The state has reached a settlement with Westchester Medical Center over the hospital system’s failure to follow discharge protocols for patients experiencing psychiatric emergencies.
An investigation by the state attorney general’s office found that WMCHealth, which operates four hospitals in the Hudson Valley, repeatedly broke federally and state required protocols to evaluate and stabilize patients in crisis before discharging them. In some cases, the hospital maintained incomplete or inaccurate records and did not obtain medically relevant information, including from other hospitals in the same system, before releasing patients who were at risk of decompensating, according to the settlement. In others, patients were not given clinically appropriate transportation when being transferred to other hospitals.
The lapses occurred from 2018 to 2022, including several at a time when the health system was operating below its pre-pandemic psychiatric capacity, one of many hospitals that have failed to restore beds in violation of their operating certificate.
WMCHealth neither confirmed nor denied the finding of the attorney general’s investigation but will pay $400,000 to the state in penalties and fees, according to the settlement. As part of the agreement, WMCHealth must maintain pre-pandemic levels across its system for at least three years and adopt better screening and record-keeping procedures or face fines of up to $10,000 per violation.
The settlement comes after hospitals across the state were allowed to shutter psychiatric beds during the first wave of the pandemic in 2020 to free up space for Covid-19 patients. Gov. Kathy Hochul has made restoring what the Office of Mental Health has previously estimated is over 1,000 of these beds a priority since her first year in office, blaming the cycle of hospitalization of people with untreated mental illness, in part, on the ongoing closures. Only about half of those beds have been restored to date, despite tens of millions of dollars from the Hochul administration and the threat of new fines for hospitals that do not comply.
The settlement with Attorney General Letitia James, an independently elected Democrat, represents one of the biggest actions taken by the state to date to pressure hospitals that have fallen out of compliance with their licensed bed count.
In 2020, WMCHealth, which makes up roughly a third of the Hudson Valley market share, closed 40 psychiatric beds at its hospital in Kingston, HealthAlliance-Mary’s Avenue, to become a hub for the pandemic, although no Covid patients were referred to the hospital from the Department of Health. Last year, the hospital reopened 20 beds, part of a $7 million construction project and a plan to bring 20 more online at Mid Hudson Regional Hospital in Poughkeepsie that was previously approved by the state.
The lack of beds at WMCHealth has put pressure on neighboring hospitals, filling local emergency rooms with people with mental health needs and delaying care, according to the attorney’s office.
The investigation found the practices led to repeated hospitalizations and avoidable tragedies. In one case a patient with paranoid delusions died shortly after leaving. Although a psychiatrist ordered constant supervision because the patient had recently left another treatment facility against medical advice, his record incorrectly stated that he did not have a mental health condition and proper protocols were not followed before he quit the facility, according to the settlement. The attorney general’s office also found the health system did not document de-escalation practices before medicating children to subdue them.
In addition to maintaining the new beds, WMCHealth agreed not to make any other changes to its inpatient capacity without discussing them with the attorney general’s office. The system will also adopt a series of reforms around the assessment and release of patients experiencing mental health crises, including new procedures for restraining and medicating children.
In 2022, the Hochul administration threatened fines of up to $2,000 per day for hospitals that failed to bring their psychiatric bed count in line with their licensed number. One hospital system, Rochester Regional Health, was fined close to $1 million in 2023, but no other hospitals have been fined to date. The Office of Mental Health had been working with WMCHealth to restore beds since before the directive, so no fines have ever been assessed, said Justin Mason, an agency spokesman.
“We’re pleased to have resolved this matter so we can continue to focus on meeting the diverse healthcare needs of our community,” said spokesman Andrew LaGuardia.
