# Jack Leroy Carroll v. Ralph Diaz

> District Court, C.D. California · May 27, 2022

URL: https://www.frixlaw.com/law-library/cases/9980090

## Case

- **Court:** District Court, C.D. California
- **Decided:** May 27, 2022
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/9980090

## How later opinions describe it (automated extraction)

- stating the “mailbox rule applies to § 1983 suits filed by pro se prisoners”

## Opinion text

Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 1 of 48 Page ID #:49

1
2
3
UNITED STATES DISTRICT COURT
4
CENTRAL DISTRICT OF CALIFORNIA
5

6
7 JACK LEROY CARROLL,
Case No. . 2:22-cv-02742-GW (MAR)
8 Plaintiff,

9 v.
ORDER DISMISSING COMPLAINT
RALPH DIAZ, ET AL.,
10 WITH LEAVE TO AMEND
Defendant.
11
12

13
I.
14
INTRODUCTION
15
On April 20, 2022, Jack Leroy Carroll (“Plaintiff”), proceeding in forma
16
pauperis (“IFP”) and pro se, constructively filed1 a Complaint (“Complaint”) against
17
Ralph Diaz (“Diaz”), Secretary of the California Department of Corrections and
18
Rehabilitation (“CDCR”); Gina Rasheed (“Rasheed”), a registered nurse for the
19
CDCR; Michael Felder, MD (“Felder”), Chief Medical officer of the CDCR; and John
20
Doe-One, MD, the treating physician and surgeon (collectively, “Defendants”). ECF
21
Docket No. (“Dkt.”) 1 at 3–4. For the reasons discussed below, the Court dismisses
22
the Complaint with leave to amend.
23
If Plaintiff desires to pursue this action, he is ORDERED to respond by
24
no later than June 27, 2022, by choosing one (1) of the three (3) options
25
26
27
1 Under the “mailbox rule,” when a pro se inmate gives prison authorities a pleading to mail to
court, the court deems the pleading constructively “filed” on the date it is signed. Roberts v.
28 Marshall, 627 F.3d 768, 770 n.1 (9th Cir. 2010) (citation omitted); Douglas v. Noelle, 567 F.3d 1103,
1107 (9th Cir. 2009) (stating the “mailbox rule applies to § 1983 suits filed by pro se prisoners”).
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 2 of 48 Page ID #:50

1 discussed in Part V, below. Further, Plaintiff is admonished that, if he fails to
2 timely respond, the Court may recommend that this action be dismissed without
3 further leave to amend and with prejudice for failure to state a claim and follow the
4 Court’s orders.
5 II.
6 SUMMARY OF THE COMPLAINT
7 A. FACTUAL ALLEGATIONS
8 Plaintiff alleges that each defendant showed “deliberate indifference to a
9 serious medical need” that resulted in significant injury to Plaintiff. Dkt. 1 at 8. On
10 or around December 20, 2017, while detained at California State Prison, Los Angeles
11 County, Plaintiff experienced severe pain in his right testicle, which was hard with
12 lumps. Id. at 9. One week later, Plaintiff completed a CDC 7362 Health Care Service
13 Request Form to seek medical care. Id. After completing this form, Plaintiff met
14 with Defendant Rasheed, a registered nurse “who’s job [it] is to block treatment.” Id.
15 Plaintiff alleges that Defendant Rasheed minimized his concerns and dismissed the
16 possibility of a testicular tumor. Id. When Plaintiff insisted on seeing a doctor,
17 Defendant Rasheed was offended and allegedly retaliated by writing in Plaintiff’s
18 medical report that she observed no medical abnormalities. Id.
19 A few days later, Plaintiff was seen by a doctor, Defendant Doe-One. Id.
20 After examining the Plaintiff and his medical record, Defendant Doe-One advised
21 Plaintiff that he would not be ordering any further testing and opined that “not
22 knowing the problem[] is sometimes better then [sic] the treatment.” Id. at 10.
23 Plaintiff alleges that he suffered in pain for the next two years as the cancer spread to
24 his abdomen. Id. However, it is not clear whether Plaintiff subsequently sought or
25 received medical care after his visit with Defendant Doe-One.
26 On or around March 5, 2021, Plaintiff experienced extreme pain in his stomach
27 and went “man-down,” which resulted in him being rushed to a hospital outside of
28 the prison. Id. Plaintiff was seen by a urologist who performed a feel-examination of
2
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 3 of 48 Page ID #:51

1 Plaintiff’s testicles and exclaimed, “how long has this been like this?” Id. The
2 urologist appeared to express shock at how long Plaintiff had gone without medical
3 treatment and that his cancer was not identified earlier. See id. The urologist advised
4 that the mass on Plaintiff’s testicle required urgent removal and, approximately four
5 days later, Plaintiff underwent emergency surgery to remove his right testicle, which
6 was rife with cancerous tumors. Id. at 11. Plaintiff alleges that, due to this surgery, he
7 will never be able to have children or a family, and that this realisation caused him to
8 suffer severe emotional trauma and a diminished quality of life. Id. Then, on April
9 19, 2021, Plaintiff underwent chemotherapy and was told that he was close to dying.
10 Id. Plaintiff claims that his chemotherapy compromised his immune system, which
11 rendered him especially vulnerable during the COVID-19 pandemic. Id. at 12.
12 Plaintiff claims that Defendant Diaz, the Secretary of the CDCR, and
13 Defendant Felder, the CDCR’s Chief Medical Officer, are using medicine to punish
14 and disable prisoners. Id. at 11.
15 B. CLAIMS
16 Plaintiff brings the following two claims: 1) an Eighth Amendment claim
17 alleging that Defendants were deliberately indifferent to his serious medical needs; and
18 2) a claim for medical negligence and malpractice under California law. Id. at 8.
19 C. RELIEF SOUGHT
20 Plaintiff seeks injunctive relief, in the form of proper medical diagnostic testing
21 and treatment; general damages; special damages; punitive damages; and attorneys’
22 fees and costs. Id. at 13.
23 III.
24 STANDARD OF REVIEW
25 Where a plaintiff proceeds in forma pauperis, a court must screen the
26 complaint under 28 U.S.C. § 1915 and is required to dismiss the case at any time if it
27 concludes the action is frivolous or malicious, fails to state a claim on which relief may
28 be granted, or seeks monetary relief against a defendant who is immune from such
3
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 4 of 48 Page ID #:52

1 relief. 28 U.S.C. § 1915(e)(2)(B); see Barren v. Harrington, 152 F.3d 1193, 1194
2 (9th Cir. 1998).
3 Dismissal for failure to state a claim can be warranted based on either a lack of
4 a cognizable legal theory or the absence of factual support for a cognizable legal
5 theory. See, e.g., Mendiondo v. Centinela Hosp. Med. Ctr., 521 F.3d 1097, 1104
6 (9th Cir. 2008). A complaint may also be dismissed for failure to state a claim if it
7 discloses some fact or complete defense that will necessarily defeat the claim.
8 Franklin v. Murphy, 745 F.2d 1221, 1228–29 (9th Cir. 1984), abrogated on other
9 grounds by Neitzke v. Williams, 490 U.S. 319 (1989). Although the plaintiff must
10 provide “more than labels and conclusions,” Bell Atl. Corp. v. Twombly, 550 U.S.
11 544, 555 (2007), “[s]pecific facts are not necessary; the [complaint] need only give the
12 defendant[s] fair notice of what the . . . claim is and the grounds upon which it rests.”
13 Erickson v. Pardus, 551 U.S. 89, 93 (2007) (per curiam) (citations and quotation marks
14 omitted).
15 In considering whether a complaint states a claim, a court must accept as true
16 all the material factual allegations in it. Hamilton v. Brown, 630 F.3d 889, 892–93
17 (9th Cir. 2011). However, a court need not accept as true “allegations that are merely
18 conclusory, unwarranted deductions of fact, or unreasonable inferences.” In re
19 Gilead Scis. Sec. Litig., 536 F.3d 1049, 1055 (9th Cir. 2008). The court must also
20 construe the pleading in the light most favorable to the pleading party and resolve all
21 doubts in the pleader’s favor. See, e.g., Berg v. Popham, 412 F.3d 1122, 1125 (9th Cir.
22 2005). Pro se pleadings are “to be liberally construed” and are held to a less stringent
23 standard than those drafted by a lawyer. Hebbe v. Pliler, 627 F.3d 338, 342 (9th Cir.
24 2010) (“Iqbal incorporated the Twombly pleading standard and Twombly did not
25 alter courts’ treatment of pro se filings; accordingly, we continue to construe pro se
26 filings liberally when evaluating them under Iqbal.”).
27 ///
28 ///
4
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 5 of 48 Page ID #:53

1 IV.
2 DISCUSSION
3 A. PLAINTIFF FAILS TO STATE AN OFFICIAL CAPACITY CLAIM
4 UNDER SECTION 1983
5 1. Applicable law
6 “The Eleventh Amendment prohibits federal courts from hearing suits brought
7 against an unconsenting state.” Brooks v. Sulphur Springs Valley Elec. Co-op.,
8 951 F.2d 1050, 1053 (9th Cir. 1991) (citing Pennhurst State Sch. & Hosp. v.
9 Halderman, 465 U.S. 89, 100 (1984)). The Eleventh Amendment also prohibits “suits
10 naming state agencies and departments as defendants,” regardless of whether the
11 plaintiff “seek damages or injunctive relief.” Id. The Ninth Circuit has specifically
12 held that CDCR is a state agency entitled to immunity under the Eleventh
13 Amendment. Brown v. Cal. Dep’t of Corr., 554 F.3d 747, 752 (9th Cir. 2009); see
14 also Alabama v. Pugh, 438 U.S. 781, 782 (1978) (per curiam) (finding a suit against a
15 state’s Board of Corrections is barred by the Eleventh Amendment); Stroman v.
16 California Dep’t of Corr. & Rehab., No. CV 14-524-WBS (CKD), 2014 WL 2208174,
17 at *1 (E.D. Cal. May 28, 2014) (“In the context of prisoner lawsuits against CDCR,
18 the Ninth Circuit has expressly and repeatedly held that CDCR is immune from suit
19 under the Eleventh Amendment.”).
20 An “official capacity suit is, in all respects other than name, to be treated as a
21 suit against the entity . . . [such a suit] is not a suit against the official personally, for
22 the real party in interest is the entity.” Kentucky v. Graham, 473 U.S. 159, 165–66
23 (1985) (citations and internal quotation marks omitted); see also Cmty. House, Inc. v.
24 City of Boise, Idaho, 623 F.3d 945, 966–67 (9th Cir. 2010) (an official capacity suit is
25 treated as a suit against the entity). A plaintiff may seek monetary damages under
26 section 1983 from state employees in their individual capacity. See Adler v. Lewis,
27 675 F.2d 1085, 1098 (9th Cir. 1982) (“State officials must be sued in their individual
28 capacity in an action for monetary damages.”). However, because “a suit against a
5
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 6 of 48 Page ID #:54

1 state official in his or her official capacity . . . is no different from a suit against the
2 State itself,” state officials sued in their official capacity, like the State itself, are
3 generally entitled to immunity in a section 1983 action. Flint v. Dennison,
4 488 F.3d 816, 824–25 (9th Cir. 2007) (citation omitted).
5 2. Analysis
6 Here, Plaintiff is suing the Defendants in both their official and individual
7 capacities. Dkt. 1 at 2–4. Thus, barring any applicable exception, Defendants, in their
8 capacity as state officials, are entitled to immunity in this 1983 action. If Plaintiff
9 elects to file a First Amended Complaint, he should either sue state employees in their
10 individual capacity for damages or sue state employees in their official capacity for
11 injunctive relief only.
12 Furthermore, Plaintiff’s claims against Defendants Diaz and Felder appear to
13 be based on a theory of respondeat superior liability. Dkt. 1 at 3, 9, 11. Government
14 officials may not be held liable for the unconstitutional conduct of their subordinates
15 under a theory of respondeat superior. See Ashcroft v. Iqbal, 556 U.S. 662, 676
16 (2009). Rather, to be held liable, a supervising officer has to personally take some
17 action against the plaintiff or “set in motion a series of acts by others . . . which he
18 knew or reasonably should have known, would cause others to inflict the
19 constitutional injury” on the plaintiff. Larez v. City of Los Angeles, 946 F.2d 630, 646
20 (9th Cir. 1991) (internal quotations omitted). To the extent any of Plaintiff’s claims
21 are based on a theory of respondeat superior liability, they must be dismissed. See
22 Mortimer v. Baca, 594 F.3d 714, 721 (9th Cir. 2010) (“There is no respondeat superior
23 liability under § 1983.”).
24 B. PLAINTIFF FAILS TO STATE AN INADEQUATE MEDICAL CARE
25 CLAIM UNDER THE EIGHTH AMENDMENT
26 1. Applicable law
27 Prison officials or private physicians under contract to treat state inmates
28 “violate the Eighth Amendment if they are deliberately indifferent to a prisoner’s
6
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 7 of 48 Page ID #:55

1 serious medical needs.” Peralta v. Dillard, 744 F.3d 1076, 1081 (9th Cir. 2014)
2 (citation, internal quotation marks, and alterations omitted); Farmer v. Brennan,
3 511 U.S. 825, 828 (1994); West v. Atkins, 487 U.S. 42, 54 (1988). To assert a
4 deliberate indifference claim, a prisoner plaintiff must show the defendant:
5 (1) deprived him of an objectively serious medical need, and (2) acted with a
6 subjectively culpable state of mind. Wilson v. Seiter, 501 U.S. 294, 297 (1991). “A
7 medical need is serious if failure to treat it will result in significant injury or the
8 unnecessary and wanton infliction of pain.” Peralta, 744 F.3d at 1081 (citations and
9 internal quotation marks omitted).
10 “A prison official is deliberately indifferent to [a serious medical] need if he
11 knows of and disregards an excessive risk to inmate health.” Id. at 1082 (citation and
12 internal quotation marks omitted). This “requires more than ordinary lack of due
13 care.” Colwell v. Bannister, 763 F.3d 1060, 1066 (9th Cir. 2014) (citations and internal
14 quotation marks omitted). The “official must both be aware of facts from which the
15 inference could be drawn that a substantial risk of serious harm exists, and he must
16 also draw the inference.” Id. (citation and internal quotation marks omitted).
17 “Deliberate indifference may appear when prison officials deny, delay, or
18 intentionally interfere with medical treatment, or it may be shown by the way in which
19 prison physicians provide medical care.” Id. (citation and internal quotation marks
20 omitted). In either case, however, the indifference to the inmate’s medical needs must
21 be purposeful and substantial; negligence, inadvertence, or differences in medical
22 judgment or opinion do not rise to the level of a constitutional violation. Jackson v.
23 McIntosh, 90 F.3d 330, 332 (9th Cir. 1996) (internal citations omitted) cert. denied,
24 519 U.S. 1029 (1996); Toguchi v. Chung, 391 F.3d 1051, 1060 (9th Cir. 2004)
25 (negligence constituting medical malpractice is not sufficient to establish an Eighth
26 Amendment violation); Sanchez v. Vild, 891 F.2d 240, 242 (9th Cir. 1989); Franklin v.
27 State of Or., State Welfare Div., 662 F.2d 1337, 1344 (9th Cir. 1981) (“A difference of
28 opinion between a prisoner-patient and prison medical authorities regarding treatment
7
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 8 of 48 Page ID #:56

1 does not give rise to a” section 1983 claim.”). A plaintiff “must show that the course
2 of treatment the doctors chose was medically unacceptable under the circumstances,
3 and . . . that they chose this course in conscious disregard of an excessive risk to
4 plaintiff’s health.” Jackson, 90 F.3d at 331.
5 2. Analysis
6 Here, Plaintiff alleges that CDCR medical personnel either delayed in providing
7 or failed to provide Plaintiff with necessary medical care, which resulted in Plaintiff’s
8 testicular cancer going untreated for over two years, emergency surgery to remove
9 cancerous tumors from Plaintiff’s testicle, and subsequent infertility. Dkt. 1 at 8–11.
10 Although Plaintiff has partially described the type of care he was denied and his
11 resulting injuries, Plaintiff has not shown that the lack of medical care exceeded mere
12 negligence or a difference of opinion in care. Plaintiff alleges that Defendant Rasheed
13 retaliated against Plaintiff by refusing to note in his medical record Plaintiff’s
14 complaints of testicular pain and abnormalities. Id. at 9. Yet, Plaintiff’s allegations
15 against the remaining Defendants do demonstrate a conscious disregard of an
16 excessive risk to Plaintiff’s health. See Jackson, 90 F.3d at 331. Moreover, Plaintiff’s
17 Complaint is largely devoid of specific factual allegations against Defendants Diaz and
18 Felder. In other words, Plaintiff has not alleged facts as to each individual Defendant
19 that could support an inference that the Defendants made a conscious choice to deny
20 him care, despite the risk to Plaintiff’s health.
21 If possible, any amended complaint should include additional details about
22 Plaintiff’s ailments at the time of the alleged violation and the specific conduct of the
23 CDCR medical personnel, and the amended complaint should clearly restate relevant
24 information from Plaintiff’s initial Complaint.
25 ///
26 ///
27 ///
28 ///
8
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 9 of 48 Page ID #:57

1 C. PLAINTIFF FAILS TO STATE A RETALIATION CLAIM UNDER
2 THE FIRST AMENDMENT
3 1. Applicable law
4 The First Amendment provides that “Congress shall make no law . . . abridging
5 the freedom of speech . . . .” U.S. Const. amend. I. The First Amendment also
6 guarantees the right “to petition the Government for a redress of grievances.” White
7 v. Lee, 227 F.3d 1214, 1227 (9th Cir. 2000). “To state a First Amendment retaliation
8 claim, a plaintiff must plausibly allege that (1) [s]he was engaged in a constitutionally
9 protected activity, (2) the defendant’s actions would chill a person of ordinary
10 firmness from continuing to engage in the protected activity and (3) the protected
11 activity was a substantial or motivating factor in the defendant’s conduct.” Capp v.
12 Cnty. of San Diego, 940 F.3d 1046, 1053 (9th Cir. 2019) (internal quotation marks
13 omitted) (internal citations omitted).
14 Furthermore, to state a First Amendment retaliation claim, Plaintiffs do not
15 need to show their “speech was actually inhibited or suppressed.” Lacey v. Maricopa
16 Cnty., 693 F.3d 896, 916 (9th Cir. 2012) (quoting Mendocino Env’tl. Ctr. v.
17 Mendocino Cnty., 192 F.3d 1283, 1300 (9th Cir. 1999)) (internal quotation marks
18 omitted). Rather, courts look to “whether an officials’ acts would chill or silence a
19 person of ordinary firmness from future First Amendment activities.” Id. at 916–17.
20 2. Analysis
21 Plaintiff alleges that Defendant Rasheed denied him adequate medical care in
22 retaliation for his insistence on seeking a doctor, rather than a nurse. Dkt. 1 at 9.
23 However, Plaintiff has not alleged any facts that could support a reasonable inference
24 that his protected conduct was a motivating factor in the alleged denial of medical
25 care; rather, Plaintiff merely makes a conclusory allegation that he believes the denial
26 of medical care was retaliatory. Id. Without more, Plaintiff has failed to state a claim
27 for retaliation.
28 ///
9
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 10 of 48 Page ID #:58

1 V.
2 LEAVE TO FILE A FIRST AMENDED COMPLAINT
3 For the foregoing reasons, the Complaint is subject to dismissal. As the Court
4 is unable to determine whether amendment would be futile, leave to amend is granted.
5 See Lucas v. Dep’t of Corr., 66 F.3d 245, 248 (9th Cir. 1995) (per curiam).
6 Accordingly, IT IS ORDERED THAT by June 27, Plaintiff must choose
7 one (1) of the following three (3) options:
8 1. Plaintiff may file an Amended Complaint to attempt to cure the
9 deficiencies discussed above. The Clerk of Court is instructed to mail Plaintiff a
10 blank Central District civil rights complaint form to use for filing an Amended
11 Complaint, which the Court encourages Plaintiff to use. The Clerk of Court is
12 also directed to mail Plaintiff a copy of the Complaint, Dkt. 1, for reference.
13 If Plaintiff chooses to file an Amended Complaint, Plaintiff is advised that
14 doing so would entirely replace the Complaint in this action. In addition, any
15 Amended Complaint must:
16 (a) be labeled “First Amended Complaint”;
17 (b) be complete in and of itself and not refer in any manner to prior
18 complaints, i.e., it must include all the claims on which Plaintiff seeks to
19 proceed, (see Local Rule 15-2);
20 (c) contain a “short plain” statement of the claim(s) for relief, see Fed. R.
21 Civ. P. 8(a) and identify whether Plaintiff is suing each Defendant in
22 their individual and/or official capacity;
23 (d) make each allegation “simple, concise and direct,” Fed. R. Civ. P. 8(d)(1);
24 (e) make allegations in numbered paragraphs, “each limited as far as
25 practicable to a single set of circumstances,” Fed. R. Civ. P. 10(b);
26 (f) set forth clearly the sequence of events (including specific relevant dates)
27 which allegedly gives rise to the claim(s) for relief, including what each
28
10
Case P:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 11o0f48 Page ID #:59

1 defendant did and how each specific defendant’s conduct injured
2 plaintiff; and
3 (g) not add defendants or claims without leave of coutt.
4 2. Alternatively, Plaintiff may file a notice with the Court that they intend
5 | to stand on the allegations in his Complaint. If Plaintiff chooses to stand on the
6 | Complaint despite the deficiencies in the claims identified above, then the Court will
7 | submit a recommendation to the assigned district judge that the Complaint be
8 | dismissed with prejudice for failure to state a claim, subject to Plaintiffs right at
9 | that time to file Objections with the district judge as provided in the Local Rules
10 | Governing Duties of Magistrate Judges.
11 3. Finally, Plaintiff may voluntarily dismiss the action without prejudice,
12 | pursuant to Federal Rule of Civil Procedure 41 (a). The Clerk of Court is directed
13 | to mail Plaintiff a blank Notice of Dismissal Form, which the Court
14 | encourages Plaintiff to use if they choose to voluntarily dismiss the action.
15
16 Plaintiff is explicitly cautioned that failure to timely file an Amended
17 | Complaint may result in this action being dismissed with prejudice for failure
18 | to state a claim, or for failure to prosecute and/or obey Court orders pursuant
19 | to Federal Rule of Civil Procedure 41(b).
20
21
22 | Dated: May 27, 2022 JAX
23 HONORABLE MARGO A. ROCCONI
D4 United States Magistrate Judge
25
26
27
28
11

Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 12 of 48 Page ID #:60

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
CASE NUMBER
Plaintiff(s),
v.
NOTICE OF DISMISSAL PURSUANT
TO FEDERAL RULES OF CIVIL
PROCEDURE 41(a) or (c)
Defendant(s).
PLEASE TAKE NOTICE: (Check one)
G This action is dismissed by the Plaintiff(s) in its entirety.
G The Counterclaim brought by Claimant(s) is
dismissed by Claimant(s) in its entirety.
G The Cross-Claim brought by Claimants(s) is
dismissed by the Claimant(s) in its entirety.
G The Third-party Claim brought by Claimant(s) is
dismissed by the Claimant(s) in its entirety.
G ONLY Defendant(s)
is/are dismissed from (check one)G Complaint, G Counterclaim, G Cross-claim, G Third-Party Claim
brought by .
The dismissal is made pursuant to F.R.Civ.P. 41(a) or (c).
Date Signature of Attorney/Party
NOTE: F.R.Civ.P. 41(a): This notice may be filed at any time before service by the adverse party of an answer or of a motion for
summary judgment, whichever first occurs.
F.R.Civ.P. 41(c): Counterclaims, cross-claims & third-party claims may be dismissed before service of a responsive
pleading or prior to the beginning of trial.
CV-09 (03/10) NOTICE OF DISMISSAL PURSUANT TO FEDERAL RULES OF CIVIL PROCEDURE 41(a) or (c)
□□□□□□□□□□□□□□□□□□□□□□□ Daoatrbhtiet chddO622622 Pagga3 of 88 Page ID #:61
APR 25 2022
CENTRAL DISTRICT OF CALIFORWLA
: DEP R iv wi
JACK LEROY CARROLL PR ecelved
FULL NAME S a Tn
canne and E-mail
COMMITTED NAME (if different) on “Bae
ate Initi
P.0.Box 8457 ee
FULL ADDRESS INCLUDING NAME OF INSTITUTION Number of pages scanned:
“>
Lancagter, California. 93539-8457
V-90846
PRISON NUMBER (if applicable)

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
JACK LEROY CARROLL CASE NUMBER 9 99-CV-02742-GW-MAR
PLAINTIFF,
□ CIVIL RIGHTS COMPLAINT
SECRETARY OF CDCR RALPH DIAZ, et al. PURSUANT TO (Check one)
Kk] 42 U.S.C. § 1983
DEFENDANT(S): QO) Bivens y. Six Unknown Agents 403 U.S. 388 (1971)
A. PREVIOUS LAWSUITS
1. Have you brought any other lawsuits in a federal court while a prisoner: 0 Yes No
2. Iflour answer to “1,” is yes, how many? N/A
Déscribe the lawsuit in the space below. (If there is more than one lawsuit, describe the additional lawsuits on an
attached piece of paper using the same outline.)
N/A

CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page | of 6

.
Cds6@2 □□□□□□□□□□□□□□□□□□□□□ Dioounreah81 FiddO62H22 Paggda of 88 Page ID #:62
a. Parties to Shis previous lawsuit:
: 1 Plaintiff_N/A

Defendants N/A
: i=... +--+:
bj Court N/A
En
c:| Docket orcase number N/A
d.| Name of judge to whom case was assigned __ N/A
e.| Disposition (For example: Was the case dismissed? Ifso, what: the basis for dismissal? Was it
4 appealed? Is it stil! pending?) N/A
Issties raised: ___ N/A
g.| Approximate date of filing lawsuit: N/A
h.| Approximate date of disposition __ N/A

B, EX USTION OF ADMINISTRATIVE REMEDIES
L Is ere a grievance procedure available at the institution where the events relating to your current complaint
occurred? El Yes ONo
2. Have you filed a grievance concerning the facts relating to your current complaint? [Yes
If-your answer is no, explain why not: □
See attached Health Care Services appeal Loo No, KVSP-HC-71000489
.
dated August 23, 2021
3, Is: he grievance procedure completed? IX} Yes [I No
if your answer □□ no, explain why.not.

4. Please attach copies of papers related to the grievance procedure. Exhibit A
C. JURISDICTION
This complaint alleges that the civil rights of plaintiff JACK LEROY CARROLI .
{print plaintiff's name)
‘who p#esently resides at_ California State Prison-Los Angeles County □
: (mating address or-place of confinement)
avere Violated by the actions of thé defendant(s} named below, which actions were. directed against plaintiff at
(institution/city where violation occurred}
CIVIL RIGHTS COMPLAINT
CV-66 (2A) | Page 2 of fi

“pene Dodounreanb1 Fid#d®84776/22 PaggelS of 88 Page ID #:63

on (dite or dates)_ 12/27/2017 12/29/2017 , 93/09/2024
(Claim f) (Claim I). (Claim 11)
NOTE: You need not name more than one defendant or allege. more-than one claim. [Ifyou are naming more than
five (5) defendants, make a copy of this page to provide the information for additional defendants.
1, Dbfendant RALPH DIAZ resides or works at
‘Gull name of first defendant)
P.O.Box 588500, Elk Grove, CA. 95758
| (full address of first defendant) —
Secretary of. CDCR
. (defendatit’s position and title, if any}
The defendant ts sued‘in his/her (Check one or both}: individual & official capacity.
Explain how this, defendant was.acting under color of law:
jefendant Diaz was responsible for implementin superivisin and
-antorcing complaince with policies and procedures of the CDCR.
2. Défendant _ GIWA RASH E ED resides. works at
(fullname of first detendant}
P.0.Box 5104, Delano, CA. 93216
: (fuil address of first defendant)
| Registered Nurse for CDCR.
(defendant's position an title, iFany}
1 defendant is sued in his/her (Check one or both): 8 individual official capacity.
BE; plain how this defendant was acting under color of law:
Hefenant Rasheed was deliberately indifferent to a. serious medical
Wedical need, and her failure to treat resulted in sienificat injury.
3. Défendant _ MICHAEL. FELDER, MD resides or works at
. (full name of first defendant}
P.O;Box 5104, Delano, GA. 93216
: (full address of first defendant)
Chief Medical Officer of CDCR
. (defendants position and title, H any)
the sued in his/her (Check one or both); W individual & official capacity.
EX lain how this defendant was acting under color of law:
Jefendant Felder was responsible for superivisine plaintiffs'
Medical treatment and his failure resulted in significat injury.
7 CIVIL RIGHTS COMPLAINT:
CVG (7/97) | Page.3 of &

mena azanLNae Doounreanb1 Fid€dO647767/22 Paggels of 88 Page ID #:64
4 oe
4. Defendant _ JOHN DOE-ONE, MD resides or Works.
: {fulliameoffirstdefendant) □□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□
P.O.Box 5104, Delano, GA.
{full address of first defendant}
Phy Sician and Surgeon
(deiendant's position and tile, i any)
The defendant is sued in hissher (Check.one or both): & individual official capacity.
Explain how this defendant was acting under color of law:
Nefendan t John Doe~One was the medical doctor who failed to treat
□ he plaintiff for a serious medical need weeulting in significat injury
5. Ditendan resides or works at-
: (full name of first defendant}
(full address of first defendant)
. (defendant's position-and title, if any)
‘The defendant is. sued in his/her (Check one or both): OJ individual 1 official capacity,
: plain how this defendant was acting under color of law:

CIVIL RIGHTS COMPLAINT
CV-68 (797) Page 4.of 6

□□□□□□□□□□□□□□□□□□□□□□□□□ Ddounreah81 FitddOB/2ZA222 Paggeal3 of 88 Page ID #:65

D. CLAIMS*
CLAIM I
The igllowing civil right has been violated:
Eighth Amendment viglation-Deliberate Indiffence to serious medical
needs. Plaintiff respectfully request that the court refer to attached
typ¢d civil complaint, page 7, under CLAIM FOR RELIEF, paragraphs 19 __
thegugh 25, hereby incorporated by reference.
Riou is seeking a federal/state cognizable claim concerning
violation ef both nedexal aes stats va
REF R TO NEXT PAGE FOR CIVIL COMPLAINT

Suppoyting Facts: Include all facts you consider important. State the facts clearly, in your own words, and without
citing fegal authority or argument. Be certain you describe, in separately numbered paragraphs, exactly what each
DEFE NDANT (by name) did to violate -your tight.
Plaintiff respectfully request that the court refer to attached Typed
civil Complaint, pages 4-6, under SUPPORTING FACTS, paragraphs 6
through 18. hereby incorporated by reference. This has allowed the
petiltioner to include all facts clearly/exactly what each defendant
did (by name) to violate his civil rights.

“| TO NEXT PAGE, FOR CIVIL COMPLAINT

te
there is more than one claim, describe the additional claim(s} on another attached piece of piper using thé same
outing.
| CIVIL. RIGHTS COMPLAINT
EV-66 (7/97) | Pave 3 af 6

— DodOounreanb1 Fid#dO84776/22 Paggels8 of 88 Page ID #:66

1 JACK LEROY CARROLL
CDARE V-90846
2 P.Q.Box 8457 FCB3-146U
Lancaster, California. 93539-8457
5 yo
5 UNITED STATES DISTRICT COURT
6 | CENTRAL DISTRICT OF CALIFORNIA
8 JACK LEROY CARROLL, )
. Plaintiff, ) CASE NO.
9 vs; )
10 SEGRETARY OF CDCR RALPH DIAZ, 4 COMPLAINT UNDER THE CIVIL |
_ CHIEF MEDICAL OFFICER MICHAEL ) RIGHTS ACT OF 42 USC § 1983
11 FELDER, DOCTOR JOHN DOE-ONE, AND )
REGISTERED NURSE GIWA RASHEED. )
12 ne IN THEIR OFFICIAL AND ) DEMAND FOR JURY TRAIL
INDIVIDUAL CAPACITIES ,.
13 Defendants. }
14
Db JURISDICTION
16 | 1. This complaint for damages concerns. the defendant's
17 fai ure to maintain an Eighth Amendment protection claim based on
18 "de iberate indifference to a serious medical need". Plaintiff will
19 dem nstrate that the defendant's actions/failure. to treat him for
20 Stage 1 seminomas testicular tumors resulted in further significant
21 injbpry, unnecessary and wanton infliction of pain. Plaintiff intends to
29 seeps the response to this need was deliberately indifferent,
23 pursuant McGuckin v. Smith, 947 F.2d 1050, 1059-60 ((th Gir. 1092),
2h Plaintifé intends to demonstrate that the failure of the defendant's
25 to. ffer basic medical treatment to Stage 1 seminomas testicular
26 tumpes would result in testicular Cancer, and the removal. of

97 thei the plaintiffs testicle. The defendant's negligence will
280

□□□□□□□□□□□□□□□□□□□□□□□ Doounteanb1 Fit DB/226122 Paggel¥ of 88 Page ID #:67

1 lune "by showing (a) a purposeful act. or failure to
2 redpond to a prisoner's pain or possible need and (b) harm caused
3 by lindifference." Jett, 439 F.3d at 1096 (citation omitted).
4 The plaintiff will not show that the defendant’s failure "to
5 act in the face of a unjestifiably high risk that is either known
6 or |s0 obvious that it showld be known", as. this is insufficient
7 to establish an Righth Amendment vidlation under Farmer v. Brennan,
8 511 U.S. 825, 836-37 & n.5 (1994) (Citation omitted). Rather,
§ plalitiff will show that the defendant's with deliberate indifference
10 fective knew of and distregarded an excessive risk to his
t1 hea th and safety pusuant to Toguchi v. Chung, 391 F.3d 1051,
12 105) (9th Cir. 2004). :
13 : 2. The. plaintiff is seéking to exercise a supplemental
14 jurisdiction state law claim concerning medical negligence and
T5 neste ene California law. Plaintiff intends to establish
16 ae gnizable federal/state claim by showing "(1) the duty of
17 the] professional to use such skill, prudence, and diligence as
18 oth r members of his profession commonly possess and exercise;
13 (2) }a breach of that duty; (3) a proximate causal connection
20 between the negligent conduct and the resulting injury; and (4)
21 actwtal loss or damage resulting from the professional's
29 negligence." Sampson v. Ukiah Valley Med. Ctr., No. 15-CV-00160-
23 ito 2017 WL 2834001, at n.5 (N.D.Cal., June 30, 2017) (quoting
2h Machado v. Cal. Dep't of Corrs. and Rehab., 12-¢cv-6501-JS8C, 2013
25 WL fone a (N.D. Gal., Oct. 28, 2013). In the state claim
26 plagntife intends to prove that some defendant's had a federal/
27 state liability to provide basic treatment under state law.
28 |
.

~pmenen Dodounreanb1 Fid€d®84276/22 Pagg@8 of 88 Page ID #:68

1 VENUE
7 3. All of the claims giving rise to the claims alleged
z herein, arose in the city of Delano California. Since then,
4 plaintiff has been transferred to a medical Institution for
5 se medical treatment. This institution is called California
6 State Prison-Los Angeles County, and as the name implies, is
7 located in Los Angeles County, and therefore, the United States
8 Disitrict Court-Central District of California is the ecerrect
9: venue pursuant to 28 USC § 1391.
10 | CLAIMS.
11 (1) 4, Plaintiff alleges, and therefore believes that each
12 def ndant showed “deliberate indifference to a serious medical
13 need", and this resulted in further significant injury, specifically;
14 the Loss of his testicle to testicular Cancer, which violated
15 the Eihth Amendment of the United States Constitution.
1h (2); 5. Plaintiff alleges, and therefore believes that each
7 def ndant violated state law. Plaintiff is seeking a federal/state
18 cog izable claim concerning medical negligence and malpractice
19 und v California law. Plaintiff will prove that the defendant's
“20 had duty as a professional to use such skill, prudence, and diligence
21 as | ther members of his profession commonly possess and. exercise,
22 That the defendant's breached that duty, and this negligence
23 res lted in serious injury, specifically, the loss of his teésticule
Fh to hancer. The plaintiff intends to show that. the defendant's
25 act d with a desire to cause harm. That the plaintiff clearly
6 notified the defendant's of a serious testiclar Cancerous tumor
7 in fight testicle using the only method the GDCR policy allows.
28 |

| .

nena Doounreanb1 Fitdd®8A776/22 Pagg29 of 88 Page ID #:69

7] SUPPORTING FACTS
2 | 6, On or about December 20, 2017, plaintiff Jack Leroy
3 Cayroll, noticed that his right testicle was hard with lumps.
4 Hejlwas experiencing severe pain and needed medical attention.
5 7. On or about December 27, 2017, plaintiff completed
6 a GDC 7362 Health Care Services Request form, which is California
7 Department of Corrections and Rehabilitation (CDCR) policy and
8 medical procedure created, implemented, supervised, and enforced
g by [CDCR Ralph Diaz and Chief Médical Doctor Michael Felder.
10. 8. Prisoner's know using. these CDG 7362 medical request
11 will result in seeing a Registered Nurse (RN), who's job is to
12 block treatment. The plaintiff seen RN Giwa Rasheed, and she read
13 the CDG 7362 medical form, which declared: "A week ago I noticed
14 thalt my tight testicle is 90% hard with lumps, and the back halfé
15 is soft. and hurts to the touch. Is this normal. I'd like to see
16 a. De. about this." Defendant Rasheed started to minimize the
17 plaintiff concerns. When the plaintiff asked if he had testiclar
12. RN Rasheed was dismissive of the idea of tumors, opining
419 thalt the patient did not know how to do a testiclar self-examination.
20 the plaintiff insisted on seeing a Doctor. RN Rasheed retaliated
74 by Writing in the patients medical report that she observed
92 no Medical abnormalities. This malicious act would have devastating
23 feo in the years to come.
24 9. The plaintiff a few days later seen a.Doctor_(indentified in
25 com laint as John Doe-One, who's naiie is unknown, but can be ascertained
26 ducing discovery). The plaintiff explained what he called Lumps or
97 tum rs in his. testicles causing extreme pain. The defendant examined
28 4

Case 1.09-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 2@ of 88 Page ID #:70

1 the plaintiff, and consulted the medical report written by RN
2 Gila Rasheed.
3 + 10, The defendant, Doctor John Doe-One, informed the plaintifé
4 Hee RN Rasheed seen no need to treat him for testicle tumors,
5. anid he would not be ordering diagnostic test, including CT scars
6 2 blood test. Doctor John Doe-One. opined that not knowing the
7 ma nitude of the problem, is sometimes better then the treatment.
8 11. The plaintiff asked what about the pain, and was informed
9 not to touch his testicles. The plaintiff bécame trapped between
10: GDER policy and procedure, overseen by the defendant's Diaz
411 an Felder, and the laziness and vindictiveness of defendant's
12 Ra heed and John Doe-=One. □
13 1 12, The plaintiff was forced to suffer with pain for over
14 tw years, while the testicular tumors ravaged his body. The
15: Ca cer spread to his abdomen and. bécame intolerable. The plaintiff
16 did not have access to a second-opinion, as Doctor John Doe-
17 One was his Primary Care Provider (PCP), and RN Rasheed was the
18 Nu se for the prison-yard clinic.
49 | 13. On about March 05, 2021, plaintiff felt extreme pain
20 in his stomach, and went “man-down", which résulted in him being
21 ta en to the Central Triage Center (CTC), were an ambulance
22 was called to transfer him to an out~side hospital.
23 144. Upon arrival to the out-side hospital, plaintiff was
24 seen by a Urologist who preformed a feel-examination of his
25. tetticles. She Jerked back and asked "how long has this been like
26 this?" Plaintiff explained that this issue has lasted

27 approximately 3 years. She then asked, "Have you spoken to a
28 | >
‘

Case 1.09-cv-02742-GW-MAR Document & Filed 08/23/22 Page 230f 88 Page ID#:71

| Ph sician about this?" The plaintiff responded, "YES, about 3 years.
2 ago", and was told to deal with it. The Urologist stated, “this is
3 not’ normal and it's not o.k." The Urologist informed the plaintiff
4 that the mass/tumor needed to be removed now.
5 15. On or about March 09, 2021, the plaintiff had emergency
6 surgery to remove his right testicale due to Cancerséus tumors. The
7 plaintiff was able. to examine the right testicale after the surgery,
8 while it was in a clear-cup next to the hospital bad. The
9 re lization that he would never have children and/or family.
10 suddenly struck him.
11 □ 16. The plaintiff became overwhelmed, and begin suffering
12 severe emotional. trauma while considering his quality of life. □
13 %Itlis clear to the plaintiff that the medical policies of the
14 CDER, and supervision of the policies directly contributed to
5 loss of his testicle. The Secretary of CDCR Diaz and the
16 Cheif Medical Dector Felder are using medicine to punish and
17 disable prisoners.
18 17. The plaintiff has underwent chemo treatment on
19 April 19, 2021, and was informed that he was close ta dying
20 dud to blood platlet count being 24, which could cause. internal
2 bleedi ng
22 | 18. The plaintiff filed a California Correctional Health
23 Cate Services grievance concerning defendant's malpractice and the
Ph brdach of basic medical standards of care succinetly described
25 heveinabove. Plaintiff has thus exhausted his administrative
26 remedies on August 23, 2021. Plaintiff filed a. staff complaint.
97 and was told this is a matter for the courts.

aT .
Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 88 Page ID#:22

1 CLAIM FOR RELIEF
2 Eighth Amendment Violation-Deliberate Indifference
3 to. Serious Medical Needs
4 t19. Plaintiff refers to, and incorporates by reference herein
5 the allegations. of paragraphs 1 through 18, inclusive.
6 420, Plaintiff's medical condition, as described herein,
7 constitutes a serious medical need in that failure to treat the
9 maps has resulted in further significant injuries. Said
g inj ries included, but are not necessarily limited to, physical
10 Limitation, which has caused substantial distress and impaired
+ daily regular functions, as well as, very painful medical treatments
12 whigh has caused nausea and sickness.
13 21. Plaintiff alleges that the failure to act and/or provided

14 treatment earlier, left him susceptible and/or vulnerable during
15 the COVID-19 pandemic. His immune system was compromised; and
15 feo delayed and/or postpone for chemotherapy. This left
17 the plaintiff in danger of death.
18 Plaintiff is informed and believes, and therefore alleges,
49 that the defendant's acted intentionally in the manner described
9 abo e, and with knowledge of plaintiff's suffering and the risk
2\ pt serious harm that could result from their actions or
29 refusal to act.
23 123, Fach defendant's conduct violates 42 U.S.C. § 1983, because
Phi thal conduct constitutes deliberate indifference to plaintiff's
25 serjious medical needs in violation of his. Eighth Ametidment Right
26 to Ibe free. from Cruel and Unusual Punishment.

7 24, As approximate result of the defendant's conduct, plaintiff
23 7

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 23 of 88 Page ID#:73

| has suffered and continues to suffer general damages in the form
2 of severe pain and suffering and emotional distress. Plaintiff
3 is|informed and believes, and therefore alleges, that he will have
4 special damages in the future in the form of sexual dysfunction,
5 an interpersonal relationships.
6 DOs In acting as described herein above, defendant's acted
7 de picably, knowingly, wilfully, and maliciously, or with reckless
8 or|callous disregard for plaintiff's federally protected Rights,
9 en titling plaintiff to award of exemplary and punitive damages.
10
11 PRAYER FOR RELIEF
WHEREFORE, plaintiff Jack Leroy Carroll prays for judgment
13 against each/all defendant's as fallows:
14 Lis For injuntive relief in the form of proper medical diagostic
15 testing and treatment, according to proof,
1h - on For general damages, according to proof,
17 a For special damages, according to proof,
18 Ae For punitive damages, according to proof,
19 Bs For reasonable attorneys fees pursuant to 42 U.S.C. § 1988,
20 6. For court cost of the civil complaint, and
?) Ps For such other and further relief as the court deems
22 just and proper.
23
24 DAT Aprilt520, 2022
25
26 AA EROY CARROLL
I ropria Persona
7 i
28

Case 2:22-cv-02742-GW-MAR Document & Filed 08/23/22 Page 26o0f 88 Page ID#:714

] DECLARATION IN SUPPORT OF COMPLAINT
2 I, Jack Leroy Carroll declare under penaity of perjury,
3 under the laws of the State of California, that the forgoing is
4 true and correct. Executed on April 20, 2022, at California State
5 Prilson-Los Angeles County, P.O.Box 8457, Lancaster, California.
6 93539.
7
8 wii oD
J eroy Carro
g
Af
11
12
13
14
15
1h
17
18
19
20
21
22
23
24
25 .
26
270
28

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 2% of 88 Page ID#:75
E., REQUEST FOR RELIEF
I beli¢ve that Iam entitled to the folowing specific relief:
WHEHEFORE PLAINTIFF Jack Leroy Carroll prays for judgment against each
and all defendant's as fallows: □
1. | For injuntive relief in the form or proper medical diavostic
testing/treatment, according to proof;
2. For general damages, according to proof, □
3. | For special damages, according to proof
4. | For punitive damages, acordings to prooi
5. For reasonable attorneys fees pursuant to 47 U.S.C § 1988:
6. | For cost of the civil complaint, and
7. for such other. and further relief as the court deems just and proper.

ese

ols 20, 2022
| (Date) (Stenature of Plaintiffi

CIVIL RIGHTS COMPLAINT
CV-66 17875 Page 6 of 6

“J
Case 2:22-cv-02742-GW-MAR Document & Filed 08/23/22 Page 26 of 88 Page ID #:76 .

STATE OF HSUFORNA OUPARTMENT OF QORSECTIONS atl REMASS ITATION
HEALTH CARE GRIEVANCE Pase □□□□
COCR 602 HO (Rev. 10/49)
STAFF USEONLY Expeitie)? [ives “wba VEEN Do RIL Pe
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iF you tring you have a medical, méntal health or dental emergency, notify staf immedistely, jf i SPCe is Headed, us94 Section 4 of the
COCA. HO A Health Care Grlevanca Allathinent, Only one COCR 802 HO A wit be Becepied, Yoo rust sulmAgeis hegith care arevance to the Hegith Cars
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SECTION AD ere tee ony noah ey me
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BY PEACIN' RUCUATTIALS IN THIS BOX, | REQUEST TO RECHIVE AN INTERVIEW AT THE INSTITUTIONAL LEVEL. CL
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Case 2:22-cv-02742-GW-MAR -Document & Filed 08/23/22 Page 29 of 88 Page ID #:27
Patient NamelCARROLL, JACK LEROY Paiient MRN □□□□□□
Birih Date oi 1954 a Financial Number 18000003 {1201 07a? □□□□□□
* Auth (Verified) *

7342 (Res. 03704) HEALTH CARE SERVICES REQUEST FORM —-WP\# MENT OF conaections
Ad PART 1: TO BE COMPLETED BY THE PATIENT
A fee-of $5.00 □□□ he-charged to yur trast aecount for-eich health eare visit,
. i Ifyou believe this is an urgentiemergent health earé néed, contact the correctional afficer on-duty.
| REQUEST FOR: MEDICAL Br MENTAL HEALTH Fy] DENTALO]. MEDICATION REFILL)
iWAME ? COC NUMBER HOUSING
. wa a, 7-2” " . *
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: i REASON YOUARE REQUESTING HEALTH CARE SERVICES, (Describe Vour Health Problem And How Long You Have Had
, j The Problem) <4 we ge eee we ERs The al Pts Hecby
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A) NOTE: IF THE PATIENT IS UNABLE TO COMPL ETE THE FORM, A HEALTH CARE STAFF MEMBER SHALL COMPLETE THE FORM ON
HE BEALE OF THE PATIENT AND- DATE AND SIGN THE FORA
: PART ill: TO BE COMPLETED-AFTER PATIENT'S APPOINTMENT
: EC) Visitis not exempt from $3.00 copayment. (Send pink copy to Famate Trust Olfice.)
□ PART fl; TO BE COMPLETED BY THE TRIAGE REGISTERED NURSE
[Dates Time Received: □□□ □ . Recefved hy: ree TT.
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Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 36 of 838 Page ID #:78

Ht =HEALTHCARESERVICES
ay | re a 4 hes . wd ee
Institutional Level Response
Closing Date: MAY 8 7 207
To: | CARROLL, JACK:(¥90846)
C 003 2224001UP
Kern Valley State Prison
PO Box 3130
Delano, CA 93216
Tricking #: KVSP HC 21000489
RULHS AND REGULATIONS .
The riles governing these issues are: California Code.of Regulations, Title 15; Health Care Department.
Operations Manual; Mental Health Services Delivery System Program Guide; California Department of
Corredtions and Rehabilitation Department Operations Manual,
HEAITH CARE GRIEVANCE SUMMARY .
in. your CDCR 602 HC, Health Care Grievance, you explained the decision, action, condition, omission, policy,
or regilation that has had a material adverse effect upon your health or welfare for which you seek
administrative remedy.
Issie Description
Issue: Grievances ( Grievance History } This is the second 602 you have. submitted-and the last one
: Was seat back half missing.
Issue:| ‘Disagreement with Treatment { You were seen 3 years ago for your right testicle being hard
| Primary Care Provider ) with lumps.and told it was fine by the doctor; however, you
:. now have cancer in your right testicle and require chemo,
Issue:.; Staff Complaints ( Deliberate ‘Medical malpractice and negligence as you could have died
| Indifference ) had you not.seen the outside doctor and you would like an
investigation into this.
vrs VIEW
On 5/ p00 you were interviewed by L. Aflague HCARN regarding this health care grievance, During the
intervidw, you were allowed the opportunity to fully explain your health care grievance issue(s).
wsTiLUTIONAL LEVEL DISPOSITION
intervention. i] Intervention.
BASIS FOR INSTITUTIONAL LEVEL DISPOSITION
Your health care grievance package and health record, and all pertinent departmental ‘policies and procedures.
were raviewed. These records indicate:
|* This is-the second 602 you have submitted and the last one was sent back half trissing. A copy of
KYVSP HC 20000952 has been attached with your current erievance,
Note 1: Th institutional Jevei review is bused on records available as of the date the Institutional Level Response is signed by the reviewing
authority. - wm tet,
Note 2: The chasing date reflects the closed, mailed/delivered date of the health care priévance. wea wtb we
Note 3: Petmanent health case grievance document. Do not remove from the health care grievance packaze. OAR
ROGAD
yyy 14 BE
HEALTH CARE SERVICES:

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 32 of 88 Page ID #:729

STATE OF CELIFORNA DECARTMENT OF OOMMECTIONS □□□ TATION
HEALTHCARE GRIEVANCE Paye
COCR 602 HE (Rav. 10/18}
FREE USE ONL ae — mae ; Track ey v7 om ye trey Bien —
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. “|
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Case 2:22-cv-02742-GW-MAR Document & Filed 08/23/22 Page 22 of 88 Page ID #:80
. IL.CARROLL, V90846
KVSP HC 21000489
: Page’? of 2.
| * You weréseen 3 years ago for your right testicle being hard with iumps.and told it was fine by the
doctor; however, you now have cancer in your right testicle and require chemo. In review of your
healthcare records, you were evaluated by an RN who completed a physical assessment and a lump
was not palpable during that medical encounter. You were then referred to the Primary Care
Provider who performed a physical examination on you as well, It was noted that everything was
: functioning correctly with urination and ejaculation. There were no suspicious lumps or palpable
changes. of concern. The anatomy was noted to be within norma! limits. Based on this. physical
exam and medical history of the complaint, there was no indication that further work up was
medically necessary, While you may not agree with the decisions of your treatment team, it does
: not constitute staff misconduct or deliberate indifference to your health care needs.
‘| © Medical malpractice and negligence as you-could have died had you not seen the outside doctor
and. you would like an investigation into this. California Correctional Health Care Services takes
your complaint.against any personnel seriously and all efforts are made to-ensure these:matters are
researched and responded to accordingly. However, it is not in the purview of grievants to dictate
adminiswative actions regarding health care grievance review, disciplinary measures, or adverse
action against staff. Further, all such personnel actions are confidential and will notbe shared with,
inmates, staff, or the public. It is not in-the purview of ‘grievants to dictate administrative actions in
: regard to the health care grievance process. Your health care grievance was processed per
California Code of Regulations, Title 15, Chapter 2, Subchapter 2, Article 5.
Whila the health care grievance ptocess is a-medns of setting forth your health care concerns, it is not a
substitute for direct communication about your health with your health care: providers. You are encouraged to
contisue your care with your assigned health care providers.and share. with them new or additional clinical
information about your conditions that you believe may affect your care. However, California law directs.
your Health care providers to offer and provide only thé care they determine to be currently medically or
clinicdily necessary: for you, in accordance with appropriate policies and procedures. Previous orders from
other health care facilities or staff, input from health care consultants, and/or your own personal preferences
may be considered, but.do not contro! the professional judgment of your current health care providers.
If youjare dissatisfied with the Institutional Level Response, follow the instructions on the CDCR 602 HC,
Healtl Care Grievanee, and submit the entire heaith care grievance package for headquarters’ level
review. The héadquartets” level reviaw constitutes. the final disposition on your health care grievance and
exhausts your administrative remedies.

ee Ss (22 {2
4 M.A. Relder, MS,, MBA Reviewed and Signed Date
Chief Executive Officer
Ker Valley State Prison

CEIVE,
“HOCAS ©
| jug 44 0

Note |: t institutional level review is ‘Dased on cecdrds available as of the date the Institutional Level Respane is signed bv the reviewing:
authority, !
Nate 2 1 ¢ Closing date reflects the closed, muiled/delivered date of the health care grievance.
Note3: Permanent health care grievance document. Da notremave from the health care grievance package,
HEALTH CABE SERVICES

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 23 of 88 Page ID#:21

BS □□ eyo NA.
mm = HEALTHCARESERVICES (4)
Seri”
Headquarters’ Level Response
Closing Date: 29 202i
To: CARROLL, JACK (V90846)
Kern Valley State Prison
PO Box 3130
: ‘Delano, CA 93216
“Froin: California Correctional Health Care Services
Health Care Correspondence and Appeals Branch
P.O. Box 588500
: Elk Grove, CA 95758
Tratking #: KVSP HC 21000489
RULES AND REGULATIONS
The:tules governing these issues are: California Code of Regulations; Title £5;-Health Care Department
Operations Manual; Mental Health Services Delivery System Program Guide: California: Department of
Corrections and Rehabilitation Department Operations Manual.
HE: LTH CARE.GRIEVANCE APPEAL SUMMARY
In your CDCR 602 HC, Health Care Grievance, you explained the decision, action, condition, omission, policy,
or regulation that has had a material adverse effect upon Your health or welfare for which you seek
administrative remedy,
Issu Description
fssug: Grievances. (Grievance History) You indicated this is the second CDCR 602, Héalth Care
Grievance; you have submitted. You indicated the last one
. was sent back and half of it was missing.
Issug: Disagreement with Treatment You stated you were seen three years ago for your right
: (Primary Care Provider) testicle being hard with lumps and told it was fine by the
. doctor; however, you now have cancer in your right testicle
: and require chemotherapy.
Issue: Staff Complaints You alleged medical malpractice. and negligence as you could
{investigation Request) have died had you not been seen the outside doctor. You
would like an investigation.
HEAD UARTERS’ LEVEL DISPOSITION
No intervention. Intervention,

Nate 1 The headquarters! ievel review is based on records available ag of the-date the Headquarters’ Level Response is signed by the
reviewthe auttiotity, ,
Note.2: The closing date réflects:the closed. miailed‘delivered daie of the’ health care prievance:
wea Pe ot arce P.O. Bux 388500
“T CARE SERVICES Elk Grave, CA 95758

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 24a of 88 Page ID #:82

J.CARROLL, V90846
: KVSP HC 21000489
| Page 2 of 3
BASIS FOR HEADQUARTERS’ LEVEL DISPOSITION .
Your health care grievance’ package and health record, and all pertinent departmental! Policies and procedures
werg reviewed, You are enrolled in the Chronic Care Program, where your medical conditions and medication
neegs are closely. monitored .:Progress notes indicate there.is-a plan of care in place.and the primary care
provider (PCP) has discussed the plan of care with you. Your health resords support you have received
evailation. and treatment for testicular seminoma, as determined medically necessary, including, but not limited
to, PCP evaluations, diagnostic imaging, urology consultations, oncology consultations, surgery, and
chemotherapy.
AS ipdicated in the Institutional Level Response, you were seen and evaluated by nursing staff.on
December 29, 2017, for concerns related to lumps and pain in your testicle. You. were referred to the PCP. On
January 3, 2018, you were.seen and evaluated. by the PCP who noted your symptoms and concerns. The PCP
notel things were functioning correctly and there were no suspicious lumps.at that tine.
On March 5, 2021, you-received a nursing assessment for abdoniinal pain and subsequently transferréd to.an
outstde hospital for care. You received diagnostic imaging including an ultrasound and were referred to urology
for finer evaluation.
On June 29, 2021, you were seen and evaluated by the PCP. A history of testicular seminoma was noted. The
provider noted you underwent testicular surgery and were being treated by an oncolagist following two-rounds of
chenjotherapy. You have a follow-up encounter with oncology pending scheduling.
You medical condition will continue to be monitored with care provided as determined medically or clinically
indicated by the primary care provider. If you have additional health care neéds, you may access health care
servires by utilizing the approved processes. in accordance with California Correctional Health Care Services
policy.
Ther is no indication your care has not been provided pursuant to the rules and regulations governing the _
management and delivery of medically or clinically necessary health gare services. Patients shall be accorded
impaftial (equal, unbiased) access’to. treatment or accommodations that are determined to be medically or
clinigally indicated, based oni the patient’s individual presentation, history, and exam findings, in accordance
with appropriate policies and procedures, Treatment determined:to be medically or clinically indicated for
anotier patient may not be determined to bé appropriate for you; this does not constitute a violation of your right
to impartial access to. medically or clinically necessary health care.
alleged negligent care; however, your allegation is refuted. by professional health care staff familiar with
‘your health care history, as well as a review of your health record.
Calif ria Correctional Health Care Services takes your complaint against-any personnel seriously and all
efforls-are made to ensure these matters are researched and responded to accordingiy. However, it is not in the
purview of grievants to dictate administrative actions regarding health care grievance review, disciplinary
measpres, or adverse action against staff. Further, all such.personnei actidns-are confidential and will not be
shared with inmates, staff, or the public.
Ree ards indicate-you have been provided with a complete copy of health care grievance tracking number
KYSP HC 20000952. If you need additional information please contact the health care grievance coordinator at
your institution.

Note 1: The headquarters’ jevel review is based on records available as of the date the Headquarters’ Level Response is signed by the □
reviewing authority.
Note {The closing date reflects the closed, mailed/delivered date of the health care grievance.
math cae PO. Box SR 500
HEALTH CARE SERVICES Elk Grove, CA 95758

Case 2:22-cv-02742-GW-MAR Document & Filed 08/23/22 Page 25 of 88 Page ID #:83

J.CARROLL, V90846
KVSP HC.21000489
Page 3 of 3
While the health care grievance process is a means of.sétting forth your health care concerns, it is nota
substitute for direct communication about your health with your health care providers. You are encouraged to
continue your care with your assigned health care providers.and share with thern new or additional clinical
information about your conditions that you believe may affect your care. However; California lat directs your
health care providers to offer and provide only the care they determine to be currently medically or clinically
necgssary for you, in accordance with appropriate policies and procedures. Previous orders from other health
care/facilities or staff, input from. health care consultants, and/or your own personal preferences may be
congidered, but do not control the professional judgment of your.current health: care providers.
This decision exhausts your administrative remedies.
Digitally signed by HCCAB
Pa WA Date: 2021.08.20 10:23:06.
-07'00' August 20, 2021
S. Gates, Chief Reviewed and Signed Date
Health Care-Correspondence and Appeals Branch
Polidy and Risk Management Services
California Correctional Health Care Services

‘Note 1:/The headquarters’ level review is based on records available a8 of the date the Headquarters’ Level Response is signed by the
reviews authority.
Note The closing date reflects the closed, mailed/delivered date of the health care grievance.
teayha cape eeputene P.O. Box $88300
HEALTH CARE SERVICES Elk Grove, CA 95758

Case ree Document 8 Filed 08/23/22 Page 26 of 88 Page ID #:84
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@pe 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 2% of 88 Page ID #:85
ws la ALIS PmABDRF Enforcement Program
a MEDICAL BOARD 2005 Evergreen sige, Sil 1200
oy into, CA. 95815-5401
Pra OF CALIFORNIA ei phone: (916) 263-2528
Say Fax: (914) 263-2435
a i Protecting consumers by advancing high quality, safe médical care. www. mbe.ca.gov.
Gavin Newsot , Governor, State of California | Business, Consumer Services and Housing Agency i Department of Consumer Affairs.

Mareh 14, 2022

Jack Carrol CDCR #V90846
Kern Valley State Prison FCB3-227
PO Box 5103
Delano, CA 93216

Re: . Your complaint to the Medical Board of California
Dear. ack Carrol:
This ig to acknowledge receipt of the complaint you submitted to the Medical Board of California
(Board). The Board initiated Control Number 8002022086695 although you have not provided
the full name of the treating practitioner(s) for the Board to proceed with investigating your
complaint.
Pleas provide the full name of the practitioner in question by March 28, 2022. Without
the practitioner's full name, the Board will be unable to pursue the review of your □
complaint and it will be closed.
Pursu int to Business and Professions Code section 2230.5, the Medical Board of California
(Board) must file an Accusation (formal charges against a physician's license) within three (3)
yearsiof the date the Board is first notified of the act or omission alleged as the ground for
disciplinary action or seven (7) years from the date of the incident, whichever occurs first. As
‘such, jf you wish to provide any additional! information to the Board that may assist our office in
investigating the treatment provided, please send these documents to us immediately.
Docuipents may include patient records, photographs, audiotapes, correspondence, billing
statements, proof of payments, etc. Please refer to the contro] number shown above in your
correspondence or contact with us. You will be advised of the status of your. complaint at various
stages throughout the complaint review process.
We at preciate your patience and thank you for bringing your-concerns to our attention.
CENTRAL COMPLAINT UNIT
MEDICAL BOARD OF CALIFORNIA

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 28 of 88 Page ID #:26
= GS CALIFORNIA GRAARTHENT OF . ay
lied Con mea! GENERAL SERVICES Governor Gavin Newsom

| 01/08/2022

+ Jack L. Carroll v90846
| POBox 5103
‘| Delano, CA 93216
| RE: Claim 21006528 for Jack L. Carroll V90846 against Department of Corrections
| and Rehabilitation
| Dear Jack Carroll,
Government Claims Program (GCP) staff completed its investigation of your claim
| and-rejected it for the following reasons.
| The claim involves complex issues that are beyond the scope.of analysis and legal
| — interpretation typically undertaken by the GCP. Claims involving complex issues are
| best determined by the courts. Therefore, staff did not make a determination _
| Tegarding the merit of the claim, and itis being rejected so you can initiate.court
1 action if you choose te pursue this matter further.
| Additionally, the GCP has no jurisdiction to consider.claims presented more than one
| year after accrual of the cause of action, pursuant to Government Code section
1 941.2.
‘| If you choose to pursue court action in this matter, it is not necessary or proper to
41 include the GCP in your lawsuit unléss the GCP was identified as a defendant in your
4 Original claim. Please consult Government Cede section 955.4 Tegarding proper
{| service of summons,
| If you have questions about this matter, - please feel free to contact GCP by phone,
| mail, or-email using the contact information below. Please.remember to reférence
| the assigned claim number (21006528) in your communication.
. Sincérely,
Bhan (ns
4 Sheila Emami, Program Analyst
; Government Claims Program
gcinfo@dgs.ca.gov

of ice of Risk and Insurance Management ! Stata of California | Government Operations Agency
797 Seo Strewt, Floor | West Sacramento, CA 95805 | 1 800.955.0045 £ 918-378-8387

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 29 of 88 Page ID #:87
STATE OF CALIFORNIA __ DEPARTMENT OF GENERAL SERVICES
GOVERNMENT CLAIM OFFICE OF RISK AND INSURANCE MANAGEMENT
BGS ORIM 006 Rev. 08/19)

UCLAIMANT INFORMATION ee
LAST NAME FIRST NAME MIDDLE INITIAL
INMATE OR PATIENT IDENTIFICATION NUMBER (if applicable} BUSINESS NAME(if applicable}
TELEPHONE NUMBER EMAIL ADDRESS
None : None:
MAILING ADDRESS CITY STATE 21
IS THE CLAIMANT UNDER 18 YEARS OF AGE? INSURED NAME(Insurance Company Subrogation)
IS THIS AN AMENDMENT □□□ PREVIOUSLY EXISTING CLAIM? EXISTING CLAIMNUMBER (fapplicabie} [EXISTING CLAIMANT NAMBE(H applicable}
fe ae
LAST NAME; FIRST NAME MIDDLEINITIAL
TELEPHONE NU EMAIL ADDRESS

None None None. None
STATE AGENGIRS OR EMPLOYEES AGAINST WHOM THECLAIM IS FILED DATE OF INCIDENT
California Department of Corrections On Going
LATE CLAIM EXBLANATION (Required, if incident was more than six months ago}
The failure of Department of Correctional employees to treat the claimant
for testiclar tumors, resulted in the loss of his r ight testicle, and the need
for ‘chemo treatment. The claimant was told he could die from treatment, and
was transferred to a new medical prison 60 days ago. .
DOLLAR AMOU T OF CLAIM CIVIL CASE TYPE(Required, ifamount is mare than $10,000)
$500,000 NO [_] Limited 25,000arless) Gi Non-Limited (over $25,000)
DOLLAR AMOUNT EXPLANATION
Deliberate Indiffererice to a serious medical need result ing in injury
INCIDENT LOCATION
Delano, California.
SPECIFIC DAMABE OR INJURY DESCRIPTION
The claimant informed the CDCR medical department that. he had testicle tumors
in his right testicle. The Primary Care Provider and Regiistered Nurse refused
to provide the claimant with any real treatment. The Cancer spread to his
abdomen apd nearly-him. Due to the laziness and vindictiveness he loss a testicl
CIRCUMSTANCES THAT LED TO DAMAGE OR INJURY
Claimant requested medical help to treat his testicle tumors. His Primary
Care Provider and Registered Nurse wished him dead. They refused to give any
treatment, and allowed the Cancer to spread to his abdomen. He was only saved
by treatment from outside the CDCR. The prison MD and RN tried to kill him.
EXPLAIN WHY : BELIEVE THE STATE IS RESPONSIBLE FOR THE DAMAGE OR INJURY
The CDCR: Medical Doctor and Registered Nurse refused to treat the claimant for.
testiclan tumors, allowing Gancer to spead throughout his body for three years.
The CDCR Doctor and Registered Nurse were his only medical option, as they
had the power to block ALL medical help. The CDCR employed the MD and RN.
TE

oT
Case 2:22-cv-02742-GW-MAR Document & Filed 08/23/22 Page 48 of 88 Page ID #:88
STATE. OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES
_ FEE WAIVER REQUEST OFFICE OF RISKAND INSURANCE MANAGEMENT
‘DGS GRIM 005 (Rep. 09/19).
CLAIMANT. INFORMATION
FIRST NAME | LAST.NAME
Jack L. . Garroll
CLAIM NUMBER {IF KNOWN) , TELEPHONE NUMBER
None
If you are.ag inmate in a correctional facility, please attach a certified copy of your trust account balance.
iNMATE IDENTIFI NUMBER.
V-90846
FINANCIAL INFORMATION
(itam i eceiving financial assistance fram one or more of the following programs
* Supplemental Security income (SSt} and State Supplemental Payments (SSP)
* California Work Opportunity and Responsibility to Kids (CalWORKS}
. CaiFresh/SNAP {formerly Food Stamps)
* General Relief (GR) or General Assistarice (GA)
□□□ Number of household members and monthly household income are within one of the categories below.
Number of Household Menibers Maximum Monthly Household Income
i $1,012
| 2 $1,372
3 $1,732

5 $2,452
6 $2,812
. For each additional househoid member beyond 6, add $360 to.the maximum monthly household. income
CLAIMANT CERTIFICATION □
frequesta wail) r of the $25 fee to file a government claim. fdeciore under penalty of perjury, per Penal Code Section 72. that the infarmation
provided on this.application is true and correct.
Signature, Date
April 20, 20292
Department of General Services
Office of Risk and Insurance Management
Government Claims Program
PO Box 989052, MS.414
West Sacramento, CA 95798-9052
1-800-955-0045 - Eile'a Government Claim

Case 2:22-cv-02742-GW-MAR Document 8 Filed 08/23/22 Page 22 of 88 Page ID #:89
STATE OF CAI IFORNIA DEPARTMENT OF GENERAL SERVICES
GOVERNMENT CLAIM OFFICE OF RISKAND INSURANCE MANAGEMENT
DGS ORIM 006'(Rev. 08/19}

AUTOMOBILE CLAIMINFORMATION ee
DOES THE CLAIMINVOLVE A STATE VEHICLE? VEHICLE LICENSE NUMBER(f known] STATE DRIVER NAME (if known)
Yes No None None
HAS ACLAIM BEEN FILED WITH: YOUR INSURANCE CARRIER? INSURANCE CARRIER NAME INSURANCE CLAIM NUMBER
[]Yes . No None None
HAVE YOU RECEIVEDAN INSURANCE PAYMENT FOR THIS DAMAGE OR 'NJURY? AMOUNT RECEIVED (if any} AMOUNT QF DEDUCTIBLE(if any)
[] Yes | xX]No Piled Civil suit. Pending
“NOTICE AND SIGNATURE ee
‘declare underipenalty of perjury under thé lawsof the State of California that all the information I have provided istrue and correct to.
the best of my information and belief. | further understand that if f have provided information that isfalse, intentionally incomplete, or
misleading | may be charged witha felony punishable by upto-four yearsinstate prison and/ora fine of up □□□□□□□□□□□□□□□□□□□□□
section72). -
SIGNATURE _ PRINTED NAME DATE
: Jack Leroy Carroll April 20, 2022

e include a check or money order for $25, payable ta the State of California.
* S25 filing fee is not required for amendments te existing claims:
□ Confirm sections relating to this claim are complete and the form is signed. .
* Attach copies of any documentation thatsupports your claim. Do notsubmit originals.
Mail the claim fgrm and all.attachments to: Claim forms can.aiso be delivered ta:
Office of Riskand Insurance Management’ Office of Risk.and Insurance Management
Government Claims Program Goverment Claims Program
P.O.Bax 989052, MS4i4. 707 ard Street, ist Floor
West Sacramento,CA 95798-9052 West Sacramento,CA 95605:
4-800-955-0045

This ricticeis pravided pursuant to thé Information Practices Actof 1977, California Civil Cade Sections1798.17&1798.24and the Féderal
Privacy Act (Public Law93-579).
The Departmen of General Services(DGS), Office of Risk and Insurance Management (ORiM),is requesting ihe information specified on this
form pursuant ta Government Code Section 905.2(c}.
The principal putpose far requesting this datais to process claims against the:state The information provided will/may be disclosed te a person,or
io another ageri¢y where the transferis necessary forthe transferee-agency to perfarmits constitutional or statutory duties,and the use Is.
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Page 2 of 2

Case 2:22-cv-02742-GW-MAR Document & Filed 08/23/22 Page 42 of 88 Page ID #:90

F SE MAIL
BY PERSON IN STATE CUSTODY
(Fed. R. Civ. P. 5; 28 U.S.C. § 1746)
I, __JACK LEROY CARROLL declare:
I am over 18 years of age and a party to this action. | am a resident of CALIFORNIA STATE
PRISON-LOS ANGELES COUNTY Prison,
in the county of _LOS ANGEGES .
State of California. My prison address is:__P.0.BOX 8457 - Lancaster, California ,
93539-8457 .
On April 21, 2022 .
(DATE)
I served the attached: 42 U.S.C. § 1983 CIVIL RIGHTS COMPLAINT and
SUPPORTING EVIDENCE (Documentary evidence
(DESCRIBE DOCUMENT)
on the parties herein by placing true and correct copies thereof, enclosed in a sealed envelope, with postage
ELECTRIC FILING
thereon fully paid, in the RAAB ITOBOR so provided at the above-named correctional
institution in which I am presently confined. The envelope was addressed as follows:
Was} handed to the Prison Law Libarian for processing in accordance
with United States District Court-Central District of California
policy for E-Processing 42 U.S.C. § 1983 Civil Complaint.
I declare under penalty of perjury under the laws of the United States of America that the foregoing
is true and correct. □
Executed on_April 21, 2022 “2TwH
(DATE) (DRCLARANT’S SIGNATURE)
poe LEROY CARROLL

Civ-69 (Rev 9/97) ODMA\PCDOCS\WORDPERFECT22832\1
Me

Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 43 of 48 Page ID #:91
FULL NAME

COMMITTED NAME (if different)
FULL ADDRESS INCLUDING NAME OF INSTITUTION
PRISON NUMBER (if applicable)

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
CASE NUMBER
To be supplied by the Clerk
PLAINTIFF,
v. CIVIL RIGHTS COMPLAINT
PURSUANT TO (Check one)
G 42 U.S.C. § 1983
DEFENDANT(S). G Bivens v. Six Unknown Agents 403 U.S. 388 (1971)
A. PREVIOUS LAWSUITS
1. Have you brought any other lawsuits in a federal court while a prisoner: G Yes G No
2. If your answer to “1.” is yes, how many?
Describe the lawsuit in the space below. (If there is more than one lawsuit, describe the additional lawsuits on an
attached piece of paper using the same outline.)

CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page 1 of 6
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 44 of 48 Page ID #:92
a. Parties to this previous lawsuit:
Plaintiff
Defendants
b. Court

c. Docket or case number
d. Name of judge to whom case was assigned
e. Disposition (For example: Was the case dismissed? If so, what was the basis for dismissal? Was it
appealed? Is it still pending?)
f. Issues raised:
g. Approximate date of filing lawsuit:
h. Approximate date of disposition
B. EXHAUSTION OF ADMINISTRATIVE REMEDIES

1. Is there a grievance procedure available at the institution where the events relating to your current complaint
occurred? G Yes G No
2. Have you filed a grievance concerning the facts relating to your current complaint? G Yes G No
If your answer is no, explain why not

3. Is the grievance procedure completed? G Yes G No
If your answer is no, explain why not

4. Please attach copies of papers related to the grievance procedure.
C. JURISDICTION
This complaint alleges that the civil rights of plaintiff
(print plaintiff's name)
who presently resides at ,
(mailing address or place of confinement)
were violated by the actions of the defendant(s) named below, which actions were directed against plaintiff at
(institution/city where violation occurred)
CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page 2 of 6
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 45 of 48 Page ID #:93
on (date or dates) , , .
(Claim I) (Claim II) (Claim III)
NOTE: You need not name more than one defendant or allege more than one claim. If you are naming more than
five (5) defendants, make a copy of this page to provide the information for additional defendants.
1. Defendant resides or works at
(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)
The defendant is sued in his/her (Check one or both): G individual G official capacity.
Explain how this defendant was acting under color of law:
2. Defendant resides or works at
(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)
The defendant is sued in his/her (Check one or both): G individual G official capacity.
Explain how this defendant was acting under color of law:

3. Defendant resides or works at
(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)
The defendant is sued in his/her (Check one or both): G individual G official capacity.
Explain how this defendant was acting under color of law:

CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page 3 of 6
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 46 of 48 Page ID #:94
4. Defendant resides or works at
(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)
The defendant is sued in his/her (Check one or both): G individual G official capacity.
Explain how this defendant was acting under color of law:

5. Defendant resides or works at
(full name of first defendant)
(full address of first defendant)
(defendant's position and title, if any)

The defendant is sued in his/her (Check one or both): G individual G official capacity.
Explain how this defendant was acting under color of law:

CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page 4 of 6
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 47 of 48 Page ID #:95
D. CLAIMS*
CLAIM I
The following civil right has been violated:

Supporting Facts: Include all facts you consider important. State the facts clearly, in your own words, and without
citing legal authority or argument. Be certain you describe, in separately numbered paragraphs, exactly what each
DEFENDANT (by name) did to violate your right.

*If there is more than one claim, describe the additional claim(s) on another attached piece of paper using the same
outline.
CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page 5 of 6
Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 48 of 48 Page ID #:96
E. REQUEST FOR RELIEF
I believe that I am entitled to the following specific relief:

(Date) (Signature of Plaintiff)

CIVIL RIGHTS COMPLAINT
CV-66 (7/97) Page 6 of 6

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/9980090. Public record. Not legal advice.