NOT FOR PUBLICATION FILED

UNITED STATES COURT OF APPEALS NOV 25 2025

MOLLY C. DWYER, CLERK

U.S. COURT OF APPEALS

FOR THE NINTH CIRCUIT

CHRISTOPHER BRIGHTLY, No. 24-7472 D.C. No. Plaintiff - Appellant, 4:21-cv-00127-JCH v.

MEMORANDUM*

CORIZON INCORPORATED, named as Corizon Health Incorporated, Health Care Contractor at A.D.O.C. Tucson, Statewide / "was"; CENTURION OF ARIZONA, LLC, Health Care Contractor at A.D.O.C. Tucson, Statewide; NATALIE BELL, N.P. / Provider Medical Care at A.S.P.C. Tucson Complex; NICK SALYER, Physician Assistant Centurion at A.S.P.C. Tucson Complex; JILLIAN RILEY, N.P. / Provider Medical Care at A.S.P.C. Tucson Complex; DOROTHY HINES, N.P. / Provider Medical Care at A.S.P.C. Tucson Complex/ Douglas Comple; LAURA ELLIOTT, N.P. / Provider Medical Care at A.S.P.C. Tucson Complex; A. FERGUSON, AKA Alicia Ferguson, F.H.A. Facility Health Administrator at A.S.P.C. Tucson Complex; ABLE SALAZAR, Centurion Site Medical Director at A.S.P.C. Tucson Complex; DAVID SHINN, Director, Arizona Department of Corrections, Rehabilitation, and Reentry, Director at A.D.O.C. Phoenix;

* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3.

NAPHCARE, INC.; RYAN THORNELL,

Director of the Arizona Department of Corrections, Rehabilitation,

Defendants - Appellees.

Appeal from the United States District Court for the District of Arizona John Charles Hinderaker, District Judge, Presiding

Submitted November 21, 2025** Phoenix, Arizona

Before: MURGUIA, Chief Judge, and HAWKINS and HURWITZ, Circuit Judges.

Christopher Brightly brings a 42 U.S.C. § 1983 action against prison

healthcare providers and several of their employees alleging inadequate medical

treatment while he was incarcerated in Arizona state prisons. He appeals a summary

judgment order entered under Federal Rule of Civil Procedure 54(b) on his claims

against Centurion of Arizona, LLC, and Laura Elliott, a Centurion nurse practitioner

(collectively, “Defendants”).

We have jurisdiction under 28 U.S.C. § 1291. “We review de novo the grant

of summary judgment, and review pursuant to Federal Rule of Civil Procedure 56(c),

under which the contested evidence is viewed in the light most favorable to the

nonmoving party . . . .” Johnson v. Barr, 79 F.4th 996, 999 (9th Cir. 2023) (cleaned

** The panel unanimously concludes this case is suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2).

2 24-7472 up).

We affirm.

1. To prevail on his deliberate indifference claims, Brightly must show “harm

caused by the indifference.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006).

Brightly argues that the district court erred in concluding that expert testimony was

required to show a question of fact as to causation. He contends that because “the

average person” knows that medication tends “to make patients better,” a jury could

conclude, without the benefit of expert testimony, “that if Elliott and Centurion

chose not to follow specialists’ recommendations and failed to provide consistent

medication as prescribed, it could have caused [his] condition to worsen.”

On this record, we disagree. As the district court noted, even assuming that

Defendants failed to follow specialists’ recommendations and inconsistently

dispensed prescribed medication, it does not necessarily follow that Brightly’s

claimed complications were caused by these actions or omissions. The Defendants

submitted expert testimony that Brightly’s complications were not caused by a lapse

of his antifungal medication and that it was “not even clear that” they were caused

by a Valley Fever relapse. Instead, the expert opined that Brightly’s hospitalizations

could have been caused by “worsening stenosis, scarring, vascular impairment,

infection of hardware (non-fungal) or a combination of the above.” Indeed, one of

Brightly’s treating physicians opined that the complications likely resulted from

3 24-7472 delay in diagnosing the disease, which occurred before Defendants undertook

Brightly’s care. The district court therefore did not err in applying the general rule

that expert testimony is needed to show causation in complex medical cases. See

Hutchinson v. United States, 838 F.2d 390, 393-94 (9th Cir. 1988); United States v.

Urena, 659 F.3d 903, 908 (9th Cir. 2011).

2. In the alternative, Brightly argues that the testimony of two treating

physicians, Drs. Sewell and Avila, raises a triable question of fact on causation.

Brightly does not contest the district court’s finding that Dr. Sewell, a family

medicine practitioner, was not a Valley Fever expert. Instead, he contends that

because the district court relied on Dr. Sewell’s opinion in issuing a preliminary

injunction, it must also do so at the summary judgment stage. But the district court

never found Dr. Sewell to be a qualified expert on causation. Moreover, the court

was not required to rely on evidence at summary judgment simply because it did so

when issuing a preliminary injunction. See Herb Reed Enters. LLC v. Fla. Ent.

Mgmt., Inc., 736 F.3d 1239, 1250 n.5 (9th Cir. 2013) (“Due to the urgency of

obtaining a preliminary injunction at a point when there has been limited factual

development, the rules of evidence do not apply strictly to preliminary injunction

proceedings.”).

Brightly also argues that Dr. Avila could provide the required testimony

because a treating physician may testify as to causation “to the extent that his

4 24-7472 opinions were formed during the course of treatment.” Goodman v. Staples The Off.

Superstore, LLC, 644 F.3d 817, 826 (9th Cir. 2011). But even assuming Dr. Avila’s

opinions were formed during treatment, she did not opine that the Defendants’

actions and omissions caused Brightly’s complications. Rather, she concluded:

While it is concerning that Mr. Brightly’s treatment course was interrupted during the above-mentioned time, it is my professional opinion that the severity of the patient’s case is more likely due to a delay in his diagnosis of Coccidiomycosis meningitis. If the patient had been brought to medical attention for more prompt diagnosis and initiation of treatment, he likely would not have experienced such a devastating and complex infection.

The delay in diagnosis occurred before Centurion and Elliott assumed

Brightly’s care.

AFFIRMED.

5 24-7472