Source: US State of New York
EW YORK – New York Attorney General Letitia James today announced a landmark 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 found that three WMCHealth hospitals in the Hudson Valley – Westchester Medical Center in Valhalla (WMC-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 much-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.
“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,” said Attorney General James. “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.”
This is the first settlement 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. The OAG investigation 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.
The OAG launched an investigation in 2022 after hearing and receiving powerful testimony at Attorney General James’ Mental Health Hearings, which 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. The ensuing investigation uncovered troubling lapses in patient care at the three hospitals, including:
- Discharging patients with active suicidal ideation or other emergency psychiatric conditions without proper stabilization;
- Improperly medicating agitated children without sufficiently attempting to de-escalate their behavior or documenting those efforts;
- Failing to follow protocols to protect vulnerable patients from leaving the hospital before being properly discharged, leading to preventable tragedies;
- Failing to obtain vital input from family members and community providers; and
- Maintaining incomplete or inaccurate medical records and violating WMCHealth’s own policies.
The investigation revealed that many patients who sought care at WMCHealth emergency rooms were discharged prematurely or received inadequate care or supervision. For example:
- 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.
Declining capacity for inpatient psychiatric beds has harmed communities across the state, especially in the Hudson Valley, where there are very few other hospitals in the region that provide this service. As one WMCHealth nurse testified at Attorney General James’ 2022 Mental Health Hearing, the continued closure of HealthAlliance Hospital’s psychiatric unit “eliminated all in-patient psych beds in Ulster County” and forced patients to instead travel up to 90 minutes for care. Another mental health provider called the loss of beds “horrible for the patients” and said, “85 percent of the patients I used to see on a regular basis are gone and I have no idea where they are.” The provider testified that as a result of the lost capacity, “patients are spending more time in the ER than they should,” and that people were “stuck for days waiting for a bed,” often sleeping on stretchers in hallways, and that the emergency room was “just not set up to hold patients for longer periods.”
Following OAG’s investigation, WMCHealth finally reopened 20 of the psychiatric beds at HealthAlliance Hospital in December 2024 and has announced plans to construct an additional 20-bed psychiatric unit at MidHudson Regional Hospital. These additions will finally restore pre-COVID inpatient psychiatric capacity across the three hospitals, and as part of today’s settlement, WMCHealth cannot close any of its reopened inpatient beds for the next three years. For the two years thereafter, the health system must consult with OAG before making any changes to inpatient capacity.
As a result of the investigation, WMCHealth must implement extensive reforms at its emergency rooms in Valhalla, Poughkeepsie, and Kingston. For one, 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. The settlement requires WMCHealth hospitals try to gather information about patients’ conditions from past medical records, family members, treatment providers, or other sources, and to consider this information when making determinations about the patients’ treatment plans. WMCHealth must also establish relationships and open lines of communication with community behavioral health agencies and residential facilities that frequently send patients to the emergency room – making it easier to coordinate care and ensure all relevant providers are connected to best treat the patient.
To set patients with complex needs (including patients who repeatedly visit the emergency room for mental health conditions) up for success post-discharge, staff will be required to evaluate whether patients may struggle to transition to community-based care after being discharged. For these patients, WMCHealth must develop individualized discharge plans to ensure patients have access to necessary follow-up mental health care and, where appropriate, develop care plans to improve treatment for patients upon any return visit to the emergency room.
In addition, WMCHealth must develop new protocols for using restraints and medication to treat agitated patients, particularly children – meaning emergency room 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 robust 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.
WMCHealth has also committed to making new and meaningful investments in implementing a new behavioral health service, such as deploying peer counselors in the emergency room, making mental health providers available at its primary care clinics, expanding substance use disorder treatment at the HealthAlliance Hospital and MidHudson Regional Hospital emergency rooms, and enacting an evidence-based procedure to make post-discharge follow-up calls to patients who are screened for moderate or high-risk of suicide.
“Children experiencing serious psychiatric distress were put in danger by inadequate hospital protocol and procedures. Now, thanks to Attorney General James, the children in our care and many others in Westchester will be able to get the emergency care they need,” said Ron Richter, CEO of JCCA. “We are grateful to AG James for listening – and responding – to our struggles trying to get the right urgent care for our kids. She is a true partner in making New York a better place for all. It does take a village, including our state’s hospital system, to ensure the safety of our kids and all community members.”
“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,” said Stephanie Marquesano, Founder of The Harris Project. “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.”
“We want to thank New York State Attorney General Letitia James for her steadfast commitment to supporting mental health services in Westchester County,” said Westchester County Executive Ken Jenkins. “When our residents are experiencing a mental health or substance use crisis, it is often a matter that must be attended to immediately, and the care these patients receive at Westchester Medical Center is of utmost importance. Ultimately, this settlement means that vulnerable patients who are admitted will not be put at risk or discharged prematurely without adequate mental health crisis intervention. By requiring WMCHealth Hospitals to gather more detailed information about patients’ conditions before determining their treatment, we are ensuring higher quality, more compassionate care.”
“I deeply appreciate this thorough and detailed investigation by Attorney General James into the inadequate treatment of patients experiencing mental health crises,” said Ulster County Executive Jen Metzger. “The findings on past practices are unacceptable and deeply concerning, and the settlement’s requirements for extensive reforms of policies and procedures, from intake through treatment and release, will ensure that our residents receive the proper mental health care they need and deserve. Ulster County will soon open an around-the-clock Crisis Support Center just blocks from the hospital, and we look forward to partnering with both HealthAlliance and the Office of the Attorney General as we all collectively work to strengthen our system of care for residents struggling with mental health and substance use.”
“Too many families in the Hudson Valley have watched loved ones fall through the cracks of a broken mental health system,” said Senator Nathalia Fernandez. “This agreement marks a turning point in how we treat and value psychiatric care. I commend Attorney General James for stepping in and securing reforms that put patient safety, accountability, and compassion back at the center of care.”
“For years, our Ulster County community has been sounding the alarm about the devastating loss of local mental health and substance use disorder care in Kingston,” said Senator Michelle Hinchey. “We’re grateful that Attorney General Letitia James has joined us in this fight, leading to new service protections and patient-centered care that will be implemented at Kingston HealthAlliance and across all WMCHealth hospitals so our neighbors have greater access to the life-saving services they deserve.”
“Today’s announcement by New York Attorney General Letitia James marks a significant milestone in tackling the mental health crisis in New York,” said Senator Shelley B. Mayer. “This settlement establishes a robust precedent, ensuring that individuals in crisis receive the essential care they need and rightfully deserve. I commend Attorney General James for her unwavering commitment to the people of New York and for her leadership in driving all hospitals and psychiatric units to make substantial improvements in delivering dignified and high-quality mental healthcare.”
“Comprehensive psychiatric care is not just vital for the safety and well-being of individuals, but for all of society,” said Senator James Skoufis. “Our communities, schools, and families are safer when patients get the care they need. I’m very grateful for Attorney General James’ successful efforts here in the Hudson Valley.”
“This settlement, the first of its kind in the nation, is incredibly welcome news,” said New York Assemblymember Dana Levenberg. “The expansion of access to psychiatric evaluation and care at Westchester Medical Center will save lives in my district. I applaud our Attorney General for her tireless efforts on behalf of New Yorkers, which are truly appreciated.”
“This settlement represents a vital step forward in treating mental health with the urgency, dignity, and care it deserves,” said New York Assemblymember Nader Sayegh. “I commend Attorney General James for holding institutions accountable and ensuring that no patient in crisis is turned away, neglected, or left without a path to healing. This agreement offers not just reform, but hope for families, youth, and individuals who need to know that their lives and well-being matter.”
“Congress passed EMTALA in 1986 to ensure that individuals experiencing mental health crises receive the full, stabilizing care they need,” said Assemblymember MaryJane Shimsky. “I am happy that the parties involved here have arrived at this robust settlement, which should restore and improve acute mental health care for Hudson Valley residents. We in state government are well aware New York must keep building its capacity for these critical, and often complex, cases. To that end I will continue to support greater investments in psychiatric and mental health care in the 2025-2026 State Budget and in subsequent budgets—including training and incentives for more mental health professionals to enter the field as providers of inpatient and outpatient services.”
This matter was handled by Assistant Attorney General Michael Reisman and Assistant Attorney General and Special Assistant to the First Deputy Gina Bull, under the supervision of Health Care Bureau Chief Sudarsana Srinivasan. The Health Care Bureau is part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux and overseen by First Deputy Attorney General Jennifer Levy.
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