Jack Leroy Carroll v. Ralph Diaz

Case 2:22-cv-02742-GW-MAR Document 8 Filed 05/27/22 Page 1 of 48 Page ID #:49 [3] UNITED STATES DISTRICT COURT [4] CENTRAL DISTRICT OF CALIFORNIA [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. [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 [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 [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). [21] 22 | Dated: May 27, 2022 JAX 23 HONORABLE MARGO A. ROCCONI D4 United States Magistrate Judge [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-0016023 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 Doe17 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 [15] 1h [24] 25 . [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 ; Expatited? ves Sie INSP HC DULY bol aa, RN cantssnronreecd erent te en □□□ te enna ean itty patina init wee. Cie meh foo alone erwin “(3 = ol Saft Mameland Tite Print, Seto —_ 7 aa 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 Gravance Gfica for orpcassing, Rbter is Calfmia Code af Raguistans (OCH, Tile 14 Chanter 2. Subchanter 2. Sciete 9 fer further Decamgs wilh tre hasith care Qeevadce process, _. _ . Do not axched mere than ons row of text per ling, WRITE, PRINT, or TYPE CLEARLY In Diack OF hiue Was Pama [ast] Peat, hub “™ Scns Times Cagectt. Neck VIC8H6 [C2 ~272SECT aia. {Explain the applied néaith ears eciicy. decision. actGn, comdihan, of omissian that pas hag a mintevial a2veres ahacl Liban your heath or SECTION AD ere tee ony noah ey me ___. / Avebare 2o¢ which you.seek adminstiative remady: / Tiss Wee Cee, Steel 600. haan conittesd, the tastene wes Saitheck eacl La (ee ASR Sil tacit, ea obebaccan Dayco eanam iy cigs pesien A Nee ‘ 4 □□□ . : : a he ORL Wa Als uw th Lents. □□□ □□ eC Aad 4; □□ RS Sevens Teh cies Tee. ~~ i. rte r Jet 7% , . Stet . cer Ae i dia Gere ctrl backiat Sencapecseeate eany. Ghee Pea Wa mp lace Stomach cael VeSbTbesmeel, ope. See COS. hte Way GT 4 the LEMTE eve com 2 or it hh ar oy Bo catlipracesh □□ AS _ Sy FES Ca “Shak VA. . Snbe Cases Comied Noe eathian tas! Nerden Ae be cuet aseg, Th Seiek postive S Wed Siac \ desdtoles Lista” Soot nomay cet eit Veg oy eg ta Choms Trgebeg This | ES ees tee none ERA. a, i : * et oF : oy F ” Cowl eflyen Yeveks a wan't ein ote Seay Ae cee eT Seen ke cupylety ip she oF Cons of Pusicaly chi aed bac! 4h. Cove er Se Cece Belen! ony Paytey Awetice | hes | io is} oy: ‘ _~", Ne ~ 1 MS : . all AAlarocdied □ —Thare Shodel pe cn yaw AM Ve Wey ewase altos Aon an, Supporting ae tached. Rafer ta CCR 3999,227 a Yes fi Ne _ _ Grievant Si atures if Lorie Vdeeds {Date Submitted: f □ □ L224 _ BY PEACIN' RUCUATTIALS IN THIS BOX, | REQUEST TO RECHIVE AN INTERVIEW AT THE INSTITUTIONAL LEVEL. CL SECTICN 8] [HBALTH CARE GRIEVANCE REVIEW INSTITUTIONAL LEVEL: Stall Use Only Is a COC 602 40 Aatachas? OF Yes Jets ae AL: This griavente hasbeen: mm Fejacted (See sleched tetterferinstuctien: tet ee, , DALE! . ee my Withers | ioe sgctinn- EY “| wf □□□ AE Accented Assigned Ts. -bpe pa \ Tile: Date Ansigned, ch) & wa cuall | 2 ve em eB om tater S972) enlel eleeed Socquaied? UM Yes (7 No Date of interview: 5 HA / a) inarvigy Leagan C4 Build A eB interiewer Ne na aise Te fgetntis fefr scl Pa if dé. : Signature: eee a Cane 3, ~ Nevins pe BVE. Hed Pay sored BEE SYR 2B mangaing Aupatity . A, = , Pt Siqnatora: Me ff Pines, da. Name-aed Taig fornt) □□□ Pel cle ¥ KO 2 see CO Sf 27 eA Disposition: Bez ateched fetter £7] imerventiori Bene intervention JACGO Usa ly: Date dissed and maled/calivared te qrlavant: | Ay & Fy 72 ry : erm vrata gr ety □□□□□□□□□□□□□□□□□□□□□□□□□□□ TT bilgi er eeenner dem in rattle gh germ nn geshah dase □ Eieemaiaee 7 Riese Gammon, "eS ee “eK : ee CPFABS asepado 0 TU Achoenni dna □□ PANGM sod quenuces i ee pee” HVom i PERCH GACT Sewinmdtel gy 0 auans samen wfuemagas : w/o: 4 : Lewduw?”? 3ipwer Piaase check one: P ABE pe Ay 27 aq eh oe, : Kos. : Epessclltaete Tjnetreacher litem: ATG hg Tp pF u's Bo N LYE a | Assinebis Cart “Eee, Shronge mete wo Que : VVASE. Grob = = / Am ag Rey ey PU te 1 emnpiniey SEB ER SOR TS j 2g tS OG j woes EE j . □ 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” " . * i (Lau “ff _>. | (GOP Qn srt. PADENT SIGNATURE DATE (ee Ls : 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 tien ef fea, crs, ZK ths “hye CO. rs aie Debta ves be cee st fies Te gee Do poet Tika 3 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. Date? Time Reviewed hy RA: bE, Reviewed ES: . Pain'Scaley 1 2 3 4 5 § 7 8 9 10 | mag 4O: T: P: R: BP: WEIGHT: : TY : en ree 4A: 4p: See Nursing Encounter Form re a te 4 — [ } __ er HAPPOINTMENT EMERGENCY - “URGENT 1! ROUTINE CHEDULED AS: USIMEDIATELY) — UWITHEN 25 SUBST (VITHIN FH CALENDAR D4¥s) IREFERRED TO Pcp, . DATE OF APPOINTMENT: Re IDOMPLETED BY [NAME OF INSTITUTION iPUNTSSTANIP NAME TSHINATLRR TGLE IDATETIME COMMLETED 4 | PDC 73 62 (Rev. 03/04) Cuisine! - thesis Recand sthaw lontc sepasment applivablet Pink = Saraare Tre! Oiler fifiapasiier applcartes □□□ □ dqenate : ‘ □ wm SoTL Sipe Bt AD . er ee : ee PA 4k Pacihty Gisotay HS? -J . 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 — STAPF UST ONLY Expedited? (1 Yas Si a5 PAURAT 3 se ce ite a □ | i Holidy, RN IT Z , eeeeermurpnir' er TTA epeerinutant pers pepuuinetuity opparrn fan : □□ re mente tr Y-(2- a Rat Neo. pre Te rint: > ONS 7 Bae □ if you tnisk you have a medical, mental health ‘or dental emargency, nollfy staff immediately. iF sedi BPace 1 Needed use Sechon A of □□ COIR S02:HC A haath Care Gravance Ataenment. Oniy one COCR 892 HO A will ba ancecied. vey must sutocha heath tare drevance to the Hesith Care Gravance GFice for crogassing. Refer to California Code of Reguletions (CCR) Tike 18 Chagter 2 Surchapter 2. Aricts 0 fer fuctnar guidance wih iha health □□ ee ee ss Do nol axcued mora than one row of text perling., WRITG, PRINT, af TYPE CLEAALY In blask arbiue ink, raat Name (Lasierst, [chase = Tonvian = . “| SECTI ON . HExplain the applied health care eofcy, decision. actor, canddion. or amissisn that nes fade maternal averse eect upon your heath ar nue jwralfiees for whieh you Sask aiminstalive remedy: _ __. _. _. 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J <—ift " we . 4 □ □□ Mecn@all Maloreetied There Shatcl be cn VaveSte pelea pido Nano Was wag Aliaachts Lager, Supporting: scumenis Attached, Referio COR 3999,.227 Ti Yes No ‘Gtisvant Sishaturel. -”“*Wiatas Sumntlne fy, Omens Grievant Sig atreN hee bl bari FOEU4 _ (Date Submitted: tf / 5 fof _ □ BY PLACING MY GHTIALS IN THIS BOX, | REQUEST TO RECEIVE AN INTERVIEW AT THE INSTITUTIONAL LEVEL, Lg SECTION B HEALTA-CARE GRIEVANCE REVIEW INSTITUTIONAL LEVEL; Staff Use Only tga OGCR 862 HO A auachad? fT] Yes De Fo TFRs. grisvarc 2 hag heteire Relected#See atsched letter fer instuntiony Omer Data: _. Tl Wiherant (sae section E} 3 theehe | Spb [ice Accepted Aangned Te: ~ ei’, Title: Tite Sosigned “| ATA Cats tuelp My * iss “seared be Lined 2 "8 sneer na ere ermine “ as a fe). ~~ □□□ te terion Daeducded? iW ves Tp Rdia-otiniesvew ef fro / Opa, terme incase Lop, 4 (neti Canidae! 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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 de espa in WS beet clad mee isnt feshiie i bet Hat Vato he AeA tPA? ety Leer fla — i AS pes Ces bar □□□ Shey, [fo deta — Hobvie.s thea pm Mélical teapot Shasy Hat ! if ives bLerse/ wt th. Fd i. berweps Ad fee LM Cotte) om ber waeat, Lwith Chacke Ply □□ Wve She. hails caer LT ies beech hea Bfezlig Cah! the Chg I bie! 0 fenpnel 1 ind ot Ettected Nigey" <°o. Wap □□ gach = Pike (ree Hi eS Cea oF. TH te HOGA @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 $25, payable ta the State of California. * S25 filing fee is not required for amendments te existing claims: □ Confirm sections relating to this claim are complete and the form is signed. . * Attach copies of any documentation thatsupports your claim. Do notsubmit originals. Mail the claim fgrm and all.attachments to: Claim forms can.aiso be delivered ta: Office of Riskand Insurance Management’ Office of Risk.and Insurance Management Government Claims Program Goverment Claims Program P.O.Bax 989052, MS4i4. 707 ard Street, ist Floor West Sacramento,CA 95798-9052 West Sacramento,CA 95605: 4-800-955-0045 This ricticeis pravided pursuant to thé Information Practices Actof 1977, California Civil Cade Sections1798.17&1798.24and the Féderal Privacy Act (Public Law93-579). The Departmen of General Services(DGS), Office of Risk and Insurance Management (ORiM),is requesting ihe information specified on this form pursuant ta Government Code Section 905.2(c}. The principal putpose far requesting this datais to process claims against the:state The information provided will/may be disclosed te a person,or io another ageri¢y where the transferis necessary forthe transferee-agency to perfarmits constitutional or statutory duties,and the use Is. compatible with ia purpose for which the information was collected and the use ortransferis accounted forin accordance with California Civil Code Section 1798.25; Individuals should not provide personal information that is not requested, The subrnission fall information requested is mandatory unless otherwise noted. if you fail to provide the information requested:toDGS$ or if the information proy dedis deemed incomplete or unreadable, this may resuilina delay in processing, Department Pri iacy Policy . The information tollected by DGS Is subject to the limitations in the Information. Practices Act of 1977and state policy {see State Administrative Manual 5310-5340,7}. For more information on how we care-for your personal information, please readthe DGS PrivacyPolicy. Access to Your information ‘ORIM is respongible for maintaining collected recards and retaining them forS years. Youhave-a right to access records containing personal information mairtained by the state entity. To requestaccess,coniact: DGSORIM Public Record Officer 707 3'¢St., West Sacramento,CA.95605 916).376-5300. 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