NewYork-Presbyterian Hospital has agreed to undertake a series of reforms to settle claims the hospital system frequently puts patients experiencing mental health emergencies at risk by failing to provide adequate supervision and allowing them to leave hospital care without authorization, the state attorney general’s office said Monday.
The settlement, which follows a years-long investigation by the AG’s office, includes a $500,000 fine, and a promise by NewYork-Presbyterian to pay a $10,000 penalty for any future violations of the settlement terms, which include new protocols for evaluating patients. Attorney General Letitia James said in a statement the settlement would protect patients and help ensure “that no one is left without care in their most vulnerable moments.”
The settlement includes no admission of wrongdoing, but requires the hospital to improve screening policies to better identify whether patients are at risk of suicide or violence. It also requires NewYork-Presbyterian to strengthen patient monitoring to better ensure that patients seeking care do not elope — that is, leave the hospital without authorization.
“Too many New Yorkers experiencing mental health crises have been met with 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 treat these crises with urgency and compassion.”
Angela Karafazli, a spokesperson for NewYork-Presbyterian, said in a statement the hospital was “committed to continuous improvement for our patients and the communities we serve.” The hospital system includes 10 campuses across the metropolitan area, but the settlement largely focuses on activities at its Brooklyn Methodist campus.
The settlement comes as policies regarding treatment for those with mental illness are a matter of increasing public concern. Some 3 million adult New Yorkers live with mental illness and the COVID-19 pandemic “dramatically increased” the need for mental health services, according to the agreement.
Former Mayor Eric Adams pushed for more involuntary hospital admissions of New Yorkers considered to be at risk to themself or to others; Mayor Zohran Mamdani has taken a different approach, establishing the Mayor’s Office of Community Safety, under which the city has encouraged less police involvement and more long-term care options for people in distress, over involuntary hospitalization.
In several documented episodes, according to court papers memorializing the settlement, the hospital failed to retain patients with serious psychiatric issues.
In one instance, in 2022, a woman in her 70s with bipolar disorder and schizophrenia was sent by her nursing home to NewYork Presbyterian-Methodist after she refused to take her antipsychotic medication, grew delusional and assaulted a staff member at the nursing home, according to the court papers.
The agreement stated that a triage nurse at the hospital failed to adequately review her paperwork or note that she was at risk of elopement, or departure without authorization. The patient eloped before she could be transferred by ambulance back to her nursing home.
Two days later, the NYPD informed the hospital that the woman had been sleeping in building lobbies, according to the AG’s findings.
In another instance, a young man with a history of schizophrenia and previous psychiatric hospitalization arrived at the hospital with complaints of auditory hallucinations. Medical professionals stated that the patient was “possibly suicidal” and had “homicidal ideation,” noting that the patient “couldn’t control when he wanted to hurt people,” according to the documents.
Despite being determined by staff to be a harm to himself and others and in need of involuntary inpatient treatment, the patient was left unattended and fled the emergency department before a nurse reported him missing.
Glen Liebman, the CEO of Mental Health Association in New York State, an Albany-based advocacy group, praised the settlement and said it affirmed the need for strong oversight of the health care system.
“ If something happened with you where you’re in a mental health crisis and you end up in the hospital, and you’re in the hospital for just a short time, and then you’re discharged without a real strong discharge plan, then that frankly sets up for a really bad scenario for an individual,” Liebman told Gothamist.
Jonathan Purtle, an associate professor at NYU School of Global and Public Health who specializes in mental health care, said some of the problems uncovered by state investigators were related to costs and could only be solved with help from state and federal lawmakers.
Purtle said one of the findings from the attorney general’s investigation was that the hospital had failed to bring all of its licensed inpatient psychiatric beds back online after the pandemic, despite being legally required to do so.
As of May 2023, the attorney general’s office said, more than 100 psychiatric beds across the hospital system remained out of operation.
“ In general, mental health services and psychiatric services have been reimbursed at suboptimal rates compared to physical health services in public insurance [and] in private insurance,” Purtle said. “And this is something that can be fixed by larger policies, especially around Medicaid reimbursement rates.”
Karafazli, the NewYork-Presbyterian spokesperson, said the hospital was intent on providing safety and care for its patients with mental health needs.
“Since 2022, we have continued to strengthen policies and workflows, expand mental health capacity with inpatient beds and outpatient services, and improve safety — improvements that the Attorney General’s findings acknowledge,” Karafazli said.