Warren R. Harris v. Muriel Bowser , in Her Official Capacity As the Mayor of the District of Columbia

United States Court of Appeals
FOR THE DISTRICT OF COLUMBIA CIRCUIT
Argued October 7, 2022 Decided February 24, 2023
No. 21-7122
WARREN R. HARRIS ,
APPELLANT
v.
M URIEL B OWSER , IN HER OFFICIAL CAPACITY AS THE M AYOR
OF THE DISTRICT OF C OLUMBIA , ET AL.,
APPELLEES
Appeal from the United States District Court
for the District of Columbia
(No. 1:18-cv-00768)
Angela M. Farren argued the cause for appellant. With
her on the briefs were Francis H. Morrison III, Mary N.
McGarity Clark, Nicholas E. Gaglio, and Melanie Kiser.
Holly M. Johnson, Senior Assistant Attorney General, Of-
fice of the Attorney General for the District of Columbia, ar-
gued the cause for appellees. With her on the brief were Karl
A. Racine, Attorney General, Caroline S. Van Zile, Solicitor
General, Ashwin P. Phatak, Principal Deputy Solicitor Gen-
eral, and Carl J. Schifferle, Deputy Solicitor General.

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Before: HENDERSON and WALKER , Circuit Judges, and
TATEL, Senior Circuit Judge.
Opinion for the Court filed by Circuit Judge WALKER .
WALKER , Circuit Judge: The District of Columbia Depart-
ment of Behavioral Health had a policy of restraining civilly-
committed hospital patients during transport to court hearings.
It applied that policy to Warren Harris. He says the policy vi-
olated his Fifth Amendment right to be free from unjustified
bodily restraint.
It did not.
I. Background
In 2017, the Department of Behavioral Health recom-
mended to the D.C. Superior Court that a civilly-committed pa-
tient named Warren Harris be conditionally released from St.
Elizabeth’s Hospital. To decide whether to accept that recom-
mendation, the superior court scheduled a hearing.
Back then, the Department of Behavioral Health’s policy
was for the Department of Corrections to transport so-called
“forensic” detainees from the hospital to court. JA 144. Fo-
rensic detainees include patients, like Harris, who have been
found not guilty by reason of insanity.
During transit, the Department of Corrections places trans-
portees in full restraints. Thus, on the way to and from his
hearing, Harris was restrained using handcuffs, a waist chain,
and leg restraints. The Department of Corrections also re-
moved Harris’s belt, forcing court staff to help him hold up his
trousers at the hearing.

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After the superior court granted Harris conditional release,
he filed a § 1983 suit against an assortment of D.C. offi-
cials — including the directors of the Department of Correc-
tions and the Department of Behavioral Health. See 42 U.S.C.
§ 1983. Harris alleged that they violated his Fifth Amendment
due-process rights by transporting him in restraints. He sought
damages for “pain and suffering, degradation, and humiliation”
caused by the restraints. JA 16.1
The district court granted summary judgment for the D.C.
officials. Though civilly-committed patients like Harris enjoy
a Fifth Amendment right against bodily restraint, that right will
sometimes give way to important government interests. That,
the court held, was the case here.
Harris appealed. Reviewing the district court’s decision
de novo, we affirm. See Thompson v. District of Columbia,
832 F.3d 339, 344 (D.C. Cir. 2016).
II. The Fifth Amendment Due Process Framework
The Fifth Amendment Due Process Clause guarantees that
“[n]o person shall . . . be deprived of life, liberty, or property,
without due process of law.” U.S. Const. Amend. V. The “core
of the liberty protected by the Due Process Clause” is the “lib-
erty from bodily restraint.” Youngberg v. Romeo, 457 U.S.
307, 316 (1982) (cleaned up); see also Bolling v. Sharpe, 347
1 Harris also brought claims for injunctive and declaratory relief. But
those claims are now moot. In 2021, D.C. changed its restraint pol-
icy. It now requires an individual assessment of a detainee’s “risk of
harm to [him]self or others or for elopement.” JA 497. Had that
policy been in place when Harris was transported, he likely would
not have been restrained.

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U.S. 497, 499 (1954) (Fifth Amendment protections apply to
D.C.).
That right is retained when someone is lawfully confined,
but it is “not absolute.” Youngberg, 457 U.S. at 320. The gov-
ernment may restrain detainees, for instance, “to protect them
as well as others from violence.” Id. To decide whether a gov-
ernment intrusion on the right is allowed by the Constitution,
courts “balance the liberty of the individual and the demands
of an organized society.” Id. (cleaned up); see also Bell v.
Wolfish, 441 U.S. 520, 539 (1979).
The Supreme Court has given guidance about how the test
works when a detainee has not been convicted of a crime. The
two leading cases are Bell, 441 U.S. at 523, and Youngberg,
457 U.S. at 309.
In Bell, the Supreme Court considered the rights of pretrial
detainees. 441 U.S. at 523. Because they have not been con-
victed, the government may not impose restrictions that are in-
tended to punish. Id. at 535-37. Instead, restrictions must be
“reasonably related to a legitimate government[ ] objective.”
Id. at 539. And even then, restrictions which are “excessive in
relation to th[eir] purpose” are impermissible. Id. at 561. In
deciding whether there is a legitimate, nonexcessive govern-
ment interest, courts should defer to the “professional expertise
of corrections officials,” and not impose the “court’s idea of
how best to operate a detention facility.” Id. at 539, 540 n.23
(cleaned up).
In Youngberg, the Supreme Court evaluated the rights of
civilly-committed patients. 457 U.S. at 309. It found that
“there are occasions [o]n which it is necessary for the [govern-
ment] to restrain [patients]” as part of their medical treatment.
Id. at 320. To decide whether a restraint violates due process,

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a court should balance “the individual’s interest in liberty
against the [government’s] asserted reasons for restraining in-
dividual liberty.” Id. A decision to restrain a patient is “pre-
sumptively valid” if “made by a professional.” Id. at 323. If
so, “liability may be imposed only when the decision” is “a
substantial departure from accepted professional judgment,
practice, or standards.” Id.
Bell and Youngberg require a similar analysis. Both ask
whether the government’s reason for imposing restraints fur-
thers its legitimate interest. Bell, 441 U.S. at 540; Youngberg,
457 U.S. at 321. And both give deference to the “professional
expertise” of government officials. Bell, 441 U.S. at 548
(cleaned up); Youngberg, 457 U.S. at 324.
But the two tests concentrate on different aspects of the
inquiry. Under Bell, courts home in on whether the govern-
ment’s justification was “related to a legitimate nonpuni-
tive . . . purpose.” 441 U.S. at 561. Yet under Youngberg,
courts focus on whether “professional judgment in fact was ex-
ercised.” 457 U.S. at 321 (cleaned up). Though the differences
between those standards might sometimes matter, they will of-
ten produce the same result. Cf. Beaulieu v. Ludeman, 690 F.3d
1017, 1032 (8th Cir. 2012) (“Whether one applies Youngberg’s
professional judgment standard or Bell’s punitive versus non-
punitive distinction, the outcome is the same.” (cleaned up)).
Perhaps for that reason, courts of appeals are split on
which test applies where, as here, a civilly-committed patient
is restrained for a nonmedical purpose. See, e.g., Rosado v.
Maxymillian, 2022 WL 54181, at *3 n.4 (2d Cir. 2022) (defer-
ring under Youngberg to the “judgment exercised by security
officials” tasked with ensuring that civilly-committed patients
do not escape during transport); Lane v. Williams, 689 F.3d
879, 882 (7th Cir. 2012) (refusing to apply Youngberg to a

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civil-commitment facility’s security policy because that case
applies only to “treatment decisions”); Matherly v. Andrews,
859 F.3d 264, 274-76 (4th Cir. 2017) (harmonizing Bell and
Youngberg into one test).
We need not pick a side in that split. Bell and Youngberg
each show that the D.C. officials did not violate Harris’s Fifth
Amendment rights.
III. The Restraints Were Justified Under Bell
Start with Bell. To survive Fifth Amendment scrutiny, re-
strictions must be “reasonably related to a legitimate,” nonpu-
nitive, “government[ ] objective.” Bell, 441 U.S. at 539. And
those restrictions must not be “excessive in relation to that pur-
pose.” Id. at 561.
The Department of Behavioral Health’s restraint policy
clears that test. As in Bell, the policy is “reasonably related
to . . . maintaining . . . security.” Id. at 540. The policy re-
quired forensic detainees to be transported by the Department
of Corrections. And the Department of Corrections restrained
transportees to “prevent injuries, escapes, and to safeguard the
public.” JA 459. According to the unrebutted testimony of the
Government’s expert, the policy achieved that goal: “re-
straints” ensure “the safety of individuals being transported, the
staff members and the public, and also . . . prevent or discour-
age escape.” JA 508-09 (declaration of Roy Gravette).
The policy was also not excessive. The Government’s ex-
pert testified that “the decision to use handcuffs, leg irons[,]
and a belly chain was appropriate for the type of trip and [the]
circumstances.” Id. at 509. Plus, transporting detainees in full
restraints for security reasons “is a common practice among
corrections systems nationwide.” Id. at 494 (declaration of

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John M. Armstrong, Commander of the D.C. Court Transport
Unit). That suggests the Department’s transport policy was not
so outside the bounds of normal practice that we should view
it as unconstitutionally excessive.2
True, Harris’s expert says “it would be unusual for a cor-
rectional department to assert its own restraint practices” over
a civilly-committed patient. JA 225. But here, the Department
of Behavioral Health’s Chief Nurse Executive, not the Depart-
ment of Corrections, adopted the restraint policy. JA 147; see
also Beaulieu, 690 F.3d at 1032-33 (finding that full-restraint
policies are commonly used to transport civil detainees).
IV. The Restraints Were Justified Under Youngberg
To show that the restraint policy violated the Constitution
under Youngberg, Harris must prove that it was not an exercise
of “professional judgment.” Youngberg, 457 U.S. at 323.
There are two ways to do that. First, he could demonstrate that
the policy was not “made by a professional.” Id. Second, even
if it was made by a professional, he could show that the policy
was “such a substantial departure from accepted professional
judgment, practice, or standards . . . that the person responsible
actually did not base the decision on such a judgment.” Id.
Harris fails to do either.
2 Though we have significant qualms about how the Department’s
policy was applied at Harris’s hearing — court staff should not need
to help a patient hold up his pants — that does not make the Depart-
ment of Behavioral Health’s general policy unconstitutional. Why
the court permitted the proceeding to continue without recessing to
allow Harris to appear before it fully clothed and without assistance
is inexplicable.

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First, the policy was “made by a professional.” Id. The
Department of Behavioral Health’s Chief Nurse Executive ap-
proved the hospital’s policy of having detainees transported in
full restraints by the Department of Corrections. JA 147. She
is a registered nurse with a PhD and has experience in hospital
administration, so she is “competent . . . by education, training
[and] experience” to make decisions about patient safety dur-
ing transport. Youngberg, 457 U.S. at 323 n.30.3
Second, the policy was not a “substantial departure” from
the “practice[s] or standards” for transporting civilly-commit-
ted patients. Id. at 323. As we have already noted, the Gov-
ernment’s expert said the policy reflects “basic correctional
principles and techniques” and “utilize[s] the same basic escort
restraint procedures” as other law-enforcement agencies na-
tionwide. JA 508-09 (declaration of Roy Gravette).
No evidence rebuts that testimony. Harris’s expert con-
ceded that he was not qualified “to offer an opinion on th[e]
technical issues” involved in “transporting inmates.” JA 482.
He instead opined that the use of restraints “represents a sub-
stantial deviation from typical medical judgment.” Id. (empha-
sis added).
But the Nurse Executive was entitled to consider security
in her decision about the transport-restraint policy. See Young-
berg, 457 U.S. at 324 (the government may “restrain
3 At one point in his briefing, Harris suggested that he is not chal-
lenging the policy writ-large, but instead line-level correctional offi-
cials’ decision to restrain him — and that those officers are not pro-
fessionals who get deference under Youngberg. Harris Br. 21-23.
But Harris backed away from that point at argument, clarifying that
he was aggrieved by a “blanket . . . policy” that subjected him to re-
straints even though he “did not pose a risk of danger or elopement.”
Oral Arg. Tr. 6.

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residents . . . when . . . necessary to assure . . . safety”); Beau-
lieu, 690 at 1033 (a restraint policy was a reasonable exercise
of professional judgment under Youngberg where it was
adopted “for the safety of the public and staff and to prevent
escapes”).
So even if Harris shows that the Nurse Executive’s deci-
sion was not the best medical decision, he does not show that
it was a “substantial departure from accepted professional judg-
ment,” because hospital administrators like the Nurse Execu-
tive may base their judgments on security concerns as well as
medical ones. Youngberg, 457 U.S. at 323.
Because Harris offers no evidence to show that the policy
was a substantial departure from accepted standards for trans-
porting civilly-committed patients, his claim under Youngberg
fails.
So ordered.

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