The New Jersey man who confessed to killing 6-year-old Etan Patz was in a hospital under suicide watch Friday when prosecutors formally charged him with the 1979 murder, a case that rocked the nation.
As new revelations about his severe mental illness surfaced, Pedro Hernandez, 51, was ordered held without bail for psychiatric examination.
Prosecutors filed the murder charge 33 years to the day after the boy disappeared while walking -- alone for the first time -- to a school bus stop in his SoHo neighborhood.
At the time, Hernandez was 18 and working as a stock clerk at a grocery down the street from Etan's home.
A law enforcement source said Hernandez was taken to Bellevue Hospital Center on Friday morning because of concerns that he was suicidal. The arraignment was done at 6:20 p.m. via a special video link between the hospital and a fifth-floor courtroom in Manhattan Criminal Court.
The image of Hernandez, dressed in an orange jail jumpsuit and sporting a goatee and shaved head, was projected on a big screen in the courtroom. Seated next to his court-appointed attorney, Harvey Fishbein, Hernandez did not enter a plea.
"It has been 33 years and justice has not yet been done in this case," Assistant District Attorney Armand Durastanti told Judge Matthew Sciarrino Jr.
Fishbein said after the arraignment that Hernandez's psychiatric history includes "auditory and visual hallucinations."
The lawyer said the defendant has been diagnosed with bipolar disorder and schizophrenia.
That was confirmed by Hernandez's relatives, who added that he also suffers from anger-control issues and is battling cancer.
Cop: He admitted killing boy
In a single-page felony complaint signed by NYPD Det. David Ramirez of the missing persons squad, Hernandez, of Maple Shade, N.J., was charged with one count of second-degree murder.
He has admitted to police that he strangled Etan on May 25, 1979, in the bodega at 448 W. Broadway where he worked.
Police said Hernandez stated to them that he lured Etan with the promise of soda. He later put the boy's body in a plastic bag and dumped it in an alley area next to 113 Thompson St., about a block and a half away.
Investigators were seen Friday entering the bodega basement.
"This is the beginning of the legal process, not the end," Manhattan District Attorney Cyrus Vance Jr. said in a statement. "There is much investigative and other work ahead, and it will be conducted in a measured and careful manner."
The court-ordered psychiatric exam will help determine whether Hernandez is fit to stand trial and assist in his own defense. He is due back in court June 25 for a bail hearing, officials said.
Hernandez has told investigators he took drugs, including cocaine, in the late 1970s and '80s, but whether he was under the influence of drugs at the time of the killing is not known, a law enforcement source said.
The source also said Hernandez appears to have had "significant" mental health issues for most of his life.
With the case against him based largely on the confession, and with no body ever found, legal experts say investigators will need to find corroborating evidence before going to trial. Under New York law, confessions alone are not sufficient to convict someone of a crime.
Police have not provided a motive for the killing.
Sister says he told her
Norma Hernandez, the defendant's sister, said Friday that her brother had told relatives in 1980 that he had killed a boy. She told police that her brother admitted the slaying while the family was on a church prayer retreat in New Jersey, she said.
"He said he hid the child in a Dumpster," Norma Hernandez said. "The pastor heard it too."
Police officials said they have no record of such a call.
The arraignment of Hernandez came on National Missing Children's Day -- a day of remembrance sparked by Etan's disappearance.
The street outside the Manhattan Criminal Court Building at 100 Centre St. was lined with news vans throughout the day.
Inside, Hernandez's wife, Rosemary, and daughter, Becky, sat on a bench in the hallway outside a courtroom, but left before the arraignment. The two politely refused to comment.
On Prince Street in SoHo, where Etan lived, his father, Stan Patz, returned to the family's apartment on Friday. He declined to speak to reporters.
At a news conference Thursday, Kelly said Hernandez spoke with investigators for more than 3 1/2 hours. Detectives videotaped the statement.
"He was remorseful," Kelly said of Hernandez, who broke down and cried during the interview.
At some point during the interview, Hernandez was read his Miranda rights, Kelly said.
A law enforcement source said that Hernandez said in his statement to police that a "feeling overwhelmed him" when he killed Etan.
If Hernandez is found fit to stand trial, it would be up to the defense to explore whether his mental condition at the time he said he killed Patz prevented him from knowing what he did was wrong.
With Kevin Deutsch
and Igor Kossov