United States v. Shronda Covington

USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 1 of 38 PUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 25-4282 UNITED STATES OF AMERICA, Plaintiff – Appellee, v. SHRONDA COVINGTON, Defendant – Appellant. No. 25-4283 UNITED STATES OF AMERICA, Plaintiff – Appellee, v. TONYA FARLEY, Defendant – Appellant. Appeals from the United States District Court for the Eastern District of Virginia, at Richmond. Roderick Charles Young, District Judge. (3:23-cr-00068-RCY-1; 3:23-cr- 00068-RCY-2) Argued: May 8, 2026 Decided: July 2, 2026 Before WYNN, RUSHING, and HEYTENS, Circuit Judges. USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 2 of 38 Affirmed in part, vacated in part, and remanded by published opinion. Judge Heytens wrote the opinion, which Judge Wynn joined and which Judge Rushing joined except as to Part II(C)(2). Judge Rushing wrote an opinion concurring in part and dissenting in part. ARGUED: Fernando Groene, FERNANDO GROENE, PC, Williamsburg, Virginia; Robert James Wagner, ROBERT J. WAGNER PLC, Richmond, Virginia, for Appellants. Katherine McCallister, UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellee. ON BRIEF: Harmeet K. Dhillon, Assistant Attorney General, Jesus A. Osete, Principal Deputy Assistant Attorney General, Andrew G. Braniff, Christopher C. Wang, Appellate Section, Civil Rights Division, UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellee. 2 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 3 of 38 TOBY HEYTENS, Circuit Judge: An incarcerated person—whom we will call W.W.—died a horrific death in Bureau of Prisons (BOP) custody. After an investigation, various BOP employees were charged with criminal offenses arising from W.W.’s death, including Shronda Covington and Tonya Farley. A jury found Covington guilty of violating W.W.’s constitutional rights under 18 U.S.C. § 242 and both Covington and Farley guilty of making false statements in violation of 18 U.S.C. § 1001. We conclude the evidence was sufficient to convict Covington and Farley on all three counts and reject their various other challenges to their Section 1001 convictions. But we conclude the district court erred in: (1) denying Covington’s request for a proximate-cause instruction on the Section 242 count; and (2) calculating Farley’s offense level under the United States Sentencing Guidelines. We thus vacate Covington’s conviction on the Section 242 count, vacate both defendants’ sentences, and remand for further proceedings. I. Around 3:30 a.m. on January 9, 2021, W.W. began experiencing a medical crisis. Covington was the highest-ranking official on duty when the crisis began, and, for the next four-and-a-half hours, she was the only on-site official with authority to call a physician or send an inmate to the hospital. Jurors heard competing stories about that night. According to correctional officers on duty, Covington was told that W.W. needed medical attention—specifically, that he kept falling and hitting his head, could not respond to questions, was incontinent, and was 3 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 4 of 38 “eating out of the trash can,” JA 1909—but did nothing to help him. The government also presented evidence that, before clocking out at 8 a.m., Covington asked another officer to enter a record falsely stating that Covington had “done her rounds that night.” JA 2111. In contrast, Covington insisted correctional officers never told her about W.W.’s symptoms. Over the next 24 hours, multiple BOP employees interacted with W.W. as he continued to deteriorate. Farley—a BOP nurse—was one of those employees. Farley examined W.W., saw his alarming symptoms, learned he had fallen, and believed he might have a head injury. But rather than contacting the on-call physician (Dr. Young) or sending W.W. to the hospital per BOP policy, Farley called the prison’s on-call psychologist, Dr. Biber. Farley told Dr. Biber about W.W.’s symptoms, said W.W. “wasn’t going to go to the hospital,” and relayed information from another nurse that W.W. “had a razor blade in his cell, [was] carrying it around, and that there was concern that he might try to use it to cut himself.” JA 2470. Dr. Biber directed the prison to place W.W. on suicide watch. Farley then submitted a “clinical encounter” report stating W.W. showed no signs of “acute distress.” JA 6108–09. W.W. was strapped to a gurney and moved to a suicide-watch cell, where he was unstrapped. Over the next ten hours, W.W. repeatedly fell—crashing into walls and hitting his head. Officers saw those falls but did not intervene. Around 6:30 a.m. on January 10, 2021, W.W. fell headfirst into a wall and did not move again. Roughly 90 minutes later, BOP employees entered the suicide-watch cell and found W.W.’s dead body. A medical examiner concluded W.W. sustained multiple skull fractures and that the cause of death was blunt force trauma to the head. 4 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 5 of 38 The Department of Justice’s Office of the Inspector General (OIG) launched an investigation into W.W.’s death. When OIG interviewed Covington, she claimed she did not know about W.W.’s symptoms on January 9 or ask another officer to enter a false record stating she did her rounds that morning. For her part, Farley claimed that: (1) she called Dr. Young (the on-call physician) on January 9; (2) Dr. Young told her to call Dr. Biber (the on-call psychologist); and (3) Dr. Young said W.W. “would not be going to the hospital.” JA 2571–72. Covington and Farley (as well as a third codefendant who was found not guilty on the sole charge against her) were charged with violating 18 U.S.C. § 242 by willfully depriving W.W. of his Eighth Amendment right to be free from cruel and unusual punishment. Such violations are generally misdemeanors. See United States v. Cowden, 882 F.3d 464, 475 (4th Cir. 2018). But if “bodily injury” or “death” “results from” a violation, the offense becomes a felony and the defendant is subject to more severe penalties. 18 U.S.C. § 242; see Cowden, 882 F.3d at 475. Here, the indictment charged that Covington’s and Farley’s conduct “resulted in” both W.W.’s bodily injury and death. JA 95. Covington and Farley also were charged with making false statements to OIG investigators in violation of 18 U.S.C. § 1001. Finally, Farley was charged with violating 18 U.S.C. § 1519 by including false information in her January 9 clinical report. During the lead-up to trial, the parties disagreed about how the jury should be instructed on Section 242’s “bodily injury . . . [or] death results from” element. Covington requested a proximate-cause instruction, asking the district court to charge the jury that the government “must prove beyond a reasonable doubt that W.W.’s death or bodily injury 5 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 6 of 38 was a proximate result of the defendant’s conduct, in the sense of being a natural and foreseeable result of that conduct.” JA 1173. In contrast, the government asserted it need only prove that Covington’s actions were a but-for cause of W.W.’s injury or death. The district court sided with the government and gave instructions that referenced only but-for causation. After an 11-day trial, the jury returned its verdict. On the Section 242 charges, the jury found Covington guilty and Farley not guilty and further found that Covington’s Section 242 violation resulted in bodily injury to W.W. but not his death. The jury found both Covington and Farley guilty of making false statements to OIG investigators (the Section 1001 charges) but found Farley not guilty of making a false report (the Section 1519 charge). At sentencing, the parties debated whether the district court could consider Farley’s January 9, 2021, conduct in calculating the advisory Guidelines range for her sole offense of conviction: making false statements to OIG. Farley asserted her actions or omissions on January 9 were not “relevant conduct” as defined by the Guidelines; and, even if they were, a recent amendment barred the district court from considering conduct for which she was acquitted (deliberate indifference to W.W.’s constitutional rights and making a false clinical report). The district court disagreed and later applied three enhancements—in Guidelines lingo, “adjustments”—based on Farley’s January 9 conduct. Without those enhancements, Farley’s Guidelines range would have been zero to six months of imprisonment; including them increased that range to 10 to 16 months. The district court sentenced Farley to six months of incarceration followed by six months of home detention 6 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 7 of 38 and Covington to a year of incarceration followed by a year of home detention. II. Covington challenges her 18 U.S.C. § 242 conviction on two primary grounds. She first argues that the district court erred by not instructing the jury that, for Section 242 purposes, bodily injury only “results from” a defendant’s conduct if that conduct was both the but-for and proximate cause of the victim’s injury. Covington also contends the jury heard insufficient evidence to find her guilty on the Section 242 count, both in general and on the bodily-injury enhancement. We must start with Covington’s sufficiency challenge because “any defendant who prevails” on such grounds is “entitled to a judgment of acquittal without further proceeding[s].” United States v. Huskey, 90 F.4th 651, 662 (4th Cir. 2024). For purposes of this appeal, we will assume that we assess sufficiency by reference to Section 242’s true “elements” rather than “how the jury was instructed” in Covington’s case. Musacchio v. United States, 577 U.S. 237, 243 (2016). 1 Because the parties disagree about what Section 242’s precise requirements are, our analysis will proceed in three parts. First, we ask whether—as a matter of statutory interpretation—Section 242’s “bodily injury results from” language requires that the 1 Musacchio holds that “when a jury instruction sets forth all the elements of the charged crime but incorrectly adds one more element, a sufficiency challenge should be assessed against the elements of the charged crime” rather than against the erroneous jury instruction. 577 U.S. at 243 (emphasis added). Because the parties have not briefed the issue and it is not outcome-determinative in this appeal, we assume without deciding that Musacchio’s rule extends to situations—like this one—when a district court allegedly omits a requirement rather than adding an incorrect one. 7 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 8 of 38 defendant’s conduct be the proximate cause of the victim’s injury. We conclude it does. Second, having identified Section 242’s requirements, we consider whether there was sufficient evidence to support the jury’s verdict. We conclude there was. Third, having determined Covington was not entitled to a judgment of acquittal, we ask whether Covington’s Section 242 conviction must be vacated because the jury was improperly instructed. For a final time, we answer yes. We thus vacate Covington’s Section 242 conviction and remand for further proceedings. A. “The law has long considered causation a hybrid concept, consisting of two constituent parts: actual cause and legal cause.” Burrage v. United States, 571 U.S. 204, 210 (2014). Conduct is an outcome’s “actual” cause if “the result would not have happened in the absence of the conduct; or, putting it another way, that ‘but for’ the antecedent conduct the result would not have occurred.” Wayne R. LaFave, 1 Substantive Criminal Law § 6.4(b) (3d ed. 2025) (LaFave). In contrast, “legal” or “proximate” cause is often described “in terms of foreseeability or the scope of the risk created by the predicate conduct” and “serves . . . to preclude liability in situations where the causal link between conduct and result is so attenuated that the consequence is more aptly described as mere fortuity.” Paroline v. United States, 572 U.S. 434, 445 (2014). Our threshold question here is whether Section 242’s authorization of greater penalties when “bodily injury results” requires only a showing of but-for cause (as the government argues) or also that the defendant’s conduct was the proximate cause of the victim’s injury (as Covington contends). 8 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 9 of 38 This Court has already addressed that question in connection with Section 242’s closely related neighbor: 18 U.S.C. § 241. Section 241 makes it unlawful to conspire against someone for exercising their constitutional rights, and, like Section 242, it imposes heightened penalties if a particular outcome “results from” the violation. See § 241 (“if death results from” a violation, defendant “shall be fined . . . or imprisoned for any term of years or for life, or both, or may be sentenced to death”). In United States v. Harris, 701 F.2d 1095 (4th Cir. 1983), this Court—quoting a case interpreting Section 242—stated that “the phrase ‘if death results’ ” in Section 241 means “that the ‘death ensued as a proximate result of the accuseds’ willful violation of a victim’s defined rights.’ ” Id. at 1101 (quoting United States v. Hayes, 589 F.2d 811, 820 (5th Cir. 1979)). The Second Circuit has likewise concluded that Section 241’s “results from” language incorporates a proximate-cause requirement. See United States v. Guillette, 547 F.2d 743, 749–50 (2d Cir. 1976). That conclusion lines up with background principles about how causation operates in criminal law. See Hewitt v. United States, 606 U.S. 419, 431 (2025) (“When interpreting statutes, we recognize that Congress legislates against the backdrop[ ] of certain unexpressed presumptions.” (alterations and quotation marks removed)). As the Supreme Court has explained, if an offense “requires not merely conduct but also a specified result of conduct, a defendant generally may not be convicted unless his conduct is both (1) the actual cause, and (2) . . . the ‘proximate cause’[ ] of the result.” Burrage, 571 U.S. at 210 (quotation marks removed); accord LaFave § 6.4; see also Model Penal Code § 2.03 (A.L.I. 2025). That general rule applies even when a statute does not “expressly impose” a 9 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 10 of 38 proximate-cause requirement. Paroline, 572 U.S. at 446. Having previously stated that Section 241’s “results from” language incorporates a proximate-cause requirement, it would be passing strange to read Section 242’s identical “results from” language differently. Sections 241 and 242 trace their lineage to the same Reconstruction-era statute, and Congress first added “results” language to both provisions in the Civil Rights Act of 1968. See United States v. Williams, 341 U.S. 70, 73–74 (1951) (describing these provisions’ common history); Pub. L. No. 90-284, § 103(a)–(b), 82 Stat. 73, 75 (1968). Indeed, this Court relied on Section 242 precedent—the Fifth Circuit’s decision in Hayes—when construing Section 241 in Harris. See 701 F.2d at 1101. Because the two provisions travel together, we conclude that Section 242’s “results from” provision also requires that the specified outcome (here, bodily injury) occur “as a proximate result of the accuseds’ willful violation of ” the victim’s rights. Id. (quotation marks removed). Adopting the government’s contrary position would create a genuine circuit split, an outcome we generally “try to avoid.” Scott v. Baltimore Cnty., 101 F.4th 336, 348 (4th Cir. 2024). The First and Fifth Circuits have held that “death” only “results from” a Section 242 violation if it is the “proximate result of ” the violation, United States v. Marler, 756 F.2d 206, 215–16 (1st Cir. 1985); Hayes, 589 F.2d at 821–22, and we know of no circuit going the other way. Cf. United States v. Gonzalez, 906 F.3d 784, 799 (9th Cir. 2018) (holding district court’s failure to instruct on proximate cause was not so obviously erroneous as to constitute plain error, thus leaving open whether Section 242 has a proximate-cause requirement). We also cannot see—and the government does not identify—any reason we would interpret Section 242’s “death results from” and “bodily 10 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 11 of 38 injury results from” clauses differently from each other. The government does not grapple with either this Court’s Section 241 precedent or the circuit split its preferred approach would create. Instead, the government relies on a line of cases about a different statute: a provision of the Controlled Substances Act authorizing enhanced penalties if “death or serious bodily injury results from” certain drug offenses. 21 U.S.C. § 841(b). In Burrage v. United States, 571 U.S. 204 (2014), the Supreme Court held that provision’s “death . . . results from” language requires, at “minimum,” that the defendant’s conduct be a but-for cause of the victim’s death while specifically reserving whether it also requires proximate cause. Id. at 208, 210–11. But like each of our “sister circuit[s] to address the question,” United States v. Jeffries, 958 F.3d 517, 520 (6th Cir. 2020), this Court has concluded—both before and after Burrage—that Section 841(b) contains no proximate-cause requirement. See United States v. Patterson, 38 F.3d 139, 144–45 (4th Cir. 1994) (pre-Burrage); United States v. Alvarado, 816 F.3d 242, 249 (4th Cir. 2016) (post-Burrage). Although the government’s brief assumes that the logic of our Section 841(b) decisions transfers neatly to Section 242, the reality is not so simple. For one thing, we think our statements about the closely analogous Section 241 bear much more directly on our interpretation of Section 242 than those about a drug-trafficking provision housed in a different title of the United States Code. What is more, our sister circuits are divided about whether (and if so, when) Section 841(b)’s no-proximate-cause rule extends beyond that provision’s specific context. Compare, e.g., United States v. Pineda-Doval, 614 F.3d 1019, 1026–28 (9th Cir. 2010) (declining to extend Section 841(b) precedent to a human 11 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 12 of 38 smuggling statute), with United States v. Webb, 655 F.3d 1238, 1255–56 (11th Cir. 2011) (extending Section 841(b) precedent to a healthcare fraud statute). Like the Ninth Circuit, we understand “[s]entencing factors applicable to drug crimes” like Section 841(b)’s penalty provision to be an “exception to the rule that the [g]overnment prove proximate cause when the charging statute calls for a certain result.” Pineda-Doval, 614 F.3d at 1028. “[T]he prevailing sense in the courts” is that these factors create “strict liability,” and thus, in that context, “[i]t is by no means unusual to peg the sentence to factors that were not known—or even foreseeable—to the defendant at the time the crime was committed.” Id. (quotation marks removed). But strict liability offenses, while “not unknown to the criminal law,” are “generally disfavored,” which further suggests that Section 841(b)’s lack of a proximate-cause requirement may be the exception rather than the rule. United States v. United States Gypsum Co., 438 U.S. 422, 437–38 (1978). And even if the logic of our Section 841(b) no-proximate-cause decisions extends to other statutes not currently before us (a question we do not decide), the government does not explain how the Reconstruction-era civil rights statute we consider here is analogous to the Controlled Substances Act in any relevant sense. We recognize that Congress has included express foreseeability or proximate-cause language in some criminal statutes. See Patterson, 38 F.3d at 145 n.7 (comparing Section 841(b) with the since-repealed Section 848(m)(4) of the Controlled Substances Act); Webb, 655 F.3d at 1256–57 (collecting criminal statutes with proximate-cause language). And it is true that “[w]here Congress includes particular language in one section of a statute but omits it in another section of the same Act, it is generally presumed that 12 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 13 of 38 Congress acts intentionally and purposely in the disparate inclusion or exclusion.” Russello v. United States, 464 U.S. 16, 23 (1983) (quotation marks removed). But that familiar rule of thumb is far less helpful when analyzing “different statutes,” even when those statutes have “identical language.” Yates v. United States, 574 U.S. 528, 537 (2015) (emphasis added). Much of the express foreseeability or proximate-cause language courts have identified appears in statutes that criminalize far different conduct than Section 242. See Patterson, 38 F.3d at 145 n.7 (continuing criminal enterprise provision of Controlled Substances Act); Webb, 655 F.3d at 1256–57 (provisions dealing with explosive devices, terrorism, criminal restitution, and aircraft-related fraud). What is more, Congress added express proximate-cause language to those other statutes decades after it first inserted “results” language into Section 242. 2 Cf. Bruesewitz v. Wyeth LLC, 562 U.S. 223, 242 (2011) (explaining that “[p]ost-enactment legislative history” does not “shed light on what legislators understood” when they enacted an earlier statute). As far as we are aware, courts have identified only one criminal civil rights statute that includes express proximate-cause language. That statute is 18 U.S.C. § 247(d), which 2 Compare Pub. L. No. 90-284, § 103(b), 82 Stat. 73, 75 (1968) (18 U.S.C. § 242), with Pub. L. No. 98-473, § 1014, 98 Stat. 1837, 2142 (1984) (18 U.S.C. § 844), and Pub. L. No. 100-690, § 7001, 102 Stat. 4181, 4391 (1988) (21 U.S.C. § 848(m)(4)), and Pub. L. No. 103-322, §§ 40113, 40221(a), § 250002(a)(2), 108 Stat. 1796, 1904, 1907, 1928, 2083 (1994) (18 U.S.C. §§ 2248, 2259, 2264, 2327), and Pub. L. No. 104-132, § 204(a), 110 Stat. 1214, 1227–28 (1996) (18 U.S.C. § 3663A), and Pub. L. No. 104-155, § 3, 110 Stat. 1392, 1392–93 (1996) (18 U.S.C. § 247), and Pub. L. No. 106-181, § 506(c)(1), 114 Stat. 62, 137–38 (2000) (18 U.S.C. § 38), and Pub. L. No. 107-56, § 809(a), 115 Stat. 272, 379–80 (2001) (18 U.S.C. § 3286), and Pub. L. No. 108-405, § 102(a), 118 Stat. 2260, 2263 (2004) (18 U.S.C. § 3771). 13 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 14 of 38 imposes enhanced penalties for destruction of religious property if “bodily injury results to any person, including any public safety officer performing duties as a direct or proximate result of conduct prohibited by” Section 247. See Webb, 655 F.3d at 1256; see also 18 U.S.C. § 247(d)(3) (similar). That language does not undermine our conclusion here. To begin—and unlike Section 241—Section 247 does not share a common statutory ancestor with Section 242. Compare Williams, 341 U.S. at 73–74 (describing how Sections 241 and 242 emerged from the same Reconstruction-era act), with S. Rep. No. 100-324, at 2–3 (1988) (citing “the growing number of incidents of religiously motivated violence” as the explanation for passing Section 247). Congress also added the “proximate result” language to Section 247 nearly three decades after it first added Section 242’s “results” language. Compare Pub. L. No. 90-284, § 103(b), 82 Stat. 73, 75 (1968) (adding “results” language to Section 242), with Pub. L. No. 104-155, § 3, 110 Stat. 1392, 1392–93 (1996) (adding proximate-cause language to Section 247). Finally, and most importantly, Section 247(d)’s “proximate result” language does not modify that offense’s causation element. Instead, it describes one category of victims whose harm can trigger the enhanced penalty provision: public safety officers “performing duties as a direct or proximate result of ” the defendant’s unlawful conduct. 18 U.S.C. § 247(d). Indeed, Section 247’s causation element is phrased identically to Section 242’s: Its enhanced penalties kick in only if “bodily injury results.” 14 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 15 of 38 18 U.S.C. § 247(d). 3 For all those reasons, Section 247(d)’s use of “proximate” sheds little light on the question before us. In sum, we hold that bodily injury only “results from” a defendant’s Section 242 violation if the defendant’s conduct was both the but-for and proximate cause of the victim’s injury. B. Having clarified the statutory requirements of a Section 242 bodily-injury offense, we turn to Covington’s sufficiency challenge. In assessing sufficiency, we consider all evidence the jury had before it—“both admissible and inadmissible”—viewed “in the light most favorable to the prosecution.” Huskey, 90 F.4th at 662 (quotation marks removed). We must assume the jury “resolved all credibility disputes or judgment calls in the government’s favor” and “uphold the jury’s verdict if any rational trier of fact could have found the essential elements of the crime beyond a reasonable doubt.” Id. (quotation marks removed). Applying those rigorous standards, we conclude Covington was not entitled to a judgment of acquittal on the Section 242 count. To show Covington violated the Eighth Amendment, the government had to prove that W.W. suffered from an “objectively serious” medical condition and that Covington “subjectively knew of and disregarded an excessive risk to [W.W.’s] health or safety.” Hixson v. Moran, 1 F.4th 297, 302 (4th Cir. 2021). Covington asserts there was insufficient We know of no decisions analyzing whether Section 247’s “results from” language 3 imposes a proximate-cause requirement. 15 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 16 of 38 evidence to prove either the objective or subjective elements, but the record tells a different story. The jury heard testimony that multiple officers told Covington during her shift that W.W. was falling repeatedly and hitting his head, could not respond to questions, and was incontinent and “eating out of the trash can.” JA 1909. W.W.’s cellmate was so worried that he pressed the duress button at least five times. Based on that evidence, a reasonable jury could have found that Covington subjectively knew W.W. was suffering from an “objectively serious” medical condition that was “so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.” Hixson, 1 F.4th at 302 (quotation marks removed). Covington errs in claiming that she lacked the required mens rea for Section 242 liability because she did not personally know W.W., “b[ear] him ill will,” or set out to violate his constitutional rights. Covington Br. 47. A defendant need not act with malice or “have been thinking in constitutional terms” to violate Section 242. Screws v. United States, 325 U.S. 91, 106 (1945). Instead, the statute requires that the defendant acted “with the particular purpose of violating a protected right” or “recklessly disregarded the risk that [she] would do so.” Cowden, 882 F.3d at 474 (alterations and quotation marks removed). The evidence would have permitted a reasonable jury to find that standard satisfied here. For purposes of Covington’s sufficiency challenge, we must assume the jury credited witnesses’ testimony that they repeatedly told her about W.W.’s symptoms. And despite conceding that BOP policy would have required her to act had she known about those symptoms, Covington admitted on the stand that she “took no action for [W.W.] that night.” JA 3192. Given that testimony, a reasonable jury could have found that Covington, 16 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 17 of 38 at minimum, “recklessly disregarded the risk” that her failure to act would deprive W.W. of his rights. Cowden, 882 F.3d at 474 (alterations and quotation marks removed). Finally, we reject Covington’s contention that there was insufficient evidence to support a finding that she “caused serious bodily injury to W.W.” Covington Br. 45. As we have explained, to satisfy that element, the government needed to prove that: (1) W.W. suffered at least one bodily injury; (2) but for Covington’s unlawful omissions, W.W. would not have suffered that injury; and (3) Covington’s unlawful omissions proximately caused that injury. “[B]odily injury” is a capacious term that includes, among other things, “any . . . injury to the body, no matter how temporary.” United States v. Perkins, 470 F.3d 150, 161 (4th Cir. 2006) (quotation marks removed). Here too, we conclude the evidence was sufficient to permit a reasonable jury to make the required findings. The jury heard evidence that W.W. fell repeatedly, both before and after Covington’s shift ended. It also heard that Covington knew W.W. was in serious distress and that she did nothing to help him, both during her shift and upon leaving the facility. A reasonable jury could have concluded that, but for Covington’s failure to intervene, W.W. would not have continued falling and sustaining bodily injury and that her failure to act had “a sufficient connection to” at least one of those injuries to satisfy the statute’s proximate-cause requirement. Paroline, 572 U.S. at 444. C. Having rejected Covington’s sufficiency challenge, we turn to the jury instructions. Covington argues the district court should have instructed the jury that the government needed to prove W.W.’s “bodily injury was a proximate result of the defendant’s conduct, 17 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 18 of 38 in the sense of being a natural and foreseeable result of that conduct.” JA 1173. That argument raises two questions: (1) whether there was error; and, if so, (2) whether any error was harmless. We conclude the district court exceeded its discretion by failing to instruct the jury on proximate cause. And because the government has not discharged its burden to show that error was harmless, we vacate Covington’s conviction on the Section 242 count and remand for further proceedings. See United States v. McFadden, 823 F.3d 217, 219– 20, 228 (4th Cir. 2016). 1. We review “[a] trial court’s decision not to give a proposed instruction . . . for abuse of discretion.” United States v. Raza, 876 F.3d 604, 614 (4th Cir. 2017). Refusing to give a particular instruction is “reversible error only if ” the proposed instruction: “(1) was correct, (2) was not substantially covered by the charge that the district court actually gave to the jury, and (3) involved some point so important that the failure to give the instruction seriously impaired the defendant’s defense.” Id. (quotation marks removed). All three requirements are satisfied here. The government dedicates its argument to the first issue, contending that “[n]o proximate cause instruction was required” because Section 242 requires only but-for causation. U.S. Br. 76–77. As we have explained, we disagree, and the government identifies no issues with the specific wording that Covington proposed. We thus conclude the proposed instruction accurately stated the law. We also conclude the content of Covington’s proposed instruction “was not substantially covered by” those the district court “actually gave.” Raza, 876 F.3d at 614 18 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 19 of 38 (quotation marks removed). To the contrary, the jury was told the government need prove only that “but for the [d]efendant’s deliberate indifference to [W.W.’s] serious medical needs, [W.W.] would not have suffered injury.” JA 1343. The jury was never informed of the government’s additional burden to prove that Covington proximately caused W.W. bodily injury. And even considering the jury instructions “as a whole,” we cannot see how anything in the court’s instructions “substantially covered” the missing proximate-cause requirement. Raza, 876 F.3d at 613–14 (quotation marks removed). Finally, Covington’s proposed proximate-cause instruction involved a “point so important that the failure to give the instruction seriously impaired [her] defense.” Raza, 876 F.3d at 614 (quotation marks removed). Covington’s theory of the case was—and remains—that she could not have foreseen the tragedy that ensued when she left the prison on the morning of January 9, 2021. We thus conclude the district court exceeded its discretion by declining to instruct the jury on proximate cause. 2. Even when (as here) a defendant preserves an objection, erroneous jury instructions are subject to harmless-error analysis. See Neder v. United States, 527 U.S. 1, 8–10 (1999). “The burden rests on the government, the beneficiary of the error, to show harmlessness.” United States v. Garcia-Lagunas, 835 F.3d 479, 488 (4th Cir. 2016). Two types of harmlessness are potentially relevant here. First, failing to expressly instruct a jury about a particular element is harmless if “the jury necessarily found the omitted element” given the court’s other instructions. United States v. Brown, 202 F.3d 691, 700 (4th Cir. 2000). Second, an instructional error is also harmless when “a reviewing 19 USCA4 Appeal: 25-4282 Doc: 104 Filed: 07/02/2026 Pg: 20 of 38 court concludes beyond a reasonable doubt that the omitted element was uncontested and supported by overwhelming evidence, such that the jury verdict would have been the same absent the error.” Id. (quoting Neder, 527 U.S. at 17). To begin, it is not clear the government has made any harmless-error argument. Rather, the government seems to have put all its eggs in the no-error basket, arguing that Section 242 has no proximate-cause requirement and the district court’s instructions were thus correct. The closest the government comes to a harmlessness argument is its claim that “no proximate-cause instruction was necessary” because bodily injury “is inherently foreseeable in most Section 242 cases” and “was an eminently ‘foreseeable result’ here” given the information Covington had. U.S. Br. 78–79 (discussing