One May afternoon in 2024, a 49-year-old homeless man with a long history of mental illness stood in the middle of a street in the Bronx, talking to himself, screaming at traffic and nearly getting hit by cars.
The police were summoned, checked his record and found he had three outstanding warrants, including one for felony weapon possession. The man was arrested after resisting, court records show, and was taken to a locked psychiatric ward at Jacobi Medical Center, a city hospital in the Bronx, to await arraignment.
There, the man, identified in the records only as Louis M. to protect his privacy, was handcuffed to the bed, shackled at the legs and guarded by a police officer.
His arraignment was delayed, but the restraints stayed on. After three days, his psychiatrist asked police officers to remove them; they declined, repeatedly. He remained chained to his bed around the clock, except for one or two bathroom trips a day.
His lawyers say it took 26 days after his arrest for his restraints to finally be removed. Several months later, all the criminal charges against him were dropped.
The length of Louis M.’s immobilization was unusual. But shackling mentally ill people awaiting criminal arraignment has long been standard police procedure in New York City.
The Police Department’s patrol guide instructs officers: “Do not remove handcuffs or leg restraints, unless requested by attending physician.” Such requests are almost never granted, legal service lawyers and psychiatrists say.
The practice is being challenged in a suit to be heard in Albany on Wednesday at the State Court of Appeals, New York’s highest court. The suit argues that it is unnecessary for the police to shackle people in locked psychiatric wards because the wards are already set up to deal with potentially violent patients.
More than that, the suit says, the practice is psychologically and physically harmful, and violates patients’ due process rights and state mental hygiene law, which places strict limits on shackling.
Keeping Louis M. chained to a bed for weeks “offends the most basic notions of justice,” says the suit, brought on his behalf by the Mental Hygiene Legal Service, a state agency that represents psychiatric patients.
While people who are arrested are supposed to be arraigned before a judge within 24 hours, the legal service says longer delays are routine. A recent analysis by the Legal Aid Society found that arrestees held in hospitals were disproportionately likely to face delayed arraignments, for a variety of reasons.
In court filings, the city maintains that hospital wards “are designed for different purposes than holding cells focused on preventing the flight of someone accused of a crime.” It argues that keeping arrestees in restraints is a necessary safety precaution, and that limits on shackling do not apply to the police.
The suit raises fundamental questions of jurisdiction. An arrestee held involuntarily in a psychiatric ward is simultaneously in the custody of the police and the hospital. Each is subject to different rules and laws. What happens when the two dominions clash?
The suit predates the election of Mayor Zohran Mamdani, who campaigned on a pledge to sharply reduce the police’s role in dealing with people suffering from severe mental illness. A spokesman for Mr. Mamdani said on Tuesday that the mayor’s administration could not comment on the specific circumstances of the case, but that it was “committed to improving the city’s approach to helping New Yorkers facing mental health challenges by advancing an all-of-government, holistic approach to the issue.”
The policy laid out in the patrol guide applies equally to people accused of murder and those charged with burglary or simple drug possession. The legal service said it had one client who was shackled for a week after her arrest on charges of sending a threatening text message to her sister.
In a friend-of-the-court brief, two senior psychiatrists at Mount Sinai Medical Center with a combined 40 years’ experience in emergency psychiatric units identified “exactly one instance” in which they remembered police officers agreeing to remove a patient’s shackles.
The brief cites the case of a 60-year-old woman with a urinary tract infection who was shackled in 2020 and “frequently urinated on herself and constantly cried over the odor and embarrassment” because officers were slow to take her to the bathroom.
According to the suit and psychiatric literature, extended shackling can cause PTSD, “general mental state deterioration,” bedsores, bleeding, blood clotting and infection. The Mount Sinai psychiatrists write that the practice can “cause immense and severe physical and psychological harm to patients and impact clinicians’ abilities to provide appropriate treatment at a time of acute and particular need.”
Dr. Elizabeth Ford, a psychiatrist who in recent years oversaw New York City hospitals’ care for people under arrest, said that shackles are so stressful to patients that they cause the very outbursts they seek to control.
“There’s this general sense that if you take the cuffs off, someone is going to be more aggressive,” she said. “My experience has been the opposite.”
Formally, the lawsuit being argued on Wednesday appeals a judge’s denial of a writ of habeas corpus, the basic legal safeguard for challenging improper detention.
Louis M.’s lawyers filed the habeas motion in 2024 against the Police Department and Jacobi Medical Center to seek his unshackling. Two lower courts held that habeas did not apply because the motion sought only release from restraints, not total release from the hospital.
After Wednesday’s hearing, the Court of Appeals is not expected to rule for weeks, at least.
The city notes that when Jacobi initially sought a court order to have Louis M. involuntarily held, a psychiatrist testified that he had a history of aggression and paranoia that could recur. He also grew “extremely angry” when asked why he had stopped taking medication, according to court records.
But the legal service says that while Louis M. was in the ward, his clinicians found him “calm and cooperative.”
State mental hygiene law and guidelines say that psychiatric patients should generally be restrained only on a doctor’s orders. Restraints must typically be removed after two hours, and kept off except for patients who are making “overt gestures” threatening themselves or others.
Marcia Richard, a woman with a history of mental illness and drug addiction, said in an interview that she was often shackled by the police in locked wards in New York City, for periods of up to a week.
“When I went into the bathroom, that’s the only time they took the handcuffs off, but they’d keep the shackles on,” said Ms. Richard, 56, who now works as a peer counselor. “I showered in the shackles. I washed up in the shackles.”
Sometimes, she said, the restraints injured her: “I had cuts on my wrists, I had cuts on my ankles. Sometimes they were too tight, and your feet are swollen.”
The city argues in its court papers that shackling prevents patients from being violent to hospital staff.
But Louis M.’s lawyers argue that locked, guarded psychiatric wards are “staffed and equipped to manage behavioral outbursts.” Techniques used in these wards to calm patients include verbal de-escalation, medication and seclusion.
Laureena Novotnak, the Mental Hygiene Legal Service lawyer who is arguing at the Court of Appeals on Wednesday, said that by definition, people are placed in locked psychiatric wards because they’re “having trouble controlling their behavior.”
She added, “Maybe it would be safer if you chained all the patients around the clock, but nobody would ever get better.”