(PC) Jackson v. Griffith ( 2023 )

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 EASTERN DISTRICT OF CALIFORNIA 10 11 FRED JAY JACKSON, Case No. 1:20-cv-00073-ADA-SKO 12 Plaintiff, FINDINGS AND RECOMMENDATIONS 13 v. TO GRANT DEFENDANT’S MOTION TO DISMISS 14 L. D. GRIFFITH, (Doc. 34) 15 Defendant. 16 14-DAY OBJECTION PERIOD 17 18 Plaintiff Fred Jay Jackson seeks to hold Defendant Griffith liable for a violation of his 19 civil rights pursuant to 42 U.S.C. § 1983. Pending before the Court is Defendant’s Motion to 20 Dismiss Plaintiff’s Second Amended Complaint, or, in the Alternative, for Summary Judgment. 21 (Doc. 34.) Plaintiff has opposed the motion (Doc. 37), and Defendant has filed a reply brief (Doc. 22 38). 23 I. PROCEDURAL BACKGROUND 24 Plaintiff initiated this action with the filing of his complaint on January 15, 2020. (Doc. 1.) 25 In its First Screening Order issued May 22, 2020, the Court found Plaintiff had failed to state a 26 claim upon which relief could be granted. (Doc. 11.) Plaintiff was directed to file either a first 27 amended complaint, curing the deficiencies identified in the screening order, or to file a notice of voluntary dismissal, within 21 days. (Id. at 7-8.) 1 When Plaintiff failed to file a first amended complaint or notice of voluntary dismissal, on 2 June 25, 2020, the Court issued its Order To Show Cause (“OSC”) Why Action Should Not Be 3 Dismissed For Failure To Comply With The Court’s Order. (Doc. 12.) Plaintiff responded to the 4 OSC, indicating he did not receive the screening order. (Doc. 13.) On July 15, 2020, the Court 5 discharged the OSC and granted Plaintiff a 30-day extension of time within which to file a first 6 amended complaint. (Doc. 14.) 7 Plaintiff filed his first amended complaint on August 10, 2020. (Doc. 15.) In its Second 8 Screening Order issued May 4, 2021, the Court again found Plaintiff had failed to state a claim 9 upon which relief could be granted. (Doc. 16.) Plaintiff was directed to file a second amended 10 complaint, curing the deficiencies identified in the order within 21 days. (Id. at 8-9.) 11 Plaintiff filed his second amended complaint on June 10, 2021. (Doc. 19.) On April 13, 12 2022, the Court issued Findings and Recommendations, recommending that the action proceed on 13 Plaintiff’s cognizable substantive due process claim against Defendant Griffith, and that the 14 remaining claims be dismissed. (Doc. 24.) The assigned district judge issued an Order Adopting 15 the Findings and Recommendations on May 24, 2022. (Doc. 26.) 16 Following successful service of process, Defendant filed the instant motion to dismiss, or 17 in the alternative, motion for summary judgment, on September 27, 2022. (Doc. 34.) The motion 18 is fully briefed (Docs. 37 & 38) and has been submitted for decision. 19 II. SUBSTANTIVE DUE PROCESS CLAIM ASSERTED IN THE SECOND AMENDED COMPLAINT 20 21 This action proceeds only on Plaintiff’s substantive due process claim asserted in his 22 second amended complaint. (See Doc. 24 at 10-11 & Doc. 26.) In the Findings and 23 Recommendations concerning Plaintiff’s second amended complaint, the Court found that 24 Plaintiff has set forth sufficient facts to assert a plausible due process claim: 25 The Ninth Circuit has held that “the Fourteenth Amendment substantively protects a person’s rights to be free from unjustified 26 intrusions to the body, to refuse unwanted medical treatment and to receive sufficient information to exercise these rights intelligently.” 27 Benson v. Terhune, 304 F.3d 874, 884 (9th Cir. 2002) (citations omitted). In White v. Napoleon, which the Ninth Circuit cited 1 “[p]risoners have a right to such information as is reasonably necessary to make an informed decision to accept or reject proposed 2 [medical] treatment, as well as a reasonable explanation of the viable alternative treatments that can be made available in a prison setting.” 3 897 F.2d 103, 113 (3d Cir. 1990); see also Pabon v. Wright, 459 F.3d 241, 250 (2d Cir. 2006) (prisoners have “a liberty interest in 4 receiving such information as a reasonable patient would require in order to make an informed decision as to whether to accept or reject 5 proposed medical treatment”) (citing White, 897 F.2d at 113). 6 . . . Plaintiff has provided sufficient facts to state a cognizable substantive due process claim. He alleges Dr. Griffith intentionally 7 failed to read Plaintiff the consent form, failed to inform him of the risks and side effects of the prostrate biopsy procedure, and failed to 8 inform him of the alternative medical options such as an MRI. Plaintiff also contends he would have “100%” declined the procedure 9 had he been made aware of the risks and side effects and the medical alternatives. Benson v. Terhune, 304 F.3d at 884; White v. Napoleon, 10 897 F.2d at 113. 11 Additionally, as noted above, despite the conclusory nature of Plaintiff’s assertion that Dr. Griffith acted under color of state law, 12 liberally construing the second amended complaint, the Court finds that Plaintiff has sufficiently alleged, at this stage of the proceedings, 13 that the defendant was acting under color of state law. 14 (Id. at 11.) 15 III. REQUESTS FOR JUDICIAL NOTICE 16 Defendant has filed two request for judicial notice. (Docs. 34-2 & 38-3.) In his first 17 request, Defendant asks the Court to take judicial notice of the following: 18 1. Four documents from Kings County Superior Court Case Number 16C0052: 19 (a) the first amended complaint filed June 8, 2016; (b) a notice of entry of 20 judgment and order in favor of Defendant Griffith filed March 16, 2017; (c) an 21 order re Plaintiff’s motion for reconsideration filed April 26, 2017; and (d) 22 Plaintiff’s notice of appeal filed May 11, 2017 23 2. Three documents from California Court of Appeal for the Fifth Appellate 24 District Case Number F075670: (a) the opinion issued September 30, 2019; (b) 25 Plaintiff’s petition for rehearing and notice filed October 18, 2019; and (c) the 26 order denying the petition for rehearing issued October 28, 2019 27 3. Two documents from the California Supreme Court Case Number S258690: (a) Plaintiff’s petition for review filed October 21, 2019, and (b) the order 1 denying review issued December 11, 2019 2 4. Three documents filed in the instant action, to wit: Plaintiff original, first 3 amended, and second amended complaints 4 (Doc. 34-2 at 2-3.) In his second request which was filed following Plaintiff’s opposition to the 5 motion, Defendant asks this Court to take judicial notice of the following: 6 1. An October 13, 2022, order finding Plaintiff to be a vexatious litigant pursuant 7 to California Code of Civil Procedure section 391.7 in Kern County Superior 8 Court Case Number BCV-21-101400 9 2. The Fifth District Court of Appeal’s October 25, 2022, opinion in Case 10 Number F083707 11 3. This Court’s Findings and Recommendations issued April 13, 2022 12 (Doc. 38-3 at 2.) 13 A court can take judicial notice of “documents on file in federal or state courts.” Harris v. 14 County of Orange, 682 F.3d 1126, 1131–32 (9th Cir. 2012); U.S. ex rel. Robinson Rancheria 15 Citizens Council v. Borneo, Inc., 971 F.2d 244, 248 (9th Cir. 1992) (a court “may take notice of 16 proceedings in other courts, both within and without the federal judicial system, if those 17 proceedings have a direct relation to matters at issue”); United States v. Wilson, 631 F.2d 118, 18 119 (9th Cir. 1980) (“a court may take judicial notice of its own records in other cases”). If a 19 court takes judicial notice of a document, it must specify what facts it judicially noticed from the 20 document. Borneo, 971 F.2d at 248. Finally, a “federal district court can take judicial notice of its 21 own records, and this is the established rule.” Chandler v. United States, 378 F.2d 906, 909 (9th 22 Cir. 1967) (internal citations omitted). 23 Defendant’s request for judicial notice, as set forth above, is granted. The judicial notice 24 of these documents does not convert defendant’s motion to dismiss to a summary judgment 25 motion. See United States v. Ritchie, 342 F.3d 903, 907-08 (9th Cir. 2003) (a court's consideration 26 of documents attached to a complaint or incorporated by reference or matter of judicial notice will 27 not convert a motion to dismiss into a motion for summary judgment). 1 IV. LEGAL STANDARDS: MOTION TO DISMISS 2 A motion to dismiss under Rule 12(b)(6) “tests the legal sufficiency of a claim.” Navarro 3 v. Block, 250 F.3d 729, 732 (9th Cir. 2001). In resolving a 12(b)(6) motion, the Court’s review is 4 generally limited to the “allegations contained in the pleadings, exhibits attached to the complaint, 5 and matters properly subject to judicial notice.” Manzarek v. St. Paul Fire & Marine Ins. Co., 519 6 F.3d 1025, 1030-31 (9th Cir. 2008) (internal quotation marks & citations omitted). Dismissal is 7 proper if there is a “lack of a cognizable legal theory or the absence of sufficient facts alleged 8 under a cognizable legal theory.” Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 9 1988) (citation omitted). 10 “To survive a motion to dismiss, a complaint must contain sufficient factual matter, 11 accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 12 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). The Court 13 “accept[s] as true all well-pleaded allegations of material fact, and construe[s] them in the light 14 most favorable to the non-moving party.” Daniels-Hall v. Nat’l Educ. Ass’n, 629 F.3d 992, 998 15 (9th Cir. 2010) (citation omitted). In addition, the Court construes pleadings of pro se prisoners 16 liberally and affords them the benefit of any doubt. Hebbe v. Pliler, 627 F.3d 338, 342 (9th Cir. 17 2010) (citation omitted). However, “the liberal pleading standard … applies only to a plaintiff’s 18 factual allegations,” not his legal theories. Neitze v. Williams, 490 U.S. 319, 330 n.9 (1989). 19 Finally, leave to amend must be granted “[u]nless it is absolutely clear that no amendment 20 can cure the defects.” Lucas v. Dep't of Corr., 66 F.3d 245, 248 (9th Cir. 1995) (per curiam); see 21 also Lopez v. Smith, 203 F.3d 1122, 1126 (9th Cir. 2000) (en banc). 22 V. DISCUSSION 23 A. Res Judicata Bars Plaintiff’s Claim in This Action 24 Defendant contends Plaintiff’s claim for substantive due process should be barred by the 25 doctrine of res judicata. (Doc. 34 at 2-6.) Defendant contends “Plaintiff’s attempt to impose 26 liability under state law for Dr. Griffith’s alleged malpractice was fully adjudicated in state court” 27 and that “the allegations in the [second amended complaint] are that Plaintiff received inadequate 1 in Kings County Superior Court asserts claims that “Dr. Griffith’s urology treatment fell below 2 the standard of care and that he lacked informed consent for a transrectal guided biopsy he 3 believed was not performed within the standard of care.” (Id.) The state court granted 4 Defendant’s motion for summary judgment in October 2016 and entered judgment in Defendant’s 5 favor on March 16, 2017. (Id.) Plaintiff’s motion for reconsideration was denied in April 2017, 6 and Plaintiff filed a notice of appeal on May 11, 2017. (Id.) The appellate court affirmed the trial 7 court’s judgment in Defendant’s favor and denied a petition for rehearing. (Id.) The California 8 Supreme Court denied Plaintiff’s petition for review on December 11, 2019. (Id.) 9 Plaintiff contends res judicata does not bar his claim. (Doc. 37.) He argues “res judicata 10 does not bar plaintiff’s claim that are predicated on events that postdate the filing of the initial 11 complaint.” (Id. at 3.) Plaintiff then contends that the state trial court erred in granting summary 12 judgment. (Id. at 3-5.) Citing the California constitution, Plaintiff reasons that the state trial 13 court’s decision denied him a “liberty interest in receiving such information as a reasonable 14 patient would require in order to make an informed decision as to whether to accept or reject 15 proposed medical treatment.” (Id. at 6-7.) Plaintiff contends because the California Code of Civil 16 Procedure “allow for tolling beyond the three year requirement when in cases of intentional 17 concealment are involved …. For the above reasons defendant Griffith M.D. should be held to 18 account and culpable as res judicata is not applicable in this case.” (Id. at 7.) Plaintiff then 19 proceeds to contend that the state trial court’s ruling were erroneous. (Id. at 7-8.) 20 1. Applicable Legal Standards 21 Claim preclusion bars litigation of claims that were or could have been raised in a prior 22 action. Holcombe v. Hosmer, 477 F.3d 1094, 1097 (9th Cir. 2007) (quotation marks omitted). 23 Claim preclusion “requires three things: (1) identity of claims; (2) a final judgment on the merits; 24 and (3) the same parties, or privity between parties.” Harris, 682 F.3d at 1132 (citing Cell 25 Therapeutics, Inc. v. Lash Grp., Inc., 586 F.3d 1204, 1212 (9th Cir. 2010)). 26 The doctrine of res judicata, or claim preclusion, “bars repetitious suits involving the same 27 cause of action once a court of competent jurisdiction has entered a final judgment on the merits.” 1 quotation marks omitted). Under the Federal Full Faith and Credit Statute, 28 U.S.C. § 1738, a 2 federal court must give a state court judgment the same preclusive effect as the state court 3 judgment would receive by another court of that state. See 28 U.S.C. § 1738; Maldonado v. 4 Harris, 370 F.3d 945, 951 (9th Cir. 2004) (“28 U.S.C. § 1738 generally requires federal courts to 5 give state court judgments the same res judicata effect that they would be given by another court 6 of that state”). The Ninth Circuit has made it clear that a section 1983 claim brought in federal 7 court is subject to the principles of issue and claim preclusion by a prior state court judgment. 8 Gonzales v. Cal. Dep’t of Corr., 739 F.3d 1226, 1231 (9th Cir. 2014). 9 California courts employ the primary rights theory to determine what constitutes the same 10 cause of action for claim preclusion purposes, and under this theory, a cause of action is (1) a 11 primary right possessed by the plaintiff, (2) a corresponding primary duty devolving upon the 12 defendant, and (3) a harm done by the defendant which consists in a breach of such primary right 13 and duty. Brodheim v. Cry, 584 F.3d 1262, 1268 (9th Cir. 2009) (citing City of Martinez v. 14 Texaco Trading & Transp., Inc., 353 F.3d 758, 762 (9th Cir. 2003)). If two actions involve the 15 same injury to the plaintiff and the same wrong by the defendant, then the same primary right is at 16 stake even if in the second suit the plaintiff pleads different theories of recovery, seeks different 17 forms of relief and/or adds new facts supporting recovery. Id. (citing Eichman v. Fotomat Corp., 18 147 Cal. App. 3d 1170, 1174 (1983)). 19 “California's claim preclusion law...prevents relitigation between the same parties or 20 parties in privity with them.” DKN Holdings LLC v. Faerber, 61 Cal. 4th 813, 824 (2015). Privity 21 is a legal conclusion which designates a person “so identified in interest with a party to former 22 litigation that he represents precisely the same right” being adjudicated. In re Schimmels, 127 23 F.3d 875, 881 (9th Cir. 1997) (quoting Southwest Airlines Co. v. Texas Int'l Airlines, Inc., 546 24 F.2d 84, 94 (5th Cir. 1977)); Nordhorn v. Ladish Co., 9 F.3d 1402, 1405 (9th Cir. 1993) (“[W]hen 25 two parties are so closely aligned in interest that one is the virtual representative of the other, a 26 claim by or against one will serve to bar the same claim by or against the other”) (citation 27 omitted). 1 “A judgment is on the merits for purposes of res judicata if the substance of the claim is 2 tried and determined.” Johnson v. City of Loma Linda, 24 Cal. 4th 61, 77 (2000) (citation & 3 internal quotation marks omitted). 4 2. Analysis 5 The Court considers the identity of claim, whether there is a final judgment on the merits, 6 and if the previous litigation involved the same parties, or privity between parties. Harris, 682 7 F.3d at 1132. 8 a. Identity of Claim 9 The allegations of Plaintiff's present complaint demonstrate that there is an identity of 10 claims between this action and the prior action. 11 In this action, Plaintiff’s operative second amended complaint asserts a substantive due 12 process claim, alleging Defendant Griffith failed to read Plaintiff the consent form, failed to 13 inform Plaintiff of the risks and side effects of the prostrate biopsy procedure and failed to inform 14 him of the alternative medical options affecting Plaintiff’s liberty interest to make an informed 15 decision as to whether to accept or reject proposed regarding medical treatment. In the state trial 16 court action, Plaintiff pursued a medical malpractice or negligence action on a theory of a failure 17 to inform Plaintiff of the harm or complications from a prostrate procedure. (See Doc. 34-3 at 9- 18 18.) Griffith moved for summary judgment in the state court proceeding and the trial court 19 granted the motion, finding “there is no triable issue of material fact in regards to Dr. Griffith 20 breaching the standard of care, or causing any of Plaintiff’s injuries,” including finding “the 21 proper informed consent was obtained and that the actions of Dr. Griffith were not a substantial 22 factor in the harm allegedly incurred by Plaintiff.” (Doc. 34-3 at 22-24.) 23 The actions involve the same injury: an inability to make an informed decision concerning 24 a medical procedure. They also involve the same defendant: Lyle Griffith, M.D. Harris, 682 F.3d 25 at 1132. Thus, the Court finds there is an identity of claims between the prior action and the 26 instant action. Harris, 682 F.3d at 1132. Further, both cases involve the same primary right at 27 stake because Plaintiff possessed a primary right that corresponded with Defendant’s primary 1 duty. Brodheim, 584 F.3d at 1268. In other words, Plaintiff’s substantive due process claim 2 derives from the same primary right as the one he litigated and lost in state court concerning a 3 liberty interest in his ability to make an informed choice concerning a medical procedure. To the 4 extent Plaintiff’s action asserts a different theory of recovery—a violation of his substantive due 5 process rights versus medical malpractice or negligence—res judicata principles still apply. Id. 6 Both suits also arise out of the same set of facts and Plaintiff’s claim here could have been 7 raised in the state court action. See Owens v. Kaiser Foundation Health Plan Inc., 244 F.3d 708, 8 716 (9th Cir. 2001) (finding that res judicata barred litigation of even “distinctively different” 9 claims in subsequent action that could have been raised in a prior action because both suits would 10 arise out of the same nucleus of facts); McClain v. Apodaca, 793 F.2d 1031, 1034 (9th Cir.1986) 11 (a plaintiff “cannot avoid the bar of res judicata merely by alleging conduct by the defendant not 12 alleged in his prior action or by pleading a new legal theory”). 13 b. Final Judgment on the Merits 14 A final decision on the merits “includes any prior adjudication of an issue in another 15 action that is determined to be sufficiently firm to be accorded conclusive effect.” Citizens for 16 Open Access etc. Tide, Inc. v. Seadrift Assn., 60 Cal. App. 4th 1053, 1065 (Cal. Ct. App. 1998). 17 Here, the state court adjudicated Defendant’s summary judgment motion and entered judgment in 18 favor of Defendant Griffith. (Doc. 34-3 at 20.) Further, the state trial court’s decision was 19 affirmed on appeal and the California Supreme Court denied review. Franklin & Franklin v. 7- 20 Eleven Owners for Fair Franchising, 85 Cal. App. 4th 1168, 1174 (2000) (res judicata bar does 21 not attach until appeal from trial court judgment has been exhausted). The state court’s 22 adjudication is a final judgment on the merits and should be accorded conclusive effect. 23 c. Same Parties 24 Claim preclusion “prevents relitigation of the same cause of action in a second suit 25 between the same parties or parties in privity with them.” Mycogen Corp. v. Monsanto, 28 Cal. 26 4th 888, 896 (2002). Here, the Kings County Superior Court action and the instant action involve 27 the same parties: Plaintiff and Lyle D. Griffith, M.D. Harris, 682 F.3d at 1132. 1 In sum, Plaintiff should be precluded from relitigating the same cause of action decided on 2 the merits by the Kings County Superior Court and affirmed following state court appellate 3 review. Tohono O'Odham Nation, 563 U.S. at 315. This Court finds the Kings County Superior 4 Court’s judgment is entitled to full faith and credit in this Court. 28 U.S.C. § 1738. Further, 5 because Plaintiff’s second amended complaint is barred by the doctrine of res judicata, 6 amendment would be futile. Hartmann v. CDCR, 707 F.3d 1114, 1130 (9th Cir. 2013) (“A district 7 court may deny leave to amend when amendment would be futile”); accord Lopez v. Smith, 203 8 F.3d at 1129 (“Courts are not required to grant leave to amend if a complaint lacks merit 9 entirely”). Therefore, the Court will recommend Defendant’s motion to dismiss be granted. 10 3. Defendant’s Request Pursuant to Rule 12(d) 11 Defendant’s motion includes a request to convert his motion to dismiss to a motion for 12 summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure. (Doc. 34 at 7-9.) 13 Federal Rule of Civil Procedure 12(d) states that “[i]f, on a motion under Rule 12(b)(6) or 14 12(c), matters outside the pleadings are presented to and not excluded by the court, the motion 15 must be treated as one for summary judgment under Rule 56. All parties must be given a 16 reasonable opportunity to present all the material that is pertinent to the motion.” Whether to 17 convert a Rule 12(b)(6) motion into one for summary judgment pursuant to Rule 12(d), when the 18 opposing party has notice that the court may look beyond the pleadings, is at the discretion of the 19 district court. Hamilton Materials, Inc. v. Dow Chemical Corp., 494 F.3d 1203, 1207 (9th Cir. 20 2007). 21 First, while Plaintiff arguably had “notice that the court may look beyond the pleadings” 22 because Plaintiff submitted a Separate Statement of Undisputed Facts with his opposition to 23 Defendant’s motion to dismiss, the Court is hesitant to convert the motion to dismiss into one for 24 summary judgment where Plaintiff did not receive formal notice of the requirements for summary 25 judgment. See Woods v. Carey, 684 F.3d 934, 935 (9th Cir. 2012) (notices must be served 26 concurrently with motion for summary judgment so that pro se prisoner plaintiffs have fair, 27 timely and adequate notice of what is required of them); Rand v. Rowland, 154 F.3d 952, 960 (9th 1 provided with notice of the requirements for summary judgment). 2 Second, the Court’s recommendation to grant Defendant’s motion to dismiss as barred by 3 the doctrine of res judicata necessarily involves the dismissal of this action with prejudice. See, 4 e.g., Cramer v. Dickenson, No. 1:08-cv-00375-AWI-GSA-PC, 2013 WL 127639, at *5 5 (recommending defendants’ motion to dismiss be granted and that the action be dismissed “in its 6 entirety, with prejudice, for Plaintiff’s failure to state a claim … based on the doctrine of res 7 judicata”) (E.D. Cal. Jan. 9, 2013), adopted in full on March 21, 2013, 2013 WL 1192402, 8 affirmed on appeal, 586 Fed. Appx. 381 (9th Cir. 2014). And the Court’s review herein was 9 limited to the “allegations contained in the pleadings, exhibits attached to the complaint, and 10 matters properly subject to judicial notice.” Manzarek, 519 F.3d at 1030-31. 11 In sum, the Court declines to convert Defendant’s motion to dismiss to a motion for 12 summary judgment. 13 VI. CONCLUSION AND RECOMMENDATION 14 For the reasons set forth above, IT IS HEREBY RECOMMENDED that: 15 1. Defendant’s motion to dismiss be GRANTED; 16 2. Plaintiff’s second amended complaint be DISMISSED without leave to amend for a 17 failure to state claim; and 18 3. This action be DISMISSED with prejudice and the case closed. 19 These Findings and Recommendations will be submitted to the district judge assigned to 20 this case, pursuant to 28 U.S.C. § 636(b)(l). Within 14 days of the date of service of these 21 Findings and Recommendations, a party may file written objections with the Court. The 22 document should be captioned, “Objections to Magistrate Judge’s Findings and 23 Recommendations.” Failure to file objections within the specified time may result in waiver of 24 rights on appeal. Wilkerson v. Wheeler, 772 F.3d 834, 839 (9th Cir. 2014) (citing Baxter v. 25 Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)). 26 IT IS SO ORDERED. 27 Dated: September 5, 2023 /s/ Sheila K. Oberto . 1 UNITED STATES MAGISTRATE JUDGE 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27