24-1997-cv J.M. v. Sessions

In the United States Court of Appeals for the Second Circuit ___________

August Term 2025 Argued: October 3, 2025 Decided: December 23, 2025

No. 24-1997-cv ___________________

J.M., AS ADMINISTRATOR OF THE ESTATE OF HER SON, C.B., Plaintiff-Appellant, v. ASHLEY SESSIONS, ELISE M. WILLIAMS, COREY C. BEHLEN, RAYMOND J. MCGINN, KATHERINA L. CASSATA, MICHAEL NOVACK, Defendants-Appellees,*

DOES 1-6, Defendants. _______________ Appeal from the United States District Court for the Northern District of New York No. 1:20-cv-91, Glenn T. Suddaby, Judge. ___________

Before: PARKER, CARNEY, and KAHN, Circuit Judges. ________________

Plaintiff-Appellant J.M. commenced this action on behalf of her son, C.B., who died while residing at a facility operated by the New York State Office for People with

* The Clerk of Court is respectfully directed to amend the case caption as indicated above.

1 Developmental Disabilities. Plaintiff alleged that Defendants-Appellees—C.B.’s caretakers—ignored C.B.’s pleas for help and obvious signs of heart failure, resulting in his death. Plaintiff asserted a cause of action under

for violations of C.B.’s substantive due process rights and brought state law claims for negligence and medical malpractice. The United States District Court for the Northern District of New York (Suddaby, J.) granted Defendants-Appellees’ motion for summary judgment on Plaintiff’s § 1983 claim and declined to exercise supplemental jurisdiction over Plaintiff’s state law claims. Plaintiff timely appealed.

We conclude that the district court erred in determining that C.B. had no substantive due process right to adequate medical care because he voluntarily admitted himself to the state-run facility. Under our decision in Society for Good Will to Retarded Children, Inc. v. Cuomo,

(2d Cir. 1984), C.B. was entitled to adequate medical care pursuant to the substantive guarantees of the Due Process Clause regardless of whether he was admitted to the facility by a court order or voluntarily. Pursuant to DeShaney v. Winnebago County Department of Social Services,

(1989), these rights arise when, as here, the state exercises sufficient control over a voluntarily committed resident’s life and such control renders that individual incapable of helping themselves. Therefore, we VACATE the order and judgment of the district court and REMAND the matter for further proceedings in conformity with this opinion. ________________

SAMUEL SHAPIRO (Ilann Margalit Maazel, Laura Kokotailo, on the brief), Emery Celli Brinckerhoff Abady Ward & Maazel, LLP, New York, NY, for Plaintiff- Appellant.

DOUGLAS E. WAGNER, Assistant Solicitor General (Jeffrey W. Lang, Deputy Solicitor General, Barbara D. Underwood, Solicitor General, on the brief), for Letitia James, Attorney General of the State of New York, Albany, NY, for Defendants-Appellees Elise M. Williams, Corey C. Behlen, Raymond J. McGinn, Katherina L. Cassata, Michael Novack.

BENJAMIN W. HILL, (Alexandra N. Von Stackelberg, on the brief), Capezza Hill, LLP, Albany, NY, for Defendant- Appellee Ashley Sessions. ________________

2 Maria Araújo Kahn, Circuit Judge:

Plaintiff-Appellant J.M. commenced this action on behalf of her son, C.B., who

died at the age of 34 while residing at the Valley Ridge Center for Intensive Treatment, a

facility operated by the New York State Office for People with Developmental Disabilities

(“OPWDD”). J.M. alleges that Defendants-Appellees—C.B.’s caretakers at Valley

Ridge—ignored C.B.’s pleas for help and obvious signs of heart failure, resulting in his

death. She brought a constitutional claim under

for violations of C.B.’s

substantive due process rights and state law claims for negligence and medical

malpractice. The district court granted Defendants’ motion for summary judgment in

full. The principal issue on appeal is whether C.B., a voluntarily admitted resident at a

state-run mental health facility, may bring a substantive due process claim against the

state for its failure to provide adequate medical care. We hold that he may. Accordingly,

the order and judgment of the district court are VACATED and the matter is

REMANDED to the district court for further proceedings in conformity with this

opinion.

BACKGROUND

I. FACTS

The following facts are taken from the summary judgment record, which are

undisputed unless otherwise noted. Because this appeal arises from a grant of summary

3 judgment, we view the evidence in the light most favorable to J.M. as the non-moving

party and draw all reasonable inferences in her favor. See Reese v. Triborough Bridge &

Tunnel Auth.,

(2d Cir. 2024).

On the morning of April 9, 2018, C.B. was found unresponsive in his bedroom at

Valley Ridge. He was declared dead shortly after EMS arrived. His autopsy revealed

that he likely died of cardiomyopathy, a heart condition. J.M. alleges that Defendants—

current and former Valley Ridge employees—by ignoring signs of C.B.’s worsening

medical condition, caused C.B.’s death.

A. C.B.’s Voluntary Admission to Valley Ridge

C.B. was born in 1983. He suffered from autism, mood disorder NOS (not

otherwise specified), impulse control disorder, mild mental retardation, and antisocial

personality disorder, and he had a history of closed head injury. During his childhood,

C.B. lived at home with his mother, J.M. However, around the time he turned 18, J.M.

determined that C.B. “couldn’t be home,” and placed him in the care of the New York

State OPWDD. App’x 2246.

In 2015, C.B. applied for and was granted voluntary admission to the Valley Ridge

Center for Intensive Treatment in Norwich, New York (“Valley Ridge”). Valley Ridge is

a secure facility—enclosed by tall perimeter fencing—that houses residents who are

voluntarily admitted, like C.B., and residents who are involuntarily admitted by court

4 order. Regardless of their admission status, Valley Ridge treats all residents the same.

Residents are not free to leave as they please and are always under staff supervision.

Valley Ridge apprised C.B. of these restrictions when he arrived in May 2015.

Upon admission, Valley Ridge provided C.B. with—and he signed—a “Notice of Status

and Rights,” which explained that he would “live, sleep, work and play [at Valley Ridge]

unless [he was] allowed to go somewhere else.” App’x 2238. It further informed C.B.

that he would not be free to leave, providing:

At any time, you may tell the director or other staff members that you want to leave. However, you may not leave for three days unless the director lets you. If the director thinks you need to stay, he may ask a court for an order to keep you here.

C.B.’s access to medical care at Valley Ridge was also highly restricted. He could

not see a doctor or go to the hospital without permission. Nor could he contact 911 to

seek emergency medical services. If he dialed 911, his call would be routed to Valley

Ridge’s safety department. He was dependent on Valley Ridge’s on-site providers to

receive medical care.

Defendants in this action are current and former Valley Ridge staff members who

were responsible for caring for C.B. The Valley Ridge staff included direct care staff, who

supervised the housing unit where C.B. lived, and medical staff. The medical staff

included one nurse practitioner, Defendant Raymond McGinn, and several registered

nurses, including Defendant Elise Williams, and proposed defendant Anita Baral. The

5 direct care staff included: Defendant Michael Novack, the supervisor of the unit where

C.B. lived; Defendant Katherina Cassata, a staff member on duty in the days before C.B.’s

death; Defendant Corey Behlen, the head of the night shift on April 8-9, 2018; and

Defendant Ashley Sessions, a trainee who worked the night shift on April 8-9, 2018.

B. C.B.’s Medical Condition and Death

In the months leading up to C.B.’s death, his health began to deteriorate

substantially. In 2017, he was diagnosed with hypertension. In the early months of 2018,

he began gaining weight rapidly, putting on at least 13 pounds between December 2017

and April 2018, despite being placed on a calorie-controlled diet and engaging in regular

exercise. 1 In the weeks before his death, C.B.’s breathing was erratic, he “was always

complaining of heart burn,” he grew lethargic during the day, and he complained of

nocturia (needing to urinate frequently at night). App’x 964. As C.B.’s medical providers

later acknowledged, these are all well-known symptoms of heart failure.

C.B.’s symptoms grew more severe in his final days. On April 4, he reported to

Defendant Cassata that “he couldn’t breathe, that his chest hurt” and that “[h]e was tired

all the time.” App’x 925. By April 6, he was unable to complete basic tasks. Cassata

testified that C.B. “looked physically sick”: “He had no color. He was sweating. He was

clammy to the touch. He was out of breath . . . . [H]e was sitting down in the chair trying

1 The extent of C.B.’s weight gain is disputed. C.B.’s weight chart indicates that he gained either 13 or 21 pounds during this four-month period.

6 to vacuum sitting down . . . scooching himself along.” App’x 929. This was a “dramatic

change” from C.B.’s ordinary behavior.

On this occasion, Cassata testified that she

notified the nurse on duty, Anita Baral, who “looked at him, told him to have some water”

and to “go lay down.” App’x 1978. 2

On the morning before he died, C.B.’s symptoms became even more severe. He

called his mother, J.M., and told her he was having problems breathing and could not

urinate and abruptly hung up on her, which was highly unusual. Sensing an emergency,

J.M. called Defendant Novack and reported C.B.’s symptoms. C.B. then told Novack that

he was struggling to breathe and asked to go to the hospital. Novack did not document

either interaction; the parties dispute whether he notified nursing of C.B.’s symptoms.

C.B. was not taken to a hospital.

Later that afternoon, Defendant Williams saw C.B. at Valley Ridge’s clinic. When

C.B. arrived, Willliams observed that he was having difficulty breathing. C.B. also

complained of difficulty urinating. Williams took C.B.’s vital signs, which were within

normal limits, listened to his lungs, which appeared clear, and examined his bladder.

Williams did not check C.B.’s respiratory rate, listen to his heart, or perform an EKG. She

believed his symptoms were caused by sinus congestion, told him to take cough syrup,

2 Cassata also testified that she documented C.B.’s condition, but those notes are missing from the record. She further testified that she was instructed to take C.B.’s vitals on both days, which were within normal limits, and which she recorded on a trifold paper towel.

7 and encouraged him to drink water and stay hydrated. However, as Plaintiff’s expert

notes, given C.B.’s “underlying cardiomyopathy,” “aggressively hydrat[ing] . . . was the

worst thing [he] could do,” as it would cause his “diseased heart” to “go into pulmonary

edema.” App’x 2301. With that, Williams sent C.B. back to his housing unit. The visit

lasted less than 15 minutes, and Williams did not follow up on his condition thereafter.

That night, Defendant Sessions was assigned to C.B.’s housing unit and was

responsible for performing bed checks every two hours: at 11pm, 1am, 3am, and 5am.

Sessions failed to check on C.B. at 3am and 5am and instead falsified records to reflect

that she had performed the required checks (a lie she subsequently repeated to the New

York State police). Instead of performing the checks, Sessions watched movies. Her

supervisor, Defendant Behlen, was also present that night. He noticed Sessions on the

computer but failed to ensure that she had completed the required bed checks. He was

watching TV in the unit’s living room.

C.B. died alone in his bed sometime between four and six in the morning.

Plaintiff’s expert opined that shortly before his death, C.B. would have awoken due to his

“abrupt development of pulmonary edema and [would have] experienced the sensation

of drowning.” App’x 1170. He was discovered unresponsive at 6:30am, cold to the touch

and with blue lips.

8 II. PROCEDURAL HISTORY

Plaintiff brought this action in the U.S. District Court for the Northern District of

New York, asserting a claim under

that Defendants violated C.B.’s

substantive due process rights under the Fourteenth Amendment, as well as medical

malpractice and negligence claims under state law.

Just prior to the close of discovery, and sixteen months after the district court’s

deadline to amend the pleadings, Plaintiff moved to amend her complaint to add claims

against a new defendant, Anita Baral, a nurse who treated C.B. during the time period

leading up to his death. Magistrate Judge Hummel denied the motion, ruling that

Plaintiff had failed to establish “good cause” under Rule 16(b). The court found that

Plaintiff had not been diligent in adding Baral because Defendants had turned over an

investigative report fourteen months earlier which reflected Baral’s treatment of C.B. The

court further found that adding Baral at the eleventh hour would prejudice Defendants.

The district court affirmed Magistrate Judge Hummel’s order.

At the close of discovery, Defendants moved for summary judgment, which the

district court granted on July 11, 2024. The court found that C.B. could not bring a

substantive due process claim because he was voluntarily admitted to Valley Ridge and,

as such, found that the state did not affirmatively deprive him of liberty so as to trigger a

constitutional duty of care. Having granted summary judgment on Plaintiff’s sole federal

9 claim, the court declined to exercise supplemental jurisdiction over the remaining state

law claims.

DISCUSSION

We review the district court’s grant of summary judgment de novo, construing the

evidence in the light most favorable to the non-movant and drawing all reasonable

inferences in their favor. Kowalchuck v. Metro. Transp. Auth.,

(2d Cir.

2024).

The district court’s disposition of Plaintiff’s suit turned on the single issue of

whether C.B., as a voluntarily admitted resident at Valley Ridge, had a substantive due

process right to adequate medical care. We address this constitutional question before

turning to Defendants’ qualified immunity defense and the denial of Plaintiff’s request to

amend her complaint.

I. FOURTEENTH AMENDMENT CLAIM

The Due Process Clause of the Fourteenth Amendment provides that “[n]o State

shall . . . deprive any person of life, liberty, or property, without due process of law.” In

Youngberg v. Romeo, the Supreme Court applied this Clause to protect the right of

involuntarily committed patients to “conditions of reasonable care and safety” including

the right to “adequate food, shelter, clothing, and medical care.”

(1982);

see also Collins v. City of Harker Heights,

, 127–28 (1992) (“The ‘process’ that the

Constitution guarantees in connection with any deprivation of liberty thus includes a

10 continuing obligation to satisfy certain minimal custodial standards.”). This is, in part,

because when a “person is institutionalized,” they become “wholly dependent on the

[s]tate.” Youngberg,

. That total dependency confers on the state an

affirmative “duty to provide certain services and care.”

Shortly after Youngberg, we extended these rights to “anyone in a state institution”

regardless of how they came to be institutionalized. Soc’y for Good Will to Retarded

Children, Inc. v. Cuomo,

(2d Cir. 1984). In Society for Good Will, thirteen

residents at “a state[-]operated school for [individuals with developmental disabilities]”

alleged that the facility violated their substantive due process rights as recognized in

Youngberg.

. The state argued that these rights did not apply because the

residents “were not admitted to the Center with a court order[,]” i.e., they were “not

classified as ‘involuntary.’”

. We found this distinction to be “irrelevant,” and,

echoing Youngberg, we held that once a person is in the state’s custody and “dependent

on the state” for their essential needs, the state acquires a duty to provide for those needs

“in a manner that [does] not deprive [that person] of constitutional rights.”

.

These rights, however, do not extend to the public at large. Several years after

Society for Good Will, in DeShaney v. Winnebago County Department of Social Services, the

Supreme Court rejected the idea that the Due Process Clause imposes an affirmative duty

on the government generally to guarantee citizens “certain minimal levels of safety and

security.”

(1989). There, a toddler, Joshua DeShaney, resided with his

11 father, who severely beat him.

. Over the course of roughly two years, Joshua’s

family and doctors repeatedly reported the father’s abuse, but county social workers

failed to meaningfully intervene.

at 192–93. Eventually, Joshua’s father beat him so

badly that he suffered severe brain damage and was expected to be “confined to an

institution” for the rest of his life.

. Joshua’s representative sued Winnebago

County, alleging that the social workers violated his substantive due process rights by

failing “to protect him against a risk of violence at his father’s hands.”

The Court

rejected Joshua’s claim, finding that the “State’s failure to protect an individual against

private violence simply does not constitute a violation of the Due Process Clause.”

. The Court reasoned that the Clause is a “limitation on the State’s power to act,” not

an “affirmative obligation on the State to ensure” life, liberty, and property.

.

The Clause’s “purpose was to protect the people from the State, not to ensure that the

State protected them from each other.”

.

In DeShaney, however, the Court expressly noted that the state does acquire

affirmative duties to those it involuntarily confines. “[W]hen 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.”

at 199–200 (citing Youngberg,

). This is because “when the State by the

affirmative exercise of its power so restrains an individual’s liberty that it renders him

unable to care for himself, and at the same time fails to provide for his basic human

12 needs—e.g., food, clothing, shelter, medical care, and reasonable safety—it transgresses

the substantive limits on state action set by the Eighth Amendment and the Due Process

Clause.” Id. at 200. Thus, when the state curtails liberty “through incarceration,

institutionalization, or other similar restraint of personal liberty” it “trigger[s] the protections

of the Due Process Clause.” Id. (emphasis added).

Since DeShaney, we have referred to this as the “special relationship” exception to

the general rule that the Due Process Clause confers no affirmative rights. See Lombardi

v. Whitman,

, 79 n.3 (2d Cir. 2007) (providing that the “special relationship”

exception “arise[s] ordinarily if a government actor has assumed an obligation to protect

an individual by restricting the individual’s freedom in some manner, as by

imprisonment”). We have typically “focused on involuntary custody” as the “linchpin”

of the special relationship exception analysis. See Matican v. City of New York,

(2d Cir. 2008) (finding no special relationship between a confidential informant

and a police department because the informant “was not in custody at the time” and the

state “did not render[] him unable to care for himself” (internal quotation marks

omitted)). But see Charles v. Orange County,

(2d Cir. 2019) (finding “special

relationship” between county and civil immigration detainees). We have not, since our

decision in Society for Good Will, had occasion to reiterate our holding “that anyone in a

state institution has a right to safe conditions” regardless of “whether they are voluntary

or involuntary residents.”

.

13 Defendants argue that DeShaney abrogated Society for Good Will’s holding that the

voluntary/involuntary distinction is irrelevant. Specifically, pursuant to DeShaney, they

argue that the substantive due process analysis turns entirely on whether a resident was

admitted voluntarily because the state cannot affirmatively deprive voluntarily admitted

residents of liberty, as DeShaney requires, because they freely submitted to the state’s

control. We are unpersuaded.

Nothing in DeShaney undermines Society for Good Will. Unlike Society for Good Will,

DeShaney does not concern the substantive due process rights of people already within

the state’s custody. Joshua DeShaney was harmed “not while he was in the State’s

custody, but while he was in the custody of his natural father, who was in no sense a state

actor.” DeShaney,

. Moreover, the state “played no part” in “render[ing]

him any more vulnerable to” his father’s abuse.

. Conversely, plaintiffs in Society

for Good Will (and C.B. here) were in the state’s custody and were rendered more

vulnerable by the restraints of their custodial care. See

.

This distinction is critical. That the Due Process Clause confers no affirmative

obligation on the state to protect private individuals from private violence, as the Court

held in DeShaney,

, does not mean that the Constitution does not protect

those already within the state’s custody and dependent on the state for care. 3 DeShaney

3 We previously recognized this distinction in Brooks v. Giuliani,

(2d Cir. 1996). There, we held that the state had no affirmative obligation to continue funding services for disabled adults.

. However, we distinguished Society for Good Will, 14 itself recognizes as much, noting that “[h]ad the State by the affirmative exercise of its

power removed Joshua from free society and placed him in a foster home operated by its

agents, we might have a situation sufficiently analogous to incarceration or

institutionalization to give rise to an affirmative duty to protect.”

n.9.

Nor does DeShaney’s dictum concerning the scope of substantive due process

rights conflict with Society for Good Will. DeShaney broadly rejects the notion that the Due

Process Clause confers an “affirmative right to governmental aid,” and excepts from that

general principle circumstances 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.”

; see also Matican,

(noting same). DeShaney thus recognizes

substantive due process rights where the state affirmatively restrains an “individual’s

freedom to act on his own behalf” through “incarceration, institutionalization, or other

similar restraint of personal liberty.”

.

noting that the level of care required for those in the state’s custody was distinct from the state’s obligation to provide such services in the first instance. See

(“Society for Good Will dealt with the level of care required by the Due Process Clause, but the state’s obligation to provide care and funding in that case was undisputed. When, however, the government disclaims any entitlement to continued funding, and then ends this funding, the reach of Society for Good Will is controlled by the Supreme Court’s subsequent holding in DeShaney . . . .”). We drew the same distinction in Suffolk Parents of Handicapped Adults v. Wingate. See

, 823 (2d Cir. 1996). Both Brooks and Suffolks Parents acknowledged that substantive due process rights attach when, as here, individuals are subject to custodial restraints. See Brooks,

; Suffolk Parents, 101 F.3d at 824.

15 Society for Good Will, although decided four years earlier, followed the same path

as DeShaney. In Society for Good Will, we held as an initial matter that the state had no

affirmative obligation to provide services to individuals with developmental disabilities.

See

. However, the state’s obligations changed once it assumed custody:

Even granting that the State of New York was not required to build schools for the mentally retarded or admit voluntary residents, once it chose to house those voluntary residents, thus making them dependent on the state, it was required to do so in a manner that would not deprive them of constitutional rights.

This analysis fits well within DeShaney’s substantive due process framework. The

state’s affirmative choice to assume custody of the residents, and render them totally

dependent on the state for their basic needs, constituted an “affirmative act of restraining

the individual’s freedom to act on his own behalf—through incarceration,

institutionalization, or other similar restraint of personal liberty.” DeShaney,

(emphasis added). As DeShaney instructs, and as we held in Society for Good Will, this

“trigger[s] the protections of the Due Process Clause.”

Admission status is a poor measure of the state’s control and the resident’s

resulting dependence. Contrary to Defendants’ position, the state affirmatively acts to

restrain the liberty of both involuntarily committed and voluntarily committed residents.

The facts of C.B.’s custody make this clear. At Valley Ridge, all residents are treated the

same and have the same restrictions on their freedoms. As the state’s counsel conceded

at oral argument, staff are not even told which residents are admitted voluntarily or

16 pursuant to court order, and the standard of care is the same for all residents. Moreover,

regardless of admission status, residents are not free to leave. To do so, a voluntary

resident must submit a written request to the director, who, under New York Law, is

empowered to “retain the resident” for up to 72 hours if “there are reasonable grounds

for belief that the resident may be in need of involuntary care and treatment.”

(b) (McKinney 2011). This process is similar for residents who

are involuntarily admitted pursuant to a medical certification. See

§ 15.31(a)

(providing right to “request for hearing on the question of need for care and treatment at

a school” within “sixty days [of] the date of involuntary admission”). We see little sense

in placing dispositive weight on a distinction that in fact makes no difference in a

resident’s care or ability to leave state custody freely.

Youngberg itself, which DeShaney cites approvingly, underscores the point that

how a resident was initially admitted is not the determinative factor that triggers due

process protections. There, as here, the resident’s mother “asked the Philadelphia County

Court of Common Pleas to admit Romeo to a state facility on a permanent basis . . .

[because] she was unable to care for [him] or control his violence.”

; see

also

(Burger, C.J., concurring) (“The State did not seek custody of respondent;

his family understandably sought the State’s aid to meet a serious need.”). In both cases,

the residents were admitted because their mothers sought the state’s assistance. It is a

legal fiction to say that the state affirmatively acted to restrain the liberty of one but not

17 the other. Instead, and as we recognized in Society for Good Will, in determining whether

the constitutional protections recognized in Youngberg arise, we look to the nature of the

custodial relationship at the time an injury occurs, not to how such custody began. See

Soc’y for Good Will,

. A focus on the nature of the custody, rather than the

form of its inception, better adheres to DeShaney’s analysis. 4

This approach appropriately follows the principles set forth in Society for Good Will,

DeShaney, and Youngberg. By limiting Youngberg’s substantive due process rights to

individuals whose liberty has been restrained such as the residents of Valley Ridge, we

4 Several of our sister circuits have held similarly, and do not place dispositive weight on admission status. See, e.g., Camp v. Gregory,

(7th Cir. 1995) (“The question is not so much how the individual got into state custody, but to what extent the state exercises dominion and control over that individual.” (quoting Walton v. Alexander,

(5th Cir. 1995) (en banc) (Parker, J., concurring specially)); Torisky v. Schweiker,

(3rd Cir. 2006) (“[E]ven commitments formally labeled as ‘voluntary’ may arguably amount to de facto deprivations of liberty from their inception.”); Shelton v. Ark. Dep’t of Hum. Servs.,

, 840 (8th Cir. 2012) (“A patient’s status at the time of admission is not necessarily dispositive, however, because a patient’s status may change over time.”); cf. Lanman v. Hinson,

(6th Cir. 2008) (disagreeing that “because [a mental health patient] voluntarily committed himself . . . and was theoretically free to leave at any time, he was not owed any duties under the Fourteenth Amendment”). But see, e.g., Monahan v. Dorchester Counseling Ctr., Inc,

(1st Cir. 1992) (finding that the state did not owe a “due process duty to assume a special responsibility” for a resident injured while not in the state’s custody “[b]ecause the state did not commit [the resident] involuntarily” and thus “did not take an affirmative act of restraining his liberty” (internal quotation marks omitted)); Walton,

(noting that a special relationship “does not arise solely because the state exercises custodial control over an individual such as is the case when a person voluntarily resides in a state facility”); Campbell v. State of Wash. Dep’t of Soc. & Health Servs.,

(9th Cir. 2011) (same).

18 heed DeShaney’s warning not to “thrust upon” the states novel tort liability through our

“expansion of the Due Process Clause of the Fourteenth Amendment.” 5 DeShaney,

. However, DeShaney is clear that substantive due process rights arise when

the state affirmatively “restrain[s] the individual’s freedom to act on his own behalf.”

. Looking beyond technical labels and considering the actual relationship between

the resident and the state to determine whether the Due Process Clause applies faithfully

adheres to DeShaney’s command and our controlling precedent. See Torisky,

(endorsing “looking beyond the label of an individual’s confinement to ascertain

whether the state has deprived an individual of liberty in such a way as to trigger

Youngberg’s protections”).

This approach also supports the state’s compelling interest in promoting

voluntary admission to state-run mental health facilities. New York law provides that all

state “officers having duties to perform relating to persons with developmental

disabilities” are required “to encourage any such person . . . to apply for admission as a

5 Brown v. City of New York is a useful counterpoint. See

(2d Cir. 2019) (summary order). There, we considered a homeless shelter resident’s substantive due process claim alleging “dangerous conditions and negligent treatment” in a city-run shelter.

. No due process rights were triggered in Brown because, although she was subject to a curfew, she was free to leave during the day, and the city could not “force individuals to stay.”

. Thus, the state’s restraints on her liberty were not to such a degree that she was unable to care for herself.

19 voluntary resident.”

(a). 6 This statutory preference reflects

a well-settled therapeutic fact—“treatment which is accepted voluntarily is likely to be

more effective”—and allows residential treatment facilities to operate relatively free of

court involvement. Gunnar Dybwad & Stanley S. Herr, Unnecessary Coercion: An End to

Involuntary Civil Commitment of Retarded Persons,

, 756 (1979). We

decline to disadvantage individuals with disabilities for heeding the state’s

encouragement and accepting custodial care, especially when, once admitted, the state

treats such residents identically to their involuntarily committed counterparts. A

different approach would undermine these laudable goals.

Accordingly, and in line with DeShaney, we hold that 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

degree of control the state exercises over a resident, including limitations on a resident’s

absolute right to leave, the availability of recourse to self-help, and the custody’s overall

similarity to court-ordered involuntary commitment are all relevant to this

determination. See DeShaney,

(recognizing due process rights in the

context of “incarceration, institutionalization, or other similar restraint of personal liberty”

(emphasis added)).

6 The statute further provides that “it shall be [the director’s] duty to convert . . . any involuntary resident suitable and willing to . . . a voluntary status.”

§ 15.21(a).

20 Looking to the facts of C.B.’s custodial treatment, we have little trouble concluding

that his commitment entitled him to substantive due process protections. Valley Ridge

profoundly restrained C.B.’s liberty, including by limiting his ability to freely leave

custody. If C.B. wanted to leave the locked facility, Valley Ridge required him to submit

a formal written request to the director. As provided in the Notice of Status and Rights

C.B. signed upon admission, Valley Ridge treated the 72-hour hold as the normal practice.

See App’x 2238 (“[Y]ou may not leave for three days unless the director lets you.”). C.B.

was free to ask to leave but not actually free to leave. As other circuits recognize, this

distinction matters. See Kennedy v. Schafer,

(8th Cir. 1995) (holding that if

the facility “could lawfully have detained” a voluntarily admitted patient over her

request to leave, “the situation that she was in was sufficiently analogous to incarceration

or institutionalization to give rise to an affirmative duty to protect” (internal quotation

marks omitted)); Torisky,

(doubting voluntary status where record was

“far from clear that any of the plaintiffs were in a position to extricate themselves from

state custody at the time of . . . their injuries”).

Beyond his inability to leave, staff exercised near-total control over C.B.’s life. He

was under constant supervision. Valley Ridge controlled what he did, where he went,

and what he ate. Its staff also tightly circumscribed his access to medical care. They did

not allow him to see a doctor or to go to the emergency room without permission. Nor

could he contact emergency services. If he dialed 911, Valley Ridge rerouted the call to

21 its safety department, which retained the ultimate decision about whether to call

emergency services. As Defendant Williams described, if a resident were to somehow

call 911, Valley Ridge presumptively viewed it as “making a false report to 911 and they

could get arrested.” App’x 479.

The combination of these restraints and C.B.’s corresponding dependence on the

state is sufficient to trigger substantive due process protections. By preventing him from

freely leaving, and by proactively monopolizing the power to call an ambulance,

emergency care (or law enforcement, for that matter), Valley Ridge completely disabled

C.B. from caring for himself. In emergent circumstances, C.B.’s life was entirely in the

state’s hands. As then- Chief Judge Easterbrook noted in a related context, “[i]f the state

forbids private rescue of a drowning man, then the state must furnish a competent rescue

service of its own.” Witkowski v. Milwaukee County,

(7th Cir. 2007). Here,

by maintaining complete control over C.B.’s life, and rendering him completely

dependent on the state, Valley Ridge was required to operate within the limits set by

Youngberg, Society for Good Will, and DeShaney.

Defendants’ arguments to the contrary are unpersuasive. They argue that C.B.’s

personal liberty was not restricted because C.B. was “free to leave” rendering his care

voluntary. Appellees’ Br. 31. They insist that “nothing prevented him . . . from seeking

outside care in a more orderly fashion, with advance notice to Valley Ridge.” Appellees’

Br. 33. We disagree. C.B.’s status was not rendered voluntary simply because he could

22 ask to leave—that he could not leave without initiating a lengthy process that could

ultimately lead to a court-ordered commitment establishes the opposite. Indeed, even

residents initially admitted involuntarily by medical certification must follow a similar

process to leave. See

. Moreover, even if he did ask, it is

hard to imagine that Valley Ridge would have immediately or expeditiously set free, to

independently care for his basic needs, a developmentally disabled man who had spent

his entire adult life institutionalized. To the contrary, Defendant Williams acknowledged

Valley Ridge’s practice of taking “72 hours” to “have discussion[s] with [residents] about

safe ways to depart our facility and getting everything set up where they can do it in a

safe manner.” App’x 479.

Even assuming he could care for his general needs while at Valley Ridge, C.B.’s

medical condition, in the days leading up to his death, would have precluded such a

release. Contrary to Defendants’ contention, his medical emergency actually did prevent

him from “seeking outside care in a more orderly fashion.” Appellees’ Br. 33. By the

time C.B. told Novack that he could not breathe and asked to go to the hospital, he had

only one day to live—two fewer than the (possibly requisite) remaining waiting period.

Under these circumstances, Valley Ridge’s affirmative restraints on C.B.’s freedom to care

for himself entitled C.B. to substantive to due process protections.

23 II. QUALIFIED IMMUNITY

Defendants argue that even if they violated C.B.’s constitutional rights, they are

entitled to qualified immunity because it was not clearly established when C.B. died

whether and under what circumstances a voluntarily committed resident has substantive

due process rights. Although Defendants raised this argument below, the district court

did not reach it because it found that C.B.’s admission status foreclosed his constitutional

claim.

We find that under Youngberg, DeShaney, and Society for Good Will, C.B.’s

substantive due process right to adequate medical care was clearly established. “A right

is clearly established if the contours of the right are sufficiently clear that a reasonable

official would understand that what they are doing violates that right.” Eaton v. Estabrook,

, 93 (2d Cir. 2025) (alterations adopted) (quoting Linton v. Zorn,

(2d Cir. 2025)). “Even when we find a right clearly established, defendants ‘may

nonetheless establish immunity by showing that reasonable persons in their position

would not have understood that their conduct was within the scope of the established

prohibition.’” Wiggins v. Griffin,

(2d Cir. 2023) (quoting LaBounty v.

Coughlin,

(2d Cir. 1998)).

Decades of authority from the Supreme Court and this Court have established the

right to adequate medical care for developmentally disabled residents in state custody

who are dependent on the state for care. See Youngberg,

(recognizing

24 committed resident’s right to “adequate food, shelter, clothing, and medical care”); Soc’y

for Good Will,

(“[A]nyone in a state institution has a right to safe

conditions.”); P.C. v. McLaughlin,

(2d Cir. 1990) (“[Individuals with

developmental disabilities] in the custody of state officials have constitutionally protected

rights to adequate food, shelter, clothing and medical care . . . .” (citation omitted)); G.B.

v. DiPace, No. 14-cv-0500,

, at *6 (N.D.N.Y. Mar. 27, 2019) (“The Second

Circuit has further clearly established that a developmentally disabled individual in the

custody of state officials ha[s] constitutionally protected rights to adequate food, shelter,

clothing and medical car[e], to safe living conditions and to freedom from undue bodily

restraint.” (internal quotation marks omitted)).

Moreover, a reasonable person in Defendants’ position would have known that

their conduct was unlawful. As counsel for the State of New York conceded, Valley Ridge

staff were unaware of any resident’s admission status and treated all residents pursuant

to the same standard of care. Defendants could not, in other words, reasonably believe

that their conduct was lawful due to C.B.’s admission status because this information was

unknown (and unknowable) to them as a matter of course.

Although we find that C.B.’s right to adequate medical care was clearly

established, we are “mindful that we are a court of review, not of first view,” Cutter v.

Wilkinson,

, 718 n.7 (2005), and thus leave to the district court (or a jury) to

consider in the first instance whether each individual Defendant violated C.B.’s clearly

25 established rights. See Eaton, 144 F.4th at 90, 98 (delineating contours of clearly

established right and remanding to resolve “factual disputes bearing on whether

[defendant’s conduct] was unconstitutionally excessive under the Fourteenth

Amendment . . . precluding summary judgment . . . on qualified immunity grounds”);

Ark. Tchr. Ret. Sys. v. Goldman Sachs Grp., Inc.,

(2d Cir. 2021) (“It is our

general policy that the trial court should consider arguments—and weigh relevant

evidence—in the first instance.” (internal quotation marks omitted)).

III. MOTION TO AMEND

Finally, we turn to whether the district court erred in denying J.M. leave to amend

to add claims against a new defendant, Anita Baral. We review the denial for abuse of

discretion. Grochowski v. Phoenix Constr.,

, 86 (2d Cir. 2003).

Where, as here, a party moves to amend after the deadline imposed by the court’s

scheduling order, the moving party must show “good cause” for the amendment. Kassner

v. 2nd Ave. Delicatessen Inc.,

(2d Cir. 2007); see also Fed. R. Civ. P. 16(b).

The “primary consideration” in determining good cause “is whether the moving party

can demonstrate diligence.” Kassner,

. “[A] party fails to show good cause

when the proposed amendment rests on information that the party knew, or should have

known, in advance of the deadline.” Dervan v. Gordian Grp. LLC, No. 16-cv-1694,

, at *1 (S.D.N.Y. June 20, 2018) (Nathan, J.) (internal quotation marks omitted).

26 Plaintiff argues that she learned new facts about Baral’s potential liability during

the depositions of Defendant Cassata and Baral on February 8, 2022. In sum and

substance, Plaintiff alleges that during Cassata’s deposition, she discovered that Cassata

notified Baral of C.B.’s symptoms—including his difficulty breathing and chest pains—

but Baral failed to provide medical care. J.M. argues she moved diligently to amend her

complaint to add claims against Baral once she discovered these new facts.

The record reveals that Plaintiff knew, or had reason to know, of Baral’s

involvement well over a year before the February 2022 depositions. In September 2020,

Defendants identified Baral as someone who “may have discoverable information

relating to the events of April 8-9, 2018” on their initial disclosures. App’x 159. Then, in

January 2021, Defendants disclosed OPWDD’s internal investigation notes, which

included interview notes for Cassata and Baral. fThe notes reflect that on April 4, 2018,

Cassata noticed that C.B. was tired, ill, and had difficulty breathing, that she notified

Baral, and that Baral visited C.B. and failed to provide medical care. App’x at 1142

(“[Baral] patted [C.B.] on his back and told him to drink plenty of fluids and get some

rest.”).

These notes were more than sufficient to put Plaintiff on notice of her potential

claim against Baral. The district court thus acted well within its discretion in finding that

Plaintiff failed to exercise the diligence necessary to establish “good cause.”

27 CONCLUSION

The order and judgment of the district court are VACATED and the case

REMANDED for further proceedings in conformity with this opinion.

28