Committee on Hospitals, Oversight – Impacts of the Maimonides Health System and NYCH+H Merger, March 2026

Speaker A (00:06:17)

At this time, please do not approach the dais. If you'd like to testify, please see one of the sergeant-at-arms to fill out a testimony slip. Please silence all electronic devices. Chair, you may begin.

Speaker B (00:06:37)

Sorry. Good morning. I am Councilmember Mercedes Narcisse, Chair of the Committee on Hospitals. Thank you for joining us today for this oversight hearing on impacts of the Maimonides Health System and NYC HNH merger.

Speaker C (00:07:01)

I, I know how important our hospitals are to New York City.

Speaker B (00:07:03)

For generations, our hospitals have served as lifelines for communities that too often face barriers to care for low-income families, immigrants, seniors, individuals with disabilities, and patients who are uninsured or underinsured. These institutions are not simply healthcare providers. They are anchors of stability in our neighborhoods and essential pillars for, of our public health infrastructure. New York City Health and Hospitals and Maimonides Health have each played a critical role in fulfilling that mission. HNH, as our public hospital system, has long been the backbone of care for those who might otherwise fall through the cracks. Maimonides, for more than a century, has served Central and South Brooklyn as a major safety net institution, providing high-quality, high-volume quality emergency care, maternity services, trauma care, cardiac services, behavioral healthcare, and more to one of the most diverse patient populations in the city. The proposed merger between HNH and Maimonides is a significant development for Brooklyn's healthcare landscape, with important considerations for patients, workers, and the broader system. Our focus today is to better understand the details of this proposal. Ask thoughtful questions, thoroughly examine how any potential transition will affect the communities this institution serves. We also recognize that safety net hospitals across our city face real fiscal pressures. Ensuring long-term sustainability whilst preserving access and quality in a complex challenge. This hearing provides an opportunity to better understanding— understand how this proposed merger would affect reimbursement structures, financial stability, governance, service delivery, and workforce protections. We must ensure that our hospital remains open and that services continue without interruption. Patients must continue to receive timely, high-quality care without confusion or disruption. The dedicated workforce—nurses, doctors, technicians, support staff, and administrators— who sustain this institution every day must be treated fairly and supported throughout the transition. Our goal is simply to protect and strengthen access to care for New Yorkers. That means ensure that Brooklyn communities, especially those who are most vulnerable do not experience reduction in services, longer wait times, or any decline. It also means safeguarding the cultural competent care that patients depend on. Mamanides serves one of the most diverse population in the city, including large immigrant communities and our longstanding Orthodox Jewish communities. And any transition must continue to honor the linguistic, cultural, and religious needs that are essential to patient trust and positive healthcare outcomes. We also understand that institutional identity and community confidence matter. For many families, these hospitals represent not just access to care, but a legacy of excellence and trusted presence in their neighborhoods. As we review this proposal, our focus is transparency and clarity— how governance, service delivery, and workforce protections will function. Would function so that patient staff— that patients, staff, and the broader community can be confident that quality, stability, and trust remain central throughout any transition. I look forward to hearing from the hospital leadership, labor representative advocates, and community members. This is an important conversation for the future of healthcare in Brooklyn and for the continuous strength of our city safety net hospital. So I want to thank everyone that's here this morning. Before I begin, I would like to thank committee staff, senior leg— I mean, um, legislative counsel, which is not here with us, Riyad Oghuzarara, and Policy Analyst Manu Abut. And I saw— is this some— okay. And if I do not acknowledge you, I will come back. I also want to thank my staff, Frank Shea that's here, Ms. Gala, and of course, my fellow Courtney Lee. And all my constituents that make it possible for me to be here. And I would like to rep— I mean, to acknowledge my colleagues. Um, I don't want to push my colleague's last name. I, I'm trying to remember the last name. I had to make sure Aldebol, did I say it right? Thank you. Thank you. I'm gonna get used to the name, just give me a little time. We will now— we'll now be hearing testimony from the representative from the administration, and I will turn it over to the policy analyst to administer the oath to the panel. And thank you, Chair. We will now hear testimony from members of the administration. Will you please raise your right hand?

Speaker D (00:14:29)

Do you affirm to tell the truth, the whole truth, nothing but the truth before the committee, and respond honestly to the council members' questions?

Speaker B (00:14:37)

Perfect. Thank you.

Speaker C (00:14:40)

Good morning, Chairwoman Narcisse and members of the Committee on Hospitals. I'm always happy to sit before an experienced nurse who understands the— I'm a primary care doctor and I'm the proud CEO of New York City Health and Hospitals, an exciting planned partnership with Maimonides health and discuss what the partnership can mean for patients, employees, and the broader community. I grew up in South Brooklyn, just a couple of miles from Maimonides, so I understand the importance of this hospital in the community on a personal level. When I've been visiting, people have asked me, well, you know, have you been to Maimonides before? And I could always say, yes, when I was 10, I was at Maimonides for the first time. To visit an aunt of mine who was hospitalized there. So I know how important the hospital is to the lives of South Brooklyn. The union of New York City Health Hospitals and Maimonides is a natural fit. Both share a deep commitment to accessible, culturally humble care that meets the needs of diverse New Yorkers. Health Hospitals, as committee members know, is actually a federation of hospitals, each guided by the unique characteristics of the neighborhoods it serves. Uh, Elmhurst Hospital and Bellevue Hospital are two great trauma hospitals, but you would never confuse the two of them. Uh, the same would be true of Harlem and Jacobi. Uh, when you go into our hospitals, each looks a little different, and we like that. We like the idea that each of our hospitals represents the needs of its surrounding community. We are not trying to create a cookie-cutter set of hospitals that are all[No speech] communities, and that's how we will partner with Maimonides. By joining our system, Maimonides will be able to offer New Yorkers expanded access to high-quality care, seamless digital access to health records through MyChart, and ongoing financial stability. And I think that financial stability will make a huge difference because it's impossible to feel good about your institution and its ability to serve the community when you're in a financially difficult position. I know that because when I joined Health Hospitals 2 billion, uh, 8 years ago, the deficit was over $2 billion and people were saying that I had to close hospitals, and I said, no, we're going to grow out of this, and we did grow out of it. And our system is much stronger now because we're not in deficit. We have enough money to take care of our patients. Maimonides Health will also benefit from having increased funding, ongoing capital investments, which are very much needed at the Maimonides campus, access to technology, and additional resources to support ongoing care and community engagement. The transaction is anticipated to close by April 1, 2026. After that date, Maimonides Health will legally be part of the New York City Health and Hospital System. The hospitals, though, will continue to have their own operating certificate and in New York, all hospitals, even those that are part of a system, are all individually licensed, and that continues to be the case. Well, after April 1st, while the transaction will be legally complete, the integration of the system will, will take many, many months thereafter. We have preserved We're committed to the preservation of Maimonides' historic cultural identity and cultural practices, and we'll ensure that these values are central as we come together. We understand the critical role that the Orthodox community has played in creating the hospital and supporting the hospital, and we look forward to honoring that and taking care of all of our patients, families, and staff in the years ahead. Happy to answer any questions or hear your thoughts about this partnership.

Speaker B (00:19:22)

Thank you. Thank you, Dr. Katz. Make it very sweet and short. So now, from what I just heard from you, that's the reason I have full confidence in you for a lot of ways, many ways. Because I remember the deficit that the H&H were in, the hole for $2 billion, and very quickly you were able to work it out. So I want to say thank you, and I always tell you I appreciate you for all the kind work and hard work that you've been doing in New York City, and we're happy to have you, and Francisco can kind of like want you, but we got you here, so thank you for that. I have a few questions for you. It's going to go with the hospital. But before I get to the regular question that I already prepared, but I heard something about the integration of the system. From my understanding, they have Power in terms of the billing and the records right now, and then I know H&H using Epic.

Speaker C (00:20:30)

So is that what we're talking about, the integration of all the systems and the recording too? That's correct, Chair. Maimonides Hospital has more than 5 different primitive electronic health records, and some of the physicians are still charting on paper, something I certainly did during residency but have not done recently. And when we, the city and Health and Hospitals, negotiated our contract with Epic, which is considered the leading platform for electronic health record, we did something very smart. We negotiated that if we grew, we would just pay per-user price. So we can extend by— through this merger, once they become us, we will be able to extend the electronic health record to all of the patients and the providers, and they won't have to pay the same as if they were developing Epic from the beginning because we already have a double honor roll system that we will just put over their hospital and we'll just have to pay user prices. So much less than anyone who would want to develop it. And meanwhile, they'll get a state-of-the-art system that will enable them to provide better patient care. And one of the— there are many things that people love about MyChart, one of my, the favorite one that I'll mention because listeners will immediately understand. When you're in the hospital, you can follow your own progress on your telephone. You can look yourself up, you can see your own labs, you can see the plan, you can read your doctor notes, you can see your X-rays. So many people, maybe some of you have had family members in a hospital You're waiting for the doctor to call you or the nurse to call you and tell you what the results said. You're waiting, you know you had the CT scan, you wanna know what it said. You'll see on our Epic system the results at the same time that your doctor or nurse will see the result. And so there's no more of this, you know, it relieves so much anxiety. You're not wondering, well geez, has someone forgotten me? Because you know that until the X-ray result appears hears on your phone, they don't have the result either. So nobody is— it's not that they're taking care of somebody else. You can send messages to your patients. My patients send me messages in both English and Spanish that I respond to. You can make appointments. You can cancel appointments. So I think patients will find that they'll get much better care when they have a modern electronic health system.

Speaker B (00:23:19)

I agree with you. Less anxiety when you're waiting for your results. Let's come to the hospital. One of the questions that I have heard from many: will the facilities currently run by Maimonides keep the Maimonides name after the merger? Absolutely.

Speaker C (00:23:38)

As is true of all of our hospitals, that people will always know when— if you ask somebody who works at Harlem Hospital, where do they work? They're not going to say, I work for New York City Health and Hospitals. They're going to say, I work for Harlem Hospital. Okay. Right. I mean, it will be exactly the same. People will say, I work at Maimonides Hospital. I went to Maimonides Hospital.

Speaker B (00:24:00)

Nothing will change. Okay. Before I get to the next question, we talk about that from your statement, opening statement, if I recall, we were at negative $2 billion.

Speaker C (00:24:12)

Now, are you in surplus? We spend every nickel on our patients is how we think about it. There's so much need, so whatever revenue we take in, we will spend on our patients. But we don't have a deficit. We're not borrowing money. We're not behind. We meet our payrolls. We're not cutting positions. We're not cutting clinics. We're expanding. I mean, we are a much bigger system than we were 8 years ago, and now there's no deficit. So you can grow out of a deficit. You don't have to shrink because you have a deficit.

Speaker B (00:24:53)

Okay, got it. Pending legal and regulatory approval of this merger, does HNH have knowledge of how the $2.2 billion state grant will be allocated over the next 5 years? Has the governor's office described the perimeters for how they intend to, um, for this money to be used?

Speaker C (00:25:19)

Yes, $500 million is for capital, which is something the hospital very much needs. At the top of our list of things we want to do is provide a new maternity ward for the hospital. Hospital has about 6 births a year. I was going to get to that. Thank you. Really needs a more modernized maternity ward. $1.5 billion is for operational costs. So this is recognizing that Maimonides currently has a deficit that requires that the state provide them funding to keep it open every year. And we— when we worked with the state on the project, they understand that it will take us some time to grow out of the Maimonides deficit with new systems. For example, to implement Epic takes about 15 months. So the potential savings and growths at Maimonides won't happen right away. So we need the state to continue to support, and then $200 million is loan forgiveness. So $200 million is money that Maimonides currently owes that the state forgives.

Speaker B (00:26:46)

Love that. Can you please describe how, how this partnership will allow Maimonides and H&H to access higher Medicaid reimbursement rates and how long will it take to take effect?

Speaker C (00:27:03)

Yes. So the health and hospitals benefits from a higher rate of Medicaid reimbursement, and it's maybe worth thinking about why that is because it affects so much about this partnership. The federal government recognizes that municipal hospitals take care of many more uninsured patients than other hospitals, and so needs a mechanism of being able to provide a higher payment to government hospitals that are doing this. Also, you remember that when President Johnson created Medicaid in the early '60s, it was always a federal-local match, 50/50 in most cases. So the federal government pays 50% and then a state or city provides the match. So only a government can make the match, and that's why only government hospitals have the higher rate, because they— you cannot make the match with anything other than a certified public expense. Expenditure. So once it happens, we will immediately be able to get additional money for Maimonides. And to answer your question, how much? It's about $9 million a month for doing exactly what they do now. So no improvements of any kind, just the difference between the hospital joining us on April 1st and joining us on May 1st is $9 million. They will get $9 million more for doing exactly the same thing because we can make the match as a government hospital, but a private entity cannot make the match and so cannot get the higher rates.

Speaker B (00:29:02)

I'm glad you highlight that out because I was trying to explain it myself, so I'm going to replay it for folks. I was saying that that's why the private hospital it would not be a good match for them. That's why they walk away.

Speaker C (00:29:14)

So HNH will provide the support system. As usual, you have it exactly right.

Speaker B (00:29:22)

No, you're right. Um, have DHS payment resumed? How has New York— I mean, HNH absorbed all of the financial cuts that have resulted from changes to federal law? And does this merger help or hinder the hospital system as it prepares itself for more cuts starting in January 2027?

Speaker C (00:29:49)

Maimonides joining us will help us provide better patient care in Brooklyn in the specialty areas for our patients. Health Hospitals shines especially in primary care and emergency care. Maimonides shines in specialty care. So our patients in Brooklyn will get better care because of this. But financially, there will be no benefit to Health Hospitals, and that was deliberate on my part. I never wanted— my motivation, and I think the city's motivation, was to help Maimonides. I never wanted anyone to feel we were doing this for money to benefit us. So we signed all the papers to say that every dollar at Maimonides Campus stays at Maimonides Campus. So there's no cross subsidy. So if, as things get better, Maimonides does better and better, good for them. We'll invest that money into services at Maimonides, but it will not help or hurt. So we've been very clear that there's no cross-subsidy in either direction. For Maimonides, one of the things that I've told them over and over again is when this goes forward, their budget grows, but they can only spend as much money as they have. You know, this is, you know, to me, you know, many people make hospital financing, in my view, more complicated than it has to be. It's just like your checking account. You get to spend the money you have. You don't get to spend the money you don't have. So come our joining, we Maimonides, the doctors, the nurses, the organization will get to decide based on what the community needs, what it wants to spend their money on. My job will be, but you can't spend more money than you have. Right, that's in my view part of how this got to be a problem for Maimonides because they have been spending more money than they have. But with this joining, they will get more money, better rate of reimbursements, and we will make sure that they will run on the amount of money they have.

Speaker B (00:32:15)

Got it. How Have Maimonides staff been informed about the pending merger and the impacts it will have on their employment, their scheduling, their benefits, their job responsibilities, and I may say their union affiliation too?

Speaker C (00:32:34)

Sure, so we have had, um, I've personally been to 2 town halls, but I know that Maimonides has had additional meetings, additional information provided. Maybe a good moment to say that the people who work at Maimonides will not be becoming city employees. So all of the unionized staff will remain employees of the— of a Maimonides Corporation that will come out of the existing corporation. So that was designed specifically to prevent disruptions of unionized staff. And the process of trying to bring people to city employment would've been very complicated and made many people unhappy because how would you deal with seniority, right? So you have nurses in both places. How would you deal with what if one job specification was different than another job specification. So part of what I think was wise about this deal is none of that changes. We, we as health and hospitals will have a contract with that entity that will serve as an employment entity. We'll continue to employ all of the nurses, social workers, technicians. They will continue to to work for a company that will come out of the existing Maimonides nonprofit. The doctors will be in their own group. So that is considered the modern way that people employ doctors. So the doctors will have their own organization, and we will contract with that organization. The leadership will be employed by Health Hospitals, and I have already made clear that when this goes forward, Svetlana Lipskaya, who's been the very successful CEO of South Brooklyn Health, will become the CEO of Maimonides, a Russian Jewish immigrant to New York City, She fits the incredible capabilities that will be necessary for Maimonides to do well in the future. But overwhelmingly, people will remain in their same jobs, same union agreements. We, of course, will respect all union contracts and union rules as they exist now.

Speaker B (00:35:19)

When you say leadership, what do you mean by just the top? Sitna Na is one of my favorite, by the way. We were— we had a meeting the other day. She's lovely. Lovely. So does that mean the leadership from the president, CEO? What leadership? Because some nurses that is nurse practitioners, some doctors that cardiologists, all those leadership, are you touching that area?

Speaker C (00:35:46)

No. So the chief medical officer, the chief nursing officer, the chief executive officer, those top-level positions need to be health and hospital for legal reasons because we are becoming the legal entity that holds that contract. And so you have to show in that that you really are running it. It's not a sham. We're not accepting the higher rate of Medicaid without ourselves running the hospital. So that means The CMO, the chief medical officer, the chief nursing officer, the chief executive officer have to be health and hospital employees. But the overwhelming remaining, the people you mentioned, well, the doctors will be in their own doctors group. The nurses, along with the leader, anyone who is a unionized nurse will remain in the existing group. Over time, for people who are not unionized, We will look at that question. That is not an immediate question of whether they will come to us or not come to us, but on day 2, everybody remains. And certainly, our assumption is in perpetuity, all the union workers will remain because those positions are very hard to move. Managerial positions, you can ask yourself which is better. Unionized positions is an established contract, is an established union negotiating certificate. Those things are complicated to change. And our overall view of this whole partnership is we want to help in the areas that need help. We don't want to change things that are working. So for us, what isn't working They need financial stability. They need a modern electronic health record. Really, those are the two big things they need. That's what we want to focus on. And so we've tried to create an organization that leaves as much of everything else alone because there's not a problem. If in future years, you know, people have other ideas, we can look at those. But, but the unionized staff will, we will always need to stay stay in an organization that's successor to the existing nonprofit.

Speaker B (00:38:13)

But you have, in terms of some nurses, some administrative level that's lower, that's not unionized.

Speaker C (00:38:22)

So are you planning to get— Certainly not at the beginning. And again, it goes to the same idea. The problem at Maimonides is not nursing. The problem at Maimonides is not the doctors. So we're trying going forward to not mess with things that are working. We want to fix the things that are not working, the finances and the electronic health record. And then we want to learn and we want to listen to people and we want to understand their points of view. And, you know, again, some people might favor moving to Citi employment, some people might not. There are different pluses and minuses, as you know, of being in city employment, not being in city employment. But we— this seems like the wrong moment to try to answer that question because first, it isn't the problem, and second, I feel that, you know, I always like when I am responsible for something, I like to learn. I don't like to come in and say This needs to change. I like to say, show me how things work. I currently spend 1 day a week at Maimonides. Svetlana is currently spending 3 days a week at Maimonides. We want to learn. We want to hear what people think is working. We want to hear what people think is not working. We want to understand people's hopes and vision for the hospital going forward. And anything that doesn't have to get done by April 1st, we are trying not to do because there are so many regulatory issues. And we think that people will be most comforted by knowing in day 2 it will look the same. There will be a new CEO. There'll be a chief medical officer who is their current chief medical officer, but he will be employed by us now. There will be a a CNO who is employed by us but is the same CNO as they are currently. We're trying to, as much as possible, maintain continuity.

Speaker B (00:40:27)

I have another question while we're talking about April 1st, which is April 1st is the merger, right? So I know you cannot talk about it much, but does— don't we have a lawsuit over the head that should be in afterward, after that, in April 20-something. What is it? I forgot. April—

Speaker C (00:40:47)

I, I read it somewhere. So what's the date? You're correct, it's mid-April. Um, but there's no, uh, restraining order, so there's nothing that prevents it from—

Speaker B (00:41:00)

the deal from happening on, uh, April 1st or March 31st. Okay. Um, the employees— I still have— there's a lot of texts coming to me. If you see me checking, because some my colleagues, the nurses, you know, they want to know what's going on. Will employees who are already retired or approaching retirement retain all their existing retirement benefits under the merger? Yeah, nothing would— nothing's going to change. Okay, I like that part. Will HNH honor existing union pathways for promotion, seniority, and grievance procedure?

Speaker C (00:41:34)

I'm assuming everything's going to stay the same.

Speaker B (00:41:39)

Everything stays the same. For staff who will remain, will they keep their sick time and pay time of time that they have accrued? I know it probably sounds minute, but for, I mean, for those folks that are going through it, it's very important. Um, they have accrued before that merger, so would they keep the same?

Speaker C (00:42:04)

Everything will stay the same. And I hope you appreciate that's, I think, the wisdom of how we did this, right? Because someone might have gone in and say, okay, everybody, you know, is going to have to go to city employment. And then you'd have to imagine the issues you would have. You'd have all of those issues. Well, what about their retirement? What if they're 12 years toward their retirement? Now you're going to start them at zero. So the whole idea was No, everybody just maintains, you know, what they have.

Speaker B (00:42:34)

This one again, just for clarification, I'm going to continue asking them. Are there any collective bargaining agreements with employee unions that you have that Mamadidis is a party to that will be impacted by this merger?

Speaker C (00:42:49)

If you want me to repeat it, I'll repeat it again. No, I understand. We are talking to the unions. Unions are familiar to us, right? We have the same unions representing different— we— CNA, excuse me, NYSNA represent out of California. Neuron just went off on the California nurses. The NYSNA represents nurses in both places. 1199 is— we work with because they represent some of our workers, and CIR represents the residents in both places. These are all unions that we love working with. We are talking to all of them. We're figuring out issues of, you know, future, you know, relations. But I don't anticipate any problems. The reception that we've gotten from the other unions has been positive, and our current relationship with the other unions is positive. We've always seen ourselves as a pro-labor organization, so I don't anticipate any problems.

Speaker B (00:43:59)

As an independent teaching hospital, Maimonides offers a broad range of educational and research options, including opportunities to engage in basic science research, clinical research, or health services research. Will all this education and research options be preserved after the merger, or will some of this program be reduced?

Speaker C (00:44:21)

Have students, residents, and researchers been been made aware of the potential impact, if any, of this merger? Going into it again, you know, we're learning, we're growing. Our assumption— we ourselves do lots of research. We have lots of residents, as you'll remember from your time of working and teaching residents. I'm sure you taught many a resident in the Elmhurst emergency department. We too do teaching and research. There's all reasons to believe we're all going to continue to do that and that it will only grow as we are more together.

Speaker B (00:44:57)

The reason for this question too, it's are they aware? Because they get anxious. A lot of people getting very anxious around this. And they calling me, they texting me. I have some questions I'm going to ask you for them too. Will all Mamani's hospital and community-based sites remain open and operational?

Speaker C (00:45:17)

Because I know they have more than one site. Yes. So for everybody's knowledge, there is the main campus of Maimonides. There is Midwood Hospital, which has a separate operating license. It's about a 120-bed hospital, community hospital in the Midwood area. And then there is a freestanding emergency room in Bay Ridge. So those are the three, and, and then there are, there are offices in many, many places, but those are the three biggest parts of the campus.

Speaker B (00:45:56)

So there will not be any interruption, everything gonna remain the same? I don't want to assume things, so I'm going to continue asking. I appreciate that. Does Maimonides have a private contract for ambulance, ambulances, and if so, will the term of the merger impact such contracts. But let's talk about all the contracts, the subcontract they have.

Speaker C (00:46:15)

You're going to look over all of them? Correct. Since you asked, we're actually very, very excited. One of the amazing assets that Maimonides has is a very functional EMS with their own ambulances, which is something Health Hospital currently does not have. We, I think probably it was 20 or 30 years ago, the city moved the ambulances from Health Hospitals to the fire department. So Health Hospitals no longer has an ambulance service. Maimonides, like many private hospitals, still does, and I've had presentations from them. I think they're incredibly successful, and we're looking at how they may have a broader mission, and we might grow them for other needs in Brooklyn. But beyond that, for other contracts, going into it, we, as part of any merger or partnership, we accept whatever they have in terms of contracts. But we will want to look at things like, for example, if Health Hospitals has a contract that has better prices on a particular commodity than Maimonides, we would want to end that contract and use the city contract. It could turn out the opposite. It could turn out that there's something where they're getting a better rate than we're getting, in which case we'll want to build on their contract. But that's a huge, huge scope of work and not something that we are going to do prior to the the merger happening. But we don't, we don't go into it with any expectations. We, we want to do whatever would make the most sense, and we will include the people in Maimonides about, you know, that. But it exists on every level, every sort of IV pump, right? Every X-ray machine, right? Every catheter that's used, right? Every Pharmaceutical, you have to look at hospitals are huge purchasers, right? And so you have to look at all of the contracts and ask yourself, you know, well, which is the better contract? Because we probably would not want to maintain two sets of contracts for the same thing. That's not how you get the best price. You get the best price by bundling your volume. But it is also true that that sometimes there are unique needs. You know, one doctor does a procedure that requires a catheter that only one company makes. So you have to contract with that one company to get that one catheter. So, and that's true at health and hospitals today. So usually, you know, the 80/20 rule works. You know, 80% of the stuff, you know, is easy to buy and 20% can be very specific and you might have to make special arrangements.

Speaker B (00:49:22)

So some folks have their niche, and that niche is the small things that you don't get all over, and they probably have to get it. But overall, you're going to review all the contracts, correct? Correct. Yeah, correct. Okay. My manager offers various links to community supports. And before I get to the next question, MWBEs, you're gonna still using the same compact to make sure that you have the MWBE fairness?

Speaker C (00:49:53)

Right. I— we don't know much right there. Currently using different contracting rules than the city, so we don't know that much right now about what their MWBE usage is. But when we go— when we do contracting, we of course always follow the MWBE rules of city.

Speaker B (00:50:12)

So you're going to follow the same rules even as over there? Correct. Okay. Maimonides offers various lengths of community supports and rehabilitative services for patients with disabilities, including a partnership with Independence Care System, a Brooklyn health home that focuses on care management at the Maimonides Neurology Clinic site. Will this partnership with ICS and BHH continue at Maimonides, neurological—

Speaker C (00:50:43)

I mean, neurology clinic site after the system merged with HNH? I look forward to learning more about it, right? I think Maimonides is a good community provider, you know, works with all sorts of organizations, and we look forward to learning more about them. We go in on day 2, everything will look exactly the same. But these are programs I don't know anything about. But again, I think what's important is what the orientation is. We're not there to change things that are working. We're there to fix things that are not working. It is my assumption that we will learn about things in the Maimonides system that we think are better than what we do, and we will want to increase that. It's possible that there will be things that we will learn we do better than Maimonides does in Brooklyn, and we will want them to adopt it. But I don't want to make judgments before I really understand things. I want to see things. I've been touring the facilities. I've been talking to people. I have to be in a place before I can possibly make any determinations about, you know, how— how you're going to go forward. But we're not— again, I think the big thing that we want to stress to people, it's not— we're not— this is not a takeover. We don't have like 1,000 employees that we're looking to place at Maimonides. We don't have 100 organizations that we're looking to take over the community work. We are focused on the things that need to be fixed, and then we want to learn.. And we want to see and we want to use what we learn maybe to improve our hospitals, right? If there's a unique service that, again, just using it as an example, the service that you're asking about, maybe that's a service we want for our patients in South Brooklyn. We don't have it. But that's why we want to take an approach of let's learn, let's see what things— what I'd like to be able to do in 3 years is say, Here are 10 things that are better at Health Hospitals because of what we learned at Maimonides, and here are 10 things that are better at Maimonides because of what we had at Health Hospitals.

Speaker B (00:53:05)

That seems like the best, best way to go forward. So you're a data-driven person. You're going to look into it and you're going to make the best possible judgment. Correct. Okay. Local Law 12 of 2023 requires city agencies to develop a published and 5-year accessibility plan. While H&H is not always considered a city agency, has H&H conducted similar accessibility assessment or published an accessibility plan? And what, for Mamani's? For Mamani's? Not yet. Not yet. Okay. Culture concerns that we have, given the incredibly diverse populations of Brooklyn Heights patients that Mamani's currently serves? Does HNH have the resources and staff to ensure that patients receive culturally concordant or culturally congruent care after the merger?

Speaker C (00:54:01)

I think that's a concern. Yeah, I think it's one of the things that, that Health Hospitals does best. Okay. We serve at Woodhull a large Orthodox Jewish population. We serve at At Harlem, a very large West African population. I mean, this is, this is who we are. We, you know, Elmhurst is, you know, an international center, one of the largest Tibetan communities anywhere. I mean, this is who we are. We are interested and supportive of all cultures, and we don't produce cookie-cutter hospitals. That's not who we are.

Speaker B (00:54:46)

And we intend to, you know, respect the cultural traditions that have built Maimonides and made it the amazing place it is. You know, when you say Elmhurst, since I spent a lot of time there, that's my home, and I know we serve everyone, and I'm expecting for you to be culturally, you know, everything you do to be sensitive to everyone's culture. That's what I expected from any hospital for that matter, given the incredibly diverse population of Brooklyn Heights, right? So I'm going to ask that again. What has outreach and engagement looked like in the surrounding neighborhoods?

Speaker C (00:55:26)

Will they be willing to host, you willing to host some community conversations? Yes, and the community has been, certainly in the two open houses that I've been to, community was very much presence. The diverse set of views about it— there are many people, especially from the Sunset Park area, were very excited that because of this they would be able to use NYC care at Maimonides or have additional services. You know, we certainly have heard concerns at community settings from the Orthodox Jewish community. Who are worried about whether or not the hospital will still respect their, you know, cultural traditions, and we've explained absolutely. But as you say, change makes people worried and anxious, and, you know, it's—

Speaker B (00:56:23)

I think that once it all happens, people will relax, but I understand why until it happens, people are anxious. The board. What will the new community advisory board look like?

Speaker C (00:56:42)

Will it include members from both the former— I mean, the Maimonides Group and H&H Facilities? How? Well, the, the community advisory board needs to represent the community right around Maimonides, right? So we're listeners. We, we won't be health and hospital people on the community advisory board.

Speaker B (00:57:01)

It will all all be about the people who live around Maimonides and who use Maimonides and help Maimonides. We've been joined by C.M. Sanchez. All right, you enter your billing system. There's some questions I know that have been coming to me. I don't want to ignore those folks that are watching and sending their questions in. Um, here are numbers of questions that they had. What are you doing to ensure that the expert doctors do not leave because of the city takeover? I'm sorry, I don't know about city takeover, but that's one of the questions from the community around by, um, Chair. Can you say again? What would you be doing to ensure to, um, that the expert, the doctors, the specialty, like cardiologists and all those so on and so forth, doctors do not—

Speaker C (00:57:59)

what are you going to do to prevent them from leaving the hospital? So I've met with all of the chairs and a large number of the doctors and have gotten a lot of support, actually. Their chief of cardiology, Jacob, told me, you know, I say to my, to my doctors, I'm staying, so you're staying. So there will always be people who come and go. I mean, you can't— New York has a very active doctor set of hospitals, and people will go from one hospital to another. But I don't— I'm not expecting any departures widespread from Maimonides, and I've gotten a lot of support support for the idea of a system that's really focused on clinical work. I mean, one of the things that the doctors like is that I believe that the major decisions in a system should not be made by administrators. It should be made by doctors and nurses and social workers because we're a clinical enterprise. That's what we do. And so those should be the, the leading voices.

Speaker B (00:59:17)

And I think that people respect that and like that. Okay. The next question I can ask for that person is so many questions. Orthodox community concerns include, will the hospital continue strictly kosher food, Sabbath elevators, and other consideration and sensitivities?

Speaker C (00:59:44)

The hospital was started as a Jewish community hospital. Catarango, the—

Speaker B (00:59:47)

whatever. Basically, they want to know if the hospital— the answer is yes. The answer is yes. Okay. What— who the other leaders that you've been communicating with?

Speaker C (00:59:58)

Do you have leaders in the community that you— when you did outreach? Uh, yes. Uh, I have met with, uh, a group of Orthodox rabbis. I have met with the Hatzolah ambulance providers, and I have met with leaders in Borough Park. And as you have characterized, change is difficult and it causes a certain amount of anxiety. And that's why what we've tried to, you know, help people understand is that we're not here to change things. We're here to fix the two problems that Maimonides has. And right now, the two problems are really compromising the ability of Maimonides to work. I've heard many doctors talk about what it's like to not have any support staff in their clinic to help them see patients. You know, to me, that's a very critical issue. And I understand that they don't have enough support staff because they are in deficit. That's what you do when you're in deficit. You cut the support staff. Then you can't take care of the patients in the proper way. That's— those are the issues we're trying to fix. We're not trying to change the cultural identity. We're not trying to fix the physicians. We're not trying to fix the nurses. We're not trying to fix the social workers. We're trying to fix the financial problem, and by fixing the financial problem, we will fix the capital problem, right? Because they don't have any money to improve the things that need to be fixed, like the maternal ward.

Speaker B (01:01:43)

So these are the areas that we want to focus on.

Speaker C (01:01:47)

Yeah, I heard about the maternal ward. It's just like it needs to be done over totally. Can happen under the current circumstances. I mean, it's impossible. I mean, that's why, you know, we think this is the right thing. This is the only path that would allow, in fact, for that to happen.

Speaker B (01:02:08)

If this doesn't happen, there's no capital dollar to fix the maternal ward.

Speaker C (01:02:15)

Has HNH conducted a formal capital needs assessment of Mamanides? No.

Speaker B (01:02:19)

We know that the Capital needs are huge. Yeah, because you talk about the wards, so I want to know the maternal. Yeah, no, not, not yet. Okay.

Speaker C (01:02:31)

What major infrastructure deficiency have you even looked— because we talk about the, the, the maternal ward. That's the only one?

Speaker B (01:02:38)

The maternal ward is the one that rises to the top of the list.

Speaker C (01:02:42)

Because they deliver 6,000 babies, probably more than any other hospital, right? Certainly more than any other hospital in Brooklyn. Maybe the most in this, in New York City. It's certainly, if it's not the most, it's very high up. It may be the most. That's a lot of babies. It's, I mean, just to give people a sense, most of our hospitals hover around 1,000, and I think some of our hospitals go above 2,000.

Speaker B (01:03:11)

But 6,000 is quite a large number, and the women deserve a nice ward, not the ward they're currently in. Svetlana already, your president-to-be, already told me and informed me. That's why I went to a tour for something else, and now she took me to the— because I have 4 babies myself. So she goes like, yeah, you have 4 babies, we need place for the— you should see it. So she already invited me to go see it, that we need that over there. Okay. Um, my manager operates one of the busiest labor, which was Swarajabad.

Speaker C (01:03:40)

So you don't know how much the unit is, That we're going to do for the whole beautiful— No, I mean, we're still—

Speaker B (01:03:46)

we just believe that that should be the number one priority of the capital funds. Are you spending— I mean, are you planning to expand it too?

Speaker C (01:03:54)

Because the way they describe it to me, I haven't seen it. It's too—

Speaker B (01:04:00)

one of the problems is it's too cramped and not enough privacy.

Speaker C (01:04:04)

Yeah. Will any portion of the $2.2 billion be part of that? Yes, I mean, the $2.2 includes the $500 million for capital. The $500 million, yeah, that's capital. And that's at the top of our list, and Svetlana is already working on it because we know that that's right. So we want to draw up plans and figure out how we're going to renovate. As you know, no renovation in a working hospital is ever simple, right? Because you have to figure out how to renovate it while also running it, right? We're not going to close maternal ward in order to build a maternal ward. So we have to figure out how, whether we're going to do half or part, move it, right?

Speaker B (01:04:51)

So it's not, it's never a simple case when your hospital is actively running. Okay, I have more questions, but I want to know if my colleagues, you need, okay. Hello, Dr. Katz. Nice to see you again. Good to see you. Thank you. Um, and thank you, Chair, for a lot of those questions were my questions, so I kept, uh, trying to figure out what I'm actually gonna ask. But I do have some stuff. So, uh, currently— and just correct me if I'm wrong— you had mentioned that there were 5, around 5 information systems that they're currently using, including Paper? Paper would be 6. Paper would be 6. Okay. So in addition to, um, do you know if any of those fields currently collect, um, anything related to immigration status for, uh, the community? I don't think we collect immigration status. Okay. And so you can confirm that during the merger, you know, that the staff will know specifically that that is not a practice of Health Hospitals and that they'll know that on day 1? Correct. We'll make sure. Yes. Okay, because I know that sometimes mergers take— and, and that transition might take some time. And so just in between time, that, that none of that— no data fields will be added or anything like that? Correct. Okay, just wanted to get that on record.

Speaker C (01:06:10)

And then, um, do you know if they have any certified medical interpreter services and translated discharge materials currently at, um, the hospital? I know the first, they do. I don't know I haven't asked about what their discharge papers look like. I would certainly hope so. I mean, given— But it's usually a practice of HCA.

Speaker B (01:06:32)

But it is, I mean, one of the things that we'll do is we'll expand our language capability to all of Maimonides.

Speaker C (01:06:44)

And in the community sessions that they have, have translation services been provided for community members? I don't remember. Okay. I don't remember.

Speaker B (01:06:58)

I wasn't running them. I was, I was an invited guest. Okay. Uh, I don't remember. Yeah, I just want to make sure that, you know, because with transitions, it's, you know, getting information out to the community is super important in the languages that they receive it.

Speaker C (01:07:11)

So just as a heads up moving forward. Understood. I, I, I know that that many of the community-based organizations that take care of diverse populations are happy about NYC Health Hospitals' role because of our exactly the things that you mentioned, that our language capabilities and our, the fact that all our, I mean, another, you know, very different feature, of course, all our meetings are public, right? So any member of the public can attend any of our board meetings, all of which will be translated and are available, including with American Sign Language, are transmitted and are recorded. You cannot attend the board meeting of any private hospital without an invitation. Those are closed meetings.

Speaker B (01:08:06)

So just becoming part of Health Hospitals makes the public dialogue much more available. Perfect. Thank you so much. Thank you. Thank you. CM Sanchez, you got the floor. Thank you so much, Madam Chair, and good morning, Dr. Katz. Um, I'm, I'm very excited to be on this committee. I'm a, I'm an H&H family. I'm, my family's an H&H family, so I'm very excited for this new assignment, uh, to be here with Chair Narcisse. Um, so, so my question is sort of stepping back from, from the merger, this merger itself, itself, but within the context of this merger. Maimonides is a massive institution, as has been discussed— 34,000 inpatient visits last year, 923,000 outpatient visits, 7,000 staff. My first— the first part is, how does Maimonides scale compared to the rest of the hospital systems or the subparts, right, like Jacobi and others within the H&H network, just in terms of size? And then the second part is understanding the financial pressures that Maimonides is facing. Can you help us understand what led to and enabled this particular merger? When does H&H consider merging with a struggling system? What factors are considered? Sorry, I bit my tongue yesterday, so I'm like slurring over everything.

Speaker C (01:09:28)

And why have other hospitals that have closed not merged into the hospital system? Like Kingsbrook, St. Vincent, Long Island, and others. Sure. In terms of scope, I think the easiest way to think about it, since you're a health and hospital family, is it's about the size of Bellevue plus Woodhull. That's about what, what we're talking about, right? The main campus is about the size of Bellevue, 660 inpatients, and the community hospital about the size of Woodhull. So that's about— so it's a huge bite. And we, as I explained to the Chair, that was part of the thinking about leaving a structure that would continue to employ the unionized staff so that it would be possible. Otherwise, this would just be impossible. In terms of, you know, why this— so this is not something we sought out. We were asked by the, the leadership of Maimonides. They have been looking for a partner for many years. They came close to merging with Northwell, and it did not happen. Their board recognized it's very hard for independent hospitals to succeed in New York City, in the New York City market. For a variety of reasons, so they have been looking for a partner. They recognized that their payer mix had become primarily Medicaid and Medicare as opposed to private insurance, so that as a partner, their patients look like our patients in terms of payer mix. And because we get a better rate for Medicaid patients. We don't get a better rate for private insured patients. But because we get a better rate for Medicaid patients, they saw us as being able to get them additional dollars. And I think in terms of any merger, that's part of why we're the right partner. If they were to merge with a private entity, they wouldn't get the enhanced Medicaid. They might get higher rates of private insurance, but they don't don't have very many patients with private insurance. So the higher rate wouldn't be, you know, worth that. Most of the mergers that have occurred in New York have occurred with private systems acquiring hospitals that were struggling, and that's been in areas where there was enough private insurance so that when, say, NYU takes over a hospital or Northwell takes over the hospital, then the hospital gets markedly higher reimbursement for private insurance because those bigger systems have more clout in the insurance market.

Speaker B (01:12:27)

They get better rates. So no one— And it changes over time, but I just like, from the perspective of the city and the H&H system, that's my real interest to see when we can advocate more successfully than not for the city city to take on an interested partner?

Speaker C (01:12:43)

Health Hospitals will always do what the city wants to help. I mean, that's how, you know, that's how we think of ourselves, right? We are currently the provider for the ambulances that are going out in the cold weather, you know, that we've had in order to pick people up. Two of my senior staff at Bellevue carried somebody from across the street into Bellevue. Because of fear of freezing. I mean, this is who we are. You know, we see ourselves as your arm to do good in the city. We try not to interfere where we're not needed, right? We're not trying to take over the world. We're not trying to take over other hospitals. We want to do what we do well. But if the city says, and the state says, or another hospital says, we're struggling and you can uniquely help, If someone else could have helped, you know, if the Northwell deal had gone forward, then none of this would have happened, right?

Speaker B (01:13:44)

But that deal didn't go forward, and there is no other candidate at the current time. I have some follow-ups, but I want to respect the chair's time, so thank you. Thank you. If the follow-up is short, because I have to call the next CM, the follow-up is short. Yeah, it's just, I'm curious what that decision-making process was because we're financially strapped in H&H as well.

Speaker C (01:14:09)

And so is this a revenue-positive addition to the H&H system or like what made us say yes? Sure, so we said yes when the state said that they would hold us harmless for any loss in the 5 years that were going forward. So it will neither help our finances nor will it hurt our finances. Maimonides will get a bigger pie and they'll have a modern system, but they will have to live within that pie. They will not be able, we will not support borrowing money for operating costs. I would never have supported that. I believe you have to, you would like, our own checkbooks. You get to spend the money you have. You don't get to spend the money you don't have.

Speaker B (01:14:59)

And the same thing happens to hospitals as individuals when you try to spend money you don't have. Thank you. Thank you, Chair. That did it. Thank you. My— Madame Albatol. Did I say that? Yes, that was actually a good segue to my question because in addition to you know, the sources of revenue from the state, are you looking at ways to save money and looking for efficiencies in, in how Maimonides operates?

Speaker C (01:15:38)

And will that also include reductions in, in potential reductions in staffing? We're not at the moment looking or assuming that there would be any need to decrease staffing.. And I know specifically certain areas will— they have to increase staffing to do a good job. I think the big opportunity on saving money will be purchasing because in the purchasing market, clout is what gets you the best price. And that's part of why independent hospitals have trouble. So because we are, we are purchasing for our 10 acute care hospitals, 5 skilled nursing facilities, large clinics, we get better pricing just because we have more clout in the market. And when we join that with Maimonides, we will have even more clout and we will be even better able to get better prices, and Maimonides will benefit from that going forward. I'm not assuming staffing reductions because I've already heard of areas where, in my view, they need additional staff and Sometimes additional staff, if you're helping physicians to be more productive, is actually financially helpful. And that was one of the ways Health Hospital grew out of its deficit, is people were cutting support staff, not recognizing that a doctor's productivity is affected by support staff. So as one of my doctors said to me early on, My CEO wants me to see more patients, but he doesn't understand in the emergency room that no matter how many patients I see, if there's no nurse to take off the orders, the patients don't move. Doesn't matter how many patients I see.

Speaker B (01:17:29)

So my idea would be to, you know, figure out what is actually the correct staffing pattern and support that. Thank you. We talk about how bad the maternal ward is.

Speaker C (01:17:43)

So after the merger, how long after the merger will start, like, those capital budget funding to do the construction? Well, we have the funding. As soon as the merger happens, that opens the door to the funding, and Svetlana is already working on, but what's the plan, right? So, you know, that involves the engineers and figuring out, you know, what can be done. And I don't, I don't yet know what the plan is, but I know we have the money and that it's the number one priority. So it's just a question of working with the engineers and the architects to figure out what is possible for that ward.

Speaker B (01:18:20)

You got it. But you have the space? We have the space, we have the money, and we have the will. Got it. Mamanisi Health Care currently offers a variety of specialty, which we talk about, care options including hematology, oncology, collaboration with SUNY Downstate Health, neuro, orthopedic surgery unit, full-service infusion center for cancer patients, advanced cardiac care, birthing centers, and other extensive programming. Do you anticipate any for specialty care services being trimmed or moved to a different hospital system? No. No. A few years ago, there were discussions that SUNY Downstate Hospital may need to close due to financial concerns. Downstate currently offers the only, only kidney transplantation program in Brooklyn. And during discussion of their closure, Maimonides was listed as a candidate for taking on the kidney transplantation program.

Speaker C (01:19:28)

Do you believe that Mamanides and H&H would have the capacity to accommodate such a kidney transplant program if Downstate were to resume closure discussions? Well, the state has come up with a different solution for SUNY Downstate, so I, I'm not assuming, you know, that question would ever come up to us. They seem to be okay. And again, I certainly support the idea of there being a kidney transplant unit in Brooklyn.

Speaker B (01:19:56)

It's much needed. And theirs is a successful unit. All right, you answered my question because I want to know if, but there is no if now so far because I was part of it. We did a hearing on it just like I'm doing hearing. So we have about a billion dollars, hopefully with that billion dollars.

Speaker C (01:20:15)

So are you by any chance call for to consult with them to show what your recipe you've been using for to maintain the hospital in the city? I was asked when the committee discussions were being held. I was invited. Okay. But I feel that now there's a plan and they have a new hospital CEO who actually is from Health Hospitals. Okay.

Speaker E (01:20:41)

From Lincoln.

Speaker B (01:20:41)

So, you know, I look forward to their success. We want every hospital to succeed. Yeah, because it's all about patient care. Absolutely. You're a doctor. Absolutely. I'm assuming that that's all you need— patient to feel better, get better in the city. Absolutely. Okay. It is our understanding that 7 members of the Maimonides Board of Trustees have filed a lawsuit, which we were talking about earlier, to join— I mean, to enjoin this merger. How has this lawsuit affected HMH's abilities to forecast the terms and conditions of the merger, the applicable timeline to complete this partnership, and plans to allocate the $2.2 billion state grant.

Speaker C (01:21:29)

What contingency plans has HMH developed should court proceeds to delay or alter key merger milestones? The, the, as we talked about before, there, there is no restraining order. No strings. So everything can go forward. We don't anticipate any problem because of that. Any delays, the, the group that will be hurt is Maimonides, because every month delay, were it to happen, will cost Maimonides $9 million. And that's money that is desperately needed in order to extend services and improve the capital projects.

Speaker B (01:22:09)

So, you know, that's why we're working so hard, you know, to meet the April 1 deadline, because we don't want Maimonides to lose out on that money. [Speaker] Given the Trust's allegation regarding potential harm to Maimonides' mission and obligation, how does H&H plan to demonstrate the transition will preserve or improve improve care quality for communities Maimonides currently serves?

Speaker C (01:22:40)

I think you've been answering that, but— Yeah, I mean, I go back to what you said before. Change is hard. Yeah. You know, I truly believe that once it happens and everybody sees that the hospital is still Maimonides and everybody is employed and all of the doctors are there, and the only things that have changed is that now they're not in deficit now they have a new maternal ward, now they have a new electronic health record, all of the Orthodox Jewish traditions are being respected, I think the world moves on.

Speaker B (01:23:17)

But I understand why people are anxious and what their worries are. I truly believe that. I had trusted in this process because when they told me, you're involved, I said, you're a person that they can talk to. To do, because right now we had to face that Mamanides was not in a good place and we need to keep the hospital open. And I, I hope I was right by telling them that you're open door policies and you're willing to work to make sure that. So now with that, I have to tell you, one of the person that called me that was have concern feeling a little at ease to tell me, thank you, you're answering most of the question. Timeline for completion. Can you please walk us through the major requirements to complete this merger? More specifically, what regulation and administrative approvals do you need to obtain? Are there any community impact assessments that are necessary?

Speaker C (01:24:22)

What are the primary phases in H&H integration roadmap— I mean, roadmap for MIMANIDYS, and how will H&H determine when each phase is complete? Certainly. So the big approvals necessary for this to happen are the State Department of Health, the State Department of Mental Health, and the Attorney General's Office. There are also approvals specific to the EMS unit that have to occur for the EMS unit to move. The doctors must be in an independent group in order to not be in violation of the Stark Law. So we must have the ability for the doctors to be in a self-governing group and for us to be able to make to keep them on payroll and provide them with benefits. All of those things are in process, and there's nothing at this moment that precludes making the deadline. So, I mean, we're just at the very beginning of March. So all of those things are possible, but they're certainly not guaranteed, right? It's up to the AG to make her decision on yes or no. It's up to the Department of Health to make their decision, yes or no. We can't— that's up to them when they decide. That I cannot influence. Most of the integration work that you're talking about, we don't yet have timetables for because there's so much work to be done just to reach that April 1 deadline. And that April 1 deadline is so critical to Maimonides Fiscal Health that all of our energy is spent on April 1. And then our feeling is, once it happens, then we enter the deeper learning phase. And since we're not trying to fix the other things, I don't feel that I have to have a rigorous plan on how we're going to integrate everything, because in the beginning it won't be integrated, and some things Never will. Again, we're a federation. I don't try to do everything from central office. I respect the idea that licensed facilities operate under their CEO, and I have confidence in the CEOs that I've chosen. I have confidence in Svetlana for being the future CEO.

Speaker B (01:26:58)

She will run the hospital, and right now it can continue to run as it is. That's not, that's not the problem. And I'm assuming all the paperwork that entails to get the Department of Health, the department, I mean, um, mental health, and of course the attorney general, which is a local person.

Speaker C (01:27:24)

Yes, a Brooklyn person. Yeah. So have you reached the— all the paperwork already to her office? We are in discussions with her office. Not all the paperwork is yet done. Paperwork involves some, you know, very complicated things. For example, Maimonides Hospital has to submit an assessment of the value of the land that they own. Well, that's, as you might imagine, a complicated process to to figure out what a hospital building is worth, especially because you can't close a hospital building, but you still have to value, right? Because it's a transfer of assets. So there are just a lot of technical things that are part of the standard review. But the discussions are all happening, and we, of course, will fulfill whatever she and the Department of Health ask. Many of the— Much of the paperwork is on the side of Maimonides submitting, right? Because you have to remember, they are— it's the Maimonides Board that is transferring the assets to Health Hospitals. It is not— we are not taking their assets. So they have to submit the request, the petition. They have to petition the Attorney General, they have to petition the State Department of Health to transfer the assets and the licenses to Health and Hospitals.

Speaker B (01:29:00)

And so it's, it's not up to— much of the work requires their organization to prepare the paperwork rather than ours. Um, saying all that, I, I'm questioning the—

Speaker C (01:29:11)

how the board— are the board excited to transfer all this? Have we hearing anything from the board? I think with the exception of the, the 7 members that you spoke of, the majority of the board is very excited because they have been for 10 years trying to find a partner. This is not a new thing for them. For 10 years they have been trying to find a partner, and I think many of them also like the idea that we're a federation, okay? Because not all systems are federations. Some systems attempt to believe that it's best if every hospital in their system runs the same.

Speaker B (01:29:56)

But because we are a federation, it allows a lot more freedom for Maimonides to maintain its same traditions.

Speaker C (01:30:04)

Okay, so, um, what strategies will HNH use to prevent service disruption at Maimonides during major, um, transition milestones such as financial system conversion or governance restructuring? I think we'll be fine. I don't think either of those, again, because the hospital is working and we're not trying to fix those things, we're just going to leave them alone. And then as we, you know, learn more about what's working and what isn't, we will transition. But it will— the transition of things like financial system systems, that'll take years.

Speaker B (01:30:43)

And it doesn't have to be done immediately. For the time being, they can— their financial system will run as it runs.

Speaker C (01:30:55)

What performance benchmarks, community-based access metrics, and financial indicators will H&H track to ensure that the transition is meeting both clinical and operational goals? Sure. Well, the big operational goal will be, you know, to eliminate the deficit and to provide the needed staff and to address the capital needs. The quality indicators will all be based on the things that need clinical improvement. Now, some things that Maimonides does are already clinically exemplary. I looked at their left without being seen in the emergency department, and it was extremely low, which was wonderful. I've looked at their data of surgical infections, extremely low. So there are many clinical things that they do very well. Where they need help is around primary care, and it may not be that there's a problem with their primary care. They don't have a data system. So I can tell you there, there are 360,000 primary care patients in Health Hospitals, and I can tell you how good we're doing on blood pressure control and diabetes control. They don't have a system that would enable you to do that. They can't answer the question of How good is the blood pressure control of your primary care patients? I mean, we know that, that for the managed Medicaid and Medicare health plans, Health First, we are 4 of their top 10 sites in quality. Maimonides is not in the top 10, but that we don't— that may be simply because they don't have the data to look at these kinds of question. We agree, we don't, we don't know. Well, first step is give them the data. Perhaps when you, when we give them the system, it will turn out that they do exceedingly well. Yeah, we don't know. But I don't, I don't think that the overall— I've been very impressed with the doctors and the nurses, and I don't see clinical quality as the thing that is the problem. It's a thing we all can improve on, right?

Speaker B (01:33:22)

And we want them to improve and we want ourselves to improve, but I don't think that's the problem of Maimonides. Because how do you know you do well in those areas if you don't have the data to prove it? That kind of sounds like antique a little bit.

Speaker C (01:33:47)

But anyway, how does H&H plan to expand or realign community-based care and outpatient services during the transition, especially given the merger, especially given the merger's stated intent to strengthen safety net capacity? Yeah, I think, you know, step one will certainly be to get them a modern electronic health record, which will be a huge, you know, positive step for primary care. I think till you have the data, it's very hard to know how to improve their primary care network. But there, I met as recently as Friday with their medicine and their primary care, and they're anxious to do it. They're good clinicians. I have every reason to believe that, that they are already providing good primary care, but they don't have the system to show it. And when you don't have the system to show it, it's harder to figure out who are— so again, to show the value, because we have a modern Epic system, we send our doctors the lists of who are the patients that they are seeing whose diabetes control is too high. And then because we can identify them, the doctor doesn't even have to take immediate action. The medical assistants call those patients and schedule them for visits. Right. So, but if you don't have a modern system, how would you know who are the patients? Doesn't mean that you're not doing a good job when the patient comes, but you certainly can't reach out to the patients who have poor control if you don't know who they are, right? It's the difference between doing a good job with the patient in front of you and doing a good job for the whole community of patients. You need the data system to do a good job for the whole community. For the patient in front of you, you can always do a good job. If you're a good nurse, you're a good doctor, you can always take care of the patient in front of you.

Speaker B (01:35:48)

But to do a good community job, you have to have the data. So they're going to get the Epic? Yes. Okay, very good. I think I've been having you here for so long, I don't want to over— We talk about the Epic, my child's system.

Speaker C (01:36:10)

That's what you're going to give. And you don't know how long the whole merger is going to take place. About how many months, you said? The Epic implementation is a minimum of 15 months. If it all goes— and it is in progress already. Oh, it's in progress? Oh yeah, we started sending Maimonides staff to Epic trainings.

Speaker B (01:36:36)

So it began in earnest in December, January, and the goal is to finish it by March 27th. But that is a rigorous timetable and assumes nothing goes wrong. This one I'm going to ask you because I was asked about it too. Does Epic MyChart have a function that allows patients to print out their full medical records?

Speaker C (01:37:06)

Are there other means to address concerns that patients observing during the Sabbath would not be able to access their medical information online? In terms of the yes, people will be able to present their, to print out their data. So an Orthodox person would not use their phone or a computer on the Sabbath. Yeah. But an Orthodox person could ask a non-Orthodox person to, to have access to their records and to look it up for them. That would be acceptable, similar to how a synagogue might have a non-religious person to turn on the lights because an Orthodox person would not turn on the lights on a Shabbos. But there is no prohibition about asking somebody who is not Jewish to turn on the lights.

Speaker B (01:38:09)

But yes, you— people would not be able to access their electronic records on the Shabbos if they were Orthodox. Okay. And you had answered that you will make sure that the Orthodox community needs are being addressed, the food, the care, and you're going to be sensitive to the approach. And I know you are, you know, are you Jewish yourself? I am. So you know the rules. I know all of the rules. You're going to make sure that they are okay. That's the concern. That's all the question I'm having coming into the text. The concern to make sure that the hospital run with them in mind. And you know what? I'm not going to hold you any longer because you told me everything going to be all right. And I'm hoping everything gonna be all right and we're gonna take care of the people that you've been taking care of. So now we're gonna follow up with other things that need to be done. Thank you for your time. I appreciate you. Thank you. Okay, and now open the floor to public testimony. Before we begin, I remind members of the public that is a formal government proceeding, and that decorum shall be observed at all times. As such, members of the public shall remain silent at all times. The witness table is reserved for people who wish to testify. No video recording or photography is allowed for the witness table. For the witness table, further members of the public may not present audio or video recordings as testimony, but, but may submit transcripts of such recording to the Sergeant-at-Arms for inclusion in the hearing record. If you wish to speak at today's hearing, please fill out an appearance card with the Sergeant-at-Arms and wait for your name to be called. Once you have been recognized, you will have 2 minutes to speak on today's hearing oversight topics, impact of the Maimonides Health System and H&H merger. If you have a written statement or additional written testimony you wish to submit for the record, please provide a copy of that testimony to the sergeant-at-arms. You may also email written testimony to testimony@council.nyc.gov within 72 hours of this hearing. Audio and video recordings will not be accepted. When you hear your name, please come up to the witness panel.

Speaker E (01:40:58)

For the first panel, we have Abdul Rahim Tajman, Dosey Numan Campbell. I hope I say the name right. You can correct me if you want to.

Speaker B (01:41:19)

Is this working? Oh, there we are. You may begin. All right, okay. Good morning and thank you for the opportunity to— oh, one second.

Speaker E (01:41:34)

Is Tori in? Newman? Campbell? Oh, I say I, I butchered names and I apologize. You can correct me when you get here. Good morning, and thank you, Councilmembers, for the opportunity to speak today. My name is Dr. Abdurahim Dahman. I am a pediatrics resident physician at Miami Modernities Medical Center and a member of my union, the Committee of Interns and Residents. I'm testifying today regarding the planned merger with NYC Health and Hospitals and its anticipated impact on the frontline resident physicians and our patients. Residents were notified by email that the merger was approved and is expected to be finalized in the coming months by April 1st. Hospital leadership has been updating us regularly through the use of town halls as new information comes in regarding these changes. However, we would like to weigh in with our points of view and our areas of concern. Firstly, residents are concerned about the staffing and workload first and foremost. While we have not been formally notified of any major staffing changes or intentions to change them, we understand that other H&H facilities sometimes face nursing and patient transportation shortages. If patient volume increases as part of joining a larger network, we need clear guarantees that staffing, nurses, transporters, and residents will increase accordingly so that residents are not pushed into more out-of-title work and patient care does not suffer as a result. Second of all, we are concerned about our residency training. We have not been told whether or how these rotations will shift to other facilities, um, or even if the merger will preserve our teaching hospital structure and protect our residency program accreditation. This is, of course, essential to maintain educational quality and continuity. Third of all, we are in an active bargaining period. Most importantly, Maimonides leadership has said our CIR contract will not be affected accepted, and we are in the process of formalizing those commitments in a memorandum of agreement. We are simply calling for the process to be completed promptly. On a positive note, the planned transition to the Epic electronic medical record system is a welcomed one, although the timeline on that has not been communicated to us residents and— or sorry, and until today, and the anticipated learning curve may temporarily slow down productivity and increase day-to-day stress in the short term. Overall, residents feel adequately informed about the merger's timeline with regards to staffing plans, patient load, and educational implications. We would simply require further up-to-date information on these fronts.

Speaker B (01:44:13)

We respectfully request continued transparency and continued guarantees to protect both patient care and the integrity of our training programs. Thank you. And thank you. And the good news Dr. Katz is still here. Most of, most of our admin, they just walk out. So you had a chance to sit next to him, and I hear you, and you have my contact. You can find me online. You can— my staff over there, they will give you the card and whatever we can do to help. And thank you for taking the time out to come to be here.

Speaker A (01:44:40)

Thank you. I appreciate your time. Go ahead and correct the name for me. Probably I said it wrong before. No worries. Uh, it's Tori Newman Campbell. Legislative coordinator at 1199 SEIU. I'd first like to thank the Committee on Hospitals and Chair Narcisse for holding this hearing and allowing us to speak on the merger. And for time constraints, I'm just going to do top lines. A little louder, sorry, so everybody can hear. Um, is that better? Yeah. Okay. My Mommy's Health is Brooklyn's largest healthcare system. It is an important provider of healthcare services in the borough, but also a major employer. And of the healthcare workers employed in the MAMO system, about 3,500 are represented by 1199. Continuity of care is extremely important during this— during a transition like this, and our 1199 members, along with the other hard-working, diligent healthcare workers at MAMO's facilities, have all been committed to providing the best care that they can for the community. There is no doubt they will continue to do so under this transition. We have worked closely with MAMO and H&H leadership to establish a structure that will allow our members at MyMommies to maintain their union membership, benefits, and seniority. I know that was a question that you had earlier, Councilmember. With new financial security for the hospital, we also hope to see more emphasis on stabilizing staffing retention and ensuring better working conditions for all frontline workers. MyMommies Health serves a diverse population, and preserving that cultural responsiveness that they have upheld in the past will be very important during this merger. They are in a unique position with the additional $2.2 billion grant from the state that can help protect safety net care in the borough. These extra funds will help ensure they can continue to provide essential services to the populations they serve. Ensuring the workforce is protected and prioritized during the transition will also help guarantee that no one goes without the care they need. Amaury's Health can retain its commitment to the communities it serves while also benefiting from the resources and support of the larger NYC Health and Hospital System following the completion of this merger.

Speaker B (01:46:50)

It will strengthen healthcare services for Brooklyn natives while expanding the access to quality care that MAMO already provides. And one of the good thing, Dr. Katz is understand this town is a union town, and he already said, like I, I asked that question, And I'm sure he will follow up in whatever that we need to do. And if you don't get any response, you know where to call me because you have my number, my information, email me. But I'm sure this is Brooklyn we're talking about. All right. Thank you for your time. And thank you. Thank you. This is separate. He's in person there, and those are where there's Zoom there on Zoom. So I have to do in person first.

Speaker E (01:48:04)

Okay. Um, the next person is David Alexis. Please come forward. You may begin. Put it on. Put the mic on. Okay, thank you. Hello, good afternoon. Good afternoon. My name is David Alexis, and I'm here on behalf of the Commission on the Public Health System. For 35 years CPHS has worked to protect and strengthen New York City's public hospital system and ensure access to care regardless of race, immigration status, language, disability, or ability to pay. New York City Health and Hospitals is the backbone of our safety net. When private hospitals turn patients away, when coverage is lost, when communities start to collapse, they show up at H&H. That's why this proposed merger with Amanis must be examined carefully. Especially in light of the looming federal Medicaid cuts. We already know H&H operates with structural deficits. At the same time, federal Medicaid reductions and new work requirements threaten to push more New Yorkers off coverage. When people lose insurance, they don't stop getting sick. They seek care at public hospitals. So the core questions that I have are simple. Does this, um, merger strengthen H&H's ability to absorb more uninsured patients, or does it strain the system further? We need transparency about the financial impact of absorbing more money deficits, how this affects H&H's long-term fiscal stability, whether service reductions elsewhere are being considered, and how projected increases in uncompensated care are being modeled. We also are concerned about, um, labor integration. H&H is a public hospital system with civil protections. Mamani operates differently. Workforce stability is tied to patient care quality, and we cannot afford disruption during a period of federal instability. There are also concerns about data governance. Many H&H patients are immigrants. Any technology contracts or data systems associated with this merger must guaranteed— oh yeah, ironclad. But for all in all, I just want to say H&H is not just another hospital system.

Speaker B (01:50:20)

It is the system that all New Yorkers, particularly working and underserved communities, rely on, and we need it the most at this moment. Thank you. So the conclusion could be it's good news. It's good news because H&H gonna be with Mamanas, you're gonna get the care, you're gonna get increase in Medicaid, we just allowed the hospital to serve the people at a higher capacity based on all the answer, and then you still have Dr. Katz in the house. Yes, yes, yes. So thank you for your time. I appreciate it. And if your question not answered fully, you wanna follow up, you know where to get me. All right, thank you. Thank you for— to all of you who came here to share your thoughts, experiences today. If there is anyone in the chamber who Who wishes to speak but has not yet had the opportunity to do so, please raise your hand and fill in a parent's card with the sergeant at the back. So now, anyone else? I guess I see none. Seeing no hands in the chamber, we will now shift to Zoom testimony. When your name is called, please wait until a member of our team unmutes you and the sergeant-at-arms indicate that you may begin. We will now start with Teresa Scavo. You may begin. Um, Teresa, we cannot hear you. Can you unmute, Ms. Theresa Scarville? We see you online, but we're not hearing you. It's on mute. It's on mute. We unmuted you. You have to unmute. Yes, you have to unmute the button again.

Speaker D (01:52:53)

Okay, Teresa. All right, we're gonna go to the next until we can get Miss Teresa. Raisin DeGennaro, you may begin. Okay, good morning everyone. Thank you for allowing me to speak in support of bringing Maimonides Health into New York City's health and hospital system. I have lived in Brooklyn my whole life and I've been a resident in Southern Brooklyn for the last 55 years. I am the deputy director of a social services agency's older adult programs, but I am here speaking today in my personal capacity as a community resident and local volunteer. I serve as the chair of the Community Advisory Board, or CAB, for New York City Health and Hospitals South Brooklyn Health, formerly Coney Island Hospital. As an active community member and patient, I've seen South Brooklyn Health grow and flourish under the leadership of Dr. Mitch Katz, Katz, excuse me, and the facility CEO, Svetlana Lipinskaya. I feel strongly that Svetlana moving to Maimonides will allow her and health and hospital systems to provide game support and leadership to me. I trust that Svetlana as a leader and as a person. My trust comes from the fact that Svetlana came to South Brooklyn Health, at that time known as Coney Island Hospital, in January 2020, just when COVID was beginning to take over our lives. Throughout the pandemic, she was at the hospital early in the morning through late evening. During that time, she took a traumatic situation and used it to develop a hospital-wide plan to meet the needs of the community. And I and my family are recipients of life-saving procedures and programs that have been implemented during Svetlana's leadership. As the chair of the South Brooklyn Health CAB, I participate in monthly Council of CAB meetings at central office. This is a meeting of the chairs of all the community advisory boards of each of the New York City health. Thank you. Your time expired. Oh, you can conclude. Okay, I'll be fast. By serving on this council, I see firsthand that the health and hospital system is made of culturally diverse facilities and communities. There is no pressure for the facilities to be cookie cutter, just like New Yorkers are not cookie cutter. I know personally that South Brooklyn Health is supported to stay South Brooklyn Health, and I am confident that Maimonides will be supported to stay Maimonides. I see every month that individual communities and neighborhoods are what make up the health and hospital system. I think that bringing Maimonides into the health and hospital family will benefit the patients and community members who receive their care at Maimonides. I am confident that Svetlana and the health and hospital's leadership will work with all members of our community to make sure they are respected.

Speaker B (01:55:55)

Personally, I think the merger is a good thing, and I am fully supportive of it. Thank you for allowing me to speak. And thank you for taking time out to tell us about your experience. Thank you so much. Thank you. Um, the next is Teresa Scarborough. I'm coming back to you. You may begin. Theresa, I'm seeing you but I'm not hearing you. I don't know. Yeah, she's here. I don't know what's going on, Theresa. I cannot hear you. On our end, you're on mute. Your end— I know she's trying hard, but apparently we have that technical difficulty. If we cannot hear you you can submit your testimony within the 72 hours. I wish I could hear you. Now, if you are currently on the Zoom and wish to speak but have not yet, uh, have the opportunity to do so, please use the raise hand bar at your Zoom. I would like to note that everyone can submit your testimony within the 72 hours at testimony@council.nyc.gov. Within 72 hours. Teresa, going once, going twice, I cannot hear you. I didn't want to do that, but she's trying hard. Can you text me a note? I see you trying. Can you text a note? I wish I can help. But you can submit your testimony. To conclude, I am grateful to all of you that have been here, who have attended today's hearing to offer testimony about your thoughts, your experience. I want to say thank you. Your time is very precious to us. And I would like to thank again everyone that made this hearing possible. Especially the administrator that stay here, the commissioner, Dr. Katz. So appreciative of your time, and everyone else that's in the room, the union, and all the staff that make it possible as well. My staff, and of course, um, Manu, policy analyst, um, Ogazawara, policy analyst, And Aman, as I saw earlier, thank you. And all my staff that's in the room and everyone else and the sergeant, the technician. Unfortunately, Theresa, you're still looking at me, but I cannot hear you.

Speaker C (01:59:30)

So please submit your testimony. And with that, I want to say thank you, everyone.