1 WO KM 2 3 4 5 8 9 Jonathan Beede, No. CV 21-02087-PHX-JAT (JZB) 10 Plaintiff, 11 v. ORDER 12 Pinal County Sheriff’s Facility, et al., 13 Defendants.
15 I. Procedural History 16 On December 8, 2021, Plaintiff Jonathan Beede, who is confined in the Red Rock 17 Correctional Center, filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 and 18 an Application to Proceed In Forma Pauperis. On December 29, 2021, Plaintiff filed a 19 First Amended Complaint. 20 In a January 4, 2022 Order, the Court denied the Application to Proceed with leave 21 to refile. After multiple mail-related delays, Plaintiff filed a February 8, 2022 Application 22 to Proceed In Forma Pauperis (Doc. 10) and Second Amended Complaint (Doc. 12). The 23 Court will dismiss the Second Amended Complaint with leave to amend. 24 I. Application to Proceed In Forma Pauperis and Filing Fee 25 The Court will grant Plaintiff’s February 8, 2022 Application to Proceed In Forma 26 Pauperis. 28 U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 27 U.S.C. § 1915(b)(1). The Court will not assess an initial partial filing fee. Id. The statutory 28 filing fee will be collected monthly in payments of 20% of the previous month’s income 1 credited to Plaintiff’s trust account each time the amount in the account exceeds $10.00. 2 28 U.S.C. § 1915(b)(2). The Court will enter a separate Order requiring the appropriate 3 government agency to collect and forward the fees according to the statutory formula. 4 II. Statutory Screening of Prisoner Complaints 5 The Court is required to screen complaints brought by prisoners seeking relief 6 against a governmental entity or an officer or an employee of a governmental entity. 28 7 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 8 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 9 relief may be granted, or that seek monetary relief from a defendant who is immune from 10 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 11 A pleading must contain a “short and plain statement of the claim showing that the 12 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 13 not demand detailed factual allegations, “it demands more than an unadorned, the- 14 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 15 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 16 conclusory statements, do not suffice.” Id. 17 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 18 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 19 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 20 that allows the court to draw the reasonable inference that the defendant is liable for the 21 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 22 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 23 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 24 allegations may be consistent with a constitutional claim, a court must assess whether there 25 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 26 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 27 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 28 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 1 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 2 U.S. 89, 94 (2007) (per curiam)). 3 If the Court determines that a pleading could be cured by the allegation of other 4 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 5 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 6 Plaintiff’s Second Amended Complaint will be dismissed for failure to state a claim, but 7 because it may possibly be amended to state a claim, the Court will dismiss it with leave 8 to amend. 9 III. Second Amended Complaint 10 Plaintiff names the following Defendants in his two-count Second Amended 11 Complaint: Pinal County Sheriff’s Office, Wexford Health Services, Doctor Katy, and 12 Nurse Kelly. Plaintiff seeks money damages. 13 In Count One, Plaintiff alleges he was denied adequate medical care, in violation of 14 the Eighth Amendment. Plaintiff claims that when he arrived at the Pinal County Jail on 15 March 31, 2021, he informed the nurse in the booking area that he had an injury on his 16 penis that was swollen and painful and required medical attention. The nurse said she 17 would look at the injury after the booking process, but failed to do so, and then told Plaintiff 18 to submit a medical request. Plaintiff was placed in quarantine and locked down for 23 ½ 19 hours per day, leaving him only 30 minutes to request a medical form from the floor 20 detention officer on duty, who was not always willing to get the form. On April 1, 2021, 21 Plaintiff submitted a request after he woke up “in bad pain and really swollen and had 22 difficult[y urinating], started getting chills and cold sweats and every time the nurse would 23 do pill call [he] would plead for her help to get the doctor.” Plaintiff claims he submitted 24 multiple requests for help but he was not taken seriously “because of where the injury was 25 located at.” 26 On April 2, 2021, Defendant Kelly looked at Plaintiff’s injury, asked for a urine 27 sample, and said she would call the doctor. Plaintiff states that less than ten minutes later, 28 a sergeant came and transported Plaintiff to the hospital for observation. The doctor at the 1 hospital informed the corrections officers that Plaintiff needed surgery right away and 2 “needed a urologist and to be transported to Mountain Vista Medical Center for surgery.” 3 Plaintiff was scheduled for surgery at 7:00 a.m. on April 3, 2021, for treatment of a severe 4 infection. Plaintiff was at the hospital for two days and needed wound care for an 5 additional 25 days. Plaintiff states he suffered unbearable pain. 6 In Count Two, Plaintiff alleges that in April 2021, he asked the Jail’s paralegal, Ms. 7 Valdez for a complaint form and help filing a lawsuit against Defendants Wexford and 8 Pinal County Sheriff’s Office. Plaintiff claims Ms. Valdez said she was not going to help 9 Plaintiff. Plaintiff wrote “multiple requests” for lawyers’ contact information and copies, 10 but received nothing. Plaintiff then requested a power of attorney form, which Valdez 11 provided. Plaintiff completed the form and sent it out, but his friend never received it. He 12 asked Valdez for another form but she said “no,” and told Plaintiff he would have to get a 13 form on his own. Plaintiff then asked Valdez to notarize the new form but she refused and 14 accused Plaintiff of being dishonest and trying to “pull a scam.” Valdez also refused to 15 give Plaintiff a power of attorney form sent to him by his post-conviction attorney because 16 that attorney was not listed on his approved contacts. Plaintiff states he believes Valdez 17 was “finding reasons not to notarize [his] power of attorney [because] Valdez knew [he] 18 needed it for [his] medical record.” 19 IV. Failure to State a Claim 20 A. Pinal County Sheriff’s Office 21 The Pinal County Sheriff’s Office is not a proper defendant because it is a “non- 22 jural entity.” Melendres v. Arpaio, 784 F.3d 1254, 1260 (9th Cir. 2015) (citing Braillard 23 v. Maricopa County, 232 P.3d 1263, 1269 (Ariz. Ct. App. 2010)). In Arizona, the 24 responsibility of operating jails and caring for prisoners is placed by law upon the sheriff. 25 See Ariz. Rev. Stat. §§ 11-441(A)(5), 31-101. The sheriff’s office is simply an 26 administrative creation of the county sheriff to allow the sheriff to carry out statutory duties 27 and is not a “person” amenable to suit pursuant to § 1983. Accordingly, the Pinal County 28 Sheriff’s Office will be dismissed from this action. 1 B. Wexford Health Services 2 To state a claim under § 1983 against a private entity performing a traditional public 3 function, such as providing medical care to prisoners, a plaintiff must allege facts to support 4 that his constitutional rights were violated as a result of a policy, decision, or custom 5 promulgated or endorsed by the private entity. See Tsao v. Desert Palace, Inc., 698 F.3d 6 1128, 1138-39 (9th Cir. 2012); Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 1997) (per 7 curiam). A plaintiff must allege the specific policy or custom and how it violated his 8 constitutional rights. A private entity is not liable merely because it employs persons who 9 allegedly violated a plaintiff’s constitutional rights. See Tsao, 698 F.3d at 1139; Buckner, 10 116 F.3d at 452. 11 Plaintiff does not allege that any of the conduct described in the Complaint was the 12 result of a specific policy or custom of Defendant Wexford Health Services. Thus, the 13 Court will dismiss without prejudice Defendant Wexford Health Services. 14 C. Defendants Katy and Kelly 15 The Ninth Circuit Court of Appeals has held that “claims for violations of the right 16 to adequate medical care ‘brought by pretrial detainees against individual defendants under 17 the Fourteenth Amendment’ must be evaluated under an objective deliberate indifference 18 standard.” Gordon v. County of Orange, 888 F.3d 1118, 1124-25 (9th Cir. 2018) (quoting 19 Castro v. County of Los Angeles, 833 F.3d 1060, 1070 (9th Cir. 2016)). To state a medical 20 care claim, a pretrial detainee must show 21 (i) the defendant made an intentional decision with respect to the conditions under which the plaintiff was confined; (ii) those 22 conditions put the plaintiff at substantial risk of suffering 23 serious harm; (iii) the defendant did not take reasonable available measures to abate that risk, even though a reasonable 24 official in the circumstances would have appreciated the high 25 degree of risk involved—making the consequences of the defendant’s conduct obvious; and (iv) by not taking such 26 measures, the defendant caused the plaintiff’s injuries. 27 Id. at 1125. “With respect to the third element, the defendant’s conduct must be objectively 28 unreasonable, a test that will necessarily ‘turn[] on the facts and circumstances of each 1 particular case.’” Castro, 833 F.3d at 1071 (quoting Kingsley v. Hendrickson, 576 U.S. 2 389, 397 (2015); Graham v. Connor, 490 U.S. 386, 396 (1989)). 3 The “‘mere lack of due care by a state official’ does not deprive an individual of 4 life, liberty, or property under the Fourteenth Amendment.” Castro, 833 F.3d at 1071 5 (quoting Daniels v. Williams, 474 U.S. 327, 330-31 (1986)). A plaintiff must “prove more 6 than negligence but less than subjective intent—something akin to reckless disregard.” Id. 7 A mere delay in medical care, without more, is insufficient to state a claim against prison 8 officials for deliberate indifference. See Shapley v. Nev. Bd. of State Prison Comm’rs, 766 9 F.2d 404, 407 (9th Cir. 1985). 10 Plaintiff makes no allegations against Defendant Katy and therefore fails to state a 11 claim against her. Plaintiff’s only allegations against Defendant Kelly are that on April 2, 12 2021, Defendant Kelly examined his injury and called the doctor for treatment instructions. 13 These allegations do not show Defendant Kelly failed to take reasonable measures to abate 14 a risk of harm to Plaintiff; to the contrary Plaintiff’s allegations show Defendant Kelly 15 acted to immediately obtain medical treatment for Plaintiff. Plaintiff does not allege that 16 Defendant Kelly was the nurse responsible for delaying his medical care at the time of 17 booking, nor does he name the booking nurse as a defendant in this action. 18 D. Count Two 19 Although unclear, it appears Plaintiff is attempting to bring an access to courts claim 20 in Count Two. The right of meaningful access to the courts prohibits officials from actively 21 interfering with inmates’ attempts to prepare or file legal documents. Lewis v. Casey, 518 22 U.S. 343, 350 (1996). The right of access to the courts is only a right to bring petitions or 23 complaints to federal court and not a right to discover such claims or even to litigate them 24 effectively once filed with a court. Id. at 354. The right “guarantees no particular 25 methodology but rather the conferral of a capability–the capability of bringing 26 contemplated challenges to sentences or conditions of confinement before the courts.” Id. 27 at 356. 28 As a matter of standing, for an access-to-courts claim, a plaintiff must show that he 1 suffered an “actual injury” with respect to contemplated litigation. Id. at 349. To show 2 actual injury with respect to contemplated litigation, the plaintiff must demonstrate that the 3 defendants’ conduct frustrated or impeded him from bringing to court a nonfrivolous claim 4 that he wished to present. Id. at 352-53. 5 “[T]he injury requirement is not satisfied by just any type of frustrated legal claim.” 6 Id. at 354. The right of access to the courts “does not guarantee inmates the wherewithal 7 to transform themselves into litigating engines capable of filing everything from 8 shareholder derivative actions to slip-and-fall claims.” Id. at 355. The nonfrivolous claim 9 must be a direct or collateral attack on the inmate’s sentence or a challenge to the conditions 10 of his confinement. Id. “Impairment of any other litigating capacity is simply one of the 11 incidental (and perfectly constitutional) consequences of conviction and incarceration.” Id. 12 (emphasis in original). 13 Plaintiff claims Ms. Valdez refused to notarize a power of attorney document for 14 him. As an initial matter, Plaintiff does not name Ms. Valdez as a defendant in this action. 15 Even if Plaintiff had named Valdez as a defendant, Plaintiff’s allegations fail to state an 16 access to courts claim. Plaintiff does not allege why he needed the power of attorney form, 17 nor does he allege that the delay in having the form notarized prevented him from bringing 18 to court a nonfrivolous claim that he wished to present. Plaintiff has therefore failed to 19 state a claim in Count Two. 20 V. Leave to Amend 21 For the foregoing reasons, the Court will dismiss Plaintiff’s Second Amended 22 Complaint for failure to state a claim upon which relief may be granted. Within 30 days, 23 Plaintiff may submit a third amended complaint to cure the deficiencies outlined above. 24 The Clerk of Court will mail Plaintiff a court-approved form to use for filing a third 25 amended complaint. If Plaintiff fails to use the court-approved form, the Court may strike 26 the third amended complaint and dismiss this action without further notice to Plaintiff. 27 Plaintiff must clearly designate on the face of the document that it is the “Third 28 Amended Complaint.” The third amended complaint must be retyped or rewritten in its 1 entirety on the court-approved form and may not incorporate any part of the original 2 Complaint or prior Amended Complaints by reference. Plaintiff may include only one 3 claim per count. 4 In each count, Plaintiff must write short, plain statements telling the Court: (1) the 5 constitutional right Plaintiff believes was violated; (2) the name of the Defendant who 6 violated the right; (3) exactly what that Defendant did or failed to do; (4) how the action or 7 inaction of that Defendant is connected to the violation of Plaintiff’s constitutional right; 8 and (5) what specific injury Plaintiff suffered because of that Defendant’s conduct. See 9 Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976). 10 Plaintiff must repeat this process for each person he names as a Defendant. If 11 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 12 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 13 failure to state a claim. Conclusory allegations that a Defendant or group of 14 Defendants has violated a constitutional right are not acceptable and will be 15 dismissed. 16 A third amended complaint supersedes the original Complaint and prior Amended 17 Complaints. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios 18 v. Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 19 will treat the original Complaint and prior Amended Complaints as nonexistent. Ferdik, 20 963 F.2d at 1262. Any cause of action that was raised in the original Complaint or prior 21 Amended Complaints and that was voluntarily dismissed or was dismissed without 22 prejudice is waived if it is not alleged in a third amended complaint. Lacey v. Maricopa 23 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 24 VI. Warnings 25 A. Release 26 If Plaintiff is released while this case remains pending, and the filing fee has not 27 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 28 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 1 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 2 result in dismissal of this action. 3 B. Address Changes 4 Plaintiff must file and serve a notice of a change of address in accordance with Rule 5 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 6 relief with a notice of change of address. Failure to comply may result in dismissal of this 7 action. 8 C. Possible “Strike” 9 Because the Second Amended Complaint has been dismissed for failure to state a 10 claim, if Plaintiff fails to file a third amended complaint correcting the deficiencies 11 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 12 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 13 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 14 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 15 brought an action or appeal in a court of the United States that was dismissed on the 16 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 17 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 18 U.S.C. § 1915(g). 19 D. Possible Dismissal 20 If Plaintiff fails to timely comply with every provision of this Order, including these 21 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 22 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 23 the Court). 24 IT IS ORDERED: 25 (1) Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 10) is granted. 26 (2) As required by the accompanying Order to the appropriate government 27 agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial filing 28 fee. 1 (3) | The Second Amended Complaint (Doc. 12) is dismissed for failure to state aclaim. Plaintiff has 30 days from the date this Order is filed to file a third amended 3 | complaint in compliance with this Order. 4 (4) If Plaintiff fails to file a third amended complaint within 30 days, the Clerk 5 | of Court must, without further notice, enter a judgment of dismissal of this action with 6 | prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) and deny any pending unrelated motions as moot. 8 (5) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 10 Dated this 7th day of March, 2022. 11 12 a 3 13 James A. Teilborg 14 Senior United States District Judge 15 16 17 18 19 20 21 22 23 24 25 26 27 28
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Instructions for a Prisoner Filing a Civil Rights Complaint in the United States District Court for the District of Arizona
1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated persons prepare a complaint seeking relief for a violation of their federal civil rights. These complaints typically concern, but are not limited to, conditions of confinement. This form should not be used to challenge your conviction or sentence. If you want to challenge a state conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment.
2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4 provides that complaints by incarcerated persons must be filed on the court-approved form. The form must be typed or neatly handwritten. The form must be completely filled in to the extent applicable. All questions must be answered clearly and concisely in the appropriate space on the form. If needed, you may attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper. You must identify which part of the complaint is being continued and number all pages. If you do not fill out the form properly, you will be asked to submit additional or corrected information, which may delay the processing of your action. You do not need to cite law.
3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury.
4. The Filing and Administrative Fees. The total fees for this action are $402.00 ($350.00 filing fee plus $52.00 administrative fee). If you are unable to immediately pay the fees, you may request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant to 28 U.S.C. ' 1915” for additional instructions.
5. Original and Judge=s Copy. You must send an original plus one copy of your complaint and of any other documents submitted to the Court. You must send one additional copy to the Court if you wish to have a file-stamped copy of the document returned to you. All copies must be identical to the original. Copies may be legibly handwritten. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing.
6. Where to File. You should file your complaint in the division where you were confined when your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined in Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were confined in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. If you were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson Division. Mail the original and one copy of the complaint with the $402 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 12/1/20 Phoenix & Prescott Divisions: OR Tucson Division: U.S. District Court Clerk U.S. District Court Clerk U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500 401 West Washington Street, SPC 10 405 West Congress Street Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010
7. Change of Address. You must immediately notify the Court and the defendants in writing of any change in your mailing address. Failure to notify the Court of any change in your mailing address may result in the dismissal of your case.
8. Certificate of Service. You must furnish the defendants with a copy of any document you submit to the Court (except the initial complaint and application to proceed in forma pauperis). Each original document (except the initial complaint and application to proceed in forma pauperis) must include a certificate of service on the last page of the document stating the date a copy of the document was mailed to the defendants and the address to which it was mailed. See Fed. R. Civ. P. 5(a), (d). Any document received by the Court that does not include a certificate of service may be stricken. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. A certificate of service should be in the following form:
I hereby certify that a copy of the foregoing document was mailed this (month, day, year) to: Name: Address: Attorney for Defendant(s)
(Signature)
9. Amended Complaint. If you need to change any of the information in the initial complaint, you must file an amended complaint. The amended complaint must be written on the court- approved civil rights complaint form. You may file one amended complaint without leave (permission) of Court within 21 days after serving it or within 21 days after any defendant has filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants not included in the amended complaint are considered dismissed. All amended complaints are subject to screening under the Prison Litigation Reform Act; screening your amendment will take additional processing time.
10. Exhibits. You should not submit exhibits with the complaint or amended complaint. Instead, the relevant information should be paraphrased. You should keep the exhibits to use to support or oppose a motion to dismiss, a motion for summary judgment, or at trial.
11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of any judge. The only appropriate way to communicate with the Court is by filing a written pleading or motion.
2 12. Completing the Civil Rights Complaint Form.
HEADING: 1. Your Name. Print your name, prison or inmate number, and institutional mailing address on the lines provided.
2. Defendants. If there are four or fewer defendants, print the name of each. If you name more than four defendants, print the name of the first defendant on the first line, write the words “and others” on the second line, and attach an additional page listing the names of all of the defendants. Insert the additional page after page 1 and number it “1- A” at the bottom.
3. Jury Demand. If you want a jury trial, you must write “JURY TRIAL DEMANDED” in the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so may result in the loss of the right to a jury trial. A jury trial is not available if you are seeking only injunctive relief.
Part A. JURISDICTION: 1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. ' 1983 for state, county, or city defendants; “Bivens v. Six Unknown Federal Narcotics Agents” for federal defendants; or “other.” If you mark “other,” identify the source of that authority.
2. Location. Identify the institution and city where the alleged violation of your rights occurred.
3. Defendants. Print all of the requested information about each of the defendants in the spaces provided. If you are naming more than four defendants, you must provide the necessary information about each additional defendant on separate pages labeled “2-A,” “2-B,” etc., at the bottom. Insert the additional page(s) immediately behind page 2.
Part B. PREVIOUS LAWSUITS: You must identify any other lawsuit you have filed in either state or federal court while you were a prisoner. Print all of the requested information about each lawsuit in the spaces provided. If you have filed more than three lawsuits, you must provide the necessary information about each additional lawsuit on a separate page. Label the page(s) as “2-A,” “2-B,” etc., at the bottom of the page and insert the additional page(s) immediately behind page 2.
Part C. CAUSE OF ACTION: You must identify what rights each defendant violated. The form provides space to allege three separate counts (one violation per count). If you are alleging more than three counts, you must provide the necessary information about each additional count on a separate page. Number the additional pages “5-A,” “5-B,” etc., and insert them immediately behind page 5. Remember that you are limited to a total of fifteen additional pages.
3 1. Counts. You must identify which civil right was violated. You may allege the violation of only one civil right per count.
2. Issue Involved. Check the box that most closely identifies the issue involved in your claim. You may check only one box per count. If you check the box marked “Other,” you must identify the specific issue involved.
3. Supporting Facts. After you have identified which civil right was violated, you must state the supporting facts. Be as specific as possible. You must state what each individual defendant did to violate your rights. If there is more than one defendant, you must identify which defendant did what act. You also should state the date(s) on which the act(s) occurred, if possible.
4. Injury. State precisely how you were injured by the alleged violation of your rights.
5. Administrative Remedies. You must exhaust any available administrative remedies before you file a civil rights complaint. See 42 U.S.C. § 1997e. Consequently, you should disclose whether you have exhausted the inmate grievance procedures or administrative appeals for each count in your complaint. If the grievance procedures were not available for any of your counts, fully explain why on the lines provided.
Part D. REQUEST FOR RELIEF: Print the relief you are seeking in the space provided.
SIGNATURE: You must sign your name and print the date you signed the complaint. Failure to sign the complaint will delay the processing of your action. Unless you are an attorney, you may not bring an action on behalf of anyone but yourself.
FINAL NOTE
You should follow these instructions carefully. Failure to do so may result in your complaint being stricken or dismissed. All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number the pages.
4 ___________________________________________ Name and Prisoner/Booking Number ___________________________________________ Place of Confinement ___________________________________________ Mailing Address ___________________________________________ City, State, Zip Code (Failure to notify the Court of your change of address may result in dismissal of this action.)
IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA
_________________________________________ , (Full Name of Plaintiff) ) Plaintiff, v. CASE NO. __________________________________ (To be supplied by the Clerk) (1) _______________________________________ ,
(Full Name of Defendant) CIVIL RIGHTS COMPLAINT (2) _______________________________________ , BY A PRISONER
(3) _______________________________________ , G Original Complaint (4) _______________________________________ , G First Amended Complaint G Second Amended Complaint Defendant(s).
G Check if there are additional Defendants and attach page 1-A listing them.
A. JURISDICTION
1. This Court has jurisdiction over this action pursuant to: G 28 U.S.C. § 1343(a); 42 U.S.C. § 1983 G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971). G Other: .
2. Institution/city where violation occurred: .
550/555 B. DEFENDANTS
1. Name of first Defendant: . The first Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
2. Name of second Defendant: . The second Defendant is employed as: as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
3. Name of third Defendant: . The third Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
4. Name of fourth Defendant: . The fourth Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)
If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.
C. PREVIOUS LAWSUITS
1. Have you filed any other lawsuits while you were a prisoner? G Yes G No
2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:
a. First prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
b. Second prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
c. Third prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .
If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page. 2 D. CAUSE OF ACTION
COUNT I 1. State the constitutional or other federal civil right that was violated: .
2. Count I. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count I. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
.
5. Administrative Remedies: a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count I? G Yes G No c. Did you appeal your request for relief on Count I to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
3 COUNT II 1. State the constitutional or other federal civil right that was violated: .
2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count II. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
.
4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
.
5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count II? G Yes G No c. Did you appeal your request for relief on Count II to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
4 COUNT III 1. State the constitutional or other federal civil right that was violated: .
2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .
3. Supporting Facts. State as briefly as possible the FACTS supporting Count III. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.
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4. Injury. State how you were injured by the actions or inactions of the Defendant(s).
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5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count III? G Yes G No c. Did you appeal your request for relief on Count III to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .
If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.
5 E. REQUEST FOR RELIEF
State the relief you are seeking:
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I declare under penalty of perjury that the foregoing is true and correct.
Executed on DATE SIGNATURE OF PLAINTIFF
___________________________________________ (Name and title of paralegal, legal assistant, or other person who helped prepare this complaint)
___________________________________________ (Signature of attorney, if any)
___________________________________________ (Attorney=s address & telephone number)
ADDITIONAL PAGES
All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number all pages.