Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-3_13-cv-08098/USCOURTS-azd-3_13-cv-08098-0/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 MD 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Anthony Ortiz, 

Plaintiff, 

vs. 

Scott Mascher, et al., 

Defendants. 

No. CV 13-8098-PCT-GMS (JFM) 

ORDER 

On April 22, 2013, Plaintiff Anthony Ortiz, who is confined in the Yavapai 

County Jail in Camp Verde, Arizona, filed a pro se civil rights Complaint. On April 25, 

2013, Plaintiff filed a First Amended Complaint, which superseded the original 

Complaint. Plaintiff did not file an Application to Proceed In Forma Pauperis with 

either his original or First Amended Complaint. In an Order dated June 14, 2013, the 

Court required Plaintiff to either pay the $350.00 filing fee or file a complete Application 

to Proceed. Plaintiff paid the filing fee on July 11, 2013. In an Order dated August 14, 

2013, the Court dismissed the First Amended Complaint because Plaintiff had failed to 

use the court-approved form. The Court gave Plaintiff 30 days to file an amended 

complaint on the court-approved form. On September 17, 2013, Plaintiff filed his Second 

Amended Complaint (Doc. 7). The Court will dismiss the Second Amended Complaint 

with leave to amend. 

. . . . 

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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 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)). 

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 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, 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). Plaintiff’s 

Second Amended Complaint will be dismissed for failure to state a claim, but because it 

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

II. Second Amended Complaint 

 Plaintiff asserts three claims for violations of his rights to constitutionally 

adequate medical care, due process and “participation in defense.” He names the 

following Defendants: Yavapai County Sheriff Scott Mascher; attorney Alex Harris; John 

Doe Director of Wexford Health at the Yavapai County Jail; B. Payne, a Wexford Health 

nurse at the Yavapai County Jail; and the Yavapai County Board of Supervisors 

(“YCBOS”). He seeks declaratory relief as well as nominal, compensatory and punitive 

damages. 

 Plaintiff asserts the following facts in support of his Second Amended Complaint: 

Plaintiff has been a pre-trial detainee in the Yavapai County Jail since September 6, 2011. 

According to Plaintiff, jail policies are “designed by County Attorney Sheila Polk on 

behalf of the YCBOS and Sheriff Mas[c]her.” Plaintiff has bad eyesight and wears 

prescription glasses. From September 6, 2011 until April 22, 2013, Plaintiff was told by 

Wexford Health that he could not get an eye exam until he went to prison. No one told 

Plaintiff how he should go about “getting it done” until April 22, 2013. Plaintiff asserts 

that he was “in unbearable pain” for nineteen months and that he was told he would “just 

have to use reading glasses.” Plaintiff states that his attorney, Harris, who is employed 

by the YCBOS to represent him, “indicated that she does not have time for [his] problems 

and . . . pushed for [Plaintiff] to sign a plea.” Plaintiff alleges that Harris, Mascher and 

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Wexford Health “worked together” to violate his Eighth Amendment rights when they 

“promulgated a policy of deliberate indifference to [his] saf[e]ty and medical needs by 

denying [him] treatment for [his] eyes causing [him] extre[]me pain and preventing [him] 

from participating in his defense which led to Alex Harris being fired.” As a result, 

Plaintiff claims he “was subjected to malicious and sadistic pain for 22 months [and] was 

unable to parti[c]ipate in [his] defense for 22 months without being punished, hindered 

and discouraged with malicious and sadistic pain.” 

III. Failure to State a Claim

 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). A plaintiff must also 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). 

 Further, 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 v. County of Los Angeles, 294 F.3d 1186, 1188 (9th Cir. 

2001). Further, there is no respondeat superior liability under § 1983, so a defendant’s 

position as the supervisor of someone who allegedly violated a plaintiff’s constitutional 

rights does not make him liable. Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 691 

(1978); 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. 

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A. Mascher and the Yavapai County Board of Supervisors 

 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. 

 In every count, Plaintiff makes the same allegations against Mascher and the 

YCBOS. That is, the county attorney designed jail policies on behalf of the YCBOS and 

Mascher and that his attorney was employed by YCBOS. He also alleges that Mascher, 

along with Harris and Wexford Health, worked together in promulgating a policy of 

deliberate indifference to Plaintiff’s safety and medical needs by denying him treatment 

for his eyes. Such vague and conclusory assertions fail to state a claim, and Defendants 

Mascher and the YCBOS will be dismissed. 

B. Wexford Director and Nurse B. Payne 

Plaintiff names two Defendants who apparently work, or worked, for Wexford 

Health—an unnamed director and a nurse named B. Payne. However, Plaintiff fails to 

allege any facts against either the director or the nurse. Accordingly, the unnamed 

director of Wexford Health and Wexford nurse B. Payne are dismissed. 

 C. Harris 

 A prerequisite for any relief under § 1983 are allegations to support that a 

defendant acted under the color of state law. The “under color of state law” component is 

the equivalent of the “state action” requirement under the Constitution. Lugar v. 

Edmondson Oil Co, Inc., 457 U.S. 922, 928 (1982); Jensen v. Lane County, 222 F.3d 

570, 574 (9th Cir. 2000) (citing Rendell-Baker v. Kohn, 457 U.S. 830, 838 (1982); West 

v. Atkins, 487 U.S. 42, 49 (1988)). “Acting under color of state law is ‘a jurisdictional 

requisite for a § 1983 action.’” Gritchen v. Collier, 254 F.3d 807, 812 (9th Cir. 2001) 

(quoting West, 487 U.S. at 46). Whether an attorney representing a criminal defendant is 

privately retained, a public defender, or court-appointed counsel, he or she does not act 

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under color of state law. See Polk County v. Dodson, 454 U.S. 312, 317-18 (1981); 

Miranda v. Clark County, Nevada, 319 F.3d 465, 468 (9th Cir. 2003) (en banc). For this 

reason, Plaintiff fails to state a claim against Harris and she will be dismissed. 

D. Count I 

Plaintiff designates Count I as a denial of medical care in violation of the Eighth 

Amendment. 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 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, 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 

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

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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. 

 Plaintiff has failed to state a claim for denial of constitutionally adequate medical 

care. First, Plaintiff has failed to allege facts demonstrating that he has a “serious 

medical need.” Plaintiff has failed to provide any information about the condition of his 

eyes other than he has bad eyesight, wears prescription glasses, and that he was in 

extreme pain. Plaintiff does not explain what was causing the pain, what treatment he 

was seeking, and whether the failure to provide that treatment could result in further 

significant injury or the unnecessary and wanton infliction of pain. Further, Plaintiff fails 

to provide the names of who he spoke to about his need for an eye exam or other 

treatment, when, or their response(s). Finally, it is unclear whether Plaintiff’s medical 

issues were resolved around April 22, 2013, or if that is simply the date he filed his 

original Complaint. Absent additional facts, Plaintiff fails to state a claim for denial of 

medical care and Count I will be dismissed. 

 E. Count II 

 Plaintiff designates Count II as a due process violation in violation of the 

Fourteenth Amendment. However, Plaintiff provides no information about what process 

he was denied. Accordingly, Count II is dismissed. 

 F. Count III 

 Plaintiff designates Count III as a Sixth Amendment violation and alleges that 

Defendants’ actions have prevented him from participating in his defense. Plaintiff 

appears to be alleging that the denial of an eye exam caused him extreme pain, that his 

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attorney “did not have time for [his] problems,” and so she pushed him to sign a plea. He 

also alleges that “medical indifference was being used to weaken my resolve so I will 

take a plea and wa[i]ve my rights.” Plaintiff fails to state how the alleged denial of 

medical treatment prevented him from participating in his defense. Accordingly, Count 

III is dismissed. 

IV. Leave to Amend

 For the foregoing reasons, Plaintiff’s Second Amended Complaint will be 

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

Plaintiff may submit a third amended complaint to cure the deficiencies outlined above. 

The Clerk of Court will mail Plaintiff a court-approved form to use for filing a third 

amended complaint. If Plaintiff fails to use the court-approved form, the Court may 

strike the third amended complaint and dismiss this action without further notice to 

Plaintiff. 

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

Amended Complaint.” The third 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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First Amended or Second Amended Complaints by reference. Plaintiff may include only 

one claim per count. 

 A third amended complaint supersedes all prior complaints. 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 prior 

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

in the prior complaints is waived if it is not raised in a third amended complaint. King v. 

Atiyeh, 814 F.2d 565, 567 (9th Cir. 1987). 

V. Warnings

A. 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. 

B. 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. 

C. Possible “Strike”

 Because the Second Amended Complaint has been dismissed for failure to state a 

claim, if Plaintiff fails to file a third 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 

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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) The Second Amended Complaint (Doc. 7) is dismissed for failure to state a 

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

complaint in compliance with this Order. 

 (2) If Plaintiff fails to file a third 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. 

 Dated this 8th day of November, 2013. 

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Revised 5/1/2013 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.

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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 Page 11 of 20
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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 court-approved

civil rights complaint form. You may file one amended complaint without leave (permission) of

Court before any defendant has answered your original complaint. See Fed. R. Civ. P. 15(a). After

any defendant has filed an answer, you must file a motion for leave to amend and lodge (submit) a

proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate

by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants

not included in the amended complaint are considered dismissed. All amended complaints are

subject to screening under the Prison Litigation Reform Act; screening your amendment will take

additional processing time.

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

the relevant information should be paraphrased. You should keep the exhibits to use to support or

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

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

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

or motion.

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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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 Page 14 of 20
Revised 5/1/2013 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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 Page 17 of 20
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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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 Page 18 of 20
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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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 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 3:13-cv-08098-GMS--JFM Document 9 Filed 11/08/13 Page 20 of 20