Regarding Reforms To Hospital Inpatient Psychiatric Care Policies In Light Of Recent Incidents

My name is Beth Haroules and I am a senior staff attorney at the New York Civil Liberties Union (“NYCLU”). The NYCLU, the state affiliate of the American Civil Liberties Union, has approximately 48,000 members. The NYCLU is devoted to the protection and enhancement of those fundamental rights and constitutional values embodied in the Bill of Rights of the U.S. Constitution and the Constitution of the State of New York.

I would like to thank the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services for inviting the NYCLU here today to provide testimony relating to reforms to hospital inpatient psychiatric care policies. As you know, the NYCLU, in conjunction with Mental Hygiene Legal Services, Second Judicial Department and Kirkland & Ellis LLP, commenced litigation in May 2007 on behalf of all patients who have been or will be treated at Kings County Hospital Center’s (“KCHC”) psychiatric facilities. The lawsuit was brought in federal court in the Eastern District of New York. Additionally, subsequent to the filing of the lawsuit, the United States Department of Justice and the U.S. Attorney’s Office for the Eastern District of New York initiated an investigation of KCHC’s psychiatric facilities.

In January, 2010, Judge. Kiyo A. Matsumoto, the presiding judge, signed a settlement agreement and court order establishing a framework for the systemic reform of KCHC’s psychiatric facilities. The court also entered a consent judgment between the Department of Justice and the New York City Health and Hospitals Corporation. Under the terms of the settlement and the consent judgment, the NYCLU, MHLS and Kirkland & Ellis have partnered with the U.S. Department of Justice to closely monitor the hospital for the next five years to ensure that it is fulfilling its obligations to provide patients appropriate care. Our monitoring in this area is on-going. In fact, our joint panel of experts made its first site visit during the week of May 3, 2010. A report setting forth that visit’s findings must be filed publicly with the United States District Court for the Eastern District of New York within 45 days of the visit. Obviously, once those findings are made public, we will be happy to discuss the findings with your committee.

We note that this committee hearing is scheduled as an Oversight hearing to address “reforms to hospital inpatient psychiatric care policies in light of recent incidents.” We understand that your committee is responding to the story in the New York Daily News on Sunday, April 25, 2010, detailing a variety of failings at KCHC that occurred over the course of 2008 and 2009. The NYCLU, MHLS, Kirkland & Ellis, and the Department of Justice are well aware of these failings and they have been reported to the federal court. The issues presented in the Daily News article, as well as numerous other issues and factors, were part of the considerations by the parties in formulating the parameters of the January 2010 settlement agreement.

We note that meaningful reform will require a sustained commitment from both hospital administrators, as well as from city officials and elected representatives, like you and your committee members, who are responsible for ensuring that our public facilities operate within the law. Thus, in addition to the relief granted by the federal court in our lawsuit, we call on your committee to ensure that each and every individual who receives services at any city run psychiatric facility is treated in a safe and suitable environment; is given a prompt psychiatric evaluation; and is provided with treatment under humane conditions in a facility with adequate space, including ADA-compliant places to sleep, eat meals, and attend to matters of personal hygiene and bodily functions. We also call on this committee and the Council to ensure that hospital staff end the practice of unlawfully restraining patients and administering intramuscular injections of psychotropic medication, or threatening to do so, except under conditions and circumstances provided for under New York State and federal law.

Accordingly, we would suggest that, to enhance the efficacy of the committee hearing, that committee staff compile and analyze the following information about the provision and availability of psychiatric services in Kings County, in particular, and the five boroughs of New York City, in general:

• What is the total annual number of visits to Health and Hospital Corporation (“HHC”) psychiatric facilities – in Kings County and in the other boroughs;
• What are the demographics of the population that are seeking psychiatric services in Kings County and in the other boroughs;
• What is the nature of the psychiatric services sought for each of the visits;
• What psychiatric services are available in each of the five boroughs;
• What is the nature of the psychiatric services that are necessary but are lacking in each of the five boroughs;
• What is the capacity of the various psychiatric facilities operated under HHC’s auspices;
• Is there a need for increased capacity at any or all of HHC psychiatric facilities;
• How many episodes of restraint occur, on a facility by facility basis and on an annual basis at HHC psychiatric facilities;
• How many incident reports are generated to New York State Office of Mental Health by each HHC psychiatric facility on an annual basis;
• What are the yearly mean and median lengths of stay of patients in all HHC psychiatric emergency rooms;
• What is the average length of admission of patients in all HHC acute care psychiatric inpatient units;
• With what frequency are recently discharged patients, from either HHC psychiatric emergency room or inpatient units, readmitted within 30 days of discharge;
• What are the reasons for those readmissions;
• How frequently do HHC facilities request EMS/NYPD to be put onto “diversion” from HHC psychiatric facilities and under what circumstances;
• What psychiatric services are available to the children in Kings County and in other boroughs;
• What pediatric psychiatric services are needed in Kings County, and in other boroughs, but are lacking;
• What input does HHC receive from each Community Council at HHC psychiatric facilities about the state of psychiatric services in the five boroughs.

We said two years ago at the September 2008 hearing conducted by this committee that we hoped that the Council would begin taking responsibility for monitoring the abuse and neglect we have been bringing to the attention of public officials, the media, and the courts for well over three years. What had been happening in Kings County Hospital Center, and indeed, what we understand happens routinely throughout the city’s system of publicly-funded psychiatric care facilities, is an affront to human dignity. New Yorkers most in need of care and support have been denied their basic rights by the very institutions entrusted to protect them.

We continue to believe that what the Council must do now is to maintain vigilance over this situation by ensuring that other city run psychiatric facilities abide by the same reform measures. We would like to reiterate, however, that we firmly believe that it is the Council’s responsibility to provide meaningful oversight, and we suggest that it do so by holding quarterly hearings to monitor reform efforts currently underway. There has been substantial oversight of the situation at KCHC since Esmin Green’s death in the summer of 2008 and those 2008-2009 events noted in the New York Daily News article by our organization, MHLS, Kirkland & Ellis, the U.S. Department of Justice, the New York State Department of Health, CMS, and Health and Human Services. But without the benefit of the kind of spotlight that this committee and the Council can shine, the kinds of conditions that existed in KCHC may never come to light in other city run psychiatric facilities.