Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_14-cv-00393/USCOURTS-caed-2_14-cv-00393-5/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

DARIUS SIMS,

Plaintiff,

v.

SCOTT HEATLEY, et al.,

Defendants.

No. 2:14-cv-0393 KJN P

ORDER

I. Introduction

Plaintiff is a state prisoner, proceeding without counsel, with a civil rights action pursuant 

to 42 U.S.C. § 1983. Pending before the court is defendants’ motion to dismiss. Plaintiff filed 

two oppositions to the motion, and defendants filed a reply. For the following reasons, the 

undersigned partially grants defendants’ motion to dismiss, and grants plaintiff leave to file a 

second amended complaint. 

II. Legal Standard

Rule 12(b)(6) of the Federal Rules of Civil Procedures provides for motions to dismiss for 

“failure to state a claim upon which relief can be granted.” Fed. R. Civ. P. 12(b)(6). In 

considering a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6), the court 

must accept as true the allegations of the complaint in question, Erickson v. Pardus, 551 U.S. 89 

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(2007), and construe the pleading in the light most favorable to the plaintiff. Jenkins v. 

McKeithen, 395 U.S. 411, 421 (1969); Meek v. County of Riverside, 183 F.3d 962, 965 (9th Cir. 

1999). Still, to survive dismissal for failure to state a claim, a pro se complaint must contain more 

than “naked assertions,” “labels and conclusions” or “a formulaic recitation of the elements of a 

cause of action.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555-57 (2007). In other words, 

“[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory 

statements do not suffice.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). Furthermore, a claim 

upon which the court can grant relief must have facial plausibility. Twombly, 550 U.S. at 570. 

“A claim has facial plausibility when the plaintiff pleads factual content that allows the court to 

draw the reasonable inference that the defendant is liable for the misconduct alleged.” Iqbal, 556 

U.S. at 678. Attachments to a complaint are considered to be part of the complaint for purposes 

of a motion to dismiss for failure to state a claim. Hal Roach Studios v. Richard Reiner & Co., 

896 F.2d 1542, 1555 n.19 (9th Cir. 1990).

A motion to dismiss for failure to state a claim should not be granted unless it appears 

beyond doubt that the plaintiff can prove no set of facts in support of his claims which would 

entitle him to relief. Hishon v. King & Spaulding, 467 U.S. 69, 73 (1984). In general, pro se 

pleadings are held to a less stringent standard than those drafted by lawyers. Haines v. Kerner, 

404 U.S. 519, 520 (1972). The court has an obligation to construe such pleadings liberally. Bretz 

v. Kelman, 773 F.2d 1026, 1027 n.1 (9th Cir. 1985) (en banc). However, the court’s liberal 

interpretation of a pro se complaint may not supply essential elements of the claim that were not 

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

III. Plaintiff’s Amended Complaint

This action is proceeding on plaintiff’s amended complaint in which he claims that 

defendants Horowitz, Heatley, and Smith were deliberately indifferent to plaintiff’s severe health 

problems in violation of the Eighth Amendment. (ECF No. 12.) Plaintiff avers that defendant 

Heatley changed plaintiff’s medications without plaintiff’s knowledge, and that the different 

medication gave plaintiff terrible side effects. (ECF No. 12 at 5.) Plaintiff claims that defendant 

Horowitz changed plaintiff’s medication upon his arrival at Mule Creek State Prison without 

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“merits,” or concern for plaintiff, and told plaintiff “if [he] wanted medical care [he] should not 

have come to prison.” (ECF No. 12 at 5.) Plaintiff states that defendant Smith “has only written 

to” plaintiff, and that when plaintiff went to the emergency room due to his cluster migraine 

headaches, or his heart attack on October 20, defendant Smith’s statements were “incorrect and 

misleading.” (ECF No. 12 at 6.) Plaintiff claims that he was not given migraine medication for 

extreme headaches in 2013, and that despite acute gout attacks in 2012 and 2013, plaintiff was 

not given gout medication until the end of 2013. (ECF No. 12 at 7.) 

Plaintiff states that he “attached exhibits to show facts of mistreatment, cruelty, and the 

health care 602 process [he] . . . went through over the years of mistreatment.” (ECF No. 12 at 

3.) Plaintiff provided numerous exhibits with his amended complaint and with his oppositions to 

the motion to dismiss, including copies of his inmate appeals and responses by prison officials.

IV. Motion to Dismiss

Defense counsel argues that plaintiff’s claims are impermissibly based solely on 

defendants Dr. Heatley’s and Dr. Smith’s participation in reviewing plaintiff’s inmate appeals; 

plaintiff’s complaint and its exhibits demonstrate that each defendant provided plaintiff with 

reasonable and appropriate medical treatment and did not act with deliberate indifference; and 

plaintiff’s complaint does not allege facts giving rise to a claim of deliberate indifference to a 

serious medical need as a matter of law; and defendants are each entitled to qualified immunity 

because a reasonable appeals reviewer in Dr. Heatley’s and Dr. Smith’s position would not have 

believed their review of plaintiff’s appeals was constitutionally deficient, and their review of the 

appeals does not amount to a constitutional violation because plaintiff has no constitutional right 

to a specific grievance procedure. Defendants contend that a reasonable physician in defendant 

Horowitz’s position would not believe that awaiting review by the Pain Management Clinic 

before prescribing pain medication was unlawful.

V. Discussion 

Plaintiff’s administrative appeals concerning medical care, as well as the prison officials’ 

responses to the appeals, are included in the 64 pages of exhibits appended to plaintiff’s 

complaint. Contrary to defendants’ assertion, the court does not construe plaintiff’s allegations as 

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to defendants Heatley and Smith as confined to their roles in the administrative appeal process. 

The court may consider a “written instrument” that is attached to the complaint in 

determining whether the plaintiff can state a claim. Fed. R. Civ. P. 10(c); Durning v. First Boston 

Corp., 815 F.2d 1265, 1267 (9th Cir.) (court may consider a “written instrument” attached to the 

complaint “in determining whether the plaintiff can prove any set of facts in support of the 

claim”), cert. denied, 484 U.S. 944 (1987). However, the exhibits appended to plaintiff’s 

amended complaint do not negate plaintiff’s medical claims as a matter of law. See Scanlan v. 

Sisto, 2012 WL 1130668, *2-3 (E.D. Cal. March 28, 2012).

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 “The fact that plaintiff has attached 

to his complaint documents showing prison officials found defendants’ use of force was justified 

does not mean plaintiff has adopted as true all of the statements in those documents, where it is 

clear from the allegations in the complaint that he contests such findings.” Furnace v. Sullivan, 

2008 WL 4856826, *5 (N.D. Cal. Nov. 10, 2008), citing Gant v. Wallingford Bd. of Educ., 69 

F.3d 669, 674 (2d Cir. 1995) (holding Rule 10(c) of Federal Rules of Civil Procedure, providing 

that “an exhibit to a pleading is a part of the pleading for all purposes,” does not require plaintiff 

to adopt as true full contents of documents attached to complaint). 

Similarly, the fact that plaintiff appended administrative appeal responses that claim Dr. 

Horowitz was not deliberately indifferent to plaintiff’s medical needs (ECF No. 12 at 11, 14), 

does not mean that plaintiff has adopted as true such a statement where it is clear from his 

amended complaint that he contests such a finding. Here, liberally construed, and taking 

plaintiff’s claims as true, plaintiff alleges that the change in medications by defendants Horowitz 

and Heatley caused plaintiff continued pain and suffering, including untreated gout symptoms, 

debilitating cluster migraine headaches, and subsequent heart attacks. Moreover, the fact that 

plaintiff appended copies of the administrative appeal responses does not mean that plaintiff seeks

relief based solely on the roles of defendants Dr. Heatley and Dr. Smith in the administrative 

 

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In Scanlan, the district court discussed the evaluation and use of exhibits appended to the 

complaint under Rule 10(c) of the Federal Rules of Civil Procedure, and distinguished how “the 

court may reject what the plaintiff says about the report,” but “the court cannot summarily reject 

plaintiff's allegations that in fact the prison authorities took no action, regardless of what the 

incident report says.” Scanlan, 2012 WL 1130668 at *3.

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appeal process. Indeed, in his amended complaint, plaintiff does not allege that his claims are 

based on such roles. 

Moreover, in his opposition, plaintiff confirms that he was seen personally by both 

defendants Dr. Heatley and Dr. Smith (ECF No. 25 at 3-4), and now claims that defendant Dr. 

Smith also prescribed plaintiff medication without explanation. At this stage of the proceeding, 

the court declines to find that plaintiff’s allegations are rebutted by the administrative appeal 

responses appended to the complaint, or to find that defendants are entitled to qualified immunity. 

See Hunt v. Dental Dept., 865 F.2d 198, 200 (9th Cir. 1989) (court “need not defer to the 

judgment of prison doctors or administrators” when deciding the deliberate indifference element). 

Defendants are correct that prisoners have no stand-alone due process rights related to the 

administrative grievance process. See Mann v. Adams, 855 F.2d 639, 640 (9th Cir. 1988); see 

also Ramirez v. Galaza, 334 F.3d 850, 860 (9th Cir. 2003) (holding that there is no liberty interest 

entitling inmates to a specific grievance process). Put another way, prison officials are not 

required under federal law to process inmate grievances in a specific way or to respond to them in 

a favorable manner. Because there is no right to any particular grievance process, plaintiff cannot 

state a cognizable civil rights claim for a violation of his due process rights based on allegations 

that prison officials ignored or failed to properly process grievances. See,e.g., Wright v. 

Shannon, 2010 WL 445203 at *5 (E.D. Cal. Feb.2, 2010) (plaintiff's allegations that prison 

officials denied or ignored his inmate appeals failed to state a cognizable claim under the First 

Amendment); Williams v. Cate, 2009 WL 3789597 at *6 (E.D. Cal. Nov. 10, 2009) (“Plaintiff 

has no protected liberty interest in the vindication of his administrative claims.”).

However, prisoners may be able to state a cognizable civil rights claim if there is an 

ongoing constitutional violation and defendant had the authority and opportunity to prevent the 

ongoing violation, yet failed to prevent it. See Taylor v. List, 880 F.2d 1040, 1045 (9th Cir. 

1989) (supervisory official liable under Section 1983 if he or she knew of a violation and failed to 

act to prevent it). Thus, plaintiff may be able to state an Eighth Amendment claim against such 

defendants. For example, in plaintiff’s appeal No. 13044160, Dr. Smith noted plaintiff’s claim 

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that his current medication, “MAPAP 325 tablets”2 was insufficient for the period of a month, and 

that plaintiff complained he was “continuously asking inmate[s] for pain pills due to [plaintiff’s] 

suffering from [his] many health problems.” (ECF No. 12 at 20.) Dr. Smith noted that in the first 

level interview, Dr. Hawkins claimed plaintiff was requesting to be placed back on pain 

medication that was previously discontinued. (ECF No. 12 at 21.) Dr. Hawkins said plaintiff’s 

pain intake information was completed on July 23, 2012, “but it appears that it was never 

submitted to the Pain Management Committee (“PMC”).” (ECF No. 12 at 21.) Dr. Smith noted 

that Dr. Hawkins said he would submit the information to the PMC on October 15, 2013, but that 

“additional pain medication would not be ordered until the final disposition of the PMC.” (ECF 

No. 12 at 21.) Dr. Smith noted that plaintiff was currently prescribed Acetaminophen 325 mg 

tablets, one to two tablets three times a day as needed. (Id.) Although Dr. Smith may not have 

been aware of the medication change when it occurred, Dr. Smith’s review of plaintiff’s appeal 

put the doctor on notice of the medication change. 

If plaintiff was still experiencing severe pain when Dr. Smith addressed plaintiff’s appeal 

No. 13044160, plaintiff may be able to demonstrate that Dr. Smith was deliberately indifferent by 

failing to take steps to expedite the review by the Pain Management Committee (“PMC”), 

particularly in light of the lengthy delay, over one year and two months, in submitting plaintiff’s 

pain intake information to the PMC. 3 Indeed, plaintiff may be able to demonstrate Dr. Hawkins 

was deliberately indifferent by failing to expedite such review.

Similarly, Dr. Heatley was put on notice of plaintiff’s change of medication when he 

reviewed plaintiff’s appeal No. 12043072. (ECF No. 12 at 10.) In his opposition to the motion, 

plaintiff claims that he was seen by Dr. Heatley for plaintiff’s gout outbreak. (ECF No. 25 at 3.) 

Dr. Heatley allegedly denied he was to see plaintiff about his high pain level, and plaintiff claims 

that Dr. Heatley told plaintiff that “if you take these gout pills you will not get gout and the next 

time I see you I will re[-]prescribe the morphine for your pain.” (ECF No. 25 at 3.) Such a

////

 

2

 The generic name for MAPAP is Acetaminophen. 

3

 The appeal response does not state who was responsible for the delay.

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statement, taken as true, demonstrates Dr. Heatley’s awareness of plaintiff’s pain, and could raise 

an inference of deliberate indifference. 

Here, plaintiff unequivocally states that he is in extreme pain every day (ECF No. 26 at 1), 

and alleges that prescribing Acetaminophen for such pain “is a criminal act in itself!” (ECF No. 

25 at 7.) Plaintiff explains that prior to his transfer to Mule Creek State Prison, he was prescribed 

Morphine 30 mg for his pain by prison doctors, and contends that this prescription was changed 

to Tylenol 325 mg which he also alleges is ineffective. (ECF No. 25 at 1.) Plaintiff alleges that 

his cluster migraine headaches, which occur seasonally, has him bedridden for three or four 

months. (ECF No. 25 at 1.) Plaintiff claims he is unable to function in day-to-day activities 

because of these headaches and the medication change. (Id.) In light of these allegations, the 

court is disinclined to construe plaintiff’s claims as a mere difference of opinion between plaintiff 

and his treating physicians, or between plaintiff’s prior treating prison physicians and his current 

treating prison physicians. See Wilhelm v. Rotman, 680 F.3d 1113, 1123 (9th Cir. 2012) 

(awareness of need for hernia repair and repeated failure to implement prescribed surgery 

“sufficient to meet the low threshold for proceeding past the screening stage”). 

That said, plaintiff’s amended complaint is not a model of clarity, particularly with regard 

to plaintiff’s claims against defendant Dr. Smith, and does not set forth the specific facts he now 

alleges demonstrate defendants’ deliberate indifference. In addition, plaintiff does not make clear 

whether his severe pain is a daily constant, or whether his severe pain is only related to his 

seasonal migraines and is therefore limited to a three or four month period. In his pleading, 

plaintiff is required to allege facts showing that each named defendant knew of, yet disregarded, 

plaintiff’s serious medical needs. Plaintiff must allege facts showing that each defendant acted 

with a culpable state of mind. These allegations must be set forth in the pleading; defendants are 

not required to ferret through exhibits to ascertain plaintiff’s claims.

Moreover, as set forth above, plaintiff has raised new allegations in his oppositions that 

demonstrate he may be able to state a cognizable claim against defendant Dr. Smith, even if 

solely based on his role in the appeal process, and may be able to state a cognizable claim against 

Dr. Hawkins. For example, plaintiff now alleges that he heard defendant Dr. Smith say that “We 

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should just let him [plaintiff] die, then we could be done with him.” (ECF No. 25 at 2.) Such an

alleged statement raises an inference of a culpable state of mind.

Thus, defendants’ motion to dismiss plaintiff’s amended complaint is granted in part, and 

plaintiff is granted leave to file a second amended complaint that specifically sets forth his 

allegations against each named defendant, Dr. Heatley, Dr. Smith, and Dr. Horowitz. If plaintiff 

can allege facts supporting a claim against Dr. Hawkins, plaintiff is also granted leave to amend 

to plead such allegations. Plaintiff is offered the following guidance in filing the amended 

pleading. 

An individual defendant is not liable on a civil rights claim unless the facts establish the 

defendant’s personal involvement in the constitutional deprivation or a causal connection between 

the defendant’s wrongful conduct and the alleged constitutional deprivation. See Hansen v. 

Black, 885 F.2d 642, 646 (9th Cir. 1989); Johnson v. Duffy, 588 F.2d 740, 743-44 (9th Cir.

1978). 

To state a claim for violation of the Eighth Amendment based on inadequate medical care, 

plaintiff must allege “acts or omissions sufficiently harmful to evidence deliberate indifference to 

serious medical needs.” Estelle v. Gamble, 429 U.S. 97, 106 (1976). To prevail, plaintiff must 

show both that his medical needs were objectively serious, and that defendant possessed a 

sufficiently culpable state of mind. Snow v. McDaniel, 681 F.3d 978, 982 (9th Cir. 2012), 

overruled in part on other grounds by Peralta v. Dillard, 744 F.3d 1076 (9th Cir. 2014) (en banc); 

Wilson v. Seiter, 501 U.S. 294, 297-99 (1991). 

To meet the objective element, plaintiff must demonstrate the existence of a serious 

medical need. Estelle, 429 U.S. at 104. Such need exists if the failure to treat the injury or 

condition “could result in further significant injury” or cause “the unnecessary and wanton 

infliction of pain.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006) (internal quotes and 

citations omitted). Serious medical needs include “[t]he existence of an injury that a reasonable 

doctor or patient would find important and worthy of comment or treatment; the presence of a 

medical condition that significantly affects an individual’s daily activities; [and] the existence of

chronic and substantial pain.” McGuckin v. Smith, 974 F.2d 1050, 1059-60 (9th Cir. 1992), 

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overruled in part on other grounds by WMX Techs., Inc. v. Miller, 104 F.3d 1133 (9th Cir. 1997).

Under the subjective element, a prison official is deliberately indifferent only if the 

official “knows of and disregards an excessive risk to inmate health and safety.” Toguchi v. 

Chung, 391 F.3d 1051, 1057 (9th Cir. 2004) (internal quotes and citation omitted). To prevail on 

a claim for deliberate indifference, a prisoner must demonstrate that the prison official “kn[ew] of 

and disregard[ed] an excessive risk to inmate health or safety; the official must both be aware of 

the 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 “may appear when prison officials deny, delay or intentionally interfere with medical 

treatment, or it may be shown by the way in which prison physicians provide medical care.” 

Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir. 1988). The court “need not defer to the 

judgment of prison doctors or administrators” when deciding the deliberate indifference element. 

Hunt v. Dental Dept., 865 F.2d 198, 200 (9th Cir. 1989) (where prison officials were aware loss 

of his dentures was causing him severe pain and permanent physical damage, three month delay

in providing pain relief and soft food diet constituted Eighth Amendment violation). 

Delays in providing medical care may manifest deliberate indifference. Estelle, 429 U.S. 

at 104-05. To establish a claim of deliberate indifference arising from delay in providing care, a 

plaintiff must show that the delay was harmful. See Hallett v. Morgan, 296 F.3d 732, 745-46 (9th 

Cir. 2002); Berry v. Bunnell, 39 F.3d 1056, 1057 (9th Cir. 1994); McGuckin, 974 F.2d at 1059. 

In this regard, “[a] prisoner need not show his harm was substantial; however, such would 

provide additional support for the inmate’s claim that the defendant was deliberately indifferent to 

his needs.” Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006); see also McGuckin, 974 F.2d at 

1060.

In applying this standard, the Ninth Circuit has held that before it can be said that a 

prisoner’s civil rights have been abridged, “the indifference to his medical needs must be 

substantial. Mere ‘indifference,’ ‘negligence,’ or ‘medical malpractice’ will not support this 

cause of action.” Broughton v. Cutter Laboratories, 622 F.2d 458, 460 (9th Cir. 1980) (citing 

Estelle, 429 U.S. at 105-06.) A complaint that a physician has been negligent in diagnosing or 

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treating a medical condition does not state a valid claim of medical mistreatment under the Eighth 

Amendment. Even gross negligence is insufficient to establish deliberate indifference to serious 

medical needs. See Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990). A difference of 

opinion between medical professionals concerning the appropriate course of treatment generally 

does not amount to deliberate indifference to serious medical needs. Toguchi, 391 F.3d at 1058; 

Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989). Also, “a difference of opinion between a 

prisoner-patient and prison medical authorities regarding treatment does not give rise to a [§]1983 

claim.” Franklin v. Oregon, 662 F.2d 1337, 1344 (9th Cir. 1981). To establish that such a 

difference of opinion amounted to deliberate indifference, the prisoner “must show that the course 

of treatment the doctors chose was medically unacceptable under the circumstances” and “that 

they chose this course in conscious disregard of an excessive risk to [the prisoner’s] health.” See

Jackson v. McIntosh, 90 F.3d 330, 332 (9th Cir. 1996); see also Wilhelm, 680 F.3d at 1123 

(awareness of need for treatment followed by unnecessary delay in implementing the prescribed 

treatment sufficient to plead deliberate indifference); see also Snow, 681 F.3d at 988 (decision of 

non-treating, non-specialist physicians to repeatedly deny recommended surgical treatment may 

be medically unacceptable under all the circumstances.)

Thus, plaintiff is advised that rather than making statements using general terms such as 

“mistreatment,” plaintiff should set forth specific instances where each defendant allegedly 

violated plaintiff’s Eighth Amendment rights in addressing plaintiff’s complaints of pain, and set 

forth facts demonstrating how each defendant’s act or failure to act constitutes deliberate 

indifference to plaintiff’s serious medical needs.

4

 

Accordingly, for the reasons discussed above, defendants’ motion to dismiss plaintiff’s 

Eighth Amendment claims is granted in part. Plaintiff’s amended complaint is dismissed, and 

plaintiff is granted leave to file a second amended complaint. Failure to file a second amended 

 

4

 In subsequent filings, plaintiff raised vague allegations concerning a physical assault, 

harassment, and theft of personal property, etc. This action is proceeding only on plaintiff’s 

Eighth Amendment claims pertaining to his pain medications. Plaintiff should omit reference to 

unrelated allegations in any amended complaint. George v. Smith, 507 F.3d 605, 607 (7th Cir. 

2007) (Unrelated claims against different defendants must be pursued in multiple lawsuits.); see 

also Fed. R. Civ. P. 20(a)(2) (joinder of defendants not permitted unless both commonality and 

same transaction requirements are satisfied).

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complaint in accordance with this order will result in the dismissal of this action.

Plaintiff is informed that the court cannot refer to a prior pleading in order to make 

plaintiff’s second amended complaint complete. Local Rule 220 requires that an amended 

complaint be complete in itself without reference to any prior pleading. This requirement exists 

because, as a general rule, an amended complaint supersedes the original complaint. See Loux v. 

Rhay, 375 F.2d 55, 57 (9th Cir. 1967). Once plaintiff files a second amended complaint, the 

original pleading no longer serves any function in the case. Therefore, in a second amended 

complaint, as in an original complaint, each claim and the involvement of each defendant must be 

sufficiently alleged.

However, plaintiff shall not append exhibits to his second amended complaint. The 

exhibits previously supplied by plaintiff remain a part of the court record and any party may 

reference such exhibits. 

V. Conclusion

For all of the above reasons, IT IS HEREBY ORDERED that:

1. Defendants’ motion to dismiss (ECF No. 23) is granted in part;

2. Plaintiff’s amended complaint (ECF No. 12) is dismissed; and

3. Plaintiff is granted forty-five days to file a second amended complaint that complies 

with this order, the requirements of the Civil Rights Act, the Federal Rules of Civil Procedure, 

and the Local Rules of Practice. The second amended complaint must also bear the docket 

number assigned to this case and must be labeled “Second Amended Complaint.” No exhibits 

shall be appended to the second amended complaint.

Failure to file a second amended complaint in accordance with this order will result in the 

dismissal of this action.

Dated: November 4, 2014

/sims0393.mtd

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