Alliance Alert: Under an agreement with NYS Attorney General Letitia James, The health system, which is public, will be required to implement extensive reforms at its emergency rooms in Valhalla, Poughkeepsie and Kingston, including taking action to
- Implement new protocols for using restraints and medication
- deploy peer counselors in its emergency rooms,
- make mental health providers available at primary care clinics,
- expand substance use disorder treatment and
- make post-discharge follow-up calls to patients who are screened for a moderate or high-risk of suicide.
WMCHealth to Overhaul Treatment of Psych Patients Under Landmark Settlement
State Attorney General Letitia James accused the public hospital network of violating federal and state laws on emergency care by inappropriately discharging vulnerable patients.
By Maya Kaufman Politico April 21, 2025
NEW YORK — WMCHealth committed to reforming its protocols for patients with serious mental health issues after a years-long investigation by state Attorney General Letitia James found the health system was discharging vulnerable, mentally ill patients at three of its hospitals without adequately evaluating and stabilizing them.
James’ office said it is the first such settlement to result from an investigation into the inadequate treatment of behavioral health patients under the Emergency Medical Treatment and Labor Act. The federal law, known as EMTALA, requires hospital ERs to treat anyone who walks in the door.
Under the settlement, WMCHealth agreed to pay the state $400,000 in penalties and fees, but did not admit to any of the attorney general’s findings.
The health system, which is public, will be required to implement extensive reforms at its emergency rooms in Valhalla, Poughkeepsie and Kingston, including new protocols for using restraints and medication to treat agitated patients, according to James’ office. It also pledged to deploy peer counselors in its emergency rooms, make mental health providers available at primary care clinics, expand substance use disorder treatment and make post-discharge follow-up calls to patients who are screened for a moderate or high-risk of suicide.
More context: The attorney general’s office launched its WMCHealth investigation in 2022 after James hosted a series of public hearings on mental health care.
Several health care providers testified about the continued closure of inpatient psychiatric beds at the health system’s HealthAlliance Hospital in Kingston. The 40-bed unit closed to make way for Covid patients but remained out of service long after pre-pandemic regulatory requirements went back into effect, according to the settlement.
WMCHealth reopened 20 of the beds in December 2024 and plans to build a 20-bed psychiatric unit at MidHudson Regional Hospital in Poughkeepsie.
Why it matters: The 52-page settlement agreement offers an unusually detailed window into the high-stakes process of determining whether a patient who shows up to an ER during a mental health crisis should be admitted for inpatient psychiatric care — potentially against their will.
Gov. Kathy Hochul is in the middle of negotiations with the state Legislature over her proposed changes to the state’s involuntary commitment standard, which has contributed to delays in passing the state budget.
Hochul wants to loosen that standard and set new rules around how hospitals should assess psychiatric patients and coordinate their care. Critics argue the proposed changes would not stop the “revolving door” for the handful of severely mentally ill patients who cycle between hospital emergency rooms, homeless shelters and the streets.
Anecdotes included in the WMCHealth settlement offer a look at that revolving door in practice.
In one example from 2020, a woman with depression who was abusing alcohol was evaluated and discharged by two of the health system’s hospitals within 36 hours without being stabilized, according to the settlement. She was initially brought by police to the emergency department for a mental health evaluation after she refused to leave her house, which was on fire. She was discharged to a shelter after 10 hours in the ER.
The following day, the same patient called an ambulance to a second WMCHealth hospital for detox treatment but was told there were no beds available. The hospital determined she had suicidal intent, but discharged her without a psychiatric consultation, instructing her to walk to a stabilization center that was “down the hill,” according to the settlement.
What’s next: WMCHealth will develop new protocols to implement the settlement’s requirements and appoint an internal administrator to monitor compliance with the agreement. That person will submit reports to James’ office every six months for at least two years.
The health system is liable to pay a $10,000 penalty for any violation of the settlement.
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Hospital system put psychiatric patients at risk, attorney general finds
WMCHealth discharged patients without evaluation and kept inpatient beds closed for years without approval
By Philip Pantuso Albany Times Union April 21, 2025
WMCHealth, the largest hospital system in the Hudson Valley, routinely discharged vulnerable mental health patients without adequate evaluation or stabilization measures and improperly kept inpatient psychiatric beds closed for years despite a growing need for those services, an investigation by the attorney general’s office found.
The lapses in patient care occurred at three hospitals, directly contributed to at least one patient’s death and led to a settlement that commits WMCHealth to expanding access to inpatient psychiatric care and overhauling how it treats patients in acute mental health crisis.
“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,” Attorney General Letitia James said in a statement. “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.”
James’ office said this is the first settlement reached by a state attorney general for an investigation of a hospital’s inadequate treatment of mental health and substance use disorder patients under the federal Emergency Medical Treatment and Labor Act. That law requires hospitals to screen and stabilize any patient with an emergency medical condition and is more commonly invoked to require emergency rooms to provide lifesaving care.
The investigation, launched in 2022, also found violations of state Public Health Law, Mental Hygiene Law and regulations that provide standards for patient treatment in emergency rooms and prohibit hospitals from taking inpatient psychiatric beds offline without state approval. As a result, WMCHealth agreed to restore inpatient psychiatric beds it closed during the pandemic and implement “extensive reforms” to better serve patients experiencing mental health and substance use challenges, according to a release from the attorney general’s office.
The settlement, announced Monday morning, is the latest development in a yearslong fight over the state and status of WMCHealth’s behavioral health care in the Hudson Valley.
In April 2020, WMCHealth shut down the 60-bed behavioral health unit at its HealthAlliance Hospital in Kingston following a state order mandating hospitals increase available bed capacity to meet pandemic requirements. The provider transferred some of those services to another hospital in its network: MidHudson Regional in Poughkeepsie, where they were blended with that hospital’s behavioral health ward. The move forced anyone requiring inpatient psych care who would normally be treated in Kingston to travel or be transferred by ambulance to MidHudson Regional, which is 20 miles away and across the river, or further still to other WMCHealth hospitals in Valhalla or Port Jervis.
It also overtaxed frontline health care providers at MidHudson Regional, leading to lapses in care that proved fatal in at least one instance. In May 2021, Andrew Neiman walked out of the emergency room after reportedly waiting more than 14 hours to be transferred to a psychiatric unit. He was unsupervised in the ER despite a psychiatrist ordering constant monitoring of him. His body was found in the Hudson River a month later.
Meanwhile, the Kingston beds, which had provided the only inpatient behavioral health services in Ulster County and neighboring Delaware County, were never used to treat coronavirus patients. But even as COVID-19 surges waned, WMCHealth refused to commit to reopening the unit, which operated at a financial loss, prompting widespread concern among hospital staff, health advocates and elected officials that the critical services were gone for good. In response, a coalition of nurses, elected officials and patient advocates initiated a public campaign to pressure WMCHealth to bring back the beds.
Investigators from the attorney general’s office found that WMCHealth kept the Kingston unit closed for far longer than allowed by the state, which forced patients in crisis to travel longer distances for care and filled up emergency rooms with mental health and substance use patients awaiting beds.
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WMCHealth announced in 2022 that it would bring 20 beds back online in a new Kingston unit, which it cut the ribbon on in December. It also announced plans to construct a 20-bed unit at MidHudson Regional Hospital. The attorney general’s office said these steps were taken following its investigation and will restore inpatient psychiatric capacity at HealthAlliance, MidHudson Regional and Westchester Medical Center in Valhalla to pre-pandemic levels.
But at the time, WMCHealth administrators made no direct mention of the attorney general’s investigation and settlement, instead framing the decision to reopen psychiatric services as a network priority.
“This new inpatient psychiatric unit is the result of years of collaboration between WMCHealth, elected officials and community stakeholders to ensure we provide comprehensive and compassionate care tailored to the needs of our community,” WMCHealth Executive Vice President and Chief Strategy Officer Josh Ratner said when the Kingston unit reopened in December. “WMCHealth prioritizes investments in critical services, and as many organizations continue to reduce their investment in behavioral health services, bringing these beds back online at HealthAlliance Hospital has been a key priority for our network.”
WMCHealth did not immediately return a request for comment on Monday.
The attorney general’s office launched its investigation after hearing testimony at mental health hearings in 2022 about the impact of the inpatient psychiatric bed closures at HealthAlliance Hospital and “inadequate” care of young children in mental health crisis at WMC-Valhalla. The probe uncovered “troubling lapses” in patient care, 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 or document those efforts, failing to follow protocols to protect vulnerable patients from leaving the hospital before being discharged, failing to obtain vital input from family members and community providers, and maintaining incomplete or inaccurate medical records, which violated WMCHealth’s own policies.
In one instance, an adolescent who had recently attempted suicide was deemed actively suicidal was recommended for inpatient care by a staff psychiatrist. Instead, she was discharged without properly reassessing and monitoring her behavior to ensure she was stable enough for discharge, according to the attorney general’s office.
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 without adequate monitoring to ensure her condition had stabilized and with insufficient documentation that emergency room staff first tried non-invasive interventions or de-escalation techniques, according to the attorney general’s office.
The settlement WMCHealth reached with the attorney general’s office commits the hospital system to implementing extensive reforms at its emergency rooms in Valhalla, Poughkeepsie and Kingston. The network must “modify policies and procedures to ensure adequate screening” for suicide risk, substance use disorders, violence risk and safety risk for all patients who come to the emergency room. WMCHealth hospitals must also “try and gather information” about patients’ conditions from past medical records, family members, treatment providers, or other sources, and consider this information when determining the patient’s treatment plan.
The settlement also requires WMCHealth to “establish relationships and open lines of communication” with community behavioral health agencies and residential facilities that frequently send patients to the emergency room, which will make it easier to coordinate care after discharge. And for patients with complex needs, including those who repeatedly visit the emergency room for mental health conditions, WMCHealth must develop individualized discharge plans to ensure they have access to necessary follow-up care.
In addition, WMCHealth is required to develop new protocols for using restraints and medication on agitated patients, particularly children. 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 efforts to use less restrictive alternatives to de-escalate each patient’s behavior.
James secured “robust oversight measures” in the agreement with WMCHealth. The hospital system will develop a training protocol to enact the changes and appoint an internal compliance administrator, who will ensure all three hospitals adhere to the agreement and submit compliance reports to the attorney general’s office every six months for at least two years.
WMCHealth has also committed to new investments in behavioral health care, 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 deemed a moderate or high risk of suicide.
WMCHealth will pay $400,000 in penalties to New York state for the violations documented in the investigative report. If it fails to comply with the terms of the agreement, it will be liable for an additional $10,000 penalty per violation, according to the settlement.
“Too many families in the Hudson Valley have watched loved ones fall through the cracks of a broken mental health system,” state Sen. Nathalia Fernandez, a Democrat who chairs the Senate’s Alcoholism and Substance Use Disorders Committee, said in a statement. “This agreement marks a turning point in how we treat and value psychiatric care.”