1 WO KM 2 3 4 5 8 9 Victor Zhaquis Jones, No. CV 21-00667-PHX-JAT (JZB) 10 Plaintiff, 11 v. ORDER 12 Unknown Henry, et al., 13 Defendants.
14 15 On April 16, 2021, Plaintiff Victor Zhaquis Jones, who is confined in the Arizona 16 State Prison Complex-Eyman, filed a pro se civil rights Complaint pursuant to 42 U.S.C. 17 § 1983 (Doc. 1). In an April 23, 2021 Order, the Court directed Plaintiff to pay the filing 18 fee or file an Application to Proceed In Forma Pauperis. On May 6, 2021, Plaintiff paid 19 the filing and administrative fees. The Court will dismiss the Complaint with leave to 20 amend. 21 I. Statutory Screening of Prisoner Complaints 22 The Court is required to screen complaints brought by prisoners seeking relief 23 against a governmental entity or an officer or an employee of a governmental entity. 28 24 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 25 has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 26 relief may be granted, or that seek monetary relief from a defendant who is immune from 27 such relief. 28 U.S.C. § 1915A(b)(1)–(2). 28 A pleading must contain a “short and plain statement of the claim showing that the 1 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 2 not demand detailed factual allegations, “it demands more than an unadorned, the- 3 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 4 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 5 conclusory statements, do not suffice.” Id. 6 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 7 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 8 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 9 that allows the court to draw the reasonable inference that the defendant is liable for the 10 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 11 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 12 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 13 allegations may be consistent with a constitutional claim, a court must assess whether there 14 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 15 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 16 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 17 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 18 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 19 U.S. 89, 94 (2007) (per curiam)). 20 If the Court determines that a pleading could be cured by the allegation of other 21 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 22 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 23 Plaintiff’s Complaint will be dismissed for failure to state a claim, but because it may 24 possibly be amended to state a claim, the Court will dismiss it with leave to amend. 25 II. Complaint 26 Plaintiff names Deputy Warden Henry, Warden Walter Hensley, Centurion of 27 Arizona, LLC, and the Arizona Department of Corrections’ Tactical Security Unity (TSU) 28 as Defendants in his four-count Complaint. Plaintiff seeks money damages. 1 Plaintiff alleges that on November 25, 2020, between 5:30 and 9:30 p.m., an inmate 2 disturbance was in progress. Plaintiff heard an order over the loudspeaker for all inmates 3 to return to their buildings to lockdown. Plaintiff returned to his run and cubicle and 4 climbed onto his bunk. Plaintiff heard shock grenades exploding and began to smell tear 5 gas. Plaintiff claims “suddenly 10 TSU Officers all armed [with] body armor stormed his 6 run and ordered Plaintiff and other inmates off their bunks and to line up and to shut-up 7 and to keep [their] eyes pointed towards the ground.” Plaintiff was then taken to the 8 showers, stripped and told to put his arms behind his back, and his wrists were bound with 9 a plastic tie. When Plaintiff told a TSU Officer that the plastic tie was too tight and cutting 10 off his blood circulation, he was told to “shut-up.” Plaintiff “asked for a Supervisor and 11 that’s when Plaintiff was slammed face down in the dirt and he yelled stop it and he was 12 lifted up a second time and he was slammed down on his back and shoulder area, causing 13 Plaintiff extreme pain.” Plaintiff was then taken to the medical unit where a nurse “said 14 Plaintiff would be ok and Plaintiff after [illegible] was again push[ed] up against a stone 15 wall, hurting Plaintiff’s neck [and] shoulder.” 16 In Count One, Plaintiff alleges Defendant Henry violated his Eighth Amendment 17 rights “by ordering the TSU to use excessive force to put down a riot causing Plaintiff 18 permanent injury.” 19 In Count Two, Plaintiff claims Defendant Henry violated his Eighth Amendment 20 rights when he ordered the TSU unit to use excessive force, including flash grenades and 21 tear gas. Plaintiff claims he did not receive any treatment at the medical unit for his serious 22 injuries. Plaintiff alleges he “requested medical attention from Defendant Henry and . . 23 Plaintiff was scheduled to see [a] medical nurse for his injuries.” Plaintiff asked “why 24 excessive force [was used] and he was told that Defendant ordered whatever it took to bring 25 peace on Cook Unit.” Plaintiff alleges he “told Defendant that he was not involved in the 26 disturbance and Plaintiff was told that Defendant didn’t believe him, Plaintiff was never 27 charged in this matter.” 28 In Count Three, Plaintiff alleges Defendant Centurion violated his Eighth 1 Amendment rights by failing to provide adequate medical care. Plaintiff claims he suffered 2 injuries to his shoulder and neck when officers twice slammed him to the ground. At the 3 medical unit, a nurse examined his injuries and determined Plaintiff “could wait till 4 November 26, 2020” for treatment. Plaintiff claims he was not given anything for his 5 injuries or pain and was not examined until days later, when his “neck, back, shoulders and 6 arms [were] swollen [to] 3 times [their] size.” Plaintiff claims Centurion medical staff told 7 him “to just endure, because his swelling and injuries would go away, but it’s gotten 8 [worse] and . . . Plaintiff cannot sleep or sit without extreme pain.” 9 In Count Four, Plaintiff alleges the TSU Officers violated his Eighth Amendment 10 rights by using excessive force in response to the riot. 11 III. Failure to State a Claim 12 A. Defendant Hensley 13 To state a valid claim under § 1983, plaintiffs must allege that they suffered a 14 specific injury as a result of specific conduct of a defendant and show an affirmative link 15 between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 16 371-72, 377 (1976). There is no respondeat superior liability under § 1983, and therefore, 17 a defendant’s position as the supervisor of persons who allegedly violated Plaintiff’s 18 constitutional rights does not impose liability. Monell v. Dep’t of Soc. Servs., 436 U.S. 658 19 (1978); Hamilton v. Endell, 981 F.2d 1062, 1067 (9th Cir. 1992); Taylor v. List, 880 F.2d 20 1040, 1045 (9th Cir. 1989). “Because vicarious liability is inapplicable to Bivens and 21 § 1983 suits, a plaintiff must plead that each Government-official defendant, through the 22 official’s own individual actions, has violated the Constitution.” Iqbal, 556 U.S. at 676. 23 Plaintiff has not alleged that Defendant Hensley personally participated in a 24 deprivation of Plaintiff’s constitutional rights, was aware of a deprivation and failed to act, 25 or formed policies that resulted in Plaintiff’s injuries. Plaintiff has therefore failed to state 26 a claim against Defendant Hensley. 27 . . . . 28 . . . . 1 B. Defendant Henry 2 1. Excessive Force 3 When an inmate claims that prison officials violated his Eighth Amendment rights 4 by using excessive physical force, the relevant inquiry is “whether force was applied in a 5 good-faith effort to maintain or restore discipline, or maliciously and sadistically to cause 6 harm.” Hudson v. McMillian, 503 U.S. 1, 7 (1992). However, the Supreme Court has 7 made it clear that not every use of physical force violates the Eighth Amendment: 8 That is not to say that every malevolent touch by a prison guard gives rise to a federal cause of action. See Johnson v. Glick, 481 F.2d [1028, 1033 (2nd 9 Cir. 1973)] (“Not every push or shove, even if it may later seem unnecessary 10 in the peace of a judge’s chambers, violates a prisoner’s constitutional rights”). 11 12 Id. at 9. 13 Plaintiff alleges Defendant Henry violated his Eighth Amendment rights by 14 ordering “whatever it took to bring peace on Cook unit,” and ordered the TSU Officers to 15 use excessive force. Plaintiff does not allege that he heard Henry give such an order or 16 otherwise explain how he know the order was issued by Defendant Henry. Moreover, 17 Plaintiff does not allege Defendant Henry directed the use of force for the purpose of 18 maliciously and sadistically causing harm, or that any of the officers acting pursuant to 19 Defendant Henry’s orders used force for the purpose of maliciously causing harm, rather 20 than maintaining or restoring discipline. Plaintiff has therefore failed to state an Eighth 21 Amendment excessive force claim against Defendant Henry. 22 2. Medical Treatment 23 To state a § 1983 medical claim, a plaintiff must show (1) a “serious medical need” 24 by demonstrating that failure to treat the condition could result in further significant injury 25 or the unnecessary and wanton infliction of pain and (2) the defendant’s response was 26 deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). 27 “Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 28 1051, 1060 (9th Cir. 2004). To act with deliberate indifference, a prison official must both 1 know of and disregard an excessive risk to inmate health; “the official must both be aware 2 of facts from which the inference could be drawn that a substantial risk of serious harm 3 exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 4 Deliberate indifference in the medical context may be shown by a purposeful act or failure 5 to respond to a prisoner’s pain or possible medical need and harm caused by the 6 indifference. Jett, 439 F.3d at 1096. Deliberate indifference may also be shown when a 7 prison official intentionally denies, delays, or interferes with medical treatment or by the 8 way prison doctors respond to the prisoner’s medical needs. Estelle v. Gamble, 429 U.S. 9 97, 104-05 (1976); Jett, 439 F.3d at 1096. 10 To the extent Plaintiff claims that he “requested medical attention from Defendant 11 Henry,” his allegations are too vague to state a claim. It is unclear when Plaintiff requested 12 medical attention from Defendant Henry, whether or how Defendant Henry was aware of 13 Plaintiff’s injuries, and what response, if any, Defendant Henry provided. Plaintiff has 14 therefore failed to state an Eighth Amendment medical claim against Defendant Henry. 15 C. Centurion 16 To state a claim under § 1983 against a private entity performing a traditional public 17 function, such as providing medical care to prisoners, a plaintiff must allege facts to support 18 that his constitutional rights were violated as a result of a policy, decision, or custom 19 promulgated or endorsed by the private entity. See Tsao v. Desert Palace, Inc., 698 F.3d 20 1128, 1138-39 (9th Cir. 2012); Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 1997) (per 21 curiam). A plaintiff must allege the specific policy or custom and how it violated his 22 constitutional rights. A private entity is not liable merely because it employs persons who 23 allegedly violated a plaintiff’s constitutional rights. See Tsao, 698 F.3d at 1139; Buckner, 24 116 F.3d at 452. 25 Plaintiff does not allege that any of the conduct described in the Complaint was the 26 result of a specific policy or custom of Defendant Centurion. Plaintiff has therefore failed 27 to state a claim against Defendant Centurion. 28 . . . . 1 D. Defendants TSU Officers 2 Plaintiff sues ten TSU Officers, without separately identifying each and alleging 3 facts to support each used excessive force.1 Plaintiff has simply made vague and 4 conclusory allegations against a group of Defendants, without any factual specificity as to 5 what any particular Defendant did or failed to do. This is insufficient. See Marcilis v. Twp. 6 of Redford, 693 F.3d 589, 596 (6th Cir. 2012) (upholding dismissal of Bivens complaint 7 that referred to all defendants “generally and categorically” because the plaintiff had failed 8 to “‘allege, with particularity, facts that demonstrate what each defendant did to violate the 9 asserted constitutional right.’” (quoting Lanman v. Hinson, 529 F.3d 673, 684 (6th Cir. 10 2008))); Robbins v. Oklahoma, 519 F.3d 1242, 1250 (10th Cir. 2008) (“Given the 11 complaint’s use of either the collective term ‘Defendants’ or a list of the defendants named 12 individually but with no distinction as to what acts are attributable to whom, it is impossible 13 for any of these individuals to ascertain what particular unconstitutional acts they are 14 alleged to have committed.”). Accordingly, Plaintiff has failed to state a claim against 15 Defendant TSU Officers. 16 IV. Leave to Amend 17 For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to state 18 a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a first 19 amended complaint to cure the deficiencies outlined above. The Clerk of Court will mail 20 Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff fails 21 to use the court-approved form, the Court may strike the amended complaint and dismiss 22 this action without further notice to Plaintiff. 23 Plaintiff must clearly designate on the face of the document that it is the “First 24
25 1 Where the names of individual defendants are unknown at the time a complaint is filed, a plaintiff may refer to the individual unknown defendants as Defendant John (or 26 Jane) Doe 1, John Doe 2, and so on, and allege facts to support how each Doe defendant violated the plaintiff’s constitutional rights. See Wakefield v. Thompson, 177 F.3d 1160, 27 1163 (9th Cir. 1999) (where identity is unknown prior to the filing of a complaint, a plaintiff should be given an opportunity through discovery to identify the unknown defendant, 28 unless it is clear that discovery would not uncover the identities, or that the complaint would be dismissed on other grounds). 1 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 2 entirety on the court-approved form and may not incorporate any part of the original 3 Complaint by reference. Plaintiff may include only one 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, 423 U.S. at 371-72, 377. 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 first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 17 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 18 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 19 as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 20 original Complaint and that was voluntarily dismissed or was dismissed without prejudice 21 is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 22 F.3d 896, 928 (9th Cir. 2012) (en banc). 23 V. Warnings 24 A. Address Changes 25 Plaintiff must file and serve a notice of a change of address in accordance with Rule 26 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 27 relief with a notice of change of address. Failure to comply may result in dismissal of this 28 action. 1 B. 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 C. 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) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 18 has 30 days from the date this Order is filed to file a first amended complaint in compliance 19 with this Order. 20 (2) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 21 Court must, without further notice, enter a judgment of dismissal of this action with 22 prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 23 and deny any pending unrelated motions as moot. 24 . . . . 25 . . . . 26 . . . . 27 . . . . 28 . . . . 1 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. 3 Dated this 9th day of June, 2021. 4 ' ° = James A, CO 7 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(a) 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 $400.00 ($350.00 filing fee plus $50.00 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 $400 filing and administrative fees or the application to proceed in forma pauperis to:
Revised 3/11/16 1 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. 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. 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.
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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 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. . 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.
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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 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. . 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. 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.