1 MDR 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Gerald Vaughn Gwen, No. CV-24-08023-PCT-JAT (JFM) 10 Plaintiff, 11 v. ORDER 12 Leon Cattolico, et al., 13 Defendants.
15 Self-represented Plaintiff Gerald Vaughn Gwen, who is confined in CoreCivic’s 16 Red Rock Correctional Center, has filed a civil rights Complaint pursuant to 42 U.S.C. 17 § 1983 (Doc. 1) and an Application to Proceed In Forma Pauperis (Doc. 5). The Court will 18 grant the Application to Proceed and will dismiss the Complaint with leave to amend. 19 I. Application to Proceed In Forma Pauperis and Filing Fee 20 The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 28 21 U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. 22 § 1915(b)(1). The Court will assess an initial partial filing fee of $27.88. The remainder 23 of the fee will be collected monthly in payments of 20% of the previous month’s income 24 credited to Plaintiff’s trust account each time the amount in the account exceeds $10.00. 25 28 U.S.C. § 1915(b)(2). The Court will enter a separate Order requiring the appropriate 26 government agency to collect and forward the fees according to the statutory formula. 27 . . . . 28 . . . . 1 II. Statutory Screening of Prisoner Complaints 2 The Court is required to screen complaints brought by prisoners seeking relief 3 against a governmental entity or an officer or an employee of a governmental entity. 28 4 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 5 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 6 relief may be granted, or that seek monetary relief from a defendant who is immune from 7 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 8 A pleading must contain a “short and plain statement of the claim showing that the 9 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 10 not demand detailed factual allegations, “it demands more than an unadorned, the- 11 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 12 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 13 conclusory statements, do not suffice.” Id. 14 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 15 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 16 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 17 that allows the court to draw the reasonable inference that the defendant is liable for the 18 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 19 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 20 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 21 allegations may be consistent with a constitutional claim, a court must assess whether there 22 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 23 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 24 must “continue to construe [self-represented litigant’s] filings liberally.” Hebbe v. Pliler, 25 627 F.3d 338, 342 (9th Cir. 2010). A “complaint [filed by a self-represented prisoner] 26 ‘must be held to less stringent standards than formal pleadings drafted by lawyers.’” Id. 27 (quoting Erickson v. Pardus, 551 U.S. 89, 94 (2007) (per curiam)). 28 . . . . 1 If the Court determines that a pleading could be cured by the allegation of other 2 facts, a self-represented litigant is entitled to an opportunity to amend a complaint before 3 dismissal of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en 4 banc). The Court will dismiss Plaintiff’s Complaint for failure to state a claim, but because 5 it may possibly be amended to state a claim, the Court will dismiss it with leave to amend. 6 III. Complaint 7 In his one-count Complaint, Plaintiff names as Defendants Dr. Leon Cattolico and 8 Health Services Administrator Becky Payne. Plaintiff raises a claim under the Eighth and 9 Fourteenth Amendments regarding his medical care and seeks declaratory relief and 10 monetary damages. 11 Plaintiff alleges that on November 12, 2020, while confined in the Yavapai County 12 Detention Center, he submitted a health needs request informing medical providers he was 13 experiencing “flu symptoms.” He contends Defendant Cattolico assigned a nurse to 14 “evaluate [Plaintiff’s] virus symptoms” and designated “the incident” as “high priority” 15 and “an infectious disease.” 16 Plaintiff asserts he complained to a nurse on November 13, 2020, that he was 17 concerned he was not receiving “timely or adequate medical care to address his serious flu 18 symptoms.” According to Plaintiff, medical records indicate Defendant Cattolico “was 19 informed.” 20 Plaintiff claims he complained to a nurse on November 16, 2020, that he was “not 21 rec[ei]ving adequate medical care regarding his flu symptoms.” He alleges he informed 22 nurses on November 18 that he was concerned he was not receiving adequate medical care, 23 had not been seen by a doctor, was feeling worse, was nauseated, and was unable to eat. 24 Plaintiff alleges he complained to a detention officer on November 19 that he had not been 25 seen by a doctor, was nauseated, and had been unable to eat. He contends “records 26 indicate” Defendant Cattolico was informed the same day. 27 Plaintiff asserts that on November 19, 2020, Defendant Cattolico authorized the 28 lockdown of the unit where Plaintiff was housed. He claims he was not tested to determine 1 if he was infected with the coronavirus, despite Defendants’ knowledge that at least seven 2 inmates had tested positive in November and despite Defendant Cattolico authorizing 3 emergency medical treatment for an inmate in the same unit as Plaintiff. 4 Plaintiff alleges he complained to a nurse on November 20, 2020, that he was being 5 given medications unrelated to his flu symptoms and “not known to treat [the] 6 coronavirus,” his grievances about treatment choices had gone unanswered, and he had to 7 force himself to eat. He claims this information was presented to Defendant Payne. 8 Plaintiff also asserts that on November 20, a nurse informed Defendant Payne of Plaintiff’s 9 flu symptoms. 10 Plaintiff contends he did not see Defendant Cattolico until November 20, 2020. He 11 alleges Defendant Cattolico reviewed his “various medical symptoms requiring medical 12 treatment,” including flu symptoms, nausea, headaches, shortness of breath, dry mouth, 13 appetite loss, an inability to eat, weight loss, neck pain, shoulder pain, and numbness in his 14 arms and legs. 15 Plaintiff also claims he received a December 4, 2020 x-ray for his neck injury. He 16 asserts that on December 7, Defendant Cattolico received and reviewed the radiologist’s 17 report “detailing an injury to Plaintiff[’s] cervical spine” but did not discuss the report with 18 Plaintiff. Plaintiff claims a nurse “informed [him] of the existence of [the] report” on 19 December 7. 20 In addition, Plaintiff alleges he filed a November 4, 2020 grievance regarding 21 “various issues,” including “Defendant[s’] deliberate indifference to his serious medical 22 needs.” He claims that although the grievance was assigned to Defendant Payne the same 23 day, she did not respond it and “releas[ed] the grievance without a response some 11 24 months later.” Plaintiff asserts he filed a November 25, 2020 grievance regarding 25 Defendants’ negligence and deliberate indifference and the lack of a response to his prior 26 grievances, this grievance was also assigned to Defendant Payne, but he never received a 27 response to it. Plaintiff also contends he filed a January 22, 2021 grievance concerning his 28 cervical spine injury and informing Defendants that his condition was worsening, he was 1 experiencing spasms, and his pain was so great that he was unable to put on t-shirt without 2 severe pain. He asserts the grievance was assigned to Defendant Payne four days later, but 3 it was “released without a medical response” in December 2021. 4 Plaintiff claims he was never tested at the Yavapai County Detention Center to 5 determine if he “was positive for COVID-19 virus.” He asserts that when he transferred 6 to the custody of the Arizona Department of Corrections in March 2021, he tested positive 7 for the antibody indicating a prior COVID-19 infection. Plaintiff also contends that while 8 in the custody of the Arizona Department of Corrections, he was “twice diagnosed with 9 cervical spine converity [sic] the right or mild torticollis of the cervical spine.” 10 Plaintiff alleges he was never adequately provided medical treatment for his flu 11 symptoms or cervical spine injury while at the Yavapai County Detention Center. He 12 contends Defendants had “actual knowledge of the excessive dangers of harm attributed to 13 [the] coronavirus, including the possibility of death.” Plaintiff asserts Defendants were 14 “deliberately indifferent to his serious medical needs,” exposed him to an “unreasonable 15 and excessive risk of harm,” had “actual knowledge of a subjectively serious injury and 16 illness requiring immediate medical treatment,” and “intentionally disregarded the risk.” 17 As his injury, Plaintiff contends he was “exposed and contracted” COVID-19, was 18 “never tested or treated,” and was subjected to an “unreasonable and excessive risk of harm 19 to his immediate and long-term health.” 20 IV. Failure to State a Claim 21 Although self-represented pleadings are liberally construed, Haines v. Kerner, 404 22 U.S. 519, 520-21 (1972), conclusory and vague allegations will not support a cause of 23 action. Ivey v. Bd. of Regents, 673 F.2d 266, 268 (9th Cir. 1982). Further, a liberal 24 interpretation of a civil rights complaint may not supply essential elements of the claim 25 that were not initially pled. Id. 26 To state a valid claim under § 1983, plaintiffs must allege that they suffered a 27 specific injury as a result of specific conduct of a defendant and show an affirmative link 28 between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 1 371-72, 377 (1976). There is no respondeat superior liability under § 1983, and therefore, 2 a defendant’s position as the supervisor of persons who allegedly violated Plaintiff’s 3 constitutional rights does not impose liability. Monell v. Dep’t of Soc. Servs., 436 U.S. 658 4 (1978); Hamilton v. Endell, 981 F.2d 1062, 1067 (9th Cir. 1992); Taylor v. List, 880 F.2d 5 1040, 1045 (9th Cir. 1989). “Because vicarious liability is inapplicable to . . . § 1983 suits, 6 a plaintiff must plead that each Government-official defendant, through the official’s own 7 individual actions, has violated the Constitution.” Iqbal, 556 U.S. at 676. “A plaintiff must 8 allege facts, not simply conclusions, that show that an individual was personally involved 9 in the deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir. 10 1998). 11 The Ninth Circuit Court of Appeals has held that “claims for violations of the right 12 to adequate medical care ‘brought by pretrial detainees against individual defendants under 13 the Fourteenth Amendment’ must be evaluated under an objective deliberate indifference 14 standard.” Gordon v. County of Orange, 888 F.3d 1118, 1124-25 (9th Cir. 2018) (quoting 15 Castro v. County of Los Angeles, 833 F.3d 1060, 1070 (9th Cir. 2016)). To state a medical 16 care claim, a pretrial detainee must show 17 (i) the defendant made an intentional decision with respect to the conditions under which the plaintiff was confined; (ii) those 18 conditions put the plaintiff at substantial risk of suffering 19 serious harm; (iii) the defendant did not take reasonable available measures to abate that risk, even though a reasonable 20 official in the circumstances would have appreciated the high degree of risk involved—making the consequences of the 21 defendant’s conduct obvious; and (iv) by not taking such 22 measures, the defendant caused the plaintiff’s injuries. 23 Id. at 1125. “With respect to the third element, the defendant’s conduct must be objectively 24 unreasonable, a test that will necessarily ‘turn[] on the facts and circumstances of each 25 particular case.’” Castro, 833 F.3d at 1071 (quoting Kingsley v. Hendrickson, 576 U.S. 26 389, 397 (2015); Graham v. Connor, 490 U.S. 386, 396 (1989)). 27 The “‘mere lack of due care by a state official’ does not deprive an individual of 28 life, liberty, or property under the Fourteenth Amendment.” Castro, 833 F.3d at 1071 1 (quoting Daniels v. Williams, 474 U.S. 327, 330-31 (1986)). A plaintiff must “prove more 2 than negligence but less than subjective intent—something akin to reckless disregard.” Id. 3 A mere delay in medical care, without more, is insufficient to state a claim against prison 4 officials for deliberate indifference. See Shapley v. Nev. Bd. of State Prison Comm’rs, 766 5 F.2d 404, 407 (9th Cir. 1985). 6 Plaintiff’s allegations do not support a conclusion that either Defendant’s conduct 7 was objectively unreasonable. At most, it appears Defendant Payne failed to respond to 8 Plaintiff’s grievances and Defendant Cattolico took eight days to see Plaintiff regarding his 9 “flu symptoms” and failed to discuss x-rays results with Plaintiff. It is not clear how their 10 conduct caused any injury Plaintiff may have suffered. Absent more, Plaintiff’s vague, 11 conclusory, and disjointed allegations are insufficient to state a claim. 12 V. Leave to Amend 13 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 14 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 15 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 16 mail Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff 17 fails to use the court-approved form, the Court may strike the amended complaint and 18 dismiss this action without further notice to Plaintiff. 19 Plaintiff must clearly designate on the face of the document that it is the “First 20 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 21 entirety on the court-approved form and may not incorporate any part of the original 22 Complaint by reference. Plaintiff may include only one claim per count. 23 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 24 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 25 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 26 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 27 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 28 1 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 2 F.3d 896, 928 (9th Cir. 2012) (en banc). 3 If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 4 telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 5 of the Defendant who violated the right; (3) exactly what that Defendant did or failed to 6 do; (4) how the action or inaction of that Defendant is connected to the violation of 7 Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of 8 that Defendant’s conduct. See Rizzo, 423 U.S. at 371-72, 377. 9 Plaintiff must repeat this process for each person he names as a Defendant. If 10 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 11 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 12 failure to state a claim. Conclusory allegations that a Defendant or group of 13 Defendants has violated a constitutional right are not acceptable and will be 14 dismissed. 15 VI. Warnings 16 A. Release 17 If Plaintiff is released while this case remains pending, and the filing fee has not 18 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 19 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 20 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 21 result in dismissal of this action. 22 B. Address Changes 23 Plaintiff must file and serve a notice of a change of address in accordance with Rule 24 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 25 relief with a notice of change of address. Failure to comply may result in dismissal of this 26 action. 27 . . . . 28 . . . . 1 C. Possible “Strike” 2 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 3 fails to file an amended complaint correcting the deficiencies identified in this Order, the 4 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 5 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 6 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 7 occasions, while incarcerated or detained in any facility, brought an action or appeal in a 8 court of the United States that was dismissed on the grounds that it is frivolous, malicious, 9 or fails to state a claim upon which relief may be granted, unless the prisoner is under 10 imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 11 D. Possible Dismissal 12 If Plaintiff fails to timely comply with every provision of this Order, including these 13 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 14 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 15 the Court). 16 IT IS ORDERED: 17 (1) Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 5) is granted. 18 (2) As required by the accompanying Order to the appropriate government 19 agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 20 of $27.88. 21 (3) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 22 has 30 days from the date this Order is filed to file a first amended complaint in compliance 23 with this Order. 24 (4) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 25 Court must, without further notice, enter a judgment of dismissal of this action with 26 prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 27 and deny any pending unrelated motions as moot. 28 . . . . 1 (5) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 3 Dated this 17th day of May, 2024. 4 ' ° 7 = James A. C rg Senior United States District Judge 8 9 10 11 12 13 14 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 $455.00 ($350.00 filing fee plus $55.00 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. Unless you are an inmate housed at an Arizona Department of Corrections facility that participates in electronic filing, mail the original and one copy of the complaint with the $455 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 12/1/23 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. 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.
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 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:
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.