Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_20-cv-00201/USCOURTS-azd-2_20-cv-00201-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 42:1983 Prisoner Civil Rights

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WO JL

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Bruce J. Dent, Jr.,

Plaintiff, 

v. 

Corizon Incorporated, et al.,

Defendants.

No. CV 20-00201-PHX-MTL (DMF)

ORDER

Plaintiff Bruce J. Dent, Jr., who is confined in the Arizona State Prison ComplexYuma, has filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 (Doc. 1) and 

an Application to Proceed In Forma Pauperis (Doc. 2). The Court will dismiss the 

Complaint with leave to amend. 

I. Application to Proceed In Forma Pauperis and Filing Fee

The Court will grant Plaintiff’s Application to Proceed In Forma Pauperis. 28 

U.S.C. § 1915(a). Plaintiff must pay the statutory filing fee of $350.00. 28 U.S.C. 

§ 1915(b)(1). The Court will not assess an initial partial filing fee. Id. The statutory filing 

fee will be collected monthly in payments of 20% of the previous month’s income credited 

to Plaintiff’s trust account each time the amount in the account exceeds $10.00. 28 U.S.C. 

§ 1915(b)(2). The Court will enter a separate Order requiring the appropriate government 

agency to collect and forward the fees according to the statutory formula.

....

....

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II. Statutory Screening of Prisoner Complaints

The Court is required to screen complaints brought by prisoners seeking relief 

against a governmental entity or an officer or an employee of a governmental entity. 28 

U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 

has raised claims that are legally frivolous or malicious, that fail to state a claim upon which 

relief may be granted, or that seek monetary relief from a defendant who is immune from 

such relief. 28 U.S.C. § 1915A(b)(1)–(2). 

A pleading must contain a “short and plain statement of the claim showing that the 

pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 

not demand detailed factual allegations, “it demands more than an unadorned, thedefendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 

(2009). “Threadbare recitals of the elements of a cause of action, supported by mere 

conclusory statements, do not suffice.” Id.

“[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 

claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 

550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 

that allows the court to draw the reasonable inference that the defendant is liable for the 

misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 

relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 

experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 

allegations may be consistent with a constitutional claim, a court must assess whether there 

are other “more likely explanations” for a defendant’s conduct. Id. at 681.

But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 

must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 

(9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 

standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 

U.S. 89, 94 (2007) (per curiam)). 

If the Court determines that a pleading could be cured by the allegation of other 

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facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 

of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). 

Plaintiff’s Complaint will be dismissed for failure to state a claim, but because it may 

possibly be amended to state a claim, the Court will dismiss it with leave to amend.

III. Complaint

In his four-count Complaint, Plaintiff sues the former contracted healthcare provider 

for the Arizona Department of Corrections, Corizon Inc. (“Corizon”),1former ADC

Director Charles L. Ryan,2 Facility Health Administrator (FHA) Adam Perkins, and 

Assistant FHA Michael Delgado. Plaintiff asserts claims related to his medical care. He 

seeks monetary relief.

In Count One, Plaintiff alleges that on February 5, 2018, he sustained a serious 

work-related injury. Plaintiff was x-rayed the next day, and the x-ray showed there were 

no broken bones or fractures. Plaintiff immediately requested an MRI and CT scan. 

Plaintiff asserts that Defendant Corizon did not “want to pay for a[n] MRI or CT scan” 

because “they” thought his injury was not serious enough, and his requests were denied. 

Plaintiff filed a complaint at the administrative level and requested to be seen by a certified 

specialist. He was sent out for “hand therapy,” which caused further damage. Plaintiff 

claims Corizon knew the full extent of his injury and “made it that much worse.” Plaintiff 

continued to request an MRI and CT scan but was “disregarded” for eight months before 

he finally underwent an MRI. The MRI showed a longitudinal split of the radial collateral 

ligament of the third-MCP, third-MCP joint effusions, and a slight volar subluxation of the 

proximal phalanx relative to the metacarpal. Plaintiff underwent reconstructive surgery for 

his hand. The surgeon who operated on Plaintiff told him, “You only have a 50% chance 

of recovery, due to you not getting in to see us” earlier. 

Plaintiff alleges that because of Corizon’s “procrastination and inadequate 

1 As of July 1, 2019, the contracted healthcare provider for ADC prisoners is 

Centurion Health LLC.

2 Charles Ryan stepped down as ADC Director on September 13, 2019. David Shinn 

is the current ADC Director.

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healthcare,” he did not undergo an MRI “in a timely manner,” which resulted in a “saddle 

deformity.” Plaintiff asserts that Corizon “has a history of malpractice” and has been held 

in contempt of court due to its inadequate healthcare services. Plaintiff claims he has 

suffered severe pain and discomfort “for quite some time” because of the split and torn 

ligaments. He is permanently injured because his injuries were not diagnosed “until it was 

too late.” Plaintiff alleges that Corizon deliberately disregarded his injury by 

“generalizing” his injury with those of others, stating that these types of injuries tend to 

heal themselves. Plaintiff asserts that as a result of the saddle deformity, he is “disabled 

for life” and will not be able to join the workforce upon his release from prison, nor will 

he be able to take a job that requires full use of both hands. Plaintiff also is currently 

suffering the onset of arthritis.

In Count Two, Plaintiff alleges that Defendant Ryan contracted with Corizon to 

provide healthcare to ADC prisoners, and it was Ryan’s duty to ensure prisoners received 

adequate healthcare. Plaintiff asserts that Ryan knew Corizon was neglecting the duties 

set forth in the contract. Plaintiff claims Ryan “cannot release himself from contractual 

obligations” without terminating the contract with Corizon, and Ryan is therefore 

responsible for the violation of Plaintiff’s right to adequate healthcare. Plaintiff alleges 

that because of Ryan’s indifference to his contractual obligations, Plaintiff is suffering from 

permanent damage. Plaintiff asserts he has suffered unnecessary pain and discomfort in 

performing his daily activities because of the untreated ligament damage.

In Count Three, Plaintiff alleges that Defendant Perkins, Corizon’s Facility Health 

Administrator, had a duty to monitor healthcare services. Plaintiff asserts that Perkins 

approves or disapproves all off-unit appointments. Plaintiff claims that providers at Central 

Unit told him that all decisions regarding treatment for serious injuries are made at the 

FHA level, and Perkins was the “overseer” at the time Plaintiff’s requests for an MRI and 

CT scan were denied. Plaintiff alleges he “was denied” for eight months and was only 

given the MRI because he sought help from a third-party intervener, who has “had a hand 

in forcing Corizon to take better care of its patients.” Plaintiff asserts that Perkins approved 

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physical therapy without knowing the full extent of Plaintiff’s injuries, which resulted in 

further damage and unnecessary pain and suffering. Plaintiff claims he submitted “quite a 

few” Health Needs Requests (HNRs) at the FHA level but did not receive a response 

notifying him of any actions that would be taken. Plaintiff alleges that because of Perkins’s 

“total disregard” for Plaintiff’s serious injury, his hand healed “completely wrong.” 

Plaintiff asserts that he had reconstructive surgery “to no avail,” because of Perkins’s 

“deliberate neglect,” and as a result, Plaintiff is “permanently mangled.”

In Count Four, Plaintiff alleges that Defendant Delgado, as Corizon’s Assistant 

FHA, was supposed to advocate for Plaintiff’s “medical issues,” especially serious injuries. 

Plaintiff asserts that providers at Central Unit requested MRIs and CT scans but were 

“rejected” because Corizon administrators “want[ed] to keep the corporation’s costs 

down.” Plaintiff claims that after consistent complaints and third-party assistance, Corizon 

“finally decided” to send him out for an MRI, “only to find out that there were a number 

of things wrong” with his hand. Plaintiff alleges that before he had the MRI, he was sent 

out to physical therapy for six weeks, but he could not endure any more pain at that time. 

Plaintiff asserts that Corizon, via its administrators, refused to send him out to continue 

therapy and told Plaintiff that the physical therapy exercises could be done in his cell. 

Plaintiff claims after the “post-therapy waiting period,” he sought help from the Prison Law 

Office to get an MRI and a consultation with a specialist. Plaintiff alleges the specialist 

told him that because Plaintiff was not seen in a timely manner, he would most likely suffer 

from permanent damage. Plaintiff asserts his surgeon made the same statement “in so 

many words.”

IV. Failure to State a Claim

Although pro se pleadings are liberally construed, Haines v. Kerner, 404 U.S. 519, 

520-21 (1972), conclusory and vague allegations will not support a cause of action. Ivey 

v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982). Further, a 

liberal interpretation of a civil rights complaint may not supply essential elements of the 

claim that were not initially pled. Id. 

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A. Defendant Corizon

To state a claim under § 1983 against a private entity performing a traditional public 

function, such as providing medical care for prisoners, a plaintiff must allege facts to 

support that his constitutional rights were violated as a result of a policy, decision, or 

custom promulgated or endorsed by the private entity. See Tsao v. Desert Palace, Inc., 

698 F.3d 1128, 1138-39 (9th Cir. 2012); Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 

1997). A plaintiff must allege the specific policy or custom and how it violated his 

constitutional rights. A private entity is not liable merely because it employs persons who 

allegedly violated a plaintiff’s constitutional rights. See Tsao, 698 F.3d at 1138-39; 

Buckner, 116 F.3d at 452.

Plaintiff has not alleged that any of the conduct described in the Complaint was the 

result of a specific policy or custom of Defendant Corizon. Thus, the Court will dismiss 

without prejudice Defendant Corizon.

B. Defendants Ryan, Perkins, and Delgado

To state a valid claim under § 1983, plaintiffs must allege that they suffered a 

specific injury as a result of specific conduct of a defendant and show an affirmative link 

between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 

371-72, 377 (1976). There is no respondeat superior liability under § 1983, and therefore, 

a defendant’s position as the supervisor of persons who allegedly violated Plaintiff’s 

constitutional rights does not impose liability. Monell v. Dep’t of Soc. Servs. of New York, 

436 U.S. 658 (1978); Hamilton v. Endell, 981 F.2d 1062, 1067 (9th Cir. 1992); Taylor v. 

List, 880 F.2d 1040, 1045 (9th Cir. 1989). “Because vicarious liability is inapplicable to 

Bivens and § 1983 suits, a plaintiff must plead that each Government-official defendant, 

through the official’s own individual actions, has violated the Constitution.” Iqbal, 556 

U.S. at 676. 

Plaintiff has not alleged that Defendants Ryan, Perkins, or Delgado personally 

participated in a deprivation of Plaintiff’s constitutional rights, were aware of a deprivation 

and failed to act, or formed policies that resulted in Plaintiff’s injuries. Plaintiff’s vague 

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and conclusory allegations concerning these Defendants’ conduct are insufficient to 

support a conclusion that Ryan, Perkins, or Delgado was personally involved in or aware 

of Plaintiff’s injuries or treatment. Plaintiff alleges that he repeatedly requested an MRI 

and CT scan for eight months, but he provides no detail regarding any such request, 

including when or to whom he made a request or the response to his request. Similarly, 

Plaintiff vaguely claims he submitted “quite a few” HNRs, but he provides no detail about 

any such HNRs, including when or to whom he submitted an HNR, the information he 

included in the HNR, or the response, if any, to the HNR. Plaintiff speculates that 

Defendant Perkins denied requests for offsite appointments merely because unidentified 

providers told Plaintiff decisions regarding offsite appointments were made “at the FHA 

level,” and Perkins was the “overseer” at the time, but Plaintiff does not allege any facts to 

support a conclusion that Perkins was aware of Plaintiff’s injury or treatment. Plaintiff also 

does not provide sufficient detail about the physical therapy he underwent, such as when 

or who ordered physical therapy or why the physical therapy caused further damage to his 

hand. 

In sum, Plaintiff’s allegations in the Complaint are insufficient to state a claim 

against Defendants Ryan, Perkins, and Delgado, and these Defendants will therefore be 

dismissed. 

V. Leave to Amend

For the foregoing reasons, Plaintiff’s Complaint will be dismissed for failure to state 

a claim upon which relief may be granted. Within 30 days, Plaintiff may submit a first 

amended complaint to cure the deficiencies outlined above. The Clerk of Court will mail 

Plaintiff a court-approved form to use for filing a first amended complaint. If Plaintiff fails 

to use the court-approved form, the Court may strike the amended complaint and dismiss 

this action without further notice to Plaintiff.

Plaintiff must clearly designate on the face of the document that it is the “First 

Amended Complaint.” The first amended complaint must be retyped or rewritten in its 

entirety on the court-approved form and may not incorporate any part of the original 

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Complaint by reference. Plaintiff may include only one claim per count.

A first amended complaint supersedes the original Complaint. Ferdik v. Bonzelet, 

963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. Richard Feiner & Co., 896 F.2d 

1542, 1546 (9th Cir. 1990). After amendment, the Court will treat the original Complaint 

as nonexistent. Ferdik, 963 F.2d at 1262. Any cause of action that was raised in the 

original Complaint and that was voluntarily dismissed or was dismissed without prejudice 

is waived if it is not alleged in a first amended complaint. Lacey v. Maricopa County, 693 

F.3d 896, 928 (9th Cir. 2012) (en banc).

If Plaintiff files an amended complaint, Plaintiff must write short, plain statements 

telling the Court: (1) the constitutional right Plaintiff believes was violated; (2) the name 

of the Defendant who violated the right; (3) exactly what that Defendant did or failed to 

do; (4) how the action or inaction of that Defendant is connected to the violation of 

Plaintiff’s constitutional right; and (5) what specific injury Plaintiff suffered because of 

that Defendant’s conduct. See Rizzo, 423 U.S. at 371-72, 377.

Plaintiff must repeat this process for each person he names as a Defendant. If 

Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 

injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 

failure to state a claim. Conclusory allegations that a Defendant or group of 

Defendants has violated a constitutional right are not acceptable and will be 

dismissed.

Plaintiff should be aware that not every claim by a prisoner relating to inadequate 

medical treatment states a violation of the Eighth Amendment. To state a § 1983 medical 

claim, a plaintiff must show (1) a “serious medical need” by demonstrating that failure to 

treat the condition could result in further significant injury or the unnecessary and wanton 

infliction of pain and (2) the defendant’s response was deliberately indifferent. Jett v. 

Penner, 439 F.3d 1091, 1096 (9th Cir. 2006).

“Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 

1051, 1060 (9th Cir. 2004). To act with deliberate indifference, a prison official must both 

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know of and disregard an excessive risk to inmate health; “the official must both be aware 

of facts from which the inference could be drawn that a substantial risk of serious harm 

exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 

Deliberate indifference in the medical context may be shown by a purposeful act or failure 

to respond to a prisoner’s pain or possible medical need and harm caused by the 

indifference. Jett, 439 F.3d at 1096. Deliberate indifference may also be shown when a 

prison official intentionally denies, delays, or interferes with medical treatment or by the 

way prison doctors respond to the prisoner’s medical needs. Estelle v. Gamble, 429 U.S. 

97, 104-05 (1976); Jett, 439 F.3d at 1096.

Deliberate indifference is a higher standard than negligence or lack of ordinary due 

care for the prisoner’s safety. Farmer, 511 U.S. at 835. “Neither negligence nor gross 

negligence will constitute deliberate indifference.” Clement v. California Dep’t of Corr., 

220 F. Supp. 2d 1098, 1105 (N.D. Cal. 2002); see also Broughton v. Cutter Labs., 622 F.2d 

458, 460 (9th Cir. 1980) (mere claims of “indifference,” “negligence,” or “medical 

malpractice” do not support a claim under § 1983). “A difference of opinion does not 

amount to deliberate indifference to [a plaintiff’s] serious medical needs.” Sanchez v. Vild, 

891 F.2d 240, 242 (9th Cir. 1989). A mere delay in medical care, without more, is 

insufficient to state a claim against prison officials for deliberate indifference. See Shapley 

v. Nevada Bd. of State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985). The 

indifference must be substantial. The action must rise to a level of “unnecessary and 

wanton infliction of pain.” Estelle, 429 U.S. at 105.

VI. Warnings

A. Release

If Plaintiff is released while this case remains pending, and the filing fee has not 

been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 

that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 

(2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 

result in dismissal of this action.

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B. Address Changes

Plaintiff must file and serve a notice of a change of address in accordance with Rule 

83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 

relief with a notice of change of address. Failure to comply may result in dismissal of this 

action.

C. Possible “Strike”

Because the Complaint has been dismissed for failure to state a claim, if Plaintiff 

fails to file an amended complaint correcting the deficiencies identified in this Order, the 

dismissal may count as a “strike” under the “3-strikes” provision of 28 U.S.C. § 1915(g). 

Under the 3-strikes provision, a prisoner may not bring a civil action or appeal a civil 

judgment in forma pauperis under 28 U.S.C. § 1915 “if the prisoner has, on 3 or more prior 

occasions, while incarcerated or detained in any facility, brought an action or appeal in a 

court of the United States that was dismissed on the grounds that it is frivolous, malicious, 

or fails to state a claim upon which relief may be granted, unless the prisoner is under 

imminent danger of serious physical injury.” 28 U.S.C. § 1915(g). 

D. Possible Dismissal

If Plaintiff fails to timely comply with every provision of this Order, including these 

warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 

at 1260-61 (a district court may dismiss an action for failure to comply with any order of 

the Court).

IT IS ORDERED: 

(1) Plaintiff’s Application to Proceed In Forma Pauperis (Doc. 2) is granted.

(2) As required by the accompanying Order to the appropriate government 

agency, Plaintiff must pay the $350.00 filing fee and is not assessed an initial partial filing 

fee.

(3) The Complaint (Doc. 1) is dismissed for failure to state a claim. Plaintiff 

has 30 days from the date this Order is filed to file a first amended complaint in compliance 

with this Order.

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(4) If Plaintiff fails to file an amended complaint within 30 days, the Clerk of 

Court must, without further notice, enter a judgment of dismissal of this action with 

prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g)

and deny any pending unrelated motions as moot.

(5) The Clerk of Court must mail Plaintiff a court-approved form for filing a 

civil rights complaint by a prisoner.

Dated this 29th day of January, 2020.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 11 of 21
Revised 3/11/16 1

Instructions for a Prisoner Filing a Civil Rights Complaint 

in the United States District Court for the District of Arizona

1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated 

persons prepare a complaint seeking relief for a violation of their federal civil rights. These 

complaints typically concern, but are not limited to, conditions of confinement. This form

should not be used to challenge your conviction or sentence. If you want to challenge a state 

conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas 

corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you 

should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the 

judgment. 

2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4(a) provides that complaints by 

incarcerated persons must be filed on the court-approved form. The form must be typed or 

neatly handwritten. The form must be completely filled in to the extent applicable. All questions 

must be answered clearly and concisely in the appropriate space on the form. If needed, you may 

attach additional pages, but no more than fifteen additional pages, of standard letter-sized 

paper. You must identify which part of the complaint is being continued and number all pages. If 

you do not fill out the form properly, you will be asked to submit additional or corrected 

information, which may delay the processing of your action. You do not need to cite law. 

3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a 

material fact, you may be prosecuted for perjury.

4. The Filing and Administrative Fees. The total fees for this action are $400.00 ($350.00 filing 

fee plus $50.00 administrative fee). If you are unable to immediately pay the fees, you may 

request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking 

Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant 

to 28 U.S.C. ' 1915” for additional instructions.

5. Original and Judge=s Copy. You must send an original plus one copy of your complaint and 

of any other documents submitted to the Court. You must send one additional copy to the Court if 

you wish to have a file-stamped copy of the document returned to you. All copies must be 

identical to the original. Copies may be legibly handwritten. This section does not apply to 

inmates housed at an Arizona Department of Corrections facility that participates in 

electronic filing.

6. Where to File. You should file your complaint in the division where you were confined 

when your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined 

in Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were 

confined in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. 

If you were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the 

Tucson Division. Mail the original and one copy of the complaint with the $400 filing and 

administrative fees or the application to proceed in forma pauperis to:

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 12 of 21
2

Phoenix & Prescott Divisions: OR Tucson Division:

U.S. District Court Clerk U.S. District Court Clerk

U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500

401 West Washington Street, SPC 10 405 West Congress Street

Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010

7. Change of Address. You must immediately notify the Court and the defendants in writing of 

any change in your mailing address. Failure to notify the Court of any change in your mailing 

address may result in the dismissal of your case.

8. Certificate of Service. You must furnish the defendants with a copy of any document you 

submit to the Court (except the initial complaint and application to proceed in forma pauperis). 

Each original document (except the initial complaint and application to proceed in forma pauperis) 

must include a certificate of service on the last page of the document stating the date a copy of the 

document was mailed to the defendants and the address to which it was mailed. See Fed. R. Civ. 

P. 5(a), (d). Any document received by the Court that does not include a certificate of service 

may be stricken. This section does not apply to inmates housed at an Arizona Department of 

Corrections facility that participates in electronic filing.

A certificate of service should be in the following form:

I hereby certify that a copy of the foregoing document was mailed

this (month, day, year) to:

Name: 

Address: 

 Attorney for Defendant(s)

 

(Signature)

9. Amended Complaint. If you need to change any of the information in the initial complaint, 

you must file an amended complaint. The amended complaint must be written on the 

court-approved civil rights complaint form. You may file one amended complaint without leave 

(permission) of Court within 21 days after serving it or within 21 days after any defendant has filed 

an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a motion for 

leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In addition, an 

amended complaint may not incorporate by reference any part of your prior complaint. LRCiv 

15.1(a)(2). Any allegations or defendants not included in the amended complaint are 

considered dismissed. All amended complaints are subject to screening under the Prison 

Litigation Reform Act; screening your amendment will take additional processing time.

10. Exhibits. You should not submit exhibits with the complaint or amended complaint. 

Instead, the relevant information should be paraphrased. You should keep the exhibits to use to 

support or oppose a motion to dismiss, a motion for summary judgment, or at trial.

11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of 

any judge. The only appropriate way to communicate with the Court is by filing a written 

pleading or motion.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 13 of 21
3

12. Completing the Civil Rights Complaint Form.

HEADING:

1. Your Name. Print your name, prison or inmate number, and institutional mailing 

address on the lines provided.

2. Defendants. If there are four or fewer defendants, print the name of each. If you 

name more than four defendants, print the name of the first defendant on the first line, 

write the words “and others” on the second line, and attach an additional page listing the 

names of all of the defendants. Insert the additional page after page 1 and number it 

“1-A” at the bottom.

3. Jury Demand. If you want a jury trial, you must write “JURY TRIAL DEMANDED”

in the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so 

may result in the loss of the right to a jury trial. A jury trial is not available if you are 

seeking only injunctive relief.

Part A. JURISDICTION:

1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. ' 1983 

for state, county, or city defendants; “Bivens v. Six Unknown Federal Narcotics Agents”

for federal defendants; or “other.” If you mark “other,” identify the source of that 

authority. 

2. Location. Identify the institution and city where the alleged violation of your rights 

occurred. 

3. Defendants. Print all of the requested information about each of the defendants in the 

spaces provided. If you are naming more than four defendants, you must provide the 

necessary information about each additional defendant on separate pages labeled “2-A,”

“2-B,” etc., at the bottom. Insert the additional page(s) immediately behind page 2.

Part B. PREVIOUS LAWSUITS:

You must identify any other lawsuit you have filed in either state or federal court while you 

were a prisoner. Print all of the requested information about each lawsuit in the spaces provided. 

If you have filed more than three lawsuits, you must provide the necessary information about each 

additional lawsuit on a separate page. Label the page(s) as “2-A,” “2-B,” etc., at the bottom of the 

page and insert the additional page(s) immediately behind page 2.

Part C. CAUSE OF ACTION:

You must identify what rights each defendant violated. The form provides space to allege 

three separate counts (one violation per count). If you are alleging more than three counts, you 

must provide the necessary information about each additional count on a separate page. Number 

the additional pages “5-A,” “5-B,” etc., and insert them immediately behind page 5. Remember 

that you are limited to a total of fifteen additional pages.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 14 of 21
4

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.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 15 of 21
Revised 3/11/16 1 550/555

___________________________________________

Name and Prisoner/Booking Number

___________________________________________ Place of Confinement

___________________________________________

Mailing Address

___________________________________________

City, State, Zip Code

(Failure to notify the Court of your change of address may result in dismissal of this action.)

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

_________________________________________ ,

(Full Name of Plaintiff)

)

Plaintiff,

v. 

(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. This Court has jurisdiction over this action pursuant to:

G 28 U.S.C. § 1343(a); 42 U.S.C. § 1983

G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971).

G Other: .

2. Institution/city where violation occurred: .

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 16 of 21
2

B. DEFENDANTS

1. Name of first Defendant: . The first Defendant is employed 

as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

2. Name of second Defendant: . The second Defendant is employed as:

as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

3. Name of third Defendant: . The third Defendant is employed 

as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

4. Name of fourth Defendant: . The fourth Defendant is employed 

as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.

C. PREVIOUS LAWSUITS

1. Have you filed any other lawsuits while you were a prisoner? G Yes G No

2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:

a. First prior lawsuit:

1. Parties: v. 

2. Court and case number: .

3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.

b. Second prior lawsuit:

1. Parties: v. 

2. Court and case number: .

3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.

c. Third prior lawsuit:

1. Parties: v. 

2. Court and case number: .

3. Result: (Was the case dismissed? Was it appealed? Is it still pending?)

.

If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 17 of 21
3

D. CAUSE OF ACTION

COUNT I

1. State the constitutional or other federal civil right that was violated: 

.

2. Count I. Identify the issue involved. Check only one. State additional issues in separate counts.

G Basic necessities G Mail G Access to the court G Medical care 

G Disciplinary proceedings G Property G Exercise of religion G Retaliation

G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts. State as briefly as possible the FACTS supporting Count I. Describe exactly what 

each Defendant did or did not do that violated your rights. State the facts clearly in your own words without 

citing legal authority or arguments.

.

4. Injury. State how you were injured by the actions or inactions of the Defendant(s).

.

5. Administrative Remedies:

a. Are there any administrative remedies (grievance procedures or administrative appeals) available at 

your institution? G Yes G No

b. Did you submit a request for administrative relief on Count I? G Yes G No

c. Did you appeal your request for relief on Count I to the highest level? G Yes G No

d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you 

did not. 

.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 18 of 21
4

COUNT II

1. State the constitutional or other federal civil right that was violated: 

.

2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts.

G Basic necessities G Mail G Access to the court G Medical care 

G Disciplinary proceedings G Property G Exercise of religion G Retaliation

G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts. State as briefly as possible the FACTS supporting Count II. Describe exactly what 

each Defendant did or did not do that violated your rights. State the facts clearly in your own words without 

citing legal authority or arguments.

.

4. Injury. State how you were injured by the actions or inactions of the Defendant(s).

.

5. Administrative Remedies.

a. Are there any administrative remedies (grievance procedures or administrative appeals) available at 

your institution? G Yes G No

b. Did you submit a request for administrative relief on Count II? G Yes G No

c. Did you appeal your request for relief on Count II to the highest level? G Yes G No

d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you 

did not. 

.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 19 of 21
5

COUNT III

1. State the constitutional or other federal civil right that was violated: 

.

2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts.

G Basic necessities G Mail G Access to the court G Medical care 

G Disciplinary proceedings G Property G Exercise of religion G Retaliation

G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts. State as briefly as possible the FACTS supporting Count III. Describe exactly what 

each Defendant did or did not do that violated your rights. State the facts clearly in your own words without 

citing legal authority or arguments.

.

4. Injury. State how you were injured by the actions or inactions of the Defendant(s).

.

5. Administrative Remedies.

a. Are there any administrative remedies (grievance procedures or administrative appeals) available at 

your institution? G Yes G No

b. Did you submit a request for administrative relief on Count III? G Yes G No

c. Did you appeal your request for relief on Count III to the highest level? G Yes G No

d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you 

did not. 

.

If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 20 of 21
6

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.

Case 2:20-cv-00201-MTL Document 5 Filed 01/29/20 Page 21 of 21