New York Attorney General Letitia James announced a landmark settlement Monday with NewYork-Presbyterian Hospital following a years-long investigation that found the hospital system repeatedly failed patients arriving in psychiatric crisis — leaving vulnerable people without proper care, allowing dangerous patients to walk out of emergency rooms unsupervised and keeping more than 100 psychiatric beds offline even as demand surged.

The settlement requires sweeping reforms across the NYP system and extracts $500,000 from the hospital for its misconduct, with a $10,000 penalty for each future violation of the settlement’s terms.

“Mental health care is necessary medical care, and hospitals have a legal and moral obligation to treat these crises with urgency and compassion,” James said.

The Attorney General’s office reviewed thousands of emergency department visits involving behavioral health conditions, along with patient records, hospital policies and psychiatric bed capacity data. What it found was a pattern of failures at nearly every stage of care.

NYP consistently failed to properly screen and stabilize patients with psychiatric conditions, did not maintain adequate supervision of high-risk patients and routinely discharged people without the follow-up support they needed. Staff also failed to gather basic information from family members or outside providers.

The consequences were concrete. In one case, a patient with a history of suicide attempts and homicidal ideation told staff he “couldn’t control when he wanted to hurt people.” He was determined to need inpatient admission and waited more than two days in the emergency department for a bed. Despite an order for close supervision, he walked out before being transferred.

In another, a teenage patient who had initially been cleared for discharge was later found to be at high risk for suicide or violence after staff reached his mother. Because safety precautions had not been put in place, he eloped within minutes.

In a third case, a man brought in by EMS and police after attacking a bystander ran from the emergency department — chased by staff and security — while the hospital waited until the following day to notify law enforcement.

The investigation also found that NYP failed to restore its licensed inpatient psychiatric beds after the COVID-19 pandemic, despite a legal requirement to do so and a documented surge in mental health need. As of May 2023, more than 100 psychiatric beds across the NYP system remained out of service. State regulators had directed hospitals to restore capacity as the pandemic subsided; NYP did not fully comply.

Under the agreement, NYP must overhaul its emergency department screening and monitoring protocols, establish mandatory observation procedures for high-risk patients, upgrade its electronic health records system to give providers real-time access to complete patient information and ensure that patients with complex needs leave the hospital with scheduled follow-up appointments and connections to ongoing care.

The hospital must also implement formal elopement prevention measures, requiring immediate escalation and full documentation any time a high-need patient goes missing. NYP will remain subject to continued monitoring and quality assurance reviews.

Mental health advocacy groups welcomed the settlement. “These findings reflect the unfortunate reality individuals and families have experienced for years,” said Nathan McLaughlin, executive director of NAMI New York State.

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