KYLE K., Larry K., Personally, et al., Plaintiffs-Appellees,

v. Maggie CHAPMAN, in her individual capacity, LarryFoston, in his individual capacity, DefendantsAppellants.
No. 99-11048. United States Court of Appeals, Eleventh Circuit.

April 5, 2000. Appeal from the United States District Court for the Middle District of Georgia, (No. 98-00018-5-CV-3-DF), Duross Fitzpatrick, Judge. Before BLACK and WILSON, Circuit Judg es, and RONEY, Senior Circuit Judge. RONEY, Senior Circuit Judge: This is an appeal from the denial of a Fed.R. Civ.P. Rule 12(b)(6) motion to dismiss on qualified immunity grounds a complaint that alleged a substantiv e due process denial of medical treatment claim and physical abuse claim. This section 1983 complaint was brought on behalf of Kyle K., a mentally retarded child born in 1981, by his parents, against various ment al health professionals, administrators, and direct care personnel connected with Central State Hospital (CSH), a Georgia hospital and residential treatment facility for the mentally disabled, concerning Kyle's treatment . Six of those defendants, Maggie Chapman, Larry Foston, Bettye Liggins, Elbert Johnson, Dorothy Simmons , and Annie Poole appeal the denial of their Rule 12(b)(6) motion. They are non-professionals called H ealth Services Technicians ("HST"s) who provided direct care to Kyle. Defendants raise essentially two issu es on this appeal. We reverse as to one, and affirm on the other. On the first issue, defendants argue that the duty of a state, established by Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28(1982), to provide minimally adequate care, treatment and training to Kyle, specifically in this case to protect Kyle from self-injurious behavior, does not apply to non-professional state employees such as these defendants. Since there was no clearly-established law that

### 2 would make the requirements of Youngberg apply to non-professional employees at the time of the actions subject to this complaint, these defendants are entitled to qualified immunity and the complaint against them alleging that cause of action should have been dismissed. On the second issue, defendants argue that the c ourt erred in denying qualified immunity to these defendants "who allegedly abused the mentally retardedminor Plaintiff, where no specific averments of fact are made against Appellants individually, where the av erments are made 'on information and belief,' and where the District Court refused to require Plaintiffs to make a more definite statement." We affirm on the ground that, although further procedures will be necessary inorder to develop the claim against each of these individual defendants, the complaint a lleges with sufficient particularity facts establishing a causal connection between defendants' actions and th e alleged constitutional violation fo r purposes of overcoming defendants' Rule 12(b)(6) motion to dismiss the complaint on qualified immunity grounds.
I. Whether the amended complaint sufficiently states a claim is a matter of law we review de novo, assuming that all the allegations are true. See Williams v. Alabama State Univ., 102 F.3d 1179,1182(11th Cir.1997). Qualified immunity shields government offi cials performing discretionary functions from civil liability if their conduct violates "no clearly establis hed statutory or constitutional rights of which a reasonable person would have known." Harlow v. Fitzgerald, 457 U.S. 800, 102 S.Ct. 2727, 73 L.Ed.2d 396 (1982). Defendants are entitled to qualified immunity in a Rule 12(b)(6) motion to dismiss only if the complaint fails to allege facts that would show a violation of a clearly established constitutional right. See Williams, 102 F.3d at 1182.
II. Kyle K. was born January 6, 1981. According to th e complaint, Kyle was diagnosed at an early age with autism. In 1991, he was adm itted to Central State Hospital (CSH), a Georgia hospital and residential treatment facility for the mentally disabled after his parents became unable to handle his frequent temper

### 3 tantrums, agitation and mood swings. From the time he was admitted to CSH, Kyle had continuous episodes of self-abuse which included head-banging, face-slapping, body-pinching, body-hurling, biting his hands and upper arms, scratching his face and poking his eyes. In the summer of 1996, he was transferred to another institution.
III. Plaintiffs' substantive due process claims fall into two categories: the first concerns defendants' failure to protect Kyle from his self-abusive behavior, and the second relates to a llegations that defendants abused Kyle physically and mentally.
A. As to the first category, plaintiffs have alleged that the defendants violated Kyle's substantive rights under the due process clause of the Fourteenth Amendment set forth in Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28( 1982), specifi cally, his right to reasonably safe conditions of confinement, freedom from unreasonable bodily restraints, and such minimally adequate training as might be required to ensure safety and freedom from restraint. The allegation amounts to a failure to properly treatKyle's self-abusive behavior. Clearly this type of allegation falls within the duties contemplated in Youngberg. This duty, however, has never been held applicable to non-professional employees. The district c ourt rejected in a footnote the argument that this case was distinguishable because defendants in this case were non-professionals, but it appears that this distinction is dispositive. In reaching this conclusion, we look first to Youngberg, the controlling case regarding substantive due process rights of th e involuntarily civilly committed patient. In Youngberg, the mother of a mentally retarded man, who, like Kyle in this case, was injure d in part by his own violence, brought suit against the superintendent of the institution, the Director of Resi dent Life, and the Director for the unit in which the

### 4 plaintiff's son resided. All three were administrato rs who had varying degrees of supervisory authority over the treatment provided to the patient. In arriving at the proper standard for analyzing whether the state adequately has protected the patient's rights, the Court determined that liability hinges on th e "professional judgment" standard. "[L]iability may be imposed only when the decision by the professi onal is such a substantial departure from accepted professional judgment, practice, or standards as to de monstrate that the person responsible actually did not base the decision on such a judgment." Youngberg, 457 U.S. at 323, 102 S.Ct. 2452. The Court in Youngberg, defined a professional decision maker as "a person competent, whether by education, training or experience, to make the particular decision at issue." Youngberg, 457 U.S. at 323, 102 S.Ct. 2452. What is implicit in Youngberg is that the alleged constitutional violation is related to some aspect of the treatment decision made by a professional decision maker. Individuals with some role in the decision making process regarding treatment were defendants in two Eleventh Circuit cases addressing substantive due process claims in a similar context. In Rodgers v. Horsley, 39 F.3d 308(11th Cir.1994), an involuntarily comm itted patient who was allegedly raped brought a section 1983 action against the director of the hospital and chief administrator of the admissions unit. Both parties were responsible for "hiring, training, and supervising the individuals charged with monitoring patients." 39 F.3d at 310. Similarly, in Dolihite v. Maughon, 74 F.3d 1027(11th Cir.1996), the parents of an adolescent committed to a state hospital who suffered severe injuries after he tried to hang himself, brought suit against the social worker and psychologists, mental health professionals who had direct decision making authority over the patient, and administrative personnel. It must be noted that Dolihitewas decided in 1996, the year in which Kyle was transferred from CSH, and th erefore is not applicable in determining whether the defendant's alleged conduct violated cl early established law. In addition, Dolihiteis inapplicable because it only addresses the responsibilities of professional decision makers.1 The relevant portions of the complaint state:
57. Upon information and belief, the abusive tr eatment of Kyle by the HST Defendants included, among other things, punitively lock ing Kyle in closets, hitting, pushing, withholding food, forcing cold showers, gra bbing his genitals and verbal abuse. These actions were taken in response to Kyle's exhib iting predicable autistic behaviors. They were for the convenience of staff and in lieu of treatment. These activities were known or should have been known to supervisory [defendants]....
96. Kyle was subject to acts of battery, personal physical invasion, improper restraint and excessive punishment by the HST Defendant s. Such Defendants did not have the 

### 5 Defendants in this case are not decision makers as defined inYoungberg. Instead they are the direct care workers whose primary responsibility is carrying out the directions of the officials who determine patient care. Plaintiffs have cited no case in which non-professionals such as these defendants were held to have violated the rights alleged. Whether the Youngberg standards should apply to non-professionals may be arguable, but with no clearly established law to that effect, defendants are entitled to qualified immunity on this claim.
B. As to the allegations of physical abuse categor y of plaintiff's claims, defendants acknowledge that a patient in a mental hospital has a substantive due process right to a safe environment, Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28(1982). A clai m that those charged with the responsibility of providing daily care to such a patient inflicted physi cal or mental abuse on him states the denial of a constitutional right. Defendants contend that in this case, however, plaintiffs' allegations of abuse in their complaint lacked the factual specificity required to overcome the defense of qualified immunity. We hold that the complaint is sufficient to withstand a Rule 12(b)(6) motion. As is required under Fed.R.Civ.P. 8(a), the complaint contains a short and plain statement of the facts upon which the claims against these defendants are based sufficient to allege violation of a clearly established constitutional right. 1authority or discretionary right to subject him to or inflict abuse or to any physical restraint in non-emergencies without the order of a physician, nor to inflict physical punishment....
98. Kyle was seized, held, restrained and touched by HST Defendants beyond that permitted by his treatment plan or by order of physician or by rules of the facility. Such actions were non-consensual. He was touched, pulled and grabbed, in cluding grabbed in his genitals, without cause, excessively, maliciously and as punishment. 

### 6 Defendants complain that the allegations are t oo general because they collectively accuse all the defendants of all the acts and because the accuser, Kyle, is mentally impaired and unable to communicate his fears or to report abuse by others. The fact thatdefendants are accused collectively does not render the complaint deficient. The complaint can be fairly read to aver that all defendants are responsible for the alleged conduct. Defendants' contention regarding Kyle's inability to communicate is a question of proof, not pleading. It is conceivable that there are other sources of knowledge con cerning the alleged misconduct. Nor does this complaint suffer fro m the deficiencies discussed in GJR Investments, Inc., v. County of Escambia, Fla., 132 F.3d 1359(11th Cir.1998) and Oladeinde v. City of Birmingham, 963 F.2d 1481(11th Cir.1992), upon which defendants' rely for their argument that the complaint does not meet the heightened pleading requirement applicable to section 1983 actions against individual government officials. In both GJR and Oladeinde, the Court addressed the problem of "shotgun pleading," in which the complaint "presents scores of allegations regardless of their relevance and incorporates them in their entirety into several counts asserting discrete claims for relief, each of which c ontains several references to haphazardly described constitutional 'rights.' " GJR Investments, 132 F.3d at 1368. No such problem exists here. In this case, plaintiffs have identified the defenda nts who were personally involved in the care of Kyle and in the alleged acts upon which the alleged constitutional violation is based. The complaint alleges with sufficient particularity facts establishing a causal conn ection between defendants' actions and the alleged constitutional violation for purposes of overcoming defendants' qualified i mmunity. More specificity can be

### 7 developed as the case proceeds. Of course, we voice no opinion as to whether the defendants, or any one of them, may be able to prevail ultimately on a motion for summary judgment.
IV. In conclusion, defendants are entitled to qualified i mmunity on plaintiffs' claim that defendants failed to provide minimally adequate care, treatment and trai ning in violation of Kyle's 14th amendment substantive due process rights as established in Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28(1982). There is no clearly-established law that would make the requirements of Youngberg apply to non-professional employees at the time of the actions subject to this comp laint. The complaint against them alleging that cause of action should have been dismissed. The complaint adequately states a cause of action to withstand a 12(b)(6) motion, however, regarding the allegations that defendants abused Kyle in violati on of his substantive due process rights. We therefore affirm the district court's decision that these defendants are not entitled to qualified immunity on these claims on a motion to dismiss. AFFIRMED IN PART, REVERSED IN PART AND REMANDED FOR FURTHER
PROCEEDINGS CONSISTENT WITH THIS OPINION.