Rachmistrivka Letter
To Maimonides Medical Center
This letter is long overdue. There are really no words that can adequately express our feelings to your
wonderful facility. We are attempting to communicate our feelings of gratitude and appreciation that
we have in our hearts and minds on behalf of the entire Jewish Community, on behalf of Grand Rabbi
Twersky's Family, on behalf of the Rachmistrivke Kehila, on behalf of the Jewish nation worldwide we
would like to take this opportunity to express thanks and gratitude for the good care and special attention
that was granted to our Dear Grand Rabbi, Rabbi Chal Y. Twersky Shelita.
At this point we want acknowledge Maimonides Medical Center Doctors, Specialists, Nurses and all
practitioners that cared for our beloved Rabbi with kindheartedness and special attention.
Specific recognition is given to Dr. Vitzhok Kupfer, Director, Medical Intensive Care Unit & the MICU
Staff. We are fortunate in having Dr. Kupfer as the Rabbi's physician and is granting Rabbi Twersky the
best care humanly possible. We would also like to acknowledge Ms. Mintz Interim Chief Nursing Officer
for her kindness and compassion, and of course expertise in dealing with the Rabbi and his family. A
shoutout is due to all of the Nursing Staff. Last but not least, kudos to our wonderful Executive Vice
President of Maimonides, Douglas Jablon whose name is synonymous with Maimonides Medical Center.
His is a labor of love. He's always there to lend a helping hand and listening ear. May he continue to be
there for our community for many happy healthy years.
After on our team. We thank Keven Cottingham Asst Vice President of Operations for always
facilitating and helping make our stay at the hospital easier and more pleasant.
An honorable mention is due to the following individuals who are always ready and eager to help:
Mr. Chasky Rosenberg, Mr. David Shapiro, Mr. Chalm Fleischer, Mr. Yidel Feig, Rabbi Benzion Leser and
Rabbi Sholom Peach Greenberg. Their support and assistance is available 24/7. We are grateful to have
them on our team.
It is not every day that a hospital has the chance to care for a distinguished and exceptional individual
like our Rabbi. The fact that your institution appreciated their good fortune and extended the Rabbi the
exclusive care and compassion that he received, speaks miles for Maimonides as a great hospital, and for
the staff as gentle and caring individuals. We are proud to have this hospital in our neighborhood.
May G-d continue to guide you and help you heal patients and their families like you have helped us.
With much gratitude and admiration,
Rabli Moshe Kramer
On one side are allegations of mismanagement, self-enrichment and poor performance putting Brooklyn residents in danger.
On the other is a dismissal of these complaints as a disinformation campaign — spread by mailers, leaflets and on social media — meant to disparage the quality of care.
In politics, this would be business as usual.
But this fight is happening over Maimonides Medical Center — Brooklyn’s largest safety-net hospital, in Borough Park.
Caught in the middle of the drama that’s been unfolding publicly since February are patients at the 700-bed facility and their family members, some of whom shared horrible recent experiences with THE CITY.
Judi Mann said her son Abraham, just 10 days old on May 5, was sent home from Maimonides after a doctor attributed his continual vomiting to stomach acid.
Mann said she and her baby spent about four hours in an emergency department hallway at Maimonides, with little attention, before they were sent home.
After Abraham continued to vomit throughout the night, Mann consulted her pediatrician — who told her to urgently head to Mt. Sinai hospital in Manhattan, where Abraham had been born.
Doctors there had Abraham in the operating room within 30 minutes, which later confirmed their suspicion that he was suffering from a dangerous condition known as malrotation of the intestines.
“If I had listened to Maimonides, he would not have survived,” said Mann, 25. “The fact that they just sent us home without actually checking him, they didn’t give us the time of day, we barely saw a doctor — it was just a very traumatizing experience.”
A spokesperson for Maimonides declined comment, citing the Health Insurance Portability and Accountability Act — a law protecting patient privacy, known as HIPAA.
The group rallying for better treatment of patients and more oversight of Maimonides and top officials at the hospital can agree on one thing: These have been challenging times.
Documents show the hospital was able to stay on a reasonable financial footing through the early months of the pandemic — largely because of federal reimbursements — but this was followed by a loss of $60 million in the first half of 2021.
In May 2021, Maimonides and the Brooklyn Cyclones minor league baseball team announced that the club’s Coney Island ballpark was being renamed for the hospital, under a 10-year deal whose financials weren’t publicly revealed at the time.
Hospital officials declined to provide further information on the finances covering all of 2021.
In the first four months of 2022, the hospital came in $33 million short on its budget, according to records reviewed by THE CITY. Again, hospital officials wouldn’t provide more recent budget information when asked.
In 2020, at both the start and height of the pandemic, top hospital executives took home considerable increases in compensation, as the New York Post first reported in February.
Ken Gibbs, who was appointed CEO of Maimonides in January 2016, went from a $1.8 million payout in 2019 to $3.2 million in 2020, according to nonprofit tax forms filed with the IRS.
Hospital officials insist this wasn’t a raise or a bonus, but rather compensation that had been deferred to ensure that Gibbs would serve for at least five years — a mark he happened to hit in 2020, when the funds were paid out.
(Critics say it doesn’t matter what the extra income is called when it goes to top executives rather than to basic services, such as having air conditioning in every patient’s room.)
The financial losses have exacerbated staffing shortages, particularly among nurses, that have been a hallmark of the pandemic as COVID waves spread among medical personnel.
In February, the New York State Nurses Association, a union representing nurses, held a rally outside Maimonides hospital decrying the working conditions.
“The hospital is understaffed on virtually every unit, impeding essential care to patients,” NYSNA president Nancy Hagans, a registered nurse at Maimonides, said at the time.
Since then, the hospital has hired more than 200 nurses – and within the last week has made offers to 50 more, according to senior hospital leaders. A spokesperson for the hospital didn’t provide any additional figures, including staffing totals, when asked.
The hospital also submitted a staffing ratio plan to the State Department of Health that was due on July 1 — a new requirement for all hospitals under a law passed last year — but declined to share that plan with THE CITY.
State DOH officials said all the plans will be publicly posted online at the end of the month.
In a statement provided to THE CITY, the nurses’ association president said the union is now working with hospital leaders to resolve the challenges that were deepened by the pandemic.
“Despite these challenges, Maimonides nurses and health care professionals continue to be proud of the high-quality, culturally-competent care that we provide,” said Hagans. “We will continue to dedicate ourselves to caring for our community and advocating for the safe staffing and quality care that every patient deserves.”
Hospital officials have said the staffing and financial issues at Maimonides are impacting all hospitals in the wake of the pandemic — but particularly at safety-net hospitals that get federal reimbursement only for a fraction of the costs of services for their high number of patients on Medicaid.
Brian Conway, a spokesperson for the Greater New York Hospital Association — a powerful industry trade association whose board is chaired by Gibbs — confirmed those two issues are impacting hospitals system-wide.
Maimonides officials say their nursing staff ratios are on par with similar local hospitals, but they declined to provide specific figures other than a six-to-one ratio of nurses to patients in the general medical surgical units.
But Mendy Reiner, a co-chair of the group of rabbis and other local leaders calling itself “Save Maimonides,” says the hospital is trying to hide behind normal challenges to explain away a level of care that is far below the norm.
“It’s not a shortage like at other hospitals, it’s outright neglect,” said Reiner, 45, a founder of a health care nonprofit, who mentioned recently hearing about a case of a mother with cancer who was being treated in a room without air conditioning, where the temperature topped out at 89 degrees.
“A patient needs to go to the bathroom. If there’s nobody else to take that person to the bathroom, and the patient falls, that’s neglect and mismanagement,” he added. “When management is allocating the hospitals’ limited money to multi-millionaire dollar executive bonuses instead of hiring staff, it’s beyond mismanagement. It looks like self-dealing and that’s why we’re so angry.”
In response, Maimonides spokesperson Stephanie Baez reiterated that Gibbs didn’t get a raise or bonus in 2020.
“When the Board of Trustees appointed Ken as President and CEO of the hospital in 2016, he agreed to have a portion of his compensation deferred every year for the first five years of his tenure,” she said. “Upon completion of that five-year commitment, he received a one-time payment of that deferred compensation.”
Reiner’s group has taken out bus shelter ads in Borough Park urging the hospital to “improve conditions and save lives.”
Meanwhile, community residents have received campaign-like mailers targeting the chair of the Maimonides board of directors, Gene Keilin, including his personal email and phone number. The mailers purport to be from a group called United for Nurses — which isn’t registered with New York’s Department of State and has no online presence.
The mailers excerpt the February story in The Post, highlighting Gibbs’ pay package. They also claim the hospital is “on the brink of going broke.”
Reiner said his group had nothing to do with those mailers.
Five local elected officials went public with their own concerns on July 7 — writing a letter to Gibbs demanding a “town-hall style meeting where you can engage the public directly.”
In a response to the elected officials, Gibbs offered to meet with them individually or as a group, but didn’t address the idea of a town hall.
Brooklyn Councilmember Kalman Yeger, Assemblymembers Simcha Eichenstein, Marcela Mitaynes and Robert Carroll, and Sen. Simcha Felder followed up with a second letter on July 20, calling “100% false” a statement by a hospital PR rep, published in the New York Post, that referred to the letter as a “smear campaign” and a “malicious attack on the efforts of our nurses, doctors, administrators, and staff, which have been nothing short of heroic over the past two years.”
The elected officials wrote: “We were clear in the original letter, and we will be clear again: we place full responsibility for the problems at Maimonides solely on the hospital’s management team.”
They continue to demand a public meeting on hospital conditions.
‘Absolutely Horrific’
On June 30, Sarah Besser was taken by ambulance to Maimonides hospital, the night after she celebrated her 91st birthday at a dinner with family.
She was accompanied by her granddaughter, Blima Marcus, a 37-year-old nurse practitioner at NYU Langone Health in Manhattan — who said the lapses she saw in her grandmother’s nursing care over the course of the following week were egregious.
“The nursing care was horrific — absolutely horrific. But then also the medical care was really poor,” said Marcus.
Ben Fractenberg/THE CITY
Among the issues Marcus cited — and in some cases tweeted about in real time — was the lack of an attempt to reduce her grandmother’s blood pressure during the course of the entire night she was admitted.
Marcus also couldn’t get nurses to check her grandmother’s sugar levels despite her being a diabetic. At one point, they mistakenly gave Besser glucose water to drink.
No nurses checked her grandmother’s skin for seven days, according to Marcus. It was the family that turned Besser from side to side to prevent bed sores. It was also the family, rather than nurses, who changed her and walked her to the bathroom.
The care wasn’t any better for Besser’s roommate, according to Marcus, who had to lift herself on and off a bedpan on her own. At one point the woman peed on herself and had to wait six hours for a nurse to change her.
“There’s a lot of negligence that went on,” said Marcus. “There are basics that I know as a nurse that you’re supposed to do, and I know they weren’t done. And that makes me mad.”
Baez, the Maimonides spokesperson, said that HIPAA restrictions prevent the hospital from commenting on the case.
Marcus said the nurses told her they had as many as eight to 10 patients at a time, when the number should have been four or five.
She said her tweets complaining about conditions caught the attention of hospital officials, who met with her a few days after her grandmother was admitted. But she said they simply denied the nurses’ claims about the number of patients they were handling as “false.”
“That’s leadership gaslighting me,” she said. “I don’t know how you get past that if your leadership is poor.”
Marcus said she was flooded with supervisors and VPs checking in on how her family was doing, but that the nursing care didn’t improve one bit.
Borough Park resident and nurse practitioner Blima Marcus.
Ben Fractenberg/THE CITY
Additionally, no new imaging was done for days despite her grandmother’s deteriorating condition, which included going into kidney failure. No new ideas were offered for treatment.
It wasn’t until six days after Besser’s arrival that she was suddenly rushed into surgery, during which doctors removed 15 feet of dead bowel, according to Marcus.
Besser died 24 hours later.
Marcus is clear that she doesn’t blame the hospital for her grandmother’s death.
“But I am wondering,” she said, “had I taken her elsewhere, would the outcome have been different?”
The HIPAA patient privacy law generally prevents hospital officials from commenting on specific cases.
However, top hospital leaders said they’ve had a lot of work to do toward addressing patient satisfaction — and that they’ve been doing it, including by engaging with the community.
They said low ratings of hospital services — such as a D grade for hospital safety in 2022 by the nonprofit Leapfrog, and two stars out of five for overall rating from Medicare.gov — have been moving and will continue to move in a positive direction.
(The Leapfrog rating has been fairly consistently at a D grade, with one F, since at least 2019.)
On a ranking of patient satisfaction, Maimonides appears at the bottom of a list of 157 hospitals, at 55%, maintained by the state Department of Health. The top hospital listed, Elizabethtown Community Hospital in Elizabethtown, N.Y., received a satisfaction rate of 83% of its patients.
And the officials pointed to good results nationally in a number of areas — including top 10 placement as far as survival rates for heart attacks and strokes.
They also said the bulk of community members know the hospital from the emergency department, which they acknowledge is 40% smaller than it needs to be. They said the facility is being expanded in phases, ultimately more than doubling in size, starting in 2024.
When it comes to the campaign to call attention to the community’s concerns about the hospital’s performance — the leaders say the complaints are part of a disinformation campaign.
In a recent email to hospital personnel, Gibbs said the hospital was countering the “destructive, cynical campaign” with a website touting the great things happening at Maimonides, at www.maimotruth.com.
Hospital officials also say people have been leafleting outside Maimonides who claim they’re members of the nurses union or of health care union SEIU 1199, but both unions have made proactive statements to their members denying any participation.
Yeger, one of the signatories of the letter exchange between elected officials and Gibbs, said the request for better dialogue between the hospital and the community isn’t a big ask.
He said better serving the community’s healthcare needs shouldn’t be either.
“If you live in the neighborhood, you shouldn’t be shopping for a hospital elsewhere,” he told THE CITY. “You should be able to trust the hospital in your neighborhood.”
No comments:
Post a Comment