Claims of Prolonged Seclusion and Restraint Represent Facially Plausible Departures from Accepted Professional Judgment Standards
In Riddick v. Barber, 109 F.4th 639 (4th Cir. 2024), the U.S. Court of Appeals for the Fourth Circuit reversed and remanded the U.S. District Court for the Eastern District of Virginia’s dismissal of a patient’s allegations of civil rights violations under the Fourteenth Amendment while civilly committed in Virginia. The Fourth Circuit ruled that, at pleading, the alleged facts, even without explicitly stating the applicable professional standard, met the facially plausible standard required for a reasonable inference of departure from professional judgment.
Facts of the Case
Rashad Riddick was a civilly committed patient at the state-run Central State Hospital in Virginia. In January 2018, Mr. Riddick alleged he was placed in four-point restraints for two weeks based on an indefinite-duration standing order. While restrained, he was allegedly prohibited from attending group treatment sessions, religious services, the gym, or the law library. While bathing, he reported being permitted to remove only one arm at a time from restraints.
During the two weeks in restraints, Mr. Riddick filed a complaint with the hospital claiming that state regulations prohibited restraint lasting more than four hours per 12 Va. Admin. Code § 35-115-110(C)(14) (2022). The hospital director’s response confirmed the use of restraints and seclusion while simultaneously claiming exemption from state regulatory standards following an exemption from the interim Commissioner of the Virginia Department of Behavioral Health and Developmental Services (DBHDS).
Mr. Riddick replied that such an exemption could not be valid because of his lack of aggression, hinderance of access to services, and the absence of a time limitation, each required elements for an exemption per 12 Va. Admin. Code § 35-115-10(D) (2017). Moreover, the exemption allowed hospital staff to restrain Mr. Riddick based only on hypothetical concern for future aggression. The following day, Mr. Riddick was released from restraints and transferred to a seclusion wing of the hospital, where he allegedly remained for 577 days without physical contact.
During seclusion, Mr. Riddick claimed denial of access to outdoor recreation for one year, denial of attendance to religious services, and denial of access to treatment groups. While in seclusion, Mr. Riddick, as a pro se plaintiff, nevertheless sued the hospital director, interim Commissioner of DBHDS, and other state officials under 42 U.S.C. § 1983 (1996), alleging their actions violated the Fourteenth Amendment right to freedom from unreasonable restraint.
The U.S. District Court for the Eastern District of Virginia first dismissed Mr. Riddick’s suit without prejudice, finding that he had failed to state a claim as he had not identified specific professional standards governing the use of restraints and seclusion as required for Youngberg-style claims (referring to Youngberg v. Romeo, 457 U.S. 307 (1982)). The court further found that, even if a violation had occurred, Mr. Riddick had not sufficiently alleged the interim Commissioner of DBHDS’s personal participation in, and personal liability for, such acts. Finally, the court denied Mr. Riddick’s requests for appointed counsel, as the concerns raised were not complex enough and based on his apparent ability to represent himself. Mr. Riddick’s first appeal to the Fourth Circuit was ultimately denied because his claim was dismissed without prejudice, raising the question of the order's finality.
In his second suit, Mr. Riddick amended his complaint to the U.S. District Court for the Eastern District of Virginia by identifying the relevant Virginia administrative code that limits restraints or seclusion to no more than four hours. His second suit was dismissed with prejudice after a finding that, because state regulations allowed exemptions from the administrative code’s limits, Mr. Riddick had again failed to state a professional standard. Similarly, the district court found he failed to establish the former interim Commissioner’s personal involvement.
Mr. Riddick appealed once more to the Fourth Circuit, which reversed and remanded the district court’s dismissal of the amended complaint. Beyond this, the Fourth Circuit recommended appointment of counsel to assist Mr. Riddick, anticipating complex litigation and the potential involvement of expert witness testimony related to professional standards of practice.
Ruling and Reasoning
The U.S. Court of Appeals for the Fourth Circuit reversed the district court’s dismissal of Mr. Riddick’s second appeal, detailing the analytic framework for claims of Fourteenth Amendment violations by civilly committed patients. First, the court referenced Youngberg in discussing the “presumptively valid” nature of professional decisions in civil commitment treatment settings (Riddick, p 645). Such presumptions can be overcome by showing substantial departure from accepted professional judgment, providing greater protections for civil committees than prisoners. Although prisoners’ Eighth Amendment claims against conditions of confinement require “deliberate indifference” (Estelle v. Gamble, 429 U.S. 97 (1976)) and subjective knowledge (Farmer v. Brennan, 511 U.S. 825 (1994)), involuntarily hospitalized patients bear a lesser burden to establish culpability by hospital officials.
The next consideration was whether Mr. Riddick’s initial pleading failed because of lack of details about professional standards he claimed were violated. Disagreeing with the lower court, the Fourth Circuit found that plaintiffs need only plead sufficient facts “from which it may be reasonably inferred that such treatment fell substantially outside the professional standard of care and the bounds of professional judgment” (Riddick, p 646). Reasoning that identification of appropriate professional standards often requires expert testimony and evidence beyond a plaintiff’s grasp prior to discovery, the court found that initial claims against confinement conditions may proceed when a “substantial departure from professional norms can be inferred from those conditions” (Riddick, p 647).
The Fourth Circuit found several facially plausible indicators of substantial departure from “acceptable professional practice,” most notably Mr. Riddick’s allegation of being “held in restraints for 84 times longer than recommended, and in seclusion for 3,462 times longer” than the four hours allowed by 12 Va. Admin. Code § 35-115-110(C) (2022) or the patient’s claimed “577 days in isolation,” authorized “based only on hypothesized future aggression” (Riddick, p 648, emphasis in original).
Regarding whether the interim Commissioner’s written exemption from state regulations on the use of restraint or seclusion established the required nexus for § 1983 liability, Circuit Judge Harris opined, “while personal involvement is required, it need not be hands-on,” upending the district court’s reasoning (Riddick, p 649).
Ultimately, the Fourth Circuit found error in the pleading-stage dismissal of Mr. Riddick’s claims, given their “sufficiently plausible” nature to reasonably infer a Fourteenth Amendment violation following Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007) and Ashcroft v. Iqbal, 556 U.S. 662 (2009).
While recognizing the discretion of district courts to appoint counsel for indigent plaintiffs in civil cases, the Fourth Circuit anticipated expert testimony and trial complexity and, in the context of Mr. Riddick’s severe mental illness, recommended appointment of counsel to represent him during further litigation.
Discussion
Riddick provides a procedural model for evaluating institutional practices under the professional judgment standard, particularly when facilities seek administrative exemptions to regulatory precautions. The holding thereby significantly advances jurisprudence related to institutional care standards and exemptions from state regulation bearing on Fourteenth Amendment claims by civilly committed individuals. Several concepts emerge from the court’s analysis pertaining to forensic psychiatric roles in assisting institutional health care policy development and consultation in malpractice litigation.
Regulatory exemptions must conform to regulatory requirements. Governmental and hospital officials should also consider whether exemptions and readily anticipated actions will provide a facially plausible basis for a court with “judicial experience and common sense” to infer a substantial departure from professional judgment standards (citing Ashcroft, p 679).
Civilly committed individuals have a right to adequate treatment (Wyatt v. Stickney, 344 F. Supp. 387 (M.D. Ala. 1972)). Prolonged periods of restraint and seclusion, as described in Riddick, hinder this, particularly as Mr. Riddick was allegedly prevented from participating in therapeutic opportunities. Other fundamental rights, including safe conditions of confinement and freedom from unreasonable bodily restraint as explicated in Youngberg, were essential to the pleading stage analysis of Mr. Riddick’s complaints. Although these rights are not unlimited, Riddick emphasizes that blanket administrative authorization cannot substitute for individualized clinical judgment and documentation of the individual patient’s clinical conditions.
For consultants to psychological damage claims, Riddick revisits the Supreme Court’s “facial plausibility” standard for initial civil pleadings. Although this standard may allow fact-rich initial filings to survive early motions to dismiss, parties should anticipate later expert testimony to define acceptable professional standards.
- © 2025 American Academy of Psychiatry and the Law
