RICHMOND, Va. (CN) — The Fourth Circuit ruled Friday that an involuntarily committed mental health patient can move forward with claims that being forced to spend extended periods in restraints and seclusion violated his constitutional rights, overturning a lower court’s dismissal.
In his Fourteenth Amendment lawsuit, Rashad Riddick says Virginia’s Central State Hospital held him in four-point restraints for two weeks before he spent more than 19 months in total seclusion.
The lower court reasoned that Riddick failed to point to a professional standard of care from which his treatment departed. But plaintiffs like Riddick are not required at the pleading stage to identify an accepted professional standard governing their care, U.S. Circuit Court Judge Pamela Harris wrote in the 24-page ruling reversing the Eastern District of Virginia ruling and remanding the case.
At the pre-discovery stage the court can infer that the lengthy periods of restraint and seclusion Riddick purports frame a departure from professional judgment, Harris wrote.
She noted a plaintiff in Riddick’s circumstances would have difficulty conducting the legal research necessary to pinpoint provisions his treatment violated. “What they likely will have access to is the nature of their own conditions of confinement, and where a substantial departure from professional norms can be inferred from those conditions as alleged, their complaints survive a Rule 12(b)(6) motion to dismiss,” wrote Harris, a Barack Obama appointee.
Riddick, who was found not guilty by reason of insanity for the murders of three of his family members in 2011, outlines in his complaint that staff put him in a four-point restraint following a scuffle with another patient where Riddick claims to have been the victim. In fear of future aggression from Riddick, Jack Barber, former interim commissioner of the Virginia Department of Behavioral Health and Developmental Services, granted Central State Hospital director Rebecca Vauter an exemption to a Virginia rule that prohibits holding a patient in four-point restraints for longer than four hours.
Naming Barber and Vauter as defendants in his lawsuit, Riddick claims he spent two weeks in painful restraints and was only allowed a free limb when showering.
After Riddick filed an administrative complaint, staff released him from the restraints — only to transfer him to an empty ward where he spent 577 days alone.
Virginia law explicitly prohibits the use of seclusion or restraint of a patient as a punishment or for staff convenience.
“That regulatory baseline was exceeded here by orders of magnitude so great that it is reasonable to infer a complete abdication of professional judgment,” Harris wrote. “Against this baseline, allegations that a patient has been held in restraints for 84 times longer than recommended, and in seclusion for 3,462 times longer, can plausibly suggest a substantial — indeed, dramatic — departure from acceptable professional practice.”
According to Riddick, he could not attend church services nor treatment groups and wasn’t permitted outside recreation for a year. He received food through a slot on the nurse’s station window, and staff were prohibited from being around him on the ward. The isolation led Riddick to suffer from depression, anxiety and hallucinations while going long stretches without eating.
“Riddick was at the time, as he is today, involuntarily hospitalized due to his mental illness,” Harris wrote. “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.”
Riddick initially sought $2.7 million in damages for his treatment. Civilly committed patients may bring Fourteenth Amendment damages claims when subjected to unsafe or unreasonably restrictive conditions of confinement through the Supreme Court’s 1982 decision in Youngberg v. Romeo, in which officials from a Pennsylvania state hospital repeatedly abused a patient with an infant-level IQ and restrained him for nine straight months.
The Virginia officials insist that because this case involves an exemption from the relevant regulations, Riddick can state a Youngberg claim only if he shows Vauter contravened accepted professional standards in seeking an exemption.
The Fourth Circuit panel said what matters is whether the actual conditions claimed by Riddick 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,” Harris wrote.
Attorneys representing Barber argued Riddick failed to point to his participation in the claimed Fourteenth Amendment violations. The panel disagreed, finding Barber’s liability does not need to be hands-on.
“According to Riddick, Barber caused him to be subjected to the unconstitutional conditions at issue by authorizing exemptions that put him in restraints for two weeks and in seclusion for a year and a half,” Harris wrote.
Harris was joined by U.S. Circuit Court Judge Roger Gregory, a George H.W. Bush appointee, and U.S. Senior District Judge David Faber of the Southern District of West Virginia sitting by designation.
The panel concluded that Riddick is entitled to appointed council for the remainder of the litigation. Through a program with the Duke University School of Law, the Fourth Circuit assigned the case to students who helped flesh out Riddick’s appeal and argued in court.
“The Fourth Circuit recognized what any reasonable person understands: Civilly committed psychiatric patients are to be treated, not abused. A patient like Mr. Riddick who alleges this kind of extraordinary maltreatment ought to get his day in court,” Richard Katskee, a law professor and director of Duke’s appellate litigation clinic who worked on Riddick’s behalf, said in a statement. “Now he will.”
Attorneys representing the officials did not respond to requests for comment.