The opinion
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8 UNITED STATES DISTRICT COURT
9 EASTERN DISTRICT OF CALIFORNIA
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11 MANUEL RODRIGUEZ, Case No. 1:21-cv-00572-JLT-EPG
12 Plaintiff, ORDER ADOPTING FINDINGS AND
RECOMMENDATIONS (Doc. 101) GRANTING
13 v. IN PART, AND DENYING IN PART,
DEFENDANTS’ MOTION FOR SUMMARY
14 CHRISTIAN PFEIFFER, et al., JUDGMENT (Doc. 84)
15 Defendants.
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17 I. INTRODUCTION
18 Manuel Rodriguez alleges that while he was incarcerated at Kern Valley State Prison during July
19 1-8, 2019, defendant nurses Elva Vitto LVN, Harpreet Singh RN, and Lawrence Aflague RN violated
20 his Eighth Amendment rights by deliberate indifference to his complaints of severe pain accompanied
21 by loss of sensation in his right upper extremity. Rodriguez alleges defendants denied and delayed
22 access to a doctor including by improperly diagnosing his condition, allowing a spinal epidural abscess
23 (“SEA”) to develop compressing his spinal cord and rendering him an incomplete quadriplegic.
24 On December 29, 2023, defendants filed a motion for summary judgment. (Doc 84.) The motion
25 is made on the grounds that defendants were not deliberately indifferent as alleged and that they are
26 entitled to qualified immunity. (Id. at 1). On January 12, 2024, plaintiff filed opposition to the motion.1
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28 1 Defendants object to plaintiff’s opposition proffer of an Office of the Inspector General Independent Prison
Oversight Cycle 6 Medical Inspection Report dated February 2022 covering the period from July 2020 to
1 (Doc. 88). On February 21, 2024, defendants filed their reply including evidentiary objection and
2 supplemental evidence. (Doc. 93).
3 On October 11, 2024, the assigned magistrate judge entered findings and recommendations that
4 defendants’ motion be granted as to defendant Vitto and denied as to defendants Singh and Aflague.
5 (Doc. 101). That order informed the parties that they had thirty days within which to object to the
6 findings and recommendations and thirty days within which to respond to objections. (Id. at 20). The
7 parties were advised that “failure to file objections within the specified time may result in the waiver of
8 rights on appeal.” (Id. citing Wilkerson v. Wheeler, 772 F.3d 834, 839 (9th Cir. 2014) (citing Baxter v.
9 Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)).
10 On December 12, 2024, defendants Singh and Aflague filed objections to the findings and
11 recommendations. (Doc. 104 at 5). On January 7, 2025, Plaintiff filed a response to defendants’
12 objections. (Doc. 105).
13 II. DISCUSSION
14 A. Defendant Vitto, LVN
15 Plaintiff has not objected to the magistrate judge’s finding that defendant Vitto was not
16 deliberately indifferent to his serious medical needs and is entitled to summary judgment. (Doc. 101 at
17 8-9; Doc. 105). The magistrate judge correctly found that plaintiff did not point to facts that would
18 allow a reasonable jury to find defendant Vitto acted with deliberate indifference to plaintiff’s serious
19 medical needs. (Doc. 101 at 7, 9, citing Defendants’ Statement of Undisputed Facts (“DSUF”) 1, 2, 4,
20 10, 86). The undisputed record otherwise supports the magistrate judge’s findings. (See e.g., DSUF and
21 plaintiff’s corresponding Response to DSUF (“RDSUF”) 8, 93, 94; see also In re Oracle Corp. Sec.
22 Litig., 627 F.3d 376, 387 (9th Cir. 2010) (where the moving party meets its burden of proving an
23 absence of evidence to support the non-moving party’s case, the non-moving party “must come forth
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25 December 2020 at KVSP (“OIG Report” [Doc. 88-11]). (See Doc. 93 at 23-24). The magistrate judge in the
findings and recommendations did not rely upon the OIG Report. The Court declines to take judicial notice of
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the contents of the OIG Report and has not considered it. Fed. R. Evid. 201; Dasenbrock v. Enenmoh, 2017 WL
27 6375635, at *10 (E.D. Cal. Dec. 12, 2017), report and recommendation adopted, 2018 WL 691755 (E.D. Cal.
Feb. 1, 2018) (“While the report of the OIG is a public record whose authenticity is not in dispute, the
28 information included in the report is not the type of evidence that is subject to judicial notice under Federal Rule
of Evidence 201.”)
1 with evidence from which a jury could reasonably render a verdict in the non-moving party’s favor.”);
2 Chavira v. Oh, 2025 WL 2149340, at *2 (C.D. Cal. May 28, 2025), report and recommendation
3 adopted, 2025 WL 2144833 (C.D. Cal. July 28, 2025) (citing Celotex Corp. v. Catrett, 477 U.S. 317,
4 330 n.2 (1986)) (“The court need not entertain inferences that are unsupported by fact.”).
5 On the undisputed record, defendant Vitto merely processed plaintiff’s written request for a
6 refill of his active prescription for ibuprofen following approval of the refill by the unit RN. The prison
7 pharmacy refilled the prescription within minutes of defendant Vitto’s email request and plaintiff
8 received the refill. This all occurred without any personal clinical encounter between plaintiff and
9 defendant Vitto. No facts suggest defendant Vitto was aware plaintiff had any further medical need or
10 that defendant Vitto had responsibility to address any such further need. See e.g., Dunagan v. Case,
11 2015 WL 5896122, at *3 (E.D. Cal. Oct. 6, 2015) (“[D]efendant must purposely ignore or fail to
12 respond to a prisoner's pain or medical need in order for deliberate indifference to be established.”).
13 The magistrate judge correctly found that plaintiff failed to carry his burden of
14 demonstrating a dispute of material fact that defendant Vitto was deliberately indifferent to his
15 serious medical condition by failure to refer him to a doctor, or otherwise. In re Oracle Corp.
16 Sec. Litig., 627 F.3d at 387. Therefore, the Court adopts the magistrate judge’s findings and
17 recommendation and GRANTS defendant Vitto’s motion for summary judgment.
18 B. Defendant Singh, RN
19 Defendant Singh objects to the findings and recommendations on grounds the magistrate judge
20 failed to:
21 . . . account for the undisputed fact that Nurse Singh and Nurse Aflague never
suspected a spinal epidural abscess, i.e., an infection in the central nervous system,
22 as a possibility, let alone disregard such a risk. From start to finish, Nurse Singh and
Nurse Aflague believed that Plaintiff had a musculoskeletal issue and treated him
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accordingly—as evidenced by the x-ray, the follow-up visit, and the ibuprofen
24 prescription. Furthermore, Plaintiff’s purposeful concealment of his intravenous
drug use deprived Nurse Singh and Nurse Aflague of the opportunity to evaluate
25 and provide treatment for any medical issues that may have been caused by it, and
they made decisions regarding Plaintiff’s medical care based on the information
26 available to them at the time. Plaintiff’s piecemeal report of his symptoms centered
on his “horseplay” altercation with his cellmate, giving Nurse Singh and Nurse
27 Aflague no reason to consider a type of infection caused by bacteria through
needles.
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1 (Doc. 104 at 5).2 Plaintiff responds that the magistrate judge did not err because defendant Singh
2 should have referred plaintiff to a doctor rather than exceeding his scope of practice by attempting to
3 diagnose and treat plaintiff’s symptoms, exercising and abusing standardless referral discretion. (Doc.
4 105 at 7-13). Plaintiff also distinguishes the caselaw proffered by defendant Singh to show he lacked
5 the state of mind for deliberate indifference. (Id. at 7-8 citing Toguchi v Chung, 391 F.3d 1051 (9th
6 Cir. 2004).
7 The magistrate judge correctly found that disputed facts, construed in plaintiff’s favor, could
8 lead a reasonable jury to find defendant Singh was deliberately indifferent to plaintiff’s complaints of
9 severe radiating chest, neck and shoulder pain and loss of sensation in his hand, by not referring him to
10 a doctor. (Doc. 101 at 9-15; see also DSUF & RDSUF 17, 19, 23, 24, 25, 27, 30; plaintiff’s Further
11 Disputed Fact (“FDF”) and defendants’ Response to FDF (“RFDF”) 5, 19, 20, 21, 23, 27, 30, 31, 32,
12 33, 34; Doc. 84-14 at 29-30); Colwell v. Bannister, 763 F.3d 1060, 1066 (9th Cir. 2014) (citing
13 Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir.1988)) (Deliberate indifference “may appear
14 when prison officials deny, delay or intentionally interfere with medical treatment, or it may be shown
15 by the way in which prison physicians provide medical care.”).3
16 On these disputed facts, the magistrate judge observed defendants’ reply proffer of California
17 Department of Corrections and Rehabilitation practices and protocols and thereunder found a
18 reasonable juror could find plaintiff’s symptoms suggested a condition warranting referral to a doctor,
19 not just an unspecified consultation with a doctor.4 5 See Scott v. Beregovskaya, 2026 WL 353198, at
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2 Defendants do not object to the magistrate judge’s finding facts suggesting causation of harm to be undisputed.
22 (See Doc. 101 at 7-8 citing DSUF & RDUF 52, 53, 57, 102); see also Jett v. Penner, 439 F.3d 1091, 1096 (9th
Cir. 2006).
23 3 The Court overrules defendants’ objections to plaintiff’s FDF’s as not directed to the supporting evidence
and/or duplicative of Rule 56 standards. Rule 56(c)(2); see also Holt v. Noble House Hotels & Resort, Ltd., 370
24 F. Supp. 3d 1158, 1164 (S.D. Cal. 2019) (“[T]he court will not consider the parties' objections to the
characterization of or purported misstatement of the evidence represented”); id. (citing Hanger Prosthetics &
25 Orthotics, Inc. v. Capstone Orthopedic, Inc., 556 F.Supp.2d 1122, 1126 n.1 (E.D. Cal. 2008)) (“[N]oting that the
parties' evidentiary objections to [their adversary's] separate statements of undisputed facts are not considered
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because such objections should be directed at the evidence supporting those statements.”).
27 4 The Court corrects the Findings and Recommendations to reflect defendant Singh considered plaintiff’s
account of how he was injured. (See Doc. 84-4 at ¶¶ 6, 8; cf. Doc. 101 at 14).
28 5 The Court takes judicial notice of the CDCR practices and protocols proffered with the defendants’ reply brief.
Fed. R. Evid. 201.
1 *5 (E.D. Cal. Feb. 9, 2026) (whether a doctor failed to meet the standard of care may be probative as to
2 whether she acted with deliberate indifference).
3 Defendant Singh’s re-argument in his objections that he lacked the state of mind required for
4 deliberate indifference given plaintiff’s alleged injury, failure to disclose IV drug use, and the results
5 of Singh’s examination, is not a basis to find magistrate judge error, for the reasons discussed above.
6 Defendant Singh’s re-argument implicates the unresolved facts to be considered and resolved by a jury
7 under the subjective indifference prong, as the magistrate judge rightly observed. Defendant Singh’s
8 reliance upon Toguchi as authority otherwise is misplaced given the noted factual dispute as to
9 defendant Singh’s state of mind and subjective deliberate indifference. See Toguchi, 391 F.3d at 1060
10 (defendant MD did not know inmate was at risk of drug overdose); (Doc. 101 at 6).
11 The magistrate judge correctly found that plaintiff has carried his burden of demonstrating a
12 dispute of material fact that defendant Singh was deliberately indifferent plaintiff’s serious medical
13 condition by failure to refer him to a doctor. In re Oracle Corp. Sec. Litig., 627 F.3d at 387. Therefore,
14 the Court overrules defendant Singh’s objection and DENIES the motion for summary judgment as to
15 defendant Singh.
16 C. Defendant Aflague, RN
17 Defendant Aflague objects to the findings and recommendations on the same grounds asserted
18 by defendant Singh. (Doc. 104 at 5).6 Plaintiff responds that the magistrate judge correctly found
19 defendant Aflague should have referred him to a doctor on a more urgent basis, rather than exceeding
20 his scope of practice by attempting to diagnose and treat a musculoskeletal issue and exercising and
21 abusing standardless referral discretion. (Doc. 105 at 7-13). Plaintiff again distinguishes defendants’
22 reliance upon Toguchi as a basis to show Aflague lacked the state of mind for deliberate indifference.
23 (Id.).
24 The magistrate judge correctly found disputed facts, construed in plaintiff’s favor, that could
25 lead a reasonable jury to find defendant Aflague was aware of symptoms of worsening severe and
26 radiating pain and right side extremity loss of sensation, limited range of head movement, and admitted
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6 See n.3.
1 overuse of prescribed ibuprofen in an effort to treat the pain, warranting referral to a doctor on a more
2 urgent basis. (Doc. 101 at 15-19); see also SDUF & RSDUF 37, 38, 39, 40, 45, 46, 48, 49, 50, 51).
3 Colwell, 763 F.3d at 1066. On these disputed facts, the magistrate judge again observed defendants’
4 reply proffer of CDCR practices and protocols and thereunder found plaintiff’s continuing symptoms
5 showed a condition warranting urgent, not routine, referral to a doctor. (Doc. 101 at 18-19). See Scott,
6 2026 WL 353198, at *5.
7 As was the case with defendant Singh above, defendant Aflague’s re-argument in his objections
8 that he lacked the state of mind required for deliberate indifference given plaintiff’s alleged injury,
9 failure to disclose IV drug use, and the results of Aflague’s examination, is not a basis to find
10 magistrate judge error. Defendant Aflague’s re-argument implicates the unresolved facts to be
11 considered and resolved by a jury under the subjective indifference prong, as the magistrate judge
12 correctly observed. Toguchi is not authority otherwise, for the reasons stated. See Toguchi, 391 F.3d at
13 1060; (Doc. 101 at 6).
14 The magistrate judge correctly found that plaintiff has carried his burden of demonstrating a
15 dispute of material fact that defendant Aflague was deliberately indifferent plaintiff’s serious medical
16 condition by failure to urgently refer plaintiff to a doctor. In re Oracle Corp. Sec. Litig., 627 F.3d at
17 387. Therefore, the Court overrules defendant Aflague’s objection DENIES this defendant’s motion
18 for summary judgment.
19 D. Qualified Immunity
20 Defendants Singh and Aflague object to the magistrate judge’s findings and recommendation
21 that they are not entitled to qualified immunity. These defendants argue there was no constitutional
22 violation, but only the exercise of medical judgment. (Doc. 104 at 5, 14-16). They point to their
23 proffer on summary judgment that they acted reasonably and met the requisite standard of care and
24 did not violate clearly established law. (Doc. 84-1 at 28-29; Doc. 93 at 20-23).
25 Plaintiff responds by pointing to his argument opposing summary judgment that: the right of a
26 convicted inmate to medical treatment for a serious medical need is established, and under the
27 circumstances of this case, defendants would have been aware by both plaintiff’s complaints and the
28 medical history that they would be violating his rights by their failure to provide him with treatment
1 or access to medical care. (Doc. 105 at 13, citing Doc. 88 at 20-22).
2 The magistrate judge did not err in finding defendants Singh and Aflague were not entitled to
3 summary judgment on grounds of qualified immunity. See Sandoval v. County of San Diego, 985
4 F.3d 657, 671 (9th Cir. 2021) (citing Horton by Horton v. City of Santa Maria, 915 F.3d 592, 599 (9th
5 Cir. 2019)) (In determining whether a state official is entitled to qualified immunity in the context of
6 summary judgment, the court considers (1) whether the evidence viewed in the light most favorable
7 to the plaintiff is sufficient to show a violation of a constitutional right and (2) whether that right was
8 “clearly established at the time of the violation.”). The magistrate judge correctly found disputed
9 facts, construed in plaintiff’s favor, raising an inference that defendants Singh and Aflague were
10 deliberately indifferent to plaintiff’s complaints of severe radiating chest, neck and shoulder pain and
11 loss of sensation in his hand, by not referring him to a doctor, for the reasons discussed above.
12 Furthermore, the magistrate judge correctly observed it is clearly established that a delay in
13 access to medical care may constitute deliberate indifference to serious medical needs. (Doc. 101 at
14 19-20, citing Clement v. Gomez, 298 F.3d 898, 906 (9th Cir. 2002); see also Ashcroft v. al-Kidd, 563
15 U.S. 731, 741 (2011) (quoting Anderson v. Creighton, 483 U.S. 635, 640 (1987)) (A right is “clearly
16 established” when, “at the time of the challenged conduct, the contours of a right are sufficiently
17 clear that every reasonable official would have understood that what he is doing violates that right.”);
18 DeFrancesco v. Robbins, 136 F.4th 933, 939 (9th Cir. 2025) (citing Tuuamalemalo v. Greene, 946
19 F.3d 471, 477 (9th Cir. 2019)) (citing District of Columbia v. Wesby, 583 U.S. 48, 63 (2018)) (“The
20 rule must be settled law, which means it is dictated by controlling authority or a robust consensus of
21 cases of persuasive authority.”) (internal quotation marks omitted). The magistrate judge correctly
22 found that plaintiff carried his burden of demonstrating a dispute of material fact that defendants
23 Singh and Aflague are not entitled to summary judgment on grounds of qualified immunity. In re
24 Oracle Corp. Sec. Litig., 627 F.3d at 387. Thus, the Court adopts the recommendation and orders that
25 the motion for summary judgment based upon qualified immunity is DENIED.
26 According to 28 U.S.C. § 636(b)(1)(C), this Court conducted a de novo review of this case.
27 Having carefully reviewed the entire matter, including defendants’ objections to the magistrate
28 judge’s findings and recommendations and plaintiff’s response thereto, the Court concludes the
1 || findings and recommendations are supported by the record and proper analysis.
2 ||. CONCLUSIONS
3 Based on the foregoing, the Court ORDERS:
4 1. The Findings and Recommendations issued on October 11, 2024 (Doc. 101)
5 are ADOPTED in full.
6 2. Defendants’ Motion for Summary Judgment (Doc. 84) is GRANTED as to
7 defendant Vitto and DENIED as to defendants Singh and Aflague.
8 3. The parties are directed to meet and confer and file a joint status conference
9 statement including discussion of remaining scheduling issues, including the
10 pretrial conference and trial, no later than 30 days from the date of this
11 order.
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B IT IS SO ORDERED.
14|| Dated: _ March 17, 2026 Charis [Tourn
5 TED STATES DISTRICT JUDGE
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