Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_24-cv-01808/USCOURTS-azd-2_24-cv-01808-0/pdf.json

Parties Involved:
Jeffrey Alvarez
Defendant
Lionel Isaac Ruelas
Plaintiff
Paul Shipley
Defendant
Siji Thomas
Defendant
Ryan Thornell
Defendant

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JL

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Lionel Isaac Ruelas,

Plaintiff, 

v. 

Ryan Thornell, et al.,

Defendants.

No. CV-24-01808-PHX-JAT (DMF)

ORDER

Plaintiff Lionel Isaac Ruelas, who is confined in the Arizona State Prison ComplexEyman, has filed a pro se civil rights Complaint pursuant to 42 U.S.C. § 1983 (Doc. 1), an 

Application to Proceed In Forma Pauperis (Doc. 2), and a Motion for Appointment of 

Counsel (Doc. 4). The Court will grant the Application to Proceed, deny the Motion for 

Appointment of Counsel without prejudice, and dismiss the Complaint with leave to 

amend.

I. Application to Proceed In Forma Pauperis and Filing Fee

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

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

§ 1915(b)(1). The Court will assess an initial partial filing fee of $27.83. The remainder 

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

credited to Plaintiff’s trust account each time the amount in the account exceeds $10.00. 

28 U.S.C. § 1915(b)(2). The Court will enter a separate Order requiring the appropriate 

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

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II. Statutory Screening of Prisoner Complaints

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

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

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

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

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

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

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

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

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

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

conclusory statements, do not suffice.” Id.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

III. Complaint 

In his single-count Complaint, Plaintiff sues Arizona Department of Corrections, 

Rehabilitation and Reentry (ADCRR) Director Ryan Thornell, Nurse Practitioner Siji 

Thomas, Medical Grievance Coordinator Paul Shipley, and NaphCare Chief Medical 

Officer Jeffrey Alvarez, in their individual and official capacities. Plaintiff asserts a claim 

regarding his medical care. He seeks declaratory, injunctive, and monetary relief.

Plaintiff alleges the following:

Plaintiff suffers from vertigo, and to shower safely, he needs a shower chair. On 

January 5, 2024, Plaintiff was sent to the emergency room because he was experiencing 

extreme vertigo. On January 5, 2024, after Plaintiff was released from the emergency 

room, Defendant Thomas told Plaintiff that he would receive a shower chair and issued a 

special needs order (SNO) for the shower chair. When the shower chair did not arrive, 

Plaintiff “continued to make inquiries and requests to medical” for the shower chair. Each 

time, Defendant Thomas responded that the chair was ordered on January 5, 2024.

On January 26, 2024, Plaintiff fell in the shower, injuring his head and shoulder. 

Five days after the fall, during a follow-up appointment with CNA Hoover, Hoover told 

Plaintiff that Defendant Thomas had never ordered the shower chair. Defendant Thomas

also failed to treat Plaintiff’s new injuries, “pushing them off as though Plaintiff [faked] 

his illness.” 

Plaintiff contends that Defendant Thomas was deliberately indifferent by 

acknowledging that he has a serious medical need, “which only can be resolved by medical, 

but actively and knowingly ignored his medical needs,” which placed him directly in 

harm’s way and resulted in his fall in the shower. Plaintiff asserts his head and shoulder 

injuries “add[ed]to” his underlying conditions “and will become complicated if they 

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continue to remain untreated.” Plaintiff alleges that Defendant Thomas “has biases when 

it comes to incarcerated people,” which “drive her desire to cause harm to incarcerated 

people rather than treat[] their underlying conditions.”

Plaintiff apparently submitted a grievance asserting that Defendant Thomas had 

failed to order the shower chair. According to Plaintiff, Defendant Shipley’s response to 

Plaintiff’s grievance “was with the purpose to shift blame and responsibility onto ADCRR”

by claiming that “medical does not have the capacity to provide shower chairs.” Plaintiff 

asserts that medical SNOs are prescriptions, prescriptions may only be generated and filled 

by medical, and because Defendant Thomas was Plaintiff’s primary provider, “this 

responsibility belong[ed] to her and th[e]n the doctors upon her recommendation.” 

Plaintiff alleges that Defendant Shipley “falsif[ied] his report by claiming it is left up to 

[ADCRR] to determine medical care,” when it was “within the scope of his office to resolve 

this issue at the earliest stage.”

Plaintiff alleges that Defendant Thornell’s “actions/inactions” amounted to 

deliberate indifference because Thornell failed to maintain oversight of medical 

professionals and the medical grievance coordinator, who “actively violate incarcerated 

persons[’] rights[] by denying medical care.”

Plaintiff alleges that Defendant Alvarez’s “actions/inactions are steeped in 

deliberate indifference for not abdicating [Defendant] Thomas[’]s employment as soon as 

[Alvarez] took office.” Plaintiff asserts that Defendant Alvarez “knew [Defendant 

Thomas’s] history of having legal actions brought against her due to her medical deliberate 

indifference, malpractice, negligence, etc.”

Plaintiff claims he suffered physical injury to his head and shoulder, “wanton” pain 

and suffering, and mental and emotional injury, including fear of a second fall, anger, 

anguish, anxiety, depression, insomnia, frustration, sadness, and stress.

IV. Failure to State a Claim

A. Individual versus Official Capacity

A suit against a defendant in his or her individual capacity seeks to impose personal 

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liability upon the official. Kentucky v. Graham, 473 U.S. 159, 165-66 (1985). For a person 

to be liable in his or her individual capacity, “[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). By comparison, 

a suit against a defendant in his or her official capacity represents only another way of 

pleading an action against the entity that employs the defendant. Kentucky, 473 U.S. at 

165. That is, the real party in interest is not the named defendant, but the entity that 

employs the defendant. Id. To bring a claim against an individual in his official capacity, 

a plaintiff must show that the constitutional deprivation resulted from the entity’s policy, 

custom, or practice. Id.; Monell v. Dep’t of Soc. Servs., 436 U.S. 658, 694 (1978).

Although Plaintiff has named Defendants Thornell and Alvarez in their individual 

and official capacities, Plaintiff’s allegations fail to plausibly show that Defendants 

Thornell and Alvarez were personally involved in the deprivation of his civil rights but 

rather stem solely from their roles as the heads of the entities they oversee. Accordingly, 

the Court will construe Plaintiff’s claims as directed against Defendants Thornell and 

Alvarez in their official capacities only and will dismiss the individual-capacity claims 

against Defendants Thornell and Alvarez.

Plaintiff’s official-capacity claims against Defendants Thomas and Shipley are 

duplicative of the official-capacity claims against Defendants Thornell and Alvarez. The 

Court will therefore dismiss the official-capacity claim against Defendants Thomas and 

Shipley. 

B. Defendants Thornell and Alvarez

As noted, the real party in interest for Plaintiff’s official-capacity claims against 

Defendants Thornell and Alvarez is the entity that employs them, that is, ADCRR and 

NaphCare, respectively. To state an official-capacity claim against Defendants Thornell 

and Alvarez, Plaintiff must allege facts to support that he suffered a constitutional injury 

because of a policy, custom, or practice of ADCRR and NaphCare. Plaintiff does not allege 

the existence of an ADCRR or NaphCare policy, custom, or practice that resulted in any 

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injury to him. Plaintiff fails to state an official-capacity claim against Defendants Thornell 

and Alvarez, and these Defendants will be dismissed.

C. Defendant Thomas

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

violation of the Eighth Amendment. To state a § 1983 medical claim, a plaintiff must show 

(1) a “serious medical need” by demonstrating that failure to treat the condition could result 

in further significant injury or the unnecessary and wanton infliction of pain and (2) the 

defendant’s response was deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th 

Cir. 2006).

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

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

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

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

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

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

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

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

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

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

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

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

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

negligence will constitute deliberate indifference.” Clement v. Cal. Dep’t of Corr., 220 F. 

Supp. 2d 1098, 1105 (N.D. Cal. 2002); see also Broughton v. Cutter Labs., 622 F.2d 458, 

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

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

deliberate indifference to [a plaintiff’s] serious medical needs.” Sanchez v. Vild, 891 F.2d 

240, 242 (9th Cir. 1989). A mere delay in medical care, without more, is insufficient to 

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state a claim against prison officials for deliberate indifference. See Shapley v. Nev. 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’s allegations are too vague to state an Eighth Amendment claim against 

Defendant Thomas. Plaintiff alleges that on January 5, 2024, Defendant Thomas told him 

that she would order a shower chair and that she entered a SNO for the shower chair, but 

after he fell in the shower on January 26, 2024, a CNA told him that Thomas never ordered 

the shower chair. Plaintiff asserts that he made various inquiries about the shower chair, 

and each time, Defendant Thomas responded that the chair had been ordered on January 5. 

Plaintiff provides no factual detail concerning any of his inquiries, nor does he describe in 

sufficient detail what transpired during the appointment with CNA Hoover. Absent 

additional information, the Court cannot determine whether Defendant Thomas 

purposefully failed to respond to Plaintiff’s medical need or intentionally denied, delayed, 

or interfered with Plaintiff’s medical treatment by failing to order the shower chair. 

Plaintiff’s speculation about Defendant Thomas’s “biases” does not support a deliberate 

indifference claim. The Court will therefore dismiss Defendant Thomas.

D. Defendant Shipley

Although not entirely clear, Plaintiff’s claim against Defendant Shipley appears to 

be based solely on Shipley’s response to Plaintiff’s grievance concerning Defendant 

Thomas’s failure to order the shower chair. Prisoners have a First Amendment right to file 

prison grievances, Rhodes v. Robinson, 408 F.3d 559, 567 (9th Cir. 2005), but prisoners do 

not have “‘a separate constitutional entitlement to a specific prison grievance procedure,” 

Ramirez v. Galaza, 334 F.3d 850, 860 (9th Cir. 2003) (citing Mann v. Adams, 855 F.2d 

639, 640 (9th Cir. 1988)). Accordingly, prisoners cannot bring due process challenges to 

the processing of their grievances. See Ramirez, 334 F.3d at 860; see also McRoy v. Roe, 

509 F. App’x 660, 660 (9th Cir. 2013) (affirming dismissal of claims “arising from 

defendants’ processing of and response to his grievances because prisoners do not have a 

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‘constitutional entitlement to a specific prison grievance procedure’”) (quoting Ramirez, 

334 F.3d at 860). 

Plaintiff alleges that Defendant Shipley “falsif[ied] his report,” but he alleges no 

facts to support that Shipley was in any way involved in Plaintiff’s medical care other than 

responding to Plaintiff’s grievance. Plaintiff cannot state a claim against Defendant 

Shipley based solely on his response to Plaintiff’s grievance. Plaintiff fails to state a claim 

against Defendant Shipley, and this Defendant will be dismissed.

V. Leave to Amend

For the foregoing reasons, the Court will dismiss Plaintiff’s Complaint for failure to 

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

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

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

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

dismiss this action without further notice to Plaintiff.

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

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

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

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

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

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

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

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

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

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

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

If Plaintiff files an amended complaint, he 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; 

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(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.

VI. Motion to Appoint Counsel

In his Motion to Appoint Counsel, Plaintiff asks the Court to appoint counsel to 

represent him in this case because he has language and comprehension barriers, he suffered 

a head injury that causes confusion at times, and he has never filed a lawsuit or studied the 

law, all of which will “greatly prejudice” him. Plaintiff asserts that without an attorney to 

represent him, “the fundamental fairness doctrine and equal protection under the law would 

be in jeopardy of having no standing, as [his] execution of any legal action without an 

attorney would be unavailing.” 

There is no constitutional right to counsel in a civil case. See Turner v. Rogers, 564 

U.S. 431, 441 (2011) (“[T]he Sixth Amendment does not govern civil cases.”); Palmer v. 

Valdez, 560 F.3d 965, 970 (9th Cir. 2009). Although 28 U.S.C. § 1915(e)(1) grants the 

Court limited discretion to “request” that an attorney represent an indigent civil litigant, 

Agyeman v. Corr. Corp. of Am., 390 F.3d 1101, 1103 (9th Cir. 2004), this discretion may 

be exercised only under “exceptional circumstances.” Id.; see also Terrell v. Brewer, 935 

F.2d 1015, 1017 (9th Cir. 1991).  

A finding of exceptional circumstances requires the Court “to consider whether 

there is a ‘likelihood of success on the merits’ and whether ‘the prisoner is unable to 

articulate his claims in light of the complexity of the legal issues involved.’” Harrington 

v. Scribner, 785 F.3d 1299, 1309 (9th Cir. 2015) (quoting Palmer, 560 F.3d at 970). These 

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considerations “must be viewed together,” and neither is dispositive. Palmer, 560 F.3d at 

970. 

Having considered both elements, it does not appear at this time that exceptional 

circumstances are present that would require the appointment of counsel in this case. 

Plaintiff is in no different position than many pro se prisoner litigants, and a plaintiff’s 

assertion that he would fare better with the assistance of counsel is insufficient to 

demonstrate exceptional circumstances. See Rand v. Rowland, 113 F.3d 1520, 1525 (9th 

Cir. 1997) (“any pro se litigant certainly would be better served with the assistance of 

counsel”), withdrawn in part on reh’g en banc and overruled on other grounds, 154 F.3d 

952 (9th Cir. 1998). Thus, the Court will deny without prejudice Plaintiff’s Motion to 

Appoint Counsel. 

VII. Warnings

A. Release

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

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

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

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

result in dismissal of this action.

B. Address Changes

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

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

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

action.

C. Possible “Strike”

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

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

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

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

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

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

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

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

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

D. Possible Dismissal

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

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

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

the Court).

IT IS ORDERED: 

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

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

agency, Plaintiff must pay the $350.00 filing fee and is assessed an initial partial filing fee 

of $27.83.

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

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

with this Order.

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

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

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

and deny any pending unrelated motions as moot.

(5) Plaintiff’s Motion to Appoint Counsel (Doc. 4) is denied without prejudice.

. . . .

. . . .

. . . .

. . . .

. . . .

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

rights complaint by a prisoner.

Dated this 9th day of September, 2024.

Case 2:24-cv-01808-JAT-DMF Document 8 Filed 09/10/24 Page 12 of 22
Revised 12/1/23 

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 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 $455.00 ($350.00 filing 

fee plus $55.00 administrative fee). If you are unable to immediately pay the fees, you may 

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

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

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

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

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

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

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

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

electronic filing.

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

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

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

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

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

Division. Unless you are an inmate housed at an Arizona Department of Corrections facility 

that participates in electronic filing, mail the original and one copy of the complaint with the 

$455 filing and administrative fees or the application to proceed in forma pauperis to:

Case 2:24-cv-01808-JAT-DMF Document 8 Filed 09/10/24 Page 13 of 22
2 

Phoenix & Prescott Divisions: OR Tucson Division: 

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

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

401 West Washington Street, SPC 10 405 West Congress Street 

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

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

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

address may result in the dismissal of your case.

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

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

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

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

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

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

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

of Corrections facility that participates in electronic filing. 

A certificate of service should be in the following form: 

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

this (month, day, year) to: 

Name: 

Address: 

 Attorney for Defendant(s) 

 

(Signature) 

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

you must file an amended complaint. The amended complaint must be written on the courtapproved civil rights complaint form. You may file one amended complaint without leave 

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

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

motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In 

addition, an amended complaint may not incorporate by reference any part of your prior complaint. 

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

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

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

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

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

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

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

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

pleading or motion. 

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3 

12. Completing the Civil Rights Complaint Form. 

HEADING:

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

address on the lines provided. 

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

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

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

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

A” at the bottom. 

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

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

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

seeking only injunctive relief. 

Part A. JURISDICTION:

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

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

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

authority. 

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

occurred. 

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

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

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

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

Part B. PREVIOUS LAWSUITS:

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

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

provided. If you have filed more than three lawsuits, you must provide the necessary information 

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

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

Part C. CAUSE OF ACTION:

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

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

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

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

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

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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 2:24-cv-01808-JAT-DMF Document 8 Filed 09/10/24 Page 16 of 22
Revised 12/1/23 1 550/555

___________________________________________ Name and Prisoner/Booking Number 

___________________________________________ Place of Confinement 

___________________________________________ Mailing Address 

___________________________________________ City, State, Zip Code (Failure to notify the Court of your change of address may result in dismissal of this action.)

IN THE UNITED STATES DISTRICT COURT

 FOR THE DISTRICT OF ARIZONA 

_________________________________________ , 

(Full Name of Plaintiff) 

Plaintiff, 

v. 

(1) _______________________________________ , 

(Full Name of Defendant) 

(2) _______________________________________ , 

(3) _______________________________________ , 

(4) _______________________________________ , 

Defendant(s). 

G Check if there are additional Defendants and attach page 1-A listing them.

CASE NO. __________________________________ 

 (To be supplied by the Clerk) 

CIVIL RIGHTS COMPLAINT 

BY A PRISONER 

G Original Complaint 

G First Amended Complaint 

G Second Amended Complaint

A. JURISDICTION

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

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

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

G Other: . 

2. Institution/city where violation occurred: . 

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2

B. DEFENDANTS

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

as: ______________________________________________ at_______________________________________. 

(Position and Title) (Institution)

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

as: ______________________________________________ at_______________________________________.

 (Position and Title) (Institution)

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

as: ______________________________________________ at_______________________________________.

 (Position and Title) (Institution)

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

as: ______________________________________________ at_______________________________________.

 (Position and Title) (Institution) 

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

C. PREVIOUS LAWSUITS

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

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

a. First prior lawsuit: 

1. Parties: v. 

2. Court and case number: . 

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

. 

b. Second prior lawsuit: 

1. Parties: v. 

2. Court and case number: . 

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

. 

c. Third prior lawsuit: 

1. Parties: v. 

2. Court and case number: . 

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

. 

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

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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. 

. 

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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. 

. 

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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.

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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. 

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