RASHAD MATTHEW RIDDICK, Plaintiff - Appellant, v. JACK BARBER, Former Interim Commissioner of Virginia Department of Behavioral Health and Developmental Services; REBECCA A. VAUTER, CSH Director, Defendants - Appellees, and HUGHES MELTON, Commissioner of Virginia Department of Behavioral Health and Developmental Services, Defendant.
No. 21-1575
UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT
July 26, 2024
PUBLISHED. Argued: May 10, 2024.
UNITED STATES OF AMERICA,
Amicus Supporting Appellant.
Before GREGORY and HARRIS, Circuit Judges, and David A. FABER, Senior District Judge, United States District Judge for the Southern District of West Virginia, sitting by designation.
Reversed and remanded by published opinion. Judge Harris wrote the opinion, in which Judge Gregory and Judge Faber joined.
PAMELA HARRIS, Circuit Judge:
Rashad Matthew Riddick is involuntarily committed to Central State Hospital, a state-run psychiatric facility in Petersburg, Virginia. Alleging that he was immobilized in four-point restraints for two weeks and then placed in seclusion for a year and a half, Riddick filed a civil rights lawsuit against the hospital‘s director and the interim commissioner for the state‘s Department of Behavioral Health and Developmental Services. The district court dismissed Riddick‘s pro se complaint, reasoning that he did not adequately plead the professional standard of care from which his treatment allegedly departed or the commissioner‘s personal involvement in his conditions of confinement.
We conclude that plaintiffs like Riddick are not required at the pleading stage to identify an accepted professional standard governing their care. Instead, the requisite departure from professional judgment may be inferred from a plaintiff‘s specific factual allegations. Because Riddick has alleged facts suggesting that both defendants departed substantially from professional judgmеnt in connection with his conditions of confinement, we reverse the district court‘s dismissal of his complaint and remand for further proceedings.
I.
A.
While involuntarily committed at Central State Hospital in January 2018, Riddick was advised by hospital staff that he would be placed in four-point restraints indefinitely.1 He remained in these restraints - which he deemed a “permanent stress position” - for two weeks, during which he was prohibited from going to group treatment sessions, religious services, the gym, or the law library. When he showered, he was only permitted to remove one arm at a time from his restraints.
While restrained, Riddick filed a complaint with the hospital, contending that he was improperly placed in restraints even
The response from then-hospital director Rebecca Vauter - one of two remaining defendants in this case - was attached to Riddick‘s second amended complaint, and it confirmed that Riddick was at the time subject to restraints and “restricted to the ward.” J.A. 92-93. But, Vauter explained, the hospital was not required to meet the regulatory standards identified by Riddick because it had sought an exemption under
Riddick‘s response to Vauter - a letter also attached to his operative complaint - contended that any purported exemption wоuld be invalid. This was so, Riddick said, because he had not been physically aggressive, because his access to services was being hindered, and because Vauter had not “set a time limit” for the exemption or shown that it had been provided in writing. J.A. 95-97.
The next day, Riddick, freed of his restraints, was moved to seclusion in an empty ward of the hospital. He remained there for 577 days - over a year and a half - with no physical human contact. Riddick could not attend church services or treatment groups, and he was not permitted outside recreation for a year. He received food through a slot on the nurse‘s station window, and staff were not permitted to be around him on the ward. Riddick could not see the staff observing him from outside the ward: The nurses’ station window had been converted to a two-way mirror so that he could not see outside. Because of this isolation, Riddick “experienced gross hallucinations . . . talked to himself a lot, and experienced long periods of depression where [he]
B.
While in seclusion, Riddick sued Vauter, Barber, and other state officials under
The district court dismissed the Fourteenth Amendment counts without prejudice for failure to state a claim under
After an appeal to this court was dismissed on finality grounds, see Riddick v. Barber, 822 F. App‘x 200 (4th Cir. 2020) (per curiam) (Riddick II), Riddick filed the now-operative second amended complaint. Riddick now identified as the relevant professional standаrd against which to measure his Youngberg claim the Virginia regulations limiting restraint and seclusion to four hours and prohibiting standing orders. According to Riddick‘s complaint, those provisions “clearly identified a protected liberty interest in avoiding” two weeks of restraint and 577 days of seclusion. J.A. 87-88.
When the defendants again moved to dismiss, Riddick renewed his request for appointment of counsel, stating that the USB drive containing his legal materials had been confiscated and that he was unable to respond to the defendants’ motion. After the district court again denied his request for counsel, Riddick asked that his previous response brief be reincorporated as an opposition to the defendants’ latest motion, given his inability to prepare a new, timely filing after receiving notice of the court‘s directive on the day his response was due. The district court agreed to do so.
Riddick‘s second amended complaint was met with no more success than his first. See Riddick v. Barber, No. 3:19-cv-00071-DJN, 2021 WL 1651229 (E.D. Va. Apr. 27, 2021) (Riddick III). As to Vauter, Riddick had “again failed to adequately allege facts showing that [she] deviated from the accepted professional standard.” Id. at *6. It was still the case, the court held, that Riddick had “not stated any
Riddick timely appealed.3
II.
We review de novo a district court‘s dismissal of a complaint under
With that as background, we “acсept as true all well-pleaded facts” in Riddick‘s complaint and exhibits “and construe them in the light most favorable” to him, asking only whether Riddick has put forward a facially plausible claim. See id. Because Riddick has sufficiently pleaded that Vauter and Barber violated his Fourteenth Amendment rights under this standard, we reverse the district court‘s dismissal of Riddick‘s complaint and remand for further proceedings.
A.
The Supreme Court established the framework governing Riddick‘s claims in Youngberg v. Romeo, 457 U.S. 307 (1982). Youngberg recognizes that the
Youngberg‘s key holding is that in the civil commitment context, the proper balance is achieved by ensuring “professional judgment in fact was exercised” when challenged conditions were established or restraints imposed. Id. at 321 (internal quotation marks omitted). Under Youngberg, a decision made by a qualified professional is “presumptively valid.” Id. at 323. But that presumption is overcome, and the Fourteenth Amendment violated, if a professional‘s decision “is such a substantial departure from accepted professional judgment, practice, or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment.” Id.
Youngberg‘s professional judgment standard is more protective than the
In granting the defendants’ motion to dismiss, the district court recognized Youngberg as the governing precedent and correctly described its professional judgment rule. Riddick III, 2021 WL 1651229 at *5. Where the district court went wrong, in our view, was in holding that Riddick could not state a claim under Youngberg unless he first identified, at the pleading stage, the “accepted professional standard” from which his conditions substantially departed. Id. at *6. We agree with Riddick, joined by the United States as amicus curiae on appeal, that a plaintiff need not articulate a professional standard of care at this early stage of litigation. Instead, a plaintiff may survive a
By dismissing Riddick‘s complaint for failing to “identify the accepted professional standard” for restraints and seclusion in the civil-commitment context, id., the district court imposed a requirement supported by neither ordinary pleading standards nor Youngberg itself. A motion to dismiss under
To ultimately succeed on his Youngberg claim, of course, Riddick will be required to establish that the challenged conduct was a “substantial departure from accepted professional judgment.” 457 U.S. at 323. But the Supreme Court in Youngberg recognized that “expert testimony . . . may be relevant” in establishing the contours of the baseline “requisite professional judgment.” Id. at 323 n.31. What constitutes the relevant professional norm can be a difficult factual question; as the Ninth Circuit has explained, there is no “‘golden
In their brief, the defendants suggested that they now agree on this рoint, and at oral argument they confirmed their position that a Youngberg plaintiff need not plead the content of a specific professional standard to survive a motion to dismiss. So instead of asking us to adopt the district court‘s rationale, the defendants ask us to affirm on a different ground, arguing that Riddick‘s complaint does not set out facts from which a Youngberg violation could be inferred. We disagree. Reading Riddick‘s pro se complaint generously and applying our “judicial experience and common sense,” see Iqbal, 556 U.S. at 679, we may reasonably infer that there was a substantial departure from professional judgment in connection with Riddick‘s conditions of confinement.
First and most important, there is the length of time Riddick alleges he was subjected to restraints and then seclusion. If Riddick‘s allegations are believed - and in this posture, we accept them as true, see Matherly, 859 F.3d at 274 - then he was held in four-point restraints, or a “permanent stress position,” J.A. 85, for a full two weeks and then in “total isolation” with “absolutely no physical human contact” for 577 days, or a bit over a year and half, J.A. 86. And in considering whether these extreme time periods give rise to an inference that there has been a departure from professional standards, we even have a point of comparison: the four-hour maximum contemplated by the Virginia regulations, as incorporated in Riddick‘s complaint. See
We take as true, as the defendants emphasize, that interim commissioner Barber granted Vauter an exemption from the four-hour rule. But that does not make the regulatory default irrelevant to the professional judgment inquiry. The point of the Youngberg rule is to “prevent a judge or jury from using ‘unguided discretion‘” in assessing treatment protocols. Thomas S. v. Flaherty, 902 F.2d 250, 252 (4th Cir. 1990) (quoting Youngberg, 457 U.S. at 321). But we need not rely on our own discretion or intuitions in evaluating the duration of Riddick‘s restraint and seclusion. Instead, we have as a referenсe point an official state policy reflecting a professional norm that for the civilly committed, restraint or seclusion of over four hours will in most cases be unwarranted and counterproductive. Cf. Thomas S., 902 F.2d at 252 (relying in part on state agency written policy to identify accepted professional standard).4 Against
That reasonable inference is bolstered by the complaint‘s other allegations. First, Riddick alleges that his extended isolation сaused his mental health to deteriorate, leading to “gross hallucinations” and “long periods of depression” during which he stopped eating. J.A. 86. Riddick was at the time, as he is today, involuntarily hospitalized due to his mental illness. In considering whether exceeding the presumptive four-hour maximum by a factor of 3,462 for such a patient can support an inference of a substantial departure from professional judgment, we reasonably could take account of the effects on Riddick himself. Moreover, Riddick alleges that he spent over a year and a half in seclusion pursuant to a “standing order,” in violation of Virginia regulations, see
We recognize that in some circumstances, professional judgment may sanction certain uses of restraint or seclusion to “provide reasonable safety for all residents and personnel” within a hospital. See Youngberg, 457 U.S. at 324. But at least as alleged, that is not this case. According to Riddick, he did not physically assault or otherwise harm himself or others before he was placed in restraints and then seclusion. And when Riddick said as much in an administrative complaint, the hospital did not dispute his allegation but instead explained that its regulatory exemption allowed Riddick to be restrained or isolated based on “a concern that [he] could become aggressive” in the future. J.A. 92 (emphasis added). A court could reasonably infer that the imposition of the severe conditions of confinement alleged here - including, again, a full year and a half of seclusion - is inconsistent with accepted standards of care, and particularly so where it is based only on hypothesized future aggression.
To be clear, we do not hold that every deviation from a state regulation like
The defendants raise two primary arguments to the contrary, but we find neither persuasive. First, the defendants, echoed by the district court, insist that because this case apparently involves an exemption from the relevant regulations, Riddick can state a Youngberg claim only if he alleges that Vauter contravened accepted professional standards in seeking an exemption at all. See Riddick III, 2021 WL 1651229 at *6. But the question under Youngberg is not whether any departure from the four-hour limit could have been sought by Vauter or granted by Barber consistent with professional judgment. What matters is whether the actual conditions alleged by Riddick - the two weeks locked in restraints and the 577 days of social isolation - fall within the broad bounds of accepted practice, regardless of any exemption purporting to authorize them. Were it otherwise, Youngberg‘s presumption of validity would become an iron-clad rule, with officials able to shield themselves from liability for even the most extreme conditions of confinement so long as they first obtained an administrative sign-off.
The defendants also argue that Riddick‘s factual allegations about his restraint and seclusion are inconsistent and belied by the exhibits he attached to his complaint, rendering his claims implausible. But we see no conflict or inconsistency warranting dismissal of Riddick‘s complaint. The fact that Riddick was permitted to shower with a single limb free, for instance, does not substantively undermine his description of his restraint. Nor does Riddick‘s seeming ability to write a letter and file notarized legal documents appreciably subtract from his allegations regarding his year and a half in seclusion. The defendants are of course free to contest Riddick‘s allegations and the severity of his treatment as this case moves on from the pleading stage. But viewing the alleged facts “in the light most favorable to the plaintiff,” Matherly, 859 F.3d at 274, wе conclude that Riddick has plausibly alleged a constitutional violation.
B.
The district court dismissed Riddick‘s claims against Barber, then the interim commissioner for the Virginia Department of Behavioral Health and Developmental Services, on a different ground, finding that Riddick failed to sufficiently allege Barber‘s personal participation in the claimed Fourteenth Amendment violations. Riddick III, 2021 WL 1651229 at *5. Again, we disagree. Riddick pleaded facts plausibly connecting Barber to his alleged conditions of confinement and constitutional deprivations. That is all that is required at this stage of the proceedings. See King, 825 F.3d at 214 (explaining that plaintiff need only plead facts that are “enough to raise a right to relief above the speculative level” (quoting Twombly, 550 U.S. at 555)).
It is true, as the district court explained, that to establish
Here, Riddick pleaded facts alleging such personal involvement by Barber in the conditions of which he complains. As for the restraints, Riddick alleges specifically that he was “placed into 4-point restraints indefinitely” at the “directive” of both Barber and Vauter. J.A. 85. And he alleges that he “remained in solitary confinement per written standing order” sought by Vauter and approved by Barber. J.A. 88. Riddick‘s theory of liability, in other words, is a match with
The defendants argue primarily that this allegation is too conclusory to survive review under
We emphasize again that we are at a very early stagе of this litigation. Perhaps discovery will show that there was no exemption, notwithstanding the Vauter letter. Or perhaps there was an exemption but not one that authorized the actual conditions alleged by Riddick, so that Barber would have had no reason to anticipate the prolonged restraint and seclusion at issue. See Amisi, 93 F.4th at 670 (explaining
Given our holding that Riddick‘s complaint survives a
Though Riddick‘s briefing focuses primarily on the need for counsel going forward, the district court‘s prior rulings on the counsel issue provide important context. Riddick twice requested appointed counsel to represent him before the district court - first on the ground that his deteriorating mental health rendered him incapable of representing himself, and then because a lack of resources at Central State Hospital made it impossible for him to conduct legal research. Regarding Riddick‘s capacity to represent himself, the district court was unconvinced counsel was warranted given Riddick‘s “impressive ability to respond to the Court‘s orders and file timely and organized pleadings.” Riddick I, 2019 WL 6119715 at *10. And when denying appointed counsel for the second time, the district court explained that Riddick‘s claims were not sufficiently complex to require the assistance of appointed counsel.
Whether to appoint counsel for indigent plaintiffs in civil cases falls within the discretion of district courts. However, “it is an abuse of discretion to decline to appoint counsel where the case of an indigent plaintiff presents exceptional circumstances.” Whisenant v. Yuam, 739 F.2d 160, 163 (4th Cir. 1984), abrogated on other grounds by Mallard v. U.S. Dist. Ct., 490 U.S. 296 (1989). Whether such circumstances exist depends on “the type and complexity of the case, and the abilities of the individuals bringing it.” Id. (internal quotation marks omitted). Courts should appoint counsel “[i]f it is apparent that a pro se litigant has a colorable claim but lacks the capacity to present it.” Evans v. Kuplinski, 713 F. App‘x 167, 170 (4th Cir. 2017) (quoting Whisenant, 739 F.2d at 163).
In Evans, we reversed the denial of appointed counsel to a different patient at the same state hospital where Riddick is committed, Virginia‘s Central State Hospital. We recognized that a pro se plaintiff “does not have a general right to counsel in a
Regardless of whether counsel should have been appointed earlier - a question we do not decide in light of our reversal of the dismissal of Riddick‘s complaint, see Brooks v. Johnson, 924 F.3d 104, 122 n.9 (4th Cir. 2019) - this case appears to call for the appointment of counsel as it moves forward, see Shaw v. Foreman, 59 F.4th 121, 132 (4th Cir. 2023) (reversing dismissal of claim and pre-discovery grant of summary judgment of another claim while “recommend[ing] that the district court appoint counsel” on remand); Brooks, 924 F.3d at 122 n.9 (finding appointment question moot after vacating grant of summary judgment and suggesting on remand “that the court consider appointing counsel for [the plaintiff] to assist in litigating the case“). Riddick remains committed at Central State due to mental illness, where he lacks access to the defendants, to legal research resources and databases, and to potential witnesses. And at least as the defendants understand the case, much will turn on the nature of any exemption granted to Vauter by Barber - information that will be available to Riddick only if he can obtain the purported exemption in discovery or depose Vauter, Barber, and possibly other state employees. Given that reality, as the defendants emphasize, it will be up to Riddick at future stages of litigation to identify the accepted professional standards against which to judge his Youngberg claims, a complex undertaking that may well require expert testimony. See Whisenant, 739 F.2d at 163; Eagan, 987 F.3d at 683 (emphasizing, in context of appointment of counsel, the complexity of cases requiring plaintiffs to prove a substantial departure from accepted professional judgment). Under all the circumstances here, we think it would be most prudent for Riddick to be represented by counsel for the remainder of this litigation, and we therefore recommend that the district court appoint counsel for him consistent with local rules and procedures.
IV.
For the foregoing reasons, we reverse the district court‘s dismissal of Riddick‘s second amended complaint and remand for further proceedings.
REVERSED AND REMANDED