Doe v. Shenandoah Valley Juvenile Ctr. Comm'n

• Decision Date: 12 January 2021
• Docket Number: No. 19-1910,19-1910
• Citation: 985 F.3d 327
• Parties: John DOE 4, BY AND THROUGH his next friend, Nelson LOPEZ, on behalf of himself and all persons similarly situated, Plaintiff – Appellant, v. SHENANDOAH VALLEY JUVENILE CENTER COMMISSION, Defendant – Appellee. Current and Former State Attorneys General; Elected Prosecutors; Corrections Leaders, Criminal Justice Leaders; Disability Rights Leaders, Amici Supporting Appellant.
• Court: U.S. Court of Appeals — Fourth Circuit

985 F.3d 327

John DOE 4, BY AND THROUGH his next friend, Nelson LOPEZ, on behalf of himself and all persons similarly situated, Plaintiff – Appellant,

v.SHENANDOAH VALLEY JUVENILE CENTER COMMISSION, Defendant – Appellee.

Current and Former State Attorneys General; Elected Prosecutors; Corrections Leaders, Criminal Justice Leaders; Disability Rights Leaders, Amici Supporting Appellant.

No. 19-1910

United States Court of Appeals, Fourth Circuit.

Argued: October 28, 2020

Decided: January 12, 2021

Amended: January 14, 2021

ARGUED: Theodore A. Howard, WILEY REIN, LLP, Washington, D.C., for Appellant. Jason A. Botkins, LITTEN & SIPE, LLP, Harrisonburg, Virginia, for Appellee. ON BRIEF: Hannah E.M. Lieberman, Mirela Missova, WASHINGTON LAWYERS’ COMMITTEE FOR CIVIL RIGHTS AND URBAN AFFAIRS, Washington, D.C., for Appellant. Joshua S. Everard, LITTEN & SIPE, LLP, Harrisonburg, Virginia; Harold E. Johnson, Meredith M. Haynes, WILLIAMS MULLEN, Richmond, Virginia, for Appellee. Neil R. Ellis, Mark E. Herzog, David A. Miller, SIDLEY AUSTIN LLP, Washington, D.C., for Amici Current and Former State Attorneys General, Elected Prosecutors, Corrections Leaders, Criminal Justice Leaders, and Disability Rights Leaders.

Before GREGORY, Chief Judge, WILKINSON, and KEENAN, Circuit Judges.

Reversed and remanded by published opinion. Chief Judge Gregory wrote the opinion, in which Judge Keenan joined. Judge Wilkinson wrote a dissenting opinion.

GREGORY, Chief Judge:

Appellants are a class of unaccompanied immigrant children detained at Shenandoah Valley Juvenile Center who challenge the adequacy of their medical care. After fleeing their native countries due to harrowing traumas, many of these children struggle with severe mental illnesses, resulting in frequent self-harm and attempted suicide. Appellants filed a class action suit alleging, among other things, that the Shenandoah Valley Juvenile Center Commission fails to provide a constitutionally adequate level of mental health care due to its punitive practices and failure to implement trauma-informed care. The district court granted summary judgment to the Commission after finding that it provides adequate care by offering access to counseling and medication.

But the district court incorrectly applied a standard of deliberate indifference when it should have determined whether the Commission substantially departed from accepted standards of professional judgment. Accordingly, we reverse and remand for further proceedings so that the court may apply the appropriate standard and consider all evidence relevant to it.

I.

Appellants are immigrant children who fled their native countries—mainly Honduras, Guatemala, Mexico, and El Salvador—after experiencing appalling horrors. Some have been brutally assaulted, including by their own families. J.A. 1116–17, 1128, 1246–49. Others have seen their friends and families murdered before their eyes. Id. All faced circumstances so dire, they were forced to flee hundreds of miles for safety.

Under federal law, Appellants are unaccompanied alien children ("UACs"): children under the age of 18 who have no lawful immigration status¹ and no parent or legal guardian in the United States available to care for them. 6 U.S.C. § 279(g)(2). Upon arrival in the United States, they fall under the custody of the Department of Health and Human Service's Office of Refugee Resettlement ("ORR"). 6 U.S.C. § 279(a) ; 45 C.F.R. § 410.207. ORR coordinates the care and placement of unaccompanied children. It is responsible for identifying qualified individuals, entities, and facilities to house them; placing children in the care of those individuals or facilities; and supervising those individuals and facilities to ensure that they provide adequate care. 6 U.S.C. § 279(b)(1)(A)–(L) ; 45 C.F.R. § 410.102.

Federal statute requires these children to "be promptly placed in the least restrictive setting that is in the best interest of the child," 8 U.S.C. § 1232(c)(2)(A), and any facility housing them must be "capable of providing for the child's physical and mental well-being." Id. § 1232(c)(3)(A). Similarly, federal regulations state that ORR "shall hold UACs in facilities that are safe and sanitary and that are consistent with ORR's concern for the particular vulnerability of minors." 45 C.F.R. § 410.102(c). "Within all placements, UACs shall be treated with dignity, respect, and special concern for their particular vulnerability." Id. § 410.102(d).

A.

The Shenandoah Valley Juvenile Center ("SVJC") is a secure juvenile detention facility in Staunton, Virginia. J.A. 30. It is run by the Shenandoah Valley Juvenile Center Commission ("the Commission"), a governmental entity formed under Virginia law by the Cities of Harrisonburg, Lexington, Staunton, and Waynesboro, and the Counties of Rockingham, Augusta, and Rockbridge. Id. SVJC provides education, housing, and medical care to unaccompanied immigrant children who, in the discretion of ORR, require a secure placement due to safety concerns. J.A. 103. SVJC also houses youth from surrounding jurisdictions who have been charged with a crime but have not yet had their cases adjudicated. J.A. 125. The facility houses approximately 20 to 40 unaccompanied immigrant children at any given moment. J.A. 1599, 1650.

When a child is referred to SVJC, licensed clinicians review the child's documentation, including any case summaries, school records, disciplinary history, clinician notes, psychological evaluations, and hospitalization records. J.A. 575, 1299–1301. In some cases, clinicians reject the placement of a child at SVJC if they determine that SVJC cannot provide the necessary services for a child's mental health needs. J.A. 1302–03. If a child is accepted by SVJC, resident supervisors perform an initial intake—including a mental health questionnaire and interview—followed by an assessment by case managers and clinicians. J.A. 569–75, 1207. This assessment allows SVJC's clinicians to learn about the child's social and disciplinary history while in custody. J.A. 1301. Clinicians also learn about the child's family history and journey to the United States. Id. After the follow-up assessment, clinicians may refer a child for evaluation by a psychologist, subject to ORR approval. J.A. 103, 1383–84, 1451.

SVJC recognizes that most of the unaccompanied children it cares for have experienced severe trauma. Its Deputy Director of Programs testified before a Senate Subcommittee on Investigations that "[t]he majority of unaccompanied children in a secure setting [such as SVJC] have histories of repeated and various forms of abuse and neglect; life-threatening accidents or disasters; and interpersonal losses at an early age or for prolonged periods of time." J.A. 1967. SVJC's lead clinician testified that "a high percentage" of the unaccompanied children at SVJC have experienced trauma, J.A. 1455, and the facility's lead case manager affirmed the "high need for mental health treatment" for the children at SVJC "given the background of these minors, what they've witnessed in [their] home countr[ies] ... prior to undergoing a pretty traumatic journey to the United States." J.A. 1807. Around 2017, SVJC began including in its annual staff trainings a section on trauma, common traumatic experiences of resident children, and ways to engage with those suffering from trauma. J.A. 97, 190–91, 194–98, 205–06, 1192–93, 1961.

The facility also provides certain mental health services to its residents. Each resident is assigned a case manager and licensed mental health clinician.² J.A. 100, 881, 1064, 1853. Residents meet with their clinicians for one-on-one counseling for about an hour at least once each week. See J.A. 896–963. Residents can request additional visits with their clinicians, though their requests are sometimes denied or ignored. See J.A. 700–01, 820–21. Besides one-on-one counseling, clinicians also lead twice-weekly, 5- to 15-minute-long group counseling sessions. J.A. 955–56, 958–59, 1055–58. Additionally, the facility has a psychiatrist, Dr. Timothy Kane, who visits the facility every three to six weeks. J.A. 1385. But Dr. Kane does not provide counseling or any form of psychotherapy—rather, he prescribes medications and offers "medication management." J.A. 822, 1324–25, 1384–85, 1480–81, 1486. Despite the services it offers, SVJC acknowledges that the facility does not have "the internal capacity to deal effectively with the needs of unaccompanied kids who have severe mental illness" because it lacks the treatment capabilities of "a residential treatment center or hospital." J.A. 1357–58. For example, it does not offer prolonged exposure therapy to treat PTSD because its clinicians are not qualified to offer such treatment.³ J.A. 1487–88.

As a secure juvenile detention facility, SVJC also imposes various forms of discipline upon the children there. The facility's sanctions range from verbal reprimands to removal from daily programming and room confinement. J.A. 1838–37. To enforce these sanctions, SVJC permits staff to engage in the use of force, purportedly as a last resort. J.A. 163–84. Staff are authorized to apply "physical restraint techniques" to physically grab the child in a hold akin to a "full nelson." J.A. 579; see also J.A. 1373–74. Staff may also bind a child in handcuffs or shackles; at times, staff will place restraints onto misbehaving children, strapping them onto an "emergency restraint chair," where they are trapped until they "tire themselves out." J.A. 1096, 1375–82. While Appellants initially challenged the constitutionality of these disciplinary practices on other grounds, these forms of punishment also tie into Appellants’ claim of inadequate mental health care. Appellants argue that when children at SVJC act out due to untreated trauma, SVJC has shown a pattern and practice of quickly resorting to these harsh and punitive measures, retraumatizing these children and worsening their underlying conditions. Opening Br. at...