Ferguson v. Palm Beach County Sheriff's Department of Corrections

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF FLORIDA

CASE NO. 23-CV-81264-RAR

BERNARD FERGUSON,

Plaintiff,

v.

PALM BEACH COUNTY SHERIFF’S

DEPARTMENT OF CORRECTIONS, et al.,

Defendants.

______________________________________/

ORDER DISMISSING COMPLAINT IN PART AND GRANTING LEAVE TO AMEND

THIS CAUSE comes before the Court on Plaintiff’s pro se civil rights Complaint filed

under 42 U.S.C. § 1983. See Complaint (“Compl.”), [ECF No. 1]. Plaintiff, a pretrial detainee at

the “West Detention Center” in Palm Beach County, Florida (the “Jail”), alleges that eight

individuals and entities associated with the Jail have been deliberately indifferent to his serious

medical needs by refusing to provide him with “buprenorphine” to treat his “opioid-use disorder.”

Id. at 8.

After carefully reviewing the Complaint, the Court finds that Plaintiff has stated a prima

facie deliberate indifference claim against some (but not all) of the Defendants, but the Complaint

cannot proceed to service because it does not comply with the Federal Rules of Civil Procedure

and the Court’s Local Rules. Accordingly, the Court will dismiss some of Plaintiff’s claims and

order Plaintiff to file an amended complaint to address these remaining procedural and substantive

defects before it will allow the remaining claims to proceed to service.

FACTUAL ALLEGATIONS1

Plaintiff “was a regular heroin and oxycodone user,” and admits that he was “addicted” to

these substances and “other opiates” in the past. Id. at 6. Prior to his incarceration, Plaintiff “had

been participating in a Suboxone treatment” at a local clinic.2 Id. Plaintiff informed the Jail’s

medical staff during his intake that he “had been participating in Suboxone treatment” and that he

“had already begun to experience withdrawal symptoms,” but the Jail “never provided me with

any treatment for my addiction.” Id. Plaintiff’s withdrawal symptoms continued to worsen—he

suffered from “vomiting, nausea, diarrhea, loss of appetite, shakes, and fatigue”—until he began

to “self-medicat[e] . . . through unconventional means[.]” Id. at 6–7.3

Plaintiff again requested Suboxone from the Jail’s medical staff, who now informed him

that he should “sign-up for the M.A.P.S. program” and complete “an 85 day drug education

program called ‘Another Way.’” Id. at 7. After fulfilling these requirements, Plaintiff met with

Defendant Allison Perry, the Director of “The Recovery Research Network,” to discuss

Petitioner’s “opioid-use history.” Id. Ms. Perry arranged for Plaintiff to meet with Defendant Dr.

Ronald Waits the next day. See id. At his meeting with Dr. Waits, Plaintiff admitted that he “had

been self-medicating” with Suboxone to avoid withdrawal symptoms after a urinalysis drug test

revealed that Plaintiff “had Suboxone in [his] system.” Id. at 7–8. Despite the positive drug test,

1 Since the screening standard under § 1915A is functionally similar to the “failure to state a claim standard”

under FED. R. CIV. P. 12(b)(6), the Court will assume all of the factual allegations in the Complaint are true.

See Jones v. Bock, 549 U.S. 199, 215 (2007). The parties should not interpret the Court’s recitation of the

factual allegations in the Complaint as a comment on their veracity.

2 “Suboxone” is a brand name for the drug “buprenorphine,” which is both a Schedule III narcotic and a

treatment for patients who are addicted to opioids. See United States v. Abovyan, 988 F.3d 1288, 1296

(11th Cir. 2021).

3 Although Plaintiff never explicitly says so, the unavoidable conclusion is that Plaintiff began self-

medicating with contraband Suboxone.

Dr. Waits diagnosed Plaintiff with opioid-use disorder (“OUD”) and prescribed Plaintiff

buprenorphine to treat it. See id.

On August 7, 2023, after receiving his prescription for buprenorphine for three days,

Plaintiff was approached by Defendant Sergeant Faircloth. Sgt. Faircloth informed Plaintiff that

he had been issued a disciplinary report for “misuse of authorized medication” because of his

positive drug test before Dr. Waits had prescribed him buprenorphine. See id. at 8. Sgt. Faircloth

then explained that Plaintiff “was being taken off [his] medication pursuant to the Department’s

policy.” Id. at 9. Since then, Plaintiff has not received any buprenorphine for his OUD and is

currently suffering “severe side effects from the withdrawals.” Id. at 9.

Plaintiff eventually saw a different Jail doctor, Defendant Dr. Mouhammed,4 on August

16, 2023. Dr. Mouhammed told Plaintiff that “he would leave it to Dr. Waits to put me back on

Suboxone because he took me off, but he acknowledged that it was a mistake to take me off.” Id.

at 10. The next day, on August 17, 2023, Plaintiff “woke up laying in my own feces and bodily

waste” and “collapsed” from the “terrible withdrawal symptoms.” Id. When Plaintiff saw Ms.

Perry later that day, he “explained to her everything that has taken place in the past two weeks.”

Id. at 11. Ms. Perry agreed that she would “try to talk to Dr. Waits” about getting Plaintiff back

on medication. Id. Despite Dr. Mouhammed and Ms. Perry’s promises, Plaintiff still is not

receiving buprenorphine and is suffering from severe withdrawal symptoms while in the Jail. See

id. at 11–13.

LEGAL STANDARD

The Court “shall review . . . a complaint in a civil action in which a prisoner seeks redress

from a governmental entity or officer or employee of a governmental entity.” 28 U.S.C. § 1915A

4 In another portion of the Complaint, Plaintiff indicates that Dr. Mouhammed might be an advanced

registered nurse practitioner—not a doctor. See Compl. at 2.

(emphasis added). The definition of a “prisoner” includes “any person incarcerated or detained in

any facility who is . . . accused of [or] convicted of . . . violations of criminal law.” Id. §

1915A(c). In conducting its screening of a prisoner’s complaint, the Court must “dismiss the

complaint[] or any portion of the complaint,” when it is (1) “frivolous, malicious, or fails to state

a claim upon which relief may be granted[;]” or (2) “seeks monetary relief from a defendant who

is immune from such relief.” Id. § 1915A(b). Similarly, if a plaintiff wishes to proceed in forma

pauperis rather than prepaying the filing fee, § 1915(e)(2) requires the court to “dismiss [a] case

at any time if the court determines that . . . the action” fails for the same enumerated reasons

articulated under § 1915A. Id. § 1915(e)(2)(B) (emphasis added).

To state a claim upon which relief may be granted, a complaint’s factual allegations “must

be enough to raise a right to relief above the speculative level”—with “enough facts to state a claim

to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 570 (2007).

Under this standard, legal conclusions “are not entitled to the assumption of truth” and are

insufficient to state a claim. Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009). Moreover, “[w]here a

complaint pleads facts that are merely consistent with a defendant’s liability, it stops short of the

line between possibility and plausibility of entitlement to relief.” Id. at 678 (internal quotation

marks omitted).

Although the Court must hold the allegations in a pro se civil rights complaint “to a less

stringent standard than formal pleadings drafted by lawyers,” Haines v. Kerner, 404 U.S. 519, 520

(1972), pro se litigants are still required to comply with the Federal Rules of Civil Procedure and

the Local Rules of the Southern District of Florida, see Moon v. Newsome, 863 F.2d 835, 837 (11th

Cir. 1989) (“[A pro se litigant] is subject to the relevant law and rules of court, including the

Federal Rules of Civil Procedure.”); see also S.D. FLA. L.R. 1.1 (explaining the Local Rules apply

in all proceedings unless otherwise indicated and that the word “counsel” shall apply to a party

that is proceeding pro se). The Federal Rules of Civil Procedure require, in pertinent part, that a

pleading that states a claim for relief contain “a short and plain statement of the grounds for a

court’s jurisdiction,” “a short and plain statement of the claim showing that the pleader is entitled

to relief,” and “a demand for the relief sought[.]” FED. R. CIV. P. 8(a). “A party must state its

claims or defenses in numbered paragraphs, each limited as far as practicable to a single set of

circumstances[,]” and “each claim founded on a separate transaction or occurrence—and each

defense other than a denial—must be stated in a separate count or defense.” FED. R. CIV. P. 10(b).

If a plaintiff fails to set forth a legally sufficient claim for relief, either because the

complaint lacks sufficient factual support or because the complaint fails to comport with the

appropriate procedural rules, its usefulness is substantially diminished. Still, a pro se litigant must

generally “be given at least one chance to amend the complaint before the district court dismisses

the action with prejudice.” Woldeab v. DeKalb Cnty. Bd. of Educ., 885 F.3d 1289, 1291 (11th Cir.

2018) (quoting Bank v. Pitt, 928 F.2d 1108, 1112 (11th Cir. 1991)). “A district court need not,

however, allow an amendment (1) where there has been undue delay, bad faith, dilatory motive,

or repeated failure to cure deficiencies by amendments previously allowed; (2) where allowing

amendment would cause undue prejudice to the opposing party; or (3) where amendment would

be futile.” Bryant v. Dupree, 252 F.3d 1161, 1163 (11th Cir. 2001) (citing Forman v. Davis, 371

U.S. 178, 182 (1962)).

ANALYSIS

Plaintiff names eight Defendants in his Complaint: the “Palm Beach County Sherriff’s

Department of Corrections” (“PBSO”), Wellpath Medical, LLC, Dr. Waits, Ms. Perry, Sheriff Ric

L. Bradshaw, Sgt. Faircloth, Dr. Mouhammed, and “The Recovery Research Network, Inc.”

Compl. at 2–3. Plaintiff alleges that the Defendants were deliberately indifferent to his serious

medical needs, in violation of the Eighth Amendment and Due Process Clause of the Fourteenth

Amendment,5 by depriving him of buprenorphine for non-medical reasons. See id. at 12–13. To

state a valid deliberate-indifference-to-medical-needs claim, Plaintiff must show that he had a

“serious medical need,” that each defendant exhibited “deliberate indifference to that need,” and

that there was “causation between [each defendant’s] indifference and [Plaintiff’s] injury.” Mann

v. Taser Int’l, Inc., 588 F.3d 1291, 1306–07 (11th Cir. 2009). After reviewing Plaintiff’s

allegations, the Court finds as follows: (1) Plaintiff has stated a deliberate indifference claim

against four defendants, (2) two of the four remaining defendants must be dismissed from this

action without giving Plaintiff an opportunity to amend his claims against them, and (3) leave to

amend should be granted to remedy the remaining issues with the Complaint.

A. The Deliberately Indifferent Defendants

First, the Court finds that the facts alleged in the Complaint, if true, appear to be sufficient

to state a deliberate indifference claim. Plaintiff avers that he needs buprenorphine to treat his

OUD and, without it, he suffers from severe withdrawal symptoms (e.g., vomiting, diarrhea, loss

of appetite, “shakes,” and fatigue). See Compl. at 6–7. He further explains that Dr. Waits initially

prescribed him buprenorphine after determining it was medically necessary to treat Plaintiff’s

OUD, but that Sgt. Faircloth ordered Plaintiff’s prescription be rescinded three days later for a

non-medical reason—Plaintiff’s failed drug test. See id. at 7–9. These allegations establish a

constitutional violation. Federal courts around the country have held that OUD (and the side

effects of withdrawal from opioid usage) are “serious medical needs.” See Foelker v. Outagamie

Cnty., 394 F.3d 510, 512–13 (7th Cir. 2005) (holding that “forced withdrawal from methadone”

constituted a “serious medical need”); Quintana v. Santa Fe Cnty. Bd. of Comm’rs, 973 F.3d 1022,

5 As a pretrial detainee, “the Eighth Amendment prohibition on cruel and unusual punishment” does not

govern Plaintiff’s claim, but this has no impact on the Court’s analysis since “the standards under the

Fourteenth Amendment are identical to those under the Eighth.” Goebert v. Lee Cnty., 510 F.3d 1312, 1326

(11th Cir. 2007).

1039 (10th Cir. 2020) (Bacharach, J., concurring in part and dissenting in part) (“Just as withdrawal

from alcohol can constitute a serious medical need when the symptoms are severe, so too can

withdrawal from opiates like heroin.”). And a jail official’s decision not to treat a “serious medical

need” for non-medical reasons is textbook “deliberate indifference.” See Ancata v. Prison Health

Servs., Inc., 769 F.2d 700, 704 (11th Cir. 1985) (“[I]f necessary medical treatment has been

delayed for non-medical reasons, a case of deliberate indifference has been made out.”).

The next question, then, is whether any of the Defendants’ deliberate indifference caused

Plaintiff’s injury. Based on the contents of the Complaint, the Court is confident that four

Defendants might fit the bill: PBSO, Dr. Waits, Sgt. Faircloth, and Sheriff Bradshaw. According

to Plaintiff, Dr. Waits was “deliberately indifferent to my serious medical needs by taking me off

of my medication that he himself prescribed as a punishment while the medical needs still exist.”

Compl. at 12. The Court agrees that this is more than sufficient to state a claim of deliberate

indifference against Dr. Waits. See Lancaster v. Monroe Cnty., Ala., 116 F.3d 1419, 1425 (11th

Cir. 1997) (“[A]n official acts with deliberate indifference when he knows that an inmate is in

serious need of medical care, but he fails or refuses to obtain medical treatment for the inmate.”),

overruled on other grounds by LeFrere v. Quezada, 588 F.3d 1317 (11th Cir. 2009). Likewise,

Plaintiff says that Sgt. Faircloth deliberately “took me off of the medication as punishment” even

though he had spoken to Dr. Waits and the Jail’s medical staff about why Plaintiff had been

prescribed buprenorphine. Compl. at 13. This, if true, would also constitute deliberate

indifference. See Lancaster, 116 F.3d at 1425.

Sheriff Bradshaw and PBSO are also proper defendants, albeit for different reasons than

Dr. Waits and Sgt. Faircloth. A supervisory official (such as a sheriff) is not “liable under § 1983

for the unconstitutional acts of their subordinates on the basis of respondent superior or vicarious

liability.” Cottone v. Jenne, 326 F.3d 1352, 1360 (11th Cir. 2003) (quoting Hartley v. Parnell,

193 F.3d 1263, 1269 (11th Cir. 1999)). “Instead, supervisory liability under § 1983 occurs either

when the supervisor personally participates in the alleged unconstitutional conduct or when there

is a causal connection between the actions of a supervising official and the alleged constitutional

deprivation.” Id. The Eleventh Circuit has identified three ways that a plaintiff can demonstrate

this “causal connection”: (1) “when a history of widespread abuse puts the responsible supervisor

on notice of the need to correct the alleged deprivation, and he fails to do so[,]” (2) the supervisor

has a “custom or policy” which “results in deliberate indifference to [the plaintiff’s] constitutional

rights,” or (3) the supervisor failed “to adequately train [his] officers”—which is a de facto policy

that “giv[es] rise to governmental liability.” Christmas v. Harris Cnty., Ga., 51 F.4th 1348, 1355

(11th Cir. 2022) (cleaned up). Similarly, to bring a § 1983 claim against a local government entity

like PBSO, Plaintiff “must show: (1) that his constitutional rights were violated; (2) that the

municipality had a custom or policy that constituted deliberate indifference to that constitutional

right; and (3) that the policy or custom caused the violation.” McDowell v. Brown, 392 F.3d 1283,

1289 (11th Cir. 2004).

Plaintiff has advanced both a supervisory liability claim against Sheriff Bradshaw and a

municipal liability claim against PBSO because he alleges the existence of an established policy

that caused the Jail’s employees to be deliberately indifferent. “A policy is a decision that is

officially adopted by the municipality, or created by an official of such rank that he or she could

be said to be acting on behalf of the municipality.” Sewell v. Town of Lake Hamilton, 117 F.3d

488, 489 (11th Cir. 1997). According to Plaintiff, Sheriff Bradshaw—in his capacity as the Sheriff

of PBSO—promulgated a specific policy which deprives inmates (like himself) of medically-

necessary prescriptions if they “misuse” them or fail a drug test. See Compl. at 9, 14. At this stage

of the proceedings, where the Court must accept everything the Plaintiff avers as true, the Court

finds that this alleged policy “directs an employee” to violate an inmate’s constitutional rights by

withholding medical treatment for non-medical reasons, Bd. of Cnty. Comm’rs of Bryan Cnty.,

Okla. v. Brown, 520 U.S. 397, 404 (1997). Therefore, Plaintiff has stated a claim against Sheriff

Bradshaw and PBSO.

However, for reasons the Court will soon explain, none of the claims against these four

Defendants will be allowed to proceed until Plaintiff remedies the procedural defects that hinder

the instant Complaint.

B. The Remaining Defendants

Before addressing the Complaint’s procedural issues, the Court will address the four

remaining Defendants. To make a long story short, the Court finds that Plaintiff has failed to state

a claim against any of them. However, since Plaintiff needs to file an amended complaint no

matter what, the Court will give Plaintiff an opportunity to amend his claims against two of these

Defendants: Ms. Perry and Dr. Mouhammed. On the other hand, the other two Defendants

(Wellpath and The Recovery Research Network) must be dismissed from this action since any

further attempt to state a claim against them would be futile. See Bryant, 252 F.3d at 1163.

Plaintiff’s claims against Ms. Perry and Dr. Mouhammed are subject to dismissal since it

is unclear whether they “caused” Plaintiff’s injuries. Plaintiff asserts that he informed Ms. Perry

and Dr. Mouhammed that he had been taken off buprenorphine, but that neither of them convinced

Dr. Waits to resume the prescription. See Compl. at 13. Neither of these Defendants, by Plaintiff’s

own admission, were responsible for depriving him of access to buprenorphine. Their only link to

the alleged constitutional violation is that they were not able to reverse the Jail’s decision to no

longer supply Plaintiff with buprenorphine. See id. From what the Court can gather, neither Ms.

Perry nor Dr. Mouhammed could have prescribed buprenorphine even if they wanted to since the

authority to make that decision was apparently vested in Dr. Waits. See, e.g., Compl. at 7

(explaining that Ms. Perry referred Plaintiff to Dr. Waits to treat his OUD); see also LaMarca v.

Turner, 995 F.2d 1526, 1538–39 (11th Cir. 1993) (holding that, to show causation, the defendant’s

actions “must . . . have been the proximate cause of the plaintiffs’ injuries”). If Plaintiff wishes to

bring a claim against these two defendants, he must show in his amended complaint that they

actually had the power to remedy Plaintiff’s injuries but, through their own deliberate indifference,

failed to do so.

Conversely, the Court will not allow Plaintiff to amend his claims against Wellpath and

The Recovery Research Network. Plaintiff explains that these two entities “provide on-site

medical services at PBSO Department of Corrections, pursuant to a contract with Palm Beach

County.” Compl. at 6. When a private corporation “contracts with a county to provide medical

services to inmates, it performs a function traditionally within the exclusive prerogative of the

state. In so doing, it becomes the functional equivalent of a municipality.” Buckner v. Toro, 116

F.3d 450, 452 (11th Cir. 1997). Thus, these defendants cannot be liable under § 1983 unless they

promulgated a “custom or policy” that caused Plaintiff’s injuries, see id., but Plaintiff cannot meet

this burden. Plaintiff has already alleged that it was Sheriff Bradshaw and the PBSO—not

Wellpath and The Recovery Research Network—that are responsible for the policy which is

purportedly violating Plaintiff’s constitutional rights. See Compl. at 13–14. And, as a practical

matter, it is simply not conceivable for a private corporation that provides medical services to be

responsible for a policy that is designed to discipline prisoners for violating a jail’s rules. Since

Plaintiff cannot show that Wellpath and The Recovery Research Network are responsible for a

custom or policy that harmed him, the claims against these Defendants are dismissed with

prejudice. See 28 U.S.C. § 1915A(b).

C. Amendment is Required

Finally, the Court will explain why amendment is necessary, even though Plaintiff has

stated some viable claims for relief. The Complaint suffers from two major defects that must be

corrected. First, the Complaint does not “substantially follow” the form that this Court requires

for pro se civil rights complaints. See S.D. FLA. L.R. 88.2(a). The Court will provide Plaintiff

with a copy of the approved form, which Plaintiff must use to file his amended complaint. Second,

the Complaint’s factual allegations are not presented “in numbered paragraphs,” and each claim

against each defendant is not “stated in a separate count.” FED. R. CIV. P. 10(b). Although the

factual allegations in the Complaint, standing alone, are mostly sufficient to state a claim under §

1983, they must still be presented in a way that allows the Court to accurately adjudicate them and

for Defendants to properly respond to them. Plaintiff’s amended complaint must, in short, state

Plaintiff’s claims in numbered paragraphs and divide each claim into separate counts as required

by Rule 10(b).

For ease of reference, the Court will summarize what Plaintiff’s amended complaint must

have in order to comply with this Order: (1) it must be on the appropriate form required by S.D.

FLA. L.R. 88.2; (2) it must be divided into numbered paragraphs and separate counts as required

by FED. R. CIV. P. 10(b); (3) it must contain the same factual allegations and claims that the Court

already found to be legally sufficient against Defendants PBSO, Waits, Faircloth, and Bradshaw;6

and (4) it must allege additional facts, if any exist, which show that Defendants Perry and

Mouhammed were deliberately indifferent to Plaintiff’s serious medical needs. If Plaintiff fails to

comply with this Order, the Court may dismiss the remainder of this action. See FED. R. CIV. P.

41(b).

6 The Court warns Plaintiff that the Complaint will be “wholly superseded by [his] amended complaint,”

so anything that was presented in his Complaint that is not repeated in Plaintiff’s amended complaint will

not be considered by the Court. Dresdner Bank AG v. M/V Olympia Voyager, 463 F.3d 1210, 1215 (11th

Cir. 2006).

CONCLUSION

For the foregoing reasons, it is hereby ORDERED AND ADJUDGED as follows:

1. Plaintiff’s Complaint [ECF No. 1] is DISMISSED without prejudice. Plaintiff is

GRANTED leave to file an amended complaint not to exceed twenty (20) pages in length. On

or before October 20, 2023, the amended complaint must be docketed, signed under the penalty

of perjury, and contain a short and plain statement of a claim for relief, a basis for federal

jurisdiction, and a demand for judgment. Plaintiff shall be provided a form complaint.

2. The amended complaint must be labeled “Amended Complaint” and must show the

case number referenced above, so that it will be filed in this case.

3. The amended complaint must contain a separate paragraph as to each Defendant

explaining what that particular Defendant did and the supporting facts to show why that person is

being sued.

4. Plaintiff is reminded that the amended complaint should, at the very least, cure the

deficiencies identified within this Order to state a claim for relief.

5. Plaintiff is warned that failure to file the amended complaint on time and in

compliance with this Court’s Order shall result in dismissal of this case for failure to prosecute or

failure to comply with court orders. See FED. R. CIV. P. 41(b).

6. Plaintiff’s claims against Wellpath Medical, LLC and The Research Recovery

Network, Inc. are DISMISSED with prejudice for failure to state a claim under 28 U.S.C. §

1915A. The Clerk is instructed to TERMINATE these Defendants.

7. Plaintiff’s Motion for Leave to Proceed in forma pauperis [ECF No. 3] is

GRANTED to the extent that Plaintiff need not prepay even a partial filing fee in this case, or

prepay costs, such as for service of process. Plaintiff owes the United States a debt of $350.00

which must be paid to the Clerk of Court as funds become available. The prison having custody

of Plaintiff must make payments from the prisoner’s account to the Clerk each time the amount in

the account exceeds $10.00 until the full filing fee of $350.00 is paid. The Clerk is DIRECTED

to serve a copy of this Order on the Palm Beach County Sheriff's Office’s Inmate Trust Fund

Account Department and this Court’s Financial Department.

8. The Clerk’s Office is instructed to administratively CLOSE this case.

DONE AND ORDERED in Miami, Florida, this 19th day of September, 2023.

RODOLFO A. RUIZ IT

UNITED STATES DISTRICT JUDGE

ce: Bernard Ferguson

0398915

West Detention Center

Inmate Mail/Parcels

P.O. Box 1450

Belle Glade, FL 33430

PRO SE

Palm Beach County Sheriffs Office

ATTN: Inmate Trust Fund Department

3228 Gun Club Road

West Palm Beach, FL 33406

Financial Department,

United States District Court, Southern District of Florida

Page 13 of 13

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

for the

District of

Division

) Case No.

) (to be filled in by the Clerk’s Office)

Plaintiff(s)

(Write the full name of each plaintiff who is filing this complaint.

If the names of all the plaintiffs cannot fit in the space above, )

please write “see attached” in the space and attach an additional )

page with the full list of names.) )

-V- )

)

)

)

Defendant(s) )

(Write the full name of each defendant who is being sued. If the )

names of all the defendants cannot fit in the space above, please )

write “see attached” in the space and attach an additional page

with the full list of names. Do not include addresses here.)

COMPLAINT FOR VIOLATION OF CIVIL RIGHTS

(Prisoner Complaint)

NOTICE

Federal Rules of Civil Procedure 5.2 addresses the privacy and security concerns resulting from public access to

electronic court files. Under this rule, papers filed with the court should not contain: an individual’s full social

security number or full birth date; the full name of a person known to be a minor; or a complete financial account

number. A filing may include only: the last four digits of a social security number; the year of an individual’s

birth; a minor’s initials; and the last four digits of a financial account number.

Except as noted in this form, plaintiff need not send exhibits, affidavits, grievance or witness statements, or any

other materials to the Clerk’s Office with this complaint.

In order for your complaint to be filed, it must be accompanied by the filing fee or an application to proceed in

forma pauperis.

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

I. The Parties to This Complaint

A, The Plaintiff(s)

Provide the information below for each plaintiff named in the complaint. Attach additional pages if

needed.

Name

All other names by which

you have been known:

ID Number

Current Institution

Address

City State Zip Code

B. The Defendant(s)

Provide the information below for each defendant named in the complaint, whether the defendant is an

individual, a government agency, an organization, or a corporation. Make sure that the defendant(s)

listed below are identical to those contained in the above caption. For an individual defendant, include

the person’s job or title known) and check whether you are bringing this complaint against them in their

individual capacity or official capacity, or both. Attach additional pages if needed.

Defendant No. 1

Name

Job or Title (if known)

Shield Number

Employer

Address

City State Zip Code

1 Individual capacity © Official capacity

Defendant No. 2

Name

Job or Title (if known)

Shield Number

Employer

Address

City State Zip Code

1 Individual capacity © Official capacity

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

Defendant No. 3

Name

Job or Title (if known)

Shield Number

Employer

Address

City State Zip Code

1 Individual capacity © Official capacity

Defendant No. 4

Name

Job or Title (if known)

Shield Number

Employer

Address

City State Zip Code

1 Individual capacity © Official capacity

II. Basis for Jurisdiction

Under 42 U.S.C. § 1983, you may sue state or local officials for the “deprivation of any rights, privileges, or

immunities secured by the Constitution and [federal laws].” Under Bivens v. Six Unknown Named Agents of

Federal Bureau of Narcotics, 403 U.S. 388 (1971), you may sue federal officials for the violation of certain

constitutional rights.

A. Are you bringing suit against (check all that apply):

(C1 Federal officials (a Bivens claim)

1 State or local officials (a § 1983 claim)

B. Section 1983 allows claims alleging the “deprivation of any rights, privileges, or immunities secured by

the Constitution and [federal laws].” 42 U.S.C. § 1983. If you are suing under section 1983, what

federal constitutional or statutory right(s) do you claim is/are being violated by state or local officials?

C. Plaintiffs suing under Bivens may only recover for the violation of certain constitutional rights. If you

are suing under Bivens, what constitutional right(s) do you claim is/are being violated by federal

officials?

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

D. Section 1983 allows defendants to be found liable only when they have acted “under color of any

statute, ordinance, regulation, custom, or usage, of any State or Territory or the District of Columbia.”

42 U.S.C. § 1983. If you are suing under section 1983, explain how each defendant acted under color

of state or local law. If you are suing under Bivens, explain how each defendant acted under color of

federal law. Attach additional pages if needed.

Ill. Prisoner Status

Indicate whether you are a prisoner or other confined person as follows (check all that apply):

Oo Pretrial detainee

Oo Civilly committed detainee

Oo Immigration detainee

Oo Convicted and sentenced state prisoner

Oo Convicted and sentenced federal prisoner

o Other (explain)

IV. Statement of Claim

State as briefly as possible the facts of your case. Describe how each defendant was personally involved in the

alleged wrongful action, along with the dates and locations of all relevant events. You may wish to include

further details such as the names of other persons involved in the events giving rise to your claims. Do not cite

any cases or statutes. If more than one claim is asserted, number each claim and write a short and plain

statement of each claim in a separate paragraph. Attach additional pages if needed.

A. If the events giving rise to your claim arose outside an institution, describe where and when they arose.

B. If the events giving rise to your claim arose in an institution, describe where and when they arose.

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

C. What date and approximate time did the events giving rise to your claim(s) occur?

D. What are the facts underlying your claim(s)? (For example: What happened to you? Who did what?

Was anyone else involved? Who else saw what happened?)

V. Injuries

If you sustained injuries related to the events alleged above, describe your injuries and state what medical

treatment, if any, you required and did or did not receive.

VI. Relief

State briefly what you want the court to do for you. Make no legal arguments. Do not cite any cases or statutes.

If requesting money damages, include the amounts of any actual damages and/or punitive damages claimed for

the acts alleged. Explain the basis for these claims.

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

VII. Exhaustion of Administrative Remedies Administrative Procedures

The Prison Litigation Reform Act (“PLRA”), 42 U.S.C. § 1997e(a), requires that “[n]o action shall be brought

with respect to prison conditions under section 1983 of this title, or any other Federal law, by a prisoner confined

in any jail, prison, or other correctional facility until such administrative remedies as are available are

exhausted.”

Administrative remedies are also known as grievance procedures. Your case may be dismissed if you have not

exhausted your administrative remedies.

A. Did your claim(s) arise while you were confined in a jail, prison, or other correctional facility?

O Yes

O No

If yes, name the jail, prison, or other correctional facility where you were confined at the time of the

events giving rise to your claim(s).

B. Does the jail, prison, or other correctional facility where your claim(s) arose have a grievance

procedure?

O Yes

O No

O Do not know

C. Does the grievance procedure at the jail, prison, or other correctional facility where your claim(s) arose

cover some or all of your claims?

O Yes

O No

O Do not know

If yes, which claim(s)?

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

D. Did you file a grievance in the jail, prison, or other correctional facility where your claim(s) arose

concerning the facts relating to this complaint?

O Yes

O No

If no, did you file a grievance about the events described in this complaint at any other jail, prison, or

other correctional facility?

O Yes

O No

E. If you did file a grievance:

1. Where did you file the grievance?

2. What did you claim in your grievance?

3. What was the result, if any?

4. What steps, if any, did you take to appeal that decision? Is the grievance process completed? If

not, explain why not. (Describe all efforts to appeal to the highest level of the grievance process.)

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

F, If you did not file a grievance:

1. Ifthere are any reasons why you did not file a grievance, state them here:

2. Ifyou did not file a grievance but you did inform officials of your claim, state who you informed,

when and how, and their response, if any:

G. Please set forth any additional information that is relevant to the exhaustion of your administrative

remedies.

(Note: You may attach as exhibits to this complaint any documents related to the exhaustion of your

administrative remedies. )

VIII. Previous Lawsuits

The “three strikes rule” bars a prisoner from bringing a civil action or an appeal in federal court without paying

the filing fee if that prisoner has “on three 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).

To the best of your knowledge, have you had a case dismissed based on this “three strikes rule’?

O Yes

No

If yes, state which court dismissed your case, when this occurred, and attach a copy of the order if possible.

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

A. Have you filed other lawsuits in state or federal court dealing with the same facts involved in this

action?

O Yes

O No

B. If your answer to A is yes, describe each lawsuit by answering questions 1 through 7 below. (Jf there is

more than one lawsuit, describe the additional lawsuits on another page, using the same format.)

1. Parties to the previous lawsuit

Plaintiff(s)

Defendant(s)

2. Court (if federal court, name the district; if state court, name the county and State)

3. Docket or index number

4. Name of Judge assigned to your case

5. Approximate date of filing lawsuit

6. Is the case still pending?

O Yes

Ol No

If no, give the approximate date of disposition.

7. What was the result of the case? (For example: Was the case dismissed? Was judgment entered

in your favor? Was the case appealed?)

C. Have you filed other lawsuits in state or federal court otherwise relating to the conditions of your

imprisonment?

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

Ol Yes

O No

D. If your answer to C is yes, describe each lawsuit by answering questions 1 through 7 below. (If there is

more than one lawsuit, describe the additional lawsuits on another page, using the same format.)

1. Parties to the previous lawsuit

Plaintiff(s)

Defendant(s)

2. Court (if federal court, name the district; if state court, name the county and State)

3. Docket or index number

4. Name of Judge assigned to your case

5. Approximate date of filing lawsuit

6. Is the case still pending?

1 Yes

1 No

If no, give the approximate date of disposition

7. What was the result of the case? (For example: Was the case dismissed? Was judgment entered

in your favor? Was the case appealed?)

Pro Se 14 (Rev. 12/16) Complaint for Violation of Civil Rights (Prisoner)

IX. Certification and Closing

Under Federal Rule of Civil Procedure 11, by signing below, I certify to the best of my knowledge, information,

and belief that this complaint: (1) is not being presented for an improper purpose, such as to harass, cause

unnecessary delay, or needlessly increase the cost of litigation; (2) is supported by existing law or by a

nonfrivolous argument for extending, modifying, or reversing existing law; (3) the factual contentions have

evidentiary support or, if specifically so identified, will likely have evidentiary support after a reasonable

opportunity for further investigation or discovery; and (4) the complaint otherwise complies with the

requirements of Rule 11.

A. For Parties Without an Attorney

I agree to provide the Clerk’s Office with any changes to my address where case—related papers may be

served. I understand that my failure to keep a current address on file with the Clerk’s Office may result

in the dismissal of my case.

Date of signing:

Signature of Plaintiff

Printed Name of Plaintiff

Prison Identification #

Prison Address

City State Zip Code

B. For Attorneys

Date of signing:

Signature of Attorney

Printed Name of Attorney

Bar Number

Name of Law Firm

Address

City State Zip Code

Telephone Number

E-mail Address