Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caDC-13-07090/USCOURTS-caDC-13-07090-0/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 

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United States Court of Appeals 

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued February 24, 2015 Decided August 18, 2015 

No. 13-7082 

DAVID HARVEY, INDIVIDUALLY AND AS PERSONAL 

REPRESENTATIVE OF THE ESTATE OF CURTIS SUGGS, 

APPELLEE

v. 

DISTRICT OF COLUMBIA, 

APPELLANT

Consolidated with 13-7090, 13-7101, 13-7111 

Appeals from the United States District Court 

for the District of Columbia 

(No. 1:02-cv-02476) 

 Carl J. Schifferle, Assistant Attorney General, Office of 

the Attorney General for the District of Columbia, argued the 

cause for appellant. With him on the briefs were Irvin B. 

Nathan, Attorney General at the time the brief was filed, Todd 

S. Kim, Solicitor General, and Loren L. Alikhan, Deputy 

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Solicitor General. Mary L. Wilson, Assistant Attorney 

General, entered an appearance. 

 Marc Fielder argued the cause for appellee. With him on 

the brief was Harvey S. Williams. 

 Before: GRIFFITH and SRINIVASAN, Circuit Judges, and 

SENTELLE, Senior Circuit Judge. 

 Opinion for the Court filed by Senior Circuit Judge

SENTELLE. 

 SENTELLE, Senior Circuit Judge: Curtis Suggs died 

while residing in a group home operated by District of 

Columbia contractor, Symbral Foundation for Community 

Services, Inc. David Harvey, as personal representative of the 

estate of Suggs, brought suit against the District, Symbral, and 

Symbral’s owners, Leon and Yvonne Mohammed, asserting 

violations under 42 U.S.C. § 1983, federal law regulating 

community residential facilities, and the common law. The 

district court granted summary judgment to Harvey against 

the District on the § 1983 claim and negligence claims, and 

against Symbral and the Mohammeds for negligence. Harvey 

v. Mohammed (“Harvey I”), 841 F. Supp. 2d 164, 177, 186–

89 (D.D.C. 2012). The district court also held as a matter of 

law that the District was liable under D.C. Code § 7-

1305.05(g). Symbral and the Mohammeds settled before a 

jury trial on damages against the District. After verdict, the 

court entered judgment against the District for $2.65 million. 

The District moved for a new trial. The court denied the 

motion. Harvey v. Mohammed (“Harvey II”), 941 F. Supp. 2d 

93, 99–100 (D.D.C. 2013). The District appeals, assigning as 

error the grant of summary judgment and the denial of its 

post-trial motion. We affirm the judgment as to liability. As 

to damages, because the district court erred in excluding 

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causation evidence, we vacate and remand for 

reconsideration. 

I. BACKGROUND 

Curtis Suggs was severely disabled. He was diagnosed 

with profound cognitive and adaptive intellectual disabilities, 

cerebral palsy, controlled seizure disorder, scoliosis, 

presbyopia, hearing loss, and urinary incontinence. As an 

adult, he had approximately the functional capacity of a twoyear-old child. While he could feed himself, use the 

bathroom, and walk, he was unable to wash or dress himself, 

and required constant care and supervision. 

After the death of his parents, Suggs lived with his sister, 

Carrie Weaver. In 1967, Weaver petitioned the district court 

to have Suggs committed to the District’s custody because his 

family could no longer care for him. Under a 1925 Act 

governing commitment of intellectually disabled individuals, 

the district court found Suggs to be “feeble-minded,” 

“incapable of managing his affairs,” and a “fit subject for 

commitment to and treatment at the District Training School,” 

and ordered him committed to the District’s custody. Harvey 

I, 841 F. Supp. 2d at 171; see An Act to provide for 

commitments to, maintenance in, and discharges from the 

District Training School, and for other purposes, Pub. L. No. 

68-578, 43 Stat. 1135 (1925). 

Following his commitment, Suggs resided at Forest 

Haven, a District institution for the mentally disabled. In 

1976, Suggs was part of a class action lawsuit alleging 

various constitutional violations arising from poor conditions 

at the facility. The District agreed via consent judgment to 

close Forest Haven and place all of its residents in 

“community living arrangements.” Evans v. Williams, 206 

F.3d 1292, 1293 (D.C. Cir. 2000). The District also enacted 

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the Mentally Retarded Citizens Constitutional Rights and 

Dignity Act of 1978, establishing the Mental Retardation and 

Developmental Disabilities Administration (“MRDDA”) as 

the District agency responsible for the care and habilitation of 

persons legally committed to its custody. Harvey I, 841 F. 

Supp. 2d at 171. In 1984, the District placed Suggs at a group 

home operated by Symbral, where he resided until his death 

in 2000. 

As the district court explained, “[a]lthough MRDDA 

contractually delegated the day-to-day responsibility for the 

care and habilitation” of Suggs to Symbral, “MRDDA 

remained the agency legally responsible for Mr. Suggs.” Id. 

. . . Mr. Suggs’s MRDDA case manager was 

responsible for overseeing all of the components of 

Mr. Suggs’s individual habilitation plan (“IHP”), a 

written plan which detailed his strengths, weaknesses, 

and goals based on assessments by therapists, 

clinicians, and other health care professionals. The 

IHP is developed by the Inter–Disciplinary Team 

(“IDT”) comprised of clinicians such as a nurse, a 

speech and language pathologist, physical and 

occupational therapists, the MRDDA case manager, 

and the Symbral [qualified mental retardation 

professional]. Mr. Suggs’s MRDDA case manager 

was required to coordinate and monitor the IHP and 

was responsible for approving the IHP document. 

Additionally, the case manager was responsible for 

following up on medical recommendations made in 

the IHP to ensure that Mr. Suggs received those 

services. If Mr. Suggs was not receiving services in 

accordance with his IHP, the case manager was 

expected to inform Symbral and the case manager’s 

supervisor. Mr. Suggs’s MRDDA case manager was 

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required to visit him at least four times per year to 

carry out these responsibilities. 

Id. 

 In 1994, Suggs’s IHP reported that he was in good health 

and could feed himself, stand with support, and respond to 

communication from his peers. Beginning in 1995, he 

experienced a decline in motor function. The 1995 and 1996 

IHPs for Suggs stated that he lost strength in his upper 

extremities, depended on staff to feed him, and became 

incontinent. In September 1995, his physical therapist noted 

this deterioration and recommended a neurology consultation 

to explore the cause. Id. On March 5, 1996, Suggs’s 

MRDDA case manager, Sarah Jenkins, met with the InterDisciplinary Team for Suggs at Symbral and noted the 

recommendation by the physical therapist for a neurology 

consultation. Neither Jenkins nor the Team included the 

recommendation for the neurology consultation in Suggs’s 

1996 IHP, despite acknowledging his loss of motor function 

and his inability to feed himself. Id. 

 On February 20, 1997, the Healthcare Finance 

Administration issued a deficiency notice to Symbral for 

failing to promptly schedule the consult in 1995. The 

surveyor issued the Deficiency Notice to Yvonne 

Mohammed, who signed a Plan of Correction stating that 

Symbral would “make all medical appointments within one 

month of the recommendation.” Id. That same day, 

Mohammed scheduled a neurology appointment for Suggs. 

On March 7, 1997, Georgetown Neurologist Kenneth 

Plotkin examined Suggs. Dr. Plotkin thought that cervical 

stenosis (compression of the cervical spine) could be the 

cause of Suggs’s decreased ability to use his upper 

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extremities, and recommended that an MRI be taken of 

Suggs’s cervical spine as soon as possible. Dr. Plotkin 

reiterated this warning again on April 1, 1997. On April 18, 

1997, Georgetown Hospital conducted the requested MRI. 

The MRI showed severe spinal stenosis at the C-2 level of 

Suggs’s spine. 

 Dr. Plotkin ordered a follow-up appointment for May 1, 

1997, but Symbral did not schedule an appointment until June 

27, 1997. At that follow-up visit, Dr. Plotkin recommended 

that Suggs be examined by a neurosurgeon to determine 

whether surgery could prevent further loss of function. As of 

September 1997, Symbral had yet to schedule the 

recommended consultation. 

 Finally, in November 1997, neurosurgeon Dr. Fraser 

Henderson examined Suggs and recommended that he receive 

a laminectomy “in the next few weeks” to relieve pressure on 

the spinal cord. On December 16, 1997, Dr. Plotkin wrote 

Symbral and “recommended proceeding with the C-1-3 

laminectomy as per Dr. Henderson to be scheduled ASAP.” 

Instead of proceeding with the laminectomy, Suggs’s InterDisciplinary Team waited four months, then decided on 

March 19, 1998, to take Suggs in for a second opinion. 

Suggs’s team did not seek the second opinion regarding the 

neck surgery until April 1999, despite taking Suggs to two 

separate neurology visits at Howard University Hospital. Not 

surprisingly, Dr. Mills at Howard University recommended 

the surgery at the April appointment. Still, Suggs never 

received the laminectomy. In December 1999, a 

neurosurgeon at Providence Hospital concluded that surgery 

was unlikely to meaningfully improve Suggs’s motor function 

or neurological status. 

 

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Suggs’s cervical compression gradually caused him to 

experience a decline in motor function until he could no 

longer feed himself, chew his food, or walk. He suffered 

from frequent incontinence, dehydration, and decubitus 

ulcers. Eventually, his diaphragm became paralyzed, which 

led to his inability to breathe and his death on June 20, 2000. 

 Following Suggs’s death, Harvey brought a suit for 

damages on behalf of Suggs’s estate against Symbral, Leon 

and Yvonne Mohammed, and the District. The complaint 

alleged numerous counts against the various defendants on 

various theories of negligence and breach of fiduciary duty. 

The other defendants no longer being party to the lawsuit, 

only those claims asserted against the District are before us. 

As remains relevant to this appeal, the complaint alleged and 

the district court entered judgment on claims against the 

District for violation of Suggs’s constitutional rights, 

specifically, his right to due process under the Fifth 

Amendment; common law negligence against the District; 

and a statutory claim against the District under D.C. Code 

§ 7-1305.14(c). The district court granted summary judgment 

to Harvey on his Fifth Amendment claim against the District; 

his negligence claims against the District, Symbral, and the 

Mohammeds; and his statutory claim against the District 

under D.C. Code § 7-1305.14(c). Harvey I, 841 F. Supp. 2d 

at 177–79, 186–90; Harvey v. Mohammed (“Harvey III”), 951 

F. Supp. 2d 47, 53 (D.D.C. 2013). Symbral and the 

Mohammeds settled with Harvey before trial on damages. 

The jury entered a verdict awarding Harvey $2.9 million, of 

which $500,000 was for the amount of suffering Suggs 

experienced between December 23, 1999 and June 30, 2000. 

The district court, finding that the $500,000 amount 

represented the money to which Harvey was entitled under his 

negligence and statutory claims, allowed for contribution on 

that element of damages and entered judgment against the 

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District for $2.65 million. The court then awarded Harvey 

roughly $1.2 million in attorney fees and costs under 42 

U.S.C. § 1988. Harvey III, 951 F. Supp. 2d at 52.1

 

II. ANALYSIS 

On appeal, the District raises multiple assignments of 

error. First, the District argues that the district court erred in 

granting summary judgment to Harvey on his § 1983 claim. 

Second, the District asserts it is entitled to summary judgment 

on Harvey’s negligence and statutory claims because Harvey 

failed to give the District adequate notice of his claims under 

D.C. Code § 12-309. Lastly, the District contends that the 

court abused its discretion in excluding evidence that the 

District’s actions did not proximately cause Suggs’s health 

decline. After reviewing the record of the case and 

considering the arguments of the parties, we conclude that the 

district court did not err in entering summary judgment 

against the District on Harvey’s § 1983 claim, and we affirm 

that portion of the decision on review. We reverse the district 

court’s grant of summary judgment to Harvey on his 

negligence and statutory claims, concluding that those claims 

are barred under D.C. Code § 12-309. Because the district 

court abused its discretion by excluding causation evidence, 

we vacate the damages and remand for reconsideration. 

A. Harvey’s § 1983 Claim 

Summary judgment is appropriate when the moving party 

demonstrates that “there is no genuine issue as to any material 

 

1

 Harvey cross appealed the district court’s award of attorney fees, 

arguing that the district court made several computational errors 

and that he was entitled to an additional $67,965.13 in fees. When 

asked about this claim at oral argument, Harvey informed the Court 

that he was withdrawing the appeal. See Oral Arg. Recording 

28:56–29:10. 

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fact and the movant is entitled to judgment as a matter of 

law.” Fed. R. Civ. P. 56(a). In determining whether a 

genuine issue of material fact exists, the court must view all 

facts, and draw all reasonable inferences, in the light most 

favorable to the non-moving party. Matsushita Elec. Indus. 

Co. v. Zenith Radio, 475 U.S. 574, 587 (1986). We review 

the district court’s grant of summary judgment de novo. Ark 

Initiative v. Tidwell, 749 F.3d 1071, 1074 (D.C. Cir. 2014). 

In this case, the district court entered summary judgment 

against the District on Harvey’s claim that the District 

violated Suggs’s substantive due process rights by acting with 

deliberate indifference towards Suggs’s serious medical 

needs. 

To sustain a claim against a municipality under § 1983, a 

plaintiff must show that the policy or custom of the 

municipality caused a violation of the plaintiff’s constitutional 

rights. Monell v. Department of Social Srvs. of New York, 

436 U.S. 658, 694–95 (1978); Baker v. District of Columbia, 

326 F.3d 1302, 1306 (D.C. Cir. 2003). More specifically, in 

this case, Harvey must establish: (1) “a predicate claim of 

deliberate indifference by [District] officials to [Suggs’s] 

serious medical needs” in violation of his Due Process rights; 

and (2) “that a policy or custom of the District of Columbia 

caused” that constitutional violation. Baker, 326 F.3d at 

1306. 

The Supreme Court has historically been “reluctant to 

expand the concept of substantive due process because 

guideposts for responsible decisionmaking in this unchartered 

area are scarce and open-ended.” Collins v. City of Harker 

Heights, Tex., 503 U.S. 115, 125 (1992). To constitute a 

substantive due process violation, the defendant official’s 

behavior must be “so egregious, so outrageous, that it may 

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fairly be said to shock the contemporary conscience.” Estate 

of Phillips v. District of Columbia, 455 F.3d 397, 403 (D.C. 

Cir. 2006) (quoting Cnty. of Sacramento v. Lewis, 523 U.S. 

833, 847 n.8 (1998)). As the Supreme Court has frequently 

reminded us, the due process right “does not transform every 

tort committed by a state actor into a constitutional violation.” 

DeShaney v. Winnebago Cnty. Dep’t of Social Servs., 489 

U.S. 189, 202 (1989). We must first determine precisely what 

constitutional right has allegedly been violated. See, e.g., 

Washington v. Glucksberg, 521 U.S. 702, 721 (1997); Estate 

of Phillips, 455 F.3d at 403 (“It is therefore important . . . to 

focus on the allegations in the complaint to determine how 

petitioner describes the constitutional right at stake . . . .” 

(internal quotations omitted)). Harvey asserts that Suggs had 

a right as an involuntarily committed mental patient to all 

necessary medical treatment. 

“[T]he Due Process Clauses generally confer no 

affirmative right to governmental aid, even where such aid 

may be necessary to secure life, liberty, or protect property 

interests of which the government itself may not deprive the 

individual.” DeShaney, 489 U.S. at 196. However, “when 

the State by the affirmative exercise of its power so restrains 

an individual’s liberty that it renders him unable to care for 

himself,” “the Constitution imposes upon the State affirmative 

duties of care and protection with respect to” that individual. 

Id. at 198, 200. In other words, when the State “enter[s] into 

‘certain special relationships’ with the person,” the 

government has a “due process obligation to attend to his 

medical needs.” Harris v. District of Columbia, 932 F.2d 10, 

13–14 (D.C. Cir. 1991) (quoting DeShaney, 489 U.S. at 197). 

“The affirmative duty to protect arises not from the State’s 

knowledge of the individual’s predicament or from its 

expressions of intent to help him, but from the limitation 

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which it has imposed on his freedom to act on his own 

behalf.” DeShaney, 489 U.S. at 200. 

When the state has a heightened obligation toward an 

individual, “governmental ‘deliberate indifference’ will shock 

the conscience sufficiently” to establish a substantive due 

process violation. Smith, 413 F.3d at 93. Therefore, to 

prevail on the due process claim, Harvey was required to 

show that the District had such a “special relationship” with 

Suggs and that while in that special relationship, the District 

acted with deliberate indifference to his medical needs. He 

was then required to show, under Monell, that the violation of 

Suggs’s rights was the result of a governmental policy or 

custom of the District. We affirm the district court’s 

conclusion in granting summary judgment that Harvey has in 

fact established those elements. 

1. The District Owed a Duty to Suggs 

In Youngberg v. Romeo, 457 U.S. 307 (1982), the 

Supreme Court held that the State has an affirmative duty to 

ensure the safety and general well-being of an involuntarily 

committed mental patient. Id. at 315–16. This affirmative 

duty includes the duty to provide necessary medical care. See 

Harris, 932 F.2d at 14. The District involuntarily committed 

Suggs to its care, and thus, under Youngberg, entered into a 

special relationship with Suggs. Under the District’s revised 

statutory scheme governing the commitment of intellectually 

disabled individuals, a parent or guardian of an intellectually 

disabled individual may file a petition with the superior court 

to have the individual “committed to a facility.” D.C. Code 

§ 6-1924 (1978). Under that statute, “commitment” means 

the “placement in a facility, pursuant to a court order, of an 

individual who is at least moderately mentally retarded at the 

request of the individual’s parent or guardian without the 

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consent of the individual.” D.C. Code § 6-1902(4) (1978) 

(emphasis added). 

The District does not dispute that Suggs was 

involuntarily committed to its care, or that it owed an 

affirmative duty to Suggs while he resided at Forest Haven. 

See District’s Br. 32–33 (acknowledging mental patients are 

entitled to substantive due process rights when confined to a 

“state institution”); Evans v. Washington, 459 F. Supp. 483, 

484 (D.D.C. 1978) (entering into consent order stipulating 

that the “residents of Forest Haven . . . have a federal 

constitutional right to habilitative care and treatment based 

upon the Due Process Clause of the Fifth Amendment”). 

Rather, the District argues that once Suggs left Forest Haven 

and moved into a private home, it was no longer in a special 

relationship with him. It argues that while living in the group 

home operated by Symbral, Suggs was in the “least restrictive 

conditions necessary to achieve the purposes of habilitation,” 

D.C. Code § 7-1305.03, such that it no longer deprived Suggs 

of his liberty in a manner giving rise to a special relationship. 

We disagree. 

Suggs’s circumstance parallels the situation we addressed 

in Smith v. District of Columbia, 413 F.3d 86 (D.C. Cir. 

2005). In Smith, we considered whether the District owed a 

heightened obligation toward a juvenile delinquent whom the 

District had placed with a private company that operated 

“independent living” programs for delinquent youth. Id. at 

89–90. The District insisted it owed no obligation to the 

juvenile because his “liberty was unconstricted”: subject to 

program rules, he could “come and go” and “take [programapproved] weekend home visits.” Id. at 94. We rejected this 

argument, noting that “such flexibility hardly amounts to 

freedom from state restraints.” Id. We held that, even if the 

juvenile was subject only to the “lesser” of several restrictive 

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options, he was still being held “against his will,” and the 

District had a heightened duty to assume some responsibility 

for his well-being. Id. at 94–95. 

Similarly, the fact that Suggs was held in the least 

restrictive setting does not negate the involuntary nature of his 

commitment or the District’s duty under Youngberg to ensure 

he received adequate medical care. See DeShaney, 489 U.S. 

at 199–200 (“[W]hen the State takes a person into its custody 

and holds him there against his will, the Constitution imposes 

upon it a corresponding duty to assume some responsibility 

for his safety and general well-being.”). 

2. The District Was Deliberately Indifferent 

to Suggs’s Needs 

Harvey suggests the district court erred when it applied 

the subjective indifference standard from Farmer v. Brennan, 

511 U.S. 825 (1994), because that case involved a convicted 

inmate. In his view, individuals like Suggs “‘who have been 

involuntarily committed are entitled to more considerate 

treatment and conditions of confinement than criminals whose 

conditions of confinement are designed to punish.’” Harvey’s 

Br. 38 (quoting Youngberg, 457 U.S. at 321–22). When 

considering whether the denial of treatment to an 

involuntarily committed patient violated due process, 

“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 judgment.” Youngberg, 457 U.S. at 323; 

see also Patten v. Nichols, 274 F.3d 829, 842 (4th Cir. 2001) 

(applying the Youngberg standard to an involuntarily 

committed patient’s claim that his due process rights were 

violated). But see Chapman v. Keltner, 241 F.3d 842, 845 

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(7th Cir. 2001) (applying the deliberate indifference standard 

to a denial-of-medical care claim asserted by a pretrial 

detainee). We need not decide that issue as Harvey prevails 

even under the deliberate indifference standard. 

To establish a constitutional violation under that 

standard, Harvey must show that the District was deliberately 

indifferent to Suggs’s serious medical needs. An official is 

deliberately indifferent when she has “subjective knowledge 

of the [plaintiff’s] serious medical need and recklessly 

disregard[s] the excessive risk to [his] health or safety from 

that risk.” Baker, 326 F.3d at 1306. The District does not 

dispute that Suggs’s MRDDA case manager, Jenkins, was a 

District official. See District’s Reply Br. 1. 

The evidence establishes that Jenkins knew of Suggs’s 

medical needs and recklessly disregarded an excessive risk to 

Suggs’s health. The record shows that, as of March 1996, 

Jenkins was aware that Suggs was experiencing a rapid 

decline in motor function, that he was no longer able to feed 

himself, and that his physical therapist recommended he 

receive a neurology consultation to determine the cause of the 

deterioration. Yet she neither noted this recommendation in 

Suggs’s IHP, nor took necessary steps to ensure that Suggs 

visited a neurologist. It was only after the Healthcare Finance 

Administration issued a deficiency notice to Symbral for 

failing to promptly schedule the recommended appointment 

that Suggs finally met with a neurologist in March 1997, at 

least one year after Jenkins learned of the recommendation. 

Jenkins’s failure to ensure that Suggs received all 

necessary medical treatment continued. On March 7, 1997, 

the neurologist recommended that Suggs get an MRI 

“ASAP.” Suggs did not get an MRI until April 18, 1997, 43 

days after the recommendation. The neurologist then 

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requested that Suggs schedule a follow-up appointment for 

May 1, 1997. Symbral did not bring Suggs back to the 

neurologist until June 27, 1997, 58 days after the request. At 

that meeting, the neurologist recommended that Suggs visit a 

neurosurgeon to determine whether surgery was a viable 

option. The appointment with the neurosurgeon did not occur 

until November 11, 1997, 138 days after the request. At the 

appointment, the neurosurgeon recommended that Suggs 

receive a laminectomy “in the next few weeks.” The 

neurologist reiterated that the surgery needed to “be scheduled 

ASAP.” However, Suggs’s team, which included Jenkins, 

waited four months and then decided to get a second opinion. 

Suggs was not taken to the doctor for a second opinion until 

April 30, 1999, 408 days after the team decided to seek a 

second opinion and 536 days after the first neurosurgeon 

recommended that surgery be performed in a few weeks. 

Predictably, the second neurologist recommended that Suggs 

get a laminectomy. Predictably, Suggs never received the 

surgery. 

 In short, Jenkins repeatedly failed to monitor Suggs’s 

care and ensure that he was receiving necessary medical 

treatment. We conclude that under these facts Jenkins acted 

with deliberate indifference toward Suggs’s medical needs in 

violation of his substantive due process right to receive 

necessary medical treatment. 

3. The District’s Custom Caused the 

Constitutional Violation 

We next determine whether a District custom or policy 

caused the violation of Suggs’s constitutional rights. Harvey 

may establish such causation by showing that a District 

policymaker’s ignoring of a practice was “consistent enough 

to constitute custom.” Warren v. District of Columbia, 353 

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F.3d 36, 39 (D.C. Cir. 2004). Or he may show that the 

District responded to a need “in such a manner as to show 

‘deliberate indifference’ to the risk that not addressing the 

need will result in constitutional violations.” Id. (quoting 

Baker, 326 F.3d at 1306). The “deliberate indifference” 

standard for establishing a municipal policy is distinct from 

that required to show an underlying constitutional violation. 

It is an objective standard, “determined by analyzing whether 

the municipality knew or should have known of the risk of 

constitutional violations, but did not act.” Jones v. Horne, 

634 F.3d 588, 601 (D.C. Cir. 2011) (internal quotation marks 

omitted). Only if a municipal policy was “so likely to result 

in the violation of constitutional rights,” and the need to 

change the policy “so obvious,” could “policymakers of the 

city . . . have been deliberately indifferent to the need.” City 

of Canton v. Harris, 489 U.S. 378, 390 (1989). 

The District maintains that the district court erred in 

granting summary judgment to Harvey because he failed to 

show that it is the District’s policy or custom to subject those 

enrolled within its development disability programs to 

constitutional violations. We disagree. 

The District has a longstanding practice of deliberate 

disregard of the medical needs of involuntarily committed 

mental patients. In 2000, the District, in litigation stemming 

from the 1976 class action by Forest Haven residents, 

admitted that its “system of support for individuals with 

developmental disabilities . . . represent[s] one of the most 

serious breakdowns in the District government over the last 

two decades.” Evans v. Williams, 139 F. Supp. 2d 79, 96 

(D.D.C. 2001). It acknowledged that it “fundamentally failed 

its obligation to disabled persons,” and that its programs were 

“highly dysfunctional” and “seriously broken.” Id. at 97–98. 

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The District was aware of these failures, but did not act. 

In 1996, a federal district court found that the District had, 

“for over two years, chronically and unapologetically 

violated” its agreement to ensure that the needs of the 

intellectually disabled are met. Evans v. Barry, No. 76-cv293, 1996 WL 451054, at *2 (D.D.C. Aug. 2, 1996). In 1997, 

a court monitor found that Evans class members “are 

frequently denied necessary health services and/or adaptive 

equipment, sometimes resulting in physical injury.” Report to 

the United States District Court for the District of Columbia, 

Evans v. Barry, No. 76-0293 (Oct. 1, 1999), Joint Appendix 

381. The District has acknowledged it was “aware of 

problems of poor care provided at group homes” and its 

“systemic failures.” Evans, 139 F. Supp. 2d at 97. 

The District argues that the legislature’s enactment of the 

intellectual disabilities rights statute in 1979 is sufficient to 

rebut evidence that it had a policy of deliberate indifference. 

The District’s statutory policy is of “little value,” where, as in 

this case, “there is evidence . . . that the municipality was 

deliberately indifferent to the policy’s violation.” Daskalea v. 

District of Columbia, 227 F.3d 433, 442 (D.C. Cir. 2000). In 

the absence of evidence of actual enforcement of its paper 

policy, the District has failed to create an issue of triable fact. 

The District also argues that while it was aware of 

systemic failures in its care for the intellectually disabled, it 

was not aware that these failures “could lead to threats to the 

life and safety of disabled individuals.” Evans, 139 F. Supp. 

2d at 97. Regardless of whether the District had actual 

knowledge of constitutional violations, the evidence 

establishes that the District should have known that its policy 

of deliberate indifference was likely to result in the violation 

of rights of the committed person. As noted above, in 1996, a 

federal district court warned the District that intellectually 

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disabled individuals are “ill-equipped” to “defend against the 

city’s failure to assist their care providers in giving them the 

care and treatment they desperately need.” Evans v. Barry, 

1996 WL 451054, at *2. The District’s own compliance 

monitor warned that class members are “physical[ly] 

injur[ed]” because of the denial of health care services. 

The evidence shows that the District knew that its “entire 

mental retardation and developmental disabilities system was 

fundamentally unable to deliver even the most basic 

services,” Evans v. Williams, 139 F. Supp. 2d at 97, but did 

not act to cure the problem. Under these facts, we conclude 

that the District had a custom or policy of deliberate 

indifference to the needs of the intellectually disabled, and 

that this policy caused the violation of Suggs’s constitutional 

rights. 

* * * 

Harvey has shown that Suggs’s substantive due process 

rights were violated as a result of the District’s custom of 

deliberate indifference. The District has failed to present 

evidence creating a triable issue of fact regarding its § 1983 

liability. We therefore affirm the district court’s grant of 

summary judgment to Harvey on his § 1983 claim against the 

District. 

B. Harvey’s Negligence and Statutory Claims 

The District argues that the district court erred in finding 

it liable as a matter of law under a common law theory of 

negligence as well as D.C. Code § 7-1305.05(g) because 

Harvey’s failure to comply with D.C. Code § 12-309 bars 

those claims. Specifically, the District claims that the notices 

Harvey filed under § 12-309 were inadequate and untimely. 

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D.C. Code Section 12-309 provides: 

An action may not be maintained against the District 

of Columbia for unliquidated damages to person or 

property unless, within six months after the injury or 

damage was sustained, the claimant, his agent, or 

attorney has given notice in writing to the Mayor of 

the District of Columbia of the approximate time, 

place, cause, and circumstances of the injury or 

damage. A report in writing by the Metropolitan 

Police Department, in regular course of duty, is a 

sufficient notice under this section. 

Section 12-309 “imposes a notice requirement on everyone 

with a tort claim against the District of Columbia.” District of 

Columbia v. Dunmore, 662 A.2d 1356, 1359 (D.C. 1995). 

Compliance with the statute is mandatory for filing suit 

against the District. Brown v. District of Columbia, 853 A.2d 

733, 736 (D.C. 2004). The § 12-309 clock starts “the instant 

an injury or damage is sustained.” Id. at 737. The statute 

does not allow for tolling. Dunmore, 662 A.2d at 1360–61. 

Section 12-309 applies to District of Columbia statutory 

causes of actions as well as common law claims. Giardino v. 

District of Columbia, 505 F. Supp. 2d. 117, 120–21 (D.D.C. 

2007). It does not apply to Harvey’s § 1983 claim. Brown v. 

United States, 742 F.2d 1498, 1500 (D.C. Cir. 1984) (en 

banc). 

 Harvey filed notice letters with the Mayor’s office on 

June 16, 2000, and June 23, 2000, alleging that District 

employees negligently monitored Suggs causing him to suffer 

from various medical complications. Therefore, if Suggs 

sustained an injury on or after December 23, 1999, a date six 

months prior to the first notice, the notice was timely. If he 

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sustained an injury before December 23, 1999, the notice was 

untimely, and we must dismiss his negligence and statutory 

claims. Thus, to determine whether Harvey’s notices were 

timely under § 12-309, we must first determine when Suggs 

sustained an injury or damage. For guidance, we look to 

District of Columbia Court of Appeals’s precedent, whose 

interpretation of the substantive law of the District is binding 

on us. Payne v. District of Columbia Gov’t, 722 F.3d 345, 

353 (D.C. Cir. 2013). 

In Brown v. District of Columbia, the District of 

Columbia Court of Appeals addressed the question of when 

the § 12-309 notice period begins to run where a claimant 

sues the District for “failing to diagnose a medical condition.” 

853 A.2d at 737. The Court reasoned that because “patients 

in [failure to diagnose] cases generally suffer from an ailment 

when they first seek treatment,” the injury, for § 12-309 

purposes, “is the worsening or deterioration of the plaintiff’s 

condition.” Id. at 739. Harvey’s negligent treatment claim is 

similar to a failure to diagnose claim in that the patient suffers 

from the ailment before the negligent conduct occurred. And 

so, consistent with Brown, we conclude that Suggs sustained 

an injury, and thus the § 12-309 clock began to run, when 

Suggs’s condition worsened. 

 Based on our examination of the record, Suggs’s 

condition worsened, and he therefore sustained an injury, 

prior to December 23, 1999, and his statutory and negligence 

claims are barred under § 12-309. Suggs’s 1994 IHP noted 

that he “feeds himself independently with a spoon,” is able to 

dress himself with physical assistance, and “is independent in 

using an empty urinal.” By contrast, his 1996 IHP states that 

he “depends on staff for feeding,” “for all functional 

dressing,” and for “help with toileting.” He also wore 

“depends due to incontinence.” His 1997 IHP notes that he 

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“continues to regress physically.” By December 1998, he 

suffered from “reduced oral motor skills” and a “lack of 

chewing skills,” resulting in malnutrition and dehydration. 

One year later, on December 2, 1999, Suggs had a skin flap 

surgery to address the pressure ulcers that had developed on 

his body as a result of his lack of mobility. We cannot state 

with medical certainty the exact date on which Suggs’s 

untreated condition worsened. At a minimum, Suggs’s 

condition had worsened by December 2, 1999, the date of his 

skin flap surgery and a date more than six months before 

Harvey filed his first § 12-309 notice. We therefore conclude 

that Harvey’s statutory and negligence claims are barred 

under D.C. Code § 12-309. 

Our conclusion regarding the statutory and negligence 

claims ultimately makes no difference in the judgment. The 

verdict form submitted to the jury posed two questions. First, 

“[w]hat amount of money do you find would fairly and 

adequately compensate Curtis Suggs for the injuries and 

damages he suffered as a result of the District of Columbia’s 

deliberate indifference to Mr. Suggs’s medical needs?” The 

jury answered, “$2,900,000.” Second, “[o]ut of that total sum 

for injuries and damages, what amount is for the suffering of 

Curtis Suggs between December 23, 1999 and June 30, 

2000.” The jury responded, “$500,000.” In its order granting 

in part and denying in part the District’s motion for 

contribution, the district court noted that the “$500,000 

amount was found by the jury to arise from the District’s 

common law negligence,” as well as Harvey’s statutory claim. 

Memorandum and Order, Harvey v. Mohammed, No. 02-2476 

(D.D.C. Aug. 16, 2012), Joint Appendix 1039. Elsewhere in 

the order, the district court made clear that the damages for 

the negligence claim “are a sub-part of the total damages to be 

awarded to plaintiff under § 1983 because the District’s 

negligence and the District’s deliberate indifference ran 

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concurrently.” Id. at Joint Appendix 1038. That, of course, is 

exactly what the jury verdict provided. 

The total damages were $2.9 million. Five hundred 

thousand of that figure represented the damages incurred 

during a distinct period covered by the District’s common law 

and statutory tort liability, as well as the constitutional tort. 

Nonetheless, as the district court recognized, even absent the 

common law and statutory claims, the District was still liable 

for the total figure because of its § 1983 liability. The second 

jury question was relevant only to whether the District would 

receive contribution. That question, of course, has been 

settled already. Setting aside the contribution question, the 

second response on the jury verdict form is no longer 

relevant. The District owes the full amount under question 

one because of its constitutional torts. We can therefore 

affirm the judgment as it stands. It is well established that “in 

cases on appeal from the district court, we are to review 

‘judgments, not opinions.’” People’s Mojahedin 

Organization of Iran v. U.S. Dept. of State, 182 F.3d 17, 23 

n.7 (D.C. Cir. 1999) (quoting Chevron U.S.A. v. Natural 

Resources Defense Council, Inc., 467 U.S. 837, 842 (1984)). 

The judgment entered by the district court is not dependent 

upon the grounds to which it is assigned; therefore, as we 

uphold one adequate ground, any error as to alternative 

theories is immaterial. 

C. Causation Evidence 

The District claims that the district court erred in 

excluding its evidence contesting whether Suggs’s health 

decline was due to the District’s deliberate indifference. At 

trial, the District sought to admit the expert testimony of 

(1) Dr. Slvanus Ayeni, who planned to testify that, at the time 

he examined Suggs, he would not have benefitted from a 

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laminectomy; (2) the testimony of Kachen Alsopp, who 

planned to testify to the causes of Suggs’s condition; 

(3) Senora Simpson, who planned to testify that Suggs’s 

physical deterioration was related to cerebral palsy and his 

age; and (4) Dr. David Jackson, who planned to testify that, 

due to Suggs’s health issues, he would have suffered more 

had he had a laminectomy. Defendant District of Columbia’s 

Supplement to Joint Pretrial Statement at 1–2, Harvey v. 

Mohammed, No. 1:02-cv-2476 (D.D.C. Mar. 30, 2012), Joint 

Appendix 753–54; Joint Pretrial Statement at 17, Harvey v. 

Mohammed, No. 1:02-cv-2476 (D.D.C. Mar. 13, 2012), Joint 

Appendix 713. The District also sought to admit the opinion 

testimony of Dr. Gersh, Suggs’s treating physician, as well as 

evidence that it contacted Suggs’s sister to obtain consent for 

surgery and that Symbral’s negligence was an intervening 

cause of Suggs’s pressure sores. 

The district court excluded all the proffered evidence. 

First, the district court excluded the testimony of Dr. Ayeni, 

Alsopp, and Simpson for failure to comply with Federal Rule 

of Civil Procedure 26(a)(2) (governing the disclosure of 

expert testimony). Supplemental Pretrial Order, Harvey v. 

Mohammed, No. 1:02-cv-2476 (D.D.C. Apr. 5, 2012). The 

district court excluded the testimony of Dr. Jackson as 

irrelevant. Id. It later explained that evidence supporting the 

theory that the laminectomy would have caused Suggs more 

harm than good had no bearing upon the “sole remaining 

issue of damages.” Harvey II, 941 F. Supp. 2d at 98. The 

district court reasoned that in its summary judgment order, it 

concluded “that the District’s conduct had caused Mr. Suggs’s 

injuries,” and the District “was not allowed to relitigate 

liability at trial.” Id. at 99. The district court also excluded 

the testimony of Dr. Gersh based on the District’s failure to 

comply with Federal Rule of Civil Procedure 26(a)(2)(C). Id. 

at 100. Before the 2010 Amendments to the Rules, Rule 

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26(a)(2) allowed a party to name a treating physician as the 

party would name any other witness, that is the party did not 

need to provide the opposing side with the subject matter of 

the testimony and a summary of the facts and opinions to 

which the treating physician was expected to testify. Fed. R. 

Civ. P. 26, Advisory Comm. nn. After the amendments, 

however, the Rule required such disclosures. Fed. R. Civ. P. 

26(a)(2)(C). Although Federal Rule of Civil Procedure 

26(a)(2) was not in effect in its current form when the District 

initially made its disclosures, the district court noted that “the 

Rule went into effect before the close of discovery and the 

District in fact complied with [the Rule] with respect to 

another potential expert witness.” Harvey II, 941 F. Supp. 2d 

at 100. Thus, the district court concluded that the District’s 

failure to comply with Rule 26(a)(2) was not “substantially 

justified” or “harmless,” and it excluded the evidence. Id. 

Lastly, the district court excluded evidence that Symbral’s 

negligence was an intervening cause of Suggs’s pressure sores 

as irrelevant. 

 On appeal, the District challenges the district court’s 

exclusion of the testimony of Dr. Jackson and Dr. Gersh, as 

well as the court’s exclusion of evidence that (1) Suggs’s 

health decline was attributable in part to his pre-existing 

cerebral palsy and scoliosis; (2) Ms. Weaver, Suggs’s sister, 

refused to consent to the laminectomy, thereby severing the 

causal chain; and (3) Symbral’s negligence was an 

intervening cause for Suggs’s pressure sores. 

We review a district court’s evidentiary rulings for abuse 

of discretion. Huthnance v. District of Columbia, 722 F.3d 

371, 377 (D.C. Cir. 2013). We will reverse an erroneous 

evidentiary ruling only if the effort affects a party’s 

substantial rights. Id. 

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The district court did not abuse its discretion in excluding 

the testimony of Dr. Jackson. The District argues that Dr. 

Jackson’s testimony that Suggs would have suffered had he 

received the neck surgery is relevant because Suggs’s 

recovery for pain and suffering should be offset by the 

amount of pain he would have experienced had he gotten the 

surgery. To support this proposition, the District cites 

Hamilan Corp. v. O’Neill, 273 F.2d 89 (D.C. Cir. 1959). 

Hamilan Corp. does not support the District’s argument. In 

that case, we affirmed a jury instruction stating that a plaintiff 

who suffers secondary injuries which proximately cause 

emotional disabilities may recover damages for such 

emotional disabilities as long as they “stem from the original 

physical injury in an unbroken chain of causation.” Id. at 91. 

In this case, the district court found that Harvey “submitted 

substantial evidence on summary judgment demonstrating a 

causal connection between the District’s failure to properly 

supervise the provision of medical care to Mr. Suggs for his 

cervical stenosis, the resulting precipitous decline in Mr. 

Suggs’s health, and his ultimate death.” Pretrial Order, 

Harvey v. Mohammed, No. 02-cv-2476 (D.D.C. Mar. 22, 

2012). A plaintiff is entitled to “recover money damages for 

any injuries [he] suffered as a result of the . . . violation.” 

Halperin v. Kissinger, 606 F.2d 1192, 1207 (D.C. Cir. 1979) 

(emphasis added). The District does not explain how Dr. 

Jackson’s evidence negates the injuries Suggs suffered as a 

result of the District’s deliberate indifference. That Suggs 

might have suffered had he gotten the surgery is irrelevant to 

the question of how much he suffered (and the amount of 

damages to which he is entitled) because he did not get the 

surgery. Dr. Jackson’s testimony was properly excluded. 

Next, the district court did not abuse its discretion in 

excluding the testimony of Dr. Gersh. Discovery in this case 

closed on June 30, 2011, six months after the 2010 

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Amendments went into effect. Harvey II, 941 F. Supp. 2d at 

100. The District offers no excuse for failing to comply with 

the amended rules. Moreover, as late as March 30, 2012, one 

week before trial, the District sought to add six late-named 

witnesses and it still failed to designate Gersh as an expert. 

Id. The District did not put forth any reason for this failure. 

Under Federal Rule of Civil Procedure 37, “[i]f a party fails to 

provide information or identify a witness required by Rule 

26(a) . . . the party is not allowed to use that information or 

witness . . . at a trial, unless the failure was substantially 

justified or is harmless.” Fed. R. Civ. P. 37(c)(1). The 

district court found that the District’s failure was not 

“substantially justified” or “harmless.” Under these facts, the 

district court did not abuse its discretion. 

However, the district court abused its discretion in 

excluding evidence that Suggs’s decline was at least partially 

attributable to his pre-existing medical conditions. That 

evidence is relevant to the question of damages, and the 

District contends that it should have been allowed to crossexamine Harvey’s experts about whether Suggs’s pre-existing 

conditions were independent factors contributing to his 

decline. We agree with the District because “the basic 

purpose of a § 1983 damages award should be to compensate 

persons for injuries caused by the deprivation of constitutional 

rights.” Carey v. Piphus, 435 U.S. 247, 254 (1978). The 

district court abused its discretion by not allowing the District 

to contest damages by presenting evidence that Suggs’s 

decline in health could at least partially be attributed to preexisting medical conditions. 

Harvey points out that the district court nevertheless 

allowed the District to cross-examine an expert on alternative 

causes of Suggs’s health problems. Specifically, the District 

elicited from Harvey’s expert Dr. Sandhu the admission that 

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“it’s hard to know how much [of Suggs’s decline] is, you 

know, from their cerebral palsy versus something new,” Tr. 

Transcript 153:16–19 (Apr. 11, 2012), a fact that the District 

emphasized at closing argument, Tr. Transcript 27:5–28:8 

(Apr. 18, 2012) (“[T]here’s a lot of evidence in this case 

which shows that things that Mr. Suggs had were actually 

related to the cerebral palsy and were not related to the 

cervical stenosis. For example, Dr. Sandhu, in crossexamination, testified that curvature of the spine, scoliosis, 

and he had kyphosis, which meant it was curved forward, and 

scoliosis, which meant it was curved to the side, causes 

problems breathing. That is what caused his respiratory 

problems. That was part of his testimony.”). Yet the district 

court did not allow the District to challenge Dr. Citrin on 

cross examination with similar questions about Suggs’s preexisting medical conditions. We therefore reject Harvey’s 

argument. 

The district court abused its discretion in excluding 

evidence that Suggs’s sister refused to consent to the 

laminectomy. The District argued that the refusal to consent 

broke the chain of causation for damages, but the district 

court rejected that argument because “the District could have 

consented and simply was indifferent to consenting and did 

not consent.” Tr. Transcript 124:23–25 (Apr. 10, 2012). 

Even though the administrator of MRDDA, as Suggs’s legal 

guardian, could have consented to the surgery, it is at least 

possible that Suggs’s sister, as an adult sibling, had the 

authority to “refuse or withdraw consent.” D.C. Code § 21-

2210(a). If the District could show that Suggs’s sister had the 

authority to refuse to consent to the surgery and did so here, 

then any damages stemming from the failure to get the 

surgery after that point might not be attributable to the 

District. That evidence should be presented to the jury. 

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Lastly, the district court did not err in excluding evidence 

that Symbral’s negligence was an intervening cause of 

Suggs’s pressure sores. Under District of Columbia law, “the 

initial wrongdoer can be held liable to the injured party for the 

whole loss, including aggravation of the injuries due to 

subsequent medical negligence” because, under traditional 

tort causation principles, “medical negligence aggravating the 

original injury is foreseeable within the scope of the risk 

created by the original tortious conduct.” District of 

Columbia v. Washington Hosp. Center, 722 A.2d 332, 337 & 

n.5 (D.C. 1998) (internal quotation marks omitted); see also 

Rieser v. District of Columbia, 563 F.2d 462, 479 (D.C. Cir. 

1977) (“If a negligent, intentional or even criminal 

intervening act or end result was reasonably foreseeable to the 

original actor, his liability will not ordinarily be superseded 

by that intervening act.”). Given its history of care, 

Symbral’s negligence was certainly foreseeable. The 

District’s efforts to introduce an intervening cause fail. 

* * * 

 The District also argues that the district court erred in 

instructing the jury on the District’s probate lien against 

Suggs’s estate. We agree. There was no evidence of that lien 

before the jury, and “[t]he law is well settled that it is error to 

instruct a jury on a state of facts not disclosed by the 

evidence.” Moore & Hill, Inc. Breuninger, 34 App. D.C. 86, 

89 (D.C. Cir. 1909). Harvey argues that the lien instruction 

was nevertheless appropriate, analogizing the instruction to a 

taxation instruction. But that analogy is inapposite. A 

taxation instruction informs the jury that “any damage award 

will not be subject to income taxation” in order to ameliorate 

the possibility that a jury would erroneously assume that an 

award would be subject to taxation and thus “‘should be 

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increased substantially in order to be sure that the injured 

party is fully compensated.’” Psychiatric Inst. of Washington 

v. Allen, 509 A.2d 619, 626–27 (D.C. 1986) (quoting Norfolk 

& W. Ry. Co. v. Liepelt, 444 U.S. 490, 496 (1980)). Here, 

however, alerting the jury to the existence of the lien created 

the very risk a taxation instruction is designed to ameliorate 

by encouraging the jury to increase its award in order to “fully 

compensate” Harvey. We therefore conclude that it was error 

to instruct the jury on the District’s lien. 

Finally, the District argues that the district court erred in 

in denying the District’s motion for a 50% contribution 

against the entire verdict. We have reviewed that ruling and 

discern no error. 

CONCLUSION 

For the reasons stated above, the judgment of the district 

court is affirmed in part and reversed in part. We vacate the 

damages and remand for reconsideration. 

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