Cohen v. Alfaro, et al.

Filing 10

ORDER DISMISSING CASE WITH LEAVE TO AMEND ;Clerk to Terminate: Defendant Perez, Farooq and Yang from the Docket, signed by Magistrate Judge Michael J. Seng on 02/14/2017. (Amended Complaint 30-Day Deadline) Tim Perez (individual), Bahua Yang (Physician and Care giver at California Institution for Men, official capacity), and Muhammad Farooq (individual) terminated, (Attachments: # 1 Amended Complaint Form, # 2 Complaint, dated 01/27/17)(Martin-Gill, S)

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 1 of 18
~T}'__

DANIEL COHEN(PRO SE)

2017 J~~~ 27 P!~ ~ 24

566 S. SAN PEDRO ST.

; .

LOS ANGELES,CALIFORNIA 90013
PHONE NUMBER:[phone]
EMAIL: [e-mail]
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
DANIEL COHEN,
Plaintiff,

~s.

„ ,

Case No.: r ~ ~ '] ~ O O

SANDRA ALFARO,ALDUKWE N. ODELUGA,S.
JOSH MANAVI,TIM PEREZ, MUHAMMAD
PURSUANT TO
FAROOQ,BAHUA YANG,DOE 1 THROUGH DOE 31 CIVIL RIGHTS COMPLAINT
42 U.S.C. § 1983
Defendant's
Demand for Jury Trial

1.PLAINTIFF alleges this civil action is authorized by title 42 U.S.C.§1983 to redress the deprivation under color o
state law, of rights secured by the constitution of the United States.
I
.

JURISDICTION &VENUE

2
.THE CENTRAL DISTRICT OF CALIFORNIA is an appropriate venue under 28 U.S.C. §1391(b)(2) because it is
where Plaintiff resides and the events giving rise to this claim occurred. This court has jurisdiction under 28
U.S.C.§1331 and §1343 (a)(3) Plaintiff seeks declatory relief pursuant to 28 U.S.C. §2201 and §2202. This court ha:
jurisdiction under 28 U.S.C. § 1331 and 28 U.S.C. § 1343. Plaintiff also submits state law claims under 28 U.S.C.
§1367(a)for actions that have arisen for the same circumstances or events as the constitution violations.
I.

EXHAUSTION OF ADMINISTRATIVE REMEDIES

1. Plaintiff is fully exhausted in administrative remedies. While in custody Plaintiff filed multiple Health Care 602
appeal forms to the third (highest) administrative level. Plaintiff received a response from the highest level
without satisfactory results. While in custody Plaintiff has submitted multiple Government Board Claims
regarding the actions and omissions described in this complaint. Plaintiff has not received satisfactory results

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 1

~~c~~R~

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 2 of 18

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from the Government Board Claims Process. This complaint is timely as section 1983 provides a one year

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limitation from the date of release. Plaintiff was released from state custody on 01/29/16.

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II.

PARTIES

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5
6
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2 PLAINTIFF,DANIEL COHEN was a prisoner in state custody of California Department of Corrections and
.
Rehabilitation at, North Kern State Prison located in Delano, California, and California Institution for Men
located in Chino, California. At all times mentioned in this complaint.

8 I~ 3. DEFENDANT, WARDEN SANDRA ALFARO was the acting warden of North Kern State Prison during the
9
10
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dates and times described in this complaint and is sued in their individual and official capacity.
4 DEFENDANT,CHIEF MEDICAL EXECUTIVE ALDUKWE N. ODELUGA was the acting Chief Medical
.
executive at North Kern State Prison during the dates and times described in this complaint and is sued in their

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individual and official capacity.
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5. DEFENDANT,DOCTOR S. JOSH MANAVI was the assigned physician and care giver at North Kem State
Prison during the dates and times described in this complaint and is sued in their individual and official capac
6 DEFENDANT, WARDEN TIM PEREZ was the acting warden of California Institution for Men during the
.
dates and times described in this complaint and is sued in their individual and official capacity.

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7 DEFENDANT, CHIEF MEDICAL OFFICER MUHAMMAD FAROOQ was the acting Chief Medical Officer
.
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at California Institution for Men,Facility D during the dates and times described in this complaint and is sued
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0
their individual and official capacity.
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8. DEFENDANT,DOCTOR BAHiJA YANG was an assigned physician and care giver at California Institution
f Men, Facility D during the dates and times described in this complaint and is sued in their individual and
or
official capacity.
9 DEFENDANTS DOE 1 THROUGH 31 is and was at all times mentioned herein, some persons whom Plaintiff
.

2
6

is ignorant of their true names, titles, and positions, however; upon belief and information are associated and

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included in this action, and are somehow liable or responsible for the events and circumstances alleged herein.

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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 2

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 3 of 18

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10. Plaintiff will amend this complaint at a later time to include the true names and titles, and positions of
Defendants Doe 1 tlu~ough 21.
III. FACTS
1 1. On or about 01/14/14 while in custody at Los Angeles County Jail Plaintiff underwent a facial reconstruction
surgical procedure at Los Angeles County Medical Center. On or about 04/15/14 Plaintiff was diagnosed with
entropion to his lower left eyelid which is a complication from surgery that causes the eyelid to fold inwards
causing eyelashes and the eyelid itselfto irritate the eye. Thus, causing ongoing pain, redness, discomfort,
irritation, discharge, and tearing of the left eye and pain to the left eye socket and left cranial area. On or about
05/08/14 Plaintiff was in custody transferred from Los Angeles County Jail to North Kern State Prison with this
medical complication unresolved.
12. Plaintiff was placed into the custody of DEFENDANT WARDEN SANDRA ALFARO
13. On or about 05/15/14 Plaintiff was medically evaluated by Doctor Le at North Kern State Prison during the
normal diagnostic procedure all inmates are subject to.
14. During consultation with Doctor Le Plaintiff gave a detailed medical history of past surgeries at LAC+USC
medical center and Doctor Le ordered the medical records from LAC+USC.
15. Doctor Le also began the process to refer Plaintiff to seek treatment for his entropion.
16. On or about 05/22/14 Plaintiff was transported to Triangle eye institute located in Delano, California to consult

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with Dr.Yaplee.
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17. On or about 05/29/14 Dr. Yaplee recommended and referred Plaintiff to an ocular surgeon.
18. On or about 06/19/14 Plaintiff was evaluated via tele med consult with Dr. Kitt an Ear, Nose, and Throat
specialist who recommended and referred that Plaintiff be seen by an ocular plastics surgeon.
19. On or about 07/23/14 Plaintiff was transported to San Joaquin Valley Medical center to consult with a plastic
surgeon Dr. Michael B. Freeman.
20. Dr. Michael B. Freeman recommended and referred that Plaintiff return to LAC+USC for correction ofthe

25
entropion.
2
6

21. On or about 08/06/14 Plaintiff was called to consult with Dr. S. Josh Manavi Plaintiffs Primary Care Provider

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(
PCP).
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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 3

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 4 of 18

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22• Upon belief and information, chief medical executive Aldukwe N. Odeluga and or Chief Medical Officer Doe 1

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and or Does 2 through Does 4, participated in and denied the referral ordered by Dr. Freeman for Plaintiff to

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receive medically necessary corrective treatment at LAC+USC medical center.

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5
6
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23. Dr. S. Josh Manavi told Plaintiff"Your referral to LAC+USC for corrective surgery was denied" And "You
should speak with a lawyer"
24. On or about 08/08/14 Plaintiff was in custody transferred to California Institution for Men located in Chino,
California.

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25. Plaintiff was placed into the custody ofDEFENDANT WARDEN TIM PEREZ

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26. Upon arrival at California Institution for men Plaintiff was placed under the care of Dr. Bahua Wang and or

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Muhammad Farooq.

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27. On or about 08/20/14 Plaintiff made several attempts to obtain an ADA classification (vision impaired vest) an

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obtain Hillary or assistive equipment(tap cane and dark glasses) from Dr. Bahua Wang. who was overseen by

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Muhammad Farooq but, was denied.

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28. On or about 08/20/14 Plaintiff made several attempts to obtain proper and adequate pain medication from Dr.
Bahua Wang. who was overseen by Muhammad Farooq but, was denied.
29. On or about 08/28/14 Plaintiff suffered several small or minor injuries at California Institution for Men, due to
his vision disability and lack of auxiliary or assistive equipment.(Cane, Glasses)
30. Plaintiff began to file several CDCR form HC-602 administrative medical appeals to obtain proper pain
medication, equipment, and the necessary corrective surgery.
31. Due to these aforementioned injuries and dizziness. On or about 09/08/14 placed in the On-site Hospital Unit
aka OHU under the care of Dr. Oh

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2

32. Plaintiff spent approximately 30 days in the OHU and was discharged back to general population.

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33. Plaintiff continued to file appeals against Dr. Bahua Wang and or Muhammad Farooq and or Doe 5 through

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4

Doe 9 for not providing Plaintiff with proper medication for pain and not providing Plaintiff with auxiliary or

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assistive equipment for Plaintiffs vision disability.

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6
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34. Plaintiff continued to file appeals and government board claims for the denial oftreatment and the referral for
corrective treatment to LAC+USC.

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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 4

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 5 of 18

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35. Plaintiff sent correspondence to an organization that advocates for prisoners' rights called the Prison Law
Office(PLO)located in San Quinten, California seeking assistance with Plaintiffs medical needs.

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36. Plaintiffreceived a response from the PLO stating that the federal receiver was overseeing Plaintiffs case.

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37. On or about O1/O1/15 Plaintiff was assigned to a new Primary Care Physician(PCP)Dr. Andrew Yee.

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38. Dr. Andrew Yee provided Plaintiff with the ADA classification(DPV)aka vision impaired classification.

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Provided Plaintiff with auxiliary and assistive equipment(tap cane and dark glasses) and provided Plaintiff with

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adequate Pain medication.(Tylenol3 with codeine).

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9
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39. On or about 03/23/15 Plaintiff was transported to Riverside County Medical Center aka RCMC to consult with
Ophthalmology.
40. RCMC ophthalmologists recommended and referred Plaintiff to an ocular plastics specialist at Loma Linda
University Medical Center aka LLUMC for evaluation and treatment for the Entropion.
41. On or about 04/25/15 Plaintiff underwent surgery for entropion repair performed under the care of Doctor
at LLUMC.

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42. Plaintiffs left eyelid was sutured closed for approximately two weeks after the surgery.

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43. Plaintiffs sutures were removed and a few days later Plaintiffs lower left eyelid reverted back to the entropion.

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44. On or about 09/21/15 Plaintiff underwent a second entropion repair surgery with Dr. Issacs at LLUMC

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45. Plaintiffs leR eyelid was sutured closed for approximately two weeks after the surgery.

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46. Plaintiffs sutures were removed and a few days later Plaintiffs lower left eyelid reverted back to the entropion.

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47. On or about 01/26/16 Plaintiff underwent a third entropion repair surgery with Dr. Issacs at LLUMC

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48. Plaintiffs left eyelid was sutured closed for approximately two weeks.

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49. Plaintiff was released from custody on 01/29/16

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50. Plaintiffs sutures were removed at LLUMC during afollow-up visit and a few days later Plaintiffs lower left

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eyelid reverted back to the entropion.
51. On or about 04/25/16 Plaintiff consulted with Dr. Issacs for afollow-up. When Dr. Issacs recommended
surgery to attempt to repair Plaintiffs lower left eyelid entropion.

2 i 52. Around this Plaintiff learned that the Prison Healthcare system would not cover the costs of future treatments.
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53. Plaintiff has been working diligently to try to resolve this issue as best as possible and Plaintiff began the

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process of obtaining Medi-Cal insurance and obtained a new primary care physician at LAC+USC.

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 5

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 6 of 18

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54. Beginning on or about 06/01/16 to 01/01/16 Plaintiff has consulted with several doctors and physicians at
LAC+USC who have been unsuccessful at providing corrective treatment.

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55. As of 01/25/16 Plaintiff is currently waiting to be evaluated by ophthalmology at LAC+USC

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56. Plaintiff has been suffering moderate to severe acute pain to his left eye and cranial area for approximately two

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6
7

years to date, due to this lower left eyelid complication.
57. Plaintiff has suffered greatly as this issue has remained unresolved and has been extended for such an
unreasonable amount of time.

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58. Plaintiff experiences daily pain, irritation, redness, tearing and discharge ofthe left eye.

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59. Plaintiff is at risk of corneal infection and corneal degradation.

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IV. LEGAL CLAIMS
FIRST CAUSE OF ACTION FOR DENYING AND DELAYING OF MEDICAL CARE
58. Plaintiff realleges and incorporates by reference all ofthe paragraphs above.
59. On or about 08/06/14 Plaintiff was in custody at North Kern State Prison and had a serious medical need
Plaintiffs lower left eyelid had a complication known as entropion. Plaintiff was therefore placed among the class
persons to whom Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA, S. JOSH MANAVI all owed a

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duty as part of a special relationship.
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60. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA, S. JOSH MANAVI all took part in and had
roles of authority and liability over the adequate and proper provision of medical care to plaintiff.
61. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI failed to provide PIaintiff
with medically necessary medical care and treatment that was previously ordered by a physician.
62. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI denied plaintiff medically
necessary corrective treatment for his complication of entropion although Defendants named supra had several
options that could have provided Plaintiff with the corrective treatment required.
63. Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI had knowledge ofPlaintiffs
serious medical needs because Plaintiff was medically examined and the issue was heavily documented along
with multiple verbal complaints made by Plaintiff during consultations. Therefore; Defendants SANDRA
ALFARO, ALDUKWE N. ODELUGA, S. JOSH MANAVI acted with deliberate indifference to Plaintiffs

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serious medical needs.

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 6

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 7 of 18

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64. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI actions or omissions

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'
i
violated Plaintiffs right to be free of cruel and unusual punishment guaranteed by the 8` and 14~' amendment

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the constitution.

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65. As a direct result and proximate result of Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA, S.

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JOSH MANAVI actions or omissions described in this complaint, Plaintiff was denied medically necessary

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corrective treatment and the medical issues continued for an extended and unnecessary period oftime. Plaintiff

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is and was exposed to substantial risk of serious hann by way of infection. Plaintiff suffered wanton pain and

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affliction of physical and mental anguish and emotional distress in that plaintiff was forced to endure pain and

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suffering for an unreasonable period oftime with little to none provision of assistance to mitigate the pain and

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suffering and or physical and mental anguish or emotional distress, due to Defendants SANDRA ALFARO,

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ALDUKWE N. ODELUGA, S. JOSH MANAVI inadequate and improper provision of medical care and

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medical care management.

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66. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI acted knowingly, willfully,
and maliciously with reckless and callous disregard for Plaintiffs federally protected rights.

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67. As a result of Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI actions or

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omissions Plaintiff has suffered and will continue to suffer extreme hardship and actual and impending

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irreparable injury, pain, and emotional distress in that Plaintiff has unreasonably and unnecessarily suffered for

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an extended period oftime posing great hardship and undue burden upon plaintiff and making plaintiffs daily

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life more difficult.

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68. SECOND CAUSE OF ACTION FOR PROFESSIONAL NEGLEGENCE
69. Plaintiff realleges and incorporates by reference all ofthe paragraphs above.
70. On or about 08/06/14 Plaintiff was in custody at North Kern State Prison and was an inmate, Plaintiff was
therefore, placed among the class of persons to whom Defendants SANDRA ALFARO, ALDUKWE N.
ODELUGA,S. JOSH MANAVI owed a duty as part of a special relationship.
71. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI had a duty to use such skill,
prudence, and diligence as other members of his or her profession commonly possess and exercise.

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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 7

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 8 of 18

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72. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI negligently failed to

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Plaintiff with medically necessary treatment and care for Plaintiffs serious medical needs. Failed to insure

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Plaintiffreceived adequate and proper medical treatment within a reasonable time. Was a moving force behind

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the denial and delaying of medical care and treatment previously ordered by a physician. Failed to provide

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medically necessary auxiliary and assistive equipment.

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73. As a direct and proximate result ofthe negligence of Defendants SANDRA ALFARO,ALDUKWE N.

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ODELUGA,S. JOSH MANAVI actions or omissions described in this complaint, Plaintiff was denied

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medically necessary corrective treatment and the medical issues continued for an extended and unnecessary

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period oftime. Plaintiff is and was exposed to substantial risk of serious harm by way of infection. Plaintiff

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suffered wanton pain and affliction of physical and mental anguish and emotional distress in that plaintiff was

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f
orced to endure pain and suffering for an unreasonable period oftime with little to none provision of assistancE

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to mitigate the pain and suffering and or physical and mental anguish or emotional distress, due to Defendants

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SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI negligence.

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74. Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI acted knowingly, willfully,

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and maliciously, and with a reckless and callous disregard for Plaintiffs rights protected by California Laws.

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75. As a result of Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA, S. JOSH MANAVI actions or

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omissions Plaintiff has suffered and will continue to suffer extreme hardship and actual and impending

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irreparable injury, pain, and emotional distress in that Plaintiff has unreasonably and unnecessarily suffered for

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an extended period oftime posing great hardship and undue burden upon plaintiff and making plaintiffs daily

2
0

life more difficult.

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76. THIRD CAUSE OF ACTION FOR FAILURE TO PROVIDE ADEQUATE AND PROPER MEDICAL

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77. On or about 08/06/14 Plaintiff was in custody at North Kern State Prison and had a serious medical need

2
4

because Plaintiffs lower left eyelid had a complication known as entropion. Plaintiff was therefore placed

25

among the class of persons to whom Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH

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6

MANAVI all owed a duty as part of a special relationship.

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78. 71. Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI all took part in and had
roles of authority and liability over the adequate and proper provision of medical care to plaintiff.

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 8

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 9 of 18

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79. 72. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI failed to provide
Plaintiff with medically necessary medical care and treatment that was previously ordered by a physician.
80. 73. Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI denied plaintiff

4

medically necessary corrective treatment for his complication of entropion although Defendants named supra

5

had several options that could have provided Plaintiff with the corrective treatment required.

6

~ 81. 74. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA, S. JOSH MANAVI had knowledge of

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Plaintiffs serious medical needs because Plaintiff was medically examined and the issue was heavily

8

documented along with multiple verbal complaints made by Plaintiff during consultations. Therefore;

9

Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI acted with deliberate

10
11

indifference to Plaintiffs serious medical needs.
~ 82. 75. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA, S. JOSH MANAVI actions or omissions

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violated Plaintiffs right to be free of cruel and unusual punishment guaranteed by the 8th and 14th amendment

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ofthe constitution.

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83. 76. As a direct result and proximate result of Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,

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JOSH MANAVI actions or omissions described in this complaint, Plaintiff was denied medically necessary

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corrective treatment and the medical issues continued for an extended and unnecessary period oftime. Plaintiff

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is and was exposed to substantial risk of serious harm by way of infection. Plaintiff suffered wanton pain and

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affliction of physical and mental anguish and emotional distress in that plaintiff was forced to endure pain and

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suffering for an unreasonable period oftime with little to none provision of assistance to mitigate the pain and

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0

suffering and or physical and mental anguish or emotional distress, due to Defendants SANDRA ALFARO,

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ALDUKWE N. ODELUGA, S. JOSH MANAVI inadequate and improper provision of medical care and

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2

medical care management.

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~ 84. 77. Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI acted knowingly,

2
4

willfully, and maliciously with reckless and callous disregard for Plaintiffs federally protected rights.

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~ 85. 78. As a result of Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA, S. JOSH MANAVI actions c

2
6

omissions Plaintiff has suffered and will continue to suffer extreme hardship and actual and impending

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irreparable injury, pain, and emotional distress in that Plaintiff has unreasonably and unnecessarily suffered for

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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 9

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 10 of 18

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an extended period oftime posing great hardship and undue burden upon plaintiff and making plaintiffs daily

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life more difficult.

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4

FOURTH CAUSE OF ACTION FOR NEGLIGENT OR INTENTIONAL INFLICTION OF EMOTIONAL

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DISTRESS

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86. Plaintiffrealleges and incorporates by reference all ofthe paragaphs above.

7 ' 87. On or about 08/06/14 Plaintiff was in custody at North Kern State Prison and was an inmate and under the care
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of Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI owed a duty as part of a

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special relationship.

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88. On or about 08/06/14 Plaintiff was informed that his medically necessary treatment was denied by prison
officials and prison medical employees.
89. Defendants SANDRA ALFARO,ALDUKWE N. ODELUGA,S. JOSH MANAVI conduct was intentional anc
deliberate and done with a wanton and reckless disregard ofthe consequences to Plaintiff.

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90. As the proximate result ofthe actions or omissions alleged above plaintiff suffered fright, worry, grief, shame,

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humiliation, and embarrassment, mental anguish, and emotional distress and physical distress because Plaintiff

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was worried plaintiff felt he would not get the treatment he required. Plaintiff felt sudden and extreme terror,

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and sharp sorrow and annoyance. Plaintiff felt dishonored and disgraced and was disappointed by the actions o~

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omissions of Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA, S. JOSH MANAVI. Plaintiff felt

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loss of pride, self-respect and dignity. Plaintiff felt burdened with shame and self
-conscience and was injured it

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mind and body.

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91. The actions or omissions of Defendants SANDRA ALFARO, ALDUKWE N. ODELUGA,S. JOSH MANAVI

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2

alleged above were willful, wanton, deliberate, reckless, oppressive and improper and justify the awarding of

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exemplary and punitive damages.

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92. FIFTH CAUSE OF ACTION FOR FAILURE TO PROVIDE ADEQUATE AND PROPER MEDICAL CARE

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AND FAILURE TO COMPLETE ADEQUATE AND PROPER MEDICAL CARE TREATMENT WITHIN A

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REASONABLE TIME.

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93. Plaintiff realleges and incorporates by reference all ofthe paragraphs above.

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 10

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 11 of 18

94. On or about 08/20/14 Plaintiff was in custody at California Institution for Men and had a serious medical need
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because Plaintiffs lower left eyelid had a complication known as entropion. Plaintiff was therefore placed

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among the class of persons to whom Defendants TIM PEREZ, MLTHAMMAD FAROOQ,BAHUA YANG all

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owed a duty as part of a special relationship.

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95. Defendants TIM PEREZ, MIJHAMMAD FAROOQ,BAHUA YANG all took part in and had roles of
and liability over the adequate and proper provision of medical care to plaintiff.
96. Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG failed to provide Plaintiff with
necessary medical care and treatment within a reasonable time.
97. Defendants TIM PEREZ, MLJHAMMAD FAROOQ,BAHUA YANG failed to provide adequate and proper

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medical treatment to plaintiff which was medically necessary corrective treatment for his complication of

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entropion within a reasonable time and failed to complete the treatment necessary although Defendants named

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supra had several options that could of provided Plaintiff with the corrective treatment required within a

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reasonable time and taken steps to insure that the required medical treatment was completed.

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98. Defendants TIM PEREZ, MLJHAMMAD FAROOQ,BAHUA YANG had knowledge of Plaintiffs serious

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medical needs because Plaintiff was medically examined and the issue was heavily documented along with

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multiple verbal complaints made by Plaintiff during consultations. Therefore; Defendants TIM PEREZ,

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MLJHAMMAD FAROOQ,BAHUA YANG acted with deliberate indifference to Plaintiffs serious medical

18

needs.

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0
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99. Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG actions or omissions violated Plaintiffs
right to be free of cruel and unusual punishment guaranteed by the 8th and 14th amendment ofthe constitution.
100.As a direct result and proximate result of Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA Y.

2
2

actions or omissions described in this complaint, Plaintiff's medically necessary corrective treatment was

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unnecessarily delayed and the symptoms of Plaintiffs medical issues continued for an extended and unnecessary

2
4

period of time. Plaintiff is and was exposed to substantial risk of serious harm by way of infection. Plaintiff

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suffered wanton pain and affliction of physical and mental anguish and emotional distress in that plaintiff was

2
6

forced to endure pain and suffering for an unreasonable period oftime with little to none provision of assistance

27

to mitigate the pain and suffering and or physical and mental anguish or emotional distress, due to Defendants

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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 11

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 12 of 18

TIM PEREZ, MLJHAMMAD FAROOQ,BAHUA YANG inadequate and improper and untimely provision of
medical care and medical care management.
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lO1.Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG acted knowingly, willfully, and
maliciously with reckless and callous disregard for Plaintiffs federally protected rights.
~ 102.As a result of Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG actions or omissions

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Plaintiff has suffered and will continue to suffer extreme hardship and actual and impending irreparable injury,

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pain, and emotional distress in that Plaintiff has unreasonably and unnecessarily suffered for an extended

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oftime posing great hardship and undue burden upon plaintiff and making plaintiffs daily life more difficult.

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10

SIXTH CAUSE OF ACTION FOR PROFESSIONAL NEGLEGENCE

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103. Plaintiff realleges and incorporates by reference all ofthe paragraphs above.

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104.On or about 08/20/14 Plaintiff was in custody at California Institution for Men and was an inmate, Plaintiff was

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therefore, placed among the class of persons to whom Defendants TIM PEREZ, MLJHAMMAD FAROOQ,

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BAHUA YANG owed a duty as part of a special relationship.

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l OS.Defendants TIM PEREZ, MLTHAMMAD FAROOQ,BAHUA YANG had a duty to use such skill, prudence,
and diligence as other members of his or her profession commonly possess and exercise.
106.Defendants TIM PEREZ, MLJHAMMAD FAROOQ,BAHUA YANG negligently failed to provide Plaintiff

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with medically necessary treatment and care for Plaintiffs serious medical needs. Failed to insure Plaintiff

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received adequate and proper medical treatment within a reasonable time. Was a moving force behind the

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delaying of necessary medical care and treatment. Failed to provide medically necessary auxiliary and assistive

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equipment. Failed to take steps to insure plaintiff's treatment was completed.

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2

107.As a direct and proximate result of the negligence of Defendants TIM PEREZ, MLJHAMMAD FAROOQ,

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BAHUA YANG actions or omissions described in this complaint, Plaintiff's medically necessary corrective

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4

treatment and the medical issues continued for an extended and unnecessary period oftime. Plaintiff is and was

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exposed to substantial risk of serious harm by way of infection. Plaintiff suffered wanton pain and affliction of

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physical and mental anguish and emotional distress in that plaintiff was forced to endure pain and suffering for

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an unreasonable period oftime with little to none provision of assistance to mitigate the pain and suffering and

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CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 12

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 13 of 18

1

or physical and mental anguish ar emotional distress, due to Defendants TIM PEREZ, MUHAMMAD

2

FAROOQ,BAHLTA YANG negligence.

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4
5

108.Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG acted knowingly, willfully, and
maliciously, and with a reckless and callous disregard for Plaintiffs rights protected by California Laws.
109.As a result of Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAH[JA YANG actions or omissions

6

Plaintiffhas suffered and will continue to suffer extreme hardship and actual and impending irreparable injury,

7

pain, and emotional distress in that Plaintiff has unreasonably and unnecessarily suffered for an extended perio

8

oftime posing great hardship and undue burden upon plaintiff and making plaintiffs daily life more difficult.

9
10

SEVENTH CAUSE OF ACTION FOR NEGLIGENT OR INTENTIONAL INFLICTION OF EMOTIONAL

11

DISTRESS

12

1 10.Plaintiffrealleges and incorporates by reference all ofthe paragraphs above.

13

l l l.On or about 08/20/14 Plaintiff was in custody at California Institution for Men and was an inmate and under the

14

care of Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG who owed a duty as part of a

15

special relationship.

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18
19

1 12.On or about 08/20/14 Plaintiff was informed that his requests for ADA classification, auxiliary or assistive
equipment, adequate and proper pain medication were denied by prison officials and prison medical employees.
113.Defendants TIM PEREZ, MLJHAMMAD FAROOQ,BAHUA YANG conduct was intentional and deliberate
and done with a wanton and reckless disregard ofthe consequences to Plaintiff.

20

114.As the proximate result ofthe actions or omissions alleged above plaintiff suffered fright, worry, grief, shame,

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humiliation, and embarrassment, mental anguish, and emotional distress and physical distress because Plaintiff

2
2

was worried plaintiff felt his life would become harder and more difficult without medical help. Plaintiff felt

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sudden and extreme tenor, and sharp sorrow and annoyance. Plaintiff felt dishonored and disgraced and was

2
4

disappointed by the actions or omissions of Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHCJA

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YANG. Plaintiff felt a loss of pride, self-respect and dignity. Plaintiff felt burdened with shame and self-

2
6

conscience and was injured in mind and body.

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28

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 13

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 14 of 18

115.The actions or omissions of Defendants TIM PEREZ, MUHAMMAD FAROOQ,BAHUA YANG alleged
above were willful, wanton, deliberate, reckless, oppressive and improper and justify the awarding of exen
and punitive damages.

VI. DAMAGES
116.On or about 05/08/14 through 01/29/16 Plaintiff sustained consistent moderate to severe acute pain, redness,
irritation, discomfort, and tearing for his left eye.
1 17.On or about 05/08/14 through 01/29/16 Plaintiff sustained consistent moderate to severe acute pain to his left
eye socket and front le8 cranial lobe.
118.On or about 05/08/14 through 01/29/16 Plaintiff has suffered great hardship and undue burden placed upon his
daily living activities.
1 19. On or about 05/08/14 through 01/29/16 Plaintiff has suffered extended mental anguish and emotional distress.

VII. PRAYER FOR RELIEF
120. Plaintiff has no plain or adequate or complete remedy at law to redress the wrongs described in this complaint.
121.Plaintiff has been and will continue to be irreparably injured by the conduct of defendants unless this court
grants declatory and compensatory relief and other such relief plaintiff seeks.
122.WHEREFORE; Plaintiff respectfully prays that this court enter judgment granting Plaintiff:
123.A declaration that acts and omissions described herein violated plaintiffls rights under the constitution of laws
under the united states and the constitution of laws of California.
124.Award plaintiff the following compensatory damages against all defendants jointly and severally as follows;
As to past and future mind and body injuries ....................................................... $2,000,000
As to past and future medical and mental care ...................................................... $1,000,000
As to past and future physical, mental, and emotional pain and suffering ...................... $1,000,000
As to punitive and exemplary damages ............................................................. $1,000,000
TOTAL ...................................................................................................$5,000,000
125.Plaintiff requests nominal damages in an unknown amount.
126.Plaintiff requests a jury trial for all matters triable by jury.

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 14

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 15 of 18

127.Plaintiff requests his costs and expenses in suit.
128.Plaintiffrequests reasonable attorney fees in suit.
129.Plaintiff requests any additional relief this court deems just, proper, and equitable.

VERIFICATION

I DECLARE UNDER THE PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA
THAT THE FORGOING IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. AS TO MATTERS
BASED UPON BELIEF AND INFORMATION I BELIEVE THEM TO BE TRUE TO THE BEST OF MY
KNOWLEDGE.

RESPECTFULLY SUBMITTED

XJ .
DANIEL COHEN
PRO-SE

DATED THIS 27TH DAY OF JANUARY 2017

CIVIL RIGHTS COMPLAINT PURSUANT TO 42 U.S.C. § 1983 PG - 15

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 16 of 18
UNITED STATES DISTRICT COURT,CENTRAL DISTRICT OF CALIFORNIA
CIVI} COVER SHEET
I (a)PLAINTIFFS (Check box if you are representin yourself [,/~)
.

___.
L~ ~
.

~~

x if ou are represe tin

ourself ~ )

County of Residence of First Listed Defendant

y~~(~
(b) County of Residence of First Listed Plaintiff ~s~j

(IN U.S. PLAINTIFF CASES ONLY)

~

EXCEPTIN U.S. PLAINTIFF CASES)
(

Chec

DE END NTS

A~A~o.~~~x,~~,va
~,s.~osh
s
r~'~
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~m~z
~
`I~es ~-3~
LpS

Attorneys (Firm Name,Address and Telephone Number) If you are
representing yourself, provide the same information.

( Attorneys(Firm Name,Address and Telephone Number) If you are
c)
representing yourself, provide the same information.

566 .S~p~ sfi. LosA~~,eA 9~i3
III. CITIZENSHIP OF PRINCIPAL PARTIES-For Diversity Cases Only
(Place an X in one box for plaintiff and one for defendant)

11. BASIS OF JURISDICTION (Place an X in one box only.)
1. U.S. Government
Plaintiff

~3. Federal Question (U.S.

Citizen of This State

Government Not a Party)
Citizen of Another State

2 U.S. Government
.
Defendant

Citizen or Subject of a
Foreign Country

~4. Diversity (Indicate Citizenship
of Parties in Item III)

DEF 1

Incorporated or Principal Place
of Business in this State
~ z ~ 2 Incorporated and Principal Place
of Business in Another State
3
3 Foreign Nation

P~~

IV.ORIGIN (Place an X in one box only.)
4. Reinstated or
5. Transferred from Another u
3. Remanded from
2. Removed from
y 1.Original
~
~ District (Specify)
~ Appellate Court ~ Reopened
proceeding ~ State Court

s. nnultidistria
Litigation Transfer

LrJ

V REQUESTED IN COMPLAINT: JURY DEMAND:
.

Yes ~ No

aF 4 DEF 4
u
u 5 ~ 5
~ 6 ~ 6

s. Multidistria
~

Litigation Direct File

(Check "Yes" only if demanded in complaint.)

.
[~ MONEY DEMANDED IN COMPLAINT: $ 5 rpn _ DoC~

CLA55 ACTION under F.R.Cv.P.23: ~ Yes ~ No

VI. CAUSE OF ACTION (Cite the U.S. Civil Statute under which you are filing and write a brief statement of cause. Do not citejurisdictional statutes unless diversity.)

VII. NATURE OF SUIT (Place an X in one box only).
~
fYl'

EtS'C11TU'i~5

375 False Claims Act
376 Qui Tam
( USC 3729(a))
31
4 State
00
Reapportionment

CONTRACT

~ 240 Torts to Land

u 120 Marine

~ X45 Tort Product

~ ~ 30 Miller Ad

~ 290 AI Other Real
Property

140 Negotiable
u Instrument
410 Antitrust
150 Recovery of
&
430 Banks and Banking u ~
for~cey
ent o
4 Commerce/ICC
50
Judgment
Rates/Etc.
u 151 Medicare Ad
60
u 4 Deportation
152 Recovery of
470 Racketeer Influenced & CorruPt Or9•
u Defaulted Student
Loan (Excl. Vet.)
u 480 Consumer Credit
153 Recovery of
490 Cable/Sat N
Overpayment of
850 Securities/ComVet. Benefits
modities/Exchange
160 Stockholders'
~ Suits
890 Other Statutory
Actions
190 Other
891 Agricultural Acts
Contred
8 Environmental
93
Contract
Matters
~ 195
Product Liability
895 Freedom of Info.
Act
u 196 Franchise

u

TY CE31~11".

RE1~L P

u 110 Insurance

`~
_
PERSQNAL INJURY

i1~tNit~RATICIlV
~ 462 Naturalization
Application

P~R15dN~R

DNS

Habeas Corpus:

~ 463 Alien Detainee
ns to Vacate
~ mmgaton Actions ~ Sentence
~ fp~i~
~ 530 General
PERSONAL PROPERTY u 535 Death Penalty
~ 370 Other Fraud
Other:

'f~ HTS
~ 820 Copyrights
~ 830 Patent
~~
Trademark
"'"
S
~ 861 HIA (1395ffl

~ 862 Black Lung (923)
~ 310 Airplane
~ 371 Truth in Lending
amus/Other ~ g63 DIWGDIWW(405(g))
~ 315 Airplane
5
Product Liability
380 Other Persona
9hts
~ 864 SSID Title XVI
on Condition
320 Assault, Libel & ~ Property Damage
~ 865 R51(405 (g))
~ Slander
385 Property Damage
60 Civil Detainee
330 Fed. Employers' ~ Product Liability
u Conditions of
E ! S~SEfS
TA%
u Liability
Confinement
UPTCY
BA
870 Taxes(U.S. Plaintiff or
~ 340 Marine
pOf~F~ITUI~JP~`NALTY u Defendant)
422 Appeal 28
abiMriine Product u USC 758
~ 871 IRS-Third Party 26 USC
625 Drug Related
u L
7609
423 Withdrawal 28 ~ Seizure of Property 21
USC 881
~ 350 Motor Vehicle
u U5~ 757
u 690 Other
355 Motor Vehicle
~ Product Liability
vil Rights
~
360 Other Personal
710 Fair Labor Standards
u Injury
~ 441 Voting
Act
rsonal Injury~ 720 Labor/M9mt.
a pratice
u 442 Employment
Relations
443 Housing/
365 Personal InjuryAccommodations
u Product Liability
~ 740 Railway Labor Ad
~5 American with
~~~'~~~~ ~
896 Arbitration
67
3 Health Care/
~ 751 Family and Medical
❑DisabilitiesPharmaceutical
210 Land
Leave Ad
Employment
899 Admin. Procedures ~ condemnation
~ Personal Injury
790 Other Labor
AcUReview of Appeal of
446 American with
Product Liability
220 Foreclosure
~
~ Litigation
Agency Decision
~ Disabilities-Other
368 Asbestos
791 Employee Ret.lnc.
230 Rent Lease & ~ personal In~u
9 Constitutionality of
50
Education
u Security Act
~ ~8
State Statutes
~ E'ectment
Product Liabili~

FOR OFFICE USE ONLY:
CV-71 (07/76)

Case Number.

1
CIVIL COVER SHEET

Page 1 of 3

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 17 of 18
UNITED STATES DISTRICT COURT,CENTRAL DISTRICT OF CALIFORNIA
CIVIL COVER SHEET
VIII. VENUE: Your answers to the questions below will determine the division of the Court to which this case will be initially assigned. This initial assignment is subject
to change, in accordance with the Court's General Orders, upon review by the Court of your Complaint or Notice of Removal.
QUESTION A: Was this case removed
from state court?
Yes ~No

INRIAL b~V€SION IN CACD l5:

s

STATE CASE WAS PENDING 1N THE COUNTY OF:

Western

Los Angeles, Ventura, Santa Barbara,or San Luis Obispo
If"no," skip to Question B. If "yes," check the
u Orange
box to the right that applies,enter the
corresponding division in response to
Bernardino
Question E, below,and continue from there. u Riverside or San
—
___
—
--

Southern
Eastern
°~

QUESTION B: Is the United States,or 6.1• Do SU~Yo or more of the defendants who reside in
the district reside in Orange Co.?
one of its agencies or employees,a
PLAINTIFF in this action?
~~
check one ofthe boxes to the right
Yes ~No

If"no,"skip to Question C. If "yes," answer
Question 6.1, at right.

8.2. Do 50% or more of the defendants who reside in
the district reside in Riverside and/or San Bernardino
Counties? (Consider the two counties together.)
check one ofthe boxes to the right

♦

YES. Your case will initially be assigned to the Southern Division.
~ Enter "Southern" in response to Question E, below,and continue
from there.
~ NO. Continue to Question B.2.
YES. Your case will initially be assigned to the Eastern Division.
~ Enter "Eastern" in response to Question E, below,and continue
from there.
NO. Your case will initially be assigned to the Western Division.
Enter "Western" in response to Question E, below,and continue
from there.

.
..
QUESTION C: Is the United States,or C.7. Do 50% or more of the plaintiffs who reside in the
YES. Your case will initially be assigned to the Southern Division.
district reside in Orange Co.?
~ Enter "Southern" in response to Question E, below,and continue
one of its agencies or employees,a
from there.
DEFENDANT in this a~n?
check one ofthe boxes to the right
~~
Yes
No
~ NO. Continue to Question C.2.

If"no,"skip to Question D. If"yes," answer
Question C.1,at ri9ht.

C.2. Do 50% or more of the plaintiffs who reside in the
YES. Your case will initially be assigned to the Eastern Division.
district reside in Riverside and/or San Bernardino
u Enter "Eastern" in response to Question E, below,and continue
~ (Consider the two counties together.)
Counties.
from there.
check one ofthe boxes to the right

♦

QUESTION D: Location of plaintiffs and defendants?

NO. Your case will initially be assigned to the Western Division.
Enter "Western" in response to Question E, below,and continue
from there.

Orange County

Riverside or San
Bemardlno County

C.
tos Angeles, Ventura,
Santa Barbara,or San
Luis Obis
County j

Indicate the locations) in which 50% or more of plaintiffs who reside in this district
reside. (Check up to two boxes,or leave blank if none of these choices apply.)
Indicate the locations) in which 50% or more of defendants who reside in this
district reside. (Check up to two boxes, or leave blank if none of these choices
apply.)
D.2. Is there at least one answer in Column B?

D.1. Is there at least one answer in Column A?
Yes

~ Yes

[~No

[✓ No
/

If"yes," your case will initially be assigned to the

If"yes," your case will initially be assigned to the
SOUTHERN DIVISION.

EASTERN DIVISION.

Enter "Southern" in response to Question E, below,and continue from there.

Enter "Eastern" in response to Question E, below.

If"no," go to question D2 to the right.

If"no," your case will be assigned to the WESTERN DIVISION.

~~

Enter "Western" in response to Question E, below.

j,

lN~71AL DIV151U~1lN CACD

+QL1E5'flt?N E: Initial DivisionT
Enter the initial division determined by Question A, B, C, or D above: ~~

~~ ~~(,~~J~~~

QUESTION F: Northern Counties?
Do 50% or more of plaintiffs or defendants in this district reside in Ventura, Santa Barbara, or San Luis Obispo counties?
CV-71 (07/16)

CIVIL COVER SHEET

~ Yes

No
Page 2of 3

Case 1:17-cv-00191-MJS Document 1 Filed 01/27/17 Page 18 of 18
DISTRICT COURT,CENTRAL DISTRICT OF CALIFORNIA
UNITED STATES

CIVIL COVER SHEET
~O

IX(a). IDENTICAL CASES: Has this action been previously filed in this court?

~ YES

If yes, list case number(s):

IX(b). RELATED CASES: Is this case related (as defined below)to any civil or criminal cases) previously filed in this court?
NO
If yes, list case number(s):

~'
~

`5 — 3 ~~
5

~ES

~1~ Y
` ~~~T~

Civil cases are related when they(check all that apply):
A. Arise from the same or a closely related transaction, happening,or event;
B Call for determination of the same or substantially related or similar questions of law and fact; or
.
~ For other reasons would entail substantial duplication of labor if heard by differentjudges.
C.
Note: That cases may involve the same patent,trademark, or copyright is not,in itself, sufficient to deem cases related.

A civil forfeiture case and a criminal case are related when they(check all that apply):
A. Arise from the same or a closely related transaction, happening,or event;
B. Call for determination of the same or substantially related or similar questions of law and fact; or
C Involve one or more defendants from the criminal case in common and would entail substantial duplication of
.
labor if heard by differentjudges.

X SIGNATURE OF ATTORNEY
.
ORSELF-REPRESENTED LITIG
(

DATE:

Notice to Counsel/Parties: The submission of this Civil Cover Sheet is required by Local Rule 3-1. This Form N-71 and the information contained herein
neither replaces nor supplements the filing and service of pleadings or other papers as required bylaw,except as provided by local rules of court. For
more detailed instructions, see separate instruction sheet(N-071 A).

Key to Statistical codes relating to Social Security Cases:

861

HIA

Substantive Statement of Cause of Action
All claims for health insurance benefits(Medicare) under Title 18, Part A,ofthe Social Security Ad,as amended. Also,
include claims by hospitals,skilled nursing facilities, etc.,for certification as providers ofservices under the program.
( U.S.C.1935FF(b))
42

62
8

BL

All claims for "Black Lung" benefits under Title 4,Part B,of the Federel Goal Mine Health and Safety Ad of 1969.(30 U.S.C.
923)

863

DIWC

All claims filed by insured workers for disability insurance benefits under Title 2 of the Social Security Ad,as amended; plus
all claims filed for child's insurance benefiu based on disability. (42 U.S.C.405(g))

63
8

DIWW

All claims filed for widows or widowers insurence benefits based on disability under Title 2 of the Social Security Ad,as
amended.(42 U.S.C.405(g))

8
64

SSID

All claims for supplemental security income payments based upon disability filed under Title 16 ofthe Social Security Ad,as
amended.

65
8

RSI

Nature of Suit Code

N-71 (07/76)

Abbreviation

All claims for retirement(old age)and survivors benefits under Title 2 of the Social Security Ad,as amended.
( U.S.C.405(g))
42

CIVIL COVER SHEET

Page 3 of 3