1 KM 2 WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 James H. Schofield, No. CV-25-04794-PHX-JAT (CDB) 10 Plaintiff, 11 v. ORDER 12 Katie Hobbs, et al., 13 Defendants.
15 Self-represented Plaintiff James H. Schofield, who is confined in the Arizona State 16 Prison Complex-Lewis, 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. 2). The Court will 18 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 $9.31. The remainder of 23 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, fail to state a claim upon which 6 relief may be granted, or seek monetary relief from a defendant who is immune from such 7 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 a pleading could be cured by the allegation of other facts, a 2 self-represented litigant is entitled to an opportunity to amend a complaint before dismissal 3 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). The 4 Court will dismiss Plaintiff’s Complaint for failure to state a claim, but because it may 5 possibly be amended to state a claim, the Court will dismiss it with leave to amend. 6 III. Complaint 7 Plaintiff names the following Defendants in his two-count Complaint: Arizona 8 Governor Katie Hobbs and former Arizona Governors Doug Ducey and Jan Brewer; 9 Arizona Department of Corrections, Rehabilitation & Reentry (ADCRR) Director Ryan 10 Thornell and former ADCRR Directors David Shinn and Charles Ryan; ADCRR Assistant 11 Director John A. Doe and former ADCRR Assistant Director Larry Gann; Warden Walker; 12 Deputy Warden Town; Grievance Coordinator Vargas; and former ADCRR Medical 13 Services Assistant Director John B. Doe. Plaintiff seeks monetary damages. 14 In Count One, Plaintiff alleges violations of his Eighth Amendment right to 15 adequate medical care. In 2010, Plaintiff sustained injuries to his back after falling from 16 an upper bunk. Plaintiff received pain medication. After x-rays returned negative results, 17 he was prescribed ibuprofen, but no further treatment. The ibuprofen “had no effect on 18 [Plaintiff’s] pain, resulting in Plaintiff’s start of self-mediation, which led to drug 19 addiction.” (Doc. 1 at 6.) 20 In August 2018, Plaintiff began experiencing painful spasms in his lower back and 21 lower extremities. Plaintiff submitted a Health Needs Request (HNR) stating he was 22 experiencing extreme pain and could barely walk. A medical provider referred him to a 23 neurologist and ordered Magnetic Resonance Imaging (MRI). On September 12, 2018, 24 Plaintiff submitted an HNR stating his back was “seriously damaged,” he could not walk, 25 lift a cup of water, or turn without “making [him] fall to his knees,” and needed help. (Id.) 26 He again received x-rays “and their negative results were incorporated in the denial of 27 follow-up medical attention.” (Id.) Throughout 2018 and 2019, Plaintiff sought medical 28 care for his lower back injuries and resulting pain. 1 On January 22, 2020, Plaintiff received an MRI of his lumbar spine. Throughout 2 2020 and 2021, he “continued to give notice of his pain and suffering and the referral to be 3 seen by a neurologist went unexecuted.” (Id. at 7.) In July 2021, Plaintiff began to vomit 4 and defecate blood. Plaintiff was later told ibuprofen had “caused the creation of abrasions 5 in [his] stomach and lower intestine” and this “began a period of various alternate pain 6 treatments, without [him] being seen by a neurologist.” (Id.) Throughout 2021, 2022, and 7 2023, Plaintiff submitted HNRs regarding pain relief and his deteriorating physical health; 8 he claims these were ignored and he did not see a neurologist. 9 On March 20, 2024, and in autumn 2024, Plaintiff had a second and third MRI. (Id.) 10 He did not see a neurologist. In May 2025, he began suffering seizures; the cause of the 11 seizures remains “undetermined.” (Id. at 8.) On October 4, 2025, Plaintiff submitted an 12 HNR regarding “all his serious medical needs surrounding the injury he suffered in 2010” 13 and requested to be referred to a neurologist. (Id.) On November 9, 2025, he was seen by 14 a medical provider. On November 19, 2025, Plaintiff had a fourth MRI. Plaintiff is still 15 awaiting a consultation with a neurologist and states he is unable to walk without the 16 support of a cane. (Id.) 17 In Count Two, Plaintiff asserts a Fourteenth Amendment due process claim 18 regarding Defendants’ alleged failure to comply with the Court’s “permanent injunction, 19 which in pertinent part, was specifically crafted to once and for all satisfy Plaintiff’s serious 20 medical needs under the Court’s continuous quality improvement . . . procedures.” (Id. 21 at 20.) Plaintiff further alleges that on October 13 and November 10, 2025, he submitted 22 grievances that were returned unread and unanswered. On November 17, 2025, he filed a 23 grievance appeal that was not returned. (Id.) He claims his efforts to attain “relief for his 24 serious medical needs have been stymied at the medical level as well as the administrative 25 level, as the result of deliberate indifference.” (Id. at 21.) 26 Plaintiff argues Defendant Hobbs is liable because she appointed Defendant 27 Thornell and had notice of healthcare problems “through the Court’s permanent 28 injunction.” (Id. at 27.) He claims Defendant Hobbs is “neither protected by absolute nor 1 qualified immunity within the context of a 42 U.S.C. [§] 1983 prisoner complaint.” (Id. 2 at 28.) 3 IV. Failure to State a Claim 4 A. Defendants John A. Doe, Walker, Town, Vargas, Ducey, Gann, Brewer, Ryan, and John B. Doe 5 6 To state a valid claim under § 1983, plaintiffs must allege they suffered a specific 7 injury as a result of specific conduct of a defendant and show an affirmative link between 8 the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 371-72, 9 377 (1976). 10 Plaintiff alleges no facts regarding Defendants John A. Doe, Walker, Town, Vargas, 11 Ducey, Gann, Brewer, Ryan, or John B. Doe and therefore fails to state a claim against 12 these Defendants. 13 B. Defendants Hobbs and Thornell 14 It is unclear whether Plaintiff intends to sue Defendants Hobbs and Thornell in their 15 individual or official capacities. A suit against a defendant in his or her individual capacity 16 seeks to impose personal liability upon the official. Kentucky v. Graham, 473 U.S. 159, 17 165-66 (1985). For a person to be liable in his or her individual capacity, “[a] plaintiff 18 must allege facts, not simply conclusions, that show that an individual was personally 19 involved in the deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 20 (9th Cir. 1998). By comparison, a suit against a defendant in his or her official capacity 21 represents only another way of pleading an action against the entity that employs the 22 defendant. Kentucky v. Graham, 473 U.S. at 165. That is, the real party in interest is not 23 the named defendant, but the entity that employs the defendant. Id. To bring a claim 24 against an individual in his official capacity, a plaintiff must show that the constitutional 25 deprivation resulted from the entity’s policy, custom, or practice. Id.; Monell v. Dep’t of 26 Soc. Servs., 436 U.S. 658, 694 (1978). 27 Plaintiff’s allegations fail to plausibly show Defendants Hobbs or Thornell were 28 personally involved in the deprivation of his civil rights, but rather stem solely from their 1 roles as the heads of the entities they oversee. Accordingly, the Court will construe 2 Plaintiff’s claims as directed against these Defendants in their official capacities only and 3 evaluate them accordingly. 4 To state an Eighth Amendment claim based on a policy, practice or custom, Plaintiff 5 must allege that (1) his Eighth Amendment rights were violated by an employee or 6 employees of a Defendant; (2) the Defendant has customs or policies that amount to 7 deliberate indifference; and (3) the policies or customs were the moving force behind the 8 violation of Plaintiff’s constitutional rights in the sense that the Defendant could have 9 prevented the violation with an appropriate policy. See Gibson v. County of Washoe, 290 10 F.3d 1175, 1193-94 (9th Cir. 2002), overruled on other grounds by Castro v. County of 11 Los Angeles, 833 F.3d 1060 (9th Cir. 2016). 12 Although Plaintiff alleges generally that Defendants Hobbs and Thornell were 13 aware of problems in ADCRR’s provision of medical care because of the permanent 14 injunction in Jensen v. Thornell, CV-12-00601-PHX-ROS (D. Ariz.), Plaintiff has not 15 alleged Defendants Hobbs or Thornell promulgated specific policies, practices, or customs 16 that resulted in the denial of his medical treatment and violation of his Eighth Amendment 17 rights. Plaintiff has therefore failed to state a claim against Defendants Hobbs and 18 Thornell. 19 Finally, to the extent Plaintiff alleges the conduct discussed in the Complaint 20 violates the Jensen injunction itself, he has failed to state a claim. Standing alone, remedial 21 orders, such as those entered in Jensen, cannot serve as a substantive basis for a § 1983 22 claim for damages because such orders do not create “rights, privileges, or immunities 23 secured by the Constitution and laws.” Green v. McKaskle, 788 F.2d 1116, 1123-24 (5th 24 Cir. 1986). Moreover, Plaintiff may not enforce the decrees entered in Jensen in a separate 25 civil rights action. See Cagle v. Sutherland, 334 F.3d 980, 986 (11th Cir. 2003). 26 V. Leave to Amend 27 For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 28 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 1 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 2 mail Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff 3 fails to use the court-approved form, the Court may strike the amended complaint and 4 dismiss this action without further notice to Plaintiff. 5 Plaintiff must clearly designate on the face of the document that it is the “First 6 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 7 entirety on the court-approved form and may not incorporate any part of the original 8 Complaint by reference. Plaintiff may include only one claim per count. 9 A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 10 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 11 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 12 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action raised in the original 13 Complaint and voluntarily dismissed or dismissed without prejudice is waived if it is not 14 alleged in a first amended complaint. Lacey v. Maricopa County, 693 F.3d 896, 928 (9th 15 Cir. 2012) (en banc). 16 If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 17 telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 18 of the Defendant who violated the right; (3) exactly what that Defendant did or failed to 19 do; (4) how the action or inaction of that Defendant is connected to the violation of 20 Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of 21 that Defendant’s conduct. See Rizzo, 423 U.S. at 371-72, 377. 22 Plaintiff must repeat this process for each person he names as a Defendant. If 23 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 24 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 25 failure to state a claim. Conclusory allegations that a Defendant or group of 26 Defendants has violated a constitutional right are not acceptable and will be 27 dismissed. 28 . . . . 1 Plaintiff should note that if he seeks monetary damages, he may only do so against 2 Defendants named in their individual capacities. To state a § 1983 medical claim against 3 a defendant in his or her individual capacity, a plaintiff must show (1) a “serious medical 4 need” by demonstrating that failure to treat the condition could result in further significant 5 injury or the unnecessary and wanton infliction of pain and (2) the defendant’s response 6 was deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). 7 “Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 8 1051, 1060 (9th Cir. 2004). To act with deliberate indifference, a prison official must both 9 know of and disregard an excessive risk to inmate health; “the official must both be aware 10 of facts from which the inference could be drawn that a substantial risk of serious harm 11 exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 12 Deliberate indifference in the medical context may be shown by a purposeful act or failure 13 to respond to a prisoner’s pain or possible medical need and harm caused by the 14 indifference. Jett, 439 F.3d at 1096. Deliberate indifference may also be shown when a 15 prison official intentionally denies, delays, or interferes with medical treatment or by the 16 way prison doctors respond to the prisoner’s medical needs. Estelle v. Gamble, 429 U.S. 17 97, 104-05 (1976); Jett, 439 F.3d at 1096. 18 Deliberate indifference is a higher standard than negligence or lack of ordinary due 19 care for the prisoner’s safety. Farmer, 511 U.S. at 835. “Neither negligence nor gross 20 negligence will constitute deliberate indifference.” Clement v. Cal. Dep’t of Corr., 220 F. 21 Supp. 2d 1098, 1105 (N.D. Cal. 2002); see also Broughton v. Cutter Labs., 622 F.2d 458, 22 460 (9th Cir. 1980) (mere claims of “indifference,” “negligence,” or “medical malpractice” 23 do not support a claim under § 1983). “A difference of opinion does not amount to 24 deliberate indifference to [a plaintiff’s] serious medical needs.” Sanchez v. Vild, 891 F.2d 25 240, 242 (9th Cir. 1989). A mere delay in medical care, without more, is insufficient to 26 state a claim against prison officials for deliberate indifference. See Shapley v. Nev. Bd. of 27 State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985). The indifference must be 28 1 substantial. The action must rise to a level of “unnecessary and wanton infliction of pain.” 2 Estelle, 429 U.S. at 105. 3 VI. Warnings 4 A. Release 5 If Plaintiff is released while this case remains pending, and the filing fee has not 6 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 7 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 8 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 9 result in dismissal of this action. 10 B. Address Changes 11 Plaintiff must file and serve a notice of a change of address in accordance with Rule 12 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 13 relief with a notice of change of address. Failure to comply may result in dismissal of this 14 action. 15 C. Possible “Strike” 16 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 17 fails to file an amended complaint correcting the deficiencies identified in this Order, the 18 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 19 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 20 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 21 occasions, while incarcerated or detained in any facility, brought an action or appeal in a 22 court of the United States that was dismissed on the grounds that it is frivolous, malicious, 23 or fails to state a claim upon which relief may be granted, unless the prisoner is under 24 imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 25 D. Possible Dismissal 26 If Plaintiff fails to timely comply with every provision of this Order, including these 27 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 28 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 2| the Court). 3| ITIS ORDERED: 4 (1) Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) is granted. 5 (2) As required by the accompanying Order to the appropriate government 6| agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 7| of $9.31. 8 (3) |The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff has 30 days from the date this Order is filed to file a first amended complaint in compliance 10 | with this Order. 11 (4) ‘If Plaintiff fails to file an amended complaint within 30 days, the Clerk of Court must, without further notice, enter a judgment of dismissal of this action with 13 | 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. 15 (5) The Clerk of Court must mail Plaintiffa court-approved form for filing a civil 16| rights complaint by a prisoner. 17 Dated this 2nd day of June, 2026. 18
20 James A. Teilborg 21 Senior United States District Judge 22 23 24 25 26 27 28
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 $405.00 ($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 $405 filing and administrative fees or the application to proceed in forma pauperis to:
1 Revised 11/6/24 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.