Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_16-cv-02294/USCOURTS-cand-3_16-cv-02294-6/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

ALFREDO GONZALEZ,

Plaintiff,

v.

F. TUVERA, et al.,

Defendants.

Case No. 16-cv-02294-JST 

ORDER DENYING DEFENDANTS’

MOTION FOR SUMMARY 

JUDGMENT; STAYING ACTION AND 

REFERRING FOR SETTLEMENT 

PROCEEDINGS; DIRECTIONS TO 

CLERK

Re: ECF No. 25

Plaintiff, a former California state prisoner, has filed a pro se complaint under 42 U.S.C. 

§ 1983 alleging that prison officials at Salinas Valley State Prison (“SVSP”) violated his 

constitutional rights when he was housed there. Now pending before the Court is Defendants’

motion for summary judgment. ECF No. 25. Plaintiff has filed an opposition and related 

documents, ECF No. 61; and Defendants have filed a reply, ECF No. 66. For the reasons set forth 

below, Defendants’ motion for summary judgment is DENIED. 

BACKGROUND

On March 28, 2011, while housed at SVSP, Plaintiff was attacked by another inmate, 

resulting in a severe closed head injury involving a fractured skull, bruising, and internal bleeding. 

He was treated at San Jose Regional Medical Center where doctors removed a portion of his skull 

to allow the swelling in his brain to decrease; placed a catheter in his head to help drain the excess 

fluid; and placed a feeding tube in his stomach through his throat. On April 12, 2011, the flap on 

Plaintiff’s skull was reattached. On April 18, 2011, Plaintiff was discharged and returned to SVSP 

where he was admitted to the prison hospital. Compl. at 4; ECF No. 1-2 at 2-10; Kumar Decl. ¶¶ 

3, 4 and Ex. A.

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This action challenges the medical treatment that Plaintiff received after his April 2011 

return to SVSP. Plaintiff alleges that SVSP medical staff F. Tuvera, E. Bridgnell, Nurse Orfield, 

D. Bright, T. Wy, and L. Gamboa failed to provide adequate medical care following his 

emergency skull surgery. Plaintiff further alleges that SVSP medical staff and appeals office 

officials D. Bright, L. Gamboa, K. Kumar, A. Adams, J. Dunlap, J. Villafuerte, E. Talanoa, E. 

DelaRosa, F. Mejia, J. Turner, and M. Ulloa also denied him adequate medical care when they

denied and/or mishandled his inmate healthcare appeals and staff complaints requesting proper 

treatment. Plaintiff also alleges that Defendant Tuvera retaliated against him for filing inmate 

appeals by prescribing psychotropic medications that Defendant Tuvera misrepresented as pain 

medications after Plaintiff specifically informed defendant F. Tuvera that he would not take 

psychotropic medications because they made him suicidal. 

Defendants seek summary judgment on the following grounds. Defendants alleged that 

they treated Plaintiff in accordance with the recommendations of specialists in the field, and that

therefore, as a matter of law, Plaintiff cannot establish that Defendants’ reliance on expert opinion 

violated the Eighth Amendment. Defendants also argue that Plaintiff’s refusal to take 

psychotropic medications is a difference of opinion between an inmate and a medical professional 

as to his treatment which, as a matter of law, does not state an Eighth Amendment violation. 

Defendants also argue that Plaintiff’s claim against Defendant Orfield is barred by the statute of 

limitations. In the alternative, Defendants argue that they are entitled to qualified immunity. 

DISCUSSION

I. Summary Judgment Legal Standard

Summary judgment is proper where the pleadings, discovery and affidavits show there is 

“no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of 

law.” See Fed. R. Civ. P. 56(a) (2014). Material facts are those that may affect the outcome of the 

case. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute as to a material 

fact is genuine if the evidence is such that a reasonable jury could return a verdict for the 

nonmoving party. See id.

A court shall grant summary judgment “against a party who fails to make a showing 

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sufficient to establish the existence of an element essential to that party’s case, and on which that 

party will bear the burden of proof at trial [,] . . . since a complete failure of proof concerning an 

essential element of the nonmoving party’s case necessarily renders all other facts immaterial.”

See Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). The moving party bears the initial 

burden of identifying those portions of the record that demonstrate the absence of a genuine issue 

of material fact. Id. The burden then shifts to the nonmoving party to “go beyond the pleadings 

and by [his] own affidavits, or by the ‘depositions, answers to interrogatories, and admissions on 

file,’ designate ‘specific facts showing that there is a genuine issue for trial.’” See id. at 324 

(citing Fed. R. Civ. P. 56(e)).

A verified complaint may be used as an opposing affidavit under Rule 56, as long as it is 

based on personal knowledge and sets forth specific facts admissible in evidence. See Schroeder 

v. McDonald, 55 F.3d 454, 460 & nn.10-11 (9th Cir. 1995) (treating plaintiff’s verified complaint 

as opposing affidavit where, even though verification not in conformity with 28 U.S.C. § 1746, 

plaintiff stated under penalty of perjury that contents were true and correct, and allegations were 

not based purely on his belief but on his personal knowledge). Plaintiff’s complaint is made under 

penalty of perjury, so the Court considers the facts in that document in deciding the summary 

judgment motion. 

The court’s function on a summary judgment motion is not to make credibility 

determinations or weigh conflicting evidence with respect to a disputed material fact. See T.W. 

Elec. Serv. v. Pac. Elec. Contractors Ass’n, 809 F.2d 626, 630 (9th Cir. 1987). The evidence must 

be viewed in the light most favorable to the nonmoving party, and inferences to be drawn from the 

facts must be viewed in a light most favorable to the nonmoving party. See id. at 631. If the 

evidence produced by the moving party conflicts with evidence produced by the nonmoving party, 

the court must assume the truth of the evidence submitted by the nonmoving party. See Leslie v. 

Grupo ICA, 198 F.3d 1152, 1158 (9th Cir. 1999). 

II. Statute of Limitations

Defendants argue that the statute of limitations for Plaintiff’s complaint regarding 

Defendant Orfield’s actions on July 11, 2011 expired on July 11, 2015, more than a year before 

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Plaintiff filed this action on April 19, 2016.1 ECF No. 25 at 17-18. Plaintiff argues that the statute 

of limitations did not begin to run until he exhausted his administrative remedies on January 8, 

2015, and that his claim against Defendant Orfield is therefore timely. ECF No. 61 at 21-22.

A. Factual Background

The following facts are undisputed unless otherwise noted. 

Grievance No. SVSP-IA-C-11-12618, which grieves the medical treatment provided by

Defendant Orfield on July 11, 2011, was filed on August 24, 2011. Comp at 14; ECF No. 1-4 at 

23. Plaintiff did not receive any response to this grievance, despite submitting a Form 22 

requesting a status update on February 26, 2012. ECF No. 1-4 at 24; ECF No. 1-7 at 5. 

On May 12, 2013, Plaintiff filed Grievance No. SVSP-HC-13049050, which again grieved 

the medical treatment provided by Defendant Orfield on July 11, 2011. Compl. at 23; ECF No. 1-

4 at 27-30. On May 28, 2013, Grievance No. SVSP-HC-13049050 was cancelled on the grounds 

that it duplicated a prior grievance. ECF No. 1-4 at 26. 

On June 20, 2013, Plaintiff filed Grievance No. SVSP-SC-13001402 which challenged the 

cancellation of Grievance No. SVSP-HC-13049050. Compl. at 27; ECF No. 1-5 at 29-32. On 

September 13, 2013, a second level response was issued which acknowledged that the grievance

claimed that RN Orfield assaulted Plaintiff when cleaning his ear, and that Defendant Talanoa 

refused to address Plaintiff’s prior grievance regarding RN Orfield’s misconduct. ECF No. 1-5 at 

33-34. The second-level response found that staff did not commit misconduct. ECF No. 1-5 at 

33-34. On December 16, 2010, Office of Appeals Chief Zamora issued a third level response that 

acknowledged that SVSP had inter alia inadequately addressed the allegations in Grievance No. 

SVSP-HC-13049050 and ordered that Grievance No. SVSP-HC-13049050 be accepted and 

processed as a staff complaint appeal, and that a confidential inquiry be conducted if necessary. 

ECF No. 1-5 at 27-28. Grievance No. SVSP-HC-13049050 was renumbered SVSP-SC-14001419, 

 

1 Pursuant to the prisoner mailbox rule, because Plaintiff is a prisoner proceeding pro se, 

Plaintiff’s complaint is deemed filed as of the date he submitted it to prison authorities for mailing 

to the court. See Stillman v. LaMarque, 319 F.3d 1199, 1201 (9th Cir. 2003) (holding that federal 

or state habeas petition deemed filed on date submitted to prison authorities for forwarding to 

court, rather than on date received by court). Plaintiff executed a proof of service on April 19, 

2016. ECF No. 1 at 71.

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and a first/second level response was issued on February 27, 2014. ECF No. 1-4 at 21-22. 

However, this response was not timely issued to Plaintiff. Plaintiff received this response on or 

around September 19, 2014. ECF No. 1-4 at 25. Plaintiff made multiple attempts to determine 

why he had received no response to Grievance No. SVSP-SC-14001419. On May 22, 2014; June 

17, 2014; and July 24, 2014, he filed Form 22s requesting a status update. ECF Nos. 1-4 at 15-17. 

On July 24, 2014, he filed Grievance No. SVSP-HC-14051465 in an attempt to determine why

SVSP-SC-14001419 had not been returned to him. ECF Nos. 1-4 at 1-14. Plaintiff received a 

third level response to Grievance No. SVSP-SC-14001419 on January 8, 2015. ECF No. 1-4 at 

18-21. 

B. Section 1983 Statute of Limitations Standard 

Section 1983 does not contain its own limitations period. The appropriate period is that of 

the forum state’s statute of limitations for personal injury torts. See Wilson v. Garcia, 471 U.S. 

261, 275 (1985), superseded by statute on other grounds as stated in Jones v. R.R. Donnelley & 

Sons Co., 541 U.S. 369, 377-78 (2004); TwoRivers v. Lewis, 174 F.3d 987, 991 (9th Cir. 1999). In 

California, the general residual statute of limitations for personal injury actions is the two-year 

period set forth at section 335.1 of the California Code of Civil Procedure. Cal. Civ. Proc. § 335.1 

(current codification of residual limitations period, which is now two years; enacted in 2002). 

Section 335.1 therefore sets forth the applicable statute of limitations for § 1983 actions brought in 

California. See Maldonado v. Harris, 370 F.3d 945, 954 (9th Cir. 2004) (applying California’s 

prior one-year statute of limitations to the § 1983 action).

A federal court must also give effect to a state’s tolling provisions. See Hardin v. Straub, 

490 U.S. 536, 542-44 (1989). In California, this includes tolling the statute of limitations during 

imprisonment and while criminal charges are pending. The statute of limitations begins to run 

immediately after the recognized disability period ends. See Cabrera v. City of Huntington Park, 

159 F.3d 374, 378-79 (9th Cir. 1998). Section 352.1 of the California Code of Civil Procedure 

recognizes imprisonment as a disability that tolls the statute of limitations when a person is 

“imprisoned on a criminal charge, or in execution under the sentence of a criminal court for a term 

of less than for life . . . .” Cal. Civ. Proc. § 352.1(a). The tolling is not indefinite, however; the 

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disability of imprisonment delays the accrual of the cause of action for a maximum of two years. 

See id.; Fink v. Shedler, 192 F.3d 911, 916 (9th Cir. 1999) as amended on denial of reh’g and 

reh’g en banc (1999). Thus, an inmate has four years to bring a § 1983 claim for damages in 

California, i.e., the regular two-year period under section 335.1, plus two years during which the 

accrual is postponed due to the disability of imprisonment as set forth in section 352.1. The 

disability of imprisonment only delays the accrual of claims for damages under § 1983 and does 

not delay the accrual of claims for injunctive and declaratory relief under § 1983. Cal. Civ. Proc. 

§ 352.1(c). In addition, under California law, when “the exhaustion of administrative remedies is 

a prerequisite to the initiation of a civil action,” tolling of the limitations period is automatic. 

Elkins v. Derby, 12 Cal.3d 410, 414 (Cal. 1974). Accordingly, the statute of limitations is also

tolled for the period in which a prisoner administratively exhausts his underlying grievances 

pursuant to the requirements of the Prison Litigation Reform Act (“PLRA”). See Brown v. Valoff, 

422 F.3d 926, 942-43 (9th Cir. 2005) (“the applicable statute of limitations must be tolled while a 

prisoner completes the mandatory exhaustion process”). 

The PLRA’s exhaustion requirement requires “proper exhaustion” of available 

administrative remedies, “which ‘means using all steps that the agency holds out, and doing so 

properly (so that the agency addresses the issues on the merits).’” Woodford v. Ngo, 548 U.S. 81, 

90, 93 (2006) (citing Pozo v. McCaughtry, 286 F.3d 1022, 1024 (7th Cir. 2002)) (emphasis in 

original). “Proper exhaustion demands compliance with an agency’s deadlines and other critical 

procedural rules because no adjudicative system can function effectively without imposing some 

orderly structure on the course of its proceedings.” Id. at 90-91. 

The California Department of Corrections and Rehabilitation (“CDCR”) provides its 

inmates and parolees the right to file a grievance regarding “any policy, decision, action, 

condition, or omission by the department or its staff that the inmate or parolee can demonstrate as 

having a material adverse effect upon his or her health, safety, or welfare.” 15 Cal. Code Regs. 

§ 3084.1(a). The CDCR also provides its inmates the right to file grievances alleging misconduct 

by correctional officers. Id. at § 3084.9(i). In order to exhaust available administrative remedies 

within this system, a prisoner must submit his complaint on CDCR Form 602 and proceed through 

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three levels of review: (1) screening at the first level of review by a prison official who did not 

participate in the event at issue and who is of equivalent or higher rank than the participating staff, 

unless the first level review is exempted, (2) a second level review by a hiring authority or 

designee at a level no lower than Chief Deputy Warden, Deputy Regional Parole Administrator, or 

the equivalent; and (3) a third level review by a designated representative under the supervision of 

the third level Appeals Chief or equivalent. Id. § 3084.7. The third level of review exhausts 

administrative remedies. Id. § 3084.7(d)(3); see also Jackson v. Fong, 870 F.3d 928, 933 (9th Cir. 

2017) (“Administrative exhaustion within California requires the completion of the third level of 

administrative review.”). 

C. Analysis

As detailed supra in the factual background, while Plaintiff promptly grieved Defendant 

Orfield’s alleged assault by filing Grievance No. SVSP-IA-C-11-12618 on August 24, 2011, this 

grievance was not decided at the third level until over three years later, on January 8, 2015, despite 

multiple efforts by Plaintiff to have the grievance addressed. The delay in processing the appeals 

was not due to any error on Plaintiff’s part, but was because prison officials either lost the 

grievances or took months to issue a response. 

As a prisoner, Plaintiff has four years to bring a § 1983 claim for damages in California, 

i.e., the regular two-year period under section 335.1, plus two years during which accrual is 

postponed due to the disability of imprisonment as set forth in section 352.1. Cal. Civ. Proc. §§ 

335.1, 352.1(c). The statute of limitations is also tolled for the time period during which 

Plaintiff’s grievance was being reviewed. The statute of limitations therefore began on July 11, 

2011 and ran until August 24, 2011. It was tolled from August 24, 2011 to January 8, 2015, 

almost three years and four months, while Plaintiff satisfied the PLRA’s exhaustion requirement. 

When the instant action was filed on April 19, 2016, approximately eighteen months of the 

limitations period had run. Plaintiff’s Eighth Amendment claim against RN Orfield is therefore 

timely. Defendants’ motion to dismiss the claim against Defendant Orfield action as barred by the 

statute of limitations is DENIED.

/ / /

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III. First Amendment Retaliation Claim

Plaintiff alleges that Defendant Tuvera prescribed him psychotropic medication in 

retaliation for his frequent grievance activity. Defendant Tuvera argues that he is entitled to 

summary judgment because he prescribed the psychotropic medication for a legitimate 

penological goal.

A. Factual Background

The following facts are undisputed unless otherwise indicated.

Between April 2011, when Plaintiff returned from San Joaquin Regional Medical Center, 

and May 23, 2013, when Defendant Tuvera first prescribed psychotropic medications, Plaintiff 

filed at least nine grievances regarding his treatment. 

On June 6, 2011, Plaintiff submitted Grievance No. SVSP-HC-11044340 (originally 

numbered SVSP-32-C-11-12242) which alleged that Defendant Tuvera was deliberately 

indifferent to his serious medical needs when he discharged Plaintiff from the prison hospital on 

May 11, 2011. Compl. at 9; ECF No. 1-5 at 89-100; ECF No. 1-6 at 1. 

On July 31, 2011, Plaintiff submitted Grievance No. SVSP-HC-11044504 (originally 

numbered SVSP-32-11-12434) which alleged that Defendant Bridgnell improperly denied 

Plaintiff medical treatment on July 11 and 15, 2011. Compl. at 14; ECF No. 1-6 at 2-14. 

On August 24, 2011, Plaintiff submitted Grievance No. SVSP-IA-C-11-12618 which 

alleged that Defendant Orfield had assaulted him on July 11, 2011. Compl. at 14; ECF No. 1-4 at 

23. 

On December 26, 2012, Plaintiff submitted Grievance No. SVSP-SC-13001326 which 

alleged that Defendant Wy provided inadequate medical treatment on December 4, 2012.

On February 5, 2013, Plaintiff resubmitted Grievance No. SVSP-HC-C-11-12618.

On April 5, 2013, Plaintiff submitted Grievance No. SVSP-HC-13048834 which alleged 

that he was inappropriately prescribed Gabapentin which caused severe negative side effects that 

SVSP doctors refused to treat; that SVSP medical was inadequately staffed in that there was not a 

primary care physician available twenty-four hours a day; and that SVSP medical staff was 

refusing to treat his headaches. ECF No. 1-5 at 53-63.

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On April 23, 2013, Plaintiff submitted Grievance No. SVSP-HC-13048933 which 

challenged the cancellation of Grievance No. SVSP-HC-13001326. ECF No. 1-5 at 36-45.

On or about May 10, 2013, Plaintiff submitted at least two grievances. Grievance No. 

SVSP-HC-13049051 (intended to be a resubmission of Grievance No. 32-C-11-12618) alleged 

again that Defendant Orfield had assaulted him on July 11, 2011. Grievance No. SVSP-HC14001420 (originally numbered SVSP-SC-13049051) challenged Defendant Talanoa’s processing 

of Grievance No. SVSP-HC-11044504. Compl. at 23, 66. ECF No. 1-5 at 18-26.

During that same time period, Plaintiff filed at least three Form 22s (Request for Services) 

related to his grievance activity. On November 9, 2011, Plaintiff filed a Form 22 requesting a 

statue update for Grievance No. SVSP-IA-C-11-12618. ECF No. 1-7 at 3. On February 26, 2012,

Plaintiff again filed a Form 22 requesting a statue update for Grievance No. SVSP-IA-C-11-

12618. ECF No. 1-7 at 5. On March 23, 2012, Plaintiff filed a Form 22 requesting clarification 

regarding a notification of lost appeal. ECF No. 1-7 at 8. 

Prison medical staff were aware that Plaintiff had filed grievances against prison medical 

staff. Compl. at 7, 11-13.

On May 23, 2013, Plaintiff was seen by Defendant Tuvera in response to his Plaintiff’s 

complaint that he was experiencing severe head pain. ECF No. 1-14 at 18. Defendant Tuvera and 

Dr. Bright had discussed Plaintiff’s case and noted that the overuse of painkillers was a common 

contributor to post-traumatic headaches. ECF No. 1-14 at 18. Defendant Tuvera noted that 

Plaintiff was already on propranolol, which is commonly prescribed to treat migraine headaches. 

ECF No. 1-14 at 18. Defendant Tuvera recommended that Plaintiff start a daily 25 mg dose of 

amitriptyline. ECF No. 1-14 at 18. Plaintiff informed Defendant Tuvera that he refused to take 

any psychotropic medication because his previous experience with another psychotropic, Elavil, 

had caused him to feel depressed and suicidal. Compl. at 24. Defendant Tuvera responded, “This 

is amitriptyline, not Elavil” and stated that amitriptyline taken in conjunction with propranolol 

would alleviate the pain and sensation of numbness. Defendant Tuvera showed Plaintiff a 

memorandum from Defendant Bright recommending this treatment plan. Compl. at 24. Plaintiff 

started on the amitriptyline, but, like the Elavil, it made him feel depressed and suicidal. The 

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amitriptyline also did not alleviate the pain, numbness or the feeling of movement and popping in 

his skull. Compl. at 26. 

Amitriptyline is a tricyclic antidepressant and is prescribed for mental health issues, but it 

is also approved by the CDCR to treat other issues such as neuropathic pain, urinary incontinence, 

and migraine headaches. ECF No. 1-4 at 89. 

On June 17, 2013, Plaintiff had another appointment with Defendant Tuvera. He informed 

Defendant Tuvera that the amitriptyline was causing him to feel depressed and suicidal, and that 

he had not seen any improvement in his symptoms. He asked Defendant Tuvera if amitriptyline 

was a psychotropic, and Defendant Tuvera denied it. He asked Defendant Tuvera if he was 

actually being prescribed Elavil, and Defendant Tuvera denied it and stated that amitriptyline was 

a pain medication which is why it was crushed before administered to Plaintiff. Compl. at 26. 

Defendant Tuvera stated that what Plaintiff was feeling was normal, and that he should give the 

amitriptyline-propranolol combination a month or so, and then Plaintiff would see an 

improvement. Compl. at 26. 

On July 10, 2013, Plaintiff learned from his psychologist that amitriptyline is a 

psychotropic medication, and is another name for Elavil. Compl. at 27. 

On July 16, 2013, Plaintiff was seen by Defendant Tuvera. He again informed Defendant 

Tuvera that the amitriptyline caused him to feel depressed and suicidal and was not alleviating any 

of his other medical issues. He again asked Defendant Tuvera if amitriptyline was a psychotropic 

and if it was Elavil. Defendant Tuvera dodged the question and referred Plaintiff to Defendant 

Bright’s memo. Defendant Tuvera stated that he was just doing his job, and that it was Defendant 

Bright who had decided on Plaintiff’s course of treatment. Compl. at 27. 

Despite Plaintiff’s documented repeated refusals to take amitriptyline, the prescription was 

not discontinued for at least forty-five days. ECF No. 61 at 13. 

On July 28, 2013, Plaintiff filed Grievance No. SVSP-HC-13049513 alleging that 

Defendants Tuvera and Bright subjected him to psychotropic medication without his consent. 

Compl. at 28; ECF No. 1-4 at 89-92; ECF No. 1-5 at 1-6.

On February 13, 2014, Defendant Tuvera prescribed Depakote to treat Plaintiff’s 

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headaches, claiming that the neurologist had recommended the medication. Compl. at 36. 

Plaintiff again asked Defendant Tuvera if Depakote was a psychotropic, and Defendant Tuvera 

denied it, stating that it was a pain medication. Compl. at 36. Soon after starting Depakote, 

Plaintiff became depressed and suffered suicidal ideations. On February 25, 2014, Plaintiff 

learned from Dr. Bonilla that Depakote is a psychotropic medication. Compl. at 36. 

Starting February 20, 2014, Plaintiff stopped taking Depakote because he felt suicidal. 

ECF No. 25-1 at 84; ECF No. 61 at 13. Plaintiff refused the medication on five separate occasions 

(February 20, February 22, March 8, March 13 and April 4), but the medication was not 

discontinued until April 9, 2014. ECF No. 61 at 13, 131-35. 

Prior to the February 2014 appointment with Defendant Tuvera, Plaintiff last saw a 

neurologist on September 3, 2013, when he was examined via telemedicine by Dr. Jumao-As, a 

neurologist and outside specialist consulted by SVSP. Kumar Decl. ¶ 11 and ECF No. 25-1 at 81-

82. Dr. Jumao-As’ notes do not reflect a recommendation for Depakote. 

B. Standard

Retaliation by a state actor for the exercise of a constitutional right is actionable under 42 

U.S.C. § 1983, even if the act, when taken for different reasons, would have been proper. See Mt.

Healthy City Sch. Dist. Bd. of Educ. v. Doyle, 429 U.S. 274, 283-84 (1977). “Within the prison 

context, a viable claim of First Amendment retaliation entails five basic elements: (1) An 

assertion that a state actor took some adverse action against an inmate (2) because of (3) that 

prisoner’s protected conduct, and that such action (4) chilled the inmate’s exercise of his First 

Amendment rights, and (5) the action did not reasonably advance a legitimate correctional goal.” 

Rhodes v. Robinson, 408 F.3d 559, 567-68 (9th Cir. 2005) (footnote omitted). The prisoner must 

show that the type of activity he was engaged in was constitutionally protected, that the protected 

conduct was a substantial or motivating factor for the alleged retaliatory action, and that the 

retaliatory action advanced no legitimate penological interest. Hines v. Gomez, 108 F.3d 265, 

267-68 (9th Cir. 1997) (inferring retaliatory motive from circumstantial evidence). The prisoner 

bears the burden of pleading and proving absence of legitimate correctional goals for the conduct 

of which he complains. Pratt, 65 F.3d at 806. At that point, the burden shifts to the prison official 

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to show, by a preponderance of the evidence, that the retaliatory action was narrowly tailored to 

serve a legitimate penological purpose. See Schroeder v. McDonald, 55 F.3d 454, 461-62 (9th 

Cir. 1995) (defendants had qualified immunity for their decision to transfer prisoner to preserve 

internal order and discipline and maintain institutional security). 

In a retaliation analysis, the court should apply the four-factor test from Turner v. Safley, 

482 U.S. 78 (1978), to determine whether the proffered legitimate penological interest is 

reasonably related to a regulation which infringes on a prisoner’s constitutional rights. See

Brodheim v. Cry, 584 F.3d 1262, 1271-72 (9th Cir. 2009) (inmate appeal response that warned the 

inmate “to be careful what you write” was insufficiently related to penological interests to defeat 

retaliation claim). Prison officials cannot simply articulate a general justification for their actions, 

they must show why their particular action was reasonably related to the legitimate interest. 

Shephard v. Quillen, 840 F.3d 686, 692 (2016) (defendants must show that they placed plaintiff in 

administrative segregation because there were witnesses in general population whom he could 

have improperly influenced; not enough to simply assert that administrative segregation generally 

helps keep prisoners safe and investigations untainted). Courts must also consider whether there 

were ready alternatives to the retaliatory action for achieving the governmental objectives. 

Brodheim, 584 F.3d at 1272. 

C. Discussion

Defendants argue that Plaintiff cannot establish retaliation because the psychotropic 

medicines were prescribed for the legitimate correctional goal of treating Plaintiff’s symptoms. 

They state that Defendant Tuvera never forced Plaintiff to take the medication and never refused 

to discontinue the prescription. 

Defendants mischaracterize this claim. Plaintiff’s claim is that regardless of whether these 

psychotropic medications are appropriate for treating headaches, falsely stating that they were not 

psychotropic medications after learning that Plaintiff would not take psychotropic medications 

because they caused severe side effects for him does not reasonably advance a legitimate 

correctional goal. 

Defendants also mischaracterize the evidence. While Defendant Tuvera did not force 

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Plaintiff to take either medication, he caused Plaintiff to take both medications — despite 

Plaintiff’s stated objections — by falsely stating that they were not psychotropic. While 

Defendant Tuvera did not refuse to discontinue the prescriptions, he did refuse to immediately 

discontinue the prescriptions after Plaintiff expressed his refusal to take the medications. These 

medications were offered to Plaintiff for at least six weeks after he first refused to take them, and 

continue to be offered despite Plaintiff’s repeated refusals. 

In addition, there were other alternatives for treating Plaintiff’s head pain, as is evident 

from Plaintiff’s health records which show that he was prescribed medications that would treat 

seizures, epilepsy, high blood pressure, and pain. See, e.g., ECF No. 25-1 at 92, 117.

Viewing the evidence presented in the light most favorable to Plaintiff, there is a genuine 

dispute as to (1) whether Defendant Tuvera prescribed amitriptyline and Depakote in retaliation 

for Plaintiff’s protected conduct, given the proximity in time between the protected conduct and 

the prescription and Defendant Tuvera’s misrepresentation of the medications, see Shepherd, 840 

at 690 (evidence probative of retaliatory animus includes proximity in time between the protected 

speech and the alleged adverse action); and (2) whether prescribing amitriptyline and Depakote to 

treat Plaintiff’s headaches, given Plaintiff’s clear objections and his documented history of adverse 

reactions to psychotropic medications, reasonably advanced the goal of treating Plaintiff’s 

symptoms, where there were other ready alternatives, see Brodheim, 584 F.3d at 1272. Defendant 

Tuvera is not entitled to summary judgment on this First Amendment retaliation claim unless he is 

entitled to qualified immunity.

IV. Eight Amendment Claims

Defendants do not dispute that Plaintiff’s headaches and loose skull flap constituted 

serious medical needs. With respect to Plaintiff’s allegation that Defendants Wy, Bridgnell, 

Orfield, Tuvera, Bright, and Gamboa failed to provide adequate medical care following Plaintiff’s

emergency skull surgery, Defendants argue that Plaintiff cannot establish deliberate indifference 

because they consistently arranged for specialists to treat Plaintiff’s recurring headaches; they 

consistently acted in accordance with the specialists’ opinions; and Plaintiff’s disagreement with 

treating his headaches with medication is a difference of opinion between an inmate and his 

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medical care provider which, as a matter of law, does not amount to deliberate indifference. 

Defendants also argue that, with respect to the medical treatment provided for Plaintiff’s loose 

skull flap, they reasonably relied on Dr. Rahimifar’s 2011 determination that there was no signs of 

a loose cranial bone flap and did not realize that Plaintiff’s recurring complaints of headaches and 

numbness were related to a loose skull flap. Finally, Defendants argue that the delay in providing 

him surgery, without more, is insufficient to state a deliberate indifference claim. With respect to 

Plaintiff’s allegation that Defendants Bright, Gamboa, Kumar, Adams, Dunlap, Villafuerte, 

Talanoa, DelaRosa, Mejia, Turner and Ulloa denied him adequate medical care when they 

mishandled or denied his inmate healthcare appeals and staff complaints, Defendants argue that 

these defendants merely affirmed the adequate medical care provided by SVSP medical staff. 

a. Legal Standard

Deliberate indifference to a serious medical need violates the Eighth Amendment’s 

proscription against cruel and unusual punishment. See Estelle v. Gamble, 429 U.S. 97, 104

(1976); McGuckin v. Smith, 974 F.2d 1050, 1059 (9th Cir. 1992), overruled on other grounds by 

WMX Technologies, Inc. v. Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc). A 

determination of “deliberate indifference” involves an examination of two elements: the 

seriousness of the prisoner’s medical need and the nature of the defendant’s response to that need. 

See McGuckin, 974 F.2d at 1059. A “serious” medical need exists if the failure to treat a 

prisoner’s condition could result in further significant injury or the “unnecessary and wanton 

infliction of pain.” McGuckin, 974 F.2d at 1059 (citing Estelle, 429 U.S. at 104). A prison 

official is deliberately indifferent if he knows that a prisoner faces a substantial risk of serious 

harm and disregards that risk by failing to take reasonable steps to abate it. Farmer v. Brennan, 

511 U.S. 825, 837 (1994). The prison official must not only “be aware of facts from which the 

inference could be drawn that a substantial risk of serious harm exists,” but he “must also draw the 

inference.” Id. 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. Gibson v. County of 

Washoe, 290 F.3d 1175, 1188 (9th Cir. 2002), overruled on other grounds by Castro v. County of 

Los Angeles, 833 F.3d 1060, 1076 (9th Cir. 2016). Mere negligence, or even gross negligence, is 

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not enough. Farmer, 511 U.S. at 835-36 & n.4. A claim of medical malpractice or negligence is 

insufficient to make out a violation of the Eighth Amendment. McGuckin, 974 F.2d at 1059. Nor 

does “a difference of opinion between a prisoner patient and prison medical authorities regarding 

treatment” amount to deliberate indifference. Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 

1981). Consequently, a plaintiff’s opinion that medical treatment was unduly delayed does not, 

without more, state a claim of deliberate indifference. Shapley v. Nev. Bd. of State Prison 

Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985). In order to prevail on a claim involving choices 

between alternative courses of treatment, a plaintiff must show that the course of treatment the 

doctor chose was medically unacceptable under the circumstances and that he chose this course in 

conscious disregard of an excessive risk to the plaintiff’s health. Toguchi v. Chung, 391 F.3d 

1051, 1058 (9th Cir. 2004).

In order for deliberate indifference to be established, therefore, there must be a purposeful 

act or failure to act on the part of the defendant and resulting harm. See McGuckin, 974 F.2d at 

1060; Shapley, 766 F.2d at 407. A finding that the defendant’s activities resulted in “substantial” 

harm to the prisoner is not necessary, however. Neither a finding that a defendant’s actions were 

egregious nor that they resulted in significant injury to a prisoner is required to establish a 

violation of the prisoner’s federal constitutional rights, McGuckin, 974 F.2d at 1060, 1061 (citing 

Hudson v. McMillian, 503 U.S. 1, 7-10 (1992) (rejecting “significant injury” requirement and 

noting that Constitution is violated “whether or not significant injury is evident”), but the 

existence of serious harm tends to support an inmate’s deliberate indifference claims, Jett v. 

Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (citing McGuckin, 974 at 1060). A plaintiff need not 

prove complete failure to treat. Deliberate indifference may be shown where access to medical 

staff is meaningless as the staff is not competent and does not render competent care. Ortiz v. City 

of Imperial, 884 F.2d 1312, 1314 (9th Cir. 1989). 

a. Medical Treatment by Defendants Bridgnell, Orfield, and Wy

1) Background

Defendants do not address the allegedly improper or inadequate medical treatment 

provided by Defendants Bridgnell, Orfield, and Wy. Accordingly, the following facts are 

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undisputed unless otherwise noted.

Treatment by Dr. Bridgnell and RN Orfield. 

On May 19, 2011, Plaintiff was seen by Defendant Bridgnell. Plaintiff informed 

Defendant Bridgnell that, although he suffered from high blood pressure and migraines, his 

seizure and pain medications had been discontinued. Defendant Bridgnell stated that Plaintiff’s 

discharge orders prohibited him prescribing Plaintiff blood pressure or migraine medications. 

Compl. at 6. Plaintiff’s discharge orders do not prohibit prescribing medication. Rather, the 

orders specify that Plaintiff should receive Dilantin (blood pressure medication) twice a day and 

pain medication as needed. ECF No. 1-2 at 2. 

On May 21, 2011, Plaintiff was visited by his parents who expressed concern upon 

learning that Plaintiff was being denied his medications for pain, seizures, blood pressure, and 

migraines. Plaintiff’s parents stated that they would notify Sacramento (CDCR headquarters) 

about the denial of medication. Compl. at 6-7. 

On May 26, 2011, Plaintiff was called to medical, where Defendant Bridgnell angrily 

informed Plaintiff that Sacramento had contacted SVSP, stating that Plaintiff’s family had 

complained that Plaintiff was being denied his medications. Plaintiff acknowledged telling his 

family about the denial of medications. He also informed Defendant Bridgnell that his gauze had 

not been changed in days, and that he was having difficulty opening his mouth to eat. Defendant 

Bridgnell instructed Plaintiff to file a request to dental to address the mouth pain, and a request to 

medical for the change of gauze. That same day, Plaintiff was re-issued his seizure medication 

(Dilantin/Phenytoin), but not any of his other medications. Compl. at 7.

On May 30, 2011, Plaintiff’s blood pressure reached 160/110 and he was found screaming, 

crying and spinning in pain. Medical staff was notified, and Plaintiff was administered Clonidine 

and an EKG test. Plaintiff was informed that he would receive his blood pressure medication the 

next day. Compl. at 7.

On May 31, 2011, Defendant Bridgnell ordered that Plaintiff’s Dilantin level be checked, 

marking the order “urgent,” and ordered that Plaintiff be moved to a bottom tier bottom bunk. 

Compl. at 8. 

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On June 2, 2011, Plaintiff confronted Defendant Bridgnell about denying his blood 

pressure medication, and causing the spike in blood pressure on May 30 which could have killed 

him. Defendant Bridgnell denied that Plaintiff’s blood pressure had spiked on May 30, and stated 

that Plaintiff had suffered a seizure that day, unrelated to his blood pressure, and implied that it 

was because Plaintiff had overdosed on Dilantin. Plaintiff informed Defendant Bridgnell that he 

had not taken more than two Dilantin pills a night. Defendant Bridgnell responded that he would 

know if Plaintiff was lying because he could test Plaintiff’s blood. Compl. at 8-9. 

On June 6, 2011, Plaintiff filed Grievance No. SVSP-HC-11044340 alleging that 

Defendant Tuvera was deliberately indifferent to his serious medical needs when he discharged 

Plaintiff from the prison hospital on May 11, 2011. Compl. at 9. On June 20, 2011, Plaintiff filed

Grievance No. SVSP-HC-11044344 alleging that his medical Olsen review was being denied or 

delayed. Compl. at 10.

On July 10, 2011, Plaintiff filed a medical request (CDCR Form 7362), stating that the 

right side of his head was swollen and painful, his head was constantly popping on the inside, that 

it felt like his skull was moving, his left ear was not cleaned and is popping again, and his hearing 

was bad. He handed the Form 7362 to Medical Tech Assistant (“MTA”) Chu who advised him 

that he would be seen the next day. Compl. at 10.

On July 11, 2011, Plaintiff was called to C-Yard Medical but no one knew why he was 

there and only knew that he had filed a grievance. Plaintiff states that Defendant Orfield seemed 

upset about the grievance even though Plaintiff explained that the grievance was against 

Defendant Tuvera and not against C-Yard Medical. RN Orfield checked Plaintiff’s ear and 

determined that it needed cleaning. Plaintiff and RN Lisa informed Defendant Orfield that 

Plaintiff had blood in his left ear because he had suffered traumatic brain injury four months 

earlier, and had craniotomies done in the area where the ear was clogged. Plaintiff agreed to the 

ear cleaning because he had previously had his ear cleaned without issues. However, when 

Defendant Orfield flushed water through Plaintiff’s left ear, it caused him great pain, which he had 

not previously experienced during other ear cleanings. Defendant Orfield refused to stop the 

cleaning despite Plaintiff’s repeated requests. Correctional officers Ramey and Reyes asked 

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Defendant Bridgnell to help Plaintiff, but Defendant Bridgnell refused to see Plaintiff, stating that 

Plaintiff did not have an appointment and would be seen at his scheduled on appointment on July 

15, 2011. Plaintiff waited until his dizziness subsided and stated that if no doctor would see him, 

he would prefer to return to his cell where he could sleep. Compl. at 11-13. 

On July 15, 2011, when Plaintiff arrived at Medical for his scheduled appointment, 

Defendant Bridgnell refused to see Plaintiff stating that he did not have Plaintiff’s file. Plaintiff 

asked Officer Gonzalez to ask Defendant Bridgnell to see him, to just check Plaintiff’s head 

because it felt like his skull was moving, but Defendant Bridgnell refused Officer Gonzalez’s 

request. Compl. at 13-14. 

On July 17, 2011, Plaintiff was taken to the emergency room in response to his complaints 

of excruciating pain, dizziness, and movement in his skull. Plaintiff also had a high blood 

pressure of 157/109. Compl. at 14. The following day, Plaintiff was finally seen by Defendant 

Bridgnell. Plaintiff states that Defendant Bridgnell only saw him because Plaintiff had been sent 

to the emergency room the previous day. Compl. at 14. Defendant Bridgnell stated that Plaintiff 

was fine and sent him home. Compl. at 14.

Treatment by Dr. Wy. On December 4, 2012, after having filed multiple Form 7362s 

requesting medical services, Plaintiff was seen by Defendant Dr. Wy. However, Defendant Wy 

refused to address any of Plaintiff’s medical issues. Instead, Dr. Wy mentioned that Plaintiff’s 

bloodwork was off, that Plaintiff should redo his bloodwork, and that Plaintiff would be getting a 

pneumonia shot. Defendant Wy then tried to rush Plaintiff out of his office, as he did on other 

occasions. Plaintiff told Defendant Wy that he was suffering severe head pain, dizziness, blurred 

vision, numbness in the head, and constant popping and cracking in the head. Defendant Wy 

responded that it was up to the neurosurgeon to address these issues and to address the CT scan. 

Defendant Wy then told Plaintiff to get out. Compl. at 19.

2) Analysis

Viewing the evidence in the light most favorable to Plaintiff, the Court finds that there is a 

genuine dispute as to whether Defendants Bridgnell, Orfield, and Wy were deliberately indifferent 

to Plaintiff’s serious medical needs. There is a genuine dispute as to whether Defendant Bridgnell 

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purposely failed to address Plaintiff’s high blood pressure and other medical issues by denying 

medication, and refusing to examine Plaintiff. There is also a genuine dispute as whether 

Defendant Orfield purposely continued cleaning Plaintiff’s ear despite his claims that she was 

causing him severe pain. There is also a genuine dispute as to whether Defendant Wy purposely 

refused to treat Plaintiff, thereby failing to take reasonable steps to abate risks to Plaintiff’s health. 

Therefore, defendants Bridgnell, Orfield and Wy are not entitled to summary judgment unless they 

are entitled to qualified immunity.

b. Medical Treatment by Defendants Tuvera, Bright, and Gamboa

1) Background

In support of their summary judgment motion, Defendants identify certain appointments 

and tests that they allege establish that, as a matter of law, they were not deliberately indifferent to 

Plaintiff’s headaches, were unaware of his loose skull flap until late 2016, and reasonably choose 

to prescribe him psychotropic medications. In response, Plaintiff argues that many of the 

appointments and tests happened only after he had filed numerous grievances or had contacted 

CDCR headquarters; that his claims focus on the treatment for his loose skull flap and not his 

headaches; that Defendants were aware of his loose skull flap by early 2015 and unreasonably 

denied multiple requests in 2015 for examination by a neurosurgeon; and that Defendants 

prescribed him psychotropic medications under false pretenses.

The following facts are undisputed unless otherwise noted.

Prescription of Psychotropic Medications. For the factual background regarding 

Defendant Tuvera’s prescription of psychotropic medications, see Section III.A supra.

Medical Treatment Provided by SVSP – 2011 to 2014

From 2011 to 2014, SVSP medical staff struggled to determine the cause of Plaintiff’s 

head-related issues. Plaintiff reported feeling pain, dizziness, numbness, a sensation of popping in 

the skull, and a sensation that the bone flap was moving. 

During this time, Plaintiff was seen by neurosurgeon and outside specialist Dr. Leramo 

four times, on September 30, 2011; October 12, 2012; January 18, 2013; and January 23, 2013. 

The initial examination was in person and Dr. Leramo conducted a physical examination. The 

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other appointments were by telemedicine and only in the September 3, 2013, did Dr. Leramo have 

a nurse conduct a physical examination of Plaintiff. Dr. Leramo was unable to determine the 

cause of Plaintiff’s issues. Dr. Leramo speculated that the cause could be a seizure disorder, 

migraines, and/or a subdural clot, and prescribed treatment plans and diagnostic tests to address 

and/or rule out these potential diagnoses. Dr. Leramo did not notice a loose bone flap. Kumar 

Decl. ¶¶ 5, 8, 10; ECF No. 25-1 at 61-63, 73, 78, 79.

Plaintiff was also seen by neurosurgeon and outside specialist Dr. Rahimifar in person on 

December 15, 2011. Defendants describe the appointment as follows. Plaintiff reported that he 

occasionally had localized headaches at the site of the previous craniotomy, occasionally felt a 

popping noise in his head; no longer felt the bone flap moving; did not have cranial nerve, arm, or 

leg symptoms; or had not had any seizure activity. ECF No. 25-1 at 65. Dr. Rahimifar conducted 

a general physical examination and found no evidence that the cranial bone flap was loose, and 

concluded that Plaintiff “obviously had a very good result from that [craniotomy] surgery.” ECF 

No. 25-1 at 65. Dr. Rahimifar concluded that no immediate neurosurgical intervention was 

necessary and recommended that Plaintiff continue his current treatment. ECF No. 25-1 at 65. 

Plaintiff describes the appointment as follows. Dr. Rahimifar saw him for about five minutes until 

he learned that Plaintiff was a “lifer,” i.e. serving a life sentence. ECF No. 61 at 2. Upon hearing 

this information, Dr. Rahimifar walked out and did not return. ECF No. 61 at 2. A correctional 

officer inquired as to the status of Plaintiff’s appointment and was informed by a nurse that Dr. 

Rahimifar said he was done. ECF No. 61 at 2. 

Plaintiff was also seen three times by neurologist and outside specialist Dr. Jumao-As via 

telemedicine on September 3, 2013; April 4, 2014; and June 4, 2014. Dr. Jumao-As had a 

physical examination performed of Plaintiff at the first appointment, but not at subsequent 

appointments. Dr. Jumao-As was unable to determine the cause of Plaintiff’s issues. Dr. JumaoAs speculated that the cause could be intracranial tension, venous sinus thrombosis, increased 

brain pressure, a swollen optic nerve, Valley Fever, a complicated migraine, subdural hematoma, 

stroke, cardiac abnormality, hypertension, or spine issues. She prescribed treatment plans and 

diagnostic tests to address and/or rule out these potential diagnoses. Dr. Jumao-As did not notice 

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a loose bone flap. Kumar Decl. ¶¶ 11, 12, 14; ECF No. 25-1 at 81-82, 84-85, 89-90.

Plaintiff was also administered the following diagnostic tests: an August 11, 2011 CT scan 

of his brain; a November 15, 2011 CT scan of his brain; a June 19, 2012 x-ray of his cervical 

spine; a June 22, 2012 MRI of his cervical spine; a March 28, 2013 CT scan of his brain; a 2014 

EEG and EKG; and a May 2014 CT scan of his brain with and without contrast. ECF No. 25-1 at 

68-69, 71, 75-76, 87. Defendants state that none of these diagnostic tests revealed a loose bone 

flap. Kumar Decl. ¶ 13, while Plaintiff states that the May 2014 scan shows a loose skull flap, as 

indicated by Dr. Hetrick’s January 27, 2015 reading of the scan.

During this time, Plaintiff was seen by Defendants Tuvera and Gamboa. At the April and 

May 2014 appointments with Defendant Gamboa, Defendant Gamboa implemented most of Dr. 

Jumao-As’s recommendations. On September 10, 2014, Plaintiff asked Defendant Gamboa if he 

could try medications other than baclofen, oxcarbazepine, amitriptyline, or gabapentin to treat his 

headache, but Defendant Gamboa denied the request. ECF No. 25-1 at 96-97. 

Medical Treatment Provided by SVSP – 2015 to 2016

On January 13, 2015, Dr. Harris physically examined Plaintiff’s skull and determined that 

his skull flap was loose and submitted a request for services (“RFS”) for examination by a 

neurosurgeon. ECF No. 61 at 3. In the progress notes for the appointment, Dr. Harris writes: 

“Craniotomy plates loose?” ECF No. 61 at 49. Defendant Gamboa denied this request per the 

Medical Authorization Committee, and instructed that a series of skull x-rays be ordered instead. 

ECF No. 61 at 48.

On January 27, 2015, Dr. Hetrick reviewed the May 1, 2014 CT scan of Plaintiff’s brain. 

Dr. Hetrick concluded that the craniotomy flap had not healed and might be loose, and 

recommended clinical correlation. Kumar Decl. ¶ 16 and ECF No. 25-1 at 99. 

On February 2, 2015, Plaintiff was again seen by Dr. Harris. Dr. Harris reviewed Dr. 

Hetrick’s report and stated in his progress notes that he suspected a loose craniotomy flap. ECF 

No. 61 at 50, 63. Dr. Harris again submitted an RFS for examination by a neurosurgeon and 

stated that the principal diagnosis was a loose craniotomy flap. ECF No. 61 at 51. Defendant 

Kumar denied this request: “What is the clinical exam? Scalp Derm evaluation? Resubmit.” ECF 

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No. 61 at 50.

On February 18, 2015, Plaintiff was seen by Nurse Practitioner Hanter. After examining 

Plaintiff and reviewing his records, NP Hanter submitted an RFS for a scalp dermatology 

evaluation and stated that the principal diagnosis was a loose craniotomy flap. ECF No. 61 at 53-

54. The request was denied by Defendant Kumar, with a notation that NP Hanter should resubmit 

the RFS and explain what the scalp exam was.

On April 1, 2015, Plaintiff was seen by Defendant Tuvera in response to a complaint of 

chest pain, headaches, and puffiness on the right side of his face. Kumar Decl. ¶ 17 and ECF No. 

25-1 at 103. Defendant Tuvera examined Plaintiff and determined that Plaintiff was not in 

distress. ECF No. 25-1 at 103. He continued Plaintiff’s medication and scheduled him for a 

follow-up appointment in a month. ECF No. 25-1 at 103. 

On April 17, 2015, Plaintiff was seen by Defendant Tuvera to follow-up on the x-ray of the 

skull and his foot pain. Kumar Decl. ¶ 17 and ECF No. 25-1 at 105. Defendant Tuvera examined 

Plaintiff’s skull flap and found that it did not seem to move. Defendant Tuvera noted that Plaintiff 

did not have any focal neurological deficit. ECF No. 25-1 at 105. Defendant Tuvera advised 

Plaintiff that his brain was protected by the plates and screws. ECF No. 25-1 at 105. Plaintiff 

informed Defendant Tuvera that the x-rays showed non-union of his scalp bone flap. Defendant 

Tuvera did not submit an RFS for a neurosurgeon evaluation. ECF No. 61 at 30.

On July 31, 2015, Defendant Tuvera submitted an RFS for examination by a neurosurgeon 

and stated that the principal diagnosis was non-healing of the bone flap. ECF No. 25-1 at 108; 

ECF No. 61 at 56. Defendant Gamboa had the RFS returned to the PCP with directions to attach 

an IQ paper.2 ECF No. 61 at 56. 

On August 25, 2015, Plaintiff was seen by nurse practitioner Hanter. ECF No. 25-1 at 110. 

NP Hanter reported that Plaintiff was pushing for his neurosurgeon evaluation. ECF No. 25-1 at 

110. NP Hanter submitted another RFS for examination by a neurosurgeon and stated that the 

 

2

IQ refers to the InterQual computer program which the CDCR uses to determine whether a 

patient meets certain objective medical criteria for a requested service. California Correctional 

Health Services Policies & Procedures, Vol. 4, Chap. 34.2; see also Miller v. California Dep't of 

Corr. & Rehab., No. 16-CV-02431-EMC, 2018 WL 534306, at *12 (N.D. Cal. Jan. 24, 2018). 

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principal diagnosis was a loose craniotomy flap. ECF No. 61 at 57. The RFS was denied by 

Defendant Gamboa on the grounds that it did not meet the IQ criteria with the additional comment 

that an IQ should be submitted for headaches. ECF No. 61 at 57. 

On March 2, 2016, SVSP Dr. Law San Fu issued an RFS for a routine CT head scan to 

follow-up on the x-ray indicating a loose skull flap. ECF No. 61 at 58. The RFS was approved 

the following day, and the CT scan was done the following day. ECF No. 61 at 58. 

On April 27, 2016, Plaintiff filed the instant action. ECF No. 1. 

2) Discussion

With respect to Defendant Tuvera’s prescription of psychotropic medications, the Court 

finds that Plaintiff’s suicidal ideations and depression constitute a serious medical need because a 

reasonable doctor or patient would find these issues worthy of treatment. Lopez v. Smith, 203 F.3d 

1122, 1131 (9th Cir. 2000) (“Examples of serious medical needs include ‘[t]he 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.’”) (citing McGuckin, 974 F.2d at 1059-

60). It is undisputed that Defendant Tuvera was aware that Plaintiff suffered suicidal ideations 

and depression when previously on psychotropic medications and that Plaintiff refused to take any 

psychotropic medications. Viewing the evidence in the light most favorable to Plaintiff, there is a 

genuine dispute as to whether Defendant Tuvera’s prescription of psychotropic medications over 

Plaintiff’s objections and given Plaintiff’s history with psychotropic violated the Eighth 

Amendment. 

With respect to the medical treatment provided Plaintiff in 2015 to 2016, the Court finds 

that, viewing the evidence in the light most favorable to Plaintiff, there is a genuine dispute as to 

whether the repeated denials in 2015 of the RFSs for a neurosurgeon examination and the failure 

to treat the loose skull flap violated the Eighth Amendment. Plaintiff’s concern is not the medical 

treatment for his headaches, but rather the medical treatment (or lack thereof) for his loose skull 

flap. While Defendants appear to have made repeated and diligent efforts to determine the cause 

of Plaintiff’s headaches, it can also be reasonably inferred from the evidence that they ignored 

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diagnostic tests showing a loose skull flap and doctor recommendations to have the flap assessed 

by a neurologist. Defendants’ claim that they were unaware of his loose skull flap until late 2016 

is contradicted by the record. The four 2015 RFSs list the loose skull flap as a principal diagnosis; 

Dr. Hetrick’s reading of the 2014 CT scan concludes that there is likely a loose skull flap; and Dr. 

Harris’ progress notes also clearly state that his physical examination indicated a loose skull flap. 

Moreover, the grounds for denying the RFSs are unclear at best. It is simply unclear why a scalp 

dermatology evaluation is more appropriate than a neurosurgeon consultation for a loose skull 

flap. Furthermore, while it is undisputed that Defendants regularly consulted specialists and 

ordered diagnostic tests, this does not establish, as a matter of law, that Defendants took

reasonable steps to address Plaintiff’s serious medical needs. The bulk of the appointments with 

the specialists took place prior to 2015, before a CT scan and doctors’ examinations conclude that 

there is likely a loose bone flap, and Defendants failed to act to address the CT scan and the 

doctors’ recommendations for a neurosurgeon examination. 

Defendants are not entitled to summary judgment with respect to the medical treatment 

provided unless they are entitled to qualified immunity. See Ortiz, 884 F.2d at 1314 (summary 

judgment reversed where medical staff and doctor knew of head injury, disregarded evidence of 

complications to which they had been specifically alerted and without examination prescribed 

contraindicated sedatives).

b. Claims Regarding Processing of Healthcare Appeals (Defendants Bright, 

Gamboa, Kumar, Adams, Dunlap, Villafuerte, Talanoa, DelaRosa, Mejia, 

Turner and Ulloa)

Defendants’ argument that Defendants Bright, Gamboa, Kumar, Adams, Dunlap, 

Villafuerte, Talanoa, DelaRosa, Mejia, Turner and Ulloa are entitled to summary judgment relies 

on the argument that the medical care provided did not violated the Eighth Amendment. 

Specifically, they argue that because the determination of Plaintiff’s grievances and staff 

complaints “merely affirmed the medical care provided by Plaintiff’s primary physicians,” the 

manner in which these defendants addressed Plaintiff’s grievances and staff complaints did not 

violate the Eighth Amendment. As discussed supra, there is a genuine dispute as to whether 

Defendants’ medical treatment violated the Eighth Amendment. If the medical treatment 

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provided, or not provided, to Plaintiff violated his Eighth Amendment right to be free from 

deliberate indifference to his serious medical needs, whether or not the defendants who processed 

Plaintiff’s grievances and staff complaints also violated Plaintiff’s Eighth Amendment right 

depends on whether the grievances made these defendants aware that Plaintiff faced a substantial 

risk of serious harm and whether these defendants took reasonable steps to abate this risk. 

Defendants have not addressed the liability of these defendants in depth. There is therefore a 

genuine dispute as to whether Defendants Bright, Gamboa, Kumar, Adams, Dunlap, Villafuerte, 

Talanoa, DelaRosa, Mejia, Turner and Ulloa’s processing of Plaintiff’s grievances and staff 

complaints violated the Eighth Amendment. 

Defendants are not entitled to summary judgment with respect to their processing of 

Plaintiff’s grievances and staff complaints unless they are entitled to qualified immunity.

V. Qualified Immunity 

A. Standard

The defense of qualified immunity protects “government officials . . . 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). To determine whether a government official is entitled to qualified 

immunity, courts must consider (1) whether the official’s conduct violated a constitutional right, 

and (2) whether that right was “clearly established” at the time of the alleged misconduct. 

Pearson v. Callahan, 555 U.S. 223, 232 (2009). Courts may “exercise their sound discretion in 

deciding which of the two prongs of the qualified immunity analysis should be addressed first in 

light of the circumstances in the particular case at hand.” Id. at 236.

“An officer cannot be said to have violated a clearly established right unless the right’s 

contours were sufficiently definite that any reasonable official in [his] shoes would have 

understood that he was violating it, meaning that existing precedent . . . placed the statutory or 

constitutional question beyond debate.” City and County of San Francisco v. Sheehan, 135 S. Ct. 

1765, 1774 (2015) (alteration and omission in original) (citation omitted). This is an “exacting 

standard” that “gives government officials breathing room to make reasonable but mistaken 

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judgments by protect[ing] all but the plainly incompetent or those who knowingly violate the 

law.” Id. (alteration in original) (internal quotation marks omitted).

[E]xisting precedent must have “placed beyond debate the unconstitutionality of” the 

officials’ actions, as those actions unfolded in the specific context of the case at hand. 

Taylor, 135 S. Ct. at 2044. Hence, a plaintiff must prove that “precedent on the 

books” at the time the officials acted “would have made clear to [them] that [their 

actions] violated the Constitution.” Id. at 2045.

As the Supreme Court again stressed recently, “[t]he dispositive question is ‘whether 

the violative nature of [the defendants’] particular conduct is clearly established.’” 

Moreover, “[t]his inquiry ‘must be undertaken in light of the specific context of the 

case, not as a broad general proposition.’” Id. (emphasis added) (quoting Brosseau 

v. Haugen, 543 U.S. 194, 198 (2004) (per curiam)).

Hamby v. Hammond, 821 F.3d 1085, 1090-91 (9th Cir. 2016) (alterations in original) (citations 

omitted) (quoting Mullenix v. Luna, 136 S. Ct. 305 (2015)) (per curiam). The “fact-specific, 

highly contextualized nature of the ‘clearly established’ analysis” applies, regardless of the 

constitutional right at issue. Hamby, 821 F.3d at 1092. 

B. First Amendment Retaliation Claim

Defendants argue that Defendant Tuvera is entitled to qualified immunity because it is not 

clearly established that prescribing medication approved to treat an inmate’s symptoms without 

forcing the inmate to take the medication and without refusing to discontinue the use of the 

medication violates an inmate’s First Amendment right to be free from retaliation. As discussed 

supra, Defendants have mischaracterized his claim. The Court has found that, viewing the 

evidence presented in the light most favorable to Plaintiff, there is a dispute as to whether 

prescribing Plaintiff amitriptyline and Depakote to treat Plaintiff’s headaches, given Plaintiff’s 

objections and documented history of adverse reactions to psychotropic medications, reasonably 

advanced a legitimate correctional goal. Until this factual issue is resolved, it cannot be 

determined whether a reasonable physician in Defendant Tuvera’s position could have believed 

that prescribing psychotropic was lawful in light of clearly established law and in light of the

information he possessed at the time. Because resolution of this issue is critical to a proper 

determination of Defendant Tuvera’s entitlement to qualified immunity, summary judgment on 

qualified immunity is inappropriate. See, e.g., Glenn v. Washington County, 673 F.3d 864, 870 

(9th Cir. 2011). The Court DENIES Defendants’ motion for summary judgment as to the First 

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Amendment retaliation claim.

C. Eighth Amendment Claims 

With regard to the Eighth Amendment claims, the same triable issues of fact that preclude 

summary judgment for Defendants also preclude summary judgment in their favor on the qualified 

immunity defense. Taking the evidence in the light most favorable to Plaintiff, it would be clear 

to a reasonable correctional medical care provider that an Eighth Amendment violation would 

occur if she or he failed to address a loose skull flap; prescribed psychotropic medications to an 

inmate knowing that he has previously suffered severe side effects from such medications; flushed 

an inmate’s ear despite the inmate’s obvious pain and pleas to stop; and refused to treat an inmate. 

See, e.g., Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996) (summary judgment properly 

denied on qualified immunity defense to medical care providers who refused to provide a kidney 

transplant to an inmate; law was clearly established that Eighth Amendment was violated by 

deliberate indifference to medical needs). Summary judgment on qualified immunity for these 

Eighth Amendment claims is inappropriate. The Court DENIES Defendants’ motion for summary 

judgment as to the Eighth Amendment claims.

CONCLUSION

For the foregoing reasons, the Court orders as follows:

1. Defendants’ motion for summary judgment is DENIED. ECF No. 25.

2. The case is hereby REFERRED to Magistrate Judge Robert Illman for settlement 

proceedings pursuant to the Pro Se Prisoner Mediation Program. Such proceedings shall take 

place within 120 days of the date this order is filed, or as soon thereafter as Magistrate Judge 

Illman’s calendar will permit. Magistrate Judge Illman shall coordinate a place, time and date for 

one or more settlement conferences with all interested parties and/or their representatives and, 

within fifteen days of the conclusion of all settlement proceedings, shall file with the Court a 

report thereon.

The Clerk is directed to serve Magistrate Judge Illman with a copy of this order and to 

notify Magistrate Judge Illman that a copy of the Court file can be retrieved from the Court’s 

electronic filing database.

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3. In view of the referral, further proceedings in this case are hereby STAYED. The 

Clerk shall ADMINISTRATIVELY CLOSE this case until further order of the Court. If the case 

is not settled, the Court will enter a new scheduling order for further proceedings.

This order terminates ECF No. 25.

IT IS SO ORDERED.

Dated: March 21, 2019

______________________________________

JON S. TIGAR

United States District Judge

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