Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_14-cv-01397/USCOURTS-casd-3_14-cv-01397-4/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 

DAVID ROBERT BELL, 

Plaintiff,

v. 

CALIFORNIA DEPARTMENT OF 

CORRECTIONS & REHABILITATION, 

et al., 

Defendant.

 Case No.: 14cv1397 BEN (PCL) 

REPORT AND 

RECOMMENDATION RE: 

DEFENDANTS' MOTION FOR 

SUMMARY JUDGMENT [DOC. 80] 

I. INTRODUCTION 

David Robert Bell (“Plaintiff”) alleges three violations of the Civil Rights Act, 42 

U.S.C. §§ 1983, et seq., related to his medical care while incarcerated at Richard J. 

Donovan State Correctional Facility. (Doc. 1.) Plaintiff seeks monetary relief jointly and 

severally against each defendant. (Id.) 

Before this Court is a Motion for Summary Judgment made pursuant to Federal Rule 

of Civil Procedure 56 by the California Department of Corrections and Rehabilitation, Dr. 

K Thompson, Nurse Pamela Velardi, Nurse Bersamin, John Does 1 through 10, and Jane 

Does 1 through 10 (“Defendants”). (Doc. 80.) The Honorable Roger T. Benitez referred 

the matter to the undersigned Judge for Report and Recommendation pursuant to 28 U.S.C. 

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§ 636(b)(1)(B) and Local Civil Rule 72.1(c)(1)(d). After a thorough review of the pleadings 

and supporting documents, this Court recommends that the Defendants’ Motion for 

Summary Judgment be GRANTED. 

II. PROCEDURAL BACKGROUND 

Plaintiff alleges the following civil rights violations in his Complaint: (1) Defendants 

failed to provide adequate medical care; (2) Defendants were ignorant of Plaintiff’s 

medical diagnosis and failed to adequately attend to his care; (3) Defendants were 

deliberately indifferent to Plaintiff’s serious medical needs; (4) Defendants denied Plaintiff 

proper medical care; (5) Defendants’ medical acts or inactions contributed to Plaintiff’s 

future medical harms; and (6) Defendants breached an implied contract to provide 

reasonably sufficient medical care. (Doc. 1.) Following an earlier Motion for Summary 

Judgment, only Plaintiff’s first, second, and fourth claims remain. (Docs. 86, 87.) Further, 

Plaintiff’s claims against Defendants Glynn, Walker, and Seeley were deemed improper 

and dismissed. (Id.) 1

Defendants move for summary judgment claiming qualified immunity. (Doc. 80.) 

Plaintiff filed his Opposition on June 6, 2014 and Defendants replied on June 6, 2014. 

(Docs. 82; 84.) 

III. FACTUAL BACKGROUND 

A. Medical History2

While incarcerated, Plaintiff made numerous complaints of spinal and shoulder pain 

starting with his first request for medical attention in May 2012. (Doc. 80-3 at 19.) Plaintiff 

reported suffering shoulder and back injuries as a result of his work in the prison kitchen. 

(Id.) Plaintiff was examined by Nurses Bersamin and Velardi, with Velardi noting that 

                                               

1

 Defendants filed this second Motion for Summary Judgment before the first had been ruled on. To the 

extent that the instant Motion references Defendants and causes of action that are no longer live, the 

Court will consider them moot and will not discuss them here. 

2

 Plaintiff’s medical history is taken from records provided by Defendants as exhibits to their Motion for 

Summary Judgment. 

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Plaintiff both wanted to change jobs and wanted an MRI. (Id. at 21.) Plaintiff was further 

examined by a physical therapist and a family nurse practitioner later that month. (Doc. 80-

2 at 6.) The notes from his May 29, 2012 exam indicate that while Plaintiff complained of 

shoulder pain and was unready to return to work, he displayed a full range of motion in his 

left shoulder. (Doc. 80-3 at 25.) 

 Plaintiff was examined four times between June 6-7, 2012. (Id. at 26-33.) On June 

6, Bersamin submitted a second request for Plaintiff to be X-Rayed, noting that her first 

request went unfulfilled. (Id. at 27.) Less than three hours later, Plaintiff was examined by 

Bersamin again, complaining of extreme lower back pain. (Id. at 29.) Bersamin prescribed 

a muscle relaxant, added Tylenol to his pain medication, and ordered Plaintiff to continue 

with his already-prescribed medications. (Id.) On June 7, Plaintiff complained of continued 

lower back pain and indicated that the medicine he was taking wasn’t working. (Id. at 31.) 

Notes from this visit indicate Plaintiff was able to move from sitting to standing without 

assistance, however slowly. (Id.) The progress note states Plaintiff had a steady gait but 

was persistently “uncooperative.” (Id.) Roughly two hours later, Plaintiff restated his 

extreme pain to Nurse Parages and that he was unable to get himself to the canteen for 

meals. (Id. at 33.) Parages informed Plaintiff that he needed to walk for his scheduled XRay and suggested Plaintiff attempt to stretch. When Plaintiff expressed reluctance, 

Parages examined his back. She reported no protruding bones and that Plaintiff did not 

grimace when she touched him. (Id.) Parages’ note indicated Plaintiff was, despite multiple 

attempts by multiple medical staff, still reluctant to listen when she told him to take his 

medication. (Id.) 

 Plaintiff’s left shoulder was X-Rayed on June 8, 2012, showing evidence of a 

subacute nondisplaced fracture at the distal clavicle. (Id. at 35.) A later comparison X-Ray 

showed Plaintiff’s fracture was healing properly. (Id. at 37.) 

 On June 8, 2012, Plaintiff was examined by FNP Seifullah. (Id. at 39.) Plaintiff told 

her that he did not suffer any specific injury to his back that caused his persistent pain, but 

that it simply “gave out.” (Id.) Plaintiff was then prescribed Toradol and Indocin injections 

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and Decadron for his pain. (Id.) During a June 12, examination with Velardi, Plaintiff 

indicated that while he had previously reported no injury, he had in fact fallen on May 18, 

2012. (Id. at 41.) Plaintiff requested to leave the clinic before he was examined. (Id.) 

Additionally, Velardi reported Plaintiff was threatening, uncooperative, and hostile, stating 

“I’m going to sue you and take your job.” (Id.) On June 28, 2012, Plaintiff reported to Dr. 

Sedighi that his back pain was improving following taking illegally acquired morphine. 

(Id. at 43.) 

 Plaintiff was again examined by Bersamin on July 5, 2012. (Id. at 45.) In his request 

for health care services, Plaintiff indicated that an X-Ray on his back was “neg” and that 

he believed a MRI would be appropriate. (Id.) Notes from a telemedicine clinic visit with 

Dr. Christian Bentley on July 9, 2012, indicated Plaintiff complained of pain radiating in 

both legs, that he has difficulty walking and stands in a stooped position, and is wheelchairbound. (Id. at 48.) Dr. Bentley indicated Plaintiff’s shoulder fracture needed no further 

follow-up, but that Plaintiff would “probably benefit” from a MRI and a neurosurgical 

orthopedic spine surgeon referral for evaluation. (Id.) 

 On July 14, 2012, Plaintiff was examined at the Triage and Treatment Area for 

extreme pain. (Doc.080-3 at 50-51.) Triage notes indicate Plaintiff was able to move all 

extremities and once again denied recent injury. (Id.) Within an hour of being admitted to 

triage, Plaintiff was reporting improving levels of pain and increased comfort. (Id. at 51.) 

Plaintiff was next examined by Dr. Martinez on July 19, 2012 (Id. at 53-55.) Dr. Martinez 

adjusted some of Plaintiffs medications and ordered a non-emergent lower spine MRI 

“ASAP.” (Id.) 

 Plaintiff’s August 3, 2012 MRI showed a paraspinal abscess surrounding the L5-S1 

disc. (Id. at 59.) The mass was roughly 3x3x4 centimeters in size, extending into nerve 

roots. (Id.) The following day Kevin Yoo, M.D., examined Plaintiff, diagnosing Plaintiff 

with early cauda equine syndrome. Dr. Yoo recommended a laminectomy and evacuation 

of the epidural abscess. (Id.) 

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 Following surgery Plaintiff’s condition was reportedly “doing well with IV 

antibiotics.” (Id. at 64.) Plaintiff was treated with morphine following his surgery until a 

doctor deemed it unnecessary and issued orders to taper-off Plaintiff’s dosage. (Id. at 66-

68.) 

 B. Drug Abuse History 

 Plaintiff’s history of drug abuse while incarcerated dates back to at least October 

1988 when he was reported to have sought drugs for back pain while indicating no 

dysfunction. (Id. at 6.) Mental health progress notes from August 2001 indicate Plaintiff 

“appears to psychosomatize his problems with continued physical complaints,” and that 

Plaintiff has a history of alcohol abuse. (Id. at 8.) In November of 2008 Plaintiff was found 

in his cell unresponsive, not breathing, with pinpoint pupils. (Id. at 15.) Because Plaintiff 

responded to the Narcan administered by medical staff, it was presumed that Plaintiff had 

taken a narcotic overdose, likely heroin. (Id.) A July 2010 progress note detailed medical 

staff suspicion that Plaintiff was diverting another inmate’s morphine prescription. During 

Plaintiff’s May 18, 2012 examination by Velardi upon first complaining of shoulder pain, 

Velardi noted Plaintiff had pinpoint pupils and ordered a drug screen. (Id. at 21.) May 20, 

2012 records indicate that Plaintiff had tested positive for morphine despite not having a 

prescription for the drug. (Id. at 23.) Further, when Plaintiff was not satisfied with the 

course of medicines he had been prescribed to treat his lower back pain, Plaintiff admitted 

to medical staff that he had purchased morphine “on the yard.” (Id. at 43.) 

IV. STANDARD OF REVIEW 

A. Summary Judgment 

 Summary judgment will be granted, entitling the moving party to a judgment as a 

matter of law, when the moving party has demonstrated that there exists “no genuine 

issue as to any material fact.” Fed. R. Civ. P. 56(c)(2). If the moving party can 

demonstrate that no reasonable trier of fact could find other than in favor of the moving 

party, entry of summary judgment is appropriate. Celotex Corp. v. Catrett, 477 U.S. 317, 

323 (1986).

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 When the issue in question is one that the opposing party must prove at trial, the 

moving party is only required to indicate that “there is an absence of evidence in support 

of the nonmoving party’s case” for summary judgment to be granted. Id. at 325. If the 

nonmoving party fails to completely prove an essential element of their case, all other facts 

are rendered immaterial. Id. at 323. Once the moving party has sufficiently demonstrated 

the nonmoving party’s lack of supporting evidence, the burden then shifts to the opposing 

party to establish that a genuine issue of material fact does exist. Matsushita Elec. Indus. 

Co. v. Zenither Radio Corp., 475 U.S. 574, 586 (1986). 

 Once the burden has shifted, the nonmoving party must establish the existence of the 

factual dispute by tendering evidence of specific facts through affidavits or admissible 

discoverable material, rather than relying simply on conclusory allegations. Fed. R. Civ. 

Pro. 56(e); Matsushita, 475 U.S. at 586. Through reasonable inferences are drawn in favor 

of the opposing party, the nonmoving party is obligated to produce the factual predicate 

from which those inferences are drawn. See Richards v. Nielsen Freight Lines, 692 F.Supp. 

1224, 1244045 (E.D. Cal. 1985), aff’d, 810 F.2d 898, 902 (9th Cir. 1987). If the nonmoving 

party fails to present evidence in support of the existence of material facts, summary 

judgment will be granted. Matsushita, 475 U.S. at 587. 

 In ruling on a motion for summary judgment, the court need not accept legal 

conclusions “cast in the form of factual allegations.” Western Mining Council v. Watt, 643 

F.2d 618, 624 (9th Cir. 1981). “No valid interest is served by withholding summary 

judgment on a complaint that wraps nonactionable conduct in a jacket woven of legal 

conclusions and hyperbole.” Vigliotto v. Terry, 873 F.2d 1201, 1203 (9th Cir. 1989). 

B. Qualified Immunity 

Qualified immunity entitles government officials to “an immunity from suit rather 

than a mere defense to liability; and like an absolute immunity, it is effectively lost if a 

case is erroneously permitted to go to trial.” Mitchell v. Forsyth, 472 U.S. 511, 526 (1985). 

Qualified immunity shields government officials “from liability for civil damages insofar 

as their conduct does not violate clearly established statutory or constitutional rights of 

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which a reasonable person would have known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 

(1982) (citations omitted). Generally, qualified immunity doctrine must “‘give ample room 

for mistaken judgments’ by protecting ‘all but the plainly incompetent or those who 

knowingly violate the law.’” Hunter v. Bryant, 502 U.S. 224, 229 (1991). The intent of 

qualified immunity is to shield an officer from personal liability when that officer acted 

with a reasonable belief that their conduct was in compliance with the law. Pearson v. 

Callahan, 555 U.S. 223, 244 (2009). The Supreme Court has embraced an objective test 

under which “government officials performing discretionary functions generally are 

shielded from liability for civil damages insofar as their conduct does not violate clearly 

established statutory or constitutional rights of which a reasonable person would have 

known.” Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). 

“Qualified immunity is particularly amenable to summary judgment adjudication 

because ‘the entitlement is an immunity from suit rather than a mere defense to liability.’” 

Martin v. City of Oceanside, 360 F.3d 1078 1081 (9th Cir. 2004) (citing Hunter v. Bryant, 

502 U.S. 224, 227 (1991)). A court determining a motion for summary judgment based on 

a claim of qualified immunity must determine whether, viewing the evidence in the light 

most favorable to the non-moving party, the moving party has shown that there are no 

genuine issues of material fact in order to grant summary judgment. See Id. Once a §1983 

defendant produces enough evidence to require the plaintiff to go beyond his or her 

pleadings, the plaintiff must counter by producing evidence of his or her own; a district 

court is not allowed to simply assume the truth of challenged factual allegations in the 

complaint 

 The United States Supreme Court outlined a two-step qualified immunity analysis 

in Saucier v. Katz, 533 U.S. 194 (2001), requiring district courts to first determine whether 

the officer’s conduct violated a constitutional right. Saucier, 533 U.S. at 201. If no 

constitutional right was violated, the court need not inquire further. Id. If a constitutional 

violation has occurred, the court’s second inquiry under Saucier is to ask whether the law 

was “clearly established” at the time of defendants’ alleged misconduct. Id. 

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V. DISCUSSION 

Plaintiff’s remaining three claims contend that (1) Defendants failed to provide 

adequate medical care, (2) Defendants were ignorant of Plaintiff’s medical diagnosis and 

failed to adequately attend to his care, and (3) Defendants denied Plaintiff proper medical 

care. (Doc. 1.) In the instant Motion, Defendants contend that all claims fail as the 

uncontested evidence shows that Plaintiff has not met his burdens to (1) demonstrate 

infringement of a clearly established body of law demonstrating Defendants were unlawful 

in treating Plaintiff, and (2) demonstrate that Defendants infringed on any of Plaintiff’s 

rights, were they established. As such, Defendants argue they are entitled to qualified 

immunity. (Doc. 80-1 at 1.) In opposition, Plaintiff argues summary judgment on qualified 

immunity grounds is improper given factual disputes regarding Defendants’ conduct or 

motive. (Doc. 82 at 11.) 

A. Whether Defendants’ Conduct Violated A Constitutional Right 

State governments have the obligation to provide medical care for those whom they 

are punishing by incarceration. See Estelle v. Gamble, 429 U.S. 97, 103 (1976). The 

infliction of unnecessary suffering on a prisoner though the failure to treat his medical 

needs is inconsistent with the contemporary standards of decency and violates the Eighth 

Amendment. See id. A plaintiff bringing a §1983 claim alleging a violation of the Eighth 

Amendment based on the failure of a prison official to treat his medical needs must 

establish that the prison official or officials acted with “deliberate indifference” to a 

“serious medical need.” See Id. at 104; Wakefield v. Thompson, 177 F.3d 1160, 1164 (9th 

Cir. 1999). 

 The Ninth Circuit has explained that the test for deliberate indifference consists of 

two parts. See Jett v. Penner, 439 F.3d 1091, 1096 (2006). 

First, the plaintiff must show a “serious medical need” by demonstrating that 

“failure to treat a prisoner’s condition could result in further significant injury 

or the ‘unnecessary and wanton infliction of pain.’” Second, the plaintiff must 

show the defendant’s response to the need was deliberately indifferent. This 

second prong – defendant’s response to the need was deliberately indifferent 

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– is satisfied by showing (a) a purposeful act or failure to respond to a 

prisoner’s pain or possible medical need and (b) harm caused by the 

indifference. Indifference “may appear when prison officials deny, delay or 

intentionally interfere with medical treatment, or it may be shown by the way 

in which prison physicians provide medical care.” 

Id. (internal citations omitted). 

 A prison official acts with deliberate indifference only if the official knows of and 

disregards an excessive risk to an inmate’s health and safety. See Toguchi v. Chung, 391 

F.3d 1051, 1057 (9th Cir. 2004). Even if a prison official should have been aware of the 

risk, but was not, then the official has not violated the Eighth Amendment, no matter how 

severe the risk. See id. Furthermore, while poor medical treatment will at a certain point 

rise to the level of constitutional violation, mere malpractice, or even gross negligence, 

does not satisfy the requirement of deliberate indifference. See Wood v. Housewright, 900 

F.2d 1332, 1334 (9th Cir. 1990); see also Hallett v. Morgan, 296 F.3d 732, 744 (9th Cir. 

2002) (“Mere medical malpractice does not constitute cruel and unusual punishment.”). 

 Medical care less prompt or efficient than a free citizen might receive also does not 

constitute deliberate indifference. See Wood, 900 F.2d at 1335. In order for delay in 

treatment to constitute an Eighth Amendment violation, the delay must cause substantial 

harm. See Id. (holding that a delay in treatment did not substantially harm the plaintiff since 

the only remedy immediately available was a prescription for pain killers); see also Shapely 

v. Nevada Bd. Of State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985) (“[M]ere delay 

of surgery without more, is insufficient to state a claim of deliberate medical 

indifference....”). 

 Prisoners can establish an Eighth Amendment violation with respect to medical care 

and treatment if they can prove there has been deliberate indifference to serious medical 

needs. Estelle v. Gamble, 429 U.S. 97, 104 (1976). To state a claim, the prisoner must 

prove that he was confined under conditions posing a risk of objectively serious harm and 

that prison officials had a sufficiently culpable state of mind in denying him proper medical 

care. Wallis v. Baldwin, 70. F.3d 1074, 1076 (9th Cir. 1995). Thus, the relevant inquiry 

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involves both an objective and a subjective component. Clement v. Gomez, 298 F.3d 898, 

904 (9th Cir. 2002). 

1. Objective Component 

In order to establish the objective component of an Eighth Amendment claim based 

on deliberate indifference to serious medical needs, a plaintiff must demonstrate his 

medical need was sufficiently serious such that the failure to treat the prisoner’s condition 

could have resulted in further significant injury or the unnecessary and wanton infliction 

of pain. 42 U.S.C. § 1983; Estelle, 429 U.S. at 104; Jett, 439 F.3d at 1093; Clement, 298 

F.3d at 904. “The existence of an injury that a reasonable doctor or patient would find 

important and worthy of comment or treatment; the presence of a medical condition that 

significantly affects an individual’s daily activities; or the existence of chronic and 

substantial pain are...indications that a prisoner has a serious need for medical treatment.” 

Lopez v. Smith, 203 F.3d 1122, 1124 (9th Cir. 2000). 

Here, Defendants do not contest that Plaintiff suffered from a severe spinal abscess 

that prison medical staff misdiagnosed in the examinations done in June and July of 2012. 

However, evidence presented by both parties indicates that Plaintiff was seen by medical 

staff and received treatment during each visit. 

Plaintiff was examined five times in May 2012, seven times in June 2012, four times 

in July 2012, and received post-surgical care in August 2012. During each of the 

examinations, Plaintiff was properly assessed, treated for his conditions according to 

typical procedure, and received pain medication to alleviate his discomfort. Plaintiff 

received an MRI of his lumbar spine and was referred to a neurological orthopedic spine 

surgeon for evaluation pursuant to Dr. Christian Bentley’s recommendation. 

Defendants did not fail to treat Plaintiff, rather they treated Plaintiff according to 

their diagnosis. The only issue to be resolved is whether Plaintiff has provided evidence 

from which it reasonably can be inferred that Defendants acted with a sufficiently culpable 

state of mind to constitute deliberate indifference of an inmate’s medical needs. 

/// 

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2. Subjective Component 

The subjective component requires the prisoner to identify sufficient facts to indicate 

that prison officials acted with a culpable state of mind to constitute deliberate indifference. 

See Wilson v. Seiter, 501 U.S. 294, 299 (1991). A prison official demonstrates a culpable 

state of mind that is deliberately indifferent if they know that a prisoner faces a substantial 

risk of serious harm and they disregard that risk by failing to take reasonable steps to abate 

it. Farmer v. Brennan, 511 U.S. 825, 837 (1994). Such indifference must be substantial; 

inadequate treatment due to inadvertence, malpractice, or even gross negligence, does not 

amount to a constitutional violation. See Estelle, 429 U.S. at 104; Wood v. Housewright, 

900 F.2d 1332, 1334 (9th Cir. 1990). 

As a matter of law, difference of medical opinion as to the need to pursue one course 

of treatment over another is insufficient to establish deliberate indifference. See Sanchez 

v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). Medical care less prompt or efficient than a free 

citizen might receive also does not constitute deliberate indifference. See Wood, 900 F.2d 

at 1335. In order for delay in treatment to constitute an Eighth Amendment violation, the 

delay must cause substantial harm. See Id. (holding that a delay in treatment did not 

substantially harm the plaintiff since the only remedy immediately available was a 

prescription for pain killers); see also Shapely v. Nevada Bd. Of State Prison Comm’rs, 

766 F.2d 404, 407 (9th Cir. 1985) (“[M]ere delay of surgery without more, is insufficient 

to state a claim of deliberate medical indifference....”). Plaintiff “must show that the course 

of treatment the doctors chose 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) (citations omitted). 

Here, Plaintiff fails to show how Defendants’ response to Plaintiff’s lower back pain 

demonstrates deliberate indifference to Plaintiff’s medical condition. The medical record, 

taken as a whole, establishes a course of treatment that was both attentive to Plaintiff’s pain 

and reasonable under the circumstances. Plaintiff was examined over a dozen times by 

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medical professionals who adjusted their treatment, recommendations, and prescribed 

medications in response to Plaintiff’s pain. 

The records show Plaintiff was examined by a number of different Nurses, Nurse 

Practitioners, and Physicians. As a result, it is not unreasonable to believe that the medical 

staff referred back to old treatment notes before assessing Plaintiff’s condition and 

prescribing medication. To that end, any medical professional who read Plaintiff’s medical 

record would find that Plaintiff has a long and varied history as both a drug seeker and drug 

abuser while incarcerated. Had the 1988 drug seeking incident been the only time Plaintiff 

was found to have improperly sought narcotics, medical staff in 2012 would probably not 

infer continued drug seeking behavior. However, Plaintiff was found under the influence 

of narcotics repeatedly in the intervening years, up to and including the day Plaintiff first 

complained of shoulder pain to Nurse Velardi. As a result, it is wholly reasonable under 

these circumstances to attribute Plaintiff’s behavior to that of an addict seeking narcotics. 

Defendants here did not act in conscious disregard of an excessive medical risk to 

Plaintiff’s health, but rather in conscious regard to a behavioral condition Plaintiff. 

Additionally, given Plaintiff’s mental health history indicating a tendency to 

psychosomatize problems with physical complaints, Defendants’ course of treatment was 

reasonable. Insuring Plaintiff’s complaints of pain were not an effort to obtain narcotics or 

the result of a mental health issue was a reasonable medical practice. 

Plaintiff contends deliberate indifference is established by the length of time 

between Plaintiff’s first complaints of pain and his surgery. Additionally, Plaintiff argues 

his pleas for increased medical treatment fell on deaf ears because medical staff believed 

Plaintiff’s condition was a rouse to obtain narcotics. The medical record, however, 

establishes that not only were Defendants more than willing to listen to and treat Plaintiff’s 

medical condition, but also that Plaintiff was less than truthful and often an uncooperative 

patient. He was routinely examined and the progress notes indicate lower back pain, but 

also include details such as lack of grimace and ability to ambulate. Further, Plaintiff 

complained of shoulder pain during his first visit in May 2012, and did not bring up lower 

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back pain until later visits. Had Plaintiff’s first visit included lower back pain complaints, 

the time between that examination and being diagnosed with an abscess was still less than 

three months. While three months may indicate a minor delay in the ultimate surgery, 

Plaintiff’s medical needs were being attended to, in accordance to his diagnosis at the time, 

throughout. 

Plaintiff was eventually diagnosed with early stage cauda equine syndrome which 

was not likely to be discovered without an MRI. Plaintiff’s complaints, combined with 

Defendants’ experience and skill as medical providers, did not rise to the level of requiring 

an immediate MRI. This is not unreasonably delayed treatment, but rather an unfortunate 

missed diagnosis that is partially due to Plaintiff’s medical history3

. Plaintiff was 

inconsistent in his communications about the cause of his pain, at times stating there was 

no underlying injury and at another time telling a nurse he fell. There is no indication that 

had Plaintiff been more thoroughly examined upon first complaint of lower back pain, any 

issue would have been discovered. Plaintiff himself noted that a back X-Ray image was 

negative during a telemedicine visit. 

Plaintiff provides no evidence that Defendants’ treatment rose to the level of “plainly 

incompetent” nor does Plaintiff establish how Defendants’ knowingly violated any laws. 

Additionally, Plaintiff does not present any evidence refuting Defendants’ contention that 

delaying an MRI was medically acceptable under the circumstances. The medical records 

do not support a finding that treatment deliberately indifferent. There is no indication by 

Plaintiff that the time it took to have the MRI was even a “delay” instead of a conservative 

course of treatment. When looking at the circumstances as a whole, Defendants were 

presented with an inmate who had once before claimed back pain to obtain narcotics, 

illegally obtained and used narcotics, repeatedly, to the extent that he suffered an overdose, 

who was once again presenting back pain and testing positive for morphine. As such, 

                                               

3

 Defendants do not dispute that a missed diagnosis occurred. (Doc. 80-2 at 10:1-4.) 

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Defendants took reasonable steps to provide medical care to Plaintiff and did not, as 

Plaintiff contends, actively disregard a known risk to his health. 

For the reasons stated above, there are no triable issues of material fact remaining 

with respect to whether Defendants acted with deliberate indifference. Taken in the light 

most favorable to the Plaintiff, the evidence fails to demonstrate that Defendants violated 

Plaintiff’s rights under the Eighth Amendment. 

B. Whether Plaintiff’s Eighth Amendment Rights were Clearly Established 

and Whether Defendants Could Have Reasonably but Mistakenly Believed 

Their Conduct Did Not Violate a Clearly Established Constitutional Right 

 As discussed above, there is no genuine issue of material fact, and no constitutional 

violation arising from the Defendants’ act. Therefore, the Court need not inquire as to 

whether the law was “clearly established” at the time of the alleged misconduct, and may 

apply qualified immunity to the Plaintiff’s requests for monetary relief. 

 Based on the foregoing, the Court recommends GRANTING Defendants’ Motion 

for Summary Judgment based on qualified immunity. 

VI. CONCLUSION 

 For the reasons outlined above, it is hereby recommended the Court issue an Order: 

1) approving and adopting this Report and Recommendation; and 2) directing that 

Defendants’ Motion for Summary Judgment be GRANTED. 

IT IS ORDERED that no later than Thursday, August 11, 2016, 2016, any party to 

this action may file written objections and replies with the Court and serve a copy on all 

parties. The document should be captioned “Objections to Report and Recommendation.” 

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IT IS FURTHER ORDERED that any reply to the objections shall be filed with 

the Court and served on all parties no later than Thursday, August 25, 2016. The parties 

are advised that failure to file objections within the specified time may waive the right to 

raise those objections on appeal of the Court’s order. See Turner v. Duncan, 158 F.3d 449, 

455 (9th Cir. 1998); Martinez v. Ylst, 951 F.2d 1153, 1156 (9th Cir. 1991). 

Dated: July 27, 2016 

cc: The Honorable Roger Benitez 

 All Parties and Counsel of Record 

Case 3:14-cv-01397-BEN-PCL Document 95 Filed 07/27/16 Page 15 of 15