Rodrigues v. Ryan et al

Filing 7

ORDER, Plaintiff's Application to Proceed In Forma Pauperis 2 is granted; thc Complaint 1 is dismissed for failure to state a claim; Plaintiff has 30 days to file a first amended complaint in compliance with this Order; if Plaintiff fails to comply with this order, the Clerk must, without further notice, enter a judgment of dismissal of this action with prejudice that states that the dismissal may count as a "strike" under 28 U.S.C. § 1915(g). Signed by Judge David G Campbell on 11/17/14. (REW)

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1 2 SKC WO 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Anthony L. Rodrigues, 10 11 12 No. CV 14-8141-PCT-DGC (MEA) Plaintiff, vs. ORDER Charles L. Ryan, et al., 13 Defendants. 14 15 Plaintiff Anthony L. Rodrigues, who is confined in the Arizona State Prison 16 Complex-Kingman in Kingman, Arizona, has filed a pro se civil rights Complaint 17 pursuant to 42 U.S.C. § 1983 (Doc. 1) and an Application to Proceed In Forma Pauperis 18 (Doc. 2). The Court will dismiss the Complaint with leave to amend. 19 I. Application to Proceed In Forma Pauperis and Filing Fee 20 21 § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. § 1915(b)(1). 22 The Court will not assess an initial partial filing fee. Id. The statutory filing fee will be 23 collected monthly in payments of 20% of the previous month’s income credited to 24 Plaintiff’s trust account each time the amount in the account exceeds $10.00. 28 U.S.C. 25 § 1915(b)(2). The Court will enter a separate Order requiring the appropriate government 26 agency to collect and forward the fees according to the statutory formula. 27 .... 28 JDDL-K Plaintiff’s Application to Proceed In Forma Pauperis will be granted. 28 U.S.C. .... 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 6 which relief may be granted, or that seek monetary relief from a defendant who is 7 immune from 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 10 does not demand detailed factual allegations, “it demands more than an unadorned, the- 11 defendant-unlawfully-harmed-me accusation.” 12 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 13 conclusory statements, do not suffice.” Id. Ashcroft v. Iqbal, 556 U.S. 662, 678 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 17 content that allows the court to draw the reasonable inference that the defendant is liable 18 for the misconduct alleged.” Id. “Determining whether a complaint states a plausible 19 claim for relief [is] . . . a context-specific task that requires the reviewing court to draw 20 on its judicial experience and common sense.” Id. at 679. Thus, although a plaintiff’s 21 specific factual allegations may be consistent with a constitutional claim, a court must 22 assess whether there are other “more likely explanations” for a defendant’s conduct. Id. 23 at 681. 24 25 courts must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 26 342 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less 27 stringent standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. 28 JDDL-K But as the United States Court of Appeals for the Ninth Circuit has instructed, Pardus, 551 U.S. 89, 94 (2007) (per curiam)). -2- 1 If the Court determines that a pleading could be cured by the allegation of other 2 facts, a pro se 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). 4 Plaintiff’s Complaint will be dismissed 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 alleges seven counts against Defendants Charles L. Ryan, Director of the 8 Arizona Department of Corrections (“ADOC”); R. Scott Marquardt, President and CEO 9 of Management Training Corporation (“MTC”); Tara R. Diaz, Director of Contract Beds 10 Bureau-Arizona Department of Corrections; and P. Rider, Warden of the Arizona State 11 Prison Complex-Kingman. 12 13 and official capacity for a violation of Plaintiff’s rights under the Fifth, Eighth, and 14 Fourteenth Amendments, and the Americans with Disabilities Act (“ADA”). Plaintiff 15 alleges that Ryan was aware that MTC and ADOC personnel had adopted a written 16 policy imposing disciplinary sanctions “not otherwise inclusive of ADOC earned 17 incentive program (EIP) phase level privileges subject to non-discretionary loss or 18 forfeiture for alleged [ADOC policy] violation[s].” While not entirely clear, Plaintiff 19 appears to assert that the alleged policy took away certain of his “state created liberties” – 20 including participation in federally subsidized education programs and earned release 21 credits – without notice or an opportunity to be heard. Plaintiff alleges that Ryan showed 22 deliberate indifference to significant hardships that Plaintiff endured as a result of this 23 policy, including loss of educational opportunities and reassignment to housing that 24 exposed Plaintiff to conditions that aggravated his pre-existing chronic medical 25 condition. Plaintiff alleges that he suffered “emotional trauma, mental anguish, medical 26 complications involving hospitalization, loss of physical and emotional wellness and the 27 enjoyment of quality life/free of discrimination.” 28 JDDL-K In Count One, Plaintiff asserts a claim against Defendant Ryan in his individual .... -3- 1 In Count Two, Plaintiff asserts a second claim against Defendant Ryan in his 2 individual and official capacity for violation of Plaintiff’s rights under the Fifth, Eighth, 3 and Fourteenth Amendments, and the ADA. 4 Plaintiff suffered from a chronic medical condition that qualified as a disability under the 5 ADA yet denied Plaintiff’s request for alternative housing and reasonable 6 accommodation, thus exposing Plaintiff to elevated levels of stress, airborne 7 contaminants, overcrowding, extreme fluctuations in temperature, and second-hand 8 smoke. 9 compliance with the ADA deprived Plaintiff of participation in federally subsidized Plaintiff alleges that Ryan knew that Plaintiff further alleges that Ryan’s failure to enforce ADOC policies and 10 education programs. 11 disciplinary response to conduct he claims was the result of medications he used to treat 12 his disability. Plaintiff alleges that he suffered a variety of physical and emotional 13 injuries, including medical complications that required hospitalization. Plaintiff appears to allege that he suffered these losses as a 14 In Count Three, Plaintiff asserts a claim against Defendant R. Scott Marquardt in 15 his individual and official capacity for violation of Plaintiff’s rights under the Fifth, 16 Eighth, and Fourteenth Amendments, and the ADA. Plaintiff alleges nearly identical 17 facts in Count Three against Marquardt to those alleged in Count One against Ryan, 18 namely that Marquardt was aware that MTC personnel had adopted a written policy 19 imposing “non-discretionary disciplinary sanctions” that deprived Plaintiff of certain 20 alleged “liberty interests” in educational programs, leave credits, and assigned housing, 21 the last of which resulted in his exposure to preventable environmental stresses and 22 contaminants – all without notice or a hearing. Plaintiff alleges that Marquardt failed to 23 monitor, supervise, or ensure the proper training of MTC staff to prevent these losses. 24 Plaintiff alleges that he suffered emotional trauma and mental and physical 25 complications, including hospitalization. 26 27 her individual and official capacity for violation of Plaintiff’s rights under the Fifth, 28 JDDL-K In Counts Four and Five, Plaintiff asserts claims against Defendant Tara Diaz in Eighth, and Fourteenth Amendments, and the ADA. Plaintiff makes nearly identical -4- 1 allegations against Diaz to those made in Counts One and Two against Ryan. In Count 2 Four, Plaintiff alleges that Diaz was aware that MTC staff had a written policy leading to 3 the loss of Plaintiff’s “liberty interests” in educational programs, leave credits, and 4 housing without notice or a hearing, but she failed “to take corrective action and monitor, 5 supervise[,] and ensure the proper training” of these individuals. In Count Five, Plaintiff 6 alleges that Diaz knew or should have known that Plaintiff suffered from a chronic 7 medical condition recognized by the ADA, yet she denied his request for alternative 8 housing and reasonable accommodation. In both counts, Plaintiff re-alleges that he 9 suffered emotional trauma and mental and physical complications, including 10 hospitalization. 11 In Counts Six and Seven, Plaintiff asserts claims against Defendant P. Rider in her 12 individual and official capacity for violation of Plaintiff’s rights under the Fifth, Eighth, 13 and Fourteenth Amendments, and the ADA. Again, Plaintiff asserts nearly identical 14 allegations with respect to Rider as to those made in Counts One and Two against Ryan. 15 In Count Six, Plaintiff alleges that MTC personnel enforced a written policy leading to 16 the loss of Plaintiff’s alleged “liberty interests” in educational programs, leave credits, 17 and housing without notice or a hearing, but Rider failed “to monitor, supervise or take 18 corrective action to ensure the proper training” of these individuals. In Count Seven, 19 Plaintiff alleges that Rider knew that Plaintiff suffered from a chronic medical condition 20 recognized by the ADA yet denied his request for alternative housing and reasonable 21 accommodation. In both counts, Plaintiff re-alleges that he suffered emotional trauma 22 and mental and physical complications, including hospitalization. 23 24 severally violated his right to due process and equal protection and his right to be free 25 from cruel and unusual punishment, specifically by denying his requests for reasonable 26 accommodation pursuant to the ADA. Plaintiff also seeks injunctive relief requiring 27 Defendants to discontinue current policy, compensatory damages in an amount to be 28 JDDL-K Plaintiff seeks declaratory relief as to all Defendants, finding that they jointly and determined, punitive damages of $4,000,000, and attorney fees and costs. -5- 1 IV. Failure to State a Claim under § 1983 2 To prevail in a § 1983 claim, a plaintiff must show that (1) acts by the defendants 3 (2) under color of state law (3) deprived him of federal rights, privileges or immunities 4 and (4) caused him damage. Thornton v. City of St. Helens, 425 F.3d 1158, 1163-64 (9th 5 Cir. 2005) (quoting Shoshone-Bannock Tribes v. Idaho Fish & Game Comm’n, 42 F.3d 6 1278, 1284 (9th Cir. 1994)). In addition, a plaintiff must allege that he suffered a specific 7 injury as a result of the conduct of a particular defendant and he must allege an 8 affirmative link between the injury and the conduct of that defendant. Rizzo v. Goode, 9 423 U.S. 362, 371-72, 377 (1976). 10 A. 11 Plaintiff fails to state a § 1983 claim against Defendant Ryan. “A plaintiff must 12 allege facts, not simply conclusions, that show that an individual was personally involved 13 in the deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th 14 Cir. 1998). For an individual to be liable in his official capacity, a plaintiff must allege 15 injuries resulting from a policy, practice, or custom of the agency over which that 16 individual has final policy-making authority. See Cortez v. County of Los Angeles, 294 17 F.3d 1186, 1188 (9th Cir. 2002). Further, there is no respondeat superior liability under 18 § 1983, so a defendant’s position as the supervisor of someone who allegedly violated a 19 plaintiff’s constitutional rights does not make him liable. Monell v. N.Y. Dep’t of Soc. 20 Servs., 436 U.S. 658, 691 (1978); Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 1989) 21 (citation omitted). 22 constitutional violations of his subordinates if the supervisor participated in or directed 23 the violations, or knew of the violations and failed to act to prevent them.” Taylor, 880 24 F.2d at 1045. Defendant Ryan A supervisor in his individual capacity “is only liable for 25 26 ADOC, Plaintiff must allege facts showing that ADOC’s policy or custom lead to the 27 alleged violations. See Hafer v. Melo, 502 U.S. 21, 25 (1991). Plaintiff alleges that 28 JDDL-K To the extent that Plaintiff seeks to sue Ryan in his official capacity as Director of ADOC and MTC personnel adopted a “written policy” that lead to deprivations of his -6- 1 alleged liberty interests. More specifically, Plaintiff appears to allege that he suffered 2 disciplinary sanctions pursuant to “ADOC policy 809.” Plaintiff’s statements about the 3 substance of this alleged policy, however, are vague and largely incomprehensible. 4 Moreover, Plaintiff fails to allege any facts showing in short, plain terms what happened. 5 Absent further factual detail, Plaintiff’s mere statements that he was deprived of certain 6 liberty interests as a result of an ADOC policy are insufficient to state a claim. See Iqbal, 7 556 U.S. at 678 (“Threadbare recitals of the elements of a cause of action, supported by 8 mere conclusory statements, do not suffice.”). Accordingly, Plaintiff’s § 1983 claims 9 against Ryan in his official capacity will be dismissed. 10 To the extent that Plaintiff attempts to sue Ryan in his personal capacity, Plaintiff 11 also fails to state a claim. Plaintiff does not allege that Ryan participated in or directed 12 the alleged violations, or that he knew of the violations and failed to act to prevent them. 13 Accordingly, Plaintiff’s § 1983 claims against Ryan in his personal capacity will be 14 dismissed. 15 B. 16 For the same reasons discussed above with respect to Defendant Ryan, Plaintiff 17 fails to state a claim against Defendants Marquardt, Diaz, or Rider, either in their official 18 or personal capacities. Other Defendants 19 To the extent that Plaintiff attempts to sue Defendant Marquardt in his official 20 capacity as President and CEO of MTC, Plaintiff alleges that Marquardt knew MTC 21 personnel had adopted a “written policy” that led to the deprivation of certain of 22 Plaintiff’s alleged liberty interests. Plaintiff once again fails to provide an intelligible 23 description of this policy, however, or to allege any facts showing in short, plain terms 24 what occurred to deprive him of his rights. 25 26 capacity, Plaintiff alleges that Marquardt failed “to monitor, supervise[,] and ensure the 27 proper training of MTC staff responsible for the management and enforcement of ADOC 28 JDDL-K To the extent that Plaintiff attempts to sue Defendant Marquardt in his personal Policy.” Plaintiff fails, however, to allege any facts showing that Marquardt “knew of the -7- 1 violations [against Plaintiff] and failed to act to prevent them.” Taylor, 880 F.2d at 1045. 2 Accordingly, Plaintiff’s § 1983 claims against Marquardt in his personal capacity will be 3 dismissed. 4 As to Defendants Diaz and Rider, Plaintiff fails to allege any additional facts 5 regarding the alleged ADOC and MTC policy that would cure the deficiencies noted 6 above. Additionally, although Plaintiff alleges generally that he was deprived of his 7 ability to participate in federally funded educational programs; he lost “release credits”; 8 and he was reassigned to less-desirable housing – all without notice or a hearing – he fails 9 to allege specific actions on the parts of either Defendant or to allege any facts showing 10 that either Defendant was made aware of these alleged violations and failed to act to 11 prevent them. Accordingly Plaintiff has failed to state claims against Diaz and Rider in 12 either their official or individual capacities. Plaintiff’s § 1983 claims against these 13 Defendants will be dismissed. 14 V. Failure to State a Claim under the ADA 15 16 ADA, “no qualified individual with a disability shall, by reason of such disability, be 17 excluded from participation in or be denied the benefits of the services, programs, or 18 activities of a public entity, or be subjected to discrimination by any such entity.” 42 19 U.S.C. § 12132. A “public entity” is “any State or local government; [or] (B) any 20 department, agency, special purpose district, or other instrumentality of a State or States 21 or local government. . . .” 42 U.S.C. § 12131. Individuals, however, may only be sued 22 under the ADA in their official, rather than, their individual capacities. 23 Thomas, 288 F.3d 1145, 1156 (9th Cir. 2002) (plaintiff cannot sue state officials in their 24 individual capacities to vindicate rights created by Title II of the ADA). To state an 25 ADA claim, a plaintiff must allege facts to support that he: “(1) is a handicapped person; 26 (2) that he is otherwise qualified; and that [prison officials’] actions either (3) excluded 27 his participation in or denied him the benefits of a service, program, or activity; or 28 JDDL-K Plaintiff asserts violation of the ADA against all Defendants. Under Title II of the (4) otherwise subjected him to discrimination on the basis of his physical handicap.” -8- Vinson v. 1 Duffy v. Riveland, 98 F.3d 447, 455 (9th Cir. 1996). The term “qualified individual with 2 a disability” includes “an individual with a disability who, with or without . . . the 3 provision of auxiliary aids and services, meets the essential eligibility requirements for 4 the receipt of services or participation in programs or activities provided by a public 5 entity.” 42 U.S.C. § 12131(2). 6 A. 7 Plaintiff fails to state a claim under the ADA as to Defendant Ryan. Plaintiff 8 alleges in Count Two that Ryan “knew Plaintiff suffered from a chronic medical 9 condition recognized by ADOC Policy as a qualifying disability subject to [the ADA] 10 and denied Plaintiff’s request for alternative housing reassignment and reasonable 11 accommodation.” He further alleges that Ryan based this denial on the absence of 12 medical necessity rather than disability. Plaintiff appears to allege that Ryan applied the 13 wrong standard for responding to a request for reasonable accommodation under the 14 ADA. Nowhere, however, does Plaintiff allege facts showing that he has a qualifying 15 disability under the ADA. 16 excluded from a program or denied services based on disability. Plaintiff alleges that he 17 was deprived of benefits – including his preferred housing assignment and participation 18 in educational programs – and that these losses were due to conduct related to the 19 medications he took for his disability. But Plaintiff fails to provide any facts about his 20 conduct and how it resulted in his alleged deprivations or to show any connection 21 between his conduct, the medications, and his disability. Absent additional facts showing 22 that Plaintiff had a disability and was otherwise qualified for the benefits he allegedly 23 lost, Plaintiff fails to state a claim under the ADA. Accordingly, Plaintiff’s ADA claim 24 against Ryan will be dismissed. Defendant Ryan Neither does Plaintiff allege facts showing that he was 25 26 For the same reasons cited above, Plaintiff fails to state a claim under the ADA as 27 to Defendants Marquardt, Diaz, and Rider. Plaintiff alleges similar facts in Counts Five 28 JDDL-K B. and Seven against Diaz and Rider as to those alleged against Ryan in Count Two. But Remaining Defendants -9- 1 Plaintiff fails to allege additional facts anywhere in his Complaint showing that he has a 2 disability or showing that he was denied services for which he was otherwise qualified 3 simply because of that disability. Accordingly, Plaintiff fails to state a claim under the 4 ADA as to any Defendant, and his ADA claims against Marquardt, Diaz, and Rider will 5 be dismissed. 6 VI. Leave to Amend 7 For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to 8 state a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a 9 first amended complaint to cure the deficiencies outlined above. The Clerk of Court will 10 mail Plaintiff a court-approved form to use for filing a first amended complaint. If 11 Plaintiff fails to use the court-approved form, the Court may strike the amended 12 complaint and dismiss this action without further notice to Plaintiff. 13 Plaintiff must clearly designate on the face of the document that it is the “First 14 Amended Complaint.” The first amended complaint must be retyped or rewritten in its 15 entirety on the court-approved form and may not incorporate any part of the original 16 Complaint by reference. Plaintiff may include only one claim per count. 17 A first amended complaint supersedes the original complaint. Ferdik v. Bonzelet, 18 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 19 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court will treat an original 20 complaint as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised 21 in the original complaint and that was voluntarily dismissed or was dismissed without 22 prejudice is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa 23 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 24 VII. Warnings 25 A. 26 Plaintiff must pay the unpaid balance of the filing fee within 120 days of his 27 release. Also, within 30 days of his release, he must either (1) notify the Court that he Release 28 JDDL-K - 10 - 1 intends to pay the balance or (2) show good cause, in writing, why he cannot. Failure to 2 comply may result in dismissal of this action. 3 B. 4 Plaintiff must file and serve a notice of a change of address in accordance with 5 Rule 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion 6 for other relief with a notice of change of address. Failure to comply may result in 7 dismissal of this action. Address Changes 8 C. 9 Plaintiff must submit an additional copy of every filing for use by the Court. See 10 LRCiv 5.4. Failure to comply may result in the filing being stricken without further 11 notice to Plaintiff. Copies 12 D. 13 Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 14 fails to file an amended complaint correcting the deficiencies identified in this Order, the 15 dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 16 Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 17 judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more 18 prior occasions, while incarcerated or detained in any facility, brought an action or appeal 19 in a court of the United States that was dismissed on the grounds that it is frivolous, 20 malicious, or fails to state a claim upon which relief may be granted, unless the prisoner 21 is under imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). Possible “Strike” 22 E. 23 If Plaintiff fails to timely comply with every provision of this Order, including 24 these warnings, the Court may dismiss this action without further notice. See Ferdik, 963 25 F.2d at 1260-61 (a district court may dismiss an action for failure to comply with any 26 order of the Court). 27 IT IS ORDERED: 28 JDDL-K (1) Possible Dismissal Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) is granted. - 11 - 1 (2) As required by the accompanying Order to the appropriate government 2 agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial 3 filing fee. 4 (3) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 5 has 30 days from the date this Order is filed to file a first amended complaint in 6 compliance with this Order. 7 (4) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 8 Court must, without further notice, enter a judgment of dismissal of this action with 9 prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g). 10 11 12 (5) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil rights complaint by a prisoner. Dated this 17th day of November, 2014. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 JDDL-K - 12 - 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. 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 5/1/2013 1 Phoenix & Prescott Divisions: OR U.S. District Court Clerk U.S. Courthouse, Suite 130 401 West Washington Street, SPC 10 Phoenix, Arizona 85003-2119 Tucson Division: U.S. District Court Clerk U.S. Courthouse, Suite 1500 405 West Congress Street 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. 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 before any defendant has answered your original complaint. See Fed. R. Civ. P. 15(a). After any defendant has filed an answer, 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,” “2B,” 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, vs. (1) (Full Name of Defendant) (2) (3) (4) Defendant(s). G Check if there are additional Defendants and attach page 1-A listing them. ) , ) ) ) ) CASE NO. ) (To be supplied by the Clerk) , ) ) , ) ) CIVIL RIGHTS COMPLAINT , ) BY A PRISONER ) , ) G Original Complaint G First Amended Complaint ) ) G Second Amended Complaint A. JURISDICTION 1. 2. 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: . Institution/city where violation occurred: . Revised 5/1/2013 1 550/555 B. DEFENDANTS 1. Name of first Defendant: . The first Defendant is employed as: at . (Position and Title) 2. (Institution) . The second Defendant is employed as: Name of second Defendant: at . (Position and Title) 3. (Institution) Name of third Defendant: . The third Defendant is employed as: at . (Position and Title) 4. (Institution) Name of fourth Defendant: at (Position and Title) . The fourth Defendant is employed as: . (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? 2. If yes, how many lawsuits have you filed? G Yes G No . 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: v. 1. Parties: 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 1. COUNT I 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 G Yes G No institution? 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 1. COUNT II 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 1. COUNT III 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 G Yes G No institution? 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. 6

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