With Major Reforms in Place, HHC Reaches Settlement Agreement to Resolve Lawsuit Against Kings County Hospital Psychiatric Program
Jan 08, 2010
Inside the New Comprehensive Psychiatric
Emergency Program at Kings County Hospital
The New York City Health and Hospitals Corporation (HHC) today reached an amicable resolution of litigation brought against HHC and Kings County Hospital Center by the New York Civil Liberties Union and the Mental Hygiene Legal Services on May 2, 2007, regarding deficiencies in the hospital’s psychiatric unit. HHC simultaneously reached an agreement with the US Department of Justice to address similar deficiencies reported in January 2009 and in the federal complaint filed today.
“Over the past year, we have worked closely with all the parties to the litigation to identify and begin implementing reforms that go beyond merely correcting deficient conditions alleged in the original lawsuit. All the parties have contributed to the creation of a comprehensive plan to fundamentally overhaul the psychiatric program at Kings County Hospital to create a true model of safe, compassionate, patient-centered behavioral health services that others in the city and the country will want to replicate,” said HHC President Alan D. Aviles.
The terms of the settlement signed today by Judge Kiyo A. Matsumoto of the U.S. District Court, Eastern District of New York, gives the judge oversight authority to monitor improvements at the hospital that are consistent with the over-arching plan of reform announced by Aviles last year to create a model behavioral health program at Kings County Hospital Center. HHC has begun to create a model therapeutic environment that ensures the safety and security of patients and staff, and incorporates new leadership, new protocols, increased training, more robust staffing ratios and a modernized state-of-art facility. The settlement includes provisions that have been addressed by major reforms already in place:
- Relieved overcrowding and expanded therapeutic activity space. In Feb. 2009, HHC completed a new 300,000 square foot Behavioral Health Center Pavilion, which now houses the Comprehensive Psychiatric Emergency Program (CPEP), the 230 inpatient beds, and the various outpatient psychiatric services that were previously spread out over seven separate hospital buildings.
- Established a leadership team committed to reform. The hospital has made new appointments to virtually every leadership position related to behavioral health services: Kings County Hospital Executive Director, Chief Nursing Officer, Director of Behavioral Health, Director of Psychiatric Nursing, Director of the CPEP, Director of Psychiatric Inpatient Services, Director of Social Work, Director of Child & Adolescent Psychiatry, and Director of Security, among other management positions.
- Improved staffing levels. More than 360 new doctors, nurses, psychologists, social workers and other staff have been hired since the filing of the litigation.
- Reduced patient census in the CPEP by improving flow, expanding access to crisis beds. A new system of evaluation and triaging patients ensures that the average number of patients in the psychiatric emergency room now generally does not exceed 25 patients at any given time. Patient census had sometimes reached as high as 50 or more in the past.
- Reduced average length of time patients stay in the CPEP. With a more efficient triage system, the hospital has reduced the average length of time patients stay under observation in the CPEP – which includes triage, evaluation, treatment and disposition to next level of care — down to just over 9 hours compared to an average of 27 hours two years ago.
- Expanded access to more crisis beds. Patients now have access to 24 crisis beds at Kingsborough Psychiatric Center (KPC), jointly staffed by Kings County and KPC.
- Replaced hospital police with 48 new Behavioral Health Associates, non uniformed and specially trained personnel who have clinical, crisis intervention and security skills to help manage patients in crisis.
- Agreed not to place patients in seclusion. The hospital has adopted principles of a restraint-free environment; regularly assess patients for risk of violent behavior, and developed training in crisis intervention for front-line staff.
- Created a patient-centered care model. There are 17 new Peer Counselors, full time staff who been mental health patients themselves and now serve as navigators, mentors and patient advocates.
“We are pleased to bring this litigation to a conclusion and look forward to continuing our work to fully implement sweeping and radical changes for the better in the delivery of behavioral healthcare at Kings County Hospital,” added Aviles.
Additional plans for reform outlined in the settlement agreement include:
- Strengthen chronic disease care and address underlying medical conditions. A new care coordination model has been established to link mental health patients with internists to better manage the chronic medical conditions that often go untreated among the mentally ill.
- Involve patients and their families more directly in the design of care. A new Consumer and Family Behavioral Health Advisory Council will be created shortly to formally engage mental health advocates, patients, families, and members of the local Central Brooklyn community.
- Improve services for patients with developmental disabilities. New screening tool and clinical assessments have been adopted to better identify individuals with possible mental retardation and developmental disabilities. Patients will be cared for by a new specialized consultation team with appropriate training.
- Assist and support patients as they make the transition back into the community. Will create a Community Linkage Unit — a new case management and social work service team to support patients, helps prioritize access to specialized supportive housing, community crisis beds, and case management.
- Monitoring by plaintiffs. Outside experts have been retained who will provide consulting services and assist the parties in assessing the progress toward substantial and sustained compliance with the settlement terms.
Kings County Hospital Center is a member of the New York City Health and Hospitals Corporation (HHC) and is an affiliate of the SUNY-Downstate Medical School. HHC, the largest municipal hospital and health care system in the country, is a $6.3 billion public benefit corporation that serves 1.3 million New Yorkers and nearly 450,000 who are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based clinics. For more information visit www.nychhc.org/hhc
Contact: Ian Michaels (212) 788-3339