Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-5_06-cv-05148/USCOURTS-arwd-5_06-cv-05148-1/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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AO72A

(Rev. 8/82)

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

ANTOINE DAVIS PLAINTIFF

v. Civil No. 06-5148

ARAMARK; DR. HOWARD; WASHINGTON

COUNTY JAIL; and DOCTOR AND NURSES

OF THE WASHINGTON COUNTY JAIL

MEDICAL STAFF DEFENDANTS

O R D E R

Plaintiff’s complaint was filed in this case on August 11, 2006. Before the undersigned

is the issue of whether the complaint should be served. In order to assist the court in making

such determination, it is necessary that plaintiff provide additional information.

Accordingly, it is ordered that plaintiff, David Reimers, complete and sign the attached

addendum to his complaint, and return the same to the court by December 15, 2006. Plaintiff

is advised that should he fail to return the completed and executed addendum by December

15, 2006, his complaint may be dismissed without prejudice for failure to prosecute and/or

for failure to obey an order of the court.

IT IS SO ORDERED this 21st day of November 2006.

/s/ Beverly Stites Jones

HON. BEVERLY STITES JONES

UNITED STATES MAGISTRATE JUDGE

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AO72A

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IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

ANTOINE DAVIS PLAINTIFF

v. Civil No. 06-5148

ARAMARK; DR. HOWARD; WASHINGTON

COUNTY JAIL; and DOCTOR AND NURSES

OF THE WASHINGTON COUNTY JAIL

MEDICAL STAFF DEFENDANTS

ADDENDUM TO COMPLAINT

TO: ANTOINE DAVIS

This form is sent to you so that you may assist the court in making a determination as to

the issue of whether the complaint should be served upon the defendants. Accordingly, it is

required that you fill out this form and send it back to the court by December 15, 2006 Failure

to do so will result in the dismissal of your complaint.

The response must be legibly handwritten or typewritten, and all questions must be

answered completely in the proper space provided on this form. If you need additional space,

you may attach additional sheets of paper to this addendum.

RESPONSE

In your complaint, you allege your rights were violated on June 13, 2006; June 23, 2006;

and, July 10, 2006, when money was wrongfully taken from your inmate account to pay for

alleged medical expenses. You also state that you were denied proper medical attention. 

1. In your complaint, you state that medical expenses were wrongfully taken from your

inmate account. Did you see a doctor or nurse at any time prior to June 13, 2006?

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Answer: Yes __________ No ____________.

If so, when did you see a doctor or nurse and why?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

2. Did you see a doctor or nurse prior to June 23, 2006?

Answer: Yes __________ No ____________.

If so, when did you see a doctor or nurse and why?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

3. Did you see a doctor or nurse prior to July 10, 2006? 

Answer: Yes __________ No ____________.

If so, when did you see a doctor or nurse and why?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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___________________________________________________________________________

4. You state that Nurse Shirley researched these charges and determined that they were

likely charged by the commissary. Did you check with the commissary to determine whether

they made the charges?

Answer: Yes __________ No ____________.

If yes, who did you speak to, when did you speak to them, and what were you told?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

5. Were you ever denied medical treatment? 

Answer: Yes __________ No ____________.

If you answered yes, please explain.

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

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____________________________________________________________________________

6. Do you contend that you were denied proper medical treatment because you do not

agree with the medical treatment you received? 

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

7. Please state how the defendants’ refusal to allow you to seek the opinion of an outside

doctor harmed you.

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

8. You state that you are experiencing dizzy spells, headaches, and pain in your shoulders

and back. How long have you been experiencing these symptoms?

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

9. You name Dr. Howard as a defendant. Please state how you believe he or she violated

your federal constitutional rights.

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___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

10. When treated by Dr. Howard, did you make all of your symptoms known to him?

Answer: Yes __________ No ____________.

11. You have listed several entities as defendants in this case. However, the Washington

County Jail and Aramark are not entities subject to suit. Please provide the name of the

individual or individuals associated with these entities that you wish to sue. 

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

12. With respect to each of the persons listed in response to question 10, state how you

believe each of them violated your federal constitutional rights.

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___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

13. You name the doctors and nurses at the Washington County Jail as defendants in this

case. In order to ensure that all defendants receive notice of your complaint, however, we will

need a name and address for each defendant. Please provide the name and address of each doctor

and nurse you wish to sue. 

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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______________________________________________________________________________________________________________________________________________________

___________________________________________________________________________

14. Are you suing the defendants in their individual capacity, official capacity, or both?

Claims against individuals in their official capacities require proof that a policy or custom of the

entity violated your rights. Personal capacity claims, on the other hand, are those which allege

personal liability for individual actions by officials in the course of their duties.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

15. You state that you were told that you could not obtain copies of your grievances

unless you hired an attorney. When were you told this and by whom?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

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I CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS COVERED BY

THE VERIFICATION MADE BY ME ON MY INITIAL COMPLAINT.

_______________________________________

ANTOINE DAVIS

________________________________________

DATE

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