Terenzio v. Urena: Substantive Due Process, Voluntary State Care, and the Limits of Government Liability for COVID-19 in Veterans’ Homes

I. Introduction

In Terenzio v. Urena, No. 24-1244 (1st Cir. Dec. 18, 2025), the United States Court of Appeals for the First Circuit confronted a tragic fact pattern arising from the COVID-19 pandemic: three elderly veterans died after contracting COVID-19 while residing at the state-run Soldiers’ Home in Chelsea, Massachusetts. Their estates alleged that senior Massachusetts officials violated the veterans’ substantive due process rights under the Fourteenth Amendment by mishandling the pandemic response and by maintaining inhumane and unsafe living conditions at the facility.

Despite describing the alleged conduct as “quite disturbing,” the First Circuit affirmed dismissal of the case on qualified immunity grounds. The court held that, as framed on appeal, the plaintiffs (the “Representatives”) had not plausibly alleged that the defendants:

directly caused the veterans’ harm, as required by the general rule of DeShaney v. Winnebago County, or
fit within recognized exceptions (such as a “special relationship” or “state-created danger”) – exceptions that the Representatives expressly declined to rely upon or failed to adequately develop on appeal.

The opinion thus reinforces several key principles:

Substantive due process generally does not impose a federal constitutional duty on the state to protect individuals from harm, even in tragic circumstances.
To survive a motion to dismiss, § 1983 plaintiffs must plead direct causation by specific defendants (or properly invoke a narrow exception), not merely a failure to protect or to manage conditions safely.
Residents of a state-run, long-term care facility who enter voluntarily are not automatically treated as involuntary wards for constitutional purposes; some affirmative state restraint must be alleged.

At the same time, the court emphasizes that its decision is constrained by “the arguments that have been made on appeal,” signaling that different factual pleadings or legal theories might yield a different analysis in future cases.

II. Factual and Procedural Background

A. The Soldiers’ Home and the COVID-19 Outbreak

The Soldiers’ Home in Chelsea, Massachusetts is a state-operated facility providing long-term care for veterans. In spring 2020, at the onset of the COVID-19 pandemic, residents at the facility contracted the virus. Three of them – Joseph A. Terenzio, John J. Sullivan, and Maurice C. Poulin – ultimately died.

The Representatives allege that the state officials responsible for the Soldiers’ Home responded inadequately to the pandemic and tolerated dangerous and degrading living conditions. They claim that the facility’s practices violated the veterans’ substantive due process rights under the Fourteenth Amendment.

B. The Parties and Claims

The plaintiffs-appellants are:

Delma Terenzio, as Personal Representative of the Estate of Joseph A. Terenzio;
Thomas Sullivan, as Personal Representative of the Estate of John J. Sullivan;
Edward Poulin, as Personal Representative of the Estate of Maurice C. Poulin.

They brought § 1983 claims for damages against the following defendants in their individual capacities:

Francisco Ureña, former Secretary of the Massachusetts Department of Veterans’ Services;
Marylou Sudders, former Secretary of the Executive Office of Health and Human Services;
Cheryl Lussier Poppe, former Superintendent of the Soldiers’ Home;
Four unnamed “John Doe” and “Jane Doe” officials (not parties to the appeal).

The complaint advanced two main clusters of substantive due process claims:

COVID-19 response claims – alleging that defendants:
- failed to ensure proper social distancing,
- allowed sick and non-sick residents and staff to commingle,
- failed to implement adequate testing procedures for employees,
- discouraged the use of certain personal protective equipment (PPE), and
- lacked overarching COVID-19 protocols.
Living-conditions claims – alleging that defendants maintained inhumane and unsafe living conditions by:
- leaving residents sitting in their own excrement for extended periods,
- failing to clean rooms containing human waste, rodents, and bugs,
- improperly restraining residents, and
- allowing illegal drugs to enter the facility.

The plaintiffs asserted that, together, these actions and omissions violated the decedents’ substantive due process rights and those of similarly situated veterans in a putative class.

C. District Court Proceedings

The defendants moved to dismiss under Federal Rule of Civil Procedure 12(b)(6), invoking qualified immunity on two grounds:

The complaint failed to plausibly allege a substantive due process violation (no constitutional violation at all); and/or
Even if a violation were alleged, any such right was not “clearly established,” so qualified immunity would bar damages.

The District Court granted the motion and dismissed the complaint in February 2024, reasoning:

COVID-19 response claims: The plaintiffs failed to “specify how any individual Defendant was involved in the alleged misconduct.” Without individualized allegations tying particular defendants to particular harms, the claims failed both prongs of the qualified immunity analysis.
Living-conditions claims:
- The allegations did not provide “specifics” about how the named veterans themselves were harmed by the described conditions, especially since many facts were drawn from 2022 and 2023 reports, while the veterans died in 2020.
- No clearly established authority held that “physically limited, long-term residents are de facto involuntary wards of a state-run facility,” undermining any special-relationship theory and supporting qualified immunity.

D. The Appeal

On appeal, the core legal question was whether the complaint plausibly alleged a substantive due process violation that overcame qualified immunity, given:

the general rule that the state has no constitutional duty to protect individuals from harm, and
the requirement that § 1983 plaintiffs show either:
- direct, state-caused harm, or
- a recognized exception (such as a special custodial relationship or state-created danger).

Chief Judge Barron, writing for the remaining panel (after Judge Selya’s death, see 28 U.S.C. § 46(d)), affirmed the dismissal.

III. Summary of the First Circuit’s Opinion

The First Circuit’s decision turns on substantive due process doctrine and causation, as filtered through the lens of qualified immunity.

Baseline rule from DeShaney: The Due Process Clause generally does not require the state to protect individuals from private harm. A plaintiff must usually allege that a state actor directly caused the harm. (DeShaney v. Winnebago Cnty. Dep’t of Soc. Servs., 489 U.S. 189, 197 (1989)).
Pleading deficiency on causation: For both the COVID-19 response claims and the living-conditions claims, the complaint alleged that defendants “failed” to protect the residents or “failed” to provide minimally adequate conditions. The court held that these are allegations of omissions or failures to protect, not allegations that defendants “did anything to harm [the veterans] directly” (quoting Souza v. Pina, 53 F.3d 423, 426 (1st Cir. 1995)).
Rejection of plaintiffs’ proximate-cause argument: Plaintiffs invoked First Circuit precedents (such as Gutierrez-Rodriguez v. Cartagena) that recognize § 1983 liability where a state actor “sets in motion” a series of acts by others. The court found this argument inapposite because:
- the plaintiffs did not identify any “others” who inflicted the constitutional injury, and
- they did not explain how the harms were attributable to reasonably foreseeable intervening forces of the kind those precedents address.
“Affirmative acts” argument deemed waived: Plaintiffs argued on appeal that the complaint alleged “affirmative acts” by the defendants. But they simply pointed to a long list of facts, many of which described omissions or passive permission, and they did not articulate a coherent standard for what counted as “affirmative.” The court, applying United States v. Zannino, treated this as a “skeletal” argument and deemed it waived.
Distinguishing out-of-circuit prisoner precedent: Plaintiffs relied on Woodson v. City of Richmond, 88 F. Supp. 3d 551 (E.D. Va. 2015), an Eighth Amendment case involving a prisoner. The First Circuit distinguished it because there is a “dispositive distinction” between incarcerated inmates (for whom the state has custodial obligations) and individuals who have “voluntarily availed [themselves] of a Commonwealth service” (quoting Monahan v. Dorchester Counseling Ctr., Inc., 961 F.2d 987, 993 (1st Cir. 1992)).
Non-reliance on special relationship and state-created danger exceptions:
- The court acknowledged two potential exceptions to DeShaney:
  - a special relationship where the state affirmatively restrains an individual’s liberty (e.g., incarceration, involuntary commitment), and
  - a state-created danger theory (as discussed in Irish v. Fowler, 979 F.3d 65 (1st Cir. 2020)).
- However, the Representatives expressly disclaimed reliance on either exception on appeal. As such, the First Circuit did not analyze the case under those doctrines.
Harper and Monahan: voluntariness and helplessness revisited: Plaintiffs cited Harper v. Cserr, 544 F.2d 1121 (1st Cir. 1976), for the idea that patients who “voluntarily” enter a state facility may become de facto involuntary due to their “relatively helpless” condition. The court noted that Monahan, relying on DeShaney, clarified that this “helplessness” analysis only applies when the state takes an affirmative act restraining the person’s ability to act on their own. Because plaintiffs did not show that the Soldiers’ Home forced veterans to become dependent or prevented them from leaving, Harper-based arguments failed.
No special relationship created by visitation ban: Plaintiffs argued that the prohibition on family visitation during COVID-19 was an affirmative act that rendered the veterans de facto involuntary wards. The court rejected this, holding that:
- a ban on family visitation does not, by itself, constitute forcing residents to depend on the state “against [their] will,” and
- the allegation did not suggest veterans would have been barred from leaving the facility upon request.
Qualified immunity outcome: Because the complaint, as framed on appeal, did not plausibly allege that defendants directly caused the harm or that an exception applied, the court concluded that no substantive due process violation was adequately pleaded. Under the qualified immunity framework, that alone is sufficient to affirm dismissal; the court did not need to further decide whether any right was “clearly established.”

IV. Precedents Cited and Doctrinal Background

A. DeShaney and the Baseline Constitutional Rule

The starting point for the First Circuit’s analysis is DeShaney v. Winnebago County Department of Social Services, 489 U.S. 189 (1989). There, the Supreme Court held that the Due Process Clause generally:

protects individuals from government-imposed deprivations of life, liberty, or property,
but does not impose on the state a constitutional duty to protect individuals from private harms (including violence, neglect, or disease) even where the government is aware of the risk.

DeShaney recognized limited exceptions in cases where the state has taken a person into custody or otherwise significantly restrained their liberty (e.g., incarceration, involuntary institutionalization), creating a “special relationship” that triggers a duty to ensure reasonable safety.

In Terenzio, the court applies this baseline rule: absent direct state-caused harm or a recognized exception, there is no substantive due process liability merely because officials failed to protect individuals from the spread of COVID-19 or from allegedly unsanitary conditions.

B. Proximate Cause and “Setting in Motion” Liability: Gutierrez-Rodriguez

The Representatives relied on First Circuit precedents recognizing that § 1983 liability does not require the defendant to physically inflict the injury. In Gutierrez-Rodriguez v. Cartagena, 882 F.2d 553, 561 (1st Cir. 1989), quoting Springer v. Seaman, 821 F.2d 871, 879 (1st Cir. 1987), the court stated that proximate causation under § 1983 can be established when a defendant:

…sets in motion a series of acts by others which the actor knows or reasonably should know would cause others to inflict the constitutional injury.

The plaintiffs argued that this language meant state actors are “responsible for those consequences attributable to reasonably foreseeable intervening forces, including the acts of third parties.”

But the First Circuit rejected its application here for two reasons:

The plaintiffs did not identify the “others” who allegedly inflicted the constitutional injury (e.g., staff, other residents, or independent actors), nor did they characterize their conduct as constitutional wrongdoing attributable to the defendants.
They did not explain how the harms at issue fit within the class of “reasonably foreseeable intervening forces” in a way recognized by § 1983 causation doctrine.

Thus, Gutierrez-Rodriguez and similar cases could not supply the missing element of direct causation.

C. Harper and Monahan: From Helplessness to Affirmative State Restraint

The plaintiffs cited Harper v. Cserr, 544 F.2d 1121 (1st Cir. 1976), for the principle that patients who “voluntarily” commit themselves to a state facility may, in practice, become de facto involuntary due to their “relatively helpless” condition or other circumstances. From this, they argued that the veterans at the Soldiers’ Home were effectively involuntary wards, triggering a special-relationship duty under the Fourteenth Amendment.

However, Monahan v. Dorchester Counseling Center, Inc., 961 F.2d 987 (1st Cir. 1992), refined and limited Harper in light of DeShaney. Monahan held:

Helplessness alone is not enough to create a constitutional duty.
The critical factor is whether the state, by an affirmative act, has restrained an individual’s liberty so that they cannot care for themselves or seek help elsewhere.
The Constitution is implicated “only when the state takes an affirmative act which restrains the individual’s freedom to act on his own behalf.”

In Terenzio, the First Circuit applies Monahan to reject the idea that the Soldiers’ Home residents were de facto involuntary wards simply because they were elderly, disabled, or physically limited:

The plaintiffs did not plausibly allege that the state forced the veterans to remain at the facility against their will, or
that the facility’s policies barred the veterans from leaving the Home if they so chose.

The visitation ban for family members – discussed below – did not change this analysis.

D. State-Created Danger Doctrine: Irish v. Fowler

The First Circuit has recognized, at least in some form, a “state-created danger” exception, particularly as discussed in Irish v. Fowler, 979 F.3d 65 (1st Cir. 2020). Under that theory, the state may be liable if:

state actors, by affirmative conduct, create or substantially increase the risk of harm from private actors, and
the resulting harm is foreseeable and shocks the conscience.

In Terenzio, the panel notes the existence of this doctrine but does not apply it because the plaintiffs, on appeal, expressly disclaimed reliance on the state-created danger theory. That disclaimer is crucial: it prevents the court from engaging with potentially more favorable doctrinal ground and limits the opinion’s direct guidance on pandemic-related “state-created danger” claims.

E. Qualified Immunity Framework: Maldonado v. Fontanes

The court applies the familiar two-pronged qualified immunity framework, as articulated in cases such as Maldonado v. Fontanes, 568 F.3d 263, 268–69 (1st Cir. 2009). A government official is entitled to qualified immunity unless:

The plaintiffs plausibly allege facts showing that the official violated a federal constitutional right; and
The right was “clearly established” at the time of the alleged misconduct, such that a reasonable official would understand that what he or she was doing was unlawful.

Courts may address these prongs in either order. Here, the First Circuit resolves the case at the first prong, holding that the complaint, as argued, does not plausibly allege a substantive due process violation because it fails to allege:

direct causation by the defendants, and
a valid exception (special relationship or state-created danger).

Once there is no constitutional violation at all, the qualified immunity analysis ends.

V. The Court’s Legal Reasoning in Detail

A. Direct Harm vs. Failure to Protect

The center of the opinion is the distinction between:

Direct state-caused harm – where officials actively do something that harms the plaintiff; and
Failure to protect from harm – where officials fail to prevent harms from disease, third parties, or environmental conditions.

The court repeatedly notes that, as framed, the complaint charges the defendants with “failing to protect the residents from the risks associated with the COVID-19 virus” and with “fail[ing] to provide the veteran residents… with clearly established minimally adequate living conditions,” rather than with directly inflicting injury.

Relying on Souza v. Pina, 53 F.3d 423 (1st Cir. 1995), the court emphasizes that the complaint does not allege that defendants “did anything to harm [the veterans] directly” (emphasis added). Without more, that is fatal to a standard substantive due process claim under DeShaney.

B. The “Affirmative Acts” Argument and Appellate Waiver

The plaintiffs sought to recast some allegations as “affirmative acts,” likely to move the case closer to a state-created danger or special relationship theory. They pointed to, among other things:

commingling sick and non-sick residents,
discouraging certain protective gear, and
permitting others to act in unsafe ways.

However, on appeal, plaintiffs did not:

define a principled standard for what counted as “affirmative,”
distinguish between mere inaction and affirmative conduct, or
link specific alleged acts by named defendants to specific harms to the three decedents.

Instead, their citations bundled together a “long list” of allegations, many of which clearly described omissions or passive permission. The First Circuit, invoking United States v. Zannino, 895 F.2d 1, 17 (1st Cir. 1990), held that:

issues adverted to in a perfunctory manner, unaccompanied by some effort at developed argumentation, are deemed waived.

This is an important procedural holding: because plaintiffs did not develop a coherent “affirmative act” theory on appeal, the court declined to analyze their claims under that framework. The opinion thus does not decide whether, with a more robust argument, some of the alleged conduct might have been treated as affirmative acts creating or enhancing danger.

C. Distinguishing Prisoner Cases and Voluntary Residents: Woodson and Monahan

Plaintiffs relied heavily on Woodson v. City of Richmond, 88 F. Supp. 3d 551 (E.D. Va. 2015), where a state prisoner brought an Eighth Amendment claim concerning exposure to disease. The First Circuit distinguished Woodson on two levels:

Constitutional source of duty: Woodson dealt with the Eighth Amendment’s prohibition on cruel and unusual punishment, which applies to convicted prisoners who are involuntarily in state custody. The plaintiffs here relied on the Fourteenth Amendment’s substantive due process guarantee, which applies in a broader range of contexts but does not automatically impose custodial duties.
Nature of the relationship: Citing Monahan, the court found a “dispositive distinction” between:
- Prison inmates, who are involuntarily confined and fully dependent on the state; and
- Individuals who “voluntarily availed [themselves] of a Commonwealth service”, such as residents of a state-run veterans’ home who are not alleged to have been forcibly held there.

In constitutional terms, the difference is that prison inmates are in a special custodial relationship, giving rise to affirmative duties on the part of the state, while residents of a voluntary facility generally are not. Thus, Woodson could not make the law “clearly established” for purposes of qualified immunity, nor could it supply the missing special-relationship or direct-causation element.

D. The Visitation Ban and the Absence of a Special Relationship

Plaintiffs attempted to revive a special-relationship theory by pointing to the Soldiers’ Home’s prohibition on family visits during the pandemic. They argued that this restriction:

isolated the veterans, and
effectively rendered them dependent wards of the state.

The First Circuit disagreed, holding that a ban on family visitation:

does not itself show that the state “force[d]” the veterans to become dependent “against [their] will,” and
does not imply that veterans were “barred from leaving [the Soldiers’ Home] upon request.”

Under Monahan, a special relationship arises when the state affirmatively restrains the plaintiff’s ability to act on their own behalf (e.g., incarceration, involuntary hospitalization). The complaint did not allege:

that veterans were physically or legally prevented from leaving the facility, or
that the state had taken custody of them involuntarily.

Thus, even under plaintiffs’ own framing, the visitation ban did not transform the veterans into de facto involuntary wards for constitutional purposes.

E. Treatment of the Living-Conditions Allegations

The living-conditions claims, which alleged inhumane treatment such as leaving residents in their own excrement and tolerating rodent- and bug-infested spaces, raise questions similar to the COVID-19 claims:

Are these claims framed as direct harms inflicted by the defendants, or as failures to prevent harmful conditions?
Do they show a custodial or special relationship akin to incarceration?

The appellate opinion treats them alongside the COVID-19 claims, noting that the complaint alleges that defendants “failed to provide” adequate conditions and “forced” veterans “to live in unsafe and unsanitary conditions” but, in the court’s view, does not allege that defendants “did anything to harm [the veterans] directly.”

Moreover, the district court had emphasized that the complaint:

did not specify how these conditions individually harmed the three named veterans, and
relied heavily on reports from 2022 and 2023 – years after the veterans died in 2020 – calling into question the temporal and causal connection.

On appeal, the plaintiffs did not overcome these deficiencies in any developed way. The First Circuit thus affirms dismissal of the living-conditions claims on the same basic ground: lack of adequately alleged direct causation or valid exception to DeShaney.

VI. Impact and Implications

A. COVID-19 and Pandemic-Related Litigation

Terenzio fits within a broader wave of litigation seeking to hold government actors accountable for COVID-19 harms in institutional settings – prisons, nursing homes, and long-term care facilities. Its implications include:

High bar for constitutional claims: The opinion underscores that even egregious alleged failures in managing a pandemic do not automatically translate into substantive due process violations. Plaintiffs must show direct, state-caused harm or fit squarely within recognized exceptions.
Limited role for federal courts in public health mismanagement: The case reflects judicial reluctance, grounded in DeShaney, to constitutionalize alleged failures in public health policy or institutional management, particularly where residents are not in involuntary custody.

B. Long-Term Care Facilities, Veterans’ Homes, and “Voluntary” Residents

A significant doctrinal point in Terenzio is its reaffirmation that residents of state-run long-term care facilities who enter voluntarily are not automatically treated like prisoners or involuntarily committed patients for constitutional purposes. The opinion suggests:

No automatic special relationship: Elderly, disabled, or physically limited individuals do not become constitutional wards of the state merely by entering or residing in a state facility.
Affirmative restraint is critical: To trigger a special-relationship duty, plaintiffs must show that the state took affirmative steps to restrain their ability to leave or seek alternative care.

For litigation strategy, this means that claims against veterans’ homes, nursing homes, or similar institutions must carefully allege:

the non-voluntary nature of the resident’s presence (if applicable), and
any affirmative measures by which the facility or state officials prevented residents from leaving or obtaining alternative care.

C. Pleading Strategies in § 1983 Cases

Terenzio is also a cautionary tale about the importance of precise pleading and developed appellate argumentation:

Individualized causation: Complaints must tie specific defendants to specific harms suffered by named plaintiffs, not just to institutional or systemic failures.
Affirmative acts vs. omissions: Where a theory depends on “affirmative acts” (for special relationship or state-created danger), plaintiffs must clearly identify:
- what the official actually did,
- how that conduct increased the risk, and
- how it caused the injury.
Developed legal theories on appeal: The court’s reliance on Zannino underscores that underdeveloped or “skeletal” arguments are treated as waived. Appellants must fully brief their doctrinal theories, especially when seeking to fit within narrow exceptions.

D. Relationship to State Law and Criminal Proceedings

The plaintiffs analogized some of their allegations to those found sufficient for probable cause in a Massachusetts criminal case arising from another Soldiers’ Home facility, Commonwealth v. Clinton, 207 N.E.3d 487 (Mass. 2023). The First Circuit notes this, but:

probable cause for state criminal charges under state law does not automatically translate into a federal constitutional violation, and
the § 1983 framework remains governed by DeShaney, Monahan, and federal causation standards, not state criminal law concepts.

This contrast illustrates that:

state law may provide criminal or civil remedies for institutional mismanagement or neglect; but
the federal Constitution – and thus § 1983 – imposes a narrower set of obligations, particularly where the state has not taken individuals into custody in the constitutional sense.

VII. Complex Concepts Simplified

1. Substantive Due Process

The Due Process Clause has two main parts:

Procedural due process: Requires fair procedures (notice, hearing, etc.) before the government takes away life, liberty, or property.
Substantive due process: Protects individuals from certain fundamentally unfair or abusive government actions, even if procedures are followed.

In this case, plaintiffs argued substantive due process: that the government’s actions (or inaction) in running the Soldiers’ Home were so egregiously harmful that they violated basic constitutional protections.

2. Qualified Immunity

Qualified immunity is a shield for government officials sued in their individual capacities for money damages. It protects them unless:

They violated a constitutional right; and
That right was “clearly established” at the time, so a reasonable official would have known the conduct was unlawful.

If either prong is not satisfied, the official is immune. In Terenzio, the court essentially stopped at step one, finding no adequately alleged constitutional violation under the plaintiffs’ theories.

3. Special Relationship

A “special relationship” exists when the government has taken someone into its custody and deprived them of the ability to care for themselves or seek help elsewhere. Classic examples:

Prisoners
Involuntarily committed mental health patients
Foster children, in some contexts

In such situations, the government may have an affirmative constitutional duty to protect the person from harm. In Terenzio, the court held that veterans in a state-run facility who were not forcibly confined did not have such a special relationship with the state.

4. State-Created Danger

Under this theory, the government can be liable for harms caused by private parties or conditions if it:

affirmatively creates or greatly increases a danger,
knew or should have known of the danger, and
the resulting harm is closely tied to the government’s actions.

Although the First Circuit recognizes this doctrine (see Irish v. Fowler), the plaintiffs in Terenzio chose not to rely on it on appeal, so the court did not apply it.

5. Proximate Cause

Proximate cause is about legal responsibility: even if someone’s actions were a “but-for” cause of harm, the law only holds them responsible if the harm was a reasonably foreseeable result of those actions. In § 1983 cases:

Defendants can be liable if they directly cause harm, or
if they “set in motion” a series of events they should have known would lead to a constitutional injury.

The court held that the plaintiffs did not plausibly connect the defendants’ actions to the harms under these standards.

6. Appellate Waiver (“Zannino Rule”)

On appeal, parties must develop their arguments with legal reasoning and citations. If they mention an argument only briefly, without explanation or authority, the court can treat it as “waived.” In United States v. Zannino, the First Circuit famously held that:

Issues adverted to in a perfunctory manner, unaccompanied by some effort at developed argumentation, are deemed waived.

In Terenzio, the court applied this rule to the plaintiffs’ underdeveloped “affirmative acts” theory.

VIII. Conclusion

Terenzio v. Urena is a sober reminder of the limited role of substantive due process in policing government responses to crises in voluntary institutional settings. Even where conditions are described as “quite disturbing,” and even where negligence or mismanagement may be alleged under state law, the federal Constitution does not automatically provide a remedy.

The opinion’s key contributions can be summarized as follows:

It reaffirms the DeShaney principle that the state generally has no constitutional duty to protect individuals from harm unless it has taken them into custody or otherwise significantly restrained their liberty.
It clarifies that residents of a state-run veterans’ home who are there voluntarily – and who are not alleged to be barred from leaving – are not automatically in a “special relationship” with the state comparable to prisoners or involuntarily committed patients.
It emphasizes causation and specificity in § 1983 pleadings: plaintiffs must either allege direct harms by named defendants or fit within narrow exceptions; generalized failures to protect a class of residents are not enough.
It highlights the importance of developed appellate advocacy; undeveloped theories (such as the “affirmative acts” argument) will not be entertained.

While the decision leaves open the possibility that different factual allegations or better-developed legal theories might support substantive due process claims in some institutional-care settings, it sets a demanding standard for pandemic-related and long-term care litigation under § 1983. In the absence of custody-like restraints or clearly pleaded affirmative acts that create or enhance danger, plaintiffs will likely find their remedies, if any, in state law rather than in the federal Constitution.