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WMCHealth hospitals must now improve ER practices and restore capacity for inpatient psychiatric care as part of the agreement.

VALHALLA, NY — Some of the Hudson Valley's biggest hospitals will change the way they handle patients seeking treatment for mental health as part of a settlement reached with New York State.

New York Attorney General Letitia James announced the settlement with Westchester County Health Care Corporation (WMC) and HealthAlliance, Inc. (HealthAlliance), collectively known as WMCHealth, that will expand access to inpatient psychiatric care in the Hudson Valley and overhaul how the hospital system treats patients experiencing mental health crises.

An Office of the Attorney General (OAG) investigation concluded that three WMCHealth hospitals in the Hudson Valley, Westchester Medical Center in Valhalla, MidHudson Regional Hospital in Poughkeepsie, and HealthAlliance Hospital in Kingston, put vulnerable patients at risk by discharging them without adequate mental health crisis evaluation or stabilization, and improperly left needed inpatient psychiatric beds closed for years.

Under the settlement, WMCHealth has agreed to restore inpatient psychiatric beds that were closed during the COVID-19 pandemic and implement extensive reforms to better serve emergency room patients experiencing mental health and substance use challenges, according to James.

"For too long, vulnerable New Yorkers experiencing mental health or substance use crises have been met with inadequate care when they went to an emergency room for help," James said. "Mental health care is medical care, and mental health crises must be treated as the emergencies they are. This settlement should serve as a patient care model for hospitals in every corner of our great state. My office will continue to fight to ensure all New Yorkers have access to quality, compassionate emergency mental health care."

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James said the settlement is the first in the nation reached by an attorney general for an investigation of a hospital's inadequate treatment of mental health and substance use disorder patients under the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to screen and stabilize any patient who presents with an emergency medical condition.

OAG investigators also found violations of the New York Public Health Law, the New York Mental Hygiene Law, and state regulations that provide minimum standards for treatment of patients in emergency departments and prohibit hospitals from taking licensed inpatient psychiatric beds offline without state approval, according to James' office.

Officials at the the Westchester Medical Center Health Network (WMCHealth) said the healthcare provider has been at the forefront of offering mental health services to the community, and those efforts will continue.

"We strive to provide the highest level of care to every patient who comes through our doors. As the largest provider of inpatient psychiatric services in the Hudson Valley, this treatment is often under difficult and complex circumstances," WMCHealth said in a statement about the settlement. "At a time when most other healthcare organizations in the region have shifted away from investing in psychiatric care and behavioral health, WMCHealth has remained unwavering in our commitment to meeting the needs of patients across our communities. This commitment includes strengthening and expanding behavioral health services across our Network."

The healthcare group said that making improvements to the way it cares for patients is an ongoing process, and part of what has allowed its hospitals to build an enviable reputation.

"Any adjustments to the services we provide are always made in consultation and coordination with the appropriate state regulators," WMCHealth said. "Recent examples include the completion of our new inpatient psychiatric unit at HealthAlliance Hospital and our plans to permanently expand inpatient psychiatric beds at MidHudson Regional Hospital as part of our forthcoming Behavioral Health Center of Excellence."

WMCHealth added it remains focussed on getting the outcomes for all of its patients

"Our Network annually treats more than 200,000 patients in emergency departments across our hospitals," WMCHealth said. "Our goal is always to provide the highest quality care for every patient and take immediate action to address any situation where our standard of care has not been met. We also implement any necessary process improvements or operational changes to prevent future issues."

"We’re pleased to have resolved this matter so we can continue to focus on meeting the diverse healthcare needs of our community," the statement concluded.

The OAG launched an investigation in 2022 after hearing and receiving testimony at Attorney General James' Mental Health Hearings. James said the hearings highlighted the serious impact of inpatient psychiatric bed closures at HealthAlliance Hospital and raised questions about inadequate care of young children in mental health crisis at WMC-Valhalla.

See: Health Experts See COVID-Related Suicide 'Crisis' Among Young

"After the death of my son Harris by accidental overdose, I founded the Harris Project to drive systemic change for young people, and their loved ones, impacted by co-occurring mental health and substance use disorders," Stephanie Marquesano, Founder of The Harris Project said. "This settlement acknowledges the real harm caused by fragmented care and creates a powerful opportunity to reimagine emergency departments as compassionate, clinically competent entry points to healing. With restored psychiatric beds, stronger protocols, and meaningful oversight, we can increase access to care, implement quality co-occurring services, and rebuild trust across Westchester and the Mid-Hudson region. Through our Co-Occurring System of Care Committee, we’re bringing people together to listen, learn, and lead—and we welcome Westchester County Health Care Corporation to be part of creating lasting change."

The AG investigation concluded that there were lapses in patient care at the three hospitals, including:

The investigation found that many patients who sought care at WMCHealth emergency rooms were discharged prematurely or received inadequate care or supervision, according to James.

In one instance, an adolescent who had recently attempted suicide was deemed actively suicidal and recommended for inpatient care by a WMCHealth psychiatrist. Instead, she was discharged without properly reassessing and monitoring her behavior to ensure she was stable enough for discharge.

In another case, a teenager in acute distress was physically restrained and heavily medicated within minutes of arrival. Although she was so agitated that staff administered medications twice more, she was discharged quickly thereafter, without adequate time for monitoring to ensure her condition had stabilized and with insufficient documentation that emergency room staff first tried non-invasive interventions or de-escalation techniques.

In a third instance, an emergency room psychiatrist ordered constant monitoring for a patient, noting that he had recently left a treatment facility against medical advice. Despite this, the patient remained unsupervised, necessary precautions were not taken, and the patient successfully left the hospital without discharge, tragically passing away shortly thereafter.

The OAG investigators also found that WMCHealth kept an inpatient psychiatric unit at HealthAlliance Hospital closed for far longer than allowed by the state, forcing patients in crisis to travel longer distances for care and filling up local emergency rooms with mental health or substance use patients awaiting beds. In March 2020, HealthAlliance Hospital closed the 40-bed unit to increase capacity for COVID-19 patients — but the beds were never ultimately used to treat any COVID patients, and the beds remained out of service long after June 2021, when pre-COVID regulatory requirements went back into effect, investigators found.

As a result of the settlement, WMCHealth must implement reforms at its emergency rooms in Valhalla, Poughkeepsie, and Kingston.

The hospital must modify its policies and procedures to ensure adequate screening for suicide risk, substance use disorders, violence risk, and elopement safety risk for all patients who come to the emergency room.

In addition, WMCHealth must develop new protocols for using restraints and medication to treat agitated patients, particularly children, meaning ER staff will be required to clearly and thoroughly document all uses of restraints or medication to treat agitation, provide adequate clinical justification for use, and demonstrate and document specific efforts to use less restrictive alternatives to deescalate the patients' behavior.

To guarantee these changes are made, Attorney General James and WMCHealth have agreed to oversight measures. WMCHealth will develop a training protocol to enact the settlement requirements and appoint an internal compliance administrator, who will ensure all three hospitals adhere to the agreement and submit compliance reports to OAG every six months for at least two years.

WMCHealth must pay $400,000 in penalties and fees and/or costs to New York State and, if it fails to comply with the terms of the agreement, it will be liable for an additional $10,000 penalty per violation.