In July 2008, plaintiff Paul Adams, an inmate at Calpatria State Prison, was sent to Dr. Arab, an outside board certified ear, nose and throat surgeon, for evaluation due to Adams complaining that a bullet fragment, which was previously lodged near his spine, had moved and was causing him pain. Adams was previously shot in the face and neck in 1997, causing a bullet fragment to become lodged near his spine. Adams claimed that the doctors at a county prison told him that they could not operate to remove the fragment and that he should wait. When Adams arrived at Calpatria State Prison in 2007, he began to complain of pain due to the bullet fragment allegedly moving. As a result, the prison sent him to Arab for evaluation on three occasions — in July 2008, on Jan. 22, 2009, and on April 23, 2009. However, Adams claimed that Arab refused to examine him or answer his questions and that Arab then placed him on the undecided list, which prevented him from having the surgery. Adams sued Arab; the warden, Larry Small; and the operators of Calpatria State Prison, the state of California and the United States. Adams also sued several other medical providers, including a nurse practitioner, Al Lopez (who was erroneously sued as a doctor), Dr. K. Ball and Dr. D. Hjerpe; as well as J. Walker, Chief California Office of Third Level Appeal Health Care. Adams alleged that the defendants’ actions constituted a violation of his Eighth Amendment rights. The matter ultimately went to trial against Arab only on the cause of action of alleged medical indifference in violation of Adams’ 42 USC § 1983 civil rights. Adams claimed that over the course of the three visits, Arab never once examined him and Arab refused to answer any questions he had about the surgery. He alleged that all Arab would say was, “Do you want the surgery, yes or no?” Adams claimed that as a result, he did not want to have the surgery until it was explained to him. Plaintiff’s counsel contended that Adams’ refusal to agree to surgery until it was explained to him caused Arab to record on the third visit that Adams was undecided about the surgery. However, counsel contended that Adams later changed his mind and agreed to the surgery, but that on the day the surgery was to be performed, Adams cancelled it when he learned that Arab would be performing it. Thus, counsel contended that Adams did not undergo the surgery until April 11, 2011, after Adams was transferred to another institution. Defense counsel contended that Arab examined Adams, gave Adams all the necessary information about the surgery, and answered all of Adam’s questions. Counsel noted that the evidence showed that months after Adams claimed that Arab would not answer his questions, Adams met with a nurse practitioner, Lopez, and told him that he wanted Lopez, Ball or Arab to make the decision for him regarding whether or not to have the surgery. Thus, defense counsel argued that the delay in surgery was due to Adams’ unreasonable concern over becoming paralyzed from the surgery and was not due to any failure by Arab to answer questions or perform an examination., Adams claimed that he suffered pain caused by the movement of the bullet fragment and that the pain continued from the time he first met Arab until the date of the eventual surgery. Thus, Adams sought recovery of monetary damages for his pain and suffering.