NewYork-Presbyterian Hospital has agreed to undertake a series of reforms to resolve allegations that the hospital system frequently puts patients in mental health emergencies at risk by failing to provide adequate oversight and allowing patients to be discharged from the hospital without authorization, the state attorney general’s office announced Monday.
The settlement, which followed a multi-year investigation by the AG’s office, includes a $500,000 fine and a promise by NewYork-Presbyterian to pay a $10,000 fine for any future violations of the terms of the settlement, which include new procedures for evaluating patients. Attorney General Letitia James said in a statement that the settlement will help protect patients and ensure that “no one is left without care in their most vulnerable moments.”
The settlement does not include any admission of wrongdoing, but it does require hospitals to improve their testing policies to better identify whether patients are at risk for suicide or violence. The NewYork-Presbyterian Church is also calling for increased monitoring of patients seeking care to prevent them from eloping, or leaving hospitals without permission.
“Too many New Yorkers facing mental health crises have received inadequate care when they need help most,” James said. “Mental health care is necessary medical care, and hospitals have a legal and moral obligation to respond to these crises with urgency and compassion.”
NewYork-Presbyterian spokeswoman Angela Karafazuli said in a statement that the hospital is “committed to continuous improvement for the benefit of our patients and the communities we serve.” The hospital system includes 10 campuses in the metropolitan area, but the residency primarily focuses on activities at the Methodist campus in Brooklyn.
The settlement comes amid growing public concern over policies regarding the treatment of people with mental illness. Approximately 3 million adult New Yorkers live with a mental illness, and the COVID-19 pandemic has “dramatically increased” the need for mental health services, according to the agreement.
Former Mayor Eric Adams called for more involuntary hospitalizations of New Yorkers who are considered a danger to themselves or others. Mayor Zoran Mamdani took a different approach, creating the Mayor’s Office of Community Safety, under which the city encouraged less police involvement in involuntary hospitalizations and more long-term care options for people in distress.
Court documents commemorating the settlement document several episodes in which the hospital failed to admit patients with serious mental illnesses.
In one case, a 70-year-old woman with bipolar disorder and schizophrenia was sent from a nursing home to NewYork-Presbyterian Methodist Hospital in 2022 after she refused to take antipsychotic medication, became increasingly delusional, and assaulted nursing home staff, according to court documents.
The agreement stated that the hospital’s triage nurse did not properly review his documents or point out that he was at risk of elopement or unauthorized departure. The patient eloped before returning to the nursing home by ambulance.
Two days later, the NYPD alerted the hospital that a woman had been sleeping in the lobby of the building, according to the AG’s findings.
In another example, a young man with a history of schizophrenia and previous psychiatric hospitalization came to the hospital complaining of auditory hallucinations. Medical experts said the patient was “possibly suicidal” and had “homicidal ideation,” according to the document, noting that the patient “couldn’t control when he wanted to hurt someone.”
Despite staff determining that the patient was a danger to himself or others and required involuntary hospital treatment, the patient was left unattended and fled the emergency department before a nurse could report him missing.
Glenn Liebman, CEO of the New York State Mental Health Association, an Albany-based advocacy group, praised the settlement, saying it confirms the need for strong oversight of the health care system.
“If something happens and they have a mental health crisis and they end up in the hospital and they’re there for just a short period of time and then they’re discharged without really having a strong discharge plan in place, that creates, frankly, a very bad scenario for the individual,” Liebman told Gothamist.
Jonathan Pirtle, an associate professor at New York University’s School of Global Public Health who specializes in mental health care, said some of the problems identified by state investigators are cost-related and can only be resolved with cooperation from state and federal legislatures.
Pirtle said one of the findings of the attorney general’s investigation was that the hospital failed to bring all of its licensed inpatient psychiatric beds back online after the pandemic, even though it was legally required to do so.
As of May 2023, more than 100 psychiatric beds across hospitals remain inactive, according to the Attorney General’s Office.
“Mental health and psychiatric services are generally reimbursed at suboptimal rates compared to physical health services in public insurance. [and] “And this is something that can be solved with greater insurance, especially in terms of Medicaid reimbursement rates,” Pirtle said.
NewYork-Presbyterian spokeswoman Karafazuli said the hospital is focused on providing safety and care for patients with mental health needs.
“Since 2022, we have continued to strengthen our policies and workflows, expand our mental health capacity with inpatient beds and outpatient services, and improve safety. These improvements are recognized in the Attorney General’s findings,” said Karafazuri.
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