For detainees on Rikers Island spiraling right into a psychiatric disaster, a visit from the troubled jail advanced to one of many metropolis’s public hospitals can function a medical lifeline.
However that aid is usually short-lived.
In round half the instances, detainees are returned to Rikers inside hours after what critics describe as cursory hospital checks, touchdown them again in the identical surroundings that jail clinicians initially deemed unsafe for his or her psychological well being.
This cycle surfaced publicly throughout a Board of Correction oversight listening to final month.
“Whereas we do refer many sufferers to the hospital once we really feel that it’s clinically applicable, it’s finally the choice of scientific employees working at these hospitals as as to whether or not sufferers are admitted,” testified Joseph Otonichar, who oversees psychological well being look after detainees on Rikers.
“So a really massive variety of our sufferers who we imagine might meet hospital standards are finally not admitted to the hospital,” he added.
After the listening to, a veteran jail supervisor was extra blunt.
“I’m not a physician, however I’ve been doing this for a few years, and I can see when an individual is decompensated,” stated the jail official, who spoke on situation of anonymity. “And a few of these guys get despatched proper again. And it’s like, ‘How’s that attainable?’”
Detainees will be pressured to take medicine solely whereas on the hospital. Again at Rikers, even these within the midst of a critical psychological well being breakdown have the correct to say no.
The hospital back-and-forth is especially notable as a result of medical care at each Rikers and the hospitals is overseen by the identical public system, NYC Well being + Hospitals.
The revolving door underscores one of many persistent dysfunctions contained in the scandal-scarred jail system, even because it enters a brand new chapter beneath lately put in remediation supervisor Nicholas Deml and Correction Commissioner Stanley Richards. Each started their tenures earlier this month with guarantees of reform.
Steve Martin, a court-appointed monitor overseeing the division for practically a decade, has by no means made the hospital speedy returns a difficulty.
After the listening to, metropolis well being officers pushed again on the notion that referrals are routinely dismissed.
In accordance with the town’s Correctional Well being Providers — the division of NYC Well being + Hospitals that gives care within the jails — clinicians think about a broad vary of things when deciding to ship somebody experiencing a psychological well being disaster to a hospital. That features if a detainee presents an imminent hazard to themselves or others or can’t meet fundamental wants due to psychiatric signs.
Detainees are sometimes referred to Bellevue or Elmhurst hospitals for analysis for attainable inpatient psychiatric admission. Hospital clinicians then conduct their very own impartial assessments to find out whether or not hospitalization is warranted.
Information supplied by the town exhibits that about half of referrals lead to admission.
At Bellevue, there have been 650 psychological well being associated referrals in 2024, with 364 admissions, a 56% admission fee. In 2025, admissions ticked up barely to 410 out of 713 referrals, or 57.5%.
Elmhurst noticed decrease numbers and a sharper drop: 55 admissions out of 108 referrals in 2024, about 51%. The quantity fell to 40 admissions out of 102 referrals in 2025 — slightly below 40%.
In contrast, the nationwide common of individuals admitted from an emergency room into the hospital for all situations together with psychological well being crises hovers round 20%, in keeping with research.
At Rikers, medical employees generally ship the detainees proper again to the hospitals if they’ll’t be safely managed behind bars, Otonichar testified earlier than the Board of Correction.
“These are very difficult conditions to navigate,” he added.
Board Vice Chair Helen Skipper, who was launched from Rikers in 2017, questioned why medical employees on Rikers wasn’t higher at speaking with docs within the hospital.
They’re all employed by the town’s public Well being and Hospitals Corp., she famous.
“Does CHS not work with these hospitals and their scientific group? Do you not speak about the way you refer sufferers backwards and forwards and are available to a contented medium?” she requested.
“I perceive, you guys are clinicians, how does the hospital deny?”
Otonichar referred to as it a “superb query” however stated the problem is sophisticated.
“I want I had a easy reply,” he stated, including that Correctional Well being Providers works intently with hospital management to deal with difficult instances.
Patsy Yang, Senior Vice President Correctional Well being Providers at NYC Well being + Hospitals, famous that through the early days of the de Blasio administration, the town took over medical look after folks locked up on Rikers.
The transfer got here after years of poor therapy and high-profile deaths due poor medical care beneath Corizon, a personal for-profit supplier. It was achieved partially to enhance communication between medical employees at Rikers and in metropolis hospitals, she stated.
Nonetheless, Rikers clinicians generally imagine that detainees could also be higher off getting admitted to the hospital as a result of sending them again to jail poses a well being danger that others who’ve a conventional dwelling setting don’t have, Yang stated.
“There could also be sufferers who don’t meet the standard group standards for inpatient hospital admission however in our case, could also be finest cared for in a hospital setting moderately than in jail, and people are the conversations that happen, case by case,” she testified earlier than the board.
In response, BOC Board Chair Dwayne Sampson requested for a abstract of latest hospital referral instances “in order that we’ve a greater understanding of the hospitalizations and the problems occurring with it.”
Board Member Dr. Lauren Stossel, who beforehand labored at Rikers as a supervising psychiatrist, stated she believed there’s been “huge progress lately” for sufferers CHS believes needs to be admitted however are being blocked by ER employees.
Yang informed the board that area at Bellevue and Elmhurst wasn’t a difficulty.
However in an interview, Dr. Luis Marcos, who headed the general public hospital system through the Giuliani administration, stated area is all the time the prevailing issue.
“The query is: do we’ve a mattress or don’t we’ve a mattress? That tends to be the problem at Bellevue,” Dr. Marcos informed THE CITY.
In 2014, two senior docs at Rikers informed front-line clinicians that Bellevue Hospital had no accessible area and instructed them to maintain sufferers in jail except the scenario was dire.
Final week, the senior jail official who spoke on the situation of anonymity stated accessible area does exist each at metropolis hospitals and inside specialised psychological well being items on Rikers.
In Bellevue Hospital, one psychiatric ward had room for 29 sufferers however held about 15 folks on Friday morning, whereas one other unit with area for 39 had roughly 23 detainees, the official stated.
The jail system’s specialised psychological well being housing on Rikers additionally has empty beds, the official added. As of a latest morning census, the so-called PACE items — designed for detainees with critical psychological sickness — had about 290 folks in a system constructed to carry 334, leaving roughly 40 vacancies.
A spokesperson for Correctional Well being Providers stated the PACE items are designed to function under full capability to take care of a therapeutic surroundings. Filling each mattress, the spokesperson stated, would undermine the items’ capability to operate as supposed.
Nonetheless, some detainees on Rikers are coping with psychological well being points so critical that they cowl themselves with feces.
“There are positively folks on Rikers proper now who may benefit from being within the hospital,” the official stated. “However the willpower about who will get admitted or moved to these items is made by psychological well being employees.”
Jeanette Merrill, a spokesperson for CHS, declined to element what number of hospital beds for detainees are at the moment accessible. Stephanie Buhle, a consultant for HHC, didn’t reply to THE CITY’s request to talk with ER employees at Elmhurst or Bellevue.
Buhle stated folks referred from jail bear complete psychiatric assessments. In some instances, the acute misery that prompted the referral might resolve by the point the particular person is evaluated within the emergency division or might not meet the authorized standards for inpatient hospitalization.
She additionally famous that Bellevue Hospital maintains a 55-bed psychiatric unit for folks coming from the jail system, which averaged about 76% occupancy in 2025.
The battle between Rikers medical employees and ER docs has existed for many years, in keeping with a number of former jail medical employees. The hospitals have lengthy believed Rikers detainees with critical psychological well being wants are being “dumped” on them, stated one physician who requested to stay nameless.
The hospital ping-pong isn’t distinctive to New York Metropolis, stated Dr. Marc Stern, a former regional director for the state jail system within the early 2000s, who additionally headed medical providers for the Washington jail system.
“Throughout the nation, there’s fairly often a disconnect between the ER and the correctional facility,” he informed THE CITY. “The particular person within the ER simply doesn’t perceive what the capabilities are, and so they’re so various from jail to jail and jail to jail.”
