State Custody, Not Admission Status: The Second Circuit’s Control-and-Dependency Test for Substantive Due Process Duties to Voluntarily Committed Residents
Commentary on J.M. v. Sessions, No. 24‑1997‑cv (2d Cir. Dec. 23, 2025)

I. Introduction

In J.M. v. Sessions, the United States Court of Appeals for the Second Circuit confronted a recurring but under-theorized question at the intersection of constitutional law and mental health care: when does a state’s duty under the Fourteenth Amendment to provide adequate medical care extend to individuals who are “voluntarily” admitted to a state‑run institution?

The plaintiff, J.M., sued under 42 U.S.C. § 1983 as administrator of the estate of her son, C.B., a 34‑year‑old man with developmental disabilities and mental health conditions who died of cardiomyopathy while residing at Valley Ridge Center for Intensive Treatment, an intensive‑treatment facility operated by the New York State Office for People with Developmental Disabilities (OPWDD). She alleged that staff ignored obvious and escalating signs of heart failure and restricted his ability to obtain emergency care, resulting in his death. She also asserted state-law negligence and medical malpractice claims.

The district court granted summary judgment to the defendants on the § 1983 substantive due process claim, reasoning that because C.B. had voluntarily admitted himself, the state had no constitutional duty to provide adequate medical care. It then declined supplemental jurisdiction over the state-law claims. On appeal, the Second Circuit vacated and remanded, holding that:

• A voluntarily admitted resident of a state-operated mental health or developmental disabilities facility can invoke substantive due process protections where the state’s actual control over the person’s life renders them unable to care for themselves.
• DeShaney’s “special relationship” doctrine is triggered not by the formal label of “voluntary” or “involuntary” admission, but by the reality of custodial restraint and dependency.
• This right to adequate medical care for developmentally disabled persons in such state custody was clearly established, defeating a global qualified‑immunity defense (though individual liability questions are remanded).
• The district court did not abuse its discretion in denying plaintiff’s very late motion to amend to add a nurse-defendant, because plaintiff had sufficient notice of that person’s involvement well before the scheduling deadline.

This decision is doctrinally important because it reaffirms and updates the Second Circuit’s 1984 holding in Society for Good Will to Retarded Children, Inc. v. Cuomo, clarifies how it coexists with the Supreme Court’s 1989 decision in DeShaney v. Winnebago County, and articulates a functional “control-and-dependency” test for when the state’s duty of care under substantive due process arises in modern institutional settings.

II. Summary of the Opinion

A. Factual Background

C.B. was a developmentally disabled adult with autism, mild intellectual disability, mood and impulse-control disorders, a history of head injury, and antisocial personality disorder. Around age 18, his mother concluded he could not be safely cared for at home and placed him in OPWDD’s care. In 2015, he applied for and was granted voluntary admission to Valley Ridge, a highly secure OPWDD facility.

Key features of Valley Ridge’s regime included:

• Perimeter fencing and a locked, secure environment.
• Residents—both “voluntary” and court-ordered—treated identically; staff were not told who was voluntary.
• Residents were not free simply to walk out. A voluntary resident who wished to leave had to tell the director; the director could retain the resident for up to 72 hours and seek court-ordered involuntary commitment.
• Staff exerted near-total control over residents’ daily lives and access to medical care.
• Residents could not call 911 directly; any such call would be routed internally to the facility’s safety department, which decided whether to contact emergency services. Such calls could be treated as “false reports” with potential criminal consequences.

In late 2017 and early 2018, C.B. developed worsening health problems:

• Diagnosed with hypertension in 2017.
• Rapid weight gain (at least 13 pounds in four months).
• Erratic breathing, constant complaints of “heartburn,” daytime lethargy, and nocturia (frequent nighttime urination) — recognized as classic symptoms of heart failure.

In the final week of his life:

• On April 4, 2018, he reported to staff member Katherina Cassata that he could not breathe, his chest hurt, and he was exhausted. Cassata testified she informed nurse Anita Baral, who supposedly told him to drink water and lie down.
• By April 6, his condition sharply worsened; Cassata described him as pallid, clammy, sweating, out of breath, and barely able to perform simple tasks.
• On April 8, C.B. called his mother, reporting he could not breathe and could not urinate, then abruptly hung up. Concerned, his mother called unit supervisor Michael Novack and relayed the symptoms. C.B. himself told Novack he was struggling to breathe and asked to go to the hospital. The record is disputed as to whether Novack notified nursing staff, but C.B. was not sent to a hospital.
• Later that day, nurse Elise Williams evaluated C.B. in the clinic. She observed breathing difficulty and complaints of urinary trouble. She took vitals (within normal limits), listened to his lungs (clear), and checked his bladder. She did not check his respiratory rate, listen to his heart, or order an EKG. She concluded sinus congestion was the problem, told him to take cough syrup, and encouraged hydration, then sent him back to his unit. Plaintiff’s expert later opined that aggressive hydration was dangerous given underlying cardiomyopathy and likely contributed to pulmonary edema.
• That night, trainee staff member Ashley Sessions was assigned to C.B.’s unit and was required to conduct two-hour bed checks (11 p.m., 1 a.m., 3 a.m., 5 a.m.). She failed to perform the 3 a.m. and 5 a.m. checks, falsified records to say she had done them, and later lied to the state police about it. Her supervisor, Corey Behlen, saw Sessions on the computer but did not ensure that checks were done; he watched television.

C.B. died in his bed during the early-morning hours of April 9, 2018. Plaintiff’s expert opined that he would have experienced an acute onset of pulmonary edema with a sensation of drowning shortly before death. He was found unresponsive at 6:30 a.m., cold to the touch with cyanotic lips.

B. Procedural History

• Complaint: J.M. filed suit in the Northern District of New York under § 1983, alleging that Valley Ridge staff violated C.B.’s substantive due process rights to adequate medical care and safe conditions, and asserted state-law negligence and medical malpractice claims.
• Attempted amendment: Sixteen months after the deadline to amend, and shortly before the end of discovery, plaintiff moved to amend to add nurse Baral as a defendant. The magistrate judge denied the motion under Rule 16(b) for lack of “good cause,” citing plaintiff’s lack of diligence, and the district judge affirmed.
• Summary judgment: The district court granted defendants’ motion for summary judgment on the § 1983 claim, holding that because C.B. was a voluntary resident, the state had not affirmatively restricted his liberty in a way that triggered a constitutional duty of care under the “special relationship” doctrine. The court declined supplemental jurisdiction over the state-law claims.

J.M. appealed, challenging (1) the dismissal of the substantive due process claim, and (2) the denial of leave to amend to add Baral.

C. Holdings of the Second Circuit

The Second Circuit (Judge Kahn, joined by Judges Parker and Carney) held:

1. Substantive Due Process Duty Exists: The district court erred in concluding that C.B. had no substantive due process right to adequate medical care due to his voluntary admission status. Under Society for Good Will, and consistent with Youngberg and DeShaney, “anyone in a state institution” whose liberty is sufficiently restrained and who is dependent on the state for basic needs — including voluntarily admitted residents — is entitled to constitutional protection to adequate medical care and safe conditions.
2. Admission Status Is Not Dispositive: The relevant inquiry is the degree of the state’s control and the resident’s dependency, not the formal label of voluntary or involuntary admission. Where the state’s custodial control renders a person unable to help himself — as at Valley Ridge, with severe restraints on leaving and on obtaining emergency medical care — the special relationship exception applies.
3. Right Was Clearly Established: This substantive due process right for developmentally disabled persons in such custodial settings was clearly established long before 2018, particularly by Youngberg and the Second Circuit’s own decisions. Therefore, defendants cannot obtain summary judgment on a global qualified‑immunity theory based on uncertainty about voluntary residents’ rights. The case is remanded for the district court (or a jury) to consider on an individual‑defendant basis whether each violated that clearly established right.
4. Denial of Motion to Amend Affirmed: The district court did not abuse its discretion in denying plaintiff’s motion to amend to add Baral. Plaintiff had sufficient information about Baral’s role from initial disclosures and internal investigation notes well before the scheduling deadline, and thus lacked “good cause” under Rule 16(b).

The Second Circuit vacated the judgment and remanded for further proceedings consistent with its opinion, including application of the proper constitutional framework and resolution of qualified immunity as applied to each defendant.

III. Analysis of the Opinion

A. Precedents and Doctrinal Framework

1. Youngberg v. Romeo (1982): The Foundational Duty to Involuntarily Committed Persons

In Youngberg v. Romeo, 457 U.S. 307 (1982), the Supreme Court held that individuals involuntarily committed to state mental institutions are entitled, under the Due Process Clause, to:

• Reasonable conditions of safety;
• Freedom from unreasonable bodily restraints; and
• Adequate food, shelter, clothing, and medical care.

The Court reasoned that when a person is institutionalized and wholly dependent on the state, the state assumes an affirmative duty to provide certain basic services and care. Substantive due process thus imposes “minimal custodial standards” on the state when it exercises such control.

Two aspects of Youngberg are crucial in J.M. v. Sessions:

• The standard is tied to custodial dependence rather than the precise mechanism of commitment.
• The rights recognized explicitly include adequate medical care, the central issue here.

2. Society for Good Will to Retarded Children, Inc. v. Cuomo (2d Cir. 1984)

In Society for Good Will to Retarded Children, Inc. v. Cuomo, 737 F.2d 1239 (2d Cir. 1984), the Second Circuit confronted a New York state institution for persons with developmental disabilities and held that:

“Anyone in a state institution has a right to safe conditions.”

Critically, the state argued that these substantive due process rights did not apply to residents who had not been admitted by court order — i.e., those “not classified as ‘involuntary.’” The court rejected that argument as “irrelevant,” holding that once the state chooses to house voluntary residents and thereby makes them dependent on the state for the essentials of life, it must do so in a manner consistent with the Constitution.

Society for Good Will therefore stands for a broad principle: the trigger for the state’s constitutional obligations is custody and dependence, not the formal label of voluntary versus involuntary admission.

3. DeShaney v. Winnebago County (1989): The General Rule and the “Special Relationship” Exception

DeShaney v. Winnebago County Dep’t of Social Services, 489 U.S. 189 (1989), is the Supreme Court’s leading decision on the scope of the Due Process Clause as a source of affirmative duties.

The Court held that, as a general rule, the Due Process Clause is a limitation on state power rather than a guarantee of protective services. The state’s failure to protect an individual from private violence—even in the face of known danger—does not ordinarily violate the Constitution. Joshua DeShaney was grievously abused by his father, and the state’s social services agency had multiple opportunities to intervene; still, the Court held no substantive due process violation.

However, DeShaney recognizes an important exception:

“When 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.”

This is the origin of what lower courts (including the Second Circuit) call the “special relationship” doctrine. Where the state, “by the affirmative exercise of its power,” so restrains an individual’s liberty that it renders him unable to care for himself—through “incarceration, institutionalization, or other similar restraint of personal liberty”—the state has a duty to provide for basic human needs, including medical care and reasonable safety.

Key point for J.M.: DeShaney expressly leaves room for affirmative duties where the state has in fact restrained liberty in a way comparable to incarceration or institutionalization. It does not address, much less overrule, cases like Society for Good Will that concern persons already in state custody.

4. Subsequent Second Circuit Cases on Special Relationships and Institutional Care

The Second Circuit has repeatedly applied and elaborated on these precedents:

• Lombardi v. Whitman, 485 F.3d 73 (2d Cir. 2007): Recognized that a special relationship can arise where the government restricts an individual’s freedom, e.g., by imprisonment; but the case itself involved environmental exposures after the 9/11 attacks and the court found no special relationship.
• Matican v. City of New York, 524 F.3d 151 (2d Cir. 2008): Held that a confidential informant who was not in custody had no special relationship with the police department; emphasized that the “linchpin” is involuntary custody or similar restraint that renders self-help impossible.
• Charles v. Orange County, 925 F.3d 73 (2d Cir. 2019): Found a special relationship between a county and civil immigration detainees, reaffirming that non-criminal but custodial settings can trigger affirmative due process duties.
• P.C. v. McLaughlin, 913 F.2d 1033 (2d Cir. 1990): Reaffirmed that persons with developmental disabilities in state custody have constitutionally protected rights to adequate food, shelter, clothing, and medical care.
• Brooks v. Giuliani, 84 F.3d 1454 (2d Cir. 1996) & Suffolk Parents of Handicapped Adults v. Wingate, 101 F.3d 818 (2d Cir. 1996): Distinguished between (a) the state’s general decision whether to fund or provide services in the first instance (no affirmative duty under DeShaney), and (b) the level of care owed to persons already institutionalized (governed by Youngberg and Society for Good Will).
• Brown v. City of New York, 786 F. App’x 289 (2d Cir. 2019) (summary order): Held that a homeless shelter resident had no special-relationship claim because, despite a curfew, she was free to leave during the day and the city could not force her to remain. This case is used in J.M. as a contrast: in a shelter, the state does not fully prevent self-help; at Valley Ridge, the state did.

5. Sister Circuit Authority

The opinion also situates the Second Circuit’s view within broader circuit splits on the relevance of admission status:

• Some circuits, like the Seventh Circuit in Camp v. Gregory, 67 F.3d 1286 (7th Cir. 1995), and the Third Circuit in Torisky v. Schweiker, 446 F.3d 438 (3d Cir. 2006), emphasize that the key question is actual control and ability to leave, not the formal “voluntary” label.
• Other circuits, including the First, Fifth, and Ninth, have sometimes suggested that voluntary admission can defeat a special relationship because the state has not “taken” the person into custody against his will: e.g., Monahan v. Dorchester Counseling Ctr., Inc., 961 F.2d 987 (1st Cir. 1992); Walton v. Alexander, 44 F.3d 1297 (5th Cir. 1995) (en banc); Campbell v. Wash. Dep’t of Soc. & Health Servs., 671 F.3d 837 (9th Cir. 2011).
• The Second Circuit aligns with the former approach, explicitly declining to treat “voluntary” status as dispositive where the real-world conditions of custody mirror involuntary confinement.

6. Other Notable References

• Witkowski v. Milwaukee County, 480 F.3d 511 (7th Cir. 2007): Used by the Second Circuit for a vivid analogy: if the state forbids private rescue of a drowning man, it must provide competent rescue itself. Here, Valley Ridge effectively forbade residents from calling 911, thereby monopolizing the power to summon emergency care.
• Kennedy v. Schafer, 71 F.3d 292 (8th Cir. 1995): Recognized that if a facility can lawfully detain a “voluntary” patient despite a request to leave, that situation can be sufficiently analogous to incarceration to give rise to an affirmative duty.

B. The Court’s Legal Reasoning

1. DeShaney Did Not Abrogate Society for Good Will

The defendants argued that DeShaney effectively overruled or undercut the Second Circuit’s holding in Society for Good Will, such that only involuntarily committed residents could invoke substantive due process protections. The Second Circuit rejected this contention on several grounds:

• Different factual posture: DeShaney concerned a child in his father’s private custody. Joshua was harmed while in his father’s care; the state had not taken custody or increased his vulnerability by restraining his liberty. By contrast, Society for Good Will and J.M. involve people already in state institutions, whose liberty and access to self-help are substantially curtailed.
• Consistent doctrinal structure: DeShaney expressly acknowledges that once the state incarcerates or institutionalizes a person, it assumes a duty to provide for basic needs. Society for Good Will fits comfortably within that logic: it simply clarifies that, once institutionalized, the state’s duty does not turn on how the person got there.
• Confirmed by later Second Circuit cases: Cases like Brooks and Suffolk Parents explicitly distinguished between the state’s decision whether to create institutions or services at all (governed by DeShaney) and the level of care owed to persons once institutionalized (governed by Youngberg and Society for Good Will).

Thus, the court concludes that nothing in DeShaney undermines the core holding that “anyone in a state institution has a right to safe conditions,” including adequate medical care, once the state has rendered them dependent through custodial control.

2. The Focus Shifts from Admission Label to Actual Custody and Control

The central analytic move in J.M. is the court’s explicit reorientation from a formalistic question—“Was the person admitted voluntarily or involuntarily?”—to a functional one:

“When the state exercises sufficient control over a voluntarily committed resident's life and such control renders that individual incapable of helping themselves, due process protections apply.”

The court identifies several relevant factors to determine whether the degree of control and dependency is sufficient:

• Limitations on the resident’s absolute right to leave: Is the person actually free to walk away and seek care elsewhere, or must they navigate a process that effectively permits the state to keep them?
• Availability of self-help: Can the person, in practice, access external emergency services (e.g., call 911, go to the hospital), or has the state monopolized that capacity?
• Similarity to court-ordered involuntary commitment: Are the conditions of custody—security measures, supervision, movement restrictions—substantially the same as for formally involuntary residents?

The court emphasizes that at Valley Ridge:

• All residents, voluntary or involuntary, were housed in a secure, fenced facility, under constant staff supervision.
• Residents were told they could request to leave, but not simply leave; the director could hold them for 72 hours and pursue court-ordered involuntary commitment.
• C.B.’s ability to seek emergency medical care on his own was effectively eliminated: he could not go to the hospital or call 911 without staff intervention, and even a 911 call would be intercepted and treated as potentially criminal.

Given these facts, the court holds that C.B. was not “free to leave” in the constitutionally meaningful sense, nor was he able to arrange his own rescue. The state therefore had imposed a “similar restraint of personal liberty” to incarceration or involuntary institutionalization as described in DeShaney.

3. The Legal Fiction of “Voluntariness” in This Context

The opinion is candid about the limited reality of “voluntariness” in modern residential treatment for persons with significant disabilities:

• C.B.’s admission, like that of the resident in Youngberg, was initiated by his mother, who could no longer safely care for him at home.
• Once admitted, the practical ability to reverse that decision and leave the facility was heavily constrained and mediated by the state.
• From the vantage point of the resident, the experience of confinement and dependence was indistinguishable from that of residents admitted by court order.

To treat this admission as entirely “voluntary” in the sense of preserving full liberty to exit and seek care elsewhere, the court suggests, would be a “legal fiction.” It therefore refuses to base constitutional duties on such a label, preferring instead to examine the nature of the custodial relationship at the time of injury.

4. Application to C.B.: A Paradigmatic Special Relationship

Applying its framework, the court concludes that C.B. plainly fell within the special relationship doctrine:

• Substantial restraint on liberty:
  • C.B. could not simply walk out of Valley Ridge.
  • The facility treated the 72-hour retention period as standard practice for voluntary residents seeking to leave.
  • Even residents initially admitted involuntarily followed similar procedures to seek discharge, underscoring the similarity of treatment.
• Near-total control over access to emergency care:
  • C.B. could not go to a hospital without permission.
  • C.B.’s 911 calls would be internally rerouted and effectively screened by staff.
  • Staff viewed unauthorized 911 calls as potentially criminal “false reports,” deterring residents from attempting self-help.
• Dependency heightened by disability and history:
  • C.B. was developmentally disabled, had lived in institutional settings for most of his adult life, and reasonably relied on staff for recognition and response to medical distress.
  • In the final days of his life, his acute symptoms and imminent cardiopulmonary failure made it practically impossible to secure outside care “in a more orderly fashion” even if the formal mechanisms had been theoretically available.

In this environment, the court reasons, C.B. was “completely disabled” from managing his own rescue. The state, having monopolized the levers of exit and emergency access, assumed a constitutional duty to exercise that power in conformity with minimal standards of care and safety under Youngberg and Society for Good Will.

5. Policy Rationale: Encouraging Voluntary Admission, Not Penalizing It

The court also invokes policy considerations grounded in New York’s Mental Hygiene Law:

• New York law affirmatively encourages voluntary admission for persons with developmental disabilities and instructs facility directors to convert suitable involuntary residents to voluntary status.
• Therapeutically, voluntary treatment is generally considered more effective and less stigmatizing than coerced commitment.

If constitutional protections depended solely on the label of “involuntary” admission, the state’s encouragement of voluntary arrangements would perversely:

• Strip individuals of constitutional protection because they cooperated with the state’s treatment framework.
• Incentivize states and providers to push for “voluntary” labels precisely to avoid constitutional duties and potential § 1983 liability.

The Second Circuit rejects such an outcome as contrary to the purposes of both mental health law and the Constitution. Its functional test maintains incentives for voluntary admission while preserving core protections for individuals who, regardless of label, are in the state’s effective custody.

6. Qualified Immunity: Clearly Established Rights and Reasonable Expectations

Qualified immunity shields government officials from civil damages unless they violate “clearly established” constitutional rights that a reasonable official would understand. Defendants argued that, until this opinion, it was not clearly established whether voluntarily admitted residents like C.B. were entitled to substantive due process protections.

The Second Circuit disagrees, focusing on two components:

1. The Right Itself Was Clearly Established

The court points to a long line of authority:

• Youngberg (1982): Recognized a right to adequate medical care for involuntarily committed persons.
• Society for Good Will (2d Cir. 1984): Held that “anyone in a state institution” has a right to safe conditions, regardless of voluntary or involuntary admission.
• P.C. v. McLaughlin (2d Cir. 1990): Reiterated that developmentally disabled individuals in state custody have constitutionally protected rights to adequate food, shelter, clothing, and medical care.
• District court decisions like G.B. v. DiPace, 2019 WL 1385840 (N.D.N.Y. 2019), applying these principles in OPWDD contexts.

Taken together, these cases made clear that developmentally disabled persons in state-run institutions—wholly dependent on the state—had a constitutional right to adequate medical care and safe living conditions.

2. Reasonable Officials Would Not Think Admission Status Eliminated the Duty

Regardless of any abstract doubt about voluntary versus involuntary status in the case law, the court notes a practical reality: Valley Ridge staff themselves did not know which residents were voluntary and which were involuntary, and they treated all residents under a single standard of care. As a result:

• Defendants could not plausibly have believed that their constitutional obligations varied by a fact (admission status) unknown to them.
• The right at issue is not a novel one—whether voluntary residents have rights—but the long-established right of institutionalized, dependent persons to adequate care.

The court therefore holds that C.B.’s right to adequate medical care as a developmentally disabled person in state custody was clearly established at the time of his death. However, it cautions that whether each individual defendant actually violated that right—and whether a reasonable person in that defendant’s specific position would have understood that their conduct was unlawful—are fact-intensive questions best addressed by the district court on remand.

7. Denial of Leave to Amend: Rule 16(b) and Diligence

Finally, the court affirms the denial of plaintiff’s motion to add nurse Baral as a defendant. The key legal standard is Federal Rule of Civil Procedure 16(b), which requires “good cause” to modify a scheduling order once issued. The central inquiry is the moving party’s diligence.

The Second Circuit agrees that plaintiff failed to show diligence:

• In September 2020, defendants’ initial disclosures identified Baral as someone who may have discoverable information about the events of April 8–9, 2018.
• In January 2021, OPWDD’s internal investigation notes—produced to plaintiff—described Cassata notifying Baral about C.B.’s symptoms (fatigue, illness, breathing difficulty) on April 4, and Baral responding with minimal care (“drink plenty of fluids and get some rest”).
• These materials were sufficient to put plaintiff on notice of Baral’s involvement and potential liability long before the deadline to amend pleadings.

Although plaintiff claims that depositions in February 2022 revealed new details, the court finds that the essential facts indicating Baral’s potential liability were available more than a year earlier. As a result, denying amendment was not an abuse of discretion.

C. Impact and Implications

1. Clarifying the Special Relationship Doctrine in the Second Circuit

J.M. v. Sessions significantly clarifies the scope of the “special relationship” doctrine in the Second Circuit:

• It confirms that Society for Good Will remains good law and was not silently displaced by DeShaney.
• It articulates a control-and-dependency test in practical terms, making clear that:
  • Formal “voluntary” status does not automatically bar a due process claim.
  • The key is whether the state’s actual restrictions and practices have rendered the individual unable to care for basic needs and obtain help.
• It aligns the Second Circuit with other circuits that look beyond labels to real-world custody, while distinguishing decisions that elevate the voluntary/involuntary distinction.

Going forward, litigants and courts in the Second Circuit will have a clearer framework for evaluating whether a special relationship exists in:

• State-operated psychiatric and developmental disability facilities;
• Residential treatment centers and group homes under state control;
• Civil detention contexts where purportedly voluntary placements nonetheless involve significant restraints.

2. Consequences for State-Run Facilities and OPWDD

For New York and similar jurisdictions, the decision has concrete operational and legal ramifications:

• Uniform constitutional duties: Facilities cannot assume that “voluntary” residents fall outside the protections owed to involuntary residents. If the physical and procedural regime is the same, constitutional obligations are the same.
• Policies on exit and 911 access will face heightened scrutiny. Practices that:
  • Delay or effectively prevent resident exit; or
  • Intercept, discourage, or punish attempts to call emergency services
  arguably deepen the state’s duty of care as they disable self-help.
• Staff training and accountability: The facts of this case—ignored pleas for help, minimal evaluations despite clear danger signs, falsified observation records, and failure to supervise—are likely to be used in future training as examples of conduct that may expose staff to § 1983 liability.
• Coordination with state tort systems: Plaintiffs often bring state-law negligence or malpractice claims alongside § 1983 claims. This decision preserves a federal constitutional avenue where state tort law alone might be insufficient to secure accountability.

3. Litigation Strategy: Pleading and Proving Custody-Based Duties

For practitioners, the opinion offers guideposts on how to plead and litigate similar cases:

• Plead facts showing actual control and disability of self-help:
  • Describe physical security (locked doors, fencing, key control, staff escorts).
  • Explain policies governing exit and discharge, including practical timeframes.
  • Detail restrictions on external communication and emergency calls.
• Emphasize dependency:
  • Resident’s cognitive, developmental, or psychiatric limitations;
  • Long-term institutionalization;
  • Reliance on staff for recognizing and responding to emergent medical conditions.
• Prepare for qualified immunity arguments:
  • Cite Youngberg, Society for Good Will, P.C. v. McLaughlin, and J.M. to show that rights were clearly established.
  • Focus not only on abstract rights but on what a reasonable staff member would understand in a closed, high-control facility.
• Act promptly on new information:
  • Initial disclosures and internal investigations often reveal all key players; delay in moving to amend can be fatal under Rule 16(b).

4. Potential Extension Beyond OPWDD Facilities

While the opinion is grounded in the context of state-run developmental disability facilities, its reasoning may influence other settings where:

• The state or its agents operate secure residential facilities (e.g., juvenile facilities, certain treatment programs, state-secured group homes); and
• Residents are nominally “voluntary” but are, in practice, unable to leave freely or summon outside help.

At the same time, the court deliberately contrasts situations like homeless shelters (Brown) where individuals are generally free to leave, signaling that not all state-provided housing or services will trigger heightened constitutional duties.

IV. Complex Concepts Simplified

1. Substantive vs. Procedural Due Process

• Procedural due process concerns the procedures the government must follow before depriving someone of life, liberty, or property (e.g., notice, a hearing).
• Substantive due process, at issue here, asks whether the government’s actions are so unjustified or harmful that they violate certain fundamental rights, regardless of procedure. In custodial settings, this includes the affirmative duty to provide basic needs and ensure reasonable safety.

2. The “Special Relationship” Doctrine

Ordinarily, the Constitution does not require the government to protect individuals from harm by private parties. The “special relationship” doctrine is an exception: when the state has taken custody of a person and significantly limits their ability to care for themselves (like prisoners or involuntarily committed patients), the state must provide for that person’s basic needs and safety.

J.M. clarifies that this special relationship can exist even when admission is labeled “voluntary,” if the actual conditions of custody prevent meaningful self-help.

3. Voluntary vs. Involuntary Commitment Under New York Law

• Voluntary admission: The person (or guardian) applies for admission. However:
  • To leave, a voluntary resident must usually notify the facility director.
  • The director can hold the resident for up to 72 hours if there are reasonable grounds to believe they need involuntary care, and can seek a court order to continue the confinement.
• Involuntary commitment: A court or doctor orders the person into a facility based on specific statutory criteria (danger to self/others, inability to care for basic needs, etc.).

On paper, these regimes differ. But J.M. underscores that when residential life and restrictions look the same for both groups, the constitutional analysis must focus on actual control and dependency, not just the procedural label.

4. Qualified Immunity

Qualified immunity protects government officials from being personally sued for damages unless:

1. They violated a constitutional right; and
2. The right was “clearly established” at the time so that a reasonable official would understand their conduct was unlawful.

It is not enough that the law be unsettled in some narrow, factual sense. If existing precedent clearly establishes a general principle (e.g., that institutionalized, developmentally disabled residents have a right to adequate medical care), officials cannot avoid liability by claiming uncertainty about peripheral details (like whether the resident’s admission was voluntary).

5. Summary Judgment

Summary judgment is a procedural device allowing a court to decide a case (or issues within a case) without a trial when there is no genuine dispute of material fact and the moving party is entitled to judgment as a matter of law. The court must view the evidence in the light most favorable to the non-moving party.

Here, the district court granted summary judgment to defendants on the constitutional claim based solely on C.B.’s admission status. The Second Circuit held that this was legal error and that, under the correct legal framework, factual questions about what each defendant did or failed to do must be evaluated by the lower court or a jury.

6. Rule 16(b) “Good Cause” for Amending Pleadings

Federal cases typically proceed under a scheduling order with a deadline for amending pleadings. After that deadline, a party seeking to add new claims or defendants must show “good cause,” usually met by demonstrating that:

• The party could not reasonably have discovered the relevant information earlier, despite diligent effort; and
• The amendment will not unduly prejudice the other side.

In J.M., the plaintiff had documents naming nurse Baral and describing her involvement well before the deadline but waited more than a year to move to amend. The court viewed this as a lack of diligence, justifying denial of the late amendment.

V. Conclusion

J.M. v. Sessions is a significant and carefully reasoned contribution to the law of substantive due process in custodial settings. The Second Circuit:

• Reaffirms that persons with developmental disabilities in state-run institutions are entitled to constitutional protection of their basic needs, including adequate medical care and safe living conditions.
• Clarifies that those protections do not turn on whether the person was admitted “voluntarily” or “involuntarily” in a procedural sense, but on the real-world degree of state control and dependency that leaves the person unable to help themselves.
• Holds that this right was clearly established by longstanding precedent, defeating a broad qualified-immunity defense and opening the door to accountability where staff ignore or mishandle obvious medical danger signs.
• Reinforces the importance of procedural discipline in litigation by upholding the denial of late amendments where plaintiffs had early notice of key actors.

Doctrinally, the opinion reconciles Youngberg, Society for Good Will, and DeShaney into a coherent framework: once the state has, in fact, restrained a person’s liberty and assumed control over their access to basic needs and emergency aid, the Constitution demands more than mere non-interference — it requires a baseline of reasonable care. Practically, it sends a strong message to state agencies and institutional providers that constitutional duties follow custody and control, not the paperwork by which residents enter their care.

On remand, the district court must now apply this clarified framework to determine whether each individual defendant’s conduct toward C.B.—from responding to his escalating symptoms to performing (or falsifying) bed checks—violated his clearly established right to adequate medical care and safe conditions while in state custody.