Travis Ball Lawsuit

Case 3:20-cv-00027-HEH-RCY Document 1 Filed 01/15/20 Page 1 of 8 PageID# 1 HadlsoA^
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IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF VIRGINIA
F JAN i 5 2020
CLERK, U.S. DISTRICT CUUKI

RICHMOND. VA
y
Action Number 5'.2Ccv'0Z7

(To be supplied by the Clerk, U.S. District Court)
Please fill out this complaint form completely. The Court needs the information requested in
order to assure that your complaint is processed as quickly as possible and that all your claims
are addressed. Please print/write legibly or type.
I. PARTIES
Pla^ff:
(a) froiU'S Adron Sctll (b)
dooHvn
(Name) (Inmate number)
(r)f-Q. ^)C/0(d0 MlcK
(Address)
Plaintiff MUST keep the Clerk of Court notified of any change of address due to transfer
or release. If plaintiff fails to keep the Clerk informed of such changes,this action may be
dismissed.
Plaintiff is advised that only persons acting under the color ofstate law are proper
defendants under Section 1983. The Commonwealth of Virginia is immune under the
Eleventh Amendment. Private parties such as attorneys and other inmates may not be
sued under Section 1983. In addition, liability under Section 1983 requires personal action
by the defendant that caused you harm. Normally,the Director of the Department of
Corrections, wardens,and sheriffs are not liable under Section 1983 when a claim against
them rests solely on the fact that they supervise persons who may have violated your rights.
In addition, prisons,jails, and departments within an institution are not persons under
Section 1983.
B. Defendant(s):
I. (a) (b)
(Name) (Title/Job Description)
(p) Mtck.
(Address)
I.. ~
fa.^r>//d6o UAiSp,ui,I/c, ^9-$"7^ '. n,
■ JAN 1^ 2020
1 J \J,
1 L
Case 3:20-cv-00027-HEH-RCY Document 1 Filed 01/15/20 Page 2 of 8 PageID# 2
(a) 7^ (b) l fi-f J^*'/

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(Address)
^ [/ch ^ ^
3. (g) fÔrSittn /{Put
(r) .f^fb4kv'nM^£ jlt^xJ>^/
(Address)
If there are additional defendants, please list them on a separate sheet of paper. Provide all
identifying information for each defendant named.
Plaintiff MUST provide a physical address for defendant(s)in order for the Court to serve
the complaint. If plaintiff does not provide a physical address for a defendant,that person
may be dismissed as a party to this action.
II. PREVIOUS LAWSUITS
A. Have yoU ever begun other lawsuits in any st^ or federal court relating
to your imprisonment? Yes[ ] No [(/]
B. If your answer to "A" is Yes: You must describe any lawsuit, whether currently
pending or closed, in the space below. If there is more than one lawsuit, you
must describe each lawsuit on another sheet of paper, using the same outline,
and attach hereto.
I. Parties to previous lawsuit:
Plaintiff(s)
Defendant(s)_
2. Court(if federal court, name the district; if state court, name the county):
3. Date lawsuit filed:
4. Docket number:
5. Name of Judge to whom case was assigned:.
6. Disposition (Was case dismissed? Appealed? Is it still pending? What relief was
granted, if any?):
in. GRIEVANCE PROCEDURE
A. At what institution did the events concerning your current complaint take place:
/ 7^''/
B. Does the institution listed in "A" have a grievance procedure? Yes[k ] No[ ]
C. If your answer to "B" is Yes:
1. Did you file a grievance based on this complaint? Yes \ [ ]
2. Ifso, where and when:Cl/" 'flvu ^ L/pUt-cJ c;, .
3. What was the result?.Z^ /ZCiÔAjcJ pUîC
4. Did you appeal? Yes[ ] No[^'^'^

5. Result ofappeal: ^
D. Ifthere was no prison grievance procedure iiythe institution, did you

complain to the prison authorities? Yes[\/^] No[ ]
If your answer is Yes, what steps did you take? S/to4^ UJi'A ^ Z/> Lyô^ ^
'C^Y^cU fÂÂ ''

If your answer is No,explain why you did not submit your complaint to the
prison authorities:
IV. STATEMENT OF THE CLAIM
State here the facts of your case. Describe how each defendant is involved and how you were harmed
by their action. Also include the dates, places ofevents, and constitutional amendments you allege
were violated.
If you intend to allege several related claims, number and set forth each claim in a separate
paragraph. Attach additional sheets if necessary.
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V. RELIEF
I understand that in a Section 1983 action the Court cannot change my sentence, release me from
custody or restore good time. I understand I should file a petition for a writ of habeas corpus if I
desire this type ofreliefÂ (please initial)
The pl^ntiff wants the Court to:(check those remedies you seek)
Award money damages in the amount of$ 1^
^Grant injunctive relief by /K <; X c<w ^
Other
VI. PLACES OF INCARCERATION
Please list the institutions at which you were incarcerated during the last six months. If you were
transferred during this period, list the date(s) oftransfer. Provide an address for each institution.
VII. CONSENT
CONSENT TO TRIAL BY A MAGISTRATE JUDGE: The parties are advised oftheir right,
pursuant to 28 U.S.C. § 636(c), to have a U.S. Magistrate Judge preside over a trial, with appeal to
the U.S. Court bf Appeals for the Fourth Circuit.
Do you consent to proceed before a U.S. Magistrate Judge: Yes[ ] No[ ]. You may
consent at any time; however, an early consent is encouraged.
VIII. SIGNATURE
If there is more than one plaintiff, each plaintiff must sign for himself or herself.
Signed this lO ^ day of ^)ctnc/(Xr'^ ,20 OiO .

Plaintiff ^&//
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Case 3:20-cv-00027-HEH-RCY Document 1-1 Filed 01/15/20 Page 1 of 10 PageID# 9
/ ^^lorthern Neck Regional JaiJ

Inmate Grievance
Grievance Number To be completed by Programs Staff
Grievance Number: Inmate Name Of\ (f^l/

Date Received: /
Inmate's Statement Briefly state the nature ofyo ur compla int

Jcîf£2
lAr LF^<^lLr\ C/â/ ^ S/1^ ^ ^ S^ /u/^
'^W.y/y , <^CA^ ^7 ^ LuJI^L ^k/f t u j//cf
(if u. ,}ii*>ie.*/ 2^ I- fcv/%»Â/
Resolution Attempted Briefly explain what you have done to solve this problem before you resorted jo a grievance form
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^ T- tv î h ^ C'(!f4eî^ /ypy^ j^-/

/^y ^ Âtrcz-L-C* i/m/^rfArJ S/A-* ■»
Relief Requested specific action or relief requested
cA^ 2^ ^ «;/
X ûulcyf J'^C Vt.l'ct £»/^ i'ks , 4-L/S *S cAr'yXC'/ g^/ynV
CiV/y) iTYÂ-^'
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y/p /X Ao'rvj ^hk. hi finlir cVv| •jUwA.j <;.4- Q,l| 4i^KJ ti'iA.rY
Inmate Signature ^ Date
Administrative Response
P|it^ Tnrvxirti) KoAifegOA^?* '^ti
20
Admin Signature Date
Inmate Review
( ) Am ( ) Am Not satisfied with the above response.

Print Inmate Name
I ( ) Do ( ) Do Not wish to appeal the decision

NORTHERN NECK REGIONAL JAIL
INMATE BEQUEST FOBM
Name_ Time /
Date / ;
Housing
INSTRUCTIONS: Please check the problem or request area. Be specific

about what action you want. This is not a greivance form.
O Coininunity Corrections CD Programs

CD Chaplin CD Properly
□ Classification CD Records
CD Commissary CD Shift Supervisor
CD Inmate Accounts CD Special Canteen
□ Mail CD Special Visit
CD Medical CD Trusty
CD Notary CD Work Release
CD Other
REQUEST:
Staff Receiving die Request: Datef-^--/" K]

Supervisory Review: T Date ^
Action Taken:
Response:
Signature^ Date
Original - Completed form forwarded to appropriate file.

Copy 1 - Completed form returned to Inmate with Action Noted/Response,
Copy 2 - Retained by Inmate at Time of Request.
INMATE BEQUEST FORM
Name Time
Date Housing.

n Community Coirecticns □ Programs

Cl Chaplin □ Property
CD Classification CD Records
CD Inmate Accounts n Special Canteen
CD Mail [D Special Visit
[D Medical ID Trusty
CD Notary O^Work Release
C3 Other
REQUEST:
5;fafF Rftceiving the Request: Qf-C I :r Date > ^ 1^,

Supervisory Review: ■ Date
Action Taken:
Response:
Date
Signature_

Copy 2 - Retained by Inmate at Time of Request.
INMATE BEQUEST FORM
Name_ Time
Date Housing

n Conimunity Corrections CI Programs

O Chaplin CD Property
Q Classification CD Records
CD Inmate Accounts O Special Canteen
CD'Mail CD Special Visit
CD Medical CD Trusty
CD Notary CD Work Release
CD, Other
REQUEST:
Staff Receiving the Request

Supervisory Review:
Action Taken:
Response: 4
Signature Date

Copy 1 - Completed form returned to Inmate with Action Noted/Response.
Copy 2- Retained,by Inmate at Time of Request.
INMATE REQUEST FORM
Name_ Time
Date Housing,

> ED Obiifauxli^ QorreGti^l^

n Chnpith > Prppeity •
ED Ciassiflcatioii □ Records
D Commissary □ Shift Supervisor
ED Inmate Accounts ED Special Canteen
□ Mail □ Special Visit
□ Medical □ Trusty
□ Notary □ Work Release
O Other ^
REQUEST:
i- . ' f ,v f-
. : - ■ - 'V ^ - -■
%
Staff Receiving the Request: mi(a. Date_jJ£jjiO.
Supervisory Review: T Date
Action Taken:
Response:
Signature, Date

Copy 2 - Retained by Imxiate at Time of Request.
INMATE BEQUEST FORM
Name. ; Time
Date Housing.

about what action you want This is not a greivance form.
LJ Community Corrections (D Programs

CD Chnplin ID Property
□ Classification CD Records
n Commissary en Shift Supervisor
O Inmate Accounts ID Special Canteen
n Mail (D Special Visit
CD Medical ID Trusty
CD Notary ID Work Release
{BT other "
REQUEST:
Staff Receiving the Request: Date
Supervisory Review: Date '

Action Taken:
Response: \ C; . I O C
■ Kl rc > 1
rC V D •
.A, '. c A ■ f '>i
Signature, Date I N

Copy 2 - Retained by Inmate at Hme of Request.
INMATEBEQUEST FORM
Naine_/ Time
Date Housing,

about what action you want. This is net a greivance form.
,v i CZ] tloiimuftify Gorrecti^ps^^ fQ-' ProgillraS;' ^ v

□ Chaplin f CD Pfeperty t
Q Classification n Records
□ Commissary n Shift Supervisor
D Inmate Accounts CD Special Canteeii
d Mail CD Sjîal Visit
Q Medical CD Trusty
Q Notary CD Work Release
CD Other
REQUEST:
Staff Receiving the Request:

Supervisory Review: Date
Action Taken:
Response:
Signature_ Date

Copy 2 - by liiiiiate
Northern Neck Regional Jail
Medical Department
Charge Sheet
Inmate Name: 'Tx; ) , D.O.B. \ C' 'lO ■ i i. 'I
Housing Unit: i". \- -I
Sick Call $10.00
Doctor Visit $10.00
Prescription $3.00
Follow Up Visit $0.00
X-Ray $20.00
Over-Counter Medication $
Other:
There is no Jail imposed condition on inmate medical treatment Allinmates

will receive medical treatment regardless oftheir ability to pay; however a
medical co-pay will be assessed to all inmatesfor services rendered Ifthe
inmate is indigenty he/she will receive service and his account willgo into a
negative status.
Inmate Signature: //{ • ■.■ ' ; ! / ! ' i !i7
iDI r 4-^-
j
[ ] Inmate Refuses to Sign; and refuses service.
[ ] Inmate Refuses to Sign; but wants service.
Nursing StaffSignature Date
Witness (ifrefusal) Date
Medical Department Signature: i I { t f-' "

[pî' i I
U{ .
Administrative Signature: . ,\u M5!7^
□ Check Box If Indigent and Currently Unable to Pay.

JNMAJE BEQUEST FORM
./
Name U\\ji
Date I Housing F- ry

n Community Corrections CD Programs

CH Chnpiin CD Property
O Classification CD Records
n Inmate Accounts CD Special Canteen
□ Mail CD Special Visit
D Medical CD Trusty
[3 Notary CD Work Release
CD Other Ui S ^ //n
REQUEST: /,r -V
V'. 2jL.
'M / r-
Staff Receiving the Request: ^ T. Date
Supervisory Review: Date
Action Taken:
Response:
Signature_ Date

Copy 2 - Retained by Ininate at Time of Request.
INMATE BEQUEST FORM
Name 7 rv;.. Time

Date_^ Housing^

about what action you want This is not a greivance form.
> Q Cbnilnuiiitjjr Gorrectioj^s $ Zl. Progr^s

i
Q Cluiplin j
CD Classification Z1 Records
CD Connjnissary Z1 Shift Supervisor
CD Inmate Accounts I I Special Canteen
[D Special Visit
CD Medical CP'
CD Notaiy CD Work Release
CD" Other V. - '/ ./
REQUEST:
r • ' -i' " . '• I 'i.

J'
} • —TTT'j
dA.
Staff Receiving thb ReêSst: i fe
Supervisory Review
Action Taken:
Response:
Sighature Date
Original -
Copy 1 -
Copy 2r Retainedi by Iimm of Requert,
AFFIDAVIT IN FORMA PAUPERIS
STATE OF VIRGINIA
CITY/COUNTY OF...^^.(S.^.
The petitioner being duly sworn,says:
1. He is unable to pay the costs of this action or give security

therefor; ^
2. His assets amount to a total of S.Qr.P.P.
Signature of Petitioner
Subscribed and sworn to before me
thisA^day ,20.?>P..
Notary Public
My commission expires:
Code 1950,§ 8-596.1; 1968, c. 359; 1977, c. 617.
The chapters of the acts of assembly referenced in the historical citation at the end of this section
may not constitute a comprehensive list of such chapters and may exclude chapters whose
provisions have expired.
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Case 3:20-cv-00027-HEH-RCY Document 1 Filed 01/15/20 Page 1 of 8 PageID# 1 HadlsoA^

CLERK, U.S. DISTRICT CUUKI

Action Number 5'.2Ccv'0Z7

(a) 7^ (b) l fi-f J^*'/

(r) Zl/^^/fe) HfuK )ht I ^.o,lk^ to/oO

II. PREVIOUS LAWSUITS

I. Parties to previous lawsuit:

3. Date lawsuit filed:

5. Name of Judge to whom case was assigned:.

in. GRIEVANCE PROCEDURE

C. If your answer to "B" is Yes:

1. Did you file a grievance based on this complaint? Yes \ [ ]

2. Ifso, where and when:Cl/" 'flvu ^ L/pUt-cJ c;, .

3. What was the result?.Z^ /ZCi^OAjcJ pU^iC

4. Did you appeal? Yes[ ] No[^'^'^

D. Ifthere was no prison grievance procedure iiythe institution, did you

'C^Y^cU f^A^A ''

IV. STATEMENT OF THE CLAIM

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U)r\. ^ LyktC/i /V- ^'AoJJnj- iiX^r^ -/iWd

/K llAfsJcM U^ ^kccLU^, 'SKpLv^r:S

h/tpjx/ h ^ l2-XI'hGm,^22. S'PoJ^

VI. PLACES OF INCARCERATION

Signed this lO ^ day of ^)ctnc/(Xr'^ ,20 OiO .

^ihiU l\fOfSiMn Mtcic J(aiI k^5 iK fVJrv\^r&u<, UJ^^P

5^(^fJvyi ^ So 4-Vtp>^ OvO-c

li/orSlUn /UuJl l'UiXi/(1^ 7f^f A<Mnty

f^v^Jl\/Lrrn^iX^^ doii)or\ Ad>rS*or\ A^t.o^ ^/

ynj er r^'ikh [/>\j Ly. l-ci^ >'/) /y\o>^

/ ^^lorthern Neck Regional JaiJ

Grievance Number: Inmate Name Of\ (f^l/

Inmate's Statement Briefly state the nature ofyo ur compla int

4'Ia ^ hA t\YvJ '>\ /n pv^

^ T- tv ^i h ^ C'(!f4e^i^ /ypy^ j^-/

Relief Requested specific action or relief requested

Inmate Signature ^ Date

Admin Signature Date

( ) Am ( ) Am Not satisfied with the above response.

I ( ) Do ( ) Do Not wish to appeal the decision

INSTRUCTIONS: Please check the problem or request area. Be specific

O Coininunity Corrections CD Programs

Staff Receiving die Request: Datef-^--/" K]

Original - Completed form forwarded to appropriate file.

INSTRUCTIONS: Please check the problem or request area. Be specific

n Community Coirecticns □ Programs

5;fafF Rftceiving the Request: Qf-C I :r Date > ^ 1^,

Original - Completed form forwarded to appropriate file.

INSTRUCTIONS: Please check the problem or request area. Be specific

n Conimunity Corrections CI Programs

Staff Receiving the Request

Original - Completed form forwarded to appropriate file.

INSTRUCTIONS: Please check the problem or request area. Be specific

> ED Obiifauxli^ QorreGti^l^

Original - Completed form forwarded to appropriate file.

INSTRUCTIONS: Please check the problem or request area. Be specific

LJ Community Corrections (D Programs

Staff Receiving the Request: Date

Supervisory Review: Date '

.A, '. c A ■ f '>i

Original - Completed form forwarded to appropriate file.

INSTRUCTIONS: Please check the problem or request area. Be specific

,v i CZ] tloiimuftify Gorrecti^ps^^ fQ-' ProgillraS;' ^ v

Staff Receiving the Request: