Amicus Curiae Brief — New York State Rifle & Pistol Association, Inc., et al., Petitioners v. Kevin P. Bruen, in His Official Capacity as Superintendent of New York State Police, et al.

Supreme Court briefSep 21, 2021

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No. 20-843

In the

Supreme Court of the United States

NEW YORK STATE RIFLE & PISTOL

ASSOCIATION, INC., et al.,

Petitioners,

KEVIN P. BRUEN, IN HIS OFFICIAL CAPACITY

AS SUPERINTENDENT OF NEW YORK

STATE POLICE, et al.,

Respondents.

On Writ of Certiorari to the United States

Court of A ppeals for the Second Circuit

BRIEF OF AMICI CURIAE AMERICAN

MEDICAL ASSOCIATION, MEDICAL SOCIETY

OF THE STATE OF NEW YORK, AMERICAN

ACADEMY OF PEDIATRICS, AND AMERICAN

ACADEMY OF CHILD AND ADOLESCENT

PSYCHIATRY IN SUPPORT OF RESPONDENTS

Erin G. Sutton

Leonard A. Nelson

A merican Medical

A ssociation

Office of General Counsel

330 N. Wabash Ave.

Suite 39300

Chicago, Illinois 60611

(312) 464-4801

Michael J. Dell

Counsel of Record

Chase Henry Mechanick

Kramer Levin Naftalis

& Frankel LLP

1177 Avenue of the Americas

New York, New York 10036

(212) 715-9100

mdell@kramerlevin.com

Counsel for Amici Curiae

307545

TABLE OF CONTENTS

Page

TABLE OF AUTHORITIES ...................................... iii

INTEREST OF AMICI CURIAE ................................ 1

STATEMENT OF THE CASE AND SUMMARY

OF ARGUMENT ................................................. 4

ARGUMENT ............................................................... 5

AMICI’S PHYSICIAN MEMBERS

HAVE FIRSTHAND KNOWLEDGE OF

THE ENORMOUS PHYSICAL,

PSYCHOLOGICAL AND SOCIAL

HARM WROUGHT BY THE FIREARM

VIOLENCE PUBLIC HEALTH CRISIS ... 5

Dr. Cherisse Berry .............................. 5

Dr. Amy Caggiula ................................ 7

Dr. Brendan Carr ................................ 8

Dr. Erick Eiting ................................... 9

Dr. Alberto Esquenazi ....................... 10

Dr. Stephen Hargarten ..................... 12

Dr. James Rachal .............................. 13

Dr. John Rozel ................................... 14

Dr. Joseph Sakran ............................. 16

Dr. Babak Sarani .............................. 18

Dr. Layla Soliman ............................. 19

Dr. Frank Tedeschi ........................... 21

M. Dr. Ricard Townsend ........................ 22

Dr. Ian Wittman ................................ 23

II.

NEW YORK’S CONCEALED CARRY

LAW AND ITS APPLICATION HERE

COMPLY WITH THE SECOND

AMENDMENT.......................................... 25

CONCLUSION .......................................................... 35

iii

TABLE OF AUTHORITIES

Page(s)

CASES

Ariz. State Legis. v. Ariz. Indep.

Redistricting Comm’n,

576 U.S. 787 (2015)........................................... 33

District of Columbia v. Heller,

554 U.S. 570 (2008)......................................25, 26

Gonzales v. Carhart,

550 U.S. 124 (2007)........................................... 32

Heller v. District of Columbia,

670 F.3d 1244 (D.C. Cir. 2011) ....................25, 29

Jackson v. San Francisco,

135 S. Ct. 2799 (2015)....................................... 26

Kachalsky v. Cty of Westchester, 701 F.3d 81

(2d Cir. 2012) .................................................... 31

McDonald v. Chicago,

561 U.S. 742 (2010)........................................... 26

N.Y. State Rifle & Pistol Ass’n, Inc. v.

City of N.Y.,

140 S. Ct. 1525 (2020)................................. 27 n.6

Printz v. U.S.,

521 U.S. 898 (1997)........................................... 33

Smith v. Robbins,

528 U.S. 259 (2000)........................................... 33

Turner Broadcasting System, Inc. v. F.C.C.,

512 U.S. 622 (1994)........................................... 32

U.S. v. Lopez,

514 U.S. 549 (1995)........................................... 33

Voisine v. United States,

136 S. Ct. 2272 (2016)....................................... 26

Statutes

New York Penal Law § 400.00(2)(f)........4, 25, 26, 27

Other Authorities

Amy Barnhorst & John Rozel, Evaluating

threats of mass shootings in the

psychiatric setting, INTERNATIONAL

REVIEW OF PSYCHIATRY (2021),

https://www.tandfonline.com/doi/abs/10.1

080/09540261.2021.1947784 ...................... 16 n.5

Army Corps of Engineers Command

Guidance (May 14, 2018),

https://corpslakes.erdc.dren.mil/employe

es/cecwon/pdfs/18May14FirearmsPossessionGuidance.pdf .............. 34 n.9

Brian Freskos, “Guns Are Stolen in America

Up to Once Every Minute.” The Trace

(Sept. 21, 2016),

https://www.thetrace.org/2016/09/stolenguns-cars-trucks-us-atlanta/ ...................... 16 n.4

Centers for Disease Control and Prevention,

Fatal Injury Reports, National, Regional

and State, 1999-2019,

https://webappa.cdc.gov/sasweb/ncipc/mo

rtrate.html. ............................................27, 28, 29

David Hemenway & Deborah Azrael, The

Relative Frequency of Offensive and

Defensive Gun Uses, 15 VIOLENCE VICT.

257 (2000),

https://connect.springerpub.com/content/

sgrvv/15/3/257.abstract............................... 16 n.3

DoD Directive 5210.56 (Nov. 6, 2020),

https://www.esd.whs.mil/Portals/54/Docu

ments/DD/issuances/dodd/521056p.PDF ... 34 n.9

Ellen Knickmeyer, “Costs of the

Afghanistan war,” AP News (Aug. 17,

2021), https://apnews.com/article/middleeast-business-afghanistan43d8f53b35e80ec18c130cd683e1a38f ......... 30 n.8

Erin Grinshteyn & David Hemenway,

Violent death rates in the US compared

to those of the other high-income

countries, 2015, 123 PREVENTIVE

MEDICINE 20 (2019)..................................... 28 n.7

Eric Elbogen, et al., Beyond Mental Illness:

Targeting Stronger and More Direct

Pathways to Violence, 4 CLIN. PSYCHOL.

SCI. 747 (2016) .................................................. 32

Federal Bureau of Investigation, “Active

Shooter Incidents: 20-Year Review 20002019” (May 2021)

https://www.fbi.gov/file-repository/activeshooter-incidents-20-year-review-20002019-060121.pdf/view ....................................... 30

John Rozel & Edward Mulvey, The Link

between Mental Illness and Gun Violence,

13 ANNUAL REV. CLIN. PSYCHOL. 445 (2017) ........ 31

Jonathan Metzl & Kenneth MacLeish,

Mental Illness, Mass Shootings, and the

Politics of American Firearms, 105 AM.

J. PUB. HEALTH 240 (2015) ............................... 31

Michael Siegel, The Impact of State-Level

Firearms Laws on Homocide Rates by

Race/Enthnicity (2020),

https://www.ojp.gov/pdffiles1/nij/grants/2

544669.pdf ......................................................... 28

Michael Siegel, et al., The Impact of State

Firearm Laws on Homicide and Suicide

Deaths in the USA, 1991-2016, 34 J.

GEN. INTERN. MED. 2021 (2019),

https://www.ncbi.nlm.nih.gov/pmc/article

s/PMC6816623/ ................................................. 29

Sadie Gurman & James R. Hagerty,

“Suspect in Pittsburgh Synagogue

Shooting Faces 29 Federal Charges,” The

Wall Street Journal (Oct. 27, 2018),

https://www.wsj.com/articles/pittsburghauthorities-report-active-shooter1540653056 ................................................ 15 n.2

vii

U.S. Census Bureau, “Historical Population

Change Data (1910-2020),”

https://www.census.gov/data/tables/timeseries/dec/popchange-data-text.html .......... 28-29

U.S Department of Homeland Security,

Mass Attacks In Public Spaces – 2019

(Aug. 2020),

https://www.secretservice.gov/sites/defau

lt/files/reports/2020-09/MAPS2019.pdf ............ 32

INTEREST OF AMICI CURIAE

The American Medical Association (“AMA”) is the

largest professional association of physicians,

residents and medical students in the United States.

Its purpose is to promote the science and art of

medicine and the betterment of public health.

Substantially all U.S. physicians, residents and

medical students are represented in its policy-making

process through state and specialty medical societies

and other physician groups seated in its House of

Delegates. AMA members practice and reside in all

50 States.1

The AMA and the Medical Society of the State of

New York represent the Litigation Center of the

American Medical Association and the State Medical

Societies. The Center is a coalition of the AMA and the

medical societies of each State and the District of

Columbia. Its purpose is to represent the views of

organized medicine in the courts. The other amici also

seek to promote public health.

Amici respectfully submit this brief to offer their

unique perspective, as healthcare providers, on the

compelling need to uphold New York’s concealed carry

law. The firearm violence that is plaguing America is

a public health crisis that amici’s members face every

day. They witness the reality, the brutal effects on our

bodies, the deaths, the grief, the suffering, and the

All parties have consented to this filing. This brief was not

authored in whole or in part by counsel for any party. No person

or entity other than amici curiae, their members, or their counsel

made a monetary contribution to the preparation or submission

of this brief.

life-long physical, psychological, social, and economic

consequences that follow survivors who can never be

made whole. The firearm violence emergencies and

trauma never end for amici’s members and other

medical professionals and staff. They devote their

lives to treating us, including in high-risk

emergencies when we are most vulnerable. We put our

lives in their hands.

We have already lost too many of our spouses and

partners, our parents, our children and our other

loved ones, friends and neighbors to gun violence.

Petitioners argue the Second Amendment should be

interpreted based on an academic debate about their

view of the mores of Seventeenth and Eighteenth

Century England and the Founding Era of our

Republic, as if those mores could show that the

Founding Fathers intended to protect the unrestricted

concealed carry of today’s vastly different handguns

that were not available hundreds of years ago and are

capable of firing high velocity rounds in our most

densely populated cities.

Petitioners’ selective

historical accounts are wrong, as Respondents and

other amici ably point out. More fundamentally,

history lessons alone cannot determine whether an

individual has a constitutional right to walk our

crowded streets with a concealed handgun without

showing proper cause.

We need to listen to the contemporary facts, learn

from the science, decline Petitioners’ proposal to

transform the Second Amendment into a mutual

destruction pact, and come together in unity to defeat

this scourge. If unrestricted concealed carry permits

had to be granted based on Petitioners’ bare

allegations, the floodgates would be opened to still

more injury and death.

Amici’s members understand the importance of

protecting our constitutional rights. They include

many individuals who grew up with and value the

recreational use of firearms or choose to own a firearm

for self-defense. But amici share the strong conviction,

informed by their healthcare work and research, that

New York and other States must be able to respond to

the untenable epidemic of firearm violence by

enacting and enforcing appropriate and constitutional

concealed carry laws such as the New York law

challenged here.

Amici respectfully submit this is the rare case in

which this Court’s decision will directly affect whether

countless people, including babies and infants, will

live or die. The stakes can hardly be higher.

STATEMENT OF THE CASE AND SUMMARY

OF ARGUMENT

The issue presented is whether New York may

enforce its reasonable licensing requirements for

individuals who wish to carry concealed handguns in

public spaces, including our streets, highways, stores,

shopping malls, movie theaters, Little League games,

hospitals, subway cars, concert halls, football

stadiums, outdoor festivals, bars, restaurants,

basketball courts, parks, political rallies, houses of

worship, and other crowded venues filled with

children and adults alike. This Court granted

certiorari to decide “[w]hether the State’s denial of

petitioners’ applications for concealed-carry licenses

for self-defense violated the Second Amendment.” The

Court should answer this question in the negative and

affirm the decision below.

Point I presents the firsthand experiences of some

of amici’s physician members who treat victims of

firearm violence. They show there is a grave public

health crisis that must be addressed by measures such

as New York’s concealed carry law.

Point II shows New York Penal Law (“NYPL”)

§ 400.00(2)(f) and its application here are completely

consistent with the Second Amendment and this

Court’s prior decisions. They further New York’s

compelling interest in curbing firearm violence. More

narrowly tailored restrictions would not be successful.

Moreover, principles of judicial deference and

federalism require that the people of New York be

given latitude to continue to implement their permit

system that works best for their needs.

ARGUMENT

AMICI’S PHYSICIAN MEMBERS HAVE

FIRSTHAND KNOWLEDGE OF THE

ENORMOUS PHYSICAL,

PSYCHOLOGICAL AND SOCIAL HARM

WROUGHT BY THE FIREARM VIOLENCE

PUBLIC HEALTH CRISIS

Dr. Cherisse Berry

Dr. Berry is Associate Medical Director of Trauma

at Bellevue Hospital Center in New York, Medical

Director of the inpatient surgery unit at NYU

Langone Health, and Associate Professor of Surgery

at the NYU Grossman School of Medicine. An

accomplished trauma surgeon, she has received

numerous awards and published 56 peer-reviewed

articles while maintaining a full-time clinical practice

at the largest level one trauma center in Manhattan.

Dr. Berry strongly supports New York’s concealed

carry law. She has seen far too many young people—

disproportionately Black men and boys—die

excruciating deaths as a result of inexplicable acts of

firearm violence. People don’t get up in the morning

with the thought that they will be shot that day. But

when different individuals are shot day after day, it is

incredibly difficult to witness so much death and to

have to communicate each one to a devastated family.

Dr. Berry has witnessed the catastrophic damage

that a single bullet can wreak on the human body.

Individuals shot in the skull generally die quickly. If

they survive, they tend to develop brain damage with

a range of permanent complications, such as an

inability to walk, eat or communicate. Some become

completely dependent on machines for the rest of their

lives.

If the bullet hits the spine, the victim is too often

rendered quadriplegic or paraplegic. He cannot move.

He may develop back ulcers. He is unable to urinate.

If the bullet strikes high enough, the brain may be

unable to send signals to the respiratory system.

Every breath requires the aid of a ventilator.

If an individual is shot in a limb and a nerve,

artery, or vein is hit, it may cause a loss of function

and require the amputation of the limb.

The most common gunshot wounds Dr. Berry

treats are in the chest and abdomen, where multiple

organs may be damaged. An individual shot in the

heart may die of a massive hemorrhage or cardiac

tamponade that causes so much blood to leak into the

pericardium or the sac that covers the heart, that the

heart is crushed by the pressure and cannot pump. If

a bullet hits a major artery, the victim may die before

he arrives at the hospital. If the lung is hit, blood may

fill the chest, requiring evacuation with a chest tube

or removal of the lung itself. Gunshot wounds to the

liver can also be lethal because they can cause

excessive bleeding. To control the bleeding and

prevent the patient from dying of shock, the affected

arterial blood vessels must be constricted with coils.

That can cause necrosis and require removal of part of

the liver. If a victim is hit in her intestines, she may

require an ostomy.

Some abdominal gunshot wounds cause the

patient to become so unstable that the initial

operation cannot be finished. Surgeons do what they

can to stop the bleeding in a damage control approach

and then send the patient—with her abdomen still

open—to the ICU, where she is further resuscitated

and warmed to prevent ongoing bleeding from trauma

induced coagulopathy. Her bowels may swell,

physically preventing closure of the abdomen; a mesh

is used to cover it. The patient needs rehabilitation for

weeks and eventually requires an abdominal wall

reconstruction.

Dr. Amy Caggiula

Dr. Caggiula is an Assistant Professor of

Emergency Medicine at George Washington

University School of Medicine and the Associate

Program Director for the Emergency Medicine

Residency Program. She knows how to shoot a gun.

Dr. Caggiula was raised in a responsible, gun-owning

family in New Hampshire, where many of her

relatives lawfully keep firearms in their homes and

enjoy using them for sport or target practice. She

strongly supports New York’s limitations on carrying

concealed handguns, to stem the sort of violence she

sees almost every day as an emergency physician in

Washington, D.C.

The firearm violence in the D.C. area

disproportionately impacts young people, especially

African Americans under the age of 30. Most of their

stories are not covered in the news. People are

unaware of the extent of the carnage. In one recent

case a woman in her early 20s was shot executionstyle in her vehicle while returning from a party.

When the woman arrived in the emergency room, she

did not have a pulse. Dr. Caggiula had to inform her

family of her death. Two family members had panic

attacks and passed out. The woman’s death was

particularly moving for Dr. Caggiula because she was

wearing the same t-shirt as Dr. Caggiula. There but

for the grace of God could have been any of us.

The treatment of firearm violence victims takes a

mental toll on emergency room physicians and staff.

It is incredibly traumatic for trainees in particular.

Every case is difficult. It never gets easier. More

experienced physicians may become inured to the

violence over time. They do their best to avoid that.

But the hardest-hit are the patients and their

families. For their sake, and for all of us, Dr. Caggiula

believes the last thing State governments should do is

make it easier for people to carry concealed handguns

in public.

Dr. Brendan Carr

Dr. Carr is a Professor and System Chair of the

Department of Emergency Medicine at the Icahn

School of Medicine at Mount Sinai in New York. He is

also a Professor in Population Health Science and

Policy. Between 2014 and 2018 he was Director of the

U.S. Department of Health and Human Services

Emergency Care Coordination Center, which oversees

the federal government’s nationwide efforts to create

patient- and community-centered emergency care

systems. He has authored more than 150 peer

reviewed publications and participated in creating

policy guidelines for many health emergencies.

Dr. Carr believes firearm violence is a public

health crisis. He has treated hundreds of patients who

have sustained gunshot wounds and delivered terrible

news to countless families. Dr. Carr vividly

remembers one patient, a child no older than 15, who

was shot and rendered paraplegic. Shortly after that,

the child’s older brother was shot and did not survive.

Dr. Carr remembers delivering the news to the boys’

mother. She collapsed on the floor and wept.

Dr. Carr has seen families, communities, and

front-line healthcare workers overwhelmed by the

massive human toll of firearm violence. He believes

New York has taken the right approach by regulating

the concealed carry of handguns in public.

Dr. Erick Eiting

Dr. Eiting is the Vice Chair and Medical Director

of Emergency Medicine at Mount Sinai Downtown in

New York City.

Dr. Eiting regularly treats firearm violence

victims. He remembers a woman in her 90s who was

admitted to the emergency room. She was at home,

minding her own business, when a bullet flew into her

apartment, struck her lower back and exited through

her upper chest. He knew that meant it was very bad.

The bullet had ripped through multiple organs. The

woman, who had been healthy and active, desperately

wanted to live. She kept asking Dr. Eiting to help her.

He remembers holding her hand, before she died a

short time later.

The woman’s last day was just a normal day for

firearm violence. The death, injury and despair

happen all too often. Dr. Eiting finds it impossible to

understand how this has become what is expected and

accepted. He believes strongly there should not be

more concealed handguns on the streets and in other

public places.

Dr. Alberto Esquenazi

Dr. Esquenazi is a physician specializing in

physical medicine and rehabilitation and the Chief

Medical Officer at MossRehab in Philadelphia. For

more than 35 years, Dr. Esquenazi has helped

gunshot survivors learn to live with the pain,

debilitating obstacles, and loss of control over their

lives resulting from their injuries.

The struggle of one patient Dr. Esquenazi treated

reflects the daunting challenges many face. The

young, athletic man, full of promise, happened to be

standing on a street when a shooter opened fire. He

survived, but the bullet severed vital nerves,

interrupting the transmission of signals from his

brain to his legs. He not only lost the use of his legs,

but also his control over his bowels, bladder, and

sexual functions.

When a bullet passes through the body, it can

rupture blood vessels, shatter bones, and puncture

organs. If a bullet strikes a victim’s limb, it may have

to be amputated and replaced with an artificial limb.

The brain and spinal cord are particularly vulnerable

to gunshot damage, even when the bullet does not

strike a person’s head or spine. If it pierces the lungs,

heart, or pelvic area, it will often cut open a major

artery and cause massive bleeding, blocking the

supply of blood and oxygen to the brain and causing it

to shut down.

A bullet that rips through the nerves in the spinal

cord can be devastating because so many of the body’s

vital functions are affected by those nerves. Any such

injury can affect a person’s ability to move his arms

and legs and to control his respiratory and bladder

muscles. These individuals must also deal with the

loss of their ability to feel physical pressure. This can

make even the simple act of sitting in a chair

dangerous. If they cannot feel the pressure as they sit,

they develop sores. If they tie their shoes too tightly,

they restrict circulation to their feet and their bodies

do not recognize the danger. Even a survivor who

retains control of his limbs may suffer from spasticity,

which causes joints to bend suddenly at extreme

angles. Victims also have to contend with brittle bones

that make any minor trauma or fall dangerous.

These

individuals

also

suffer

traumatic

disruptions to the most private and sensitive areas of

their lives. Many lose bowel and bladder control. To

urinate, they must manually insert a catheter into

their urethra four times each day for the rest of their

lives. If they don’t, the backup of the urine can lead to

kidney failure. Their sexual function is also disrupted.

For men, the loss of sensation may prevent arousal,

cause retrograde ejaculation (semen entering

backwards into the bladder), and require a urologist’s

help to express semen. Women may also be deprived

of a normal sex life.

These

painful,

disruptive

afflictions

are

emotionally devastating. Too often, the physical

trauma is compounded by depression and an inability

to build meaningful relationships. Many family

members are forced into unfamiliar caretaker roles or

must provide other support that is beyond their

emotional, practical, or financial means. Low-income,

Black,

and

Latino

communities

suffer

disproportionately. It is salt in the wound that these

survivors are also less likely to have access to

healthcare in the first place.

Dr. Esquenazi knows the devastation wrought by

firearm violence is a problem that can be solved. He

believes States should not be prevented from taking

reasonable steps to reduce firearm violence. He

opposes efforts to allow even more people to wield

concealed handguns in public.

Dr. Stephen Hargarten

Dr. Hargarten is the Founding Director of the

Comprehensive Injury Center at the Medical College

of Wisconsin, where he is a Professor of Emergency

Medicine and has served as Director of the Firearm

Injury Center. As one of the nation’s most experienced

and accomplished professionals in the field of firearm

injury prevention, he believes there is no question

that more concealed handguns on the streets will lead

to the unacceptable consequence of more injuries and

deaths.

Dr. Hargarten’s career dates back to the 1980s

when he worked at Milwaukee’s only level one trauma

center. In August 2012, he was the primary

emergency physician to treat individuals injured in

the mass shooting at a Sikh temple in Oak Creek,

Wisconsin. Wisconsin is a shall-issue concealed carry

state. Wade Michael Page, the shooter, was able to

pass a background check and legally purchase the

9mm Springfield XD(M) semi-automatic pistol he

used to murder six people and injure the others.

It is not only intentional homicides that worry

Dr. Hargarten. He is also concerned that the presence

of more firearms in public will result in unintentional

and accidental discharges, even by lawful owners.

Some weapons have design flaws, such as older singleaction revolvers that can discharge if dropped and the

hammer is hit. Good people can get drunk, feel

provoked, experience despair, or act impulsively. They

can hit bystanders. The presence of concealed

handguns in public can jeopardize the health and

safety of anyone nearby.

Firearm violence is gruesome. Bullets stretch and

rip cavities inside the body. Typical shooting victims

can lose three to five liters of blood before they are

admitted to the emergency room. If they survive, they

may be left with spinal cord injuries or confined to a

wheelchair. And there are cascading effects: overactivation of stress hormones, long-term psychological

trauma for the victim and family members, and

crippling medical expenses. To protect the public’s

health, Dr. Hargarten strongly supports laws that

limit the presence of concealed handguns in public

places.

Dr. James Rachal

Dr. Rachal is a psychiatrist and Charlotte Regional

Chairman of the Department of Psychiatry at Atrium

Health. He served as a Major in the U.S. Air Force, at

Andrews Air Force Base in Maryland, Walter Reed

Army Medical Center in Washington, D.C., and Camp

Arifjan, Kuwait, where he was Medical Director for

Mental Health Services and Officer-in-Charge of the

Combat Operations Stress Team. Dr. Rachal received

the Air Force Meritorious Service Medal for

outstanding leadership and clinical work and other

Air Force medals.

Dr. Rachal strongly believes that concealed carry

licenses should be narrowly restricted. He has seen

the awful effects of firearm violence, treating

countless survivors who developed PTSD or

behavioral health illnesses due to firearm-related

trauma. Approximately 50-60% of his male patients

have experienced or witnessed firearm violence.

Dr. Rachal has also seen that good people can act

impulsively or emotionally in difficult situations. If a

handgun is easily available it can be used to terrible

effect. People turn firearms on themselves, family

members and strangers.

Background checks on firearm purchasers are

important but can still allow dangerous people to fall

through the cracks. When Dr. Rachal worked at

Walter Reed, one of his acquaintances was Nidal

Hasan, an army psychiatrist. On November 5, 2009,

Hasan used an FN Five-seven semi-automatic pistol

he purchased legally in Killeen, Texas to kill and

injure dozens of people at Ford Hood. Dr. Rachal was

horrified by the attack and by how easy it was for

Hasan, a very troubled member of the military, to

lawfully gain access to a firearm.

Dr. John Rozel

Dr. Rozel is an Associate Professor of Psychiatry,

Adjunct Professor of Law, and faculty member at the

Center for Bioethics and Health Law at the University

of Pittsburgh. He teaches and consults on emergency

psychiatry and violence prevention. He has published

extensively on firearm violence causes and

prevention. Dr. Rozel runs a crisis center in a highgun-crime area less than a mile from a 2016 massshooting in which five people were killed, including a

pregnant woman in her third trimester. He helps

train mental health and law enforcement

professionals to identify people at risk for violence and

to collaborate across disciplines to prevent serious

acts of violence. He has experience responding to

mass-casualty events, including the October 27, 2018

mass shooting at the Tree of Life synagogue in

Pittsburgh by Robert Bowers, who had a concealed

carry license.2

Dr. Rozel believes concealed carry permits should

be tightly regulated. He holds a concealed carry

license in Pennsylvania. It was issued in a matter of

minutes, without a call to either of his references and

without any verification of need or competence with a

firearm. Dr. Rozel’s research and experience refute

the assertion that greater firearm availability will

improve public safety. The wide availability of

firearms outside the home can create dangerous

situations. Firearms may negligently discharge. They

may be used to criminally intimidate or threaten

others (even when the owner alleges it was lawful

Sadie Gurman & James Hagerty, “Suspect in Pittsburgh

Synagogue Shooting Faces 29 Federal Charges,” The Wall Street

Journal (Oct. 27, 2018), https://www.wsj.com/articles/pittsburghauthorities-report-active-shooter-1540653056.

use).3 They may be lost or stolen. One survey of 25

large cities found 4,800 firearms were reported stolen

from vehicles in a single year.4 Moreover, there are

numerous risk factors for firearm violence that are

difficult to screen for and which may not show up in a

background check, such as difficulty controlling

anger, problematic substance use, and hatred of

others based on gender, race, religion, or similar

attributes.5

Dr. Joseph Sakran

Dr. Sakran is Director of Emergency General

Surgery and Associate Chief of the Division of Acute

Care Surgery at The Johns Hopkins Hospital, and an

Associate Professor of Surgery and Nursing at The

Johns Hopkins University School of Medicine.

Firearm violence is personal for Dr. Sakran. A

Virginia area native, he had a brush with death at the

age of 17. After attending the first high school football

game of the season, he was spending time with

friends. An altercation broke out at a nearby park. A

stranger fired a gun. The 38-caliber bullet struck Dr.

3 David Hemenway & Deborah Azrael, The Relative Frequency of

Offensive and Defensive Gun Uses, 15 VIOLENCE VICT. 257–272

(2000),

https://connect.springerpub.com/content/sgrvv/15/3/257.abstract.

4 Brian Freskos, “Guns Are Stolen in America Up to Once Every

Minute.”

The

Trace

(Sept.

21,

2016),

https://www.thetrace.org/2016/09/stolen-guns-cars-trucks-usatlanta/.

5 Amy Barnhorst & John Rozel, Evaluating threats of mass

shootings in the psychiatric setting, INTERNATIONAL REVIEW OF

PSYCHIATRY

(2021),

https://www.tandfonline.com/doi/abs/10.1080/09540261.2021.19

47784.

Sakran’s throat, rupturing his trachea and injuring

his vocal cord and carotid artery. He was critically

injured, spending weeks in the hospital. He had a

tracheostomy for over six months, and numerous

surgeries during his senior year of high school. To this

day, his voice is still raspy as a result of his injury. But

Dr. Sakran survived. Too many are not so lucky.

From tragedy, Dr. Sakran found inspiration: he

resolved to become a trauma surgeon like the ones

who saved his life. He knows that what happened to

him could happen to anyone’s child in the Virginia

area, or anywhere in the country. He has seen

hundreds of people slaughtered on the streets of

Baltimore. A disproportionate number are young

Black men. Many arrive without a pulse, bleeding to

death, or die from their numerous injuries. In

addition, over the past decade, we have seen an

increase in the number of mass shootings that result

in significant injury and death.

The widespread access to firearms also contributes

to suicide. Suicide is generally an impulsive act.

Research shows that 71% of suicide attempts occur

within an hour after the decision has been made. Most

people who survive do not go on to die from a second

attempt, and in fact lead relatively productive lives.

But those who use a firearm as a method of suicide

rarely have that second chance, due to the high case

fatality rate.

Dr. Sakran believes the best medical treatment is

prevention. Common sense measures to protect the

community, like New York’s concealed carry law, are

absolutely necessary.

Dr. Babak Sarani

Dr. Sarani is a Professor of Surgery and

Emergency Medicine at George Washington

University School of Medicine and the director of

Trauma and Acute Care Surgery at The GW Medical

Faculty Associates. He treats firearm violence

victims. He also conducts research, and has published

extensively concerning mass shootings.

More than 95% of the gunshot victims he treats

were shot with handguns. When people have the

means to act lethally on impulse, the chances of injury

and death increase exponentially. Many shootings,

including suicides, are due to an impulsive act or

perceived disrespect. The victims of self-inflicted

gunshot wounds tend to be older white men in their

40s or 50s in suburban or rural areas. The others are

disproportionately African American men and boys

between the ages of 14 and 25 in cities. Many of

Dr. Sarani’s patients were simply bystanders caught

in the crossfire. Many were shot on their own porches

for no reason.

Tragically, Dr. Sarani has seen countless patients

die on the operating table. The most painful part of his

job is informing families that their loved ones have

bled to death and he could not save them. When the

patients survive, they generally bear long-lasting

physical and mental consequences.

Also tragically, Dr. Sarani never even has an

opportunity to try to save 50-60% of the individuals

who have been shot, principally those shot in the head

or the chest. They die at the scene.

Dr. Sarani has found in his research that when

handguns, generally semi-automatic, are used in

mass shootings there tend to be more deaths than

when an assault rifle is used. Individuals with

concealed handguns have an opportunity to get far

closer to their victims and then to shoot more bullets

into them before the victims can try to flee.

Dr. Layla Soliman

Dr. Soliman is an inpatient psychiatrist at Atrium

Health in Charlotte, North Carolina. She has also

worked in outpatient and crisis settings. She regularly

treats individuals who have been shot, witnessed a

shooting, or lost a loved one to firearm violence. A

grandmother came for crisis stabilization after her

toddler grandchild found his father’s gun hidden in his

boot, then shot himself. The devasted grandmother

carried the dead child’s toy soldier with her. The

memory still haunts Dr. Soliman, years later, as she

recalls feeling helpless in the face of such tragedy.

Firearm violence is a significant cause of trauma.

It can take witnesses and survivors years to begin to

recover from post-traumatic stress disorder and

related symptoms.

Dr. Soliman has personal experience using

firearms and is not anti-gun. She supports restrictions

on concealed carry licenses to help prevent firearmrelated deaths and injuries. Dr. Soliman regularly

assesses the risk that individuals will engage in

violence. She has seen people come to clinical

attention after seeking access to firearms for

“protection.” They often present in ways that appear

“normal” to the untrained eye, but harbor paranoid

delusions (such as believing they are being stalked or

surveilled). Such individuals could be extremely

dangerous if they obtain a handgun. Psychoses can be

very subtle.

Moreover, individuals who are now healthy and

lawfully obtain firearms can later develop severe

psychoses, suffer depression, react to stressful

external events in a violent manner, or have their

weapons stolen or misused by others. For example,

Dr. Soliman treated a legal firearm owner who passed

a background check before developing a drug problem

and suffering a psychotic break that culminated with

her firing her weapon into an apartment.

When a child or other loved one dies in a senseless,

random act of violence, many family members have

homicidal ideations about getting revenge. They can

too easily act on those impulses if a firearm is

available.

The average age at which current and past gun

owners say they acquired their first firearm is 22,

which is within the age range when serious, persistent

mental illness typically emerges. It is important not

to stigmatize mental illness and to note that the vast

majority of violence is not attributable to mental

illness. Still, such individuals can be at an elevated

risk of violence. Even in the absence of such illness,

suicide and homicide are two of the three leading

causes of death in the 15-24-year-old age group.

Handguns are frequently used in both.

Dr. Frank Tedeschi

Dr. Tedeschi is a child and adolescent psychiatrist

at NYU Langone Health and Clinical Assistant

Professor of Child and Adolescent Psychiatry at NYU

Grossman School of Medicine. Every day, he sees

children and teenagers who have been shot, witnessed

a shooting, or lost a parent, sibling, classmate, friend

or someone in the community to firearm violence. This

traumatizes them. Dr. Tedeschi has seen firearm

violence become shockingly normalized to young

people.

Many parents do their best to shelter their

children. But when the children see and hear about

shootings in their communities, many grow up

believing the world is a dark and frightening place

where violence lurks around every corner. The effect

on young, developing minds cannot be overstated. Dr.

Tedeschi has seen children scarred in ways that no

child should be. They develop symptoms of PTSD

similar to many combat veterans, with nightmares,

flashbacks and severe anxiety. They often carry these

symptoms well into adulthood. If they see danger at

every turn, it affects their ability to process emotions

and relate to others. They often respond by engaging

in hostile, aggressive, or even criminal behavior.

It is even worse when a parent or family member

is lost to firearm violence. Children need emotional

support. They need to feel the world is a safe place

they can trust. When they are deprived of their

support systems by firearm violence, they can lose the

ability to build healthy relationships with others.

They may be left with the feeling they must fend for

themselves. It can lead them down a path of aberrant

development that only alienates them further from

the remaining positive relationships in their lives.

This places them at a greater risk of involvement in

the criminal justice system, recidivism, and the

development of antisocial personality disorder.

Dr. Ricard Townsend

Dr. Townsend, a trauma surgeon, has treated 300

to 400 penetrating gunshot wound victims annually

since the early 1980s, in California and Pennsylvania.

He volunteered for the U.S. Army Reserve after

September 11. As a Lieutenant Colonel, he treated

gunshot victims during multiple tours in Iraq and

Afghanistan. For months at a time, Dr. Townsend

tended soldiers injured on the battlefield and then

returned home to treat large numbers of the

Americans who are shot by rapid-fire, semi-automatic

handguns in our own cities. He teaches military

expeditionary surgeons at Walter Reed Hospital

based on his experience treating civilians shot on the

streets of this country.

Dr. Townsend has treated bullet wounds in every

part of the body. Most victims need major operations.

A single bullet entering the body at 1,000 to 3,000 feet

per second can bounce off the ribs and pelvis and rip

apart multiple organs and tissues. One of the most

important factors that determines whether a victim

lives or dies is where she has been shot. A shooter

wielding a concealed handgun—who is able to get

close enough to shoot his victim in the head or chest—

is far more likely to kill than one who uses a more

powerful AR-15 rifle but misses vital organs.

Dr. Townsend remembers a young boy who was

shot in the upper abdomen—referred to as the

“surgical soul” because there are so many organs that

can be torn apart. In a flash, the boy went into cardiac

arrest and died. Dr. Townsend delivered this awful

news to the boy’s father, who was furious at

Dr. Townsend because he could not save the boy’s life.

Dr. Townsend was grateful the father was not armed.

All too often next of kin react with impulsive

vengeance after losing a family member to firearm

violence.

Dr. Townsend’s ancestor, a colonial militiaman,

was killed by British soldiers at the battle of

Lexington and Concord in 1775. Back then,

militiamen used simple flint-lock weapons. Today,

easily-available handguns can fire twenty rounds in a

few seconds. Victims are far more likely to be shot in

multiple places and suffer blood loss trauma. If major

blood vessels are ruptured, victims can bleed to death

in minutes, before first responders even arrive.

Dr. Townsend has owned firearms and respects

the Second Amendment. He believes it should not be

found to prohibit reasonable gun regulation, including

New York’s limitations on carrying a concealed

handgun.

Dr. Ian Wittman

Dr. Wittman is Chief of Emergency Medicine at

NYU Langone Hospital–Brooklyn and Co-Chair of

NYU Langone Health’s Emergency Management

Committee.

Dr. Wittman has seen the devastating effects of

firearm violence. Gunshots at close range are more

likely to cause death. It is the lethality that attracts

people to guns. Wounds to the head and neck are

frequently fatal. If not, they may render their victim

paralyzed, brain-damaged, or unable to breathe on his

own. Chest and abdomen wounds can cause rapid

death if the victim is not operated on quickly. Victims

lose a significant volume of blood and their liver,

intestines, or lungs may have to be removed. Even if a

victim survives the gunshot, the surgeries pose risks:

chronic pain, anesthesia complications, infection,

adverse reactions to medication or blood transfusions,

and dehiscence—wounds splitting and bursting back

open.

Dr. Wittman has observed that shootings are often

associated with alcohol and drug use, which affect a

person’s judgment. When an intoxicated person has a

firearm, people too often get shot.

When Dr. Wittman was a trainee in Houston,

Texas, he saw an extremely high number of shooting

victims. He sees fewer in New York, but there is still

a hideous amount of firearm violence. Dr. Wittman

treats patients with gunshot wounds regularly. In one

case, a college student no older than 20 was shot in

the head at point blank range after answering his

front door. The shooter, carrying a concealed weapon,

was able to walk past the doorman and others who did

not know he was armed. In another, a disgruntled exemployee pulled a concealed firearm out of his jacket

and murdered his former coworker on the street

outside the Empire State Building. The police

responded, but their aim was defective and they

mistakenly shot a number of bystanders. Some

required emergency operations to survive.

Dr. Wittman believes firearm violence tragedies

would become more frequent if New York’s

requirements for a concealed carry permit were

relaxed. He finds it incomprehensible that anyone

would be allowed to bring a deadly firearm into a bar

or movie theater without a special need to do so.

II.

NEW YORK’S CONCEALED CARRY LAW

AND ITS APPLICATION HERE COMPLY

WITH THE SECOND AMENDMENT

1. Petitioners argue this Court’s precedents

preclude New York from enforcing its concealed carry

law here. Not so.

In District of Columbia v. Heller, this Court

disclaimed any intention “to cast doubt” on

“longstanding”

and

“presumptively

lawful”

regulations of firearms, and provided a nonexhaustive list of such measures. 554 U.S. 570, 62627 & n.26 (2008).

NYPL § 400.00(2)(f) is just such a “longstanding”

regulation. “[T]he majority of the 19th-century courts

to consider the question held that prohibitions on

carrying concealed weapons were lawful under the

Second Amendment or state analogues.” Heller, 554

U.S. at 626. As then-Judge Kavanaugh emphasized,

“Heller affirmatively approved . . . concealed-carry

laws.” Heller v. District of Columbia, 670 F.3d 1244,

1278 (D.C. Cir. 2011) (Kavanaugh, J. dissenting)

(emphasis in original). Justice Thomas has explained

that even a law that completely prohibits concealed

carry, unlike the NYPL, would be a “narrow

limitation[]” that would not “prohibit” anyone “from

generally exercising his right to bear arms”:

Traditionally, States have imposed narrow

limitations on an individual’s exercise of his

right to keep and bear arms, such as

prohibiting the carrying of weapons in a

concealed manner or in sensitive locations, such

as government buildings. But these narrow

restrictions neither prohibit nor broadly

frustrate any individual from generally

exercising his right to bear arms.

Voisine v. U.S., 136 S. Ct. 2272, 2291 (2016) (THOMAS,

J., dissenting) (emphasis added; citations omitted).

Section 400.00(2)(f) is nothing like the “absolute

ban on handguns” Heller struck down. 554 U.S. at 628,

632. New York’s law does not ban concealed carry, let

alone “totally ban[]” handguns. Id. at 628. The two

individual Petitioners concede New York granted

them concealed carry licenses for certain purposes.

See Pet. App. 7.

Moreover, Heller addressed the core Second

Amendment “right of law-abiding, responsible citizens

to use arms in defense of hearth and home” “where the

need for defense of self, family, and property is most

acute.” 554 U.S. at 635, 628. That was the “central

holding in Heller.” McDonald v. Chicago, 561 U.S.

742, 780 (2010); see also Jackson v. San Francisco, 135

S. Ct. 2799, 2800-01 (2015) (THOMAS, J., dissenting)

(“[T]he core of the Second Amendment right” is selfdefense “in the home,” where people are “most

vulnerable—when they are sleeping, bathing,

changing clothes, or otherwise indisposed”).6

The NYPL respects this “core” right. It allows any

eligible applicant to obtain a license to use a handgun

within the home without a showing of “proper cause.”

See § 400.00(2)(a). Section 400.00(2)(f) imposes

additional license requirements only when an

applicant seeks to bring a concealed handgun into a

public space.

2. Amici join Respondents’ argument that no

more than intermediate scrutiny should apply here.

But, even if strict scrutiny were applied, the decision

below should be affirmed.

Firearm violence is a public health crisis.

Petitioners do not dispute that New York has an

important—even compelling—interest in stemming

the violence. From 2010 to 2019, firearm-related

deaths were the third leading cause of U.S. injuryrelated deaths. More than 358,000 Americans died

from firearm-related injuries, including more than

126,000 homicide victims. Firearm violence killed

more than 14,000 children under the age of 18,

including 885 under the age of five. See CDC, Fatal

6 In N.Y. State Rifle & Pistol Ass’n, Inc. v. City of N.Y., Justice

Alito, joined by Justices Thomas and Gorsuch, opined that the

Second Amendment also protects certain rights “concomitant of

the same right recognized in Heller.” 140 S. Ct. 1525, 1541 (2020)

(ALITO, J., dissenting). Such “concomitant” rights, according to

the three Justices, may include the right to take a gun outside

the home for maintenance, repair, lawful transfer of ownership,

or use at a gun range. See id. Here, Petitioners have never

contended that any such rights were impaired by the limitations

on their concealed carry permits.

Injury Reports, 1999-2019 [“Fatal Injury Reports”],

available

https://webappa.cdc.gov/sasweb/ncipc/mortrate.html.

Minority communities suffer disproportionately. See

Michael Siegel, The Impact of State-Level Firearms

Laws on Homicide Rates by Race/Ethnicity 1 (2020),

https://www.ojp.gov/pdffiles1/nij/grants/254669.pdf.7

In New York, between 2010 and 2019, 8,869 people

died of firearm-related injuries, including 3,973

homicides. See Fatal Injury Reports, supra. That

strongly underscores New York’s compelling need for

its licensing law.

3. Petitioners argue the New York law is too

restrictive. But the data shows a less restrictive

system—such as a shall-issue regime requiring no

more than a basic background check—would not be

nearly as successful in advancing New York’s

compelling interest in reducing firearm violence.

New York has a lower rate of fatal firearm violence

than many other States. During the last decade, New

York had 6.28% of the population of the fifty States

and the District of Columbia (based on the 2010

census), see U.S. Census Bureau, “Historical

Population

Change

Data

(1910-2020),”

In 2015, the firearm homicide rate in the U.S. was 4.1 per

100,000 population. In contrast, the rate in the U.K., whose

purported centuries-old mores Petitioners so heavily rely on, was

zero. See Erin Grinshteyn & David Hemenway, Violent death

rates in the US compared to those of the other high-income

countries, 2015, 123 PREVENTIVE MEDICINE 20–26 (2019). 91.6%

of the women, 82.5% of the men and 96.7% of the children aged

0-4 years killed by guns in high-income countries were from the

U.S. See id.

https://www.census.gov/data/tables/timeseries/dec/popchange-data-text.html, but 3.15% of

firearm-related homicides in these States and the

District of Columbia. See Fatal Injury Reports, supra.

New York’s approach is working. The Court should

not prevent it from continuing to work.

The New York data is consistent with a significant

and growing body of research that shows may-issue

States (where licenses and their scope are

discretionary) have lower rates of firearm-related

homicides than shall-issue States (where licenses are

issued to all who qualify). One study found shall-issue

States had a 15% higher firearm homicide rate.

Michael Siegel et al., The Impact of State Firearm

Laws on Homicide and Suicide Deaths in the USA,

1991-2016, 34 J. GEN. INTERN. MED. 2021-2028 (2019),

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816

623/, Online Supplemental Table S3. Other research

confirms that restricting public carry reduces fatal

firearm violence. See Respondents’ Br. at 44; Amici

Curiae Social Scientists and Public Health

Researchers’ Br.; see also Heller, 670 F.3d at 1286

(Kavanaugh, J., dissenting) (“[S]emi-automatic

handguns are more dangerous as a class than semiautomatic rifles because handguns can be

concealed.”).

May-issue laws saved thousands of lives and

avoided thousands of family tragedies. Had the eight

States, including New York, that have may-issue laws

and “proper cause” or “good cause” requirements to

carry in public been compelled to switch to shall-issue

regimes, the 15% higher firearm homicide rate would

have meant approximately 3,793 additional

individuals in those States — men, women, infants

and babies — would have been killed by firearm

violence between 2010 and 2019. That is more than

the number of U.S. service members killed in

Afghanistan during the entire war.8 And countless

others would have been maimed, injured, and

mentally and physically scarred.

Moreover, successful defensive firearm use in

active shooter situations by people other than trained

law enforcement officers is extremely rare. Only four

of the 345 active shooters catalogued by the FBI over

a 20-year period were stopped by a good guy with a

gun. See Federal Bureau of Investigation, “Active

Shooter Incidents: 20-Year Review 2000-2019,” at 4

(May 2021), https://www.fbi.gov/file-repository/activeshooter-incidents-20-year-review-2000-2019060121.pdf/view.

4. Even if there were room for disagreement as

to the studies showing stricter concealed carry laws

work (and there is not), important principles of

judicial deference and federalism would weigh heavily

in favor of allowing New York to enforce its licensing

law.

“[A]ssessing the risks and benefits of handgun

possession and shaping a licensing scheme to

maximize the competing public-policy objectives, as

New York did, is precisely the type of discretionary

judgment that officials in the legislative and executive

8 Ellen Knickmeyer, “Costs of the Afghanistan war,” AP News

(Aug.

17,

2021),

https://apnews.com/article/middle-eastbusiness-afghanistan-43d8f53b35e80ec18c130cd683e1a38f.

branches of state government regularly make.”

Kachalsky v. Cty of Westchester, 701 F.3d 81, 99 (2d

Cir. 2012). New York acted to address an increase in

homicides and suicides by shooting. Id. at 84. That is

an important and compelling government interest,

and the New York law is substantially related and

narrowly tailored to it. The “proper cause”

requirement and the limitations on the scope of

licenses represent an appropriate balancing of risks to

accomplish that objective. The risk factors that

indicate a person may commit firearm violence are

numerous, often subtle, as many of the physicians

explain in Part I, and may be difficult to uncover

through screening.

Petitioners point to New York’s requirement that

license applicants disclose whether they have suffered

any mental health illness, and its prohibition on

issuing licenses to those who have been involuntarily

committed. But New York cannot stop firearm

violence merely by screening applicants for mental

illness. The vast majority of gun violence is not

attributable to people with mental illness. See John

Rozel & Edward Mulvey, The Link between Mental

Illness and Gun Violence, 13 ANNUAL REV. CLIN.

PSYCHOL. 445–469 (2017). Research shows the

mentally ill account for less than 5% of firearmrelated crimes or firearm-related homicides. See

Jonathan Metzl & Kenneth MacLeish, Mental Illness,

Mass Shootings, and the Politics of American

Firearms, 105 AM. J. PUB. HEALTH 240-249 (2015).

Individuals may commit acts of violence due to

family circumstances, domestic strife, divorce,

financial distress, excessive alcohol, controlled

substance abuse, drugs, difficulty controlling anger,

hatred of others based on race, gender, religion,

national origin or other attributes, personal tragedy,

past victimization, despair and a host of other factors

that can affect any of us and that licensing authorities

cannot be expected to determine or anticipate. See

Eric Elbogen, et al., Beyond Mental Illness: Targeting

Stronger and More Direct Pathways to Violence, 4

CLIN. PSYCHOL. SCI. 747-759 (2016). Nearly a third of

mass-casualty attack perpetrators in 2019 “were

retaliating for perceived wrongs related to specific

issues in their lives … such as an ongoing feud with

neighbors, being kicked out of a retail establishment,

being teased or bullied, facing an impending eviction,

or being angered and frustrated about college debt

and job prospects.” U.S. Department of Homeland

Security, Mass Attacks In Public Spaces – 2019, at 11

(Aug.

2020),

https://www.secretservice.gov/sites/default/files/repor

ts/2020-09/MAPS2019.pdf. Moreover, individuals may

present as normal and healthy on paper, and may

even be able to talk their way out of psychiatric

interventions, while subject to paranoid delusions

that make them a danger to others.

This “Court has given state and federal

legislatures wide discretion to pass legislation in

areas where there is medical and scientific

uncertainty.” Gonzales v. Carhart, 550 U.S. 124, 163

(2007) (collecting cases). “Sound policymaking often

requires legislators to forecast future events and to

anticipate the likely impact of these events based on

deductions and inferences for which complete

empirical support may be unavailable.” Turner

Broadcasting v. F.C.C., 512 U.S. 622, 665 (1994).

Moreover, this Court has long extolled the wisdom

of our federalist system. “Deference to state

lawmaking ‘allows local policies “more sensitive to the

diverse needs of a heterogenous society,” permits

“innovation and experimentation,” enables greater

citizen “involvement in democratic processes,” and

makes government “more responsive by putting the

States in competition for a mobile citizenry.”” Ariz.

State Legis. v. Ariz. Indep. Redistricting Comm’n, 576

U.S. 787, 818 (2015) (quoting Bond v. U.S., 564 U.S.

211, 221 (2011)). This Court tries “to avoid imposing a

single solution on the States from the top down.”

Smith v. Robbins, 528 U.S. 259 (2000). What works in

Montana may not work on the crowded streets of New

York.

Some of this Court’s most important federalism

decisions have addressed the right of States to craft

their own firearm-violence control policies. See Printz

v. U.S., 521 U.S. 898 (1997); U.S. v. Lopez, 514 U.S.

549 (1995). Justice Kennedy explained:

States may perform their role as laboratories

for experimentation to devise various solutions

where the best solution is far from clear. … If a

State or municipality determines that harsh

criminal sanctions are necessary and wise to

deter students from carrying guns on school

premises, the reserved powers of the States are

sufficient to enact those measures.

Id. at 581 (Kennedy, J., concurring). Here, too, the

people of New York should be allowed to decide that

their permitting law is the “best solution.”

New York is among at least eight States that have

“may-issue” laws with proper cause requirements.

Together these heavily urbanized States have

approximately 25% of the U.S. population.9 This Court

should not cut short the opportunity for debate and

experimentation concerning concealed carry laws by

imposing a one-size-fits-all solution.

The Department of Defense also has a may issue directive and

the Army Corps of Engineers grants the District Commander

“discretion” whether to permit individuals to carry a firearm at

certain sites. See DoD Directive 5210.56 (Nov. 6, 2020),

https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/do

dd/521056p.PDF, § 4.2; Army Corps of Engineers Command

Guidance

(May

14,

2018),

https://corpslakes.erdc.dren.mil/employees/cecwon/pdfs/18May1

4-FirearmsPossessionGuidance.pdf.

CONCLUSION

The judgment below should be affirmed.

September 21, 2021

Respectfully submitted,

ERIN G. SUTTON

MICHAEL J. DELL

LEONARD A. NELSON

Counsel of Record

AMERICAN MEDICAL

CHASE HENRY MECHANICK

ASSOCIATION

KRAMER LEVIN NAFTALIS

Office of General Counsel

& FRANKEL LLP

330 N. Wabash Ave.

1177 Avenue of the

Suite 39300

Americas

Chicago, Illinois 60611

New York, NY 10036

(312) 464-4801

(212) 715-9100

Erin.sutton@ama-assn.org mdell@kramerlevin.com

Counsel for Amici Curiae American Medical

Association, Medical Society of the State of New York,

American Academy of Pediatrics, and American

Academy of Child and Adolescent Psychiatry

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.