Case Document 1 Filed 03/02/18 Page :tggm 59,2350 Mum SEJEE DD Elli-335): 9 MAR '2 2018 9 Cumanode BY IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA . (Full Name 0 intifl) Plaintiff. 8 '01 1 8 TUCJASPSUT v. CASE NO. (To be supplied by the Clerk) (I) ?M?tm? {Full Name ofDefendant) . CIVIL RIGHTS COMPLAINT mm $93 . - BYAPRISONER . 3W (3) . - Original Complaint (4) . First Amnded Complaint Defendanqs). 5860? Amended A. JURISDICTION I. This Court has jurisdiction over this action pursuant to: 23 U.S.C. 1343(a); 42 use. 1933 28 U.S.C. 1331; Riven: v. Six Unknown Federal Narcotics Agents, 403 US. 388 (1971). Other: 2. Institutionfeity where violation oocumed: Revisedmmo . 1 550/555 Case Document 1 Filed 03/02/18 Page 2 of 12 B. DEFENDANTS l. Nettie of Defendant: . . The ?rst Defendant is employed as: u. at atfo?euk B??xco (Positionand?tie) (Mum) 2. Name of fendantKMa? The second fendant' ts employed as: as: u( 9 \tu\ mundane) 3. Name of Defendant: The third Defendant is employed :ng?g ?i {Egan ex \umbh (humane; 4. Name of earth Defendant: t} . . The fourth Defendant is employed as: at "utSnn (Positionmd?r?nle) (Minion) C. PREVIOUSLAWSUITS I. Have you ?led anyother lawsuits while you were apn'soner? a Yes El No 2. Ifyes. how many lawsuits haveyou ?led? Describe the previous lawsuits: a. First prior lawsuit: I. Parties: .n v. 2. Courtandcasenm- . ?k \s 3. Result: [Wasthecase dismissed? Was ttappealed" Isitstill pending?) -. Second prior lawsuit: n\ 1. Parties: v. 2. Court and case number: Remit: (Was the case dismissed? Was it appealed? Is it still pending?) c. Third prior lawsuit: l. Parties: v. 2. Court and case number: 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) Case Document 1 Filed 03/02/18 Page 3 of 12 D. CAUSE OF ACTION COUNT I 1. tat or 0 er era] civil right that was violated: MA as: \on . 2. Count 1. Identify the' 15st involved. Check only one. State additional issues in separate counts. Basic necessities El Mail CI Access to the court Medical care CI Disciplinary pmdings El Property El Exercise of religion El Retaliation Excessive force by an of?cer El Threat to safety El Other: 3. Supporting Facts. State as brie?y as possible the FACTS supporting Count I Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal 'uthority 1 lent-9. g. I s. . xii-\n? ?e t. . xnn?smumrmmwanmu ant-?lemma?! EMMY-WK) . . 4. In' ury. -. how you were injured -y the actions or :ctions of the De endands). .. 5. Administrative Remedies: a. Arethere any administrative remedies (grievance procedures or administrative appeals) availableatyour institution? 8 Yes El No b. Did you submit a request for administrative relief on Count 3 Yes El No c. Did you appeal your request for relief on Count I to the highest level? 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W?s?n Ema"; manna Ni?? mt cm \mfm?eh ?some? \mm} av 9.: cuiwLEDl ?ixug?m ENL 3; USE Egg-35LEW. {xmm?mm .E Ema damsuix LE5 LENSLM \m 53E aims was Mb 39.51 ESE- em?V oyav? Case Document 1 Filed 03/02/18 Page 12 of 12 E. REQUEST FOR RELIEF Statethereliefyou xu\ . . . . antennas.? declare under penalty of perjury that the foregoing is true and correct. 4. DATE SIGN TURE OF PLAINTIFF a. to? 9.55 XuQro N\l\ (Name and title of paralegal. legal assistant, or other petson who helped prepare this complaint) N\l\ (Signature of attorney, if any) Nl it (Attorney's address telephone number) ADDITIONAL PAGES All questions must be answered concide in the proper space on the form. If you need more space. you may attach no more than ?fteen additional pages. But the form must be completely ?lled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number all pages. Case Document 1-1 Filed 03/02/18 Page 1 of 18 ATTACHMENT A ADC Number/Numero de ADC DateIFecha I . - IOSLIOO l7 CellIBed Number/CeldalNumero de UnitIUnidad P.O. Box/Apartado Postal ASPC Q- fax-Hg. 12 .4ch QL-ILI I wagsm You are required to be truthful. Failure to be cooperative arid any-abuse of the health care system or its staff could cause ladelay in delivery of care to you and others. and may result In disciplinary action (Use this form to describe only one problem or issue at one time). [Se le exige diga la verdad. La falta de cooperacion cualquier abuse del sistema del cuidado de la salad 0 del personal podrla retrasar Ia esistencia de este cuidado para usted para otnos puede dar layer a una aoc?n disciplineria (Use este formulario para describir un WWII AREA OF INTEREST(CheokonIyone block below)IAREA DE INTERES (MARQUE UN ESPACIO SOLAMENTE) medical/Medics Dental FHA Pharmacy/FannaciaD Mental Health/Salud Mental Eyes/Ojos Other (spewy?Otros (especi?que) PLEASE Describe your medical/dental treatment issue need in the space below. Be clear and speci?c. NO ADDED PAGES. FAVOR, ESCRIBA EN IMPRENTAI Describa su tratamiento necesldad m?dicaldental en el espacio de abajo. Describa claramente sea especifico. USE MAS sEcTIowsEccionI A II ff "SEcTIomsEchoN II A I understand that, per ARS 31-201 .,01 I will be charged a 00 Health Service fee (excluding exemptions granted by statute) for the Visit that I am herein requesting. I further understand that by paying this fee I do not have the right to dictate treatment or who provides treatment. [Entiendo que de acuerdo con ARS 31 -201 .01 se me 00me una cuota por el servicio m?dioo de 00 per la cita que aqui estoy pidiendo (excluyendo las exenoiones olorgsdasporla lay). Adem?s entiendo que al pagar esta cuota no tengo el derecho a imponer el tratamiento quien Io proporcione.] Inmate's Signature/Firma del prisionerow REMOVE THE GOLDENROD COPY AND PLACE THE REMAINDER IN THE HEALTH NEEDS REQUEST DROP LA COPIA DE COLOR AMARILLO OBSCURO DEJE LAS DEMAS EN EL BUZON PETICION DE NECESIDADES REFERRAL 3v MEDICAL STAFFIREFERENCIA Medical/M?dica CI Dental Pharmacy/Fermacia El FHA I: Mental Mental Eyes/010s El Other/ones (specify) (espeol?que) -CommentsIComentarios Staffs Ea Stamp/Finns del empleado DatelFecha TimelHora 4, VVS 7(4 51351:: ?22 203.? 3:31?" PLAN OF AOTIONIPLAN DE ACC 1/ In Mai/W SW titre dStamplFinna del empleado Date/Fecha Time/Hora -- 12/2211? W77 Distribution: White/Blanca- Health UnitlUnidad de Salud. Canary. Pink Goldenrod- InmatelAmaIillo Canario Rosa Amarillo Obscur- Prisonero Isms. "laments; 3% on?? IV 1: - - . 1101-10ES . . . . 12119112 - :18- --cv 00118 JAS DoCument 1-1 Filed 03/02/18 Paqe 3 of 18 Inmate Name magnum.) ADC Number Date A . 1 mm lava-4?1 To: ILocatlon if (not) 00(1me moan/o n. 1331;1- agj??l?m ?T?pf'lnmateSlgnature//'// Dlsulbutlorc We-Mm?aud?e Clary-Inmate I a Yes Requestsatelltnitedtomgmandm N9. AW Institution/Unit 7024301 Date Hg, MEL-KID m?fm?ag mafia! dEmL lfges givethestaff-member's name: (?am Case Document 1-1 Filed 03/02/18 Page 5 of 18 ATTACHMENT . ?mmzo?a?is??'m?i??imo?mm?? Filed 0 Inmate Informal Complaint Resolution NAME (Last. mm: (mm) ADC NUMBER k315i)?! DATE (MW {Don-in: 40. i- LOCATION Lu Teen Sanm- State - but completely the problem on which you desire assistance. Provide as many details as possible. All?. on ll! u- h: 1 -10\Rmrd-?1,7, 9 Among. Q. cirrhosis. 4 I I . "?hrj .4 .J. 53-. . c- n! 1 Hie! I. [i a - no-3 it- orSIGNATURE a i DATE 135: I Have discussed this with institution staff?? Yes No Ifyeo. ivetheetafimembernm: MT: mm emmampuuacm-me 302-11 ?mac-rm -Gdevm?ootdindorFiie 5:25:14 Received By nae Co $339353: ""yu?i?f?rie?b??f "1calendardamfmceiptofmis notice. "g Badge 2 Data-9: E. Inmate Name (Last. Fim? ADC Numgr Date . tqatteo 9-9 - Ii InstimtioMFacility Case Number . . 6 W1 (03 031(1) 0! To: Description of Grievance (To be hmate) ., V. aft-'- . .JWW . kw? ljsm+Wi ?m 4 372/, cog/m Action taken by Documentation of Resolution or Attempts at Resolution. Staff Member?s Signature Badge Number Date Pink-Inmate 39 302.1 ?5 12119112 FlnelDieirlbi?on-mte-lnm; County-6mm 3" Case Document 1-1 Filed 03/02/18 Page 8 of 18 ARIZONA DEPARTMENT OF CORRECTIONS For Distribution: Copy of Corresponding inmate 'i informal Complaint Resolution must be attached Inmate Informal Complaint Response t? ?we? INMATE NAME (Last, First MI.) (Please print) ADC NUMBER Coppess, Wellington 102400 UNIT ASPC-Tucson I Santa Rita Ml C02-18-002 FROM LOCATION Stephanie Aquino, RN, Asst. Director of Nursing Complex Health Unit CORIZON INMATE INFORMAL COMPLAINT RESPONSE Your inmate informal complaint dated 113/18 was received in the Tucson of?ce of Corizon Inmate Health Services on 1/4/18. . Your primary area of concern is not being treated for HEP C. Your concern has been reviewed by medical and it was determined that on 1117/18 you saw the medical provider who went over your current health status extensively. At this time you do not meet the necessary criteria to qualify for HEP 0 treatment while in ADOC. If you have further questions about the HEP criteria please discuss this at your next chronic care appointment. This informal complaint has been addressed. This has resolved your concern. STAFF TURE 5- DATE (mand/Irm) @611 Sr. ADON 1I2312018 . .1, . I Distribution: White and Canary or Copies - Grievance Coordinator. Pink or Copy - Inmate 802-12 . FINAL- White Inmate; Canary - Grievance Coordinator File 10116I16 Case Document 1-1 Filed 03/02/18 Page 9 of 18 ARIZONA DEPARTMENT OF CORRECTIONS For Distribution: oopyomonaspondmg Inmate Inmate Grievance INMATE NAME (Last, First M. I.) (Please print) ADC NUMBER Coppess, Wellington 102400 UNIT . CASE NUMBER ASPC-Tucson [Santa Rita 002-026-018 CORIZON INMATE GRIEVANCE RESPONSE Your inmate grievance dated 2/2/18 was received in the Tucson of?ce of Corizon Inmate Health Services on 2/2/18. Your primary area of concern is a treatment for Hepatitis C. Your concern has been reviewed by medical and it was determined on 1I17l18 you saw the provider. She explained to you the criteria for Hepatitis treatment. At this time you do not meet the quali?cations for treatment. Please keep your chronic care appointments to monitor your disease. If you need medical attention before your next chronic care visit please submit an HNR at open sick call. This grievance has been addressed. "In accordance with current policy. this response is ?nal, and constitutes exhaustion of all remedies within the Department." 333) Please note, per Revised Department Order 802.05, 1.2, pg. 5 - "Specifying the decision of the Contract Facility Health Administrator is ?nal and constitutes exhaustion of all remedies within the Departmen STAFF SIGNATURE Benjamin FHA 3 2/14/2013 Case Document 1-1 Filed 03/02/18 Page 10 of 18 Noti?cation of Diagnostic Results Facility: ASPC-T SANTA RITA Housing Area: BLZC Bed#: 018 Patient Name: WELLINGTON S. COPPESS 102400 Noti?cation Date: 01/24/2018 This is to Inform you that we have received the results of your diagnostic test performed on 01/23/2018. sed on evaluation our results were within a ble limits. No further action is needed. 9% on evaluation: ?ou will be scheduled for a follow-uE ai?ntment. If are released before your next visit. please follow-up with your doctor or AdditionalConunenu At next FU appointment. TlmeStornp: 24 January 2018 08:29:42 -- User: Julie Shuts (SHUJU01 Shute, Julie 01/24/2018 ?m ?m MSST833 - Noti?cation Of Diagnostic Results Case Document 1-1 Filed 03/02/18 Page 11 of 18 MSST833 Noti?cation of Diagnostic Results Facility: ASPC-T SANTA RITA Housing Area: BL2C Bed#: 018 Patient Name: WELLINGTON S. COPPESS .: - 102400 Noti?cation Date: 01/30/2018 This Is to Inform you that we have received the results of your diagnostic test performed on 01/26/2018. Based on evaluation our results were within table limits. No ?gher action is needed. 7 Based on evaluation on will be scheduled for a follow-u 3 our doctor or clinic. Additional Comments Within the week. TimeStamp: 30 January 2018 21:21:15 User: Julie Shute (SI-IUJU01) Shute, Julie 01/30/2018 Reviewing Practitioner Date MSST833 - Noti?cation Of Diagnostic Results Case Document 1-1 Filed 03/02/18 Page 12 of 18 MSST833 Noti?cation of Diamstic Results Facility: ASPC-T SANTA RITA Housing Area: BL2C Bed#: 018 Patient Name: WELLINGTON S. COPPESS 102400 Noti?cation Date: 02/04/2018 This is to inform you that we have reoelved the results of your diagnostic test performed on 02/02/2018. I: Based on evaluation, your results were within acceptable limits. No further action is needed. - 5 Based on evaluation on will be scheduled for a follow-u a Intment. If ou are released before our next visit lease follow-u your doctor or clinic Additional Comments Within two weeks. TimeStamp: 4 Febmary 2018 14:59:43 User: Julie Shute Shute, Julie 02/04/2018 ?Revlewlng Practitioner Date MSST833 - Noti?cation Of Diagnostic Results Case Document 1-1 Filed 03/02/18 Page 13 of 18 ATTACHMENT 35% ?45 CWONS Filed 03/ A Cl i. Inmate Informal Complaint Resolution INMATE NAME mm) mm ADC NUMBER DATE (mm 3.591 umq-xm \ogqcn mm 1? n?n TO LOCATION n'm Qaga? \lcu-d Z, problemonwhichyoudeslre assistance. vaideasmanydetailsaspossbleINMATE SIGNATURE DATE (2 Ms. Lw?r; 1 ?1 ClYas No MW ?memucm-GWWMorcm-m am.? Faun W14 AS Document 1- 1 Filed 03/ 2118 Pane 15 of 18 Received By - m. _1_Cmg_*r Title Badge Numbez?zl 5 Data/i I I I mate Name (Last, First MI.) ADC Number Date loaf-100 9 ??141 lnst?rmtioanacilityn Case Number 214a 6024-?2183 0! To: Description of Grievance {To be oompletedby the mm; Proposed ?3320Inmate's 4/0 0577/]? GdevanW'W Dag/aq/[g Action taken by Documentation of Resolution or Attempts at Resolution. Staff Member's Signature Badge Number Date Pink-Inmate 1? 302.1 Cmary-GrlevanoeFlle 9&3 12119112 Case Document 1-1 Filed 03/02/18 Page 16 of 18 ARIZONA DEPARTMENT OF CORRECTIONS For Distribution: Copy ofConespondng Inmate Informal Complaint Resolution must be attached Inmate Informal Complaint Response t? response. INMATE NAME (Last, First MI.) (Please print) ADC NUMBER Coppess, Wellington 102400 UNIT ASPC-Tucson I Santa Rita MI 002-18-016 FROM LOCATION Robert Burdine, RN, Director of Nursing Complex Health Unit CORIZON INMATE INFORMAL COMPLAINT RESPONSE Your inmate informal complaint dated 1117/18 was received in the Tucson of?ce of Corizon Inmate Health Services on 1/1811 8. Your primary area of concern is being given Trigger point injections. Your concern has been reviewed by medical and it was determined that your chart has been reviewed and this issue has been forwarded for review by the Medical Director. This informal complaint has been addressed. This has not resolved your concern pending the medics; director's review. STAFF SIGNATURE DATE Z. 2 R. Burdlne, DON 1/30/2013 Distribution: INITIAL: White and Canay or Coples - Grievance Coordinator, Pink or Copy - Inmate 802-12 White - Inmate; Canary - Grievance Coordinaor File 10116116 Case Document 1~1_ Filed 03/02/18 Page 17 of 18 ARIZONA DEPARTMENT OF CORRECTIONS - For Distribution: Inmate . - Inmate Grievance . INMATE NAME (Last, First MI.) (Please print) I Aoc NUMBER Coppess, Wellington A .. - 102400 UNIT . - CASE NUMBER ASPC-Tucson I Santa Rita 002-035-018 CORIZON INMATE GRIEVANCE RESPONSE Your inmate grievance dated 217/18 was received in the Tucson of?ce of Corizon Inmate Health Services on 2112118. Your primary area of concern is back pain. Your concern has been reviewed by medical and it was determined that there is no documentation in you chart stating that the back injections could be harmful. Your chart has been fonivarded to the Medical Director for review, but you will not be given any results. You have been given an analgesic balm and tramadol for back pain. If your condition does not get any better or worsens please submit an HNR at open sick call to be re-evaluated. This grievance has been addressed. "In accordance with current policy. this response is ?nal, and constitutes exhaustion of all remedies within the Departmen Please note, per Revised Department Order 802.05, 1.2, pg. 5 - "Specifying the decision of the Contract Facility Health Administrator is final and constitutes exhaustion of all remedies within the Department." - STAFF SIGNATURE Be?gh DATE FHA 2120/2018 Case Document 1-1 Filed 03/02/18 Page 18 of 18 MSST833 Noti?cation of Diagnostic Results Facility: ASPC-T SANTA RITA Housing Area: BL2C Bed#: 013 Patient Name: WELLINGTON S. COPPESS 102400 Noti?cation Date: 11/03/2017 This is to Inform you that we have received the results of your diagnostic test performed on 10/31/2017. I: Based on evaluation, your results were within acceptable limits. No further action is needed. 6? Based on evaluationI xou will be scheduled for a follow-up appointment. If you are released before vour nextl isit, please follow-up with your doctor or clinic. Additional Comments Low back x-ray with some abnormal ?ndings. To be reviewed at provider follow-up visit. mm 11/03/2017 ?_Reviewlng Practitioner Date Mada/weal QDF Wat, oi?? ra/v/M rad/7- T. MSST833 - Noti?cation Of Diagnostic Results Case Document 1-2 Filed 03/02/18 Page 1 of 1 FILED $5133 9 ?3 RES GPOFWDEPUW ?nk 3&9; w: 9 ma 3PM - 3:13.! games at I . ?gm? RDA \ef?xcm as Rea? 6mm?) Q\\m\es\ "Exam (3 KM: SAQVPR 3?0 \ms tamea?s gm ufkaDQ at me Vm ?Vi?wlh DNECLRA 35 33 mamm?tmeum ba?? 2/22? Rage? 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I PRIORITY MAIL 1-DAYTM ARIZONA DEPT OF CORRECTIONS Smoatei 0208MB - 10000 WILMOT --: TUCSON AZ 85756-8699 0006 00118 (LEA: Um} ?d 610% ?5 6V .cs?r Cox-T 43; 6.5 ?cL (l CLERK OF THE us DISTRICT COURT H.106 U0 ?0 405WCONGRESS ST STE 1500 ?mm jQI 5CD TUCSON AZ 85701-5010 JAS Document 1 SUPS TRACKING EP ll' 9205 8901 1220 3919 4812 13 Arizona Department 0% Correctaons ., I I I 5 Filed 03/02/18 Page 1 of 1