Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca4-18-07062/USCOURTS-ca4-18-07062-0/pdf.json

Nature of Suit Code: 540
Nature of Suit: Prisoner Petitions - Mandamus and Other
Cause of Action: 

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UNPUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

No. 18-1952

BRIAN D. FARABEE,

 Plaintiff - Appellee,

v.

DR. SRIDHAR YARATHA, Psychiatrist / M.D.; REBECCA A. VAUTER, Psy.D., 

Director / CEO,

Defendants – Appellants,

and 

VICKI MONTGOMERY, CSH Director / CEO; JIM BELL, CSH Forensic unit 

director; JOHN L. PEZZOLI, Commissioner of the Dep’t of Behavioral Health & 

Developmental Services (DBHDS); RONALD O. FORBES, Director of Medical 

Dep’t at CSH; CYNTHIA MAGHAKIAN, M.D. / Psychiatrist, at CSH; DWIGHT 

RICHARD DANSBY, Attorney of Plaintiff; ANGELA N. TORRES, Licensed 

Clinical Psychologist (LCP); NITAYA BARNETTE, Licensed Practical Nurse; 

MARKITA WOLF, Clinical Psychologist,

Defendants.

No. 18-7062

BRIAN D. FARABEE,

 Plaintiff - Appellant,

v.

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DR. YARATHA, Psychiatrist / M.D.; REBECCA A. VAUTER, Psy.D., Director / 

CEO; CYNTHIA MAGHAKIAN, M.D. / Psychiatrist, at CSH; NITAYA 

BARNETTE, Licensed Practical Nurse,

Defendants – Appellees,

and 

VICKI MONTGOMERY, CSH Director / CEO; J. BELL, CSH Forensic unit 

director; JOHN L. PEZZOLI, Commissioner of the Dep’t of Behavioral Health & 

Developmental Services (DBHDS); RONALD O. FORBES, Director of Medical 

Dep’t at CSH; DWIGHT RICHARD DANSBY, Attorney of Plaintiff; ANGELA N. 

TORRES, Licensed Clinical Psychologist (LCP); MARKITA WOLF, Clinical 

Psychologist,

Defendants.

Appeals from the United States District Court for the Eastern District of Virginia, at 

Norfolk. Henry Coke Morgan, Jr., Senior District Judge. (2:14-cv-00118-HCM-DEM)

Argued: October 30, 2019 Decided: February 6, 2020

Before DIAZ, HARRIS, and RUSHING, Circuit Judges.

Affirmed in part, reversed in part, vacated in part, and remanded by unpublished opinion. 

Judge Diaz wrote the opinion, in which Judge Harris and Judge Rushing joined.

ARGUED: Lynn Jones Blain, HARMAN, CLAYTOR, CORRIGAN & WELLMAN, 

Richmond, Virginia, for Appellants/Cross-Appellees. Jeremiah A. Denton III, 

JEREMIAH A. DENTON III, P.C., Virginia Beach, Virginia, for Appellee/CrossAppellant. ON BRIEF: Leslie A. Winneberger, George A. Somerville, HARMAN, 

CLAYTOR, CORRIGAN & WELLMAN, Richmond, Virginia, for Appellants/CrossAppellees. 

Unpublished opinions are not binding precedent in this circuit.

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DIAZ, Circuit Judge:

Brian Farabee, a former patient at Central State Hospital, brought this 42 U.S.C. 

§ 1983 suit against several hospital employees. He alleged that his due process rights were 

violated because he was denied mental health treatment that he needed, forcibly medicated, 

and unreasonably restrained, and because hospital staff encouraged another patient to 

attack him. Farabee and two of the defendants—Drs. Sridhar Yaratha and Rebecca 

Vauter—now appeal from the district court’s decision after a bench trial. Yaratha 

challenges the court’s rulings against him on two claims. Vauter appeals from an

injunction entered against her. And Farabee contends that his forced-medication claim was 

improperly denied.

For the following reasons, we reverse the district court’s judgment as to Farabee’s 

claim that he was denied necessary treatment and remand for entry of judgment in favor of

Yaratha. We also vacate the injunction entered against Vauter. We otherwise affirm the 

district court’s judgment. 

I.

A.

Farabee has a long history of mental illness.1 Since he was thirteen years old, he 

has been almost continually confined in hospitals or correctional facilities. When he was

 1 The district court detailed this history in its opinion following the bench trial. See 

J.A. 1190–1220. We accept the court’s factual findings except where clearly erroneous. 

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twenty, he was charged in Virginia state court with arson and destruction of property after 

a suicide attempt. To assess his mental state, the court referred him for an evaluation by 

Dr. Kenneth McWilliams, a clinical psychologist.

McWilliams diagnosed Farabee with borderline personality disorder and noted that 

other doctors had made the same diagnosis.2

 McWilliams found that “Farabee may well 

meet [the] legal criteria for an [insanity] defense.” J.A. 1344. He also advised that Farabee 

required “much more intensive and sophisticated therapy for childhood abuse/neglect 

issues than he [was] currently receiving” and that he was “unlikely to find such therapy 

within a state hospital.” Id. In McWilliams’s view, hospitalizing Farabee without giving 

him the therapy he needed “may well result in a life sentence to a psychiatric hospital” 

because “long-term placement in institutional settings virtually never prove[s] useful for 

treatment of borderline personality disorder.” Id. 

Due in part to McWilliams’s report, Farabee was found not guilty by reason of 

insanity and was institutionalized at Central State Hospital in Virginia. He was later found 

guilty of two counts of malicious wounding after assaulting a peer and was incarcerated 

for twelve years. Upon completing his sentence, he was again committed to Central State 

 

See Fed R. Civ. P. 52(a)(6); Anderson v. City of Bessemer City, N.C., 470 U.S. 564, 573–

76 (1985). 

2 According to Dr. McWilliams, “[b]orderline personality disorder is characterized 

by such things as recurrent episodes of intense anger and sadness, strong fears of 

abandonment, a frequent need to press relationships to see if rejection will follow, impaired 

self-esteem, poor frustration tolerance, impulsiveness in areas such as drug use and sexual 

behavior, recurrent suicidal thoughts and self-mutilation.” J.A. 1341.

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Hospital. Farabee’s treatment there between August 2012 and September 2015 is the 

subject of this case. 

B.

Farabee filed this suit in March 2014 against Yaratha, Vauter, and six other hospital 

employees.3

 Yaratha, a psychiatrist at the hospital during the relevant period, was 

Farabee’s principal treatment team leader, meaning he was usually in charge of making 

treatment decisions. Vauter is a clinical psychologist and the hospital’s director. 

In his final amended complaint, Farabee raised four due process claims. Count One

charged all defendants with denying Farabee necessary medical treatment: specifically, 

dialectical behavior therapy (“DBT”), a treatment for borderline personality disorder that 

involves intense one-on-one discussion of past traumas and is administered by 

psychologists. According to Farabee, even though McWilliams and two other doctors had

suggested DBT and Farabee had asked for it repeatedly, Yaratha and his co-defendants

never allowed it. Count Two alleged that Yaratha, Vauter, and another doctor forcibly 

gave Farabee psychotropic drugs (i.e., drugs that affect thoughts, emotions, and behavior)

on several occasions absent any medical emergency. Count Three charged that Barnette 

caused Farabee to be placed in four-point restraints by falsely reporting that Farabee had 

 3 The other six defendants were Nataya Barnette, a nurse; Dr. Cynthia Maghakian, 

another psychiatrist who sometimes filled in for Yaratha and was briefly Farabee’s team 

leader while he was assigned to another ward; Dr. Ronald Forbes, a psychiatrist and 

Medical Director at the hospital; Dr. Markita Wolf, a clinical psychologist; Vicki 

Montgomery, the hospital’s CEO; and Jim Bell, a forensic unit director at the hospital. The 

latter two were omitted from Farabee’s final amended complaint. 

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kicked her.4

 Count Four alleged that Yaratha, Vauter, and two others “allow[ed] and 

affirmatively induc[ed]” another patient, Justin Evans, to assault Farabee repeatedly as 

retaliation for the many administrative complaints Farabee had filed in his time at the 

hospital. J.A. 80.

A six-day bench trial ensued. As to Count One, it was undisputed that Farabee 

asked for but never received DBT. Farabee called as witnesses McWilliams5 and two 

doctors who evaluated Farabee around August 2012: Angela Torres, a clinical psychologist 

at Central State Hospital, and Cleve Ewell, a forensic psychiatrist at another hospital. Each 

of the three testified that they had written post-evaluation reports suggesting that Farabee

be given DBT. 

On the witness stand, McWilliams insisted that DBT was the right treatment for 

Farabee, while Torres and Ewell framed DBT as merely one of several recommendations

they had made. McWilliams also opined that denying a patient treatment due to his bad 

behavior is “kind of [at] cross-purposes” because the purpose of treatment is to help 

patients stop behaving badly, although he said that he couldn’t “fully disagree with why 

[Yaratha’s team denied Farabee DBT] because [he didn’t] fully understand why they did 

it.” J.A. 507. And Torres and Ewell acknowledged that they spent limited time with 

Farabee and that doctors who provide day-to-day treatment—like Yaratha’s team—are best 

 4 Count Three isn’t at issue in this appeal. Farabee initially named Yaratha as a codefendant on Count Three but later removed him. See J.A. 540.

5 McWilliams testified as both a lay witness (about his 1998 evaluation of Farabee) 

and as an expert witness (about whether DBT is appropriate for a patient like Farabee). 

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equipped to make treatment decisions for any given patient. None of these doctors opined 

that the decision not to give Farabee DBT lacked a basis in accepted professional opinion. 

Yaratha and Maghakian testified that while they had read the other doctors’ reports, 

they didn’t offer Farabee DBT because they believed its risks to Farabee outweighed its 

benefits. Yaratha was specifically concerned about Farabee’s ability to “address past 

stressors,” which is “an integral part of DBT,” given that he “couldn’t adequately address 

current stressors.”6

 J.A. 917. Moreover, Yaratha said, Farabee hadn’t shown that he could 

cooperate with therapists in one-on-one sessions. Hospital reports corroborate that Farabee 

frequently refused to attend one-on-one sessions with psychologists and, when he did 

attend, acted with hostility toward them. See J.A. 1245, 1256–60, 1374. Reports also show 

that Yaratha’s team continued to meet and discuss treatment options with Farabee. See 

J.A. 1256–60.

Maghakian agreed that Farabee wasn’t sufficiently “healthy and motivated,” J.A. 

824, to participate in DBT and that the treatment would have made him more paranoid and 

anxious. She explained that the hospital offered Farabee various other treatments, 

 6 The clinicians who testified at trial disagree about whether Farabee’s primary 

diagnosis is Borderline Personality Disorder or Antisocial Personality Disorder (which is 

manifested by deceit for self-gain). McWilliams believes the former is primary and that 

Farabee may not even have the latter; Torres and Ewell believe Farabee has both, but the 

former is primary; and Yaratha and Maghakian opined that Farabee has both, but the latter 

is primary. According to Maghakian, DBT doesn’t treat antisocial personality disorder. 

Yaratha maintains that this difference of opinion accounts for the disagreement about 

DBT’s appropriateness for Farabee. 

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including medication, group therapy, and occasional one-on-one meetings with

psychologists, but Farabee refused them all. Additionally, Vauter testified that the hospital 

didn’t employ a psychologist who could perform DBT, but if Farabee’s treatment team (led 

by Yaratha) had requested it, she is “certain there would [have been] a way” for the hospital 

to obtain such a psychologist. J.A. 562. And an expert witness, a psychiatrist named Dr. 

Robert Pitsenbarger, testified that DBT could traumatize someone with Farabee’s 

personality traits and that deciding whether to offer DBT to a patient with Borderline 

Personality Disorder involves risk-benefit analysis that day-to-day treatment teams are best 

positioned to perform.

As to Count Two, the parties stipulated that Farabee was forcibly medicated eight 

times while under Yaratha’s supervision in 2013 and 2014. But they disputed whether 

medical emergencies justified these forced medications. According to Yaratha, Farabee 

was either threatening to harm others or himself or smearing feces on the walls on the dates 

in question, and on other days, Farabee asked to be medicated because he felt agitated.

Yaratha also introduced contemporaneous notes indicating that he had prescribed Farabee 

psychotropic drugs on an as-needed basis to deal with his agitation. Farabee’s only 

evidence on this point was his own testimony denying that he had made threats or smeared 

feces.

As to Count Four, it was undisputed that Evans attacked Farabee on three occasions 

in the summer of 2015. The first attack was on July 23. Evans assaulted and bit Farabee, 

and Farabee reported the incident to his treatment team. The next day, Evans was 

transferred to a different ward by another doctor, but on July 28, Yaratha ordered that Evans 

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be transferred back to Farabee’s ward, ostensibly because Evans had engaged in self-harm 

and expressed discomfort in the other ward. On July 30, Evans attacked Farabee again, 

cutting his head with a sharp object before hospital staff quickly intervened. Despite 

Farabee’s request that he and Evans be separated, they were kept in the same hall of the 

same ward with just one room between them, even though the ward could accommodate 

over twenty patients. On August 13, Evans charged into Farabee’s room and attacked him 

while he slept. 

Evans testified that Yaratha and Maghakian had encouraged him to attack Farabee. 

According to Evans, Yaratha gave him subtle reminders that Evans depended on him for 

food and clothes, and staff members gave Evans food, drugs, and alcohol after his attacks, 

saying things like “[k]eep up the good work” and “Yaratha sends his regards.” J.A. 1996. 

Farabee also testified that he overheard Yaratha and Wolf (a psychologist) conspiring to 

retaliate for his many complaints and that Evans had told him that Yaratha and Wolf had 

encouraged the attacks. 

Yaratha denied these accusations. He explained that Farabee and Evans were kept 

in the same ward after Evans’s first two attacks because it had the least patients of any 

ward, which enabled staffers to monitor them closely and decreased the likelihood that 

Farabee or Evans would antagonize other patients (as they had both done in the past). 

Indeed, two staffers were assigned to be near Farabee at all times. They were seated outside

Farabee’s room when Evans entered to attack Farabee on August 13, and they separated 

the two almost immediately. Yaratha also introduced a list (dated July 31, 2015) of ten 

ways the staff had planned to manage Farabee and Evans. 

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The district court entered judgment for Farabee (and against Yaratha) on Counts 

One and Four. It rejected Farabee’s Count Two claim that he was forcibly medicated in 

violation of his rights. The court also ruled for Vauter on all counts but nevertheless 

enjoined her “to make available to [Farabee] DBT treatment, if and when [Farabee] is 

committed to an institution that is under her control.”7 JA 1216, 1222. As to Count One, 

the court awarded Farabee $100,000 in compensatory damages. As to Count Four, the 

court awarded $200,000 in compensatory and $50,000 in punitive damages. Yaratha, 

Vauter, and Farabee now appeal.

II.

The issues before us are (1) whether the district court clearly erred in ruling for 

Farabee on Counts One and Four; (2) whether the court erred as a matter of law in enjoining 

Vauter without finding that she violated Farabee’s rights; and (3) whether, as to Count 

Two, the court improperly placed upon Farabee the burden of proving that no medical 

emergency justified the forced medications. We consider each issue in turn, reviewing 

factual issues for clear error and legal issues de novo. See Equinor USA Onshore 

Properties Inc. v. Pine Res., LLC, 917 F.3d 807, 813 (4th Cir. 2019).

 7 The district court also made several rulings that were not appealed. The court 

dismissed Forbes as a defendant at the summary judgment stage; entered judgment for 

Wolf at the end of Farabee’s case and for Maghakian after the trial; ruled in favor of all 

defendants except Yaratha on Counts One and Four; and on Count Three, found that 

Barnette had falsely reported that Farabee had kicked her, thereby causing Farabee to be 

put in four-point restraints.

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A.

We first consider Yaratha’s argument that the district court clearly erred on Count 

One by finding that his denial of DBT wasn’t based on a professional judgment and thereby

violated Farabee’s due process rights. We agree with Yaratha. 

Involuntarily confined residents at state mental institutions have due process 

interests in conditions of reasonable care. Youngberg v. Romeo, 457 U.S. 307, 324 (1982). 

In evaluating these due process claims, courts apply what is known as the Youngberg

standard. Under this standard, liability “may be imposed only when the 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.” Id. at 323. “It is not appropriate for the courts to specify which of 

several professionally acceptable choices should have been made.” Patten v. Nichols, 274 

F.3d 829, 836 (4th Cir. 2001) (quoting Youngberg, 457 U.S. at 321). Courts must simply 

ensure that the “choice in question was not a sham or otherwise illegitimate.” Id. at 845 

(emphasis omitted) (quoting Romeo v. Youngberg, 644 F.2d 147, 178 (3d Cir. 1980)). This 

standard is more deferential to doctors than negligence or medical malpractice standards. 

Id. Plaintiffs bear the burden of proof by a preponderance of the evidence. See id. at 843–

46.

Here, the district court concluded that Yaratha’s decision not to provide Farabee 

with DBT was “not within the realm of professional judgment.” J.A. 1211. It based this 

ruling on several factual findings. We find it useful to disaggregate these findings. 

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First, the court found—relying on the testimonies of McWilliams, Torres, and 

Ewell—that Farabee’s primary diagnosis was Bipolar Personality Disorder, that DBT is an 

“appropriate treatment” for him, that group therapy and antipsychotic drugs are

inappropriate, and that Yaratha erroneously rejected the other doctors’ suggestion without 

consulting a clinical psychologist. J.A. 1198. The court was unpersuaded by Yaratha’s

and Maghakian’s testimonies about DBT’s risks to Farabee. This was because, in the 

court’s view, psychologists like McWilliams and Torres “generally have more training in 

and experience with DBT than psychiatrists” like Yaratha and Maghakian, “and the 

testimony of psychologists should outweigh the testimony of psychiatrists as to DBT and 

the treatment of [Bipolar Personality Disorder].” Id. Because there was conflicting

evidence on these points, we conclude that the court’s findings weren’t clear error. 

Second, the court found that Yaratha “made the decision not to offer [DBT] based 

upon [Farabee]’s exceedingly bad conduct, which is a classic symptom of his [disorder].” 

Id. As the court further explained:

Instead of understanding that such behavior is a symptom of Plaintiff’s 

[Bipolar Personality Disorder] and that it is the responsibility of the treatment 

provider to work through it, Dr. Yaratha used such behavior as grounds to 

deny Plaintiff the DBT treatment he needed.

Id.

Insofar as the court meant to imply—as Farabee suggests in his brief—that Yaratha 

withheld DBT because he wanted to avoid dealing with Farabee, we conclude that this 

finding would be clear error. Yaratha’s team met with Farabee many times and tried 

various treatments for him, including medication and individual and group therapies. J.A. 

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824–25, 837–39, 929, 938–40, 958, 959, 961, 967–68, 1026, 1031, 1256–60. There’s no 

indication that offering DBT would have burdened Yaratha in particular. He wouldn’t 

have been the one administering DBT; a psychologist would have done it. And Vauter 

testified that the hospital could have retained a psychologist who could perform DBT had 

Yaratha’s team asked for it. Accordingly, we have no reason to think that the cost or hassle 

of enlisting a psychologist affected Yaratha’s decision. In fact, if Yaratha disliked dealing 

with Farabee’s bad behavior, and if he believed (like the district court) that DBT would 

have mitigated that behavior, it seems logical that he would have ordered the treatment. 

The district court also suggested that Yaratha could have had Farabee transferred to 

another hospital to receive DBT. See J.A. 1210. That would have accomplished Yaratha’s 

supposed goal of avoiding Farabee. The fact that Yaratha didn’t have Farabee transferred 

further corroborates that his withholding of DBT wasn’t motivated by an unwillingness to 

deal with Farabee. In sum, Farabee’s theory for why Yaratha withheld DBT doesn’t add 

up.

On the other hand, if the district court believed that Farabee’s conduct affected 

Yaratha’s medical judgment—which, given the court’s use of “understanding,” we think 

is the best reading of the court’s order—that is consistent with Yaratha’s explanation for 

his decision. Yaratha said that Farabee was unable to deal with current stressors and 

couldn’t cooperate with therapists in one-on-one sessions. The court disagreed with this 

analysis, but didn’t find it to be a pretext for a decision made in bad faith.

It is of course possible that a defendant like Yaratha will offer a medical pretext for 

a decision made in bad faith. In fact, Count Four of Farabee’s complaint is premised on an 

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allegation that Yaratha bore animus toward Farabee and thus induced another patient to 

assault him. The district court ruled for Farabee on Count Four in part because it found 

Yaratha’s testimony “inconsistent and conflicting in many important respects.” J.A. 1207. 

But the court made no such finding as to Yaratha’s testimony about DBT, and our review 

doesn’t lead us to that conclusion either. Further, Count One is based solely on the 

hospital’s denial of DBT; it doesn’t include the allegations underlying Count Four. See 

J.A. 1194 n.1. And the district court found Yaratha’s testimony credible as to Count Two, 

see J.A. 1201 (referring to his testimony as “credible evidence”), indicating that its Count 

Four credibility finding didn’t bleed into the other counts. We thus decline to ascribe the 

district court’s Count Four credibility finding to Count One. 

In short, the district court’s findings don’t support a ruling that Yaratha breached 

the Youngberg standard. There is a middle ground between a good decision and a “sham”

decision. See Patten, 274 F.3d at 845. We are left with the definite and firm conviction 

that, at worst, Yaratha’s decision fell within that middle ground. 

The record supports this view. Assume that the district court was correct in giving 

McWilliams’s and Torres’s opinions great weight. We’ve reviewed the transcript of their 

testimonies. Nothing they or Ewell said suggests that the choice not to offer Farabee DBT 

was “arbitrary and unprofessional” or worse than “ordinary medical negligence.” See id.

at 845–46 (finding that the defendants’ conduct was no more than ordinary medical 

negligence and did not so depart from professional standards as to be arbitrary and 

unprofessional). McWilliams was the only one who criticized Yaratha’s decision. He 

opined that medication wouldn’t cure Farabee’s problem and that persons with Borderline 

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Personality Disorder need individual therapy before they can muster the strength to

undergo group therapy. 

But a professional disagreement doesn’t support a due process claim. While

witnesses need not use legal terms like “professional judgment,” there must be something 

in the record suggesting that a decision not to offer a particular treatment was “completely 

out of professional bounds.” Id. at 845 (quoting United States v. Charters, 863 F.2d 302, 

313 (4th Cir. 1988)). Absent such evidence, a choice not to offer a certain treatment—like 

a choice not to order an X-ray—“is a classic example of a matter for medical judgment.” 

Estelle v. Gamble, 429 U.S. 97, 107 (1976). At worst, it is medical malpractice. Id.

We don’t overturn a district court’s factual findings lightly. See Anderson, 470 U.S. 

at 573–575. But this case is unique because of the deference required by Youngberg. 

Absent a finding by the district court that Yaratha lied on the witness stand about why he 

withheld DBT, there’s simply no evidence that his decision—while perhaps misguided—

was a sham. Indeed, the district court’s own summary of the evidence doesn’t support its 

conclusion.8

 See Butts v. United States, 930 F.3d 234, 241 (4th Cir. 2019) (finding clear 

error because the district court’s conclusion after a bench trial wasn’t supported by 

substantial evidence in the record), petition for cert. filed, No. 19-740 (U.S. Dec. 6, 2019). 

Accordingly, we find that the district court clearly erred in finding for Farabee on 

Count One. 

 8 Because we reverse the district court’s Count One ruling on other grounds, we 

decline to consider Yaratha’s argument that McWilliams’s expert testimony was 

improperly admitted.

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B.

Next, we consider Yaratha’s contention that the district court clearly erred on Count 

Four by finding that he encouraged Evans to attack Farabee and thereby violated Farabee’s 

due process right to safe conditions. Yaratha argues that Farabee’s and Evans’s testimonies

were implausible, rife with inconsistencies, and partially contradicted by documentary 

evidence. While Yaratha’s argument gives us some pause, we are constrained to affirm 

the district court on Count Four.

Count Four is also governed by the Youngberg standard. In this context, that 

standard is akin to recklessness or gross negligence. See Patten, 274 F.3d at 843 (collecting 

cases). A conscious decision to allow or encourage one patient to attack another plainly 

violates that standard. 

The district court found that Count Four boiled down to a credibility contest. In the 

court’s view, Evans and Farabee were credible because their testimonies were similar in 

some respects and because some of it was corroborated by circumstantial evidence.

9

 The 

court found that Yaratha wasn’t credible because his testimony was “inconsistent and 

conflicting in many important respects.” J.A. 1207.

For instance, Farabee’s ward closed shortly after Evans’s attacks, which the court 

thought conflicted with Yaratha’s assertion that neither Evans nor Farabee could be moved 

 9 For example, Evans was found with drugs shortly after he attacked Farabee in 

August 2015, and video from the hospital showed that Evans and Farabee were only one 

room apart from each other on August 13, despite their history. The court was also 

impressed that Evans was willing to testify on Farabee’s behalf despite their long history 

of animosity toward each other. 

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to another ward. Also, staff in Farabee’s ward didn’t appear to have cooperated with an 

investigation into how Evans obtained drugs, and Yaratha didn’t call any of that ward’s 

staff to testify. Additionally, the court highlighted that, in October 2014, Yaratha had 

included Barnette’s false claim that Farabee kicked her in his annual report regarding 

whether Farabee should remain confined in a mental hospital, even though Yaratha knew 

Barnette’s claim was false. At trial, Yaratha painted this as an oversight. 

Ultimately, the court found that:

After failing to prevent Evans from attacking Plaintiff and then ordering 

Evans back to Ward 8 in close proximity to Plaintiff, Dr. Yaratha 

intentionally provided Evans with greater access to Plaintiff. He then 

suggested to Evans that he might be rewarded rather than punished for 

attacking Plaintiff, which clearly represents a complete departure from 

professional judgment.

J.A. 1214.

While we review all factual findings for clear error, we give particular deference to 

findings based on witness-credibility determinations. See Anderson, 470 U.S. at 575. In 

these situations, we only find clear error where documentary evidence contradicts a 

witness’s story or where the story itself is internally inconsistent or facially implausible, 

leaving only one permissible view of the evidence. Id.; see also United States v. Wooden, 

693 F.3d 440, 454–56 (4th Cir. 2012) (finding clear error because the testimony on which 

the district court relied contained various inconsistencies). 

As Yaratha details in his brief, there are many issues with Farabee’s and Evans’s 

testimonies. For instance, their testimonies differed with respect to many important details, 

including which staffers gave Evans drugs and alcohol and whether Yaratha explicitly 

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asked Evans to hurt Farabee. Additionally, Farabee repeatedly denied well-documented 

facts that didn’t support his case.10 And Evans told an investigator in September 2015 that 

staffers had not given him alcohol, drugs, or any other reward for attacking Farabee—

contrary to his testimony in this case. Evans’s testimony about how Yaratha encouraged 

his attacks is also suspiciously vague. And, in holding Evans’s return to Farabee’s ward 

against Yaratha, the district court appeared to discount Evans’s testimony (1) that Evans 

was only returned to that ward because he made clear that he wasn’t comfortable anywhere 

else and (2) that Evans and Farabee were constantly monitored. 

That Farabee and Evans would lie on the stand is to be expected, Yaratha posits, 

because they each have been diagnosed with Antisocial Personality Disorder, whose

symptoms include lying for personal profit or pleasure. But while it would have been

appropriate for the district court to exercise some caution when considering the patients’ 

testimonies given their diagnoses (as the court did with respect to Count Two, see J.A. 

1201), it would have been error to discredit their testimonies on that basis alone. 

Despite the issues Yaratha identifies, we cannot say that the district court’s 

conclusion is unsupported by the record. Yaratha did have a motive to retaliate against 

Farabee for his many complaints. The decision to put Evans in a room so close to Farabee 

is itself suspicious. Most of the problems with Farabee and Evans’s testimonies—except 

for Evans’s September 2015 statement to the investigator—are collateral to the allegations

 10 Specifically, Farabee disputed hospital reports that he had (among other things) 

failed to attend group therapy sessions, refused to meet with certain doctors, punched 

another patient and a staffer, intentionally clogged toilets, and defecated on the floor.

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in Count Four. And Yaratha had some credibility issues himself, as the district court 

observed. We don’t think the evidence points overwhelmingly in one direction. Were we 

the trier of fact, perhaps the result might have been different. But we are not “left with the 

definite and firm conviction” that the district court erred. See Anderson, 470 U.S. at 573. 

Thus, we are constrained to affirm on Count Four.11

C.

We turn now to consider whether the district court erred by enjoining Vauter to 

make DBT available to Farabee.

12 Ordinarily, we review injunctive orders for abuse of 

discretion. See Emergency One, Inc. v. Am. Fire Eagle Engine Co., 332 F.3d 264, 267 (4th 

Cir. 2003). But because Vauter asserts that the injunction is based on legal errors, and any 

legal error is an abuse of discretion, we effectively review her challenge de novo. See 

Hunter v. Earthgrains Co. Bakery, 281 F.3d 144, 150 (4th Cir. 2002). 

We agree with Vauter that the injunction was improper, for three reasons. First, the 

district court didn’t find Vauter liable on any counts; i.e., the court didn’t find that she 

violated Farabee’s rights. A defendant who has not violated a plaintiff’s rights cannot be 

 11 We don’t think it incongruous to affirm on Count Four despite reversing on Count 

One. The counts involve different issues: Count Four comes down to credibility 

determinations, while Count One comes down to an evaluation of a medical decision. And 

the district court’s opinion didn’t suggest that its findings on the two counts were 

interdependent. To the contrary, the court noted that Count One didn’t incorporate the 

allegations underlying Count Four. See J.A. 1194 n.1.

12 The district court ruled for Vauter on Count One because she “relied on 

[Farabee’s] treatment team to recommend what resources were necessary for his medical 

care” and later transferred Farabee to a hospital that could offer DBT. J.A. 1211. 

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enjoined. See Bloodgood v. Garraghty, 783 F.2d 470, 476 (4th Cir. 1986) (“To slap 

injunctions on state officials who have never violated the law or shown any intention to 

violate the law would exceed the proper bounds of equitable discretion.”); see also 

Greensboro Prof’l Fire Fighters Ass’n v. City of Greensboro, 64 F.3d 962, 967 n.6 (4th 

Cir. 1995) (declining to order entry of “an injunction to prohibit ‘prospective acts of 

harassment’ . . . . [b]ecause appellants have failed to establish municipal liability . . . [and 

thus] are not entitled to any remedy against the City.”). Second, as explained above, we 

don’t think Yaratha’s denial of DBT violated Farabee’s due process rights, leaving no basis

as to any defendant for the injunction. And third, Farabee’s claim for injunctive relief 

against Vauter is moot because he’s no longer in her custody. Instead, Farabee is in the 

custody of the Virginia Department of Corrections. See Incumaa v. Ozmint, 507 F.3d 281, 

286–87 (4th Cir. 2007) (“[T]he transfer of an inmate . . . to a different unit or location 

where he is no longer subject to the challenged policy, practice, or condition moots his 

claims for injunctive and declaratory relief . . . .”). 

Accordingly, we vacate the injunction against Vauter.

D.

Finally, we consider whether the district court erred on Count Two by placing upon 

Farabee the burden of proving that no emergencies justified his forced medications. As 

this is a legal question, we review it de novo. 

Persons in state custody, including mental patients, have a due process interest in

not being forcibly given psychotropic medication. Johnson v. Silvers, 742 F.2d 823, 825 

(4th Cir. 1984) (addressing mental patients); see Washington v. Harper, 494 U.S. 210, 221–

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22 (1990) (addressing mentally ill state prisoners). A plaintiff may recover if a defendant 

acting under color of state law caused him to take psychotropic drugs against his will and 

the defendant didn’t exercise professional judgment in administering the drugs. See 

Johnson, 742 F.2d at 825; see also Farabee v. Feix, 119 F. App’x 455, 458 n.3 (4th Cir. 

2005) (unpublished) (summarizing Johnson’s holding). In other words, Count Two is 

governed by the Youngberg standard. See Johnson, 742 F.2d at 825.

The parties agree that when a treatment provider forcibly medicates a patient in 

response to an emergency—like when the patient may harm himself or others—the 

provider isn’t liable because he acted with professional judgment. They disagree as to 

whether emergencies existed in the eight instances in which Farabee was forcibly 

medicated in 2013 and 2014. The district court ruled for Yaratha, stating that “[w]hile the 

evidence is conflicting, [Farabee] has not met his burden of proof.” J.A. 1212. Farabee 

now posits that the existence of an emergency is an affirmative defense, which a defendant 

must prove. We do not agree.

We generally require the plaintiff to show that the defendant acted without 

professional judgment. See Patten, 274 F.3d at 843–846 (granting the defendant summary 

judgment because the plaintiff’s evidence didn’t show a breach of the professionaljudgment standard); Johnson, 742 F.2d at 825 (stating that the plaintiff had to show that 

the “defendant [had] required him to take anti-psychotic drugs without exercising

professional judgment”). This is in keeping with the default rule that “plaintiffs bear the 

risk of failing to prove their claims.” Schaffer ex rel. Schaffer v. Weast, 546 U.S. 49, 56 

(2005). 

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We see no reason to make an exception to that rule here. Accordingly, we affirm 

the district court’s judgment for Yaratha on Count Two. 

III.

For the reasons given, we reverse the district court’s judgment as to Count One,

remand for entry of judgment on that count for Yaratha, and vacate the injunction against 

Vauter. We otherwise affirm the district court’s judgment.

AFFIRMED IN PART, VACATED IN PART,

REVERSED IN PART, AND REMANDED

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