The opinion
[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT FILED
U.S. COURT OF APPEALS
________________________ ELEVENTH CIRCUIT
APR 05 2000
THOMAS K. KAHN
No. 99-11048 CLERK
________________________
D. C. Docket No. 98-00018-5-CV-3-DF
KYLE, K., LARRY K., Personally, et al,
Plaintiffs-Appellees,
versus
MAGGIE CHAPMAN, in her individual capacity,
LARRY FOSTON, in his individual capacity,
Defendants-Appellants.
________________________
Appeal from the United States District Court
for the Middle District of Georgia
_________________________
(April 5, 2000)
Before BLACK and WILSON, Circuit Judges, and RONEY, Senior Circuit Judge.
RONEY, Senior Circuit Judge:
This is an appeal from the denial of a Fed. R. Civ. P. Rule 12(b)(6) motion to
dismiss on qualified immunity grounds a complaint that alleged a substantive due
process denial of medical treatment claim and physical abuse claim. This section
1983 complaint was brought on behalf of Kyle K., a mentally retarded child born in
1981, by his parents, against various mental health professionals, administrators, and
direct care personnel connected with Central State Hospital (CSH), a Georgia hospital
and residential treatment facility for the mentally disabled, concerning Kyle’s
treatment. Six of those defendants, Maggie Chapman, Larry Foston, Bettye Liggins,
Elbert Johnson, Dorothy Simmons, and Annie Poole appeal the denial of their Rule
12(b)(6) motion. They are non-professionals called Health Services Technicians
(“HST”s) who provided direct care to Kyle. Defendants raise essentially two issues
on this appeal. We reverse as to one, and affirm on the other.
On the first issue, defendants argue that the duty of a state, established by
Youngberg v. Romeo, 457 U.S. 307(1982), to provide minimally adequate care,
treatment and training to Kyle, specifically in this case to protect Kyle from self-
injurious behavior, does not apply to non-professional state employees such as these
defendants. Since there was no clearly-established law that would make the
requirements of Youngberg apply to non-professional employees at the time of the
actions subject to this complaint, these defendants are entitled to qualified immunity
and the complaint against them alleging that cause of action should have been
dismissed.
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On the second issue, defendants argue that the court erred in denying qualified
immunity to these defendants “who allegedly abused the mentally retarded minor
Plaintiff, where no specific averments of fact are made against Appellants
individually, where the averments are made ‘on information and belief,’ and where
the District Court refused to require Plaintiffs to make a more definite statement.” We
affirm on the ground that, although further procedures will be necessary in order to
develop the claim against each of these individual defendants, the complaint alleges
with sufficient particularity facts establishing a causal connection between defendants’
actions and the alleged constitutional violation for purposes of overcoming
defendants’ Rule 12(b)(6) motion to dismiss the complaint on qualified immunity
grounds.
I.
Whether the amended complaint sufficiently states a claim is a matter of law we
review de novo, assuming that all the allegations are true. See Williams v. Alabama
State Univ., 102 F.3d 1179,1182(11th Cir. 1997). Qualified immunity shields
government officials performing discretionary functions from civil liability if their
conduct violates “no clearly established statutory or constitutional rights of which a
reasonable person would have known.” Harlow v. Fitzgerald, 457 U.S. 800 (1982).
Defendants are entitled to qualified immunity in a Rule 12(b)(6) motion to dismiss
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only if the complaint fails to allege facts that would show a violation of a clearly
established constitutional right. See Williams, 102 F.3d at 1182.
II.
Kyle K. was born January 6, 1981. According to the complaint, Kyle was
diagnosed at an early age with autism. In 1991, he was admitted to Central State
Hospital (CSH), a Georgia hospital and residential treatment facility for the mentally
disabled after his parents became unable to handle his frequent temper tantrums,
agitation and mood swings. From the time he was admitted to CSH, Kyle had
continuous episodes of self-abuse which included head-banging, face-slapping, body-
pinching, body-hurling, biting his hands and upper arms, scratching his face and
poking his eyes. In the summer of 1996, he was transferred to another institution.
III.
Plaintiffs’ substantive due process claims fall into two categories: the first
concerns defendants’ failure to protect Kyle from his self-abusive behavior, and the
second relates to allegations that defendants abused Kyle physically and mentally.
A.
As to the first category, plaintiffs have alleged that the defendants violated
Kyle’s substantive rights under the due process clause of the Fourteenth Amendment
set forth in Youngberg v. Romeo, 457 U.S. 307(1982), specifically, his right to
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reasonably safe conditions of confinement, freedom from unreasonable bodily
restraints, and such minimally adequate training as might be required to ensure safety
and freedom from restraint.
The allegation amounts to a failure to properly treat Kyle’s self-abusive
behavior. Clearly this type of allegation falls within the duties contemplated in
Youngberg. This duty, however, has never been held applicable to non-professional
employees. The district court rejected in a footnote the argument that this case was
distinguishable because defendants in this case were non-professionals, but it appears
that this distinction is dispositive.
In reaching this conclusion, we look first to Youngberg, the controlling case
regarding substantive due process rights of the involuntarily civilly committed patient.
In Youngberg, the mother of a mentally retarded man, who, like Kyle in this case, was
injured in part by his own violence, brought suit against the superintendent of the
institution, the Director of Resident Life, and the Director for the unit in which the
plaintiff’s son resided. All three were administrators who had varying degrees of
supervisory authority over the treatment provided to the patient.
In arriving at the proper standard for analyzing whether the state adequately has
protected the patient’s rights, the Court determined that liability hinges on the
“professional judgment” standard. “[L]iablity may be imposed only when the
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decision by the professional 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.” Youngberg, 457 U.S. at 323. The
Court in Youngberg, defined a professional decision maker as “a person competent,
whether by education, training or experience, to make the particular decision at issue.”
Youngberg, 457 U.S. at 323. What is implicit in Youngberg is that the alleged
constitutional violation is related to some aspect of the treatment decision made by a
professional decision maker.
Individuals with some role in the decision making process regarding treatment
were defendants in two Eleventh Circuit cases addressing substantive due process
claims in a similar context. In Rodgers v. Horsley, 39 F.3d 308(11th Cir. 1994), an
involuntarily committed patient who was allegedly raped brought a section 1983
action against the director of the hospital and chief administrator of the admissions
unit. Both parties were responsible for “hiring, training, and supervising the
individuals charged with monitoring patients. 39 F.3d at 310. Similarly, in Dolihite
v. Maughon, 74 F.3d 1027(11th Cir. 1996), the parents of an adolescent committed to
a state hospital who suffered severe injuries after he tried to hang himself, brought suit
against the social worker and psychologists, mental health professionals who had
direct decision making authority over the patient, and administrative personnel. It
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must be noted that Dolihite was decided in 1996, the year in which Kyle was
transferred from CSH, and therefore is not applicable in determining whether the
defendant’s alleged conduct violated clearly established law. In addition, Dolihite is
inapplicable because it only addresses the responsibilities of professional decision
makers.
Defendants in this case are not decision makers as defined in Youngberg.
Instead they are the direct care workers whose primary responsibility is carrying out
the directions of the officials who determine patient care. Plaintiffs have cited no case
in which non-professionals such as these defendants were held to have violated the
rights alleged. Whether the Younberg standards should apply to non-professionals
may be arguable, but with no clearly established law to that effect, defendants are
entitled to qualified immunity on this claim.
B.
As to the allegations of physical abuse category of plaintiff’s claims, defendants
acknowledge that a patient in a mental hospital has a substantive due process right to
a safe environment, Youngberg v. Romeo, 457 U.S. 307(1982). A claim that those
charged with the responsibility of providing daily care to such a patient inflicted
physical or mental abuse on him states the denial of a constitutional right. Defendants
contend that in this case, however, plaintiffs’ allegations of abuse in their complaint
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lacked the factual specificity required to overcome the defense of qualified immunity.
We hold that the complaint is sufficient to withstand a Rule 12(b)(6) motion. As is
required under Fed. R. Civ. P. 8 (a), the complaint contains a short and plain statement
of the facts upon which the claims against these defendants are based sufficient to
allege violation of a clearly established constitutional right.1
1
The relevant portions of the complaint state:
57.
Upon information and belief, the abusive treatment
of Kyle by the HST Defendants included, among other
things, punitively locking Kyle in closets, hitting, pushing,
withholding food, forcing cold showers, grabbing his
genitals and verbal abuse. These actions were taken in
response to Kyle’s exhibiting predicable autistic behaviors.
They were for the convenience of staff and in lieu of
treatment. These activities were know or should have been
known to supervisory [defendants]....
96.
Kyle was subject to acts of battery, personal physical
invasion, improper restraint and excessive punishment by
the HST Defendants. Such Defendants did not have the
authority or discretionary right to subject him to or inflict
abuse or to any physical restraint in non-emergencies
without the order of a physician, nor to inflict physical
punishment....
98.
Kyle was seized, held, restrained and touched by
HST Defendants beyond that permitted by his treatment
plan or by order of physician or by rules of the facility.
Such actions were non-consensual. He was touched, pulled
and grabbed, including grabbed in his genitals, without
cause, excessively, maliciously and as punishment.
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Defendants complain that the allegations are too general because they
collectively accuse all the defendants of all the acts and because the accuser, Kyle, is
mentally impaired and unable to communicate his fears or to report abuse by others.
The fact that defendants are accused collectively does not render the complaint
deficient. The complaint can be fairly read to aver that all defendants are responsible
for the alleged conduct. Defendants’ contention regarding Kyle’s inability to
communicate is a question of proof, not pleading. It is conceivable that there are other
sources of knowledge concerning the alleged misconduct.
Nor does this complaint suffer from the deficiencies discussed in GJR
Investments, Inc., v. County of Escambia, Fla., 132 F.3d 1359(11th Cir. 1998) and
Oladeinde v. City of Birmingham, 963 F.2d 1481(11th Cir. 1992), upon which
defendants’ rely for their argument that the complaint does not meet the heightened
pleading requirement applicable to section 1983 actions against individual
government officials. In both GJR and Oladeinde, the Court addressed the problem
of “shotgun pleading,” in which the complaint “presents scores of allegations
regardless of their relevance and incorporates them in their entirety into several counts
asserting discrete claims for relief, each of which contains several references to
haphazardly described constitutional ‘rights.’” GJR Investments, 132 F.3d at 1368.
No such problem exists here.
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In this case, plaintiffs have identified the defendants who were personally
involved in the care of Kyle and in the alleged acts upon which the alleged
constitutional violation is based. The complaint alleges with sufficient particularity
facts establishing a causal connection between defendants’ actions and the alleged
constitutional violation for purposes of overcoming defendants’ qualified immunity.
More specificity can be developed as the case proceeds. Of course, we voice no
opinion as to whether the defendants, or any one of them, may be able to prevail
ultimately on a motion for summary judgment.
IV.
In conclusion, defendants are entitled to qualified immunity on plaintiffs’ claim
that defendants failed to provide minimally adequate care, treatment and training in
violation of Kyle’s 14th amendment substantive due process rights as established in
Youngberg v. Romeo, 457 U.S. 307(1982). There is no clearly-established law that
would make the requirements of Youngberg apply to non-professional employees at
the time of the actions subject to this complaint. The complaint against them alleging
that cause of action should have been dismissed.
The complaint adequately states a cause of action to withstand a 12(b)(6)
motion, however, regarding the allegations that defendants abused Kyle in violation
of his substantive due process rights. We therefore affirm the district court’s decision
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that these defendants are not entitled to qualified immunity on these claims on a
motion to dismiss.
AFFIRMED IN PART, REVERSED IN PART AND REMANDED FOR
FURTHER PROCEEDINGS CONSISTENT WITH THIS OPINION.
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