NYC Health + Hospitals CEO Dr. Mitchell Katz Addresses Community Concerns Over Maimonides Merger

Okay. Hi, that's so nice to meet you. My name is Penny Leifer. Um so we'll just go through a few things. Let's see how that all sounds. So good morning uh Dr. Katz. Uh welcome to Barbra 24's office. We really appreciate you taking the time to be here with us today. As president and CEO of New York City Health and Hospitals, you've had a tremendous impact on health care across New York City from expanding across through New York City Care. And then that basically the strength in the entire hospital system truly improving emergency [snorts] response and guiding guiding the city through its challenges. Your leadership has directly affected hundreds of thousands of New Yorkers. And this includes many in our community. Here in Bar Park, health care is something people really and deeply care about. Especially when it comes to institutions like Maimonides Medical Center. Which serves as a lifeline to so many of us. Now we know there's been a lot of discussion concern and speculation in the community regarding the possibility of a city takeover or not a takeover of Maimonides. People want clarity first and foremost I think. They want to understand what's happening what what it means for for for the patient care and what the future holds in regards to that. This is an important this is an opportunity for our community just to hear directly from you. We'd like to discuss Let's begin with what what exactly is being considered regarding Maimonides. Sure. So you know >> [clears throat] >> the first time I was in Maimonides I was 10 years old and I was visiting you know my aunt who was hospitalized there. So like every sort of Brooklyn kid you know Maimonides was like the hospital on the hill. So when I was approached about the city helping Maimonides I of course wanted to be of help. What what I learned in the greater process is that Maimonides has been looking for a partner for more than 10 years. And the basic reason is that it's almost impossible for independent hospitals to survive in competitive markets like New York City. Which is why almost all the hospitals have joined some larger system. Maimonides was due to join Northwell and for a variety of reasons it didn't happen. And so they have since been looking for a partner. And during this time the share of patients who have government insurance of Medicaid has grown. And public entities like New York City Health and Hospital receive higher rates of reimbursement for Medicaid patients because we take care of so many uninsured people and because the city can make the match that is required under Medicaid. So Maimonides and the state approached us on whether or not we would help Maimonides and as a Jewish boy from Brooklyn I said of course if we can be helpful. We don't need we don't need to do it in the sense that the deal has been constructed to deliberately to make sure that there is no benefit to Health and Hospitals. [clears throat] Whatever increased money that we are going to get from Maimonides will stay at Maimonides. So that was important to me because I didn't want anyone to think I was doing this in order to help Health and Hospitals. This is purely about Maimonides. So to what exactly is happening the plan is for the hospital to transfer the operating certificate to the city. The city. But all of the employees will continue to work for the residual Maimonides. So one of the concerns we've heard is we don't we don't want you know city workers. Well I I have good things to say about city workers but but they're not going to be city workers. They are going to remain employees of the non-profit. The doctors will be in their own independent PC. They will not be employees for to the city. So on day two nobody's going to notice anything. The the two big things that are going to happen is that all of a sudden Maimonides is going to get $9 million more per month for doing exactly what it's doing now. And we will give Maimonides a modern computer system which they currently do not have. More or less that's that's the arrangement. Just very short that I follow up on that. I would ask him as I've said people are looking for clarity. And so would you call this a full on takeover or not? I definitely don't call it a takeover because when you takeover implies that you want something. I'm taking your assets. That's not what this is. So New York City is Health and Hospitals is a federation of hospitals. Each of our hospitals has a different tradition. Bellevue was created prior to the signing of the Declaration of Independence. But Bellevue is a very different hospital than Elmhurst out in Queens. Maimonides will become part of our system. If the operating certificate will be the city but the way that it will be operated will be very different than the way the other hospitals are operated because the doctors won't be working for us and the nurses and all their unionized staff won't be working for us. And what the name isn't going to change. What people will see is the hospital they've always seen except that we're going to be able to fix it because there's enough money. Our first priority is to redo the maternity ward. There are 6,000 births a year and anyone who has been in the the current Maimonides maternity ward knows how inadequate it is. So we will be that's our first priority is to renovate it. Right now if Maimonides stays independent there's no money to renovate it. If we join because of the the grant the state has given to this process there will be a brand new maternity ward. So the things we we have committed we're not going to change any of the things that people believe in. All of them respect for the Jewish traditions will remain. But now there'll be enough money to run the hospital without the kinds of deficits that the hospital has had historically. Now and as you just said the name won't change. But in regards to that what could residents expect to change? Hospital will have better facilities and better staffing because our involvement will bring in more dollars for the doing the same thing Maimonides has always done. And that's why you know initially um change is always hard. And initially you know we we heard a lot of concerns starting with the doctors. And everybody said you know we can't if all the doctors leave this is not going to work. And so you know all of the doctors now are happy. Right? And they're not leaving and they've made very clear that they're not leaving. And then you know we've heard from at first many community groups were worried or unions were worried. And each time as we sort of explained it will still be Maimonides. It will still follow all the same things but now it will be adequately funded. Right? Adequately staffed. The doctors talk about trying to see patients and having no support staff. And it's not anyone's fault but there's not currently enough money. And if they stay independent there won't be enough money. There won't be a renovation of the maternal ward. So and when hospitals don't get renovated then fewer and fewer patients come who have insurance. And so that makes the the mix of patients even harder and harder to maintain. Let me ask you what I think is the most important to our viewers which is how will this impact the direct care of our community? I don't think anybody will notice anything different other than a new maternity ward and better staffing. We're not we're not all the the doctors have committed to staying. It's going to be the same nurses the same social workers the same name on the building the same the same building itself. They will they will discover a modern computer system. It will take about 15 months. But something our community is very good at of course is use of technology. When you have with with our epic system when you're in the hospital you can follow your daily progress on your telephone. You can see all of the labs that have been ordered. You can read the doctor's notes. There's no in Health and Hospitals today many times people feel like perhaps the doctor's too busy because they don't have the no one's come in and told them what the result of the CT scan is. Well, you'll you'll see on our and this is today at all our hospitals. You actually see the results at the same time your doctor does. No waiting. You can you can text your doctor on your telephone, right? So, I mean I think our this community particularly appreciates and knows how to use technology. You can you can give your family the right to to follow your hospitalization while you're while they're at home. So, if you have an elder who perhaps really cannot follow their course, the son, the daughter can follow it at home on their telephone. So, I mean the a modern computer system and the the you know, again talk about you know, Borough Park community, you have a hospital with some of the doctors are charting on paper. I mean I charted on paper, but 20 years ago I charted on paper. I wrote prescriptions on paper 20 years ago. I haven't done that in 20 years. They're still doing it. And it's all because they're under the current arrangement there's simply not enough money. So, I think people will find that they have exactly the same hospital, but that all of a sudden now it's being renovated, it's adequately staffed, and there is a modern electronic system. I think once it this happens you change is always hard. Once happens everybody's going to be like what were we worried about? Every everything looks the same. It's the same hospital, it's the same doctors, it's the same ambulance service. But change is always, you know, whenever there's change people say, "Well, what will this mean? And what if it's not the same?" So, I certainly understand that. So, on to the next concern a lot of people, probably most people think in their minds there's no it's no secret that Hatzolah the Jewish organization has open doors probably like no other hospital in the entire city system or elsewhere. Maybe in Israel, like the doors are open, they the trust is on both sides. It's a benefit for both parties. Many people are concerned once the city steps in protocols will have to be more taken in place put in place. What will be with Hatzolah? So, we've had multiple meetings with Hatzolah. They are supportive of us. They bring patients all the time to South Brooklyn and to Woodhull. We'll have the same policies. You know, from my point of view, why would you ever be opposed to people who are helping to bring in patients? And what's different about their orientation is they're not just bringing you the patient, but they're also advocating the patient and that leads to better care. So, we're we've been clear nothing nothing will change about the relationship with Hatzolah. I saw a letter they gave out they they were against this whole process. >> But you have to you should you have to talk to them now. So, it's not the same as the So, absolutely in the beginning and again the same as you said about some of the doctors. But that's changed. So, I think it's just the process of people actually, you know, learning right about what we intend to do in terms of improving things and not changing the things people don't want changed. So, if you check with them now, I think you'll get a very different answer. I've met with with several of the the different Flatbush the Hatzolah Flatbush the Hatzolah Borough Park. We met together. Would you agree with my characterization that that initially people were from Hatzolah were against it, but they have changed their minds? They were incredibly supportive, wished us well, understand again our whole goal and again you have you have to go back to So, your first question about you know, what is this? We were not seeking additional hospitals, right? I run 11 acute care hospitals, four skilled nursing facilities. We were fine. We weren't This was because someone correctly articulated that if the city took it over because of the way the Medicaid match works, we could bring them in more money. And that is So, from my point of view, we're not going to change the things that are working. We just want to help to make sure that the hospital is adequately funded. Many people are worried this is a bigger this is a bigger like I don't take over from your side, but away can give us leading his his game. One of the things I was told that the mission statement of the hospital that was like since the founding 100 years ago I don't know how how many years ago it was was that they had to serve the Orthodox community while they actually serve everyone equally, but that was like the mission statement. That's why it opened. It quietly just changed over the last five six years. And while we want to treat everyone, this is like concerning what is happening behind the doors. And if this part of [clears throat] something something we should be concerned of. Yeah, you know, I I've heard this the history and of course I wasn't part of the history, so I don't you know, I don't really know. It's it's it has made the whole thing more complicated. When I would again when I was first approached what I what I was told is that you know, the Orthodox community greatly supports Maimonides. Well, I think that's true, but they don't all support the way it's been currently administered. So, it's become a little bit more complicated, right? So, not everybody is in favor of of the way it currently is, which then makes the messaging a little bit more complicated cuz when I say, "Well, we're going to again I started with their line, which is let my motto be my motto, right? But then again, you know, we're complicated people. And it turns out that when not everybody wants Maimo to stay Maimo is what that means is the way it is today. So, we're trying to figure out, you know, we want to be with the community wants. We we are a organization that is based on cultural competency and you always have to take care of whatever the population. That's why Bellevue and Elmhurst look completely different because the surrounding communities that they're trying to take care of are completely different. And the same will be true of Maimonides. It will reflect the people it's taking care of. I was told that in the meeting with our community leaders the doctor promised them I think it was a year and a half ago that nothing will be changed without discussing and getting their okay from the same community leaders. Those who are now against us. So, they're like concerned where where did that go? Well, the the what I understand the uh uh you know, one of our traditions that in my family we respect is the the different ways to light a menorah. Right? You know, it's a majority opinion that you increase the candles. And in my house we also do the decrease the candles, the other the other way. Um and you know, to me that's an analogy of our community, right? I I don't have to agree with people, I can still respect their opinions. And when I have talked with members of the Orthodox community who are opposed to this, of course they're not opposed to me. They're very respectful and kind to me. They recognize that that we have completely changed how good hospitals are. And what they say um is that you know, this is a hospital that was built by our grandparents. And we do not agree with the idea of turning over the assets to the city. I understand that. I understand, but I can't change that. And I don't see what the alternative is, right? I don't think that a good alternative is to continue a hospital that is charting on paper, that has inadequate staffing, and desperately needs capital improvements, and doesn't have the money. I just don't I don't So, you know, I have said all along if there's another viable plan I'll help you. You come up with another viable plan. We don't We did not get involved in this because we need another hospital. So, if somebody can tell me how you're going to adequately fund the hospital I mean instead of living, you know, day-to-day. The other thing that's a little bit ironic is that Maimonides has become a public hospital. Right? I mean the the only difference is the decisions are currently being made by the governor's office in terms of how much money they have to bail out Maimonides on a week-to-week basis. So, actually in the vast majority of the patients are on Medicaid or Medicare. So, this idea of government hospital I'm not really sure in this context what that means. At least where the government in this case is a lot closer to Borough Park. It's a lot easier to for Borough Park to influence City Hall than it is to influence, you know, the state. But regardless, I I still, you know, if there is another alternative, we have said all along, you know, we are happy to help make that happen. One more question. I don't know the exact document identity everything, but but I was told that there was a one one of the documents were the promise that nothing the services we have now the Jewish community won't change, won't ever change. That was over the time changed to the next 30 years. Over the next 30 years, you probably know better than me. What are you referring to? What Well, I always the the only line I've always had is that I don't want to say that nothing will change in perpetuity because only God is perpetual. It's hard to know what medical There are things 30 years ago we did we don't do anymore in health care. So, I did not want to be in a I didn't think that it it is sensible to say that no medical services can change, right? We may decide in 30 years that that we don't want to ever do CT scans again because MRIs have gotten so much faster and they don't have radiation. So, I don't want somebody who has an odd preference for CT scan to say, "Well, we used to have CT scans and now you've taken away all the CT scans." Right? I mean, there there is always someone with an unusual opinion. I mean, I I see that today. In fact, we we we are having uh without going into it more for your amusement, we're having an argument with a surgeon who believes greatly in one type of surgery that she does that nobody else thinks is a correct surgery. But she swears that this surgery helps people and, you know, uh when we went and said, "No, this is not considered modern things." She said, "Well, you call the patients and you tell them that they're going to be harmed by" Things change, right? I mean, it's So, you know, to to say we the the Jewish traditions will be in perpetuity because that's our people. But but I I'm not prepared to say that we'll never change a medical procedure. Um I want to ask you a question and that is something that is very important to our community. In Jewish law, the final moments of life are handled with great care and dignity and there are specific religious requirements that I know you know. And families place tremendous importance on ensuring that everything is done according to Halakha often with guidance from Rabbonim and with the involvement of organizations like Hatzalah Ruach HaChaim and more. And with all the discussions surrounding Maimonides and its future, and many are concerned about whether the sensitive sensitivities will continue to be fully respected. Can you address how end-of-life care, especially when it relates to the religious needs of our community, will be handled going forward and whether the current level of cooperation and accommodation would remain in place? Yes. It's as simple as Yes. And we we have done it in smaller numbers at Woodhull, which has the Crown Heights population. Uh so, we understand and again, this is part of our DNA is that different communities have different rules. And usually birth and death are the most intense places where those rules exist. And we will we will obey and follow. Again, you know, while I am not Orthodox, half my all my in-laws are Orthodox. I know all of the Orthodox rules. I understand the differences, you know, between a Reform Jew like me and an and the Orthodox. Um and, you know, I start from a position of cultural competency. And in this case, cultural competency means following, you know, rules that are more than 5,000 years old, right? And that have to do with, you know, how we believe um things should happen at the end of life. It's not going to change. And again, we have obeyed it at other hospitals like Woodhull where, you know, we have cared for people at the end of their life. It's not going to change. And I think thank you so much and thank you for your time with us today. We really appreciate it. My pleasure. And we appreciate anything that helps to get out the word.