Sandoval v. Guldseth

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ALBERTO SANDOVAL, CDCR #AM-0186, Plaintiff, v. DAVID GULDSETH, M.D, Defendant.

No. 3:19-cv-1584-JO-RBB

United States District Court, S.D. California

August 4, 2022

ORDER: (1) GRANTING DEFENDANT GULDSETH'S MOTION FOR SUMMARY JUDGMENT [ECF No. 46] PURSUANT TO FED. R. CIV. P 56 AND (2) DENYING PLAINTIFF'S MOTION FOR RECONSIDERATION [ECF No. 55]

HON JINSOOK OHTA UNITED STATES DISTRICT JUDGE

On August 23, 2019, Plaintiff Alberto Sandoval (“Plaintiff” or “Sandoval”) currently proceeding pro se and in forma pauperis, filed this civil rights action pursuant to 42 U.S.C. § 1983. See Compl., ECF No. 1. In his complaint, Sandoval claims that Dr. David Guldseth violated his constitutional right to adequate medical care while he was housed at R.J. Donovan Correctional Facility (“RJD”).^[1] See id.

I. BACKGROUND

A. Plaintiff's Allegations Against Dr. Guldseth^[2]

In his First Amended Complaint, Sandoval alleges he suffers from a “significant joint degenerative disease” and a loss of cartilage in his right knee. Am. Compl., ECF No. 8, (hereafter “FAC”) ¶ 1. As a result, Sandoval suffers from “persistent pain and swelling” in his right knee that hinders his ability to stand or walk. Id. at ¶¶ 3-5.

Plaintiff alleges that in January 2016, Dr. Casey, an orthopedic surgeon, recommended total right knee replacement surgery to treat his condition. Id. at ¶ 6. After Sandoval transferred to RJD, however, Dr. Guldseth became his primary care physician. Id. at ¶ 16. Ignoring Dr. Casey's surgery recommendation, Dr. Guldseth treated Sandoval's knee with pain medication. Id. at ¶ 19. Sandoval complained that the pain medications were ineffective and asked to be referred to an orthopedic specialist. Id. at ¶¶ 25, 27. Dr. Guldseth ultimately referred Sandoval to an outside specialist, Dr. Cham, who recommended total right knee replacement. Id. at ¶ 30. Dr. Cham counseled Plaintiff that in order to be a good surgical candidate, he would need to stop his Morphine treatment and lose weight before the surgery. Id. at ¶¶ 55, 59. The surgery was scheduled for May 9, 2018. Id. at ¶ 61. When Sandoval saw Dr. Guldseth two weeks before the scheduled surgery, Dr. Guldseth told Sandoval he would not be cleared for surgery until he lost 50 pounds and was weaned off Morphine. Id. at ¶ 36. The surgery was canceled and Dr. Guldseth refused to refer Sandoval back to a specialist for reassessment until he lost the weight. Id. at ¶¶ 47, 51.

B. Undisputed Facts Regarding Plaintiff's Medical Care^[3]

Sandoval began seeing Dr. Guldseth as his primary care physician on February 8, 2017, after Sandoval was transferred to RJD. See Def.'s Decl., ECF No. 46-2 (hereafter “Def.'s Decl.”) ¶ 2; Def.'s Ex. A at 1; FAC ¶ 16. During this first appointment, Dr. Guldseth reviewed Sandoval's history, medications and current complaints and noted that Sandoval suffered from several other health issues in addition to the severe joint degeneration of his right knee, including hypertension, glaucoma, sleep apnea, right shoulder derangement, peptic ulcer disease, prediabetes, benign prostatic hypertrophy, gout and morbid obesity. Def.'s Decl. ¶ 2; Def.'s Ex. A. at 1. Dr. Guldseth's notes indicate that Sandoval told Dr. Guldseth that “he was denied right knee surgery recently.” Def.'s Ex. A at 1. Based on the above, Dr. Guldseth embarked on a treatment plan of managing Sandoval's knee pain with medication and physical therapy. See Def.'s Ex. A at 2; Def.'s Decl. ¶ 2. He also recommended Sandoval try to lose weight. Def.'s Decl. ¶ 2. At that time, Sandoval, who is five feet, eight inches tall, weighed 279 pounds. Def.'s Ex. A at 2.

During their next appointment, Plaintiff raised the question of knee surgery but Dr. Guldseth kept him on his pain medication treatment plan. Def.'s Ex. B at 4. Medical records indicate Sandoval asked Dr. Guldseth “when he [could] have knee surgery” at his next appointment on February 23, 2018. Id.; Def.'s Decl. ¶ 3. Sandoval said he had been told previously that he “would have to lose weight before he could have his surgery” and asked “how much weight he would need to lose.” Def.'s Ex. B at 4. Dr. Guldseth told Sandoval that ideally his Body Mass. Index (“BMI”) should be “normal or near normal” for the best surgical outcome. Id; see also Def.'s Decl. ¶ 3. At the time, Plaintiff weighed 268 pounds and his BMI was 40.7. Def.'s Ex. B at 4. (A BMI over 30 indicates obesity. Def.'s Decl. ¶ 3.) Dr. Guldseth kept Sandoval on a pain management regimen but adjusted it by adding Gabapentin^[4] as a pain reliever and taking Plaintiff off Elavil because Plaintiff complained of its side effects. Id. at ¶ 4; see also Def.'s Ex. B at 4.

When Sandoval saw Dr. Guldseth again on March 23, 2017 for his knee pain, the doctor discussed surgery as an option and advised Sandoval that he would need to lose weight to be a good surgical candidate.^[5] Def.'s Ex. D at 8. Dr. Guldseth reviewed Plaintiff's treatment history with Dr. Casey, an orthopedic specialist, and noted that Dr. Casey had recommended surgery for total right knee replacement. Id. at 8-9; see also Def.'s Decl. ¶ 7-8. Dr. Guldseth explained to Plaintiff that, while Dr. Casey had previously recommended surgery, Sandoval was ultimately denied the surgery because of his weight.^[6] Def.'s Ex. D at 8; Def.'s Decl. ¶¶ 6, 9. Given that Sandoval weighed 123.8 kilograms and had a BMI of 41.4 at that time, Dr. Guldseth informed Sandoval would have to lose some weight before any surgery, to ensure a positive outcome. Def.'s Ex. D at 8. Dr. Guldseth advised him to “exercise, drink plenty of fluids and decrease carbohydrate intake by 50%.” Id. at 9; see also Def.'s Decl. ¶ 9. Dr. Guldseth noted he would “refer Sandoval to Physical Therapy and Pain Management Group.” Def.'s Ex. D at 9. He also continued Sandoval's prescriptions for Tylenol No. 3 with Codeine and Gabapentin. Id.

Sandoval saw Dr. Guldseth and other health care professionals at least four more times between April and September 2017 for his knee pain. See Def.'s Exs. E-H. On April 26, 2017, Dr. Guldseth ordered a “[r]epeat x-ray of the right knee” and noted that a request for Sandoval to receive physical therapy was “pending.” Def.'s Ex. E at 11. Plaintiff ultimately refused the knee x-rays, which had been scheduled for May 4, 2017.^[7] Def.'s Ex. F at 12. On May 31, 2017, Sandoval had another appointment during which he complained of uncontrolled knee pain. Def.'s Ex. G at 13. Dr. Guldseth noted that the Tylenol No. 3 with Codeine did not appear to be managing Sandoval's pain, so he discontinued the Tylenol No. 3 and put Sandoval back on Morphine, twice a day. Id.; see also Def.'s Decl. ¶¶ 12-13. On August 24, 2017, Sandoval had a follow-up appointment, this time with Dr. Luzbiminda Saidro, regarding his knee pain and desire to have surgery. Def.'s Ex. H at 15. Dr. Saidro noted that Sandoval had been “seen by Orthopedics in January 2017” and a referral to Orthopedics for knee surgery was recommended “if his body mass index is less than 40.” Id. Sandoval's weight at the time was 129 kilograms and his BMI was 43.1. Id. Dr. Saidro continued Sandoval's pain medications and advised him to eat healthy and exercise to lose weight. Id. On September 13, 2017, Sandoval saw a nurse about knee pain. See Def.'s Ex. I at 17.

Despite Plaintiff's failure to lose weight, Dr. Guldseth referred to him to an orthopedic specialist on September 22, 2017. Id.; see also Def.'s Decl. ¶ 16. Dr. Guldseth submitted a Request for Services (“RFS”) for an orthopedic specialist to reevaluate Sandoval's right knee. Def.'s Ex. I at 17; Def.'s Ex. J at 19. While Sandoval waited for his orthopedic appointment, he saw Dr. Guldseth at least three more times, during which Dr. Guldseth ordered physical therapy, continued Sandoval's Morphine, increased his Gabapentin dose, added Tylenol for additional pain control, and ordered a wedge pillow so Sandoval could elevate his knee at night. Def.'s Exs. K-M; see also Def.'s Decl. ¶ 1820. On January 23, 2018, Sandoval had a tele-med appointment with orthopedic specialist, Dr. Cham, during which they discussed possible surgery. Def.'s Ex. N.

Dr. Cham told Sandoval that “the only treatment likely to provide him with any significant pain relief would be a knee replacement.” Id. at 28. Dr. Cham also noted, however, that due to his other health issues, Sandoval would need to “have a medical evaluation and then clearance before a major procedure such as arthroplasty.” Id. At his February 1, 2018 appointment with Dr. Guldseth, Sandoval indicated he wanted to go forward with the surgery. Def.'s Ex. O at 29; Def.'s Decl. ¶ 22. On February 7, 2018, Dr. Guldseth submitted an RFS^[8] seeking authorization for total right knee replacement surgery based on Dr. Cham's recommendation.^[9] Def.'s Ex. P at 32; Ex. O at 29; Def.'s Decl. ¶ 23.

While it is unclear when exactly surgery was put on the schedule, it is undisputed it was initially set for May 9, 2018. FAC ¶ 61; Def.'s Ex. R at 34; Def.'s Decl. ¶ 27. On April 26, 2018, Sandoval saw Dr. Cham for a face-to-face pre-operative visit.^[10] Def.'s Ex. Q at 33. Dr. Cham cautioned that due to Sandoval's diabetes, obesity and previous history of serious infection, he was at “significant risk for complications” with total knee replacement. Id. Dr. Cham instructed Sandoval to stop taking Morphine to help control post-operative pain. Id. He also noted Sandoval “needs to lose weight.” Id. Ultimately, Dr. Cham noted he would “request authorization and bring [Sandoval] back once we have authorization and medical clearance.” Id.

The next day, April 27, 2018, an RJD nurse received word from Dr Cham that he was canceling Sandoval's surgery. Dr. Cham indicated Sandoval was “high risk” and he wanted “[Sandoval] off morphine and [to]...