Committee on Hospitals, Impacts of the Maimonides Health System and NYC H+H Merger

(00:06:17)

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

(00:07:16)

Good morning. I am CM 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 NYCH+H merger. 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 of our public health infrastructure.

New York City Health and Hospitals and Maimonides Health have each played a critical role in fulfilling that mission. NYCH+H 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 emergency care, maternity services, trauma care, cardiac services, behavioral health care and more to one of the most diverse patient populations in the City.

The proposed merger between NYCH+H 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 and thoroughly examine how any potential transition will affect the communities these institutions serve.

We also recognize that safety net hospitals across our City face real fiscal pressures. Ensuring long-term sustainability whilst preserving access and quality is a complex challenge. This hearing provides an opportunity to better understand how this proposed merger would affect reimbursement structures, financial stability, governance, service delivery and workforce protections.

We must ensure that our hospitals remain 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 these institutions 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 ensuring 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 culturally competent care that patients depend on. Maimonides serves one of the most diverse populations in the City including large immigrant communities and longstanding Orthodox Jewish communities. 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 on how governance, service delivery and workforce protections will function so 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 representatives, advocates and community members. This is an important conversation for the future of healthcare in Brooklyn and for the continued strength of our City's safety net hospitals. I want to thank everyone that is here this morning. Before I begin, I would like to thank committee staff and I also want to thank my staff and of course my fellow colleagues and all my constituents that make it possible for me to be here. I would like to acknowledge my colleagues.

We will now be hearing testimony from the representatives from the administration and I will turn it over to the policy analyst to administer the oath to the panel.

(00:15:17)

Good morning, Chairwoman Narcisse and members of the Committee on Hospitals. I am always happy to sit before an experienced nurse who understands care. I am the CEO of New York City Health and Hospitals. I am excited about our planned partnership with Maimonides Health and to 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 have been visiting, people have asked me 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 and 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 and Hospitals, as committee members know, is actually a federation of hospitals, each guided by the unique characteristics of the neighborhoods it serves. Elmhurst Hospital and Bellevue Hospital are two great trauma hospitals, but you would never confuse the two of them. The same would be true of Harlem and Jacobi. 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 and that is 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. I think that financial stability will make a huge difference because it is impossible to feel good about your institution and its ability to serve the community when you are in a financially difficult position. I know that because when I joined Health and Hospitals eight years ago, the deficit was over $2 billion and people were saying that I had to close hospitals and I said no, we are going to grow out of this. And we did grow out of it. Our system is much stronger now because we are 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 Hospitals system. The hospitals will continue to have their own operating certificate. In New York, all hospitals, even those that are part of a system, are all individually licensed and that continues to be the case.

While after April 1 the transaction will be legally complete, the integration of the system will take many months thereafter. We are committed to the preservation of Maimonides' historic cultural identity and cultural practices and will 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.

I am happy to answer any questions or hear your thoughts about this partnership. Thank you.

(00:19:41)

Thank you, Dr. Katz. Now from what I just heard from you, that is the reason I have full confidence in you in many ways because I remember the deficit that NYCH+H was 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 work and hard work that you have been doing in New York City. We are happy to have you.

I have a few questions for you. Before I get to the regular questions that I have already prepared, I heard something about the integration of the system. From my understanding they have in terms of the billing and the records right now and I know NYCH+H is using Epic. So is that what we are talking about, the integration of all the systems and the recording?

(00:21:14)

That is correct chair. Maimonides hospital has more than five different electronic health records and some of the physicians are still charting on paper, something I certainly did during residency but have not done recently. When the City and Health and Hospitals negotiated our contract with Epic, which is considered the leading platform for electronic health records, we did something very smart. We negotiated that if we grew we would just pay per user price.

So we can extend 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 will not have to pay the same as if they were developing Epic from the beginning because we already have a system that we will just put over their hospital and we will just have to pay user prices, so much less than anyone who would want to develop it. Meanwhile, they will get a state-of-the-art system that will enable them to provide better patient care.

One of the things that people love about MyChart, one of my favorite ones that I will mention because listeners will immediately understand: when you are 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's notes. You can see your X-rays.

Many people, maybe some of you have had family members in a hospital. You are waiting for the doctor to call you or the nurse to call you and tell you what the results said. You are waiting, you know you had the CT scan, you want to know what it said. You will see on our Epic system the results at the same time that your doctor or nurse will see the result. So there is no more of this... it relieves so much anxiety. You are not wondering, has someone forgotten me? Because you know that until the X-ray result appears on your phone, they do not have the result either. So nobody is... it is not that they are 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 will get much better care when they have a modern electronic health system.

(00:26:59)

I agree with you, less anxiety when you are waiting for your results. 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. As is true of all of our hospitals, people will always know... if you ask somebody who works at Harlem Hospital where do they work? They are not going to say I work for New York City Health and Hospitals. They say I work for Harlem Hospital. It will be exactly the same. People will say I work at Maimonides Hospital. I went to Maimonides Hospital. Nothing will change.

Before I get to the next question, we talked about from your statement, opening statement if I recall, we were at negative $2 billion. Now are you at surplus?

(00:30:13)

We spend every nickel on our patients is how we think about it. There is so much need. So whatever revenue we take in, we will spend on our patients. But we do not have a deficit. We are not borrowing money. We are not behind. We meet our payrolls. We are not cutting positions. We are not cutting clinics. We are expanding. We are a much bigger system than we were eight years ago. And now there is no deficit. So you can grow out of a deficit. You do not have to shrink because you have a deficit.

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Pending legal and regulatory approval of this merger, does NYCH+H have knowledge of how the $2.2 billion state grant will be allocated over the next five years? Has the governor's office described the parameters for how they intend for this money to be used?

(00:32:17)

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. The hospital has about 6,000 births a year and 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. 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 growth at Maimonides will not 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.

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Can you please describe how this partnership will allow Maimonides and NYCH+H to access higher Medicaid reimbursement rates and how long will it take to take effect?

(00:34:40)

Yes. So Health and Hospitals benefits from a higher rate of Medicaid reimbursement. It is 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 will remember that when President Johnson created Medicaid in the early 1960s, 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 is why only government hospitals have the higher rate because you cannot make the match with anything other than a certified public expenditure.

So once it happens we will immediately be able to get additional money for Maimonides. To answer your question how much, it is 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 1 and joining us on May 1 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.

(00:37:41)

I am glad you highlighted that because I was trying to explain it myself so I am going to repeat for folks. I was saying that is why the private hospital, it would not be a good match for them. That is why they walked away. So NYCH+H will provide the support system.

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You have it exactly right.

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Have DSH payments resumed? How has NYCH+H 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?

(00:39:27)

Maimonides joining us will help us provide better patient care in Brooklyn in the specialty areas for our patients. Health and 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 and 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 is no cross subsidy. So if as things get better, Maimonides does better and better, good for them. We will invest that money into services at Maimonides, but it will not help or hurt.

So we have been very clear that there is no cross subsidy in either direction for Maimonides. One of the things that I have 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. To me, many people make hospital financing in my view more complicated than it has to be. It is just like your checking account. You get to spend the money you have. You do not get to spend the money you do not have.

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So when our joining... 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 cannot spend more money than you have. That is 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 reimbursement and we will make sure that they will run on the amount of money they have.

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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 their union affiliation?

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Sure. So we have had... I have personally been to two town halls but I know that Maimonides has had additional meetings and 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 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 have been very complicated and made many people unhappy because how would you deal with seniority? 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 as Health and Hospitals will have a contract with that entity that will serve as an employment entity. They will continue to employ all of the nurses, social workers, technicians. They will continue 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 and Hospitals and I have already made clear that when this goes forward, Svetlana Lekay who has 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 will of course respect all union contracts and union rules as they exist now.

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When you say leadership, what do you mean by that? Because some nurses are nurse practitioners, some doctors are cardiologists. Are you touching that area as well?

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She is lovely.

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No. So the chief medical officer, the chief nursing officer, the chief executive officer, those top level positions need to be Health and Hospitals for legal reasons because we are becoming the legal entity that holds that contract. And so you have to show that you really are running it. It is not a sham. We are not accepting the higher rate of Medicaid without ourselves running the hospital.

So that means the chief medical officer, the chief nursing officer, the chief executive officer have to be Health and Hospitals employees. But the overwhelming majority... the doctors will be in their own doctor's group. The nurses along with... 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 two, 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 have an established contract, have an established union negotiating certificate. Those things are complicated to change.

Our overall view of this whole partnership is we want to help in the areas that need help. We do not want to change things that are working. So for us, what is not working? They need financial stability. They need a modern electronic health record. Really, those are the two big things they need. That is what we want to focus on. And so we have tried to create an organization that...

(00:00:37)

...leaves as much of everything else alone because there is not a problem. If in future years people have other ideas, we can look at those. But the unionized staff will always need to stay in an organization that is successor to the existing nonprofit.

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But you have in terms of some nurses, some administrative level that is lower that is not unionized. So are you planning to...

(00:00:42)

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 are 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. Then we want to learn and we want to listen to people and we want to understand their points of view. Again some people might favor moving to city 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 this seems like the wrong moment to try to answer that question because first it is not the problem and second I feel that you know I always like when I am responsible something I like to learn. I do not like to come in and say this needs to change. I like to say show me how things work. I currently spend one day a week at Maimonides. Dr. Sedlano is currently spending three 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 does not have to get done by April 1, 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 two it will look the same. There will be a new CEO. There will be a chief medical officer who is their current chief medical officer, but he will be employed by us. There will be a CNO who is employed by us, but is the same CNO is there currently. We are trying to as much as possible maintain continuity.

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I have another question while we are talking about April 1, which is April 1 is the merger, right? So I know you cannot talk about it much, but do not we have a lawsuit over the head that should be in court after that in April something? What is it? I forgot. April I read it somewhere.

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So what is the date?

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You are correct. It is mid April.

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But there is no restraining order. So there is nothing that prevents the deal from happening on April 1st or March 31st.

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Okay. The employees I still have there is a lot of texts coming to me if you see me picking because some of my colleagues, the nurses, you know they want to know what is going on. Will employees who are already retired or approaching retirement retain all their existing retirement benefits under the merger? Yeah, nothing would change. Okay, I like that part.

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Will H&H honor existing union pathways for promotion, seniority, and grievance procedure? I am assuming everything going to stay the same.

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Everything stays the same.

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For staff who will remain, will they keep their sick time and pay time off time that they have accrued? I know it probably sound minute but for those folks that going through it it is very important.

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They have accrued before the merger.

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So would they keep the same?

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Everything will stay the same. And I hope you appreciate that is 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 would have to imagine the issues you would have. You would have all of those issues.

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Well, what about their retirement? What if they are 12 years toward their retirement? Now, you are going to start them at zero. So the whole idea was no, everybody just maintains you know what they have.

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Okay. This one again just for clarification I am going to continue asking them. Are there any collective bargaining agreements with employee unions that Maimonides is a party to that will be impacted by this merger? If you want me to repeat it I will repeat it again. No, I understand. I mean, we are talking to the unions. The unions are familiar to us, right? We have the same unions representing different... CNA, excuse me, 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 are figuring out issues of future relations. But I do not anticipate any problems. The reception that we have gotten from the other unions has been positive and our current relationship with the other unions is positive. We have always seen ourselves as a pro-labor organization. So I do not anticipate any problems.

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

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The reason for this question too is 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 question I am going to ask you for them too. Will all Maimonides hospital and community based site remain open and operational because I know they have more than one site.

(00:05:20)

Yes. So for everybody's knowledge there is the main campus of Maimonides, there is Midwood Hospital which has a separate operating license. It is about a 120 bed hospital community hospital in the Midwood area and then there is a freestanding emergency room in Bay Ridge.

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So those are the three and then there are offices in many many places but those are the three biggest parts of the campus.

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So there will not be any interruption, everything going to remain the same. I do not want to assume things. So I am going to continue asking. I appreciate that.

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Does Maimonides have a private contract for ambulances and if so will the terms of the merger impact such contracts? Let us talk about all the contracts, the subcontract they have. You are gonna look over all of them.

(00:06:06)

Correct. Since you asked, we are 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 and Hospitals currently does not have. I think probably it was 20 or 30 years ago the City moved the ambulances from Health and Hospitals to the fire department. So Health and Hospitals no longer has an ambulance service. Maimonides like many private hospitals still does and I have had presentations from them. I think they are incredibly successful and we are 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 partnership we accept whatever they have in terms of contracts but we will want to look at things like for example if Health and 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. Could turn out that there is something where they are getting a better rate than we are getting, in which case we will want to build on their contract. But that is a huge scope of work and not something that we are going to do prior to the merger happening. But we do not go into it with any expectations. We want to do whatever would make the most sense and we will include the people in Maimonides about that. But it exists on every level every sort of IV pump right every X-ray machine right every catheter that is 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 is not how you get the best price. You get the best price by bundling your volume. But it is also true 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. And that is true at Health and Hospitals today. So usually the 80-20 rule works. You know 80% of the stuff is easy to buy and 20% can be very specific and you might have to make special arrangements.

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So some folks have their niche and that niche is a small things that you do not get all over and they probably have to get but overall you are going to review all the contracts. Correct, you are going to make financial...

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Correct. Correct.

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Okay.

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Maimonides offers various links to community supports and before I get to the next question, MWBE you are going to still using the same... to make sure that you have MWBE fairness.

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Right. We do not know much, right? They are currently using different contracting rules than the City. So we do not know that much right now about what their MWBE usage is.

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But when we do contracting, we of course always follow the MWBE rules of the City.

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So you are going to follow the same rules, correct? Even over there.

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Correct. Okay.

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Maimonides offers various links to 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... continue at Maimonides neurology clinic site after the system... with H&H.

(00:09:22)

I look forward to learning more about it. Right. I think Maimonides as a good community provider works with all sorts of organizations and we look forward to learning more about them. We go in on day two, everything will look exactly the same. But these are programs I do not know anything about. But again, I think what is important is what the orientation is. We are not there to change things that are working. We are 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 them. It is 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 do not want to make judgments before I really understand things. I want to see things. I have been touring the facilities. I have been talking to people. I have to be in a place before I can possibly make any determinations about how you are going to go forward. But we are not... again I think the big thing that we want to stress to people, this is not a takeover. We do not have like a thousand employees that we are looking to place at Maimonides. We do not have a hundred organizations that we are 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 is a unique service that again just using it as an example, the service that you are asking about, maybe that is a service we want for our patients at South Brooklyn. We do not have it.

But that is why we want to take an approach of let us learn, let us see what things... What I would like to be able to do in three years is say here are 10 things that are better at Health and 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 and Hospitals. That seems like the best way to go forward.

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So you are a data driven person. You are going to look into it and you are going to make the best possible judgment.

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Correct.

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Okay. Local law 12 of 2023 requires city agencies to develop a published five-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... Maimonides?

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Maimonides?

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Not yet.

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Not yet. Okay.

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Cultural concerns that we have given the incredibly diverse populations of Brooklyn patients that Maimonides currently serves. Does H&H have the resources and staff to ensure that patient receive culturally concordant or culturally congruent care after the merger?

(00:11:14)

I think that is a concern.

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Yeah, I think it is one of the things that Health and Hospitals does best.

(00:11:27)

Okay. We serve at Woodhull, a large Orthodox Jewish population. We serve at Harlem, a very large West African population. I mean, this is who we are. We... Elmhurst is 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 do not produce cookie cutter hospitals. That is not who we are. And we intend to respect the cultural traditions that have built Maimonides and made it the amazing place it is.

(00:11:57)

You know, when you say Elmhurst, since I spent a lot of time there, that is my home and I know we serve everyone and I expecting for you to be culturally... everything you do to be sensitive to everyone culture. That is what I expected from any hospital for that matter given the incredibly diverse population of Brooklyn. Right. So I am going to ask that again. What has outreach and engagement looked like in the surrounding neighborhoods? Will they be willing to host... are you willing to host some community conversations?

(00:13:09)

Yes. And the community has been certainly in the two open houses that I have been to, community was very much present. There is a diverse set of views about it there. 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. 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 cultural traditions. And we have explained absolutely, but as you say, change makes people worried and anxious. I think that once it all happens, people will relax. But I understand why until it happens, people are anxious.

(00:13:45)

The board, what will the new community advisory board look like? Will it include members from both the former... Maimonides group and H&H facilities? The community advisory board needs to represent the community right around Maimonides, right? So we are listeners. It will not be Health and Hospitals people on the community advisory board. It will all be about the people who live around Maimonides and who use Maimonides and help Maimonides.

(00:14:25)

We have been joined by CM Sanchez.

(00:14:31)

All right. You answered... the billing system. There is some question I know that been coming to me. I do not want to ignore those folks that watching and sending their question in. Here are numbers of question that they had. What are you doing to ensure that the expert doctors do not leave because of the city takeover?

(00:14:54)

I am sorry. I do not know about city takeover, but that is one of the question from the community.

(00:14:58)

Chair. Can you say again? What would you be doing to ensure that the expert, the doctors like the specialty like cardiologists and all those so on and so forth... doctors do not... what you going to do to prevent them from leaving the hospital? So I have 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 doctors, I am staying, so you are staying. So there will always be people who come and go. I mean you cannot... New York has a very active doctor set of hospitals and people will go from one hospital to another but I do not... I am not expecting any departures widespread from Maimonides and I have gotten a lot of support for the idea of a system that is 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 are a clinical enterprise. That is what we do. And so those should be the leading voices. And I think that people respect that and like that.

(00:15:35)

Okay. The next question I can ask for that person is so many question. Orthodox community concerns include will the hospital continue strictly kosher food, Sabbath elevators and other consideration and sensitivities. The hospital was started as a Jewish community hospital... they want to know if the hospital...

(00:15:59)

The answer is yes.

(00:16:01)

The answer is yes. Okay.

(00:16:05)

Who are the other leaders that you have been communicating with? Do you have leaders in the community that you... when you did outreach?

(00:16:10)

Yes. I have met with 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 is why what we have tried to help people understand is that we are not here to change things. We are 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 have heard many doctors talk about what it is like to not have any support staff in their clinic to help them see patients. You know, to me that is a very critical issue. And I understand that they do not have enough support staff because they are in deficit. That is what you do when you are in deficit. You cut the support staff, then you cannot take care of the patients in the proper way. Those are the issues we are trying to fix. We are not trying to change the cultural identity. We are not trying to fix the physicians. We are not trying to fix the nurses. We are not trying to fix the social workers. We are trying to fix the financial problem. And by fixing the financial problem, we will fix the capital problem, right? Because they do not have any money to improve the things that need to be fixed like the maternal ward. So these are the areas that we want to focus on.

(00:20:42)

Yeah, I heard about the maternal ward is just like needs to be done over totally and that cannot happen under the current circumstances. I mean it is impossible. I mean that is why we think this is the right thing. This is the only path that would allow in fact for that to happen. And if this does not happen, there is no capital dollar to fix the maternal ward.

(00:21:08)

Has H&H conducted a formal capital needs assessment of Maimonides?

(00:21:13)

No, we know that the capital needs are huge.

(00:21:18)

Yeah. Because you talk about the ward. So I want to know the maternal.

(00:21:22)

Yeah. No, not yet.

(00:21:24)

Okay. What major infrastructure deficiency have you even looked... because we talk about the maternal ward that is the only one.

(00:21:32)

The maternal ward is the one that rises to the top of the list 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 New York City. It is certainly if it is not the most it is very high up, it may be the most. Just to give people a sense, most of our hospitals hover around a thousand and I think some of our hospitals go above 2,000, but to do 6,000 is quite a large number. And the women deserve a nice ward, not the ward they are currently in.

(00:21:58)

Your president already told me and informed me. That is why I went to a tour for something else and she took me to... because I have four babies myself. So she goes like, "Yeah, you have four babies. You should see it." So she already invited me to go see it that we need that over there. Okay. Maimonides operates one of the busiest labor... So you do not know how much the unit is, right? That we are going to do for the whole...

(00:22:32)

I mean we just believe that should be the number one priority of the capital funds.

(00:22:47)

Are you planning to expand it too? Because the way they describe it to me, I have not seen it.

(00:22:52)

One of the problems is it is too cramped and not enough privacy. 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... and that is at the top of our list and Dr. Sedlano is already working on it because we know that is right. So we want to draw up plans and figure out how we are 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 are not going to close maternal ward in order to build a maternal ward. So we have to figure out how whether we are going to do half or part move it, right? So it is never a simple case when your hospital is actively running.

(00:24:29)

Okay, I have more question but I want to know if my colleagues... Okay, so go on in.

(00:24:36)

Hello Dr. Katz. Nice to see you again. Good to see you. And thank you chair for a lot of those questions were my questions. So I kept trying to figure out what I am actually going to ask but I do have some stuff. So currently and just correct me if I am wrong. You had mentioned that there were around five information systems that they are currently using including paper.

(00:25:01)

Paper would be six. Okay. So in addition...

(00:01:05)

Do you know if any of those fields currently collect anything related to immigration status?

(00:01:06)

I do not collect immigration status.

(00:01:06)

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 and Hospitals and that they will know that on day one.

(00:01:07)

Correct. We will make sure. Yes.

(00:01:07)

Okay. Because I know that sometimes mergers take and that transition might take some time and so just in between time that none of that, no data fields will be added or anything like that. Correct.

(00:01:08)

Correct.

(00:01:08)

Okay. Just wanted to get that on record. And then do you know if they have any certified medical interpreter services and translated discharge materials currently at the hospital?

(00:01:09)

I know the first they do. I do not know... I have not asked about what their discharge papers look like. I would certainly hope so. I mean given... it is usually a practice of H&H but... one of the things that we will do is we will expand our language capability to all of Maimonides.

(00:01:11)

And in the community sessions that they have, have translation services been provided for community members?

(00:01:11)

I do not remember.

(00:01:12)

Okay.

(00:01:12)

I do not remember. I was not running them. I was an invited guest.

(00:01:12)

Okay.

(00:01:12)

I do not remember.

(00:01:13)

Yeah. I just want to make sure that you know because with transitions it is... getting information out to the community is super important in the languages that they receive it. So just as a heads up moving forward.

(00:01:13)

Understood. I know that many of the community-based organizations that take care of diverse populations are happy about NYC Health and Hospitals role because of our... exactly, the things that you mentioned right, that our language capabilities and our... the fact that all our... I mean another 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.

(00:01:15)

Yeah.

(00:01:15)

Without an invitation. Those are closed meetings. So just becoming part of health and hospitals makes the public dialogue much more available.

(00:01:16)

Perfect. Thank you so much.

(00:01:16)

Thank you.

(00:01:16)

Thank you. CM Sanchez.

(00:01:16)

Thank you so much, Madam Chair, and good morning, Doctor. I am very excited to be on this committee. I am an H&H family. My family is an H&H family. So I am very excited for this new assignment to be here with Chair Narcisse. So my question is sort of stepping back from this merger 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 question is how does Maimonides scale compared to the rest of the hospital systems or the sub parts like Jacob 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? And why have other hospitals that have closed not merged into the hospital system like Kings County, St. Vincent, Long Island and others?

(00:01:22)

Sure. In terms of scope, I think the easiest way to think about it since you are a health and hospital family is it is about the size of Bellevue plus Woodhull. That is about what we are talking about. The main campus is about the size of Bellevue, 660 inpatients, and the community hospital about the size of Woodhull. So it is a huge bite. And 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 why this... so this is not something we sought out. We were asked by 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 is 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 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 do not 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 is part of why we are the right partner. If they were to merge with a private entity, they would not get the enhanced Medicaid. They might get higher rates of private insurance, but they do not have very many patients with private insurance, so the higher rate would not be worth that. Most of the mergers that have occurred in New York have occurred with private systems acquiring hospitals that were struggling. And that has been in areas where there was enough private insurance so that when 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. They get better rates over time, but from the perspective of the city and the H&H system, that is my real interest to see when we can advocate more successfully for the city to take on...

(00:01:41)

Right. Well, health and hospitals will always do what the city wants to help. I mean, that is how we think of ourselves. We are currently the provider for the ambulettes that are going out in the cold weather that we have 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. We see ourselves as your arm to do good in the city. We try not to interfere where we are not needed. We are not trying to take over the world. We are not trying to take over other hospitals. We want to do what we do well. But if the city says and state says or another hospital says we are struggling and you can uniquely help... If someone else could have helped, if the Northwell deal had gone forward, then none of this would have happened. But that deal did not go forward and there is no other candidate at the current time.

(00:01:44)

I have some follow-ups, but I want to respect the chair's time. So, thank you.

(00:01:44)

Thank you. If the follow-up is short, because I have to call the next CM...

(00:01:44)

Yeah, I am curious what that decision-making process was because we are financially strapped in H&H as well. So is this a revenue positive addition to the H&H system or what made us say yes?

(00:01:45)

Sure. So we said yes when the state said that they would hold us harmless for any loss in the five years that we are going forward. So it will neither help our finances nor will it hurt our finances. Maimonides will get a bigger pie and they will 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... like our own checkbooks. You get to spend the money you have. You do not get to spend the money you do not have. And the same thing happens to hospitals as individuals when you try to spend money you do not have.

(00:01:47)

Thank you. Thank you chair.

(00:01:48)

Madam...

(00:01:48)

Yes, that was actually a good segue to my question because in addition to the sources of revenue from the state, are you looking at ways to save money and looking for efficiencies in how Maimonides operates? And will that also include potential reductions in staffing?

(00:01:50)

We are not at the moment looking or assuming that there would be any need to decrease staffing and I know specifically certain areas 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 is part of why independent hospitals have trouble. So because we are purchasing for our 10 acute care hospitals, five 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 am not assuming staffing reductions because I have already heard of areas where in my view they need additional staff and sometimes additional staff if you are helping physicians to be more productive is actually financially helpful. That was one of the ways health and hospital grew out of its deficit. 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 does not understand in the emergency room that no matter how many patients I see, if there is no nurse to take off the orders, the patients do not move. It does not matter how many patients I see. So my idea would be to figure out what is actually the correct staffing pattern and support that.

(00:01:53)

Thank you. We talk about how bad the maternal ward is. So after the merger, how long after the merger will start those capital budget funding to do the construction?

(00:01:54)

Well, we have the funding as soon as the merger happens. That opens the door to the funding and is already working on the plan. So that involves the engineers and figuring out what can be done. And I do not yet know what the plan is, but I know we have the money and that it is the number one priority. So, it is just a question of working with the engineers and the architects to figure out what is possible for that ward.

(00:01:55)

Got it. But you have the space.

(00:01:55)

We have the space. We have the money. And we have the will.

(00:01:55)

Got it. Maimonides Health currently offers a variety of specialty care options including hematology oncology collaboration with SUNY Downstate Health, neurology, orthopedic surgery, full service infusion center for cancer patients, advanced cardiac care, birthing centers and other extensive programming. Do you anticipate any specialty care services being trimmed or moved to a different hospital system?

(00:01:56)

No.

(00:01:56)

A few years ago, there were discussions that SUNY Downstate Hospital may need to close due to financial concerns. Downstate currently offers the only kidney transplantation program in Brooklyn. And during discussions of their closure, Maimonides was listed as a candidate for taking on the kidney transplantation program. Do you believe that Maimonides and H&H would have the capacity to accommodate such a kidney transplant program if Downstate were to resume closure discussions?

(00:01:59)

Well, the state has come up with a different solution for SUNY Downstate. So I am not assuming that 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. It is much needed and theirs is a successful unit.

(00:02:01)

All right. You answer 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 am doing hearing...

(00:02:02)

So we have about a billion dollars. Hopefully with that billion dollars. So are you by any chance called to consult with them to show what your recipe you have been using to maintain the hospital in the city?

(00:02:02)

I was asked when the committee discussions were being held. I was invited. But I feel that now there is a plan and they have a new hospital CEO who actually is from Health and Hospitals from Lincoln. So I look forward to their success. We want every hospital to succeed.

(00:02:04)

Yeah. Because it is all about patient care.

(00:02:04)

Absolutely.

(00:02:04)

You are a doctor. Absolutely. I am assuming that is all you need. Patients to feel better, get better in the city...

(00:02:04)

It is our understanding that seven members of the board of trustees have filed a lawsuit which we were talking about earlier to enjoin this merger. How has this lawsuit affected H&H 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. What contingency plans has H&H developed should court proceedings delay or alter key merger milestones?

(00:02:07)

As we talked about before there is no restraining order so everything can go forward we do not anticipate any problem because of that. Any delays... the group that will be hurt is Maimonides because every month delay were it to happen will cost Maimonides $9 million and that is money that is desperately needed in order to extend services and improve the capital projects. So that is why we are working so hard to meet the April one deadline because we do not want Maimonides to lose out on that money.

(00:02:10)

Given the allegations regarding potential harm to mission and obligations, how does H&H plan to demonstrate the transition will preserve or improve care quality for communities Maimonides currently serves? I think you have been answering that, but...

(00:02:11)

Yeah, I mean I go back to what you said before, change is hard. 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 are 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. But I understand why people are anxious and what their worries are.

(00:02:13)

I truly believe that I had trust in the process because once they told me you are involved, I said you are a person that they can talk to. Because right now we had to face that Maimonides was not in a good place and we need to keep the hospital open. And I hope I was right by telling them that you have open door policies and you are willing to work to make sure... so now with that I have to tell you one of the persons that called me that had concern is feeling a little at ease to tell me thank you. You are answering most of the questions. Timeline for completion... can you please walk us through the major requirements to complete this merger more specifically? What regulatory and administrative approvals do you need to obtain? Are there any community impact assessments that are necessary? What are the primary phases in H&H integration roadmap for Maimonides and how will H&H determine when each phase is complete?

(00:02:15)

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 payroll and provide them with benefits. All of those things are in process and there is nothing at this moment that precludes making the deadline. So, I mean, we are just at the very beginning of March. So all of those things are possible, but they are certainly not guaranteed. It is up to the AG to make her decision on yes or no. It is up to the Department of Health to make their decision yes or no. That is up to them when they decide. I cannot influence that.

Most of the integration work that you are talking about we do not yet have timetables for because there is so much work to be done just to reach that April one deadline and that April one deadline is so critical to Maimonides fiscal health that all of our energy is spent on April one and then our feeling is once it happens then we enter the deeper learning phase. Since we are not trying to fix the other things, I do not feel that I have to have a rigorous plan on how we are going to integrate everything because in the beginning it will not be integrated and some things never will. Again, we are a federation. I do not 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 have chosen. I have confidence in her being the future CEO. She will run the hospital and right now it can continue to run as it is. That is not the problem.

(00:02:25)

And I am assuming all the paperwork that entails to get the Department of Health, the department of mental health and of course the attorney general, which is a local person... a Brooklyn person... So, have you reached all the paperwork already to her office?

(00:02:26)

We are in discussions with her office. Not all the paperwork is yet done. Paperwork involves some very complicated things. For example, Maimonides hospital has to submit an assessment of the value of the land that they own. Well, that is, as you might imagine, a complicated process to figure out what a hospital building is worth, especially because you cannot close a hospital building, but you still have to value it because it is 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. Much of the paperwork is on the side of Maimonides submitting because you have to remember it is the Maimonides board that is transferring the assets to health and hospitals. 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. And so much of the work requires their organization to prepare the paperwork rather than ours.

(00:02:28)

Saying all that, I am questioning how... are the board excited to transfer all this? Have we heard anything from the board? Because...

(00:02:29)

With the exception of the seven 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 are a federation because not all systems are federations. Some systems attempt to believe that it is best if every hospital in their system runs the same but because we are a federation it allows a lot more freedom for Maimonides to maintain its same traditions.

(00:02:31)

Okay. So what strategies will H&H use to prevent service disruption at Maimonides during major transition milestones such as financial system conversion or governance restructuring?

(00:02:32)

I think we will be fine. I do not think either of those... again because the hospital is working and we are not trying to fix those things. We are just going to leave them alone and then as we learn more about what is working and what is not we will transition but the transition of things like financial systems... that will take years and it does not have to be done immediately. For the time being their financial system will run as it runs.

(00:02:34)

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?

(00:02:35)

Sure. Well the big operational goal will be 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 have 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 is a problem with their primary care. They do not have a data system. So I can tell you that there are 360,000 primary care patients in health and hospitals and I can tell you how good we are doing on blood pressure control and diabetes control. They do not have a system that would enable you to do that. They cannot answer the question of how good is the blood pressure control of your primary care patients. I mean we know that for the managed Medicaid and Medicare health plans, health first, we are four of their top 10 sites in quality. Maimonides is not in the top 10 but that may simply be because they do not have the data to look at these kinds of questions. We do not know. The first step is give them the data. Perhaps when we give them the system, it will turn out that they do exceedingly well.

(00:02:43)

Yeah.

(00:02:43)

We do not know. But I do not think that the overall... I have been very impressed with the doctors and the nurses and I do not see clinical quality as the thing that is the problem. It is the thing we all can improve on.

(00:02:44)

Right. And we want them to improve and we want ourselves to improve. But I do not think that is the problem of Maimonides because how do you know you do well in those areas if you do not have the data to prove it? That sounds a little... But anyway, how does H&H plan to expand or realign community based care and outpatient services during the transition especially given the merger's stated intent to strengthen safety net capacity?

(00:02:50)

Yeah, I think step one will...

(00:01:33)

Certainly be to get them a modern electronic health record which will be a huge positive step for primary care. I think until you have the data, it is very hard to know how to improve their primary care network. But I met as recently as Friday with their medicine and their primary care and they are anxious to do it. They are good clinicians. I have every reason to believe that they are already providing good primary care, but they do not have the system to show it. And when you do not have the system to show it, it is harder to figure out... 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 does not even have to take immediate action and the medical assistants call those patients and schedule them for visits. But if you do not have a modern system, how would you know who are the patients? Does not mean that you are not doing a good job when the patient comes, but you certainly cannot reach out to the patients who have poor control if you do not know who they are. It is 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 are a good nurse, you are a good doctor, you can always take care of the patient in front of you. But to do a good community job, you have to have the data.

(00:02:45)

So, they are going to get the epic.

(00:02:47)

Yes.

(00:02:47)

Okay. Very good. I think I have been having you here for so long, I do not want to... We talked about the Epic system. That is what you are going to give. And you do not know how long the whole merger is going to take place. About how many months you said maybe...

(00:02:51)

The epic implementation is a minimum of 15 months if it all goes and it is in progress already.

(00:02:58)

Oh, it is in progress.

(00:02:59)

Oh yeah. We started sending Maimonides staff to epic trainings. So it began in earnest in December January and the goal is to finish it by March 2027 but that is a rigorous timetable and assumes nothing goes wrong.

(00:03:20)

This one I am going to ask you because I was asked about it too. Does Epic have a function that allows patients to print out their full medical records? Are there other means to address concerns that patients observing during their Sabbath would not be able to access their medical information online?

(00:03:44)

So in terms of yes people will be able to print out their data. So an Orthodox person would not use their phone or a computer on the Sabbath. But an Orthodox person could ask a non-Orthodox person 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 shabbas but there is no prohibition about asking somebody who is not Jewish to turn on the lights. So but yes people would not be able to access their electronic records on the shabbas if they were Orthodox.

(00:04:47)

Okay. And you had answered that you will make sure that the Orthodox community needs are being addressed, the food, the care, and you are going to be sensitive to the approach. And I know you are. Are you Jewish as well?

(00:05:07)

I am.

(00:05:08)

So, you know the rules.

(00:05:09)

I know all the rules.

(00:05:10)

You are going to make sure that they are okay. That is the concern. That is all the question I am having coming in... the concern to make sure that the hospital run with them in mind and you know what I am not going to hold you any longer because you told me everything going to be all right and I am hoping everything going to be all right and we are going to take care of the people that you have been taking care of. So now we are going to follow up with other things that need to be done. Thank you for your time. Appreciate you.

(00:05:42)

Thank you.