Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_17-cv-01652/USCOURTS-casd-3_17-cv-01652-3/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983pr Prisoner Civil Rights

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

GEORGE W. SHUFELT,

Plaintiff,

v.

J. SILVA, M.D., et al.,

Defendant.

Case No.: 17cv1652-LAB (RBM)

ORDER ADOPTING REPORT 

AND RECOMMENDATION; AND

ORDER OF DISMISSAL

Plaintiff George Shufelt, a prisoner in state custody, filed this action bringing 

claims under 42 U.S.C. ' 1983 for alleged Eighth Amendment violations. 

Specifically, he alleges Defendants were deliberately indifferent to his serious 

medical needs. After his initial complaint was screened and dismissed, he filed a 

first amended complaint (the “FAC”), adding a claim for disability discrimination 

based on the same facts. Defendants then moved to dismiss the FAC.

Pursuant to 28 U.S.C. ' 636, the matter was referred to Magistrate Judge 

Peter Lewis for a report and recommendation. On July 13, 2018, Judge Lewis 

issued his report and recommendation (the “R&R”). After an extension, Shufelt 

filed objections to the R&R. Defendants filed a reply brief.

/ / /

/ / /

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Undisputed Facts

Before he was incarcerated in 2013, Shufelt was very active and ran several 

miles per day. In early December, 2013, he suffered a left sciatic nerve root injury. 

After this, he experienced pain and trouble walking or standing. His request for 

health care was granted, and a Dr. Ortega examined him in January, 2014. Dr. 

Ortega recommended an MRI and orthopedic consultation. Defendants Roberts 

and Glynn agreed, and gave approval. The lumbar spine MRI showed he had 

“lower lumbar degenerative and facet degenerative disease with disc 

bulge/protrusion from L3–4 through L5–S1.” Shufelt alleges that his condition 

began to worsen and he could not walk without support.

On May 19, 2014, Defendant Lewis noted in response to a grievance filed 

by Shufelt that Shufelt had refused physical therapy and failed to show up to 

medication administration. (Docket no. 1-2, Ex. A.) In June, 2014, Shufelt filed 

another grievance, seeking the help of an orthopedic surgeon. Dr. Dean 

recommended a wheelchair for him, as well as consultation with an orthopedic 

surgeon. Defendants Roberts and Lewis partially granted the recommended relief, 

giving Shufelt a wheelchair and submitting a request for an orthopedic 

consultation.

On August 26, 2014, neurosurgeon Dr. Yoo saw Shufelt. His report following 

that consultation recommended two alternatives. Shufelt vigorously objects to the 

R&R’s characterization of these, which are discussed below. In his opinion, Dr. 

Yoo was recommending surgery as the only option and continued to do so.

On September 30, 2014, Dr. Yoo examined Shufelt again. In his report, Dr. 

Yoo said he intended to perform a nerve block to determine what type of procedure 

to carry out. (Docket no. 1-2, Ex. K.) He suggested that this be done in January of 

2015, in part to accommodate Shufelt’s request to be allowed to finish his college 

work first. (Id.) Shufelt asserts that on October 7, 2014, Defendants cancelled his 

scheduled surgery. Nevertheless, on January 24, Dr. Yoo prepared to carry out 

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the nerve block. Shufelt, however, was not expecting the nerve block and refused 

it, causing the surgery to be delayed. Later, Defendants cancelled the rescheduled 

surgery because, they said, the risks outweighed the benefits. 

Shufelt had also been prescribed morphine, which Defendants also took 

away. They believed he was not actually taking it but instead was giving it to 

someone else. This was based on two medical tests showing no opiates in his 

system. Shufelt in his objections offers an explanation why the test was producing 

a “false negative.” Defendant Walker in responding to Shufelt’s grievance also 

noted that he was being prescribed Lyrica for pain, and that he had become 

“argumentative and loud” when a doctor explained why he was being denied 

morphine. (Docket no. 1-2, Ex. T.) On March 12, 2015, Dr. Yoo again examined 

Shufelt, found him “under medicated,” and said he was ready for surgery.

On May 6, 2015, Defendant Dr. Zhang examined Shufelt. Although 

Shufelt alleges he was “completely crippled” at this time, Dr. Zhang’s observations 

were that he was in a good mood, could move his feet, and was able to move his 

wheelchair rather quickly. Dr. Zhang’s report says that when he refused to 

prescribe morphine, Shufelt became “very argumentative.” Dr. Zhang submitted a 

request for surgery, which was denied on May 29, 2015, because “the risks 

outweighed the benefits.” 

Shufelt was confined to a wheelchair until on November 3, 2016 he was 

transferred to a different prison, where a different doctor approved both narcotics 

and surgery for him. He did not recover full use of his legs, but he agrees his 

quality of life is better. 

Legal Standards

A district court has jurisdiction to review a Magistrate Judge's report and 

recommendation on dispositive matters. Fed. R. Civ. P. 72(b). The Court may 

accept, reject, or modify, in whole or in part, the R & R's findings or

recommendations. 28 U.S.C. § 636(b)(1). This section does not require some 

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lesser review by the district court when no objections are filed. Thomas v. Arn, 474 

U.S. 140, 149-50 (1985). The Court reviews de novo those portions of the R & R 

to which specific written objection is made. United States v. Reyna-Tapia, 328 F.3d 

1114, 1121 (9th Cir. 2003) (en banc). 

The Eighth Amendment is violated by “deliberate indifference” to serious 

medical needs, not mere negligence. Estelle v. Gamble, 429 U.S. 97, 105–06 

(1976). Deliberate indifference arises only where a prison official “knows of and 

disregards an excessive risk to inmate health or safety; the official must both be 

aware of facts from which the inference could be drawn that a substantial risk of 

serious harm exists, and he must also draw that inference.” Farmer v. Brennan, 

511 U.S. 825, 837 (1994). Both sides appear to agree that Shufelt faced a serious 

medical need, and instead dispute whether the subjective “deliberate indifference” 

standard is met.

To establish deliberate indifference, a prisoner must establish something

worse than malpractice, or even gross negligence. Wood v. Housewright, 900 F.2d 

1332, 1334 (9th Cir.1990). Accidents and mistakes, even if they result in 

unnecessary suffering, do not amount to deliberate indifference. Gamble, 429 U.S. 

at 105. Nor does a difference of opinion between a plaintiff and defendants amount 

to an Eighth Amendment violation. Toguchi v. Chung, 391 F.3d 1051, 1058–60 

(9th Cir. 2004). To establish deliberate indifference, a plaintiff must show both that 

the course of treatment was “medically unacceptable under the circumstances,” 

and that “they chose this course in conscious disregard of an excessive risk to 

plaintiff’s health.” Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996).

Prison officials are also authorized to consider legitimate penological 

interests even in the Eighth Amendment context. Whitley v. Albers, 475 U.S. 312, 

320 (1986). See also Turner v. Safley, 482 U.S. 78, 89 (1987) (prison regulation 

that impinges on inmates’ constitutional rights is valid if reasonably related to 

legitimate penological interests). Typically, inmates’ medical needs do not clash 

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with safety and rehabilitation concerns, id., but they sometimes can. See Pullano 

v. Brammer, 684 Fed. Appx. 643, 644 (9th Cir. 2017) (remanding for examination 

of whether inmate who was denied medical treatment experienced pain and 

suffering that did not serve any penological purpose); Ramirez-Salgado v. Lewis, 

2018 WL 4214906 (E.D. Cal., Sept. 5, 2018) (holding that depriving prisoner of 

pain medication was permitted under the Eight Amendment if doing so was based 

on legitimate penological interests).

At the motion to dismiss stage, review is limited to the contents of the 

complaint, Clegg v. Cult Awareness Network, 18 F.3d 752, 754–55 (9th Cir.1994), 

including documents physically attached to the complaint or documents the 

complaint necessarily relies on and whose authenticity is not contested. Lee v. 

County of Los Angeles, 250 F.3d 668, 688 (9th Cir. 2001). Here, Shufelt attached 

numerous documents to the original complaint, and continues to cite and rely on 

them. The Court therefore treats them as part of the complaint for purposes of this 

motion.

Objections

Although Shufelt’s objections spanned eleven pages, they are aimed at only 

a few sections of the R&R. In particular, he argues that the R&R misconstrued two 

of Dr. Yoo’s recommendations or assessments. He also argues that the test 

showing no morphine in his system was flawed, and that Defendants knew he was 

taking it.

Dr. Yoo’s report of August 26, 2014 reads, in pertinent part:

I went over his options and told him that:

1. He could try to improve on his own with time and that this is possible 

but would require a length[y] amount of time.

2. He could undergo surgical treatment. I think that surgical treatment 

for this gentleman is to do L5-S1 decompression and interbody and 

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instrumented fusion as well as L4-5 decompression and Coflex 

placement.

(Docket no. 1-2, Ex. I.) Shufelt argues that Dr. Yoo was merely identifying what he, 

Shufelt, could do, and that Dr. Yoo consistently and unequivocally recommended 

surgery alone as a proper course of action. (Objections to R&R at 1–2.) This is a 

misreading of the report, however. Dr. Yoo did not say surgery as the only effective 

or reasonable option. Even though “try[ing] to improve on his own” would require 

a long time, it was “possible.” More to the point, Defendants, reading this report, 

could reasonably have interpreted it that way. The fact that Shufelt later opted for 

surgery does not mean it was the only acceptable option. 

The R&R characterizes the first option in passing as “physical rehabilitation 

in lieu of surgery.” (R&R at 8:19–21.) Elsewhere, it characterizes this option as 

“self-improvement.” (Id. at 3:1–2.) Shufelt’s objections argue that this reading is 

wrong, and that what Dr. Yoo actually said was that he could take no action at all 

and hope for a spontaneous recovery. He later dismisses this option as obviously 

ineffective and impractical, and argues that Defendants knew it would not work.

This is not, however, what Dr. Yoo said, and more importantly, Defendants were 

not bound to read Dr. Yoo’s report this way.

The report does not say what exactly Shufelt would need to do in order to 

“improve on his own,” though it clearly contemplates some kind of rehabilitation 

(e.g., rest, exercise, therapy, etc.) The report makes clear this could be an 

effective approach, even though it would take a long time. In fact, its mention of 

the time frame shows that Dr. Yoo thought it could succeed. Reading the first 

option, as Shufelt does, as ignoring the problem, is unreasonable. The existence 

of this option also shows that Dr. Yoo did not think surgery was urgently needed. 

It also bears mention that Dr. Yoo himself idelayed surgery by several months, 

suggesting he thought it was not an urgent situation.

/ / /

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Shufelt also argues that after what he calls a “sufficient time,” Defendants 

should have realized that the first option was not going to work. This objection is 

based on his misreading of the option. He has never alleged that he tried whatever 

could be done to “improve on his own,” and the record suggests in fact that he was 

refusing physical therapy appointments (or, at least, Defendants believed he was). 

He has not plausibly alleged facts supporting his conclusion that Defendants knew 

this option would not work.

Shufelt’s objections also focus on the risks vs. benefits analysis. He bases 

his objections on reports by Dr. Yoo and Dr. Vacca, which he alleges says the only 

possible downside was that the surgery might not be ineffective, and that “[a]s far 

as Risk, there was none.” (Objections at 7.) In fact, this seriously misreads both 

reports. 

Dr. Yoo’s report merely said “The patient understood the medical rationale 

for [the procedure] and understands all risks of surgical procedure and will be 

giving consent.” (Docket no. 1-2, Ex. BB.) It did not say what those risks were, 

but clearly there were some.

Dr. Vacca’s report shows he counseled Shufelt about the risks and 

drawbacks of surgery, in order to help Shufelt decide whether he wanted to 

undergo it. (Id., Ex. MM.) For example, he mentioned that 80% of patients benefit 

from surgery, and that the biggest risk is non-response. He also told Shufelt about 

the small risks of wound infection, spinal fluid leak, and the chance he would 

require additional surgery later (which was estimated at 15%). (Id.) Dr. Vacca’s 

notes make clear that Shufelt based the decision to get surgery on how badly his 

symptoms were bothering him. This implies that the decision is based on some 

kind of analysis of pros and cons, and that it is not a foregone conclusion.

Furthermore, other doctors’ reports emphasized that the risks might not 

outweigh the benefits. A report by Dr. Shakiba, dated July 10, 2015, mentions a 

discussion with Shufelt about this:

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The patient was advised that his [request for surgery] had been denied. 

He became somewhat irritated by this, reporting that he is already in a 

wheelchair and he does not understand how the risk of surgery could 

outweigh the benefits. I advised him that he could possibly not benefit 

from the surgery and develop other problems such as infection and 

other nerve damage.

(Docket no. 1-2, Ex. CC.) In short, the surgery carried some risks, not none as 

Shufelt argues. And doctors treated the weighing of risks against benefits as a 

matter that could rationally be decided either way. 

Shufelt argues that because blood was drawn for his blood tests fourteen 

hours after he had taken morphine, the morphine must have metabolized, creating 

a false negative. He also posits that the drug test could not detect small amounts 

of drugs in the system. Even assuming these facts are true, Defendants were not 

required to believe him rather than the testing laboratory. The blood test was 

unannounced (Docket no. 1-2, Ex. Q), and the test results as reported by a 

laboratory showed that the results were inconsistent with his taking prescribed 

morphine. Dr. Zhang’s notes after seeing Shufelt on May 6, 2015 reflects that 

Shufelt was being given Tylenol and Lyrica for his pain, but was occasionally 

missing his doses of Lyrica. (Id., Ex. Y.) This report also records an incident 

between Shufelt and Dr. Zhang:

He has a history of morphine sulfate diversion. Serum drug tests were 

negative on 12/09/2014 and 01/02/2015. The patient was supposed to 

be on morphine during those drug tests. His morphine was weaned off 

due to increased risk of abuse, addiction, and overdose. . . .Not soon 

after he entered the room, the patient began asking to be placed back 

on morphine for his chronic pain. The patient states that his 

neurosurgeon, Dr. Yoo, ordered narcotics for him for his pain, and he 

demanded to be placed back on morphine sulfate. The patient became 

very argumentative and began to raise his voice. Custody was called 

to prevent escalating of the situation. The patient continued to be 

argumentative and the interview was ended. I will reschedule.

/ / /

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(Id.) The R&R included this incident in its findings of fact (R&R at 4:24–5:2), and 

Shufelt has not objected to this finding.

Dr. Yoo concluded that Shufelt’s medication was not optimal and he seemed 

undermedicated. Even assuming Dr. Yoo thought Shufelt ought to be given 

morphine, nothing in the record shows Dr. Yoo knew about the negative drug tests 

or had considered the possibility that Shufelt was diverting the morphine. Dr. 

Vacca, by contrast, thought either Norco or Percocet could be prescribed, though 

he did not say it was medically necessary. (Docket no. 1-2, Ex. MM.) Furthermore, 

the record shows Defendants were motivated by the need to prevent drug abuse, 

addiction, and overdose, all of which are also legitimate medical and penological 

concerns.

The key issue with all these claims is not whether Defendants should have 

believed Shufelt or followed Dr. Yoo’s recommendations, whether Shufelt can 

show they did a poor job managing his medical care, or whether in retrospect they 

should have done things differently. The issue is whether at the time they exhibited 

deliberate indifference. Shufelt has not alleged facts showing that they did, and the 

documents he provided and relies on show that they were not indifferent. Rather, 

they were motivated by other legitimate considerations, including a concern for his 

own welfare. They were taking steps to treat his pain, provided him with mobility 

aids, arranged for a primary care physician to monitor him, and made 

arrangements for him to see other doctors. They also made a course of treatment 

available to him that they had reason to believe was medically acceptable. The 

fact that he was not showing improvement would not, by itself, put them on notice 

that the treatment was medically inappropriate, particularly because he was not 

fully cooperating.

It also bears mention that four of the Defendants are doctors and that Shufelt 

was seen and treated by doctors besides Dr. Yoo. Even though Dr. Yoo was a 

specialist, other doctors were entitled to disagree with his recommendations or 

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opinions, particularly if those opinions were based on information Dr. Yoo did not 

have or had not considered. Shufelt has not plausibly alleged facts showing that 

these other doctors’ recommendations were made in bad faith or exhibited 

deliberate indifference to his welfare.

The R&R included other recommendations, including dismissal of Shufelt’s 

ADA and Rehabilitation Act claims. Besides the fact that Shufelt added these 

claims without leave, they have no merit. They are based on the same facts as 

Shufelt’s Eighth Amendment claim, and Shufelt has not pled any facts to support 

a claim under either theory.

Conclusion and Order

The Court ADOPTS those portions of the R&R to which no objection has 

been filed. Having reviewed de novo those portions to which Shufelt has filed 

specific written objections, the Court OVERRULES the objections and ADOPTS

the R&R. The FAC is DISMISSED.

Neither the motion to dismiss nor the R&R mentioned whether dismissal 

should be with or without prejudice. Dismissal without leave to amend is normally 

appropriate only where it is clear the complaint could not be saved by amendment. 

See Lopez v. Smith, 203 F.3d 1122, 1130 (9th Cir. 2000). It appears unlikely 

Shufelt can successfully amend, particularly because he has already amended 

once. Yet neither Defendants’ motion nor the R&R addressed this point, and the 

Court cannot say for certain that he could not. 

If Shufelt believes he can successfully amend, he should file an ex parte

motion for leave to amend by March 20, 2019. His motion should include all the 

factual allegations he would like to add to the FAC. He should not include legal 

arguments or conclusions, and should not use his motion to seek reconsideration 

of any matter already decided. Any opposition is due by April 4, 2019. Shufelt’s

motion is REFERRED to Magistrate Judge Ruth Montenegro for a report and 

recommendation. Although in the interests of economy the Court is not requiring 

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Shufelt to comply fully with Civil Local Rule 15.1(b), Judge Montenegro may in her 

discretion require that he do so, and may order additional briefing.

Judge Montenegro may extend these deadlines for good cause. But because 

the Court is requiring Shufelt to make factual allegations based on facts he should 

already know and has identified pleading defects for him, he should not need any 

time for legal research.

If Shufelt does not seek leave to amend within the time permitted, the 

Court will understand that to mean he cannot successfully amend. In that 

event, this action will be dismissed without leave to amend, without further 

notice to him.

IT IS SO ORDERED.

Dated: February 20, 2019

Hon. Larry Alan Burns

Chief United States District Judge

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