9th Cir. 2001) (abrogated on other grounds). 3 “[A] bare allegation that [the individual officers’] conduct conformed to some unidentified 4 government policy or custom” is insufficient to state a Monell claim. AE ex rel. Hernandez 5 v. Cnty. of Tulare, 666 F.3d 631, 636 (9th Cir. 2012). Plaintiffs must plead objective 6 deliberate indifference. Deliberate indifference under the Due Process Clause requires 7 proof that a defendant acted with “more than negligence but less than subjective intent – 8 something akin to reckless disregard.” Gordon, 888 F.3d at 1125 (quoting Castro, 833 9 F.3d at 1071). 10 As an initial matter, the Court denied the previous motion to dismiss Plaintiffs’ 11 Monell claims with respect to the County’s alleged policies of (1) mental health assessment 12 at jail intake and (2) administrative segregation for severely disabled individuals. [Doc. 13 No. 67 at 6. See also SAC ¶¶ 160(b), (g), 240–44.] 14 The SAC also alleges several more traditional Monell theories, namely the alleged 15 policies of failing to “implement commonsense reforms,” deficient screening for mental 16 health at intake, failing to ensure medication continuity, and failing to share information 17 and coordinate care for seriously ill patients. [SAC ¶ 160(a), (c), (d).]. With the exception 18 of the first theory, discussed below, the Court finds these claims sufficient to survive a 19 motion to dismiss. [See SAC ¶¶ 171–259.] For example, the SAC alleges a custom and 20 practice of failing to properly continue medication for incoming inmates. [SAC ¶ 182.] 21 Plaintiffs incorporate the declaration of a medical doctor in another case to support the 22 existence of this practice and the resulting danger to detainees. [SAC ¶¶ 183–84.] 23 Plaintiffs also allege several ways the County was aware of the dangers of failing to 24 continue medication. [SAC ¶¶ 185–86 (reports provided to Sheriff’s Department in 2017 25 and 2018), ¶¶ 187–88 (facts concerning a 2019 death in SDCJ and resulting litigation). 26 Finally, Plaintiffs allege how the County of San Diego failed to ensure the continuity of 27 Decedent’s medication and that this led to his death. [SAC ¶¶ 189–92.] 28 1 The alleged policy of “ignoring and failing to implement commonsense reforms, 2 recommended by experts to remedy the record-setting inmate deaths and injuries in County 3 jails,” [SAC ¶ 160(a)], however, is inadequately pleaded. The theory consists only of 4 loosely pled legal conclusions without any specific factual support—which the Court is not 5 required to accept. See Cholla Ready Mix Inc. v. Civish, 382 F.3d 969, 973 (9th Cir. 2004). 6 2. Monell Omission Theories 7 Next are the omission-based Monell theories of how Plaintiffs allege that the County 8 of San Diego failed to act, resulting in the violation of Plaintiffs’ Fourteenth Amendment 9 rights. These theories are predicated upon the idea that the County’s failure “amounts to 10 deliberate indifference[.]” City of Canton v. Harris, 489 U.S. 378, 388 (1989). Like a 11 traditional Monell claim, Plaintiffs must (1) establish a direct causal link between a 12 county’s alleged omission and the alleged constitutional violation, and (2) plead objective 13 deliberate indifference. Castro, 833 F.3d at 1075–76 (citing City of Canton, 489 U.S. at 14 385). “Where a § 1983 plaintiff can establish that the facts available to city policymakers 15 put them on actual or constructive notice that the particular omission is substantially certain 16 to result in the violation of the constitutional rights of their citizens, the dictates of Monell 17 are satisfied.” City of Canton, 489 U.S. at 396 (O’Connor, J., concurring). 18 The County of San Diego yet again challenges Plaintiffs’ failure to train claim, 19 which the Court already found adequately pleaded in the FAC. [Doc. No. 67 at 8.] 20 Defendants have provided no facts or argument that would change this decision. 21 The SAC also outlines several additional Monell omission theories. [SAC ¶ 160(e) 22 failing to promulgate adequate suicide prevention policies and training, (f) failing to 23 promulgate adequate policy and training to address conservatorship status and treatment 24 refusal protocols, and (h) failure to promulgate adequate safety check policy.] As with 25 most of the traditional Monell theories, Plaintiffs have adequately pleaded the County’s 26 alleged omission, how that omission is linked to the alleged constitutional violation, and 27 how the County had actual or constructive notice of the likelihood of a resulting 28 constitutional violation. [SAC ¶¶ 203–216 (allegations regarding suicide prevention), 1 217–225 (allegations regarding conservatorship and treatment refusal), and 249–51 2 (allegations regarding safety checks).] 3 F. Fourth Cause of Action: ADA Claim Against the County of San Diego 4 (Successor in Interest) 5 1. Reasonable Accommodation Theory 6 Plaintiffs allege that the County violated the Americans with Disabilities Act of 1990 7 (“ADA”) because it did not reasonably accommodate Decedent by placing him in the PSU 8 instead of administrative segregation. [SAC ¶ 268.] Defendants are correct that a 9 defendant may “defeat the [reasonable accommodation] claim by showing that the 10 plaintiff’s proposed accommodation would cause an ‘undue burden.’” Mayfield v. City of 11 Mesa, 131 F.4th 1100, 1110 (9th Cir. 2025). However, “[t]he reasonableness of an 12 accommodation is ordinarily a question of fact.” Lujan v. Pac. Mar. Ass’n, 165 F.3d 738, 13 743 (9th Cir. 1999); see also Humphrey v. Mem’l Hosps. Ass’n, 239 F.3d 1128, 1139 (9th 14 Cir. 2001) (“Ordinarily, whether an accommodation would pose an undue hardship on the 15 employer is a factual question.”) The Court will not make this factual determination on a 16 12(b)(6) motion. 17 2. Disparate Impact Theory 18 Plaintiffs alternatively rely on a disparate impact theory. The Court’s previous order 19 dismissed Plaintiffs’ ADA claims because the FAC did not allege disparate treatment. 20 Now the SAC contains allegations that the County’s administrative segregation policy 21 disproportionately burdens inmates with severe mental illness, like the Decedent, in 22 comparison to inmates without severe mental illness. [See SAC ¶¶ 271–76.] For example, 23 according to Plaintiffs, inmates without severe mental illness are placed in administrative 24 segregation for disciplinary purposes for a limited period of time and allowed access to 25 additional facilities, whereas inmates with severe mental illness face an indefinite stay 26 without access to those facilities. [Id. ¶¶ 273–75.] The County of San Diego does not 27 substantively challenge these allegations, arguing instead that Plaintiffs have not shown 28 that “administrative segregation had an excessively burdensome impact on Decedent.” 1 [Doc. No. 73 at 34 (emphasis added).] Whether Plaintiffs will ultimately be able prove 2 these allegations remains to be seen, but that is not grounds for dismissing Plaintiffs’ ADA 3 claim at this stage. 4 G. Fifth Cause of Action: Violation of the Rehabilitation Act 29 U.S.C. 5 § 794(a) Against the County of San Diego (Successor in Interest) 6 The Ninth Circuit has found that a claim pursuant to the Rehabilitation Act tracks 7 the ADA. See Cnty. of Kitsap, 260 F.3d at 1138 (a Rehabilitation Act claim requires 8 intentional discrimination measured by the deliberate indifference standard). Plaintiffs 9 have stated a claim under the disparate impact theory of the ADA and therefore also state 10 a claim for violation of the Rehabilitation Act. 11 H. Sixth Cause of Action: Violation of Cal. Civil Code § 52.1 (Bane Act) 12 (Successor in Interest) 13 Plaintiffs bring Bane Act claims against Defendants Cruz, Medenwald-Hogg, Ross, 14 Balingit, Ortiz, Boyd, and Does 1–20. The Ninth Circuit has explained that the Bane Act 15 requires a showing of coercion. Lyall v. City of Los Angeles, 807 F.3d 1178, 1196 (9th Cir. 16 2015); see Cal. Civ. Code § 52.1 (requiring “threats, intimidation, or coercion”). The Ninth 17 Circuit has adopted the position that the Bane Act does not require the “threat, intimidation 18 or coercion” element of the claim to be different than the constitutional violation alleged. 19 Reese v. Cnty. of Sacramento, 888 F.3d 1030, 1043 (9th Cir. 2018). An adequately pleaded 20 claim for deliberate indifference satisfies the specific intent requirement of the Bane Act. 21 See id. at 1045 (“[A] reckless disregard for a person’s constitutional rights is evidence of a 22 specific intent to deprive that person of those rights.”). Defendants do not contest this 23 standard; rather, they argue that Plaintiffs have not shown deliberate indifference. [Doc. 24 No. 84 at 11; Doc. No. 81-1 at 18.] 25 Given the Court’s decision that the claims against Defendants Medenwald-Hogg, 26 Ross, Balingit, and Cruz have survived the deliberate indifference threshold at the 27 dismissal stage, the Court finds that Plaintiffs have adequately pleaded a Bane Act claim 28 1 against those defendants based on their deliberate indifference to Decedent’s medical 2 needs. All other Bane Act claims are DISMISSED. 3 I. Seventh & Eighth Causes of Action (Successor in Interest and Brenda 4 Settles, respectively) 5 The seventh and eighth causes of action are negligence and wrongful death actions 6 against Defendants Guerra-Ramirez, Cruz, Medenwald-Hogg, Ross, Balingit, Ortiz, Boyd, 7 Naphcare and Does 1–20. 8 i. Individual County Defendants 9 In their opposition to the motion to dismiss, “Plaintiff[s] agree[] to dismiss the 10 [negligence and wrongful death] causes of action against Defendants Guerra-Ramirez, 11 Ross, and Does 6–20. [Doc. No. 82 at 6, 36]. The Court DISMISSES the SAC’s seventh 12 and eighth causes of action against these individual County Defendants. 13 The remaining individual County Defendants are Defendants Ortiz, Boyd, and Does 14 1–5. The Court has already dismissed all claims against Does 1–5. See Section III.A., 15 supra. With respect to Defendants Ortiz and Boyd, both housing officers at GBDF, 16 Plaintiffs allege that Decedent was injured because they negligently did not make timely 17 safety checks on Decedent immediately before his death. [Doc. No. 82 at 36.] Defendants 18 argue that this theory means that “the County is immune, under [Cal. Gov. Code § 844.6],” 19 because Plaintiffs do not allege “that County Defendants knew or had reason to know 20 [Decedent] needed medical care and failed to take reasonable action to summon it.” [Doc. 21 No. 84 at 11.] 22 It appears that Defendants erroneously rely on the standard for failure to summon 23 medical care in § 845.6, instead of the general provision for injury due to negligence in 24 § 844.6, as Plaintiffs have alleged. [See SAC ¶ 293 (“The allegations [against] Defendants 25 Guerra-Ramirez, Ortiz, and Boyd, all employees of the County of San Diego, are made 26 under Gov. Code § 844.6.”)]. Section 845.6 provides a limited exception to the public 27 entity liability of § 844.6(a) when an “employee knows or has reason to know that the 28 prisoner is in need of immediate medical care and he fails to take reasonable action to 1 summon such medical care.” But § 844.6(d) clearly states that “[n]othing in this section 2 exonerates a public employee from liability for injury proximately caused by his negligent 3 or wrongful act or omission.” (emphasis added); see also Collins v. Cnty. of San Diego, 4 275 Cal. Rptr. 3d 290, 308 (Ca. Ct. App. 2021) (“[S]ection 844.6 provides immunity to a 5 public entity, but does not, as the proposed instruction stated, immunize individual 6 employees.”). As Plaintiffs point out, the seventh and eighth causes of action name 7 Defendants Ortiz and Boyd individually; neither cause of action names Defendant County 8 of San Diego. [See SAC at ¶¶ 292, 308.] And as Defendants argued elsewhere, “the 9 untimely safety check, as pleaded in the SAC, appears to be akin to negligence[.]” [Doc. 10 No. 73 at 22.] The Court DENIES the motion to dismiss the seventh and eighth causes of 11 action against Defendants Ortiz and Boyd. 12 ii. Naphcare Defendants 13 Plaintiffs acknowledge that the SAC “erroneously” named Naphcare in the seventh 14 and eighth causes of action. [Doc. No. 85 at 29–30.] The Court’s previous order dismissed 15 Plaintiffs’ negligence and wrongful death claims against Defendants Naphcare of San 16 Diego, LLC and Naphcare Inc. with prejudice. [Doc. No. 67 at 23.] The SAC’s seventh 17 and eighth causes of action against Naphcare are again DISMISSED WITH 18 PREJUDICE. 19 The remaining individual Naphcare Defendants are Cruz, Balingit, and Medenwald- 20 Hogg. These Defendants argue that the SAC is insufficient to allege the seventh and eighth 21 causes of action because it does not contain allegations necessary for the basic elements of 22 a claim, such as the duty of the medical professional and the standard of care. [Doc. No. 23 81-1 at 18.] Plaintiffs’ two sentence response that the SAC’s deliberate indifference 24 allegations with respect to the § 1983 claims suffice does not persuade the Court. [Doc. 25 No. 85 at 31.] The Court DISMISSES Plaintiffs’ seventh and eighth causes of action 26 against the Individual Naphcare Defendants. 27 /// 28 /// 1 J. CONCLUSION 2 In summary, the Court: 3 1. DISMISSES the SAC’s claims against Does 1–20; 4 2. DISMISSES the SAC’s seventh and eighth causes of action against 5 Defendants Cruz, Medenwald-Hogg, Balingit, Guerra-Ramirez, and Ross; 6 3. DISMISSES the SAC’s first, second, and sixth causes of action against 7 Defendants Ortiz and Boyd; 8 4. DISMISSES WITH PREJUDICE the SAC’s seventh and eighth causes of 9 action against Naphcare of San Diego, LLC and Naphcare Inc.; 10 5. DISMISSES the SAC’s § 1983 claim against the Defendant County of San 11 Diego based on an alleged policy of “failing to implement commonsense 12 reforms”; and 13 6. Otherwise DENIES the Defendants’ motions to dismiss. 14 /// 15 /// 16 /// 17 /// 18 /// 19 /// 20 /// 21 /// 22 /// 23 /// 24 /// 25 /// 26 /// 27 /// 28 /// 1 The SAC’s remaining claims are listed below. Defendants shall answer these 2 ||remaining claims by December 5, 2025. 3 1. First cause of action against Defendants Cruz, Medenwald-Hogg, Ross, and 4 Balingit; 5 2. Second cause of action against Defendants Cruz, Medenwald-Hogg, Ross, 6 and Balingit; 7 3. Third cause of action against Defendant County of San Diego; 8 4. Fourth cause of action against Defendant County of San Diego; 9 5. Fifth cause of action against the Defendant County of San Diego; 10 6. Sixth cause of action against Defendants Cruz, Medenwald-Hogg, Ross, and 11 Balingit; 12 7. Seventh cause of action against Defendants Ortiz and Boyd; and 13 8. Eighth cause of action against Defendants Ortiz and Boyd. 14 It is SO ORDERED. 15 16 || Dated: October 30, 2025 (GB 17 Hon. Cathy Ann Bencivengo 18 United States District Judge 19 20 21 22 23 24 25 26 27 28

16