Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-01158/USCOURTS-azd-2_12-cv-01158-4/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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1

 Production of documents or other discovery is premature prior to the filing of a

complaint that states a claim and service and appearance by any defendant. 

JDDL-K

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Brent Daniel Van DeCasteele, 

Plaintiff, 

vs.

Maricopa County, et al., 

Defendants.

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No. CV 12-1158 PHX RCB (BSB)

O R D E R

Plaintiff Brent Daniel Van DeCasteele, who is confined in the Arizona State Prison

Complex-Eyman, Cook Unit, in Florence, Arizona, filed a pro se civil rights Complaint

pursuant to 42 U.S.C. § 1983, which the Court dismissed for failure to state a claim with

leave to amend. (Doc. 1, 11.) Plaintiff has filed a First Amended Complaint and a motion

for order for production of medical records. (Doc. 15, 16.) The Court will deny the motion

as premature prior to service on any Defendant1

 and will dismiss the First Amended

Complaint with leave to amend.

I. 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

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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, the-defendantunlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 129 S. Ct. 1937, 1949 (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 1950. 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 1951.

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 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). The Court

should not, however, advise the litigant how to cure the defects. This type of advice “would

undermine district judges’ role as impartial decisionmakers.” Pliler v. Ford, 542 U.S. 225,

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231 (2004); see also Lopez, 203 F.3d at 1131 n.13 (declining to decide whether the court was

required to inform a litigant of deficiencies). The Court will dismiss Plaintiff’s First

Amended Complaint for failure to state a claim, but because it may possibly be saved by

amendment, the Court will dismiss it with leave to amend.

II. First Amended Complaint

Plaintiff alleges three counts for denial of constitutionally adequate medical care and

threats to safety. Plaintiff sues Maricopa County, Maricopa County Sheriff Joseph M.

Arpaio, and unknown primary health care doctors. Plaintiff seeks injunctive and

compensatory relief.

Plaintiff alleges the following facts in his First Amended Complaint: in September or

October 2011, Plaintiff was held in the Lower Buckeye Jail and was assigned to a top bunk

without a guardrail or ladder to climb down from the bunk. As Plaintiff was climbing down

from the bunk, he fell and landed on a steel table that was bolted to the wall, which fractured

his back at the T-10 and T-11 vertebra and caused internal bleeding. On October 6, 2011,

x-rays of his back were made that showed the fractures. Although Plaintiff was seen by four

nurses, he was left lying in pain for four days before being rushed to the Maricopa County

Medical Center and admitted into intensive care. Plaintiff was hospitalized for three days,

before he was transferred to the Arizona Department of Corrections (ADC). Plaintiff

suffered severe pain and sustained nerve damage in his back. 

III. Failure to State a Claim

A plaintiff may seek relief for violations of his federal constitutional or statutory rights

under 42 U.S.C. § 1983. To state a claim under § 1983, a plaintiff must allege facts

supporting that (1) the conduct about which he complains was committed by a person acting

under the color of state law and (2) the conduct deprived him of a federal constitutional or

statutory right. Wood v. Ostrander, 879 F.2d 583, 587 (9th Cir. 1989). In addition, a

plaintiff must allege that he suffered a specific injury as a result of the conduct of a particular

defendant and he must allege an affirmative link between the injury and the conduct of that

defendant. Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976).

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A. Maricopa County

Plaintiff sues Maricopa County. A municipality, such as a city or county, is a

“person” for purposes of § 1983 and may be sued. See Leatherman v. Tarrant County

Narcotics Intelligence and Coordination Unit, 507 U.S. 163, 166 (1993); Monell v. Dep’t of

Soc. Servs., 436 U.S. 658, 694 (1978). To state a claim against a municipality under § 1983,

a plaintiff must allege facts to support that his constitutional rights were violated pursuant

to a policy or custom of the municipality. Cortez v. County of Los Angeles, 294 F.3d 1186,

1188 (9th Cir. 2001) (citing Monell, 436 U.S. at 690-91); Thompson v. City of Los Angeles,

885 F.2d 1439, 1443 (9th Cir. 1989)). A municipality may not be sued solely because an

injury was inflicted by one of its employees or agents. Long v. County of Los Angeles, 442

F.3d 1178, 1185 (9th Cir. 2006). Therefore, a § 1983 claim against a municipal defendant

“cannot succeed as a matter of law” unless a plaintiff: (1) contends that the municipal

defendant maintains a policy or custom pertinent to the plaintiff’s alleged injury; and (2)

explains how such policy or custom caused the plaintiff’s injury. Sadoski v. Mosley, 435

F.3d 1076, 1080 (9th Cir. 2006) (affirming dismissal of a municipal defendant pursuant to

Fed. R. Civ. P. 12(b)(6)). 

Plaintiff fails to allege that Maricopa County maintained a policy or custom that

resulted in the violation of Plaintiff’s federal constitutional rights. He also fails to allege

facts to support that any constitutional injury was the result of a municipal policy or custom.

Accordingly, Plaintiff also fails to state a claim against Maricopa County and it will be

dismissed. 

B. Sheriff Arpaio

Plaintiff also sues Sheriff Arpaio. Although Arpaio may properly be sued for

constitutional violations, Plaintiff fails to state a claim against him. “A plaintiff must allege

facts, not simply conclusions, that show that an individual was personally involved in the

deprivation of his civil rights.” Barren v. Harrington, 152 F.3d 1193, 1194 (9th Cir. 1998).

For an individual to be liable in his official capacity, a plaintiff must allege that the official

acted as a result of a policy, practice, or custom. See Cortez, 294 F.3d at 1188. Further,

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there is no respondeat superior liability under § 1983, so a defendant’s position as the

supervisor of a someone who allegedly violated a plaintiff’s constitutional rights does not

make him liable. Monell, 436 U.S. at 691; Taylor v. List, 880 F.2d 1040, 1045 (9th Cir.

1989). A supervisor in his individual capacity, “is only liable for constitutional violations

of his subordinates if the supervisor participated in or directed the violations, or knew of the

violations and failed to act to prevent them.” Taylor, 880 F.2d at 1045. 

Plaintiff fails to allege any facts against Arpaio. Plaintiff does not allege that Arpaio

directly violated his constitutional rights. He also fails to allege facts to support that

Plaintiff’s constitutional rights were violated as a result of a policy or custom promulgated

or endorsed by Arpaio. Accordingly, Plaintiff fails to state a claim against Arpaio and he

will be dismissed. 

C. Unknown Primary Care Physicians

Plaintiff sues unknown primary care physicians. Rule 10(a) of the Federal Rules of

Civil Procedure requires the plaintiff to include the names of the parties in the action. As a

practical matter, it is impossible in most instances for the United States Marshal or his

designee to serve a summons and complaint or amended complaint upon an anonymous

defendant.

The Ninth Circuit has held that where identity is unknown prior to the filing of a

complaint, the plaintiff should be given an opportunity through discovery to identify the

unknown defendants, unless it is clear that discovery would not uncover the identities, or that

the complaint would be dismissed on other grounds. Wakefield v. Thompson, 177 F.3d

1160, 1163 (9th Cir. 1999) (citing Gillespie v. Civiletti, 629 F.2d 637, 642 (9th Cir. 1980)).

Where the names of individual defendants are unknown at the time a complaint is filed, a

plaintiff may refer to the individual unknown defendants as Defendant John (or Jane) Doe

1, John Doe 2, and so on, and allege facts to support how each particular Doe defendant

violated the plaintiff’s constitutional rights. A plaintiff may thereafter use the discovery

process to obtain the names of fictitiously-named defendants whom he believes violated his

constitutional rights and seek leave to amend to name those defendants.

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2

 The presence of a ladder does not eliminate the possibility of a fall. 

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As discussed herein, Plaintiff will be granted leave to file a an amended complaint in

which he should name as Defendants the person(s) who allegedly denied him constitutionally

adequate medical care. If Plaintiff does not know the names of those person(s), Plaintiff may

refer to each such person by a fictitious name, e.g., John Doe 1, John Doe 2, and so on and

allege facts to support how each defendant violated his constitutional rights. That is, Plaintiff

must allege when, where, and how any Doe defendant acted with deliberate indifference to

his serious medical needs. For example, Plaintiff must allege how a particular defendant

knew about Plaintiff’s serious medical needs and facts to support that such defendant

nevertheless failed to provide or obtain medical treatment. 

D. Threat to Safety

Plaintiff designates Count I as a claim for threat to safety or conditions of

confinement, apparently referring to the absence of guardrails or a ladder to descend from

upper bunks. To state a claim under § 1983 for failure to protect or threats to safety, an

inmate must allege facts to support that he was incarcerated under conditions posing a

substantial risk of harm and that prison officials were “deliberately indifferent” to those risks.

Farmer v. Brennan, 511 U.S. 825, 832-33 (1994). To adequately allege deliberate

indifference, a plaintiff must allege facts to support that a defendant knew of, but

disregarded, an excessive risk to inmate safety. Id. at 837. That is, “the official must both

[have been] aware of facts from which the inference could be drawn that a substantial risk

of serious harm exist[ed], and he must also [have] draw[n] the inference.” Id.

Plaintiff appears to contend that the absence of a ladder posed a threat to his safety

and that he fell and injured himself because of the absence of a ladder.2 Plaintiff fails to

allege facts to support that the absence of a ladder posed a substantial threat to his safety.

Moreover, Plaintiff fails to allege facts to support that anyone knew that the failure to provide

ladders posed a substantial threat to his safety but failed to act to alleviate that threat.

Further, Plaintiff fails to allege facts to connect either Defendant, or anyone else, to the

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asserted threat to his safety. For all of these reasons, Plaintiff fails to state a claim for threat

to safety. 

E. Medical Care

Plaintiff designates Counts II and III as claims for constitutionally inadequate medical

care. Not every claim by a prisoner relating to inadequate medical treatment states a

violation of the Eighth or Fourteenth Amendment. To state a § 1983 medical claim, a

plaintiff must show that the defendants acted with “deliberate indifference to serious medical

needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (quoting Estelle v. Gamble, 429

U.S. 97, 104 (1976)). 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, 439 F.3d at 1096 (quotations omitted).

“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 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, 511 U.S. at 837. 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, 429 U.S. at 104-05; 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

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3

 As noted above, if the name of such person is currently unknown to Plaintiff, he

may identify that person by a fictitious name, e.g., John or Jane Doe, and allege facts to

support that the Doe defendant acted with deliberate indifference to Plaintiff’s serious

medical needs. 

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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.

Plaintiff sufficiently alleges that he had a serious medical need after falling, but he

fails to allege facts to support that any Defendant knew, or should have known, about his

serious medical needs, but nevertheless failed to provide or obtain medical care or treatment.

Plaintiff must allege facts to support that one or more persons named as defendants knew,

or should have known, that Plaintiff was seriously injured – including when and how – and

that such defendant failed to treat or alleviate Plaintiff’s medical condition. Plaintiff has not

named a jail officer or medical staff-member, who acted with deliberate indifference to his

serious medical needs, as a Defendant. For that reason, Plaintiff fails to state a claim in

Counts II or III.3

IV. Leave to Amend

For the foregoing reasons, Plaintiff’s First Amended Complaint will be dismissed for

failure to state a claim upon which relief may be granted. Within 30 days, Plaintiff may

submit a second amended complaint to cure the deficiencies outlined above. The Clerk of

Court will mail Plaintiff a court-approved form to use for filing a second amended complaint.

If Plaintiff fails to use the court-approved form, the Court may strike the second 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 “Second

Amended Complaint.” The second 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 or First Amended Complaint by reference. Plaintiff may include only one claim

per count. 

A second amended complaint supersedes the original Complaint and First Amended

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 and First Amended Complaint as nonexistent. Ferdik, 963 F.2d

at 1262. Any cause of action that was raised in the original Complaint or First Amended

complaint is waived if it is not raised in a second amended complaint. King v. Atiyeh, 814

F.2d 565, 567 (9th Cir. 1987).

V. Warnings

A. Release

Plaintiff must pay the unpaid balance of the filing fee within 120 days of his release.

Also, within 30 days of his release, he must either (1) notify the Court that he intends to pay

the balance or (2) show good cause, in writing, why he cannot. Failure to comply may result

in dismissal of this action.

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. Copies

Plaintiff must submit an additional copy of every filing for use by the Court. See

LRCiv 5.4. Failure to comply may result in the filing being stricken without further notice

to Plaintiff.

D. Possible “Strike”

Because the First Amended Complaint has been dismissed for failure to state a claim,

if Plaintiff fails to file a second 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.

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§ 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). 

E. 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) The First Amended Complaint (Doc. 15) is dismissed for failure to state a

claim. Plaintiff has 30 days from the date this Order is filed to file a second amended

complaint in compliance with this Order. 

(2) If Plaintiff fails to file a second 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).

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

rights complaint by a prisoner.

(4) Plaintiff’s motion for order requiring production of his medical records is

denied as premature. (Doc. 16.)

DATED this 16th day of November, 2012.

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Revised 3/9/07 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 Fee. The filing fee for this action is $350.00. If you are unable to immediately

pay the filing fee, you may request leave to proceed in forma pauperis. Please review the

“Information for Prisoners Seeking Leave to Proceed with a (Non-Habeas) Civil Action in

Federal Court In Forma Pauperis Pursuant to 28 U.S.C. § 1915” for additional instructions.

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

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

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

identical to the original. Copies may be legibly handwritten.

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

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

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

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

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

in the Tucson Division. Mail the original and one copy of the complaint with the $350 filing

fee or the application to proceed in forma pauperis to:

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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. 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 courtapproved civil rights complaint form. You may file one amended complaint without leave

(permission) of Court before any defendant has answered your original complaint. See Fed. R.

Civ. P. 15(a). After any defendant has filed an answer, you must file a motion for leave to

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

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

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

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

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

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

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

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

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

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

pleading or motion.

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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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 13 of 20
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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 14 of 20
Revised 3/9/07 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, )

)

 vs. ) CASE NO. 

) (To be supplied by the Clerk)

(1) , )

(Full Name of Defendant) )

(2) , )

) CIVIL RIGHTS COMPLAINT

(3) ,) BY A PRISONER

)

(4) , ) G Original Complaint

Defendant(s). ) G First Amended Complaint

G Check if there are additional Defendants and attach page 1-A listing them. ) 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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 15 of 20
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:

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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 16 of 20
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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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 17 of 20
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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 18 of 20
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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 19 of 20
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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 2:12-cv-01158-RCB--BSB Document 17 Filed 11/16/12 Page 20 of 20