Tuesday, November 29, 2022

Attorney General James Sues Orleans County Nursing Home for Years of Fraud and Resident Neglect

 

Owners of The Villages Allegedly Misused More Than $18 Million in Government Funds 

Disinvestment Led to Chronic Understaffing, Inhumane Conditions, and Harm to Residents 

New York Attorney General Letitia James today filed a lawsuit against Comprehensive at Orleans LLC doing business as The Villages of Orleans Health and Rehabilitation Center (The Villages), a nursing home in Albion, New York, for years of financial fraud that resulted in significant resident neglect and harm. Following an extensive investigation conducted by the Office of the Attorney General (OAG), the lawsuit — filed against the owners, operators, and related companies (owners) — demonstrates how the owners took advantage of the state’s Medicaid program to increase their personal profits, rather than use those funds for the intended purposes of staffing and patient care.

“Every individual deserves to live out their golden years in comfort and with dignity,” said Attorney General James. “Yet the abject failure of The Villages and its owners to uphold their duty under the law caused residents to suffer inhumane treatment, neglect, and harm. Instead of investing in staffing and resources, the owners allegedly disregarded laws designed to protect residents. I will continue to monitor nursing homes and residential care facilities statewide to ensure the safety of our most vulnerable communities. I encourage anyone who has witnessed alarming conditions, resident neglect, or abuse at a nursing home to contact my office.” 

Under New York law, owners of nursing homes have a “special obligation” to provide a high level of care and quality of life for residents, and to ensure the facility is sufficiently staffed so as to provide that care. The Villages’ owners failed in their duty to residents by engaging in a scheme to divert funds away from the facility to increase their own personal profit, drastically cutting staffing at The Villages to do so. With this lawsuit, OAG seeks to compel the owners to return all funds fraudulently received, to appoint a receiver and financial monitor to stop the self-dealing and a healthcare monitor to improve care, and to require The Villages to stop admitting new patients until further notice.

The owners wove a complicated web of fraud, using their ownership stakes in multiple companies to turn The Villages into a profit machine. The named respondents in the complaint are The Villages of Orleans LLC; Telegraph Realty LLC (Telegraph), which owns the real property where The Villages is; CHMS Group LLC (CHMS), which provides administrative services to The Villages; and ML Kids Holdings LLC (ML Kids), which received over $1.5 million in cash transfers from Telegraph. Also named are individual owners, including the sole official owner of The Villages, his three sons-in law, his daughter-in-law; three undisclosed owners of The Villages; and the owners of Telegraph Realty LLC. Together, these individuals are referred to as the “owners.”

Financial Scheme

In January 2014, the owners formed Telegraph for the sole purpose of buying the real property on which The Villages sits, which they did a year later in January 2015. The Villages has since paid “rent” to Telegraph. CHMS was formed in January 2015, and The Villages has since paid CHMS for administrative services, including accounting, insurance billing, and payroll.

From 2015 through 2021, The Villages received $86.4 million in funding, including millions in taxpayer dollars from Medicare and Medicaid, intended to provide quality healthcare to vulnerable residents. Instead, the owners cut staffing to increase their personal profits. By making payments to Telegraph and CHMS, and by making other transfers to themselves directly and indirectly, the owners were able to divert $18.6 million — more than 20% of The Villages’ operating budget. When the Villages was owned by Orleans County, the facility’s nursing home rating from the Centers for Medicare & Medicaid Services (CMS) was three out of five stars. In April 2015, just four months after the owners purchased The Villages, CMS decreased the rating to one star, the lowest possible rating.

Devastating Consequences

The OAG asserts in the suit filed today that The Villages’ reprehensible history of insufficient staffing and low quality of care is directly traceable to the owners’ financial scheme. Residents were subject to repeated abuse and neglect as the most basic functions of care were abandoned. Residents were forced to sit in their own urine and feces for hours; suffered malnourishment and dehydration; developed sepsis, gangrene, and other infections due to gaping bed sores and inadequate wound care; endured medical toxicity and unexplained doping; and sustained falls and other physical injuries. Some of these abuses, including other unmonitored or undocumented circumstances, resulted in hospitalization and even death. 

The lawsuit’s allegations include: 

  • A woman was admitted to The Villages in January 2021 with a Stage II bed sore which was not treated for more than two weeks. Six months later, in June 2021, she suffered from two Stage III bed sores and an external wound care consultant ordered a new treatment, which The Villages did not implement until a week later. By July, both wounds had advanced to the point of being “unstageable.” A friend of the woman told OAG she received more than 1,000 texts asking for help with basic necessities like using the restroom or getting food and water. One text reported she had been “lying in a dirty diaper for hours,” and another lamented, “I just need a glass of water.” The Villages gave the resident psychotropic medications for severe anxiety, though there was no such diagnosis in her medical records. She was found unresponsive on July 13 and sent to the hospital, where she died.
  • A woman admitted to The Villages in January 2020 for rehabilitation of a broken leg soon began refusing her food and medication and spoke of wanting to die. An external psychological consult determined she was at high-risk for self-harm, and ordered staff check on her every 30 minutes. The Villages failed to monitor the woman, and she was found dead in early February 2020, less than a month after she was admitted. Her death was not reported to the New York State Department of Health (DOH) as required by law. 
  • A man was admitted to The Villages in November 2020 to rehabilitate after a leg amputation, so he could gain enough strength to use his prosthetic and live independently. During his three months at The Villages, he had only a handful of physical therapy sessions, during which he was often left to sit without exercise or assistance. Due to his amputation, he required help with cleaning and caring for himself, but staff frequently failed to change his diaper in a timely manner, leaving him to often spend hours sitting in his own urine. He now resides in a different facility and is making great progress.

COVID-19 Pandemic

Residents’ low quality of life and unacceptable level of care further worsened with the onset of the COVID-19 pandemic as The Villages’ already stretched thin staff was forced to work even longer hours. Notably, management at The Villages tried to keep positive COVID-19 cases secret, and either delayed or entirely neglected to enforce proper protocols for quarantining infected residents. The owners forced staff to report to work even when they were sick, provided little to no personal protective equipment, failed to implement infection or isolation protocols, and did not report positive COVID-19 cases, resulting in unnecessary and preventable deaths. 

A Licensed Practical Nurse (LPN) at The Villages disclosed that the facility had its first COVID-19 case on March 30, 2020. Though the individual’s chart noted he’d had a fever for three days before he tested positive, nothing was done to prevent further spread of the virus. The Villages was so short staffed that employees were caring for residents who were both positive and negative for COVID-19 without following any quarantine protocols. As the pandemic progressed, COVID-19 positive employees, forced to report to work despite being sick, mixed with COVID-19 negative residents, and all residents intermingled regardless of infection status. Employees were told that if their temperature check indicated they had a fever, they were to go outside for an hour and come back to take their temperature again.  

Rather than hire enough medical staff qualified to deliver the level of care that nursing homes are required to provide, the owners instead expected Certified Nursing Assistants to perform work they were not licensed to handle. Staff and other witnesses reported times when The Villages was dangerously understaffed, such as an overnight shift where just four employees were on hand to care for all residents in the 120-bed facility. Despite this, the owners prioritized increasing resident admissions at The Villages in order to drive up revenue — even when the facility was providing substantially fewer hours of nursing care per resident than the state’s safety average, adding to the dangerous environment.  

Remedies

The OAG found that the owners engaged in repeated and persistent fraud and illegality in operating The Villages, including a systemic, intentional pattern of understaffing. These actions stripped residents of their dignity and caused physical and emotional harm, while enabling the owners to reap enormous profits. In her lawsuit filed today, Attorney General James seeks to: 

  • Remove David Gast, Sam Halper, and Ephram Lahasky from their ownership and managerial roles at The Villages;  
  • Prohibit The Villages from admitting any new residents unless and until staffing levels meet appropriate standards;  
  • Require The Villages to engage and pay for a receiver and a financial monitor to oversee the facility’s financial operations; 
  • Require The Villages to engage and pay for a healthcare monitor to oversee the facility’s healthcare operations and ensure residents’ outcomes improve;  
  • Direct each respondent to fully disgorge any and all funds wrongfully received as part of the scheme; and  
  • Order all respondents with the exception of The Villages to reimburse New York state and the United States for the cost of the investigation. 

Respondents

The named respondents in the complaint are Bernard Fuchs, supposed sole official owner of The Villages, his son and daughter-in-law Gerald and Tova Fuchs, and his sons-in-law Joel Edelstein and Israel Freund; David Gast, undisclosed owner of The Villages; Sam Halper, undisclosed owner of The Villages; Ephram Lahasky, undisclosed owner of The Villages; Benjamin Landa and his son-in-law Joshua Farkovits; and Teresa Lichtschein and her daughter-in-law Debbie Korngut. Together, these individuals are referred to as the “owners.” 

Also named are Villages of Orleans LLC, which is controlled by Gast; Telegraph Realty LLC (Telegraph), which owns the real property where The Villages is; CHMS Group LLC (CHMS), which provides administrative services to The Villages; and ML Kids Holdings LLC (ML Kids), which received over $1.5 million in cash transfers from Telegraph and is controlled by Ephram Lahasky. Though all official paperwork associated with The Villages represents the facility is owned entirely by Bernard Fuchs, OAG’s investigation revealed he had a very limited role. In reality, David Gast, Ephram Lahasky, and Sam Halper owned, managed, and controlled The Villages.

Attorney General James has been investigating nursing homes throughout New York state based on concerns of patient neglect and other conduct that may have jeopardized the health and safety of residents and employees, both before and during the COVID-19 pandemic. In January 2021, Attorney General James released a report revealing that many nursing homes were ill-equipped and ill-prepared to deal with this crisis because of poor staffing levels and a lack of compliance with infection control protocols. Today’s lawsuit is a direct result of those investigations, some of which are still ongoing. 

Attorney General James encourages anyone with information or concerns about alarming nursing home conditions, resident abuse, or neglect to file confidential complaints online or call the MFCU hotline at (833) 249-8499. 

Attorney General James thanks the New York State Department of Health and Human Services Commissioner Mary T. Bassett; the United States Department of Health and Human Services, Office of the Inspector General (Special Agent Kirin Hage); and the Orleans County Sheriff’s Department for their assistance in this investigation.

MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding. 

Governor Hochul, the Port Authority of New York & New Jersey, American Airlines and British Airways Announce Completion of JFK's First Redevelopment Project at Terminal 8

 airport terminal

$400 Million Privately-Financed Terminal 8 Expansion Clears the Way for British Airways to Co-Locate with American Airlines in Upgraded Terminal

Premium Lounges, Enhanced Baggage Systems, and Premium Check-In Space to Create a 21st-Century Customer Experience

More than $161 Million in Contracts Awarded to MWBE Firms and Nearly $33 Million Awarded to Local Businesses

Major Concessions Upgrades Coming in Next 18 Months


 Governor Kathy Hochul, the Port Authority of New York & New Jersey, American Airlines and British Airways today announced the opening of a newly expanded Terminal 8, marking completion of the first phase of the historic JFK Vision Plan that is transforming the international airport into a world-class global hub.

"The completion of Terminal 8 is the latest milestone in our historic efforts to build a whole new JFK worthy of New York," Governor Hochul said. "I congratulate American Airlines, British Airways and the Port Authority for the first of what will be many milestones to come. We will continue our close partnerships as we transform JFK into a magnificent global gateway that will help to keep New York at the center of the world stage."

The $400 million, privately financed expansion and modernization will allow British Airways to move from its long-time home in Terminal 7 and co-locate with American Airlines in Terminal 8. The 60-year-old Terminal 7 will be demolished to clear space for a new Terminal 6 that will begin construction early next year.

Operational enhancements of Terminal 8 include five new widebody gates, four new widebody parking positions, and an expanded and upgraded baggage handling system that will together support additional transatlantic flights. The terminal has also been expanded with approximately 130,000 square feet of additional and refurbished space.

Terminal 8's expansion is a critical component of the JFK Vision Plan that is transforming the airport into what will be one of the world's finest international gateways with a 21st century customer experience and increased connectivity for travelers. The move by British Airways will bring the storied carrier closer to its partner airlines when Terminal 8 becomes home to eight oneworld® Alliance carriers. Iberia plans to move into Terminal 8 on Dec. 1, and Japan Airlines expects to move its operations to Terminal 8 in May 2023.

British Airways Chairman and CEO Sean Doyle said, "We announced our joint investment early in 2019 so it is an honor to reach this significant milestone with our business partner, American Airlines. From December 1, our customers and colleagues will be able to enjoy all the benefits that Terminal 8 has to offer."

Premium customers traveling on both airlines will now be able to enjoy an elevated travel experience at Terminal 8. Upon arrival, premium customers will be greeted at the brand new co-branded premium check-in area, which will provide personalized, concierge-style service. Thoughtfully designed architectural elements also define an exclusive check-in space for eligible customers.

Once through security, three distinctive lounges; Chelsea, Soho and Greenwich, combine the best of both brands and provide a refined, welcoming pre-flight experience for eligible customers based on cabin of travel and loyalty program status. The two brand new lounges — Chelsea and Soho — have been designed with original high-end finishes, evoking a unique sense of space while elevating the experience and service offered to every guest.

Terminal 8 will also be undergoing a major concessions upgrade across the terminal over the next 18 months, including locally-inspired food and beverage options.

The co-location of American Airlines and British Airways at Terminal 8 supports the Port Authority's mission to create greater connectivity for passengers at a transformed and more unified JFK.

The Terminal 8 project involved the work of more than 115 unique minority- and women-owned businesses that were awarded contracts totaling more than $161 million, exceeding the Port Authority's commitment to at least 30 percent MWBE participation at the agency's capital projects. Local businesses were awarded nearly $33 million in contracts at Terminal 8.

Transforming JFK Into a World-Class Global Gateway

In January 2017, the JFK Vision Plan was announced to transform John F. Kennedy International Airport into the world-class airport that New Yorkers deserve. The Vision Plan provides a strategic framework for the Port Authority and its partners to completely redevelop, modify and expand existing facilities and infrastructure. The newly expanded Terminal 8 builds on the momentum of the other three major components of the airport's transformation now underway.

  • The $9.5 billion development of a state-of-the-art New Terminal One that will anchor the airport's south side broke ground in September 2022.
  • The $1.5 billion expansion of Terminal 4, led by Delta Air Lines and JFK International Air Terminal, was approved in the spring of 2021, broke ground in the fall of 2021 and is now under construction with completion expected in the fall of next year.

The $4.2 billion development of a new Terminal 6, which will connect seamlessly to Terminal 5 to anchor the airport's north side, achieved financial close earlier this month, securing full private financing for the project, and will begin construction in the next 90 days.

All of the privately financed terminal projects combined with the Port Authority's roadway, parking and infrastructure projects represent an $18 billion transformation of JFK International and an extraordinary series of public-private partnerships. The Port Authority capital investment of $2.9 billion is leveraging private investment at a rate of more than five to one when taking into account the full private investment of more than $15 billion that has been committed to the four projects comprising the full JFK redevelopment program.

Redeveloping JFK Airport in Lockstep with the Local Community

In 2018, the JFK Redevelopment Community Advisory Council was formed. It is co-chaired by U.S. Representative Gregory Meeks and Queens Borough President Donovan Richards, and is composed of 42 elected officials, community boards, business and nonprofit organizations, civic organizations, and clergy leaders from the targeted local communities of Southeast Queens, Southwest Queens, the Rockaways, and western portions of Nassau County.

Since its inception, the Council has been working with the Port Authority to expand community outreach efforts and develop community-focused programs, ensuring that this ambitious project solicits ongoing feedback from local stakeholders and provides meaningful opportunities for the community surrounding the airport, including local businesses, MWBEs, students, and jobseekers.

This includes programming to advance the Port Authority's commitment to a 30 percent MWBE contracting goal in all categories of work, and a special focus on opportunities for local businesses across all aspects of the JFK Redevelopment program, including the Terminal 8 project, which was built by union labor under a full project-labor agreement. Other community development initiatives prioritized by the Council focus on job opportunities and workforce development programs for local residents, small business outreach and development, and educational programming for local students.

MAYOR ADAMS ANNOUNCES PLAN TO PROVIDE CARE FOR INDIVIDUALS SUFFERING FROM UNTREATED SEVERE MENTAL ILLNESS ACROSS NYC

 

Mayor Issues Directive Clarifying Responsibility to Provide Care When SMI Prevents Someone From Meeting Their Basic Needs

 

Mayor Announces 11-Point Mental Health Legislative Agenda for Upcoming Session in Albany

 

NYC to Launch Tele-Consult Line to Provide First Responders in Field With Direct Access to Clinicians


New York City Mayor Eric Adams today announced a new pathway forward to address the ongoing crisis of individuals experiencing severe mental illnesses left untreated and unsheltered in New York City’s streets and subways. In a public address, Mayor Adams detailed a compassionate new vision to tackle this crisis, beginning with a directive being issued immediately to city agencies and contractors involved in evaluating and providing care to individuals in psychiatric crisis so that more people in need of help receive it. Mayor Adams also laid out an 11-point legislative agenda that will be among his top priorities in Albany during the upcoming legislative session. The agenda takes aim at gaps in New York State’s Mental Hygiene Law that intensify the city’s challenges in meeting the needs of its most vulnerable residents with severe mental illness. Finally, Mayor Adams announced new clinical co-response teams deployed in New York City’s subways to respond to those with serious mental health issues, as well as an enhanced training in partnership with New York State for all first responders to compassionately care for those in crisis.

 

In accordance with state law and court precedent, Mayor Adams’ directive clarifies that outreach workers, city-operated hospitals, and first responders have the legal authority to provide care to New Yorkers when severe mental illness prevents them from meeting their own basic human needs to the extent that they are a danger to themselves. The directive — issued by Mayor Adams today — seeks to dispel a persistent myth that the legal standard for involuntary intervention requires an “overt act” demonstrating that the person is violent, suicidal, or engaging in outrageously dangerous behavior likely to result in imminent harm.

 

Mayor Adams also announced today that the city is developing a tele-consult line to provide police officers in the field with direct access to clinicians. This new tele-consult line will provide critical clinical advice to police officers when dealing with individuals in distress and ensure a compassionate response for those suffering with untreated serious mental illness.

 

Measures in Mayor Adams’ legislative agenda announced today include:

 

  • Making the law explicit that a person requires care when their mental illness prevents them from meeting their own basic needs;
  • Mandating that hospital clinicians consider a range of factors when assessing a patient’s need for involuntary admission or retention, including known treatment history and current ability to adhere to outpatient treatment;
  • Requiring hospitals to screen all psychiatric patients prior to discharge for their need to receive “assisted outpatient treatment” (court-ordered care under “Kendra’s Law”);
  • Allowing a broader range of trained mental health professionals to perform evaluations and community removals of individuals in crisis; and
  • Requiring hospitals to notify known community providers when their clients are admitted or released and collaborate with community providers in preparing patients for discharge.

 

Ahead of the winter months — when homelessness typically increases on subways due to the cold weather — the Adams administration has begun deploying subway clinical co-response teams, made up of joint patrols of the New York City Department of Health and Mental Hygiene (DOHMH) and the New York City Police Department (NYPD), to patrol high-traffic subway stations and respond with a clinician-led approach to those appearing to have serious mental health issues.

 

Finally, in partnership with New York State, the city will also provide comprehensive training to all clinicians, outreach workers, and first responders to ensure compassionate care that potentially could include involuntary removals when interacting with individuals in distress suffering from severe mental illnesses. The city will be rolling out this training immediately.

 

“With this announcement, we are bolstering our strategies to get people who are in danger due to untreated severe mental illness the help they need,” said Deputy Mayor for Health and Human Services Anne Williams-Isom. “We are adding layers of additional support for our first responders to work with clinical specialists in the moment and at the time it is needed, and we are pursuing all other areas for assistance: Health, social services, legal, and legislative. Thank you to our teams across government working to see that this is a coordinated, whole-of-government effort.”

 

“You can’t effectively have public safety without adequate mental health care — the two go hand-in-hand,” said Deputy Mayor for Public Safety Philip Banks III. “For too long, public safety personnel’s hands have been tied in getting those in need care before they hurt themselves or others. These directives and proposals are a common-sense way to clear those impediments and get help for those who need it most.”

 

“The NYPD works day and night to improve the quality of life of all New Yorkers, especially our city’s most vulnerable populations,” said New York City Police Department (NYPD) Commissioner Keechant L. Sewell. “This is a longstanding and very complex issue. And we will continue to work closely with our many partners to ensure that everyone has access to the services they require. This deserves the full support and attention of our collective efforts.”

 

“Responding to New Yorkers in need is the mission of the Fire Department, and we are proud to partner with Mayor Adams in addressing this critical public safety issue,” said Fire Department of the City of New York (FDNY) Commissioner Laura Kavanagh. “Our mission is simple: To be there for all New Yorkers when they need help and provide critical mental health care.”

 

“People living with serious mental illness deserve to live their lives with dignity, respect, and free from discrimination and stigma,” said DOHMH Commissioner Dr. Ashwin Vasan. “As a city, this work — at the intersection of public safety and mental illness — represents part of the larger strategy, which is centered on providing everyone living with serious mental illness the basic building blocks of recovery: Health care, a home, and a community. We know that focusing on these pillars will reduce the number of people we see in need on our streets and in our subways to begin with, and is consistent with Mayor Adams’ focus on balancing prevention and intervention. The city is galvanized to address the broader issue of supporting people with serious mental illness to improve health, prevent suffering and isolation, and improve their quality of life. In the coming weeks, we’ll be turning to trusted community groups to inform a comprehensive vision aimed at improving access to care and housing and reducing social isolation.”

 

“We are proud of our cross-agency partnership with the city’s Health Department, Health + Hospitals, NYPD, and FDNY-EMS to develop these new protocols and trainings” said Mayor’s Office of Community Mental Health (OCMH) Director Eva Wong. “Helping our fellow New Yorkers most in need get connected to care is a top priority for OCMH. These new protocols and trainings will ensure that agencies and systems responsible for connecting our community members with severe mental illnesses to treatments are working in unison to get them the support they need and deserve. We look forward to continuing our work with city and state agencies as we partner to bring compassionate care to all New Yorkers.”

 

“With today’s announcement, Mayor Adams has reaffirmed his commitment to meeting the concurrent crises of untreated mental illness and unsheltered homelessness head on,” said New York City Department of Social Services (DSS) Commissioner Gary P. Jenkins. “As part of the Subway Safety Plan, DSS-DHS outreach staff and our partners are making great strides to connect New Yorkers experiencing homelessness in the subways to critical shelter services. This new plan builds on existing efforts like these to more efficiently and effectively engage New Yorkers experiencing mental health crises and ensure they receive the services they often desperately need. We commend the mayor for continuing to lead on this issue and assembling the resources necessary to support our neighbors in need.”

 

“The city has a moral obligation to assist homeless New Yorkers suffering from untreated severe mental illness who are unable to meet their basic needs to such an extent that they are a danger to themselves,” said New York City Corporation Counsel Sylvia Hinds-Radix. “The mayor’s comprehensive plan demonstrates this administration’s commitment to using every tool at its disposal to ensure outreach workers, city-operated hospitals, and first responders are able to provide the necessary care that these individuals so desperately need.”

 

“As the largest provider of behavioral health care in New York City, NYC Health + Hospitals plays a critical role in the serious mental illness continuum of care,” said Mitchell Katz, MD, president and CEO, NYC Health + Hospitals (H+H). “We will work with our partners in the city and state to ensure that our patients receive the highest quality of care. I want to thank Mayor Adams for his commitment to New Yorkers in need.”

 

“Today’s announcement reaffirms Mayor Adams’ commitment to addressing the needs of some of the most vulnerable New Yorkers,” said Mayor’s Office of Criminal Justice Director Deanna Logan. “Investment in public health solutions, including mental health treatment, is critical to keeping New Yorkers safe. Necessary solutions like those outlined today will result in safer, healthier communities for all.

 

Since taking office in January, the Adams administration has made significant investments to address the severe mental health crisis afflicting New Yorkers and connect individuals suffering from untreated severe mental illness to care. In February, Mayor Adams rolled out the “Subway Safety Plan to connect people experiencing homelessness on the subway to shelter. Since that launch, the city has effectively connected more than 3,000 people experiencing homelessness, some of whom are also in mental health crisis, to shelters and safe havens.

 

Mayor Adams has also doubled down on investments in community supports for those living with serious mental illnesses, including investing in the expansion of the city’s clubhouse program. Clubhouses follow an evidence-based model of psychiatric rehabilitation: A one-stop treatment facility that helps people with severe mental illnesses through their recovery by providing peer support, access to services, employment and educational opportunities, socialization, and recreation in a safe, restorative, and structured setting. DOHMH is expanding the capacity at some of the most successful clubhouses, with the goal of engaging 500 more members this fiscal year. The Adams administration also launched CONNECT: Continuous Engagement between Community and Clinic Treatment earlier this year as a new model of mental health treatment that focuses on holistic care, including for people experiencing severe mental illness.

 

Mayor Adams’ address, as prepared for delivery, can be found below:

 

Good morning, New York City. I want to talk to you about a crisis we see all around us: People with severe and untreated mental illness who live out in the open, on the streets, in our subways, in danger and in need.

 

We see them every day, and our city workers are familiar with their stories. The man standing all day on the street across from the building he was evicted from 25 years ago, waiting to be let in. The shadow-boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary. The unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team.

 

These New Yorkers and hundreds of others like them are in urgent need of treatment, yet often refuse it when offered. The very nature of their illnesses keeps them from realizing they need intervention and support.  Without that intervention, they remain lost and isolated from society, tormented by delusions and disordered thinking. They cycle in and out of hospitals and jails.

 

But New Yorkers rightly expect our city to help them. And help them we will.

 

For the past eleven months, my team and I have studied the challenge of severe mental illness in the streets of our city. We have spoken to those who suffer from it and the experts who treat it. We have analyzed data gathered by our outreach teams. We have worked across many agencies, and we have consulted with our partners at the state level.

 

I want to update you on the results of these efforts and lay out the next phase of our plan to address this urgent and complex challenge.

 

My administration is determined to do more to assist people with mental illness, especially those with untreated psychotic disorders who pose a risk of harm to themselves, even if they are not an imminent threat to the public. It is not acceptable for us to see someone who clearly needs help and walk past.

 

For too long, there has been a gray area where policy, law, and accountability have not been clear, and this has allowed people in need to slip through the cracks. This culture of uncertainty has led to untold suffering and deep frustration. It cannot continue.

 

We need to change that culture and clarify our expectations. No more walking by or looking away. No more passing the buck.

 

Going forward, we will focus on action, care, and compassion. If severe mental illness is causing someone to be unsheltered and a danger to themselves, we have a moral obligation to help them get the treatment and care they need.

 

Today, we are embarking on a long-term strategy to help more of those suffering from severe and untreated mental illness find their way to treatment and recovery. It begins with an immediate shift in how we interpret our obligation to those in need and calls upon our outreach workers to take deeper actions and more intensive engagements.

 

We can no longer deny the reality that untreated psychosis can be a cruel and all-consuming condition that often requires involuntary intervention, supervised medical treatment, and long-term care. We will change the culture from the top down and take every action to get care to those who need it.

 

To do this, we will need significant help from our partners in Albany. I want to thank Governor Hochul for her support on this issue. Thanks to her leadership, we have greater resources and a stronger commitment to making progress on one of the most enduring challenges facing our city. She has been an excellent partner in our efforts, and I look forward to working with her and the State Legislature to address the longstanding gaps in our state Mental Hygiene Law.

 

To begin that process, our team has developed an 11-point legislative agenda to address those gaps, and getting it enacted will be a major priority for us in 2023. This agenda is already available online and to the public. But even as we move forward on that agenda, there is much we can do now by properly interpreting and carrying out existing law.

 

Job one is to make it universally understood by our outreach workers, hospital staff, and police officers that New York law already allows us to intervene when mental illness prevents a person from meeting their basic human needs, causing them to be a danger to themselves. This policy has been confirmed in written guidance from our state Office of Mental Health.

 

Yet a common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal, or presenting a risk of imminent harm. This myth must be put to rest. Going forward, we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs.

 

And let me be clear: We will continue to do all we can to persuade those in need of help to accept services voluntarily. But we will not abandon them if those efforts cannot overcome the person’s unawareness of their own illness. In short, we are confirming that a person’s “inability to meet basic needs,” to the extent that it poses a risk of harm, is part of the standard for mental health interventions.

 

And we will accomplish this in five specific ways. 

 

First, we have issued a new directive to our Department of Health and Mental Hygiene mobile crisis teams, FDNY-EMS, and the NYPD. This directive lays out an expedited, step-by-step process for involuntarily transporting a person experiencing a mental health crisis to a hospital for evaluation. It explicitly states that it is appropriate to use this process when a person refuses voluntary assistance and it appears that they are suffering from mental illness and are a danger to themselves due to an inability to meet their basic needs. We believe this is the first time that a mayoral administration has given this direction on the “basic needs” standard in official guidance.

 

Second, our mobile crisis teams and police officers will receive enhanced training on how to assist those in mental health crisis. There will be a new focus on the need to intervene in situations where an individual appears to be suffering from mental illness and in danger due to an inability to meet their basic needs. This will include an in-depth discussion of what “inability to meet basic needs” means and an array of options to consider before resorting to involuntary removal.

 

The first training to incorporate this new focus took place this morning, and we will soon roll it out to all current members of the mobile crisis teams and the NYPD.

 

Third, we will be launching a hotline staffed by clinicians from our H+H hospitals that will provide guidance to police officers who encounter individuals in psychiatric crisis. State law already authorizes a police officer to make a judgment call to have a person involuntarily removed to a hospital. But many officers feel uneasy using this authority when they have any doubt that the person in crisis meets the criteria. The hotline will allow an officer to describe what they are seeing to a clinical professional, or even use video calling, to get an expert opinion on what options may be available.

 

Fourth, we will develop a special cadre of clinicians paired with NYPD officers dedicated to the difficult work of getting New Yorkers in crisis into care. These specialized intervention teams will have the training, expertise, and sensitivity to ensure that those in need are safely transported to a hospital for evaluation.

 

Fifth, we will work to have the “basic needs” standard for involuntary intervention explicitly written into state law. This is point number one in our 11-point legislative agenda that I mentioned earlier. State law already gives us the scope and authority to help those who are unable to meet their own needs. But to have it clearly spelled out in legislation will help dispel the misconception that we must wait for a threatening, violent, or suicidal act to get those in crisis the help they need. We will also seek a common-sense expansion of the criteria that a hospital doctor considers in deciding whether or not to discharge a psychiatric patient.

 

All too often, a person enters a hospital in crisis and gets discharged prematurely because their current behavior is no longer as alarming as it was when they were admitted. The law should require hospital evaluators to consider not just how the person is acting at the moment of evaluation but also their treatment history, recent behavior in the community, and whether they are ready to adhere to outpatient treatment.

 

Our agenda also calls for allowing a broader range of licensed mental health professionals to staff our mobile crisis teams and perform these evaluations. This will help us get more outreach teams on the ground and enable hospital psychiatrists to spend more time providing medical care directly to patients.

 

We will also seek changes in the law to improve communication between inpatient and outpatient treatment providers, allowing better continuity of care and discharge planning. And we will look to extend the reach of one of our most successful programs — “assisted outpatient treatment” — also known as “Kendra’s Law.”

 

When used, Kendra’s Law has been shown to help those with severe mental illness avoid repeat hospitalization and arrest. But we know that many who stand to benefit from this approach are not finding their way into the program. To remedy that, hospitals must be required to screen all psychiatric patients for Kendra’s Law eligibility.

 

These relatively simple changes to the law will have an outsized impact. They will strengthen our mental health laws and incorporate what we’ve learned through experience. And they will do so without threatening anyone’s civil or legal rights.

 

This plan represents a major shift in how we care for our fellow New Yorkers in crisis, even as we build on improvements we have already made over the past 11 months. It is the logical extension of what we have been doing from day one of this administration to repair our broken mental health system. That includes the Subway Safety Plan that put more outreach workers and police officers on the trains and platforms, and increased investment into drop-in centers, safe havens, stabilization beds, and Street Health Outreach and Wellness vans. The result so far has been over 3,000 New Yorkers connected with care, support, and shelter.

 

Our city also implemented the B-HEARD pilot program, which deploys social workers and EMTs to respond to nonviolent mental health 911 calls, and we have worked with the Sanitation Department to remove illegal encampments throughout the city, many of them extremely dangerous for those living there.

 

We want all New Yorkers to have access to a safe place to live, and we are working to expand the supply of supportive and low-barrier housing. We are also piloting innovative models to connect people in shelter with the services they need to succeed — including Medicaid Home- and Community-Based Services, which includes mental health care, socialization, and connection to housing.

 

We will be enrolling appropriate people living in shelter into specialized, Medicaid-managed long-term care plans. This will offer them enhanced services with the goal of stabilizing their medical conditions, increasing connection to health care services, reducing hospitalizations, and increasing access to community housing.

 

We are adding more Support and Connection Centers and increasing investment in other community support options. And we have launched our CONNECT program, which offers continuous engagement between clinical and community partners. We are also exploring ways to use Medicaid funding to provide services to people in shelter, including those with severe mental illness. There is a huge role for the federal government to play here.

 

All of these efforts are based on our core conviction that people with severe mental illness deserve care, community, and treatment in the least restrictive setting possible. Some may see the policy shift announced today as a departure from that goal. But let me be clear: When we hospitalize those in crisis, it will be with a sense of mission to help them heal and prepare them for an appropriate community placement.

 

We can’t just stabilize people for a few days and send them back out into the city. We must build a continuum of care that helps patients transition into step-down programs and eventually into supportive housing.

 

But nobody should think decades of dysfunction can be changed overnight. The longest journey begins with a single step, and we can’t wait another day to take this one. We must lead with a sense of purpose and conviction, not get lost in a wilderness of bureaucracy and fear. We must train, teach, and empower our city workforce to get help to those who need it — and know that our city supports them in this effort. We must build out a system that will bring people into care, alleviate their pain, keep them from harming themselves or others, and get them treatment and support they need in the long term.

 

Those suffering from severe mental illness have more than a right to exist or survive. They have a right to health care, housing, and treatment. A right to dignity and respect. A right to safety and security. And above all, a right to hope. Hope for treatment, community, and healing. Hope that their future will be safe and that their illness can be managed. But that hope starts with a spark of engagement on our part, followed by a strong and supportive program of help and housing.

 

We owe our brothers and sisters that much. And, in helping them, we will also be protecting the rights of every New Yorker to live, work, thrive, and be safe.

 

Giving Tuesday 2022: Support Nos Quedamos’ Environmental Justice Youth Team

 





Support the next generation
of environmental leaders
in the South Bronx!
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In June 2023, Nos Quedamos will reach a major milestone in terms of its three-decades legacy of people-led service and innovation in community development and housing in the South Bronx.

During the last 5 years, Nos Quedamos has actively worked at developing and implementing action plans that pay homage to the core principals that formed the organization. We have also kept a vigilant eye on forward-thinking succession planning that has included the development of Nos Quedamos’ Environmental Justice Youth Team peer program—the future of environmental advocacy in the South Bronx—which is affectionately known as “asthma alley” due to the disproportional pollution inequity in the region.

Since 2021, Nos Quedamos has trained youth to become environmental leaders by expanding their knowledge and hands-on fieldwork in the Environmental Justice space and community organizing. 15 youth have graduated from two separate cohorts of the Environmental Justice Youth Team. These dynamic youth leaders have been instrumental at successfully coordinating the activation of a community rooftop garden at El Jardin de Selene (Nos Quedamos’ LEED-Silver rated mixed-use, mixed-incombuilding). The youth team members have led a series of gardening practicums and art workshops using garden-specific elements (soil, seeds, rocks, found wood, fertilizer, etc.), and also introduced the benefits of meditative healing exercises via exposure and contact to nature for the building’s multi-generational and multi-ethnic residents.


In addition, the cohort is currently having discussions around the importance of Environmental Justice in communities like the Melrose section of the South Bronx (NQ’s main catchment area) and other communities of color across the country, and planning educational outreach sessions centered on topics such as reducing the cost of energy by utilizing green spaces as “resiliency hubs” to harvest solar power; improving overall mental health through time spent in green spaces like community gardens and parks, as well as expanding access to healthy and nutritious “fresh farmed” food (parts of the South Bronx have been qualified as “food deserts”), and how these people-led changes can mitigate health conditions that currently affect the community like asthma, diabetes, and mental health (among others).

Youth cohorts have also acted as ambassadors of the community on environmental issues and have been invited to either participate on and/or moderate topic-specific panels: youth leader Imani Cenac (now part of NQ's staff in the capacity of Resiliency Organizer) moderated a panel discussion entitled “Youth Voice, Youth Leadership, and The Future” during the annual member convening of the Partnership for Resilient Communities in New Orleans in April 2022. More recently,  Carmen Vázquez (NQ's Community Organizer and youth cohort supervisor) spoke during the 2022 Urban Future Summit on the “Community Collaboration in Climate Justice” panel alongside Daphne Lundi (Mayor’s Office of Climate & Environmental Justice) and Jeannette Williams (Urban Future Lab).

Your donation will help foster tomorrow's environmental leaders TODAY!
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For more information, scan QR Code or click the link below.
nosquedamos.org/giving-tuesday-2022

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